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Chronic pains
A handful of troublemakers are responsible for many of the problems in downtown Madison
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One night in September, two men broke into Frida Mexican Grill on State Street. The owner arrived to find them getting drunk on the restaurant's liquor.

"They were trying to steal a couple thousand dollars' worth of booze," says Lt. Joe Balles of the Madison Police Department. "They drank a $600 bottle of vodka."

The two men were no ordinary criminals. Charles Lindsey and Billy Martin were both members of the "Top 24," a list of downtown Madison's chronic nuisance offenders that Balles compiled earlier this year.

Each person on the list of 24 had 10 or more contacts with police in the first five months of 2008. Lindsey, 41, was one of the worst: From January to June, he had 42 recorded police contacts, including being sent to Dane County's detox center 16 times.

Few of these contacts resulted in an arrest. In March, Lindsey was caught throwing an empty beer can on the ground at Brittingham Park and later fined $186. In June, UW police cited him for disorderly conduct on Langdon Street, drawing a $280 fine. In early September, he was sentenced to 30 days in jail and fined $88 for trying to use a stolen debit card to withdraw $100 from a downtown ATM. Lindsey apparently never paid any of his fines. He's now in jail, awaiting trial on burglary charges.

"We're kind of at our wits' end with how to deal with the behaviors of some of these individuals," says Balles. "A lot of the things we were doing, like banning people from State Street or giving tickets, weren't having the desired effect."

Balles, together with a UW law professor and his class, reviewed downtown police reports from the first five months of 2008 to determine who were the worst nuisance offenders - those who were drunk and disorderly, who panhandled, who shoplifted.

The study group found that 98 people were responsible for nearly 800 police contacts downtown during this brief period. The top 24 were responsible for nearly half of the contacts. The offenders are mostly men, and half of them are homeless. And nearly all of them, like Lindsey, abuse alcohol. Many also have mental illness or other disabilities.

"A lot of these people have chronic, challenging issues," says Steve Schooler, executive director of Porchlight Inc., which runs the men's drop-in homeless shelter downtown. "The existing system of sending them to jail, going to clinics, taking them to detox, does not work."

And it's expensive. An informal United Way analysis found that the top 24 worst offenders on Balles' list each racks up an average of $2,900 in costs per month. All those trips to detox, the hospital, the mental health center and the jail cost the community an estimated $835,000 a year.

"They do have a large cost impact," says Nan Cnare, vice president of United Way. "So it may be in everyone's best interest to do something about it."

The question is, what?

The one clear driving force behind downtown Madison's chronic nuisance issue is alcohol. Balles' study found that 43% of those police transported to detox in 2007 and the first part of 2008 came from downtown, especially the area just west of Capitol Square.

"They're not college kids," emphasizes Balles, whose study found that the average age of people transported to detox from downtown was 38.

So far this year, Dane County's detox center has had more than 3,000 intakes. Of those, nearly 400 were repeat clients. Nearly 800 listed the shelter or the street as their home address.

"Many of these folks are indigent, with no way to pay," says Dave Mack, the center's program supervisor. Some lack resources to pay for further treatment. Others refuse help.

"There are just some people who don't want treatment," says Mack. "Are we going to force them?"

The Madison police want to. Balles says his department has been talking with Dane County's corporation counsel to begin involuntarily committing individuals to treatment centers for substance abuse.

"If you take a guy to detox 20 times, shouldn't somebody be notified, instead of us taking him the 21st time?" asks Balles. "If we don't do anything significant to change the environment, we're always going to have this kind of problem."

Last month, the department started proceedings against a man who was hauled off to detox 30 times in the first 10 months of 2008. When he heard police were trying to have him committed, the man checked himself into a treatment center.

"He's just one," says Balles. "I've got more. We're going to start knocking these guys off one at a time."

Dane County funds 22 beds at Hope Haven and three beds at Tellurian, for long-term treatment.

Balles says he doesn't understand how the county chooses individuals for treatment. "It seems like the really 'deep end' chronic alcoholics have not necessarily been selected," he says.

Dane County Executive Kathleen Falk has been touting her new initiative to combat alcohol abuse. Her 2009 budget includes $50,000 to help people at risk of homelessness due to alcohol abuse, but does not specify how the money should be spent. "It's intended to start chipping away at this group of addicts," promises her spokesman, Joshua Wescott.

The city of Madison, meanwhile, has begun looking into whether it can ban certain individuals from buying alcohol, period.

