Trenton Healthcare Program

TRENTON — At 61 years old, K Ka had spent most of his life in prison.

His decades behind bars kept him from learning about life on the outside, including matters of mental health. Diagnosed with schizophrenia and suffering from bouts of paranoia, Ka didn’t understand what was going wrong with him.

“I had a mental illness and I didn’t know it,” he said. “It’s like you’ve got something wrong with you, but you don’t know what it is. They say, ‘This is your diagnosis,’ but you don’t know what it is. ‘You’re paranoid.’ Okay, what does that mean? ‘You’re schizophrenic.’ Okay, what’s that?”

As he was approaching his release date three years ago, Ka connected with the counselors of Greater Trenton Behavioral Health Care, an agency that coaches people with histories of serious mental illness to live more independently.

The agency’s supportive housing program helps clients to make doctor’s appointments, attend therapy sessions and track medications. Started in 2006 with just 12 clients, the program is now helping Ka and more than 200 others to gain what might be the greatest of medical benefits — a home.

Greater Trenton is working with the two-year-old Trenton Health Team, a collaboration among the city, local hospitals, clinics and social service organizations that is trying to stem the high rates of emergency room visits in the city. What the team and its cohorts are repeatedly finding is that the sickest, most expensive patients are often also homeless.

“Closely integrating housing and medical care is a growing trend,” said Ruth Perry, executive director of the health team. “The Trenton Health Team is working very hard to understand the health needs of our homeless residents, and looks forward to collaborating with our community partners to end the scourge of homelessness so that the homeless residents of Trenton can have better health and a better quality of life.”

Greater Trenton’s supportive housing program helps former inmates, rehabilitated patients from state hospitals and other individuals with serious mental illnesses who are at risk of homelessness.

A Normal Life

“I had been in prison for 35 years of my life,” Ka said. “This is the longest I have ever been out of prison, since I was like 10 years old.”

Ka has had to get used to his new, much larger living space, and the shadows and noises he hears at night, he said. Having lived in his new home for about a year now, he praised the supportive housing program for giving him the chance to lead a normal, healthy life.

“I am telling you that I didn’t know how to walk down the street. I didn’t know how to order something from the store. I didn’t even know how to be a nice guy,” Ka said. “All I was — was a criminal. They taught me how to be a nice person, an understanding person and to ask for help when I need it. That’s what they did for me.”

Building a normal life is often a challenge for newly released inmates, said John Monahan, CEO of Greater Trenton Behavioral Health Care. He said that attempts by former prisoners to re-enter society are often thwarted when mental illnesses go unrecognized or untreated.

“Somebody with a serious mental illness is three times more likely to end up in prison or in jail or in the hospital than those without one,” Monahan said.

The supportive housing model works by giving patients who have not had a lot of personal space or security the chance to build a life they feel is worth defending, he said.

“Just to go to my door at my house, and clear up my floor, wash my dish — to have that independence is like a foundation,” Ka said. “Once you have that, you can be more positive about other things.”

Though the main goal of supportive housing is to improve client health, the program may have the added benefit of reducing the tens of millions of dollars spent housing people at state prisons and psychiatric hospitals.

The state’s four psychiatric hospitals, Ancora, Greystone, Hagedorn and Trenton, house hundreds of patients with improving health who are considered to be on “conditional extension pending placement,” or CEPP status, said Ellen Lovejoy, a spokeswoman for the Department of Human Services.

In 2011 the hospitals housed an average of 574 CEPP patients a day at a cost of $844 each, for an annual total of over $175 million in housing costs, Lovejoy said.

By contrast, the daily cost of supportive housing for a discharged CEPP patient is $102, she said.

Housing Comes First

Joe Pege lived for a year and a half at Trenton Psychiatric Hospital.

The 64-year-old Pege said that in 2003 he decided to leave his job in the city, borrow against his house and use the money to buy a place in the Poconos, where his stepdaughter lived.

“I couldn’t find a job. I was paying a mortgage on the place up there with a home equity loan, and I couldn’t find any work after like a year,” he said. “So I started drinking heavily and I got very depressed.”

