Boston, New York, Washington — The Erich Lindemann Mental Health Center in downtown Boston is a welcome refuge for the hundreds of homeless people who have slept in its gymnasium since the city located an emergency shelter there in July.
It is an ironic lot for the special class of ''street people'' who stay there; many were committed to facilities like this before the so-called ''deinstitutionalization'' of mental -patients began a decade ago. Now they have returned, destitute and apparently no further ''rehabilitated'' (the great hope of the deinstitutionalization theory) than when they left.
According to social service officials in these East Coast cities, more and more mental patients are turning up among the ranks of the homeless.
''Sixty to 70 percent of our (homeless) population'' reports Paul Cassiarino, a psychologist at one of New York City's largest shelters for the homeless, ''has either an active mental illness or a recent psychiatric history.''
In New York, there are as many as 36,000 homeless. They number in the thousands in Washington and Boston.
The problems of homelessness are compounded with the high percentages of mentally ill and have forced social service workers to ask some difficult questions. Has deinstitutionalization failed? What is the best way to deal with the changing character of the homeless population? And why have private charities been so much more successful than publicly funded programs to help the homeless?
''This place looks more like the lobby of the Sheraton Hotel,'' says John, who has lived in the Lindeman Mental Health Center for the last three months. The indirect lighting, tinted glass, and sweeping architecture present a bizarre contrast to the bedraggled appearance of many of the residents.
For John, it is almost like returning to the hotels he used to stay at when he was a well-paid accountant some 20 years ago.
But when still in his early 30s, John began to have problems. And after one incident of violent behavior, he was committed to a state hospital in the area. His wife divorced him shortly afterward and took custody of their two children.
After this, John could find only sporadic work at jobs much less challenging and renumerative than what he had been accustomed to. Six months ago, he had to leave his rooming house in a Boston suburb when the landlord closed the building for renovations. He had no money for the security deposit on a new apartment. He spent weeks wandering the streets with his mind in a blur, he says, before he checked in at the shelter.
He now spends his time reading newspapers, remaining somewhat aloof from the other residents.
The Mental Health Department has helped John get a job washing dishes part time. With his social security benefits, he says he should be able to afford a room in a residential hotel near his place of work. But with some apprehension that his problems could recur, he looks to the future with uncertainty.
Many of the other deinstitutionalized homeless are not as well off as John. Most do not have his intelligence or physical ability and are unable to wind their way through the labyrinths of the social service system.
So many former mental patients are turning up among the homeless that they have been dubbed simply ''DIs.''
According to the Community Service Society, one of the leaders in New York City's effort to house and rehabilitate the homeless, about 65,000 of 89,000 patients have been released from New York state mental hospitals since 1968. In Massachusetts, only 2,500 of over 20,000 patients remain in state hospitals, according to Jack Gracie, a deputy commissioner in the Massachusetts Department of Mental Health.
While most mental health officials say that deinstitutionalization has run its course, so that fewer discharges will be made in the future, a stricter admittance policy means that people who would have been committed to an institution formerly have little or no connection to the state services now. Under present law in most states, a person can be involuntarily committed only if he is deemed a threat to other people or to himself.
''This leaves room for interpretation,'' says Mr. Gracie, who is also a lawyer. ''Is someone who cannot pay rent . . . or feed himself a danger to himself? Usually it (the determination) is based on the immediate chance of suicide.''
In the late 1950s, partly because of an optimistic outlook on rehabilitation, mental health departments started to release patients to small halfway houses or to the custody of their families. But unable to function in these less restrictive environments, many of the former patients eventually ended up on the street.''
The idea that everyone can get along on their own is, as yet, a utopian assumption,'' says Kermit Morrissey, an undersecretary in the Massachusetts Health and Human Services office, ''but the book is still open.''
Others argue that while the intent to give mental patients more freedom is an admirable idea in itself, the program was misguided.
''We've seen people released that can barely take care of themselves,'' charges Mitch Snyder, a member of the Community for Creative Non-Violence in Washington, a group that has extensively researched the causes and problems of homelessness.
"Maybe it was a noble edperiment," he continues," but it was based on ignorance."
