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Experts look to bipolar disorder part of homelessness equation

By: barbara cotter
May 27, 2013

The voices told Anthony Taylor to come to Colorado Springs, but they didn't tell him where to live, where to work, how to make ends meet. And so, the Texas native ended up homeless in Colorado Springs, at least for awhile.

Once his head cleared, he found a job as a truck driver. But when the voices returned, he hit the road again, ditched his truck in Kansas and started wandering up and down the highway.

"The voices were running me around in circles," Taylor says.

Finally, the voices - in a rare show of common sense - told him to call the hospital. That's how he ended up in a psychiatric facility in Oklahoma, where he got back on his medications for bipolar disorder, returned to Colorado Springs in a more stable frame of mind and eventually met with a homeless outreach worker from AspenPointe ,who got him into a housing and treatment program in 2010.

It was a 25-year journey to mental stability, one that included four stays in psychiatric hospitals, on-again-off-again commitments to taking medication, and several bouts of homelessness.

As Colorado Springs leaders continue to grapple with homelessness and panhandling in the city, the issue of mental illness and treatment is almost always part of the conversation, and bipolar disorder gets more than a passing mention.

Not every person who is homeless suffers from bipolar disorder, of course, and not everyone diagnosed with bipolar disorder ends up homeless. But numerous studies have shown a link between the two.

"I think certainly you make bad choices when you're bipolar, and that can drive you into the streets," says Dr. Elliot Cohen, a Colorado Springs psychiatrist. "The prevalence in the general population is about 2.5 to 5 percent, but with the homeless population, it's going to be a heck of a lot higher."

It's not just about choices, but about behaviors spawned by the disease that are, essentially, out of the person's control, says Max Maddox, who grew up in Colorado Springs and had occasional stretches of homelessness in his manic phases.

"You're not always functional," says Maddox, 34, who, with his mother, co-wrote the recently published "Walks on the Margins," which chronicles their unfathomable experiences with an illness that propelled him into jubilant highs, then sent him plummeting into cavernous depressions. "You're disturbing the peace in an apartment building and you're getting kicked out. So it's practical things like, 'How can a guy who's manic pay bills? Or you have three manic episodes, and you're fired three times? How are you going to get another place to live, or another job?'"



Bipolar's effects ripple out in other ways besides homelessness. It's often accompanied by substance abuse and linked strongly to an increased risk of suicide.

The illness also carries a strong risk of financial and legal problems, depending on where a person falls in the spectrum of the disorder. At their most manic, people with severe bipolar disorder can become impulsive, delusional and hallucinatory. They might go on wild spending sprees, or drive across the state for a pack of gum.

"I don't think we can even fathom what a true manic episode is like, in terms of not being able to sleep, not being able to eat, excessive spending, hypersexuality," says Lori Jarvis-Steinwert, executive director of the local chapter of the National Alliance on Mental Illness. "You hear these wild, wild stories, and you know, it's just the brain chemistry, so all impulse control gets eradicated."

There are times when the behavior is so out of control, or so aggressive, that the police get involved. Sometimes, the person is taken to a medical facility for care. Sometimes, the person ends up in jail - usually for minor offenses, although it's not unheard of for someone diagnosed as bipolar to commit violent crimes.

Maddox, an artist in Denver, had encounters with police a handful of times for minor issues in several of the places he lived and visited, and although he was arrested, he was never jailed.

"There were so many times when he was hospitalized because the police picked him up," says Maddox's mother, Kathy Brandt.

Still, critics of the mental-healthcare system in the U.S. say too many people with bipolar disorder and other debilitating mental illnesses end up behind bars. At one point last week, about 16 percent of the people in the El Paso County Criminal Justice Center had been diagnosed with a mental illness or had a mental health alert, according to Undersheriff Paula Presley.

"I can't give you a specific percentage of how many are bipolar, but out of all the mental health diagnoses that we have, bipolar would be one of the most common, in comparison to schizophrenia, for example," she says.



Paradoxically, experts say, bipolar disorder is both overdiagnosed and underdiagnosed.

"Most people who have bipolar have been bipolar for 10 years before being diagnosed," says Dr. Kevin Batterbee, a psychiatrist at Peak View Behavioral Health, explaining the underdiagnosed side of the coin. "They're usually diagnosed with depression or something else before they get an accurate diagnosis. In psychiatry, we don't have blood tests or cultures we can do to tell us what is wrong with someone. So it's easy to misdiagnose."

Cohen believes some of the overdiagnosis is caused by medical professionals who lack training specific to deciphering mental illness.

"I always ask, 'who diagnosed you?' If you tell me a PA or primary care doctor, I'm going back to square one. They're not trained to do that," Cohen says.

Bipolar disorder is also difficult to treat.

"Until you get the right medications, you can feel like a zombie, and it's hard for people to be patient with that process," Jarvis-Steinwert says. "There's so much trial and error that goes on."

Other factors come into play with treatment, including affordability, availability and duration of services. Those who work with bipolar patients or have family members with the illness say there's a shortage of psychiatrists that will worsen when a couple retire soon.

"We had a shortage before, but that shortage is intensifying," Jarvis-Steinwert said.

Treatment and medications are also expensive,an obstacle to people who are homeless because of their illness.

"Most of the people we know are disabled. They don't have insurance. They might have Medicaid, but psychiatrists who accept it are very hard to find," says Larry Ritterband, president of the Colorado Springs chapter of the Depression and Bipolar Support Alliance. "There are a few PA's that will prescribe for people, but mostly, you'd better find some money to go to a good psychiatrist."

New legislation enacted this year could help. A few weeks ago, Gov. John Hickenlooper signed a law to expand mental health services to provide walk-in crisis centers around the state, establish a mental health hotline and add short-term residential services. About $20 million is budgeted for the expansion.

Another new law creates a task force to look into revamping the state's involuntary commitment laws.

But nothing guarantees that someone with bipolar disorder will stay with their treatment. Patients often stop taking their meds, either because the side effects are too much to handle, or they're feeling on top of the world because they're manic.

"It slows them down too much," Batterbee says.

Anthony Taylor, whose symptoms started showing up when he was 20, gave up his medications early on because he didn't like how they made him feel. "It was like I always wanted to nap," he says.

Several episodes with the voices changed his mind, and today, three years after he returned to Colorado Springs and moved into his own apartment under AspenPointe's Shelter Plus Care program, he's still on his medications.

"That last episode was so severe and life-changing for me," says Taylor, 48. "By then, I was ready."

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