When she finally accepted that she could no longer allow her adult daughter to live in her home, Marti Claussen called a Honolulu homeless shelter and asked if there were any available beds.

The voice in the phone seethed: “What kind of mother are you?”

Barreling out of the speaker, the words seemed to spawn a head with two giant eyeballs and a punishing brow. Marti shuddered in judgment’s burn.

Years later, Marti recalls the phone call and her thin voice splinters, betraying the scar of an old wound.

“I can’t tell you what that did to me,” she says.

It was the spring of 2013 when Marti’s daughter Christie Claussen arrived at the doorstep of the Institute for Human Services’ emergency shelter for homeless women and families.

Nearly six years later, 45-year-old Christie is one of the longest-standing residents at Hawaii’s largest shelter. After stints living at bus stops and failed group home placements, Christie has slept in the top bunk of a metal frame bed on Kaaahi Street for two consecutive years.

“She’s stuck in this hole now and I just can’t get her out of it,” says Marti, who visits her daughter every Saturday, bringing her money, fresh laundry, two packs of cigarettes and a lift to McDonald’s for french fries and chicken sandwiches.

Christie has schizoaffective disorder, a serious mental condition characterized by hallucinations, delusions and severe swings in mood. Over 17 years, the illness has damaged her ability to think, concentrate, recall memories and make decisions.

Her behavior is largely compulsive — a reflection of what she wants in the moment, what she needs right now.

On a good day, Christie uses her eye for color and design to fashion an attractive outfit from the shelter’s wardrobe of donated clothes. She participates in conversations, even if her words percolate from the chimera of an unstable mind. Christie might even halt herself from lighting up a cigarette in her mother’s car, acknowledging Marti’s distaste for the stink of old tobacco in the seat fabric. She sings along with the radio, nailing every lyric.

More often, Christie retreats into herself. Alone on a street bench, she puffs compulsively on cigarettes and speaks gibberish. Her eyes flicker between vacant and frenetic. When she retires to the shelter at night, she requires prompts to shower and clean her teeth, which are broken and rotting from years of neglect. 

Christie inhabits an air of urgency, but she is polite — never mean or violent. When it’s time for her medication — a monthly, long-lasting injection that combats the symptoms of psychosis — she does not put up a fight.

For years Christie’s sporadic use of methamphetamine repeatedly derailed her progress, her mother says. She doesn’t use meth anymore — but the threat of relapse is lurking. The shelter abuts a late-night bar, a liquor store, an abandoned gas station and an empty building that has become a den for illicit drugs and sex. The block is thick with men looking to exploit vulnerable women.

Christie is easy prey.

“If it weren’t for me — if Christie were even still alive — she would be on the street somewhere living in a tent,” Marti says. “I do understand how families have given up on their family member. But I just can’t do that to my daughter.”

This is the story of an adult child struck by debilitating mental illness and the mother who scrabbles to help her through it, navigating a difficult balance between selfless love and self-preservation. Marti’s plight is toiling, but it is a not uncommon experience among families of people with serious mental illness.

It is also a story of impossible choices and resilience. And it illuminates a jarring gap in Hawaii’s strained mental health system.

During a series of interviews totaling more than eight hours, Marti agreed to share the details of her ordeal being the mother of an adult daughter with serious mental illness. IHS Clinical Director Jerry Coffee, who has worked on Christie’s case for six years, corroborated much of Marti’s recollection. 

Christie participated in several conversations with a reporter to the extent that she could, usually while in the company of her mother.

The Closest Thing To Home

Hawaii has the highest per capita rate of homelessness in the nation, driven in part by the soaring cost of housing. Of all of Christie’s problems, the most difficult one is finding a place to live. 

The critical shortage of special needs housing is most pronounced for people who require extensive supervision due to mental illness. Although one-third of homeless adults on Oahu have a debilitating mental disorder, most of the housing options prioritize people with physical ailments. This leaves people like Christie with slim chance of finding an adequate fit.

