Filthy mattresses, rooms infested with bedbugs, broken windows, people with mental illnesses wandering around in deep distress.
Fifty years ago, conditions like these at psychiatric hospitals were one reason that President Kennedy signed into law the Community Mental Health Act, which was supposed to ensure that people with mental illnesses could receive treatment in their communities, rather than in badly run institutions.
Five decades later, most of those bad hospitals are long gone. And many people have benefited from the changes in the mental health system that the law triggered.
But thousands of people with mental illness today are homeless or languish in prisons. And thousands more live in thinly funded "quasi-institutions" that have sprung up to house those who can't find or afford a more appropriate setting.
They exist in every state. They have different names, such as "personal care home" "rooming house" or "residential health-care facility." Some offer just a place to sleep; others, "three hots and a cot." Some have nurses on staff.
The distressing bottom line: The sorry conditions listed above were not drawn from some Sixties-era documentary expose. They are drawn from inspection reports on homes housing people with mental illnesses that operate today in New Jersey.
Advocates agree on this point: Boarding-home conditions are particularly problematic in the Garden State, which has more than a thousand such places.
Located in Tom's River, near the very busy intersection of Routes 70 and 9, Dover Woods residential health-care facility looks more like a dumpy, two-story office building. Windows are taped up, covered with plywood. The yard is overgrown, and strewn with litter, cigarette butts, and empty beer bottles.
Robert Davison knows the place well. He heads the mental health association of Essex County. A year ago he checked himself into Dover Woods under a fake name, to experience conditions first hand.
"I saw patients fighting over cigarettes, I was solicited by a woman who was profoundly psychotic for sex, prostitution," said Davison of his three-day stint on the inside. "It was loud, many people were hallucinating, screaming, a lot of substance abuse going on. it can only be described as pandemonium."
On this visit, Davison stayed outside as I ventured into the facility's lobby. He figured he would be recognized after his stay at the place last year.
Inside, the smell of urine was overwhelming. A man standing by the door had wet his pants and was talking to himself, nobody was assisting him. Another man was speaking into a pay phone, but he hadn't dialed a number. Residents sat in the lobby, staring into space, or at a television blaring day-time soaps.
The facility is state-licensed for 251 people; residents typically share a small room with one or two others. There was no staff in sight, nobody asked why I was there, or who I was.
Residents receive medications from nursing staff, Davison says, but no counseling: "The whole three days I was there, I had no interaction with the staff, the staff worked behind a glassed-in room, and basically you just went there for your medication, and there was no interaction with the staff."
Bed bugs, broken windows, no supervision
Dover Woods and places like it have become a "go to" place for mentally ill people who have no family and not enough money to rent an apartment.
"They pay their rent through their entitlements, through their Social Security disability, or other entitlements that they may be receiving," explained Mary Lynne Reynolds, who heads the mental health association in Southwestern New Jersey. She's been working to improve the living conditions for people in boarding homes.
Some homes are small, licensed only for six people, while others such as Dover Woods house more than 200 residents.
"Many of them are in less than adequate physical condition; they are very run down," said Reynolds.
The homes are licensed by the state and get inspected at least once a year by the Department of Community Affairs.
A trip to the department offices in Trenton offered insight into hundreds of inspection reports from last year. Inspectors noted bed bug infestations, problems with food safety and cleanliness, residents complaining of mistreatment, not receiving their personal allowance from their checks and on and on.
Officials in the department declined to be interviewed for this report.
The difficult challenges of housing the difficult
Mary Lynne Reynolds has been meeting on a regular basis with South Jersey boarding home operators, who tell her that their job is very difficult and demanding, and doesn't pay much at all.
"Owners have pointed out that it's tough to make a profit, that they receive roughly $26 dollars a day per resident and I still haven't really analyzed the numbers well enough to know where the truth lies," she said. "I think there is some opportunity for profit there, as there should be, this is difficult service to operate, but there is also exploitation."
Reynolds says one problem is that multiple parts of state government have a piece of the oversight of these boarding homes, and they don't communicate much.
Many boarding home residents go to "day programs" during the day, these programs are typically financed through Medicaid, and are supposed to provide therapy and meaningful activities.
Several boarding home residents I met at a day program were eager to talk about the homes where they live, but asked me not to use their names. They said they feared repercussions.
"I have a lot of problems, flashbacks and stuff like that, especially at night, I don't sleep, because I'm afraid of hurting somebody," said a middle-aged man who seemed weighed down by a lifetime of suffering. "If I'm in that state of mind when I see someone, I see an enemy, I don't see a person, it's my job to take care of that enemy, before it takes care of me. They don't see it that way, they don't want to be bothered with it.
He has lived in a facility in Atco, N.J., for more than 2 years.
"Everybody has their problems, bipolar, schizophrenia, everybody is on medication, but the place is not there to help you, they are just there to collect your money," he said.
He says that he doesn't see people getting any better: "For the period of time I have been there, the people I have seen and observed, they don't get no better," adding that he has seen people get worse.
He told me that several buildings at his facility are crawling with bedbugs.
Others at the day program complained about terrible food, mean staffers and psychotic roommates. They say their monthly personal allowance isn't enough to cover toiletries. Another resident told me his housing conditions are so unsettling, he is getting worse every day:
"I don't feel like I'm getting my mind together. It's beginning to pffffft - like that."
Operators feel overwhelmed
Only two boarding home operators agreed to comment for this report - but they didn't their names used.
They tell a different side of the story — about endless hours spent trying to serve this very difficult population, and keep people stable. They say they get calls around the clock, when residents experience problems, or are doing inappropriate things.
"Who gets a call on Thanksgiving when one of our residents is walking around the neighborhood without clothes?" asked one of them. "I do. My phone rings all the time."
They said it can cost dog owners twice as much per day to put Fido in a kennel as what boarding home operators get to provide shelter, three meals and some medical care for a person.
Mary Lynn Reynolds agrees that boarding home operators have very few options when a resident is in crisis. They can't commit a person to the hospital without having them screened first:
"Maybe they started a fist fight with another resident, or punched their fist through a wall, but when they get to the screening center, they have calmed down, and do not present evidence that would merit them being committed."
Reynolds says boarding homes simply aren't set up to deal with very mentally ill people in crisis, but that's often who ends up there.
Officials in the New Jersey Department of Human Services declined to be interviewed for this report, but pointed out that less than 10 percent of people discharged from psychiatric hospitals are sent to boarding homes.
Reynolds' organization is pushing for these homes to become places where recovery from mental illness is possible. She has organized quarterly meetings with boarding home operators, policy makers and mental health advocates to discuss improvements.
The operators insist that the state of New Jersey needs to invest more in mental health, rather than dumping people at their facilities.
"They have their frustrations with the mental health systems, which is on overload, and is at times not very responsive when they have a very difficult individual they are dealing with," Reynolds said. "The boarding home operators feel as though their needs are not being heard."
Residents of the boarding homes feel exactly the same way.
The man who said he's afraid he might hurt somebody expressed his main need succinctly: "A little counseling would help me a lot, I need to help myself, but in order to do that I need the tools from other handy people to help me out."
Mary Lynne Reynolds and Bob Davison call the severely mentally ill people our society's most forgotten. Visits to the state's boarding homes, or a look at inspection records, provide little evidence to dispute that view.