"There's a state law that prevents intoxicated people from buying alcohol," says Joel Plant, an aide to Mayor Dave Cieslewicz. "The law also prevents a known habitual drunkard from buying alcohol." He notes that Green Bay has "very successfully" used these laws to prohibit certain people from buying liquor anywhere in the city.

Efforts to curb alcohol abuse are only one part of the answer, says Balles. "We've got to have a housing solution, too. We can't just throw them back on State Street, because there's a huge likelihood they're going to relapse."

Miranda Bergemann used to spend every day on State Street, getting drunk and high. Now 26, Bergemann has been diagnosed as being bipolar with post-traumatic stress disorder. She was homeless in Madison for more than a year, sleeping outside in Peace Park and other locations she won't reveal.

"I'm trying to protect other people out there," she explains. "I don't want them to be arrested."

Although Bergemann never got in trouble with the law, she used to do "anything and everything I could to get my hands on money." She panhandled. At night, she would sell her body for a place to sleep or more drugs. Her parents in Milwaukee refused to let her come home because they were caring for her young son. Her aunt in Madison had kicked her out because of her drinking and drug use.

"I didn't have any friends at that point," says Bergemann. "I didn't have anyone to rely on, and I was lost."

She eventually met another homeless man, who brought her to Hospitality House, off Fish Hatchery Road. Hospitality House is a day center, run by Porchlight, where the homeless could spend the afternoon watching TV, using the computers, drinking hot coffee - and hopefully getting hooked up with services. Bergemann got to know Kelli Malueg, one of Porchlight's counselors. Malueg decided Bergmann qualified for a new program Porchlight was launching, called Housing First.

Under Housing First, Bergemann got a free studio apartment, a place to live while she got sober, dealt with her mental illness and eventually found a job or got on disability. Porchlight helped her furnish it and pays her utilities.

"Without Housing First, I honestly don't know what I'd do," says Bergemann, who has been in the program for a year. She's been sober the entire time. "I honestly don't ever want to go back to it."

When she first moved in, Bergemann needed intense supervision. Malueg would come by often, taking her to appointments or the food pantry. Bergemann had to learn to say no to homeless friends who asked if they could stay over. Lately, she has been taking care of herself.

"I'm really starting to cut back," says Malueg. "I'm feeling like she's becoming more independent."

She hopes Bergemann could move out of the program in two or three years. Bergmann has applied for disability, but was rejected. She's appealing, and is looking for a job. "No one's hiring," she says.

But whatever happens, she doesn't plan on returning to the streets. She remembers how it felt to wake up that first morning in her own apartment. "I was like, where the heck am I?" she laughs. "I could not sleep. It took me a month to get used to sleeping in a bed, having food in the fridge, being able to cook. I wasn't used to the civilized world."

Housing First is successful, but expensive. Porchlight got a $120,000, two-year grant from the federal government for the program. The grant is only enough to fund seven units.

Malueg says eight people have gone through Housing First; two were evicted because they couldn't stay sober. One man, a veteran, is close to graduating from the program. He got a Section 8 voucher for housing and has applied for disability. If he gets it, he'll move out.

"He's so close," says Malueg. "He's really excited about it - and excited about giving a new person the opportunity to get Housing First."

City and county officials all say they support programs like Housing First. But cost is an issue.

"The Housing First movement is something we're very interested in pursuing," says Mayor Dave Cieslewicz. But there was little room in the city's 2009 budget for a new program. "This was a tough year," he says. "Finding money for anything new was very difficult. [Housing First] needs to be a cooperative effort between the county, city and groups like the United Way."

Porchlight's Schooler says Madison has little chance of solving the chronic nuisance problem if it doesn't invest in programs like Housing First. Most homeless individuals or families go through the county's shelter system, where they work with counselors to develop an action plan.

For folks like Bergemann, with multiple mental illnesses and a substance-abuse problem, the shelter system is an insurmountable bureaucracy. Applying for disability can be overwhelming.

"It's very hard to get someone stable enough to go through the system just to apply for aid," says Schooler. "Then stable enough to receive the checks. And stable enough to use the checks to pay the rent first."

Schooler has convened a group of service providers, local officials and cops to meet regularly to discuss strategies for dealing with the chronic nuisance problem. It's a loose-knit coalition: "It's called 'Let's Try to See If We Can Figure This Out,'" jokes Schooler.

In addition to Housing First, the group is looking at creating a Street Court, which would function similarly to Drug Court. Giving chronic nuisance offenders multiple fines has little effect on behavior, says Schooler.

