Getting Out

Too scared to leave her house, Sandy has one last chance: a county crisis team that will come to her

The sisters, seven and eight, are on the floