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Last spring, Shawn Copenheaver was counting the days, waiting to be homeless.

He was 22, living at York County's crisis diversionary unit in North York, a place designed to stabilize people in the midst of a mental breakdown.

Copenheaver lives with acute paranoid schizophrenia and a closed head injury, the latter the result of an accident that split his head open when he was 15. His condition worsened once he could no longer afford one of the medicines he was prescribed.

Within two weeks, delusions and hallucinations returned. He saw visions of angels and demons and thought they were fighting a war that would determine his fate.

Copenheaver checked himself into York Hospital's psychiatric wing, Three Northeast. From there, he was transferred to the crisis diversionary unit.

A new course of medicine calmed his delusions.

In his own words
Shawn Copenheaver has lived with acute paranoid schizophrenia, and the delusions it causes, since he was 15. Here, the 23-year-old describes what they feel like, and how he's responded when in the middle of them:

But his continued recovery depended on stability, doctors told him. And stability required housing. Doctors were ready to discharge him, but he had no job, and his parents could not take him in. Days passed. Finally, just before he would have been on the street, a social worker found Copenheaver a room at the YMCA.

He lived there for a year, before moving into an apartment for young adults with severe mental illness in May. He can stay there for the next six years.

In some regards, Copenheaver is fortunate - he has a place to live and support to help him stay healthy.

For the mentally ill in York and Adams counties, that's not always the case.

As it stands now, no one - not system administrators at both the state and local level, not private health care companies, doctors, patient advocates, not those in the criminal justice system and not those living with severe mental illness - is completely satisfied with how the system works.

The biggest problem, they say, is a lack of housing. According to a county study, about three in 10 of those being treated for mental illness own their own homes. For the rest, there is not enough housing and not enough variety to fit all needs. As a result, people can get stuck, sometimes for months at a time, in the wrong place.

Often, people hear about the mental health care system only after a disaster, such as the fires in 2007 and 2008 in Springettsbury Township set at the Suburban Park apartment complex by two people who were living in a supported setting.

But people rarely discuss the system that burdens law

Mark Anderson holds the door for Shawn Copenheaver at a South Penn Street grocery. Copenheaver lives with acute paranoid schizophrenia and a closed head injury. Medicine has calmed his delusions, and a subsidized apartment has given him some stability in life to continue recovery. (Daily Record/Sunday News -- Paul Kuehnel)
enforcement and the medical community, and costs taxpayers millions of dollars every year. Often ignored are the connections between untreated mental illness and drug addiction, chronic homelessness and petty crime.

Among the problems:

  • Police officers, their options limited by state law, say they often have no choice but to arrest the mentally ill for minor crimes, such as harassment or public urination, even though the person is in the midst of a crisis. Many wind up in York County Prison, where, officials say, 20 percent of the population receives psychotropic drugs.

  • According to the state's mental health laws, people cannot be committed - that is, forced to receive treatment - unless they have made specific and serious threats to harm themselves or others.

    That means people who are suffering setbacks must bottom out before family or friends can intervene. As Allen Miller, director of WellSpan's Behavioral Health program, said, the system requires people who at that moment are thinking irrationally to make a series of rational choices in order to receive help.

    These are people's lives, said Bev Mackereth, director of York County human services.

    "We know where we need to go, we know we're supposed to take into account consumer's choice as much as possible, but we're talking about people's lives, and that's the gray area where decisions have to be made," Mackereth said.

    Stephen Rydesky tried for the third time to get his schizophrenic and bi-polar daughter committed in December because her mental health was deteriorating. But she didn't meet the legal criteria for being held long-term and refused treatment.

    Two weeks later, she tried to commit suicide by burning down the family home in Carroll Township.

  • For people who seek help - or are forced to seek help after being committed - there is often not enough money, which means not enough staff or services, to shepherd them from crisis to recovery to a stable life.

    Waiting lists

    For the last decade, York and Adams counties, along with the state, have moved toward treating people in their own communities with the greatest amount of freedom possible.

    Research has shown that gives people the best chance for improvement. Advocates add that it respects a person's rights and dignity. Called the recovery model, it says medicine isn't enough; needs such as housing, jobs, transportation and social interaction all have to be taken into account.

    But people inside and outside the system say even though budgets have grown this decade, mental health care in York and Adams counties breaks down because there are not enough resources to care for everyone's needs - especially when it comes to housing.