Dealing with both the growing number of homeless as well as their special needs has made health-care officials examine exactly what the publicly controlled shelters can, or should, do.
Robert Bryant, the supervisor of the Wards Island shelter in upper Manhattan, says this facility has an ''identity crisis,'' and that by and large, this holds true of the entire city-run program for homeless people.''Are we an emergency shelter, a halfway house, or a mental health clinic?'' Mr. Bryant asks. ''You're working in one direction and you're pulled in another direction . . . in some ways, it's all of them.''
In New York, litigation for the homeless has recently led the city and state to sign a consent decree that requires ''shelter and board to each homeless man who applies for it.'' Consequently, officials have their hands full just meeting the terms of the agreement, let alone having time to develop auxiliary services.
In Boston, state and local officials are also searching for answers to homelessness.
Responding to a public outcry after several homeless people died from exposure during last year's record-cold December, the Massachusetts Department of Mental Health opened a shelter at the defunct Boston Trade School. The shelter was originally intended as a temporary facility to handle the overflow from the 350-bed Pine Street Inn, the city's only large shelter. It wasn't until July that the Boston School Committee finally delivered an eviction notice.
Now the ''Parker Street Shelter,'' as it came to be known, is at the Lindemann Center. But, like its guests, it is without a permanent home. And officials involved in the five-month search for a new building say that, so far, the quest has been futile.
Mr. Morrissey says he wrote about a dozen letters to city officials nearly three months ago and has received ''no response whatsoever."
"I know that the city is in a parlous condition,"he says, referring to Boston's fiscal predicament, "but they must have a school or something out there." Over 20 Boston schools kept their doors closed this fall because of declining enrollment and school department cutbacks.
The biggest problem, according to Mr. Morrissey, is community opposition to location of shelters. ''I don't believe it's entirely a money issue,'' he says. ''We're in very much a situation -- 'yes we want to help, but don't do it in my backyard.' ''
People are worried about "eroded values" and "deviant human beings" in their neighborhoods, Mr. Morrissey explains.
Arlene Glasser, one of the organizers of Parker Street for the Department of Mental Health, describes the shelter as a ''transitional program'' to lead former patients along the road to a more normal life. She says the department had found a nursing home that would have been excellent for a shelter in most ways, but that all the rooms were private. ''This would be too much like a permanent living space,'' she says.
Mr. Gracie, the department deputy commissioner, concurs. ''If a shelter is too comfortable and homelike,'' he says, ''then there is no incentive for the people to find their own places.''
Others, though, see both Parker Street and the Pine Street Inn as permanent programs.
''I don't know what the alternative is,'' Mr. Morrissey admits. For some of the people, ''I suppose it is another type of institutionalization.''
While some officials debate the purpose of the shelters, others are taking a more direct approach to assist the homeless.
In the predawn darkness of a frosty November morning, the Farmers' Market in Jessup, Md. begins its daily operation. Hundreds of trucks from all over the country roll up to load and unload produce at the largest wholesale distribution center serving the nation's capital.
Behind the narrow loading docks, which snake off into the foggy distance, four figures scurry among discarded crates of produce.
''Look!'' exclaims one. ''Pears!'' With the enthusiasm of a gold miner whose pan glitters with a newfound fortune, he fingers the overripe fruit. What he and his cohorts recover this morning will make up the evening meal for some 500 homeless people, served in a back alley a short walk from the White House.
The four good Samaritans are members of the Community for Creative Non-Violence (CCNV), an organization which, besides researching the plight of the homeless, has rolled up its sleeves to help them. Three times a week, some of the 20 community members rummage through the dumpsters of this market and local supermarkets to ''shop'' for the evening meals they have cooked every night for the last two years. For the hundreds of destitute street people they serve, it is the only free evening meal available in the city.
''Society doesn't treat people any differently than food,'' reflects CCNV member Justin Brown. ''Whatever it doesn't want, it throws away.''
As winter approaches, the problems of the homeless are accentuated. Competition for free housing, food, and health services intensifies. Both public and private efforts, already limited, are further strained. But while more and more people are forced onto the streets because of high unemployment and skyrocketing rents, public funds for social services are diminishing.