A history of substance abuse can also be disqualifying — even when a housing applicant has truly disavowed drug use as a thing of their past.

“She’s stuck in this hole now and I just can’t get her out of it.” — Marti Claussen

Yet experts in homelessness, addiction and mental illness agree that it is sometimes impossible to deliver effective psychiatric or substance abuse treatment to a person with no place to live.

Christie’s lack of self-reliance does not make her a good fit for Honolulu’s Housing First Program, which gives chronically homeless people with mental illness or drug addiction the keys to an apartment.

In six years of homelessness, Christie has qualified for eight placements in group or care homes across Oahu. She was quickly evicted from most of them.

What typically happens is Christie, left unsupervised, grows restless. So she starts canvassing the neighborhood. She knocks on doors and greets homeowners: “I’m pregnant with 800 babies and can I have a dollar so I can buy cigarettes?”

Housing providers say these repeat disturbances could jeopardize the home’s ability to operate.

Christie has sometimes walked out of housing, riding a city bus back to the homeless shelter or calling for an ambulance or a lift from her mother. After a sputtering start, Christie has found comfort in the shelter’s stultifying familiarity, even if she talks constantly of finding a real home where she can cook, clean and do her own laundry.

Christie is on several housing waitlists. But a history of poor outcomes in previous placements remains a powerful force against her.

“Frankly,” says Coffee, the IHS clinical director, “a lot of those housing providers will look at Christie’s application and say, ‘not this one.’ And it’s in their right to do that.”

This is not lost on Marti, who, at 72, remains Christie’s strongest advocate and her only genuine friend.

“If a care home or group home has the option of receiving the same amount of money and taking in a little old lady who can’t get around or taking in Christie, which one are they going to choose?” she says.

Christie has been abandoned by the rest of her family, including her three kids. 

After The Oil Boom

Growing up in suburban Denver, Christie had a passport full of stamps and a black and white pony of her very own named Tinkerbell.

Every summer, Christie and her older sister Carrie flew by private plane to the family’s sprawling Kansas ranch, where they romped around in the wilderness, forging trails on three-wheelers and noodling in the lake for catfish. At night, the two Claussen girls and their parents Bud and Marti gathered to watch big rigs pump the crude oil that nourished the family’s small fortune.

Then the boom times went bust. The family went broke in the oil swoon of the 1980s. All of the boats and airplanes and ponies got sold.

Marti, who had never worked a job, says she took up selling cemetery plots for the nation’s largest death care provider. She loved the work and consistently topped the company leaderboard in regional sales.

Bud, a military veteran, worked at a couple of used car lots and picked up the leading role of raising two young women. He kept a stiff drink in hand. He never got over the financial blow.

Under the best of circumstances, Christie and Carrie could be difficult. And Bud, who could be imperious, didn’t have a clue about how to relate to them. There was lots of head-butting and the girls grew expert at keeping secrets. 

Stylish with a thick head of gorgeous hair, Christie was one of the popular kids at her public high school. Her classmates voted her the most likely student to become a famous New York fashion designer. Christie took pride in her appearance — an inherited trait — and cultivated a roster of boyfriends. Marti recalls that one young suitor said: “Trying to catch Christie is like trying to catch air with a butterfly net.”

Academically, Christie was struggling. So Marti set up a talk with the school principal.

“You know,” the principal told Marti. “Christie doesn’t test below IQ, which is what we would expect. But there’s something there that we can’t put a finger on.”

Marti figured Christie’s sinking grades were a symptom of stress from the family’s dramatic lifestyle switch. The principal sourced the problem to something deeper. He recommended the school’s special education curriculum.

Christie begged her mother to stay in her regular classes. Marti acquiesced.

Meanwhile, Christie’s older sister Carrie had developed a steady cocaine habit, Marti says. Christie soon discovered marijuana at a party she attended with Carrie as her chaperone. Marti fielded phone calls from concerned parents of the girls’ closest friends.

Christie was 14 when she and her sister checked into drug rehab.