    "We believe we've given a lot of resources to the community, but those get stretched, and the community could always use more," said Joan Erney, the Deputy Secretary of the Office of Mental Health and Substance Abuse Services.

    In 2006, the Department of Public Welfare closed Harrisburg State Hospital, where the severely mentally ill had been treated for decades.

    Eighty-five people returned to York and Adams counties to be treated in their communities. As of March 2009, 14 were living in supported apartments, like the CHIPP apartments that were in Suburban Park; nine had lived in the long-term structured residence; seven moved into community living arrangements for persons with developmental disabilities.

    Seven lived in their own homes, four in their own apartments, seven were in prison. Three were in another state hospital. In the first three years, 30 needed to be re-admitted to some type of inpatient facility for some stay.

    For the rest, moving to the community worked, state officials said.

    People just entering the system today might never step inside a state hospital - but they might encounter new problems.

    Funding was shifted from the state hospital system to York and Adams counties - $30 million dollars from 2005-2008 alone. Using that, the county paid for three smaller facilities that could offer three levels of care. Private companies were brought in to give additional support to those living on their own.

    Those in need of more intense treatment could go to Wernersville State Hospital, where York and Adams counties are allotted 50 beds. Harrisburg State Hospital had provided York and Adams counties 70 beds. Wernersville and the three new county-based facilities offer 84.

    In April, the eight-bed crisis diversionary center where Shawn Copenheaver was treated had 12 people on a waiting list, according to the county officials.

    That same month, the eight-bed, long-term structured residence in Heidelberg Township - which offers hospital-level support and supervision - had 15 people on a waiting list.

    By design, people at the long term structured residence stay for years, possibly decades. The waiting list is likely to grow, said Michelle Hovis, the director of the county's HealthChoices program, and those needing the highest levels of care will be on it.

    The county needs two or three of each of those types of facilities, said Rose Alberghini, executive director of the York County Chapter of the National Alliance on Mental Illness.

    "When you send people back to the community, they have needs not only for their mental health, their mental disorder, they have social needs, economic needs, housing, things like that," WellSpan's Miller said.

    Until those needs can all be addressed, Miller said, the system does not provide enough support to give those in recovery a real chance at succeeding.

    As the county has improved housing this decade, Steve Warren, the director of the York-Adams Mental Health/Mental Retardation program, said it has tried to provide better case management services to help people negotiate their way through the system.

    But that takes money, Warren said.

    Without it, he said, "we can't help them make those choices."

    And even if people improve to the point where they can live on their own, they often have no job or other support, so it's hard for them to find a place to live.

    According to the HealthChoices numbers, the CHIPP program - which provides homes and support services for more than 200 mentally ill people a year in York County - had a waiting list of 16 people in April. Similarly, that month, 27 people were waiting to get into eight-person group homes in the Hanover area.

    And the recovery model, advocates point out, doesn't work for everyone. Some people will always need a higher level of support. Others will suffer the setbacks that are a normal part of recovery.

    On spending the money

    Other communities have created special police units to help, rather than arrest, the mentally ill in the midst of crisis.

    Some states are reforming mental health laws that were written decades ago to free the mentally ill from lives in institutions but in some cases have made it harder to get people the care they need.

    Officials and advocates are working to bring those solutions here, but money - scarce even before recent cuts to the state budget - remains a major obstacle.

    If the county were to double or triple the mental health infrastructure, as some advocates want, it would likely have to double or triple the $30 million the state spent in four years of infrastructure upgrades. Beyond that, yearly budgets would likely have to rise.

    Housing a person in a long-term structured residence - which offers hospital-level support and supervision without the confined setting - costs almost $400 a day, Warren said. That's more than $200 a day cheaper than a state hospital setting, but still expensive.

    In comparison, it costs $63.35 a day to keep an inmate in York County Prison. A bed at a state forensic hospital, where people are sent if they are not competent to stand trail, costs on average $710 a day.

    County police chiefs want new mental health units but can't afford the training.

    During the next decade, the county will use money it has already saved to build permanent supportive housing units - which will give a person his or her own lease to an apartment. But those units, often an apartment or two within a larger building, nursing facility or retirement center being built by a private developer, will take years to complete.

    Doctors, advocates, officials, the people seeking treatment and those in recovery say that society is already spending money to deal with the severely mentally ill, but is spending it on jail cells and patchwork programs to combat chronic homelessness and drug addiction.

    What the mentally ill need, they say, is for that money to be spent on housing, case workers and social outlets in York and Adams counties.