Charles Lindsey, for example, owes thousands, including $2,600 for a 2004 drunk driving arrest. He was driving home from a holiday party at the Paradise Lounge downtown, when he crashed into a parked car. When officers arrived, he was wearing a Santa hat and was so drunk he couldn't stand up. Court records show that of the roughly $3,600 Lindsey owes, he's paid only $68.

Besides the Street Court, Schooler's group is hoping to put more outreach workers on State Street. In its 2009 budget, the city of Madison added $40,000 for a homeless-outreach worker, who Cieslewicz says could be placed downtown.

Solving the chronic nuisance problem will cost much more, says Schooler. And he doesn't see why other entities shouldn't chip in.

"Shouldn't the hospitals contribute?" he asks, noting that health-care costs for this population are through the roof. "If I were an executive at a hospital, I'd be trying to look into this."

As it turns out, one area hospital is.

Earlier this year, Dr. Cate Ranheim asked the Meriter Foundation to fund a new project: preventative health care for the homeless.

"There's this whole group of patients who don't have primary care doctors," says Ranheim, a hematologist at Meriter Medical Group. "In some sense, they're the worst people to not have primary care."

For many homeless individuals, a lack of primary care means small health problems can turn into big, expensive ones. Ranheim once told a homeless man with diabetes that he needed to refrigerate his insulin.

"He said, 'Doc, I ain't got no fridge in my truck,'" she recalls.

With a $55,000 grant from the Meriter Foundation, Ranheim will study ways the hospital can provide preventative care to homeless or poor patients. She's reviewing old case files to see whether homeless patients were readmitted and why, and she hopes to come up with a formal model that Meriter can implement next year.

Ranheim has also been meeting with Schooler to discuss small steps the hospital can take. Locked fridges in the homeless shelters, where insulin or other drugs can be stored. Testing strips so shelter residents can test their blood sugar regularly. She thinks Meriter could even fund a nurse to hold morning and evening hours at the shelter.

"I'd like to show Meriter that it's worth it," says Ranheim. "If you can prevent one admission to the ER, you can justify putting money in."

Ranheim's research shows that from January 2007 through the end of October 2008, Meriter treated nearly 600 homeless patients. Almost half came through the emergency room. These patient visits cost a total of $1.85 million. One patient, who was admitted for 35 days, had a $110,000 bill.

"These patients tend to be sicker when they arrive because they don't have good preventative health care," says Ranheim, adding that Medicaid only covers a small portion of the cost. "You're writing off about 80% of it, probably."

Recently, Ranheim treated a patient who lives in a single-room-occupancy motel near Park Street. He'd cut his arm on a piece of glass, and it was infected. Ranheim gave him an antibiotic, but worried he would return later with severe dehydration because of his diarrhea. The motel where he stayed did not have a vending machine with drinks because it got vandalized so often.

So Ranheim went downstairs to the hospital cafeteria and bought him a bottle of Propel, a hydrating sports drink. "Such a simple thing," she notes.

Meriter has tentatively agreed to fund $100,000 for the second phase of Ranheim's project.

"Everyone wants to help save puppies or sick children," she says. "Nobody wants to help the mentally ill, alcoholic homeless person." But they need care, too, she says. "It saves the community money, and, oh, by the way, it helps people."

While half the chronic nuisance offenders on Balles' list are homeless, only 6% of Dane County's overall homeless population has significant contact with police.

"The majority of homeless persons are not sitting on State Street panhandling," says Schooler. "Not only do panhandlers not represent the homeless, many are themselves not homeless. I know of several who have housing."

Those who are there asking for change use the money to fund their addictions. Giving money to them, says Schooler, "is really enabling the problem, rather than providing any real solution."

Instead, Schooler urges the community to support other approaches, starting with funding proven programs like Housing First. "If the community really wants the problems addressed, the community can come up with the resources to address it," he says.

The United Way's Nan Cnare says Balles' study has helped identify the problem. "When we started this community conversation, we weren't even sure who these people were." Now, she says, people understand nuisance offenders are only one small slice of the greater homeless population.

Most homeless people, she says, are "not necessarily threatening public safety. That's much more perception than reality."

The Madison Police Department recently got a $600 anonymous grant it can use to reward nuisance offenders for good behavior. Officers who see behavior they would like to encourage can dispense $10 gift cards to places like Walgreens or Subway.

It's almost like a holiday present, says Balles, reflecting on what makes this appropriate. "The Madison Police Department is the closest thing to family a lot of these guys got down there."

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