Christie’s classroom challenges accelerated into her junior year, when she dropped out of school. She stayed busy tending a steady affair with a boyfriend. When it ended, she had a fling and became pregnant.

At 19, Christie birthed a healthy baby girl and latched onto a new relationship that quickly took her to the alter. Christie annulled the marriage when her husband beat her brutally the day after the wedding. 

Grieving from heartbreak, Christie took up with a guy who lived in a warehouse and sold marijuana for a living.

Christie regularly took her three-year-old daughter in tow on overnights at the warehouse. This worried her parents. So Marti enacted a clever scheme, footing the bill for Christie and the baby to move into a new apartment while she tipped off police to bust the warehouse.

But it wasn’t long before Christie went back to her beau and became pregnant again.

During her second pregnancy, Christie’s father died of lung cancer. Marti buried her husband and helped Christie pay for an apartment with room for the new baby and toddler. The father of Christie’s newborn soon fled when Christie quickly entered her third pregnancy — and the baby wasn’t his. 

Christie’s ability to function as a mother steeply and inexplicably declined after the birth of her third child. She would take off in the middle of the night without notice or care. Marti stepped up to help rear her young grandkids.

“I would go over to help Christie, but really I was an enabler,” Marti says. “She’d be on the couch and I’d feel so sorry for her because she’s got these three little kids. I was trying to help her because I’d always known Christie was weaker in some ways.”

Christie had her first psychotic break when she was 28. Rage. Apparitions. Delusions. The symptoms were persistent. She was hospitalized against her will seven times that year.

Marti won full custody of Christie’s kids. As a requirement of the custody agreement, she says she had to keep the children separated from Christie — or risk losing them all to foster care. Christie responded to her mother with declarations of hatred.

“I had to choose between my daughter and my daughter’s kids,” Marti says. “Hardest thing I ever did.”

Saturday Ritual

It’s Saturday morning in Honolulu. Marti drives her silver Kia sedan to the homeless shelter, checks in at the front office — “Hi, Christie’s Mom!” — and waits outside on a concrete bench. She’s never been inside the facility where her daughter spent her last two birthdays and the last two Christmases.

Christie emerges through the shelter door wearing a tight black dress fastened by a single spaghetti strap. Her nails are polished and there are scratches on her cheek and forehead.

Christie spies her mother on the bench and smiles through pursed lips. She’s ashamed of her gray, disintegrated teeth. She feels like a monster and figures it’s why her children don’t come to visit. 

Marti latches Christie into outstretched arms. Cigarette butts and flattened fast food containers cake the pavement beneath them like deceased palm fronds. Hand-in-hand, they retreat to Marti’s car.

In the passenger seat, Christie paws through a plastic bag of gifts from her mother. There’s a lavender bra from Wal-Mart and the usual haul of cash and cigarettes.

Over chicken sandwiches, Christie vents: Her clothes and makeup were stolen — again.

“It’s like stress intensified,” Christie says, describing what it’s like to live at the shelter. “It’s all dirt and grime and cement. You can’t just go take a bubble bath.”

Marti sympathizes and pushes her daughter to stay hopeful.

Christie’s eyes narrow and something shifts in her head.

“You’re selfish,” Christie lashes. Her words ring out in the bold tone of voice so many women reserve for their mother.

“If one of my kids was living on the street, I would make sure they had a house — even if they were a bum I would make sure they had a house,” Christie continues. “But when they try to get me a house, you tell them, ‘No.’ You won’t let me have a house and you spend all the money on yourself.”

Marti gingerly dispels her daughter’s delusions: “That’s not true, honey.” She reminds Christie of the times when she had a bed in a group home and then vanished, boarding a bus back to the shelter. She brings up her trouble abiding by no-smoking rules.

“I’d quit smoking if I had a place to live,” Christie insists. Her upper lip quivers, oscillating a beauty mark similar to Marilyn Monroe’s.

