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

Mitchell poked around the city's neighborhoods for eight hours one night, looking for a place that would take Darnell. "A lot of these places knew him, and they about slammed the door in my face," recalls Mitchell, who reports the seedier personal-care homes to the state health department. He has succeeded in having several shut down, but unfortunately, he says, most of them just move to another part of town under a new name.

"We try to make sure they're at least semiclean, but it's getting harder and harder," Mitchell says. "The nicer ones are getting to be expensive, and most of our clients only get about $500 a month in social security."

Rusk State Hospital and the Harris County Psychiatric Center are sanctuaries for the mentally ill -- clean surroundings, a bed, three meals a day. And patients usually find the company more to their liking. "When he felt like he was alone and just hanging out there, that's when Darnell would start calling the hospitals," Mitchell says. "We've tried to transfer that dependence onto us."

Before ACT's involvement, Darnell Anderson spent as many as 300 days a year in mental hospitals.
Deron Neblett
Before ACT's involvement, Darnell Anderson spent as many as 300 days a year in mental hospitals.

By any standard, they've succeeded. Darnell can't drive or navigate public transportation. So for much of his tenure in the program, ACT team members have had to visit Darnell daily, sometimes twice daily, to personally hand him his medications -- making sure he doesn't "cheek" the pills -- and to chauffeur him to doctor's appointments and weekly therapy sessions.

Darnell has lived at more than a dozen locations in the last five years, from his brother's camper parked in the West End to boarding-house rooms so small they hardly contained him. About six months ago the ACT team was able to move Darnell into a good personal-care home. The owner has agreed to make sure he takes his medication every day and to provide transportation to and from the day program.

That arrangement has worked out well: Someone from ACT (it's often Tom Mitchell) visits Darnell only once or twice a week now, and he never misses his group sessions. But most important, Darnell has been admitted to the hospital just once in the last two years. For the first time since he was a child, perhaps, he has a relatively stable life -- for now, anyway.

"Medication makes me feel good," Darnell says in a smooth basso growl. "Without it, I feel lousy -- lousiest in the world. Like 16 dump trucks lettin' out sand."

Darnell is seated at a card table, across from Mitchell. He reaches back and pulls a battered brown cowhide billfold from his pocket. At times, it appears that Darnell is doing all he can to keep his heavily featured face from sliding off his head -- an unfortunate side effect of his medication. His eyes are downcast, under heavy lids. His cheeks sag, and his mouth is slack and thick-tongued. But Darnell loves company, and clearly he likes to talk. Typically, he doesn't wait long for an invitation.

"My mama's dead, my daddy's in a wheelchair, and my brother don't have good sense," he announces. "I was born in Jeff Davis Hospital, five pounds, 11 ounces. I went to Doris Miller Elementary, R.G. Lockett Junior High School. I was in special education, because I was a slow learner. Old J. Will Jones High School, at Holman and Chenevert."

As he speaks, Darnell is constructing, from the contents of his wallet, a small mountain of haphazardly folded and wadded pieces of paper. "All the places I been," he explains. The skin around the rocklike knuckles of Darnell's enormous hands is cracked from dryness. He pulls out an official State of Texas ID card, then carefully unravels what turns out to be a sulfate warning from a hospital cafeteria. Next, a receipt from yesterday's visit to the emergency room. It says Darnell had come in complaining of athlete's foot; the attending physician had added, in parentheses, the abbreviation "schizo."

"You've got to stop doing that," Mitchell says.

"I don't do that too much," Darnell replies. "I been to Rusk 34 times, been to HCPC too many times. I want to stay out of those places. They experiment on me."

ACT is often called a "hospital without walls," which explains why someone like Darnell responds so well to it. But many people with mental illness have scrupulously avoided the public mental health system for years, and they see no reason to change just because someone -- a psychiatrist, a social worker, a judge -- has put an ACT team on their case.

Right now Harris County's ACT clients are all present and accounted for -- if not all completely on board -- but this could change at any time. It's not unusual for them to disappear. "Then," Mitchell says, "we have to be detectives." Team members check with family, if there is one. They canvass hospitals and homeless shelters and log on to the Justice Information Management System, a criminal courts database.

Sometimes they get outside help. ACT clients, who are given special identification cards, have turned up at a Washington state hospital and in the protective custody of police in Boston. A few years ago Mitchell received a phone call from McAllen -- an ACT client had stripped off her clothes and climbed onto the hood of an 18-wheeler on the Mexican border.

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