SOUTH BEND — As I walk through the double front doors to the parking lot of West Park Health Care, I bump into a middle-aged woman in front of me.
"Excuse me," I say.
"Oh, excuse me," she says, glancing around with a small smile.
The woman is bundled up in her heavy blue coat, apparently headed for the stoop just past the front doors to smoke. As I take a few more steps past her, I hear her voice in a different, firmer tone: "I am your president."
I turn around. She isn't looking my direction. As I open my car, I glance toward the front doors again, and there she is, cigarette in one hand and a finger on the other wagging at the cold air in front of her.
I am leaving West Park on Western Avenue, after checking on my friend Clarence Hardin. I have been coming here more often lately, ever since Clarence fell sick.
Nearly every time, I wonder what would happen to these people if they couldn't live here.
A freeze on admissions
West Park is an assisted living facility for the mentally ill, one of only two in St. Joseph County now. There, they are fed, given their medications, cared for by staff doctors and still allowed a fair amount of personal freedom.
Clarence Hardin was a man of relatively few words, polite and smiling, yet content to keep to himself. The staff made sure he took his medicines for his schizophrenia and high blood pressure but also enforced hygiene rules. It was a place where he could thrive.
But if Clarence or someone like him were to try to move in there now, he would likely be turned away.
A state-mandated freeze a little more than a year ago means that West Park — and the only other facility like it in the county, Portage Manor — has halted new admissions, unless a prospective resident has other means to pay for it. And that rarely happens.
Diane Calderone, West Park's administrator, says that in addition to whatever Medicaid or Social Security money a person has, if any, the state's Resident Care Assistance Program pays facilities $49.35 a day. But a little more than a year ago, Indiana officials put a cap on new people entering the program.
"They've made some severe cuts," Calderone says. "In mental health, they all fight for the dollars."
This is not isolated to Indiana. The New York Times reported last month that states across the country are squeezing their budgets, resulting in caps to all sorts of mental health facilities and programs. The National Association of State Mental Health Program Directors estimated that, in the last three fiscal years, at least $2.1 billion has been cut from state mental health budgets.
Many people in need of a mental health facility are poor enough that they need government funding, whether RCAP, Social Security/disability, Medicaid or Medicare, or a combination of those.
Portage Manor, one of only 11 county homes left in Indiana, has 130 residents but 18 open beds, said Administrator Louann Becker-Pruett.
West Park, which has the capacity for 238 patients but houses 78, pinches every penny. The residents also face challenges in paying for their medications without government funding, and medications for mental illness can easily run $1,000 a month, Calderone said. For the month of November alone, Clarence's various medicines were nearly $7,000.
'A very tough year'
Some places, like the Manor, have closed. But when the 40 or so Manor residents moved to West Park in 2008, "that really turned us around," Calderone says. But "we're struggling like any other business is struggling."
She gives an example of one resident there who was accepted after being released from Westville State Prison. His personality is sweet and trouble-free as long as he has his meds.
"It costs $250 a day to house someone in jail," she says. "I just saved the taxpayer a heck of a lot of money."
Portage Manor is a little different than West Park, having a community-based board of directors and county and other governmental oversight. But their challenges are similar.
"It's been a very tough year," Becker-Pruett said, since the RCAP program was frozen. "You don't get anywhere downstate. All we hear is 'We're out of money.' It's just kind of sad."
This at a time when more people are being diagnosed with mental illness because much of the stigma is gone and understanding of its effects is greater.
Thirty years ago, Becker-Pruett said, the average age of her residents was 74. Now, it's 42.
"Parents are not being able to deal with it and reaching out for help when they used to just struggle with it," she said.
Calderone acknowledges a societal discomfort with mental illness but points to recent events, such as Rep. Gabrielle Giffords' shooting in Arizona, as examples of why we can't ignore it.
"Mental illness is mental illness," she says. "You have to take it seriously."
"Mental illness can happen to anyone between the ages of 17 and 30," Becker-Pruett said. "It could happen to any of us."