“Frankly, a lot of those housing providers will look at Christie’s application and say, ‘not this one.’” — Jerry Coffee, IHS Clinical Director 

Christie experiences reality in surges. She might start a sentence with an idea rooted in truth, but by the end of it the world she speaks about is unrecognizable. She’s pregnant and needs prenatal vitamins. Her firstborn daughter — now an adult with her own child — is still a little kid. 

Right now Christie’s delusion is that her mother is dead — but only for a blip. As soon as she puts it to words, she jolts in recognition of Marti’s patient eyes looking back at her from across the table.

Christie makes a final dig: “You should hear what they say at the shelter about you, Mom.”

Marti wrestles on a thin smile.

“Honey,” Marti starts. 

“I’m doing everything I can,” she reassures Christie. “Of course, I want you in a house — any kind of house they can find for you. I would say, ‘Yes, yes, yes.’”

Marti understands that daughters will always blame their mother. She neatly balls up her sandwich wrapper and excuses herself to the restroom.

Later, she’ll explain, “I love Christie, and I know it’s terrible, but I can only take Christie in small periods.”

Minutes later, Marti finds Christie outside the restaurant with a cigarette in hand. All of the tension has collapsed.

A passerby compliments Christie’s shoes: black suede heels with decorative laces.

“Thank you, I got them from here,” Christie says. She points a finger at her forehead.

Christie quickly self-corrects: “I mean, I thought of them first and then I got them.”

“You’re beautiful,” she adds.

Walking side-by-side with her mother back to the car, Christie talks about how she needs a pastor to help her find a real home.

The car doors slam and they drive to a drugstore, where Marti helps Christie restock her stolen makeup.

Independence Day

Independence Day of 2012 marked the return of a great deal of Christie’s personal freedom. For years prior, Marti says Christie lived in a group home in Colorado where she was subject to a court order to take her psychiatric medication. When she landed at Daniel K. Inouye International Airport in Honolulu after a 10-hour flight from Denver, the court order had dissolved along with her constant supervision.

Marti had the confidence of Christie’s former case workers, who assured her Christie was ready for this. Just in case, Marti says she filled out the paperwork to become Christie’s mental health power of attorney, a legal authority that should have given Marti the right to consent to well-intended psychiatric treatment on Christie’s behalf.

Within months of moving into her mother’s condominium in Kaneohe, Christie’s psychosis exploded. The safeguards Marti built in to prevent Christie from falling ill and thwarting her own rehabilitation were failing.

“I love Christie, and I know it’s terrible, but I can only take Christie in small periods.” — Marti Claussen

First, Christie refused to take her medication. Marti found it impossible to attain a court order in Hawaii like the one that helped stabilize Christie in Colorado.

Christie also refused to attend day programming for people with mental illness. The people there are “crazy people,” Christie asserted. So while Marti worked on weekdays, Christie was left alone.

“And then it ended up to where we had almost nothing in the living room, no pots and pans in the kitchen, no shampoo in the bathroom,” Marti recalls. “Later I’d find all of it in a Dumpster. I mean, she was just going from bad to worse and she was refusing to get any kind of help.”

When Christie wasn’t throwing away the condo furnishings, she’d wander the streets and fall into the company of drugs and men who hit on her. That’s when she started smoking meth.

Marti convinced Christie to check herself into a hospital for psychiatric treatment on a number of occasions. But usually Marti was forced to call the police to hospitalize Christie against her will. Christie would then receive treatment, without her consent, for a maximum of 48 hours.

Only if a doctor decided Christie still posed an imminent danger to herself or others after the two-day treatment expired would the hospital agree to keep her against her will for any longer. But Christie was usually sedated enough to get released. She would exit through the lobby and roam the streets. The hospital would not notify her mother.

Marti tried to exercise her power of attorney over Christie’s mental health care to compel the doctors to treat Christie for longer periods.

Marti said neither Queen’s nor Castle medical centers would honor the notarized document. Queen’s would not comment specifically on Christie’s medical record, but the hospital’s legal team said it cannot recall a time when it has counseled a doctor to deny a valid mental health power of attorney.