Just as soup kitchens and privately run shelters are a centuries-old response to the problems of homelessness, so is the dilemma about whether such services should be privately or publicly controlled. With the reduction in federal funds to state and local governments (most 1982 aid to human service departments will come in the form of block grants at 75 percent of the 1981 level), leaders are formulating social service policy with the budget ax in hand. They are also calling on private charities to pick up the slack.
And there's another major problem facing human service officials: Do the homeless even want the services that are offered?
''A person may be content to be homeless,'' says Mr. Morrissey, ''but it would be hard to choose no shelter in the winter.''
But many of the homeless do stay away from the public shelters by choice. The grim condition of city shelters in Washington and New York is well documented. Often guests are awakened as early as 5 a.m. and are crowded into showers that dribble tepid water. Reports of brutal treatment abound. To stay at most shelters, some kind of identification is required. Many of the homeless have none.
''The government shelters are run like prisons,'' CCNV's Mr. Snyder charges. ''I lived on heat grates for four months,'' he says, ''and I know that they are better than the shelters.''
To better understand the plight of the homeless and to draw attention to the lack of city shelters, Mr. Snyder and another CCNV member, Harold Moss, lived on a sidewalk heat grate last winter.
Last Dec. 30, after meeting with Snyder and other CCNV members, Washington Mayor Marion Barry announced that some District buildings would be opened to supplement the city's two existing shelters during the cold weather.
A week later, the mayor had taken no action and two more exposure-related deaths were added to the four already recorded by the city's chief medical examiner. Then CCNV staged a dramatic protest at the District Building. Four members were arrested.
Two nights later, on a tour of city shelters, Mayor Barry met Snyder at his heat grate on 19th and C Streets NW. Snyder says he tried to convince the mayor that the reason most of the street people were turning down offers of shelter was that conditions were so grim.
"The mayor told me he didn't care if 20 people froze to death," Synder claims , "and that the people were there [on the streets] by choice."
"I was right there with the mayor and he didn't say that," counters Warren Graves, an aide to Mr. Barry. He notes that while the city is grateful to Mr. Snyder and the CCNV for bringing the problem to the attention of the administration, the two groups continue to "disagree in terms of numbers. We feel we have adequate shelter for those that are out there."
CCNV's radical methods have hardly won them any friends in government circles. But even those taking more conventional approaches to publicizing the problems of the homeless agree with them on a crucial point: that privately run shelters are almost always far more humane and cost-efficient than those controlled by local or state agencies.
But there are exceptions. The 75-year-old Pine Street Inn, housing 350 men and women in downtown Boston, is often cited as an example of an efficient publicly run shelter. While its $280,000 annual budget is appropriated by the state legislature, however, volunteers do almost all of the work. It has a live-in staff of 35, all of whom were formerly homeless. Evening meals are prepared by church groups. Clothes and social services are also donated.
By contrast, the Parker Street Shelter, funded and operated by the Department of Mental Health, houses 50 people on a budget of $240,000 and offers about the same services to its guests.
''It's a wonderful kind of almost accidental model,'' says Mr. Morrissey, referring to the development of the Pine Street Inn during the last 10 years.
''I would attribute its success entirely to Paul Sullivan,'' says Morrissey, noting that the longtime director was once homeless himself. He adds that it is rare that a joint operation meets with such success.
A Mental Health Department official, who asked not to be named, says, ''Part of the reason why Pine Street has done so well is that the professional psychologists have been kept out.''
He explains that mental health caseworkers tend to ask patients too many ''obtrusive'' questions. Instead, he says, caseworkers should simply try to promote self-reliance and the sense of self-respect that the homeless need.
The basic problem with the public welfare system, Mr. Snyder says, is that clients are either made to feel that they do not deserve what they are given, or that they are being punished for being poor.
Rather than force the mentally desturbed to conform to society's standards -- often the intent of rehabilitation efforts -- society should broaden its concept of acceptable behavior, Snyder explains.''The deinstitutionalized need special kinds of support,'' Mr. Snyder stresses, ''but they also need a world and society that would tolerate them.''