Avraham has been in and out of psychiatric hospitals most of his life.
But for the last five years the energetic, rangy 40-year-old, whose head is covered by a cap in keeping with his Orthodox observance, has spent most of his days at a treatment program in the Brighton Beach section of Brooklyn.
There, he and 61 other mentally ill adults, three-quarters of them Jewish, attend group therapy, learn crafts, do light clerical work and socialize. They are closely monitored by therapists, who keep their illnesses at bay with a steady course of medication and counseling.
“This program keeps me out of the hospital and off the streets,” said Avraham, whose last name and specific illness have not been used. “I need this program badly. I thank God that I’m not homeless, and it’s because of this program.
But this program is likely to be eviscerated by the changes to the Medicaid system proposed by the Republican majority in Congress and by New York Gov. George Pataki, also a Republican.
Payments from Medicaid, the health insurance program for the poor that is jointly funded by the federal and state governments, account for 90 percent of the program’s budget.
The other 10 percent comes from the UJA-Federation of Jewish Philanthropies of New York, which has been cutting back funding to its social services beneficiaries by as much as 40 percent over the past several years, according to the executive of one such beneficiary.
The funding cuts faced by Avraham’s program, Brooklyn R.E.A.L. (Rehabilitation and Education in the Art of Living) reflect those faced by Jewish-run social service programs nationwide.
These programs include those aimed at the poor, the ill, the elderly and the newly arrived on these shores.
The threats have program administrators struggling to fins a way to preserve as much of their funding as possible.
On March 20, several of Brooklyn R.E.A.L.’s clients went on a lobbying trip to Albany, N.Y., organized by the New York Jewish Board of Family and Children’s Services.
Brooklyn R.E.A.L. is one of the board’s dozens of programs, which include residences for mentally and emotionally impaired children, counseling services for people with AIDS and three shelters for battered women.
Nina, 53, is a client at Brooklyn R.E.A.L., and went to explain to state legislators why the program is so important to her.
The petite, gray-haired woman wearing bright red lipstick was hospitalized 11 times before she joined Brooklyn R.E.A.L. eight year ago. Since then, she said, she has had just two stints in psychiatric wards.
Without the close monitoring and structure that the program provides, many patients would be more likely to go off their medications and suffer acute crises that would require hospitalization, said Nancy Loener, director of Brooklyn R.E.A.L.
“We know that hospital care is more expensive than community-based care,” she said.
In addition, Medicaid is likely to follow the national trend toward managed care, meaning that the number and duration of hospital stays will be limited.
“We’ve already seen situations in recent months where it’s difficult to get patients in psychiatric crisis admitted to the hospital, situations where they are talking about suicide and can’t control their impulses,” said Loener.
“In some cases, they are hearing voices, experiencing increased episodes of paranoia and are losing the ability to take care of themselves, to eat and to bathe,” she said.
“People in acute distress will end up calling 911 and using police time rather than getting the help they need,” said Loener.
Hospitalization for a mentally ill patient in a psychiatric ward costs $106,000 per year, according to Karen Roth, director of services for the adult mentally ill at the Jewish Board. By contrast, the entire budget for Brooklyn R.E.A.L. is about $400,000 a year, she said.
The threatened cuts in welfare and social services other Jewish-sponsored programs.
A Jewish soup kitchen and drop-in center run out of a synagogue basement in Manhattan’s Chelsea section serves about 30 homeless and near-homeless Jewish men and Women each day.
On a recent Friday afternoon, the people eating a kosher lunch of fish and spaghetti included Zemira, a talkative 28-year-old woman who lives in a nearby YMCA, and Barry, a bookish 46-year-old woman who, before mental illness turned his life upside down, had studied to be an accountant.
“Coming here gives me back a sense of community,” Zemira said, adding that she enjoys the Friday afternoon Shabbat celebrations and parties for Jewish holidays. “A lot of people who are homeless don’t have that sense of community.”
After a stay in a psychiatric hospital and seven months of living on the street, Barry has spent the last four years living in a flophouse, where 200 men sleep on beds literally caged in by fencing.
Social worker Laura Feldstein’s current mission is to get Barry out of the Flophouse conditions, which she terms “subhuman,” and into a renovated single- room-occupancy facility in Times Square.
She is one of two part-time social workers on staff at the center who help get these Jews into shelters and single-room-occupancy hotels, help them apply for welfare and Social Security benefits, do some counseling and take them on occasional field trips to places such as the New York Botanical Gardens.
The soup kitchen itself, a project of the Educational Alliance based on New York’s Lower East Side, is privately funded. This enables the program to be tailored to the needs of the Jewish homeless, most whom are mentally ill or substance abusers.
The program has lost several staff positions to funding cuts in the last several years, according Feldstein. And yet she expects to see an increase in the number of Jews who need the center’s help, once public funding for other social services is cut.
On another front in the ongoing debate over cutbacks to the poor is the plight of Russian Jewish emigres.
The overwhelming majority of Jews who come to the United States each year from the former Soviet Union, Eastern Europe and Iran enter the country as refugees.
Legislation passed this week by the House of Representatives would allow only refugees older than 75 and those who become citizens to collect welfare beyond five years.
The immigrant community and those dedicated to supporting them would be devastated by the cuts.
“When the government accepts immigrants, they are responsible to support these people,” said Boris Kaplan, 49, who arrived in New York from St. Petersburg three years ago.
“There is a lot of floating anxiety out three among the emigres about the cuts,” according to Pauline Bilus, director of Project ARI (Action for Russian Immigrants) at the Shorefront YMHA in Brooklyn’s Brighton Beach section.
Project ARI includes English-language classes, an array of social services and courses to aid acculturation. Anticipating being cut from the welfare rolls on which so many of them are dependent, hundreds of Russian Jews are rushing to become citizens.
At the Shorefront Y, recent emigres from the former Soviet Union fill every space available in the English as a Second Language/Citizenship classes.
About 1,000 immigrants attend the classes each week, and more than 1,000 more are on a waiting list. The classes are funded by a combination of federal, state and city money, and a recent state memo indicated that funding for the English classes may be cut by as much as 50 percent, Bilus said.
Eligible to apply for citizenship after five years of residence in the United States, the immigrants are crowding into tests that, once passed, expedite their interview process with Immigration and Naturalization Service officials.
Twice a month a citizenship exam is given at the Shorefront Y and at another Brooklyn location. Since the Y began the testing 10 months ago, 1,000 people have taken the exams there according to Bilus. According to the Hebrew Immigrant Aid Society, another 1,000 have been reached by the citizenship workshops and test-preparation the agency has offered in 11 cities in the last year.
“There’s a lot of anti-immigrant feeling out there, and the Russian immigrants are eager to become Americans,” said Bilus.
Even before becoming eligible to apply for citizenship, and before they are eligible to vote, those at the Shorefront Y are exercising one of their democratic rights: the right to makes their voices heard. They are lobbying state senators about their concerns by writing them letters.
Boris Velednitsky, who came to the United States in 1993, wrote to New York state Sen. Martin Solomon on March 20. The Russian native wrote in English: “I ask you to give for me possible to study English and then I will be look for job. I want to work, to pay taxes and help other people. I hope that you can help me.”