I doubt other cities have this problem

There are retarded people on the streets of New Orleans.  No, I’m not talking about the guy who cuts you off in traffic or the disruptive lady in the grocery line yapping away on her cell phone while you’re trying to check out.  I’m talking about full-blown clinically substantiated intellectual and developmental disabilities: mental retardation. 

It may be offensive to say there are retarded people living on the streets of New Orleans.  I know that is not the politically correct term, not the term preferred by advocates for people with disabilities.  But my intention is to shock.  I think it ought to deeply offend everyone that people with intellectual disabilities are left homeless on the street.

I’ve tended bar in New Orleans for over a decade, for the better part of this time in the same neighborhood.  Not much goes on that I don’t know or hear about.  I know most of my customers as friends; the beer delivery guys I’ve had for years, the beat cops, the 4 AM garbage men, the waiters, waitresses and cooks, the hotel workers, managers, etc.  The temporal variations of my neighborhood are under my constant scrutiny, both in the interest of self-preservation (I’ve never been robbed) and the general auspices of being a neighborhood bartender.  Indeed my livelihood as a bartender is dependent on understanding who is coming and going, where they’re coming from and why.  It’s how my tip bucket goes from empty to full.  It is not unusual for me to walk out of my bar at 5 a.m., half-full shift beer in hand, turn the corner and run into a potential client sleeping on a shaggy piece of cardboard in a doorway.  I’ll make a mental note.  We’ll come back.  This happened on a recent Saturday.

The following Monday was a particularly busy morning as Mondays tend to be.  I grabbed Shamus because, like myself, he has a particular disdain for anything associated with an office.  I usually can just nod to him and he already has the van key in hand, asking me if I need a top off for my Styrofoam coffee cup.  I usually do.

“Where we going?” he asked.

“Italian Plaza.”  I said.

 “Where the hell is that?”

“By Vic’s.  You know.  That thing with the fountains,”  I explained. 

“Nope, but whatever,” he said.       

The night before I had a good customer of mine, a lawyer who is aware of my double life as bartender/social worker, ask me about the guy who sleeps behind the fountain.  I did not know him, but assured we’ll check him out.  9:30 Monday morning me and Shamus we’re climbing into the back of an intricate fountain equipped with dozens of water falls and framed with classical Roman columns highlighted with neon bands for a distinctly modern ascetic.  Weird place for a homeless guy to sleep, but we’ve seen weirder. Our guy was actually sitting right outside the gates.   Just than Shamus got a call saying he was needed at the main office to work on some policy stuff.

“Alright if I go over and pick you up in an hour?”  he asked in his usual exasperated tone when he knows he’s being roped into the office.

“No problem. I got it,” I said, feeling secure in violating the cardinal outreach rule of always working in pairs.  Monday morning commuter traffic and the hustle of downtown New Orleans would protect both me and client in our new, but struggling, efforts at rapport.

I did the man’s intake.  He had big trouble giving his story; answering questions like his birth date, family history, medical or mental health problems, substance abuse history.   Gist of the story is the man has been on the streets of New Orleans for almost ten years.  He said he’s never been to a doctor, never seen a psychiatrist.  He didn’t endorse any health problems and he had no obvious organic mental health concerns that one can decipher sitting on an overturned bucket while the worker bees of New Orleans hustle to their downtown cubicles.  He was obviously not the sharpest tool in the shed and was able to articulate a turbulent academic career that terminated before the 5^th grade.  He couldn’t read or write.  He couldn’t even sign his name on the intake paperwork, tagging his new file with multiple unintelligible lines.  Four addresses down from my nocturnal place of employment, an intellectually disabled man has made his home for the last four years of his life.   

Shamus came back and picked me up.  “What you got? Anything?”

It’s the same question we always ask each other after an intake, prodding each other to see how particularly vulnerable our new client is.            

“Nothing.  Not a thing.  He’s just retarded.” I answered in an exasperated tone, reflecting an utter disgust that our citizens with developmental and intellectual disabilities have so few service and housing options in Post-Katrina New Orleans.   

“Nothing?  Not a thing?”  Shamus asked.

“Nope.  Not a thing. That shit breaks my heart, man.  A mentally retarded guy living on the street and you know he won’t rise to the top of the registry,” I said.

Here’s the problem:  Because of the extreme scarcity of housing resources in New Orleans, we are forced to do triage to decide which homeless person gets the next available housing voucher.  Our housing registry ranks homeless people based on their literal likelihood of dying soon if left on the streets or in abandoned buildings or emergency shelter.  The people who rise to the top are those with certain physical illnesses, like full-blown AIDS or end-stage cancer, or lots of emergency room visits, or the tri-morbid combination of physical illness, mental illness and substance abuse.    The tool we use to calculate position on the registry is called the Vulnerability Index and it was created by Common Ground of New York and based on homeless mortality research by Dr. Jim O’Connell of Healthcare for the Homeless in Boston.  It is scientifically tested and considered best practice in terms of identifying the chronically homeless who will die if they do not receive housing.

But being mentally retarded does not get you to the top of the registry.  There are not even any questions on the vulnerability index about mental retardation.  I doubt Boston has retarded people roaming their streets.  Really, I wonder if any other city in America has this problem.  But the man living in the Italian Plaza is just one of many retarded people we find on the streets of New Orleans.  To get him housed, Shamus and I will have to persuade the rest of the outreach team that his vulnerability and that of all the other homeless mentally retarded people is a special circumstance that outweighs the vulnerability of the hundreds of people on the registry who have life-threatening diseases. Our weekly outreach meetings are emotionally and physically draining.  Co-workers get angry with each other in heated exchanges as we decide who of the more than 900 severely disabled homeless people on our registry will get one of the five new housing vouchers we have access to each week.  F

In other cities, government – not homeless outreach workers – would be housing mentally retarded people.  Before Katrina, the strong family and social networks in New Orleans mostly picked up the slack for inadequate government support of people with intellectual disabilities.  Instead of “putting out” that uncle or cousin who was a little slow, he was incorporated into the social milieu of the family.  Additionally, tucked into some of the poorest neighborhood were both licensed and un-licensed group homes that fulfilled, at the very least, a housing niche for the mentally retarded.  Many of these facilities provided an exceptional level of care and support.  Many were run by profit-minded entrepreneurs who warehoused the disabled in run-down houses while pocketing their SSI checks.  These unlicensed “group home”  “residents” who receive SSI at $647 provided the proprietor with a monthly income of almost $7000, not to mention the state allotment of food stamps which would be pooled from all the residents.  The owners of these homes provided an interesting contrast to the often poverty-stricken neighborhoods they were allowed to flourish in.  While my opinion of group homes varies with the spectrum of their management, at the very least they provide housing.  Katrina washed all that away.  And New Orleans’ extended-family network is in pieces, scattered through Katrina Diaspora.

In the grand scheme of things I understand why providing housing for the intellectually impaired is not going to be the highest priority in the recovery from the greatest man-made disaster in American history.  You don’t have to explain it to me and it might not matter to my new client.  He couldn’t understand it anyways.  He just knows he has to sleep outside. 

It’s like I said to Shamus: “That shit breaks my heart, man.”