Working Their Way Back

By James Willwerth

On a day in 1995 that he recalls only vaguely, Bobby Frazier, a beefy sandblaster from Long Beach, Calif., took his diabetic mother to the hospital and, inexplicably, waited for her on a bench at a nearby bus stop. When he learned that she had died, he refused to leave the bench and remained there for 16 months. "My mind completely snapped," Frazier, 38, explains. "I slept sitting up and urinated on myself. My family brought food. Bus riders gave me blankets. I religiously believed that my mother would one day get off that bus."

Four years later, Frazier is well again. He has worked for two years on an elite longshoreman's crew that cleans up oil spills, and served for a year as president of his union local. He commutes to work from a new apartment, where he lives with his wife and four-year-old daughter. Frazier owes his stunning turnaround to medication that has brought his mental illness under control, but also to an underutilized treatment known as psychosocial rehabilitation. This approach aims to remedy what many see as a great failing of America's treatment of the mentally ill--once they are stabilized with drugs and released from the hospital, they are too often left to fend for themselves, with no one to counsel them, monitor their progress or help them find work. That has led to much private suffering but also to some public tragedy, as in the case of Andrew Goldstein, a New York City man suffering from schizophrenia who pushed a woman to her death off a subway platform. Goldstein's murder trial ended in a hung jury this month, but the public mental-health system's neglect of him as a ward has spurred calls for reform. Last week New York Governor George Pataki, whose administration has repeatedly squeezed mental-health budgets, proposed spending an additional $125 million for community services.

Instead of abandoning the recovering mentally ill when they leave the hospital, psychosocial rehabilitation nudges them toward jobs, apartments and increased responsibility. Individuals are assigned to treatment teams composed of psychiatric professionals and "life-skills" specialists, who see them as often as three times a day or as seldom as once a month, depending on need. These teams monitor medication and offer both practical help and psychological support in getting former patients back into the working world.

Such programs have been around since World War II, when a group of individuals released from Rockland state hospital in New York started Manhattan's Fountain House, the nation's first "clubhouse" in which the recovering mentally ill work together to run their own lives. But for years the treatment remained "the mongrel group in the basement," resisted by the medical establishment, says Ruth Hughes, director of the International Association of Psychosocial Rehabilitation Services. Today the relatively paltry funds available for treating the mentally ill go mostly to traditional or "medical-model" treatment programs that stress medication and psychotherapy. Psychosocial rehabilitation is used for fewer than 10% of those suffering from serious mental illness. Yet its success rate--those in psychosocial programs have one-third the relapse rate of traditional patients--has started to gain attention. The National Mental Health Association in October 1998 made a strong endorsement by launching Partners in Care, a campaign to replicate successful psychosocial programs around the U.S.

Frazier's ordeal at the bus stop ended when his sister persuaded him to visit the Village, a pioneering Long Beach psychosocial program. There he was found to have bipolar disorder accompanied by paranoid delusions. A staff psychiatrist prescribed the drugs Depakote and Rispiradal and asked Frazier, "What would make you happy?" He replied, "I love to work."

Frazier was assigned a treatment team, which put him to work on the Village's janitorial unit. "Bobby was a fierce worker," recalls Village director Martha Long. Counselors helped him get Medicaid, find an apartment and manage his money. Becoming a longshoreman was Frazier's idea. Like many recovering mentally ill, he is wary of too much stress, so he found work as a stevedore for two days a week. He still stays in close touch with his treatment team, which makes sure he keeps on his medication. But it is the job that has anchored his recovery. "It brought me back to my sense of reality," says Frazier.

While programs like the Village are highly structured and have specific goals, groups like Schizophrenics Anonymous, with 80 chapters around the country, tend to be more informal. S.A. holds regular meetings, similar to A.A. gatherings, to provide men and women left on their own in the community a place to socialize and unburden themselves. Joanne Verbanic, a retired Ford Motor credit specialist who used to hide her schizophrenia from co-workers because she feared discrimination, founded S.A. in 1985 to help others "who felt hopeless and alone." At a boisterous meeting recently, a young woman, Nora Baylerian, admitted "thinking the KGB and Mafia were after me." A woman in her 60s, Marjorie Mott-Hogg, responded with a chuckle, "We've all been there, Nora."

Awakenings, with 12 chapters in the New York City area, is a program aimed at "robust responders"--medical jargon for high-functioning individuals. Founder Ken Steele, who for 32 years wandered across America homeless and schizophrenic, feels that the most formidable task for the mentally ill is overcoming the social stigma. "The public's synonym for us is still psycho," he says. "We are feared and misunderstood." Partly to counter this, individuals with mental illness call themselves "consumers"--an emotionally neutral word meant to suggest people who consume medications and services associated with psychiatric disability. A voting effort, for example, is called a consumer-registration drive; psychosocial rehabilitation is considered consumer-driven.

Programs like Manhattan's Fast Track to Employment work with employers to help the recovering mentally ill find jobs. At least 50 firms have signed on, and most seem satisfied. "We had anxieties at first," admits RDS Delivery Service co-owner David Zogby, "but customers called to salute us." Says George Castaldo of American Postcard Co. of his new hires: "They come 20 minutes early in rain, snow or cold, and they give 150%."

Miriam Kravitz was in a locked psychiatric ward lying naked in a puddle of her own urine when she got a career idea that would benefit herself as well as people like her. She enrolled first in college and then in law school while homeless. In 1985, she started INCube (short for incubation), a New York City agency run by the recovering mentally ill that helps others start businesses. "We do business as well as or better than the mainstream," says Kravitz. "It's a big secret." INCube has helped start 300 businesses over a decade and counts 176 still going, from Courage Communications, whose crews install pay telephones in Manhattan, to DJ Unexpected, which provides music for parties and public events on Long Island.

There are still hurdles. Traditional mental-health professionals are more focused today on drug therapies than on social rehabilitation. Ruth Hughes argues that the profession's "belief system" still contains "the idea that people with schizophrenia never get better." Insurance companies have been slow to be convinced that these programs work and will ultimately save money. And many employers still resist hiring the mentally ill. American Postcard's Castaldo recalls telling a fellow businessman "how well I'm doing with handicapped people." The man was interested, Castaldo relates, "but when I mentioned mental health, a wall came down."

Brenda Lee Riley, who suffers from paranoid schizophrenia, hitchhiked with her husband, who had bouts of serious depression, from Ohio to California, where he beat her and sometimes pretended to hang himself. One day he ripped out the gas wall heater and flicked his lighter. Brenda survived by diving out a second-floor window. "Fire is a weird color when you're inside it," she recalls. Years later, though burn scars cover her body, medication has controlled her mental illness and she has become a part-time "life coach" at the Village. She rents her own apartment and hopes to become a writer. "I've found that it's not necessary to have a crappy life," she says. Bobby Frazier and a lot of other consumers would agree.