As an alternative, Marti says she was advised by doctors, nurses and social workers to claim that Christie had threatened to harm her. This could give the hospital the legal grounds to hold Christie for treatment beyond 48 hours.

But Marti couldn’t lie about her sick daughter.

Facing eviction, Marti concluded she couldn’t continue to house Christie without sacrificing her own sanity. So the next time Christie got released from another band-aid emergency treatment, Marti let Christie sit at a bus stop while she moved into a new home.  

“I was having social workers check on her to see if she was okay,” Marti explains. “I called the police to tell them what the situation was, but because she hadn’t committed any crimes they said, ‘Well, at least we’re aware of why she’s there and who she is.’ And that was basically it.”

Marti visited Christie every few days, taking her to Denny’s and supplying her with cash and cigarettes. She’d beg Christie to call the state Health Department’s phone line for mental health resources.

After 12 days, Christie dialed the number. A social worker met her at the bus stop and transported her to a homeless shelter.

‘When I’m Gone’

Years after the family fortune vanished, Marti mobilized to become a mother to her young grandkids.

With Christie unable to mentally function and her sister Carrie dead in her 30s of breast cancer, Marti waged a custody war for her daughters’ collective five children. When it all settled, Marti remained the primary caregiver to three of them.

The work of selling cemetery plots took on new urgency. So did Marti’s advocacy for Christie’s well being. Marti fought the Colorado mental health system for longer, more comprehensive psychiatric treatment when Christie was too ill to recognize she needed it.

When Christie wasn’t being hospitalized, Marti put her up in a modest hotel. When Christie got picked up on a trespassing charge for being on hotel grounds after checkout, Marti hired a lawyer to redirect Christie from a jail cell into hospital care.

These were long, difficult years of travails and traumas.

Fate improved when Marti secured a court order for Christie to take her medication. This led her to a bed in a group home in a leafy neighborhood on Denver’s outskirts.

With Christie recuperating and the grandchildren blossoming into adulthood, Marti figured it was her last chance to move to Hawaii, making good on an old dream she and Bud had shared for their later years. With Bud dead, Marti didn’t want to let the dream die, too. So in 2010, Marti left Colorado for a sunlit condominium in Kaneohe, with three grandchildren in tow.

Marti chose the condo for its proximity to the Hawaii State Hospital. Years later, she learned inpatient psychiatric treatment at Hawaii’s only mental hospital is available exclusively to people facing criminal charges. In Hawaii, there are no long-term residential treatment facilities for adults with mental illness.

Today, Marti lives in a studio apartment in the hub of Honolulu. She works two jobs, one conducting telemarketing surveys and another organizing focus groups for a firm of financial advisors.

“I want to know that when I’m gone, you’re going to be OK.” — Marti Claussen

Marti goes on daily uphill walks. She preps her meals to adhere to the South Beach Diet. And she works tirelessly to find housing for Christie, making calls to Christie’s case managers, her insurance company and mental health advocates.

Marti probes dentists for an affordable way to fix Christie’s teeth. She launders Christie’s clothes. She scours the city for a church where Christie, who can’t sit still or adhere to silence, might feel accepted.

Of all the wounds Marti has accumulated, she says one of the most excruciating ones was inflicted by a church staff member who instructed her to remove Christie from a prayer service — or risk her removal by the cops.

On her one day off, Marti relaxes at home or visits the beach. She keeps in close touch with Christie’s children, who do not remember their mother before she got caught in the grip of psychosis.

Infallibly, Marti reserves Saturdays for lunch with Christie.

“Mom, can I come live with you?” Christie asks regularly.

The desperation in Christie’s voice rips at Marti’s heart. But she knows deep down that it wouldn’t work out.

“You know, I’m not going to be around forever, and I want to know that you’re some place safe and stable.” Marti tells Christie.

“I want to know that when I’m gone, you’re going to be OK.”