In pockets of California, pioneers of small but aggressive programs are showing they know how to make the lives of people with severe mental illness better.
Medications are part of their strategy, but that's not all. The idea is to wrap people in a blanket of services so snugly they can't just slip away.
Experience has shown that very ill patients don't just need pills. They need multifaceted, individualized assistance with the challenges of life: keeping a roof over their heads, earning a living, making friends.
"Basically, we ask people, 'What do you want and need?' " said Martha Long, director of the Village, one of the best-known "wrap-around" programs in the state. "Most people with psychiatric illness have had the fight beat out of them. . . . What we want to do is give people a picture of what their life could be like" if they accept help.
More than medical services, the Long Beach program offers practical help in the form of job training, housing assistance, money management and general "life coaching." Clients are assigned to a team of caseworkers that includes a psychiatrist.
The Village considers hospitalization a "failure" on its part, Long says. The agency doesn't like to see people decline to that point.
Patients who find places in such expanded-service programs often turn their lives around--or at least stop their skids into homelessness and psychosis. The jobs they get are often entry-level clerical and service industry positions, but they get people back into the swing of working.
"They never gave up on me," said Jay Hill, 36, who was a 98-pound panhandler with a ferocious drug problem when he joined the Village 10 years ago. Village employees repeatedly sought him out as he begged on the streets, and urged him to get into a drug treatment program.
Now he's eight years clean, living in a group home that doesn't allow drugs or alcohol use. He's taking psychiatric medications for his illness, a condition that combines symptoms of schizophrenia and bipolar disorder. And he's been working on and off, first at the Village office, later at a Target store and as a stock clerk for the Air Force.
The Village doesn't work for everyone--"we're not perfect," said Long--but it has an impressive record.
In October, for example, 63% of the 276 clients lived independently in housing around the community. Most of the rest were in board-and-care homes or with their families. A quarter were employed. Ten percent were in school. About 2% were homeless or incarcerated and just over 3% were hospitalized.
