Causes lost

Bad news from Broadway

"We Preach Christ and Him Crucified." What if that Scripture from 1 Corinthians-chiseled in Old English font and boldly blazing in gold paint atop the altar of Manhattan's Broadway Presbyterian Church-seeped through the floor and into the basement below? Once it did. Now it rarely does.

Directly beneath its altar in the cluttered but cozy church basement is Broadway Community, Inc. (BCI), an outreach of Broadway Presbyterian Church (PCUSA). At the corner of 114th Street and Broadway, BCI aspires to serve the poor and homeless of the neighborhood around Columbia University and Union Theological Seminary.

Serving the poor through 1992 meant having a massive feeding program. But one volunteer, Chris Fay, said, "We saw the same people coming for food, year after year. We saw very few breakthroughs. The people who volunteered for the soup kitchen didn't know anything about the individuals who ate there. We were doing it to feel better about ourselves" ("Manhattan Lesson," Jan. 26, 2002).

Fay became BCI's executive director and began practicing effective compassion in the name of Christ. He and others began emphasizing the gospel along with life and work skills. They required intense accountability, including mandatory random drug testing. They worked with fewer people but helped them take a path to solid employment, putting those wanting to change into an integrated, complete job readiness "boot camp" designed to break the poverty cycle.

But Fay left BCI later in 2002, and soon BCI replaced mandatory drug testing with the hope that all individuals, when asked, would be honest about their drug or alcohol use. BCI began once again focusing on food and services for up to 200 people a day, primarily on Mondays, Wednesdays, and Fridays. It also offered an à la carte menu of programs including food service training, GED assistance, and basic computer literacy.

Eleanor Donaldson, a former missionary to Africa with a degree in clinical social work, served as director from 2003 to 2010. She acknowledges that BCI gradually lost its gospel base. Before becoming overwhelmed with administrative duties and the larger numbers seeking help, she loved to take care of people's deepest need for the gospel. She, along with others, often prayed with folks one-on-one. Over time, these mentoring roles slipped away.

The person in charge of social services is now Hakim Rasheed, a Muslim. He says BCI does deal with people's spiritual needs, although not necessarily from a Christian perspective. BCI's chef of 10 years, Michael Ennes, says a prayer still begins the lunch program, but it is all-inclusive: He "thanks the Lord and all his prophets, by all the names we call them." He mentions "first, among others, Jesus Christ," and includes the phrase, "As-Salaamu Alaykum" (Arabic for "Peace be unto you").

The executive director position at BCI has been vacant since August of last year. In her retirement, the thoughtful and soft-spoken Eleanor Donaldson says, "Prayer is what is really needed. God answers, and that's the start of things."

-Albin Sadar is a New York City writer

Bad news for the mentally ill

In December 2005, a Montgomery County, Va., special magistrate ordered that Virginia Tech student Seung-Hui Cho receive treatment for mental illness. His roommate was concerned about Cho's suicidal tendencies, but Cho left a hospital after an overnight stay with an order to attend outpatient treatment-which he apparently never received.

On April 16, 2007, Cho opened fire on the Virginia Tech campus. He killed 32 students and faculty, wounded 25 others, and took his own life. Could it happen again? In Virginia alone 200 mentally ill persons who posed a threat to themselves or others were turned away from psychiatric facilities over the past year, according to a state report released in June. The report calls the practice "streeting"-putting mentally ill people back on the streets because no one will treat them.

"This is a problem in all of the United States," said Dr. E. Fuller Torrey, a psychiatrist and founder of the Treatment Advocacy Center, a national nonprofit organization based in Virginia that promotes treatment of the mentally ill. To save money, states for decades have been cutting the number of beds in state-funded psychiatric hospitals, sometimes portrayed as One Flew Over the Cuckoo's Nest monsters. From 1955 to 2008 the number of psychiatric hospital beds per 100,000 people plummeted from 340 to 17, according to the Stanley Medical Research Institute (SMRI).

With nowhere to turn, "streeted" patients often become homeless and eventually land in jail. Nationally, three times more people suffering from serious mental illness are in jail than in hospitals, according to a 2010 SMRI report. On average, 15 percent to 20 percent of inmates are mentally ill. The problem is worst in Arizona and Nevada, where prisons have 10 times more mentally ill people than hospitals.

The January shooting of Rep. Gabrielle Giffords in Tucson was no accident, Torrey says. In the months leading up to Jared Loughner's rampage that killed six and wounded 24, Pima County shut down beds and made it very difficult for a mentally ill patient to be hospitalized against his will. Loughner had displayed concerning signs of illness such as random outbursts, but he never received treatment.

"It's hard to keep these people on medications because half of them don't even realize they're sick," Torrey said. "They'll tell their doctors, 'I'll be fine, as soon as the CIA stops putting these voices in my head.' And many of these people are the ones who commit felonies and violent acts."

Untreated mentally ill patients often cost states even more money than hospitalization. Broward County, Fla., pays $80 a day to house a regular inmate and $130 a day for a mentally ill inmate. The average Texas inmate costs taxpayers about $22,000 per year, but mentally ill prisoners cost almost twice as much. And the mentally ill are often repeat offenders.

State government bureaucracies, with each department focused on its own budget, continue to cut mental health budgets despite the cost to other agencies. The 2010 Stanley study estimated that in Nevada, a mentally ill homeless man could cost the county at least $1 million over 10 years on the streets before he dies.

Cuts to state psychiatric hospitals also drive more mentally ill people to already-overloaded emergency rooms. In South Carolina, where the mental health budget shrank by $81 million, "hospital emergency rooms have become the safety net for the mentally ill," said a recent South Carolina Hospital Association report, producing "a huge influx" of mentally ill patients for which the ER is unequipped.

Torrey, who for 10 years volunteered in Washington providing services to the homeless and mentally ill, said for-profit privatization isn't always the answer: "They treat the easy patients and they ignore the more difficult patients because those cost more money." Medicare and Medicaid don't cover all the costs for mentally ill patients, so hospitals typically lose money on every case.

The best facilities he's encountered are faith-based, nonprofit organizations that dedicate themselves to treating patients no one else will treat. Church groups run most shelters in the D.C. area, Torrey said, stepping in where the government won't: "Homeless shelters would fall apart without faith-based organizations."

-Alicia Constant is a Virginia journalist