Hands On

When the sickest of Harris County's mentally ill break down, an ACT team is there to pick up the pieces and put them back together again

Tom Mitchell started learning what it was like to live with mental illness almost 30 years ago, after he returned from Vietnam.

At the time, the public mental health system was, in effect, going public: People who had been shut away in state hospitals were being encouraged, sometimes forced, to live among the rest of us. To ease the transition, federally funded treatment centers opened around the country, offering medication, housing, job training and psychotherapy. An incorrigible idealist, Mitchell was pursuing a sociology degree while working for the phone company when he quit his job and, at half the pay, went to work for the Mental Health and Mental Retardation Authority of Harris County.

In 1973 Mitchell was pulling graveyard shifts at Terry Hall, a residential halfway house in Montrose, where he met a young man with schizophrenia named Darnell Anderson. The hope for Darnell and others like him was that with medication and a little guidance, they could control the symptoms of their disease -- the voices, hallucinations and paranoia -- and, someday, be able to care for themselves.

Director Tom Mitchell worries that ACT could be privatized.
Deron Neblett
Director Tom Mitchell worries that ACT could be privatized.

No one knew yet that such a humble wish was itself a delusion.

Darnell was raised poor in the West End. But by age 20, his frame of reference in life had become Rusk State Hospital, where nothing asked is nothing gained. Darnell built his reputation at Terry Hall around a question, "Will you do me one small favor?" His needs were rarely unreasonable -- a pair of shoes, a ride someplace, "soda water" or a bag of chips. But until Darnell got what he wanted, his requests would escalate into relentless demands. If they could, other people, even some of the Terry Hall staff, avoided him.

On the late shift, Tom Mitchell often found himself alone with Darnell. After midnight, while others slept, Darnell seemed more tranquil and lucid. He told funny stories about his family and his life before it was devastated by the chemical imbalance in his brain.

In the three decades since they first became acquainted, Mitchell and Darnell have traveled separate but parallel roads through the public mental health system. Mitchell got a master's degree and became a licensed social worker. He made his way up the clinical ranks at MHMRA of Harris County until 1987, when he left to become director of community-support programs at the Tri-County mental health authority in Conroe. Mitchell ran Tri-County's Fairweather Lodge, which helped groups of mentally ill people set up a home together. They cared for each other and supported themselves by developing a small business, such as a janitorial service.

Harris County had its own Fairweather Lodge, but it wasn't much help to Darnell. Darnell, it seemed, couldn't be relied upon to take his medication or, on the other hand, not to ingest a week's worth of the drugs at once. More often than not, Darnell was in Rusk State Hospital or the Harris County Psychiatric Center.

Sometimes he was off his meds and psychotic. Sometimes he was just being Darnell, in need of a favor.

"Darnell's job is to be Darnell," Tom Mitchell says. It's mid-morning on a weekday in January. The city is veiled in a storm-driven gloom. Pelting rain and a cold wind slap Mitchell's sport utility vehicle as he exits U.S. 59 in north Houston.

"When people have been as sick as Darnell has," he says, "for as long as he has, and with the system the way it is, he just considers it his job to be Darnell. It's his purpose."

Mitchell pulls into a strip mall on Stuebner-Airline and parks in front of a sign that reads, "The Caring Place Adult Daycare and Beauty Salon." He double-times it through a steady downpour and goes inside.

A wiry 53-year-old Houston native with a trim, graying beard and hair the color of wet sand, Mitchell returned to MHMRA of Harris County in 1993 to help the agency launch something called Assertive Community Treatment. ACT was developed in the early 1970s, but it took 20 years before anyone outside Wisconsin and Michigan really tried it. Texas adopted it earlier than most states and, in 1996, made ACT mandatory at all county and local mental health agencies.

There are two types of patients in the public mental health system: those who use the clinics, and those who use the hospitals. The two groups are almost mutually exclusive; people who use the clinics avoid the hospital. They also tend to have fuller and more stable lives. ACT addresses what science and advocacy have long understood but most everyone else ignores: Public mental health clinics can do little for some people who suffer chronically from illnesses like schizophrenia and bipolar disease.

To make it on their own, these patients need unfettered access to medical care, as well as the full range of social-welfare services. Without constant support, the worst symptoms of their diseases return, and they start showing up regularly in emergency rooms, or are admitted to the hospital over and over again for anywhere from a few days to a few years. It's also true that most homeless people and, according to the U.S. Department of Justice, at least 16 percent of the nation's prison population have a serious mental illness.

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