Without a place, without a paycheck, Pege’s mental health declined and he checked himself into a psychiatric hospital in Pennsylvania, he said.

“They don’t have housing or anything. So you go to a place on the grounds, or you sleep at different churches at night,” he said. “I did that a lot, then I heard that you can live at the state hospital in Trenton and they don’t let you go until they have housing for you.”

Pege returned to the city and was admitted to the state hospital’s psychiatric ward, where he worked to control his depression. Though he was well enough to leave the ward after six months, he spent another year living at the cottages on the hospital grounds because he had nowhere else to stay, he said.

Now in supportive housing for the last five years, Pege has kept his mental illness under control and stayed out of the state hospital, he said.

Recognizing the dual benefits of the program, DHS in January awarded a nearly $500,000 grant to Greater Trenton to help cover the costs for 50 of its supportive housing units. Greater Trenton is funded to supply only 148 units. It expects to fill 210 units by the end of the fiscal year as more of its clients achieve self-sustaining recoveries.

“When someone is not healthy, they need lots of support. As they get healthier, then they’re able to function more independently, which reduces the demand on staff,” Monahan said. “It’s that simple.”

A Home as Treatment

Along with the Trenton Health Team, Greater Trenton is one of a growing number of organizations that see housing as a medical intervention that not only stabilizes patients with chronic illnesses, but reduces overall health care costs by decreasing demand for expensive treatments.

After tracking a homeless patient who went to the emergency room more than 450 times in a single year, the Trenton Health Team and Greater Trenton Behavioral Health placed her in another of Greater Trenton’s housing programs, and saw her emergency room visits drop to just 26 the following year.

The same rationale for helping that patient has led to other efforts to identify and house complex patients who are homeless or at risk of becoming homeless.

Counselors with Greater Trenton’s Adult Treatment Program helped Nanette Martin, a former inmate at Mercer County Correction Center, afford her own apartment, thanks to a federal program called SOAR, which streamlines applications for Social Security Disability benefits for the mentally ill.

“I did three and a half years in prison and they sent me home. I didn’t receive any medication, I didn’t do any treatment,” Martin said.

Martin had no record of mental health problems, but after a period of homelessness, living in abandoned houses and backyards, she was diagnosed with bipolar disorder, borderline schizophrenia, and post-traumatic stress disorder, she said. Three years after her release, she was back in prison.

“I came home. I committed another charge. They locked me up, and this time I said, ‘Something had to be wrong with me’,” she said.

After serving her time, Martin fought to get off the streets and into treatment. She worked with her sister to apply for Social Security, but was denied.

“It took me like six months to do all this stuff. We did all this paperwork, and I called all these people and sent all these things, and they denied me,” she said. “My sister said don’t give up, get a lawyer and all this and that, but because of my illness and not being on medication, I easily gave up.”

Now clean, sober and stable for two years, Martin will enroll at Mercer County Community College in the fall for her associate’s degree. She said that having and defending her home has given her a reason to stay off the streets, on her meds, and in good health.

“I feel good about my place, because I can go in and lock my door. That is the most wonderful thing to me, is to have a lock on my door, because I have been abused and taken advantage of so many times in my life that I never had a door to lock,” she said. “Now I am blessed with that,” she said. “I clean my apartment every day, but every week I just like really deep-clean it, and be like,’Yes, this is mine.'”

Contact Joshua Rosenau at (609) 989-5707 or jrosenau@njtimes.com.

About the Trenton Health Team
Trenton Health Team (THT) is an alliance of the city’s major providers of healthcare services including Capital Health, St. Francis Medical Center, Henry J. Austin Health Center and the city’s Health Department. In collaboration with residents and the city’s active social services network, THT is developing an integrated healthcare delivery system to transform the city’s fragmented primary care system and restore health to the city. THT aims to make Trenton the healthiest city in the state. Support for the Trenton Health Team was provided in part by a grant from The Nicholson Foundation. For more information, visit www.trentonhealthteam.org.