Taking Mental Health to the Streets

Paulette Lee welcomes visitors to her apartment. While this may not seem to be a noteworthy event, it’s a major milestone in Lee’s life. Not too long ago, Lee, who suffers from paranoid schizophrenia, heard and reacted to voices. She wasn’t taking her meds. She had lost all contact with her family, and was homeless.

“I didn’t have the money, and I was out in the dark and the cold, and hot in the summertime, and just got put in jail four or five times at Greyhound for trying to stay there for the night to the next day in the morning time.”

Today, Lee is living independently in an apartment. She’s taking her medication, no longer listens to the voices, and has reconnected with her family. Lee is one of the many success stories for UAB’s Research and Evaluation of Assertive Community Treatment Program, REACT for short.

It’s modeled after a program that was created in Wisconsin more than thirty years ago, and is now used in 35 states, as well as Canada, England, Sweden and Australia. UAB psychiatric social worker Harry Findley is the REACT team leader. He says that the goal of the team is to go out into the community and find people who have fallen through the cracks. The team learns of these clients through UAB’s outpatient clinic.

“They may notice that someone’s missing appointments, or they’re coming to appointments irregularly, and they’re not taking their medications as prescribed, and with some intervention from assertive outreach program like ours, they’re able to get back on track, stick with their medications and become stable again.”

The REACT team consists of nurses, social workers, substance abuse specialists, liaisons with the court, landlords and an ex-police officer. Each one of these folks brings a different skill set to the table. But, in order to help clients, the REACT team has to first find their clients and That’s not easy. They could be homeless, sleeping or living under bridges or in public parks, staying in seedy motels or just wandering aimlessly. Once the clinic has lost touch with them, it’s full-time social worker, part-time private investigator for REACT team members. They get their assignments every morning, and its time to hit the streets.

On this day, social worker Duncan Gibson and case manager Jodie Kirk are determined to track down several elusive patients.

(Gibson) “The way we describe it, we’re a hospital without walls. We treat people in the community. And, so, we’re trying to find one of our clients who needs medicine every day, and our plan is to meet him daily, to give him his medicine.”

Gibson says it’s been almost a week since they’ve seen Don. They make their way to a downtown motel, where they’ve found him before. Gibson admits that she’s scared to come alone. She and Kirk approach his room. The knock on the door. They can hear the television, so they knock again.

(Gibson) “Don, we’re from the REACT team. Are you there?”

Not having any luck, the two social workers-turned-PI’s ask for help from the desk clerk, who’s standing behind a protective plate of glass.

(Duncan) “If you do see him, will you tell him that we’ve been coming and to meet us?”

(Front desk clerk) “Early, early in the morning, like four or five in the morning.”

(Duncan laughs) “We don’t start work that early. If you see him, will you remind him to meet us at 11 at the church so that we’ll buy him some lunch?”

Leaving the motel, a little frustrated, the two return to their car. While patrolling the streets, their luck changes. They happen to see someone else on their list for that day. He’s hanging out at a gas station, instead of doing his court-mandated community service hours at a downtown church.

(Gibson) “Wyndell, hey, how are you. Hold on. I’ll pull over. Hey, how you doing?”

(Wyndell) “Alright. I didn’t make it down there on time.”

(Gibson) “Can you go there now? We can give you a ride.

(Wyndell) “I went to jail yesterday, you know.”

(Gibson) “I know.”

It’s not unusual for clients to land in jail – picked up for offenses like public intoxication or trespassing. Often, after discussions between the REACT team, the District Attorney’s office and the judge, the offender may be invited to join a Jail Diversion program specifically for people with mental illness. Legal aid attorney Jacquette Edmundson Clancy is the liaison between the REACT team and the judge.

“The jail is not equipped to deal with people with mental illnesses on a long-term basis. And, what the jail diversion program gives us is an avenue to divert them from being re-arrested and thrown back into the court system.”

Staying on their meds would keep a lot of the clients out of jail. But, Clancy says convincing them isn’t always easy.

“I had a client once to tell me that he had a voice in his head that spoke to him, and that he was very close to his voice. And, the voice told him that, hey, if you take your medication, I’ll die. Now to the average person, that may sound crazy. But, in actuality, it makes a lotta sense because if indeed he takes his medication, the voice will disappear and it will make him feel a little Longley. So, he didn’t want to get rid of his friend, so he didn’t take his medication. ”

The success of assertive community treatment programs like REACT varies from community to community. Psychiatric social worker Finley says very few of the team’s long-term patients need additional psychiatric hospitalization and few return to jail once they are engaged in the program. At the end of the day, Finley says that the members of the REACT team will do whatever it takes to help people with mental illness reach their goals.

“Goals … like I’d like to have my own apartment. I’d really like to be able to manage my money in order to have enough food to eat for the entire month. I’d like to stay stable on medications, so I don’t have to go to the hospital again.”

(Lee) “I want to meet a man and get married.”

Again, REACT client Paulette Lee.

“I don’t know if I’m going to do it, but I want to meet someone and get married again. I’d been married once, and I want to get married one more time, before it’s too late. I’d like to get married again.”