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

"We are involved in these people's lives so closely, they will run you dry," says Gold, a clinical therapist who's been with ACT about a year. "Some people love the attention, and others just want us out of their business."

For about 20 years now Edward Carter has had a reputation in certain circles that rivals Darnell Anderson's. Edward (his name has been changed) often could be found hanging around the old HPD headquarters at 61 Riesner, which could be why he's been arrested so often for urinating in public.

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

"He likes the police station," Mitchell says. "He stands out front and talks to himself."

Mitchell says that coincidentally he and Edward both graduated from San Jacinto High School, several years apart. Edward has a "phenomenal" memory, Mitchell says, and occasionally the two men trade stories about the teachers they had in common. Edward likes Party on the Plaza, but the police won't let him in unaccompanied. A couple of years ago Mitchell escorted him to the Thursday-night event, which Edward calmly enjoyed.

"He's not taking his meds now," Mitchell explains, "but he's not in the hospital as much as he used to be, either. We've been able to head that off because we know him. We can predict his day-to-day behavior. We're not afraid of him like some people are."

Edward lives in a boarding house in a far-east-Houston subdivision of rotting, low-slung tract housing. The boarding house is an old single-story apartment complex, all harsh lines, craggy brick and dirty windows. Mitchell points out a drug haven a few doors down. He says he once proposed, only half jokingly, that ACT team members wear T-shirts that announce, "I Am Not a Narc."

A half-dozen anxious-looking men and women are standing next to the parking lot. Up close, a few appear to be medicated, but Mitchell seems not to recognize any ACT clients among them. He asks for Edward and is pointed that-a-way, where, on the concrete slab just outside an open doorway, a woman in a lawn chair is smoking a cigarette next to an old console television blaring the .38 Special hit "Hold On Loosely."

The woman smiles at Mitchell and hitches her thumb toward the open door. Her teeth are black nubs peeking out from pale gums, possibly a side effect associated with an older generation of antipsychotics. Drugs like haloperidol, used to treat schizophrenia, cause dental rot or, in some cases, tardive dyskinesia, involuntary spasms that can breed permanent neurological damage. Newer medications, or "atypicals," are much kinder and considered more effective, especially in older patients.

But for a drug to work, one has to take it, and Edward hasn't been taking his for about a year now. His boarding-house room is about eight feet by ten feet, space enough for twin beds, a nightstand and a small dresser. The linoleum-tiled floor emits a damp chill. Edward is laid out on a bed along the far wall, atop a loose blue sheet; his clothed body is half-covered by a tattered beige blanket. He looks to be about 50, tall, large-bellied and thick across the chest, with gray hair and an unkempt silver beard.

"How ya doing, Edward," Mitchell says.

"Well, Tom," Edward replies slowly in a voice that reverberates off the Sheetrock walls. "I just don't know why I'm so sleepy."

"Because you've been up all night," Mitchell says with gentle reproach.

"Why aren't you taking your medicine, Edward?"

"Well, Tom, I just don't think I'm mentally ill. I really don't think I am, Tom."

Mitchell visits with Edward for 20 minutes, trying to interest him, once again, in taking his medication. But Edward keeps repeating how sleepy he is. At one point, he manages to ask Mitchell about his social security check, which goes directly to the ACT team; Edward gets about $80 after the team has paid for his housing, such as it is, and a few other obligations.

Before Mitchell leaves, Edward releases a torrent of words, unintelligible except for seemingly random references to George W. Bush and Glen McCarthy, the Houston oilman who built the late Shamrock Hotel. "When he starts going like this," Mitchell says sadly, over the accelerated babble, "there's nothing you can do but wait for it to stop."

For centuries the mystery of why some minds work better than others has been so impenetrable that the public's response to mental illness has ranged from ignorance to cruelty. In the 1950s the notion was widely held that schizophrenia was caused by poor parenting. Before that theory was discredited, an entire generation of mental health professionals was fishing with the wrong bait.

The '90s were referred to as the Decade of the Brain, but science is really just learning what makes people like Edward Carter and Darnell Anderson so different. In recent years scientists have identified genes that may be linked to schizophrenia. Of the three million Americans with the disease -- about 1.5 percent of the population -- 300,000 had a parent who suffered from it, too. Mood disorders, such as major depression and bipolar disease, also "clearly run in families," according to the first ever U.S. surgeon general's report on mental illness, released in December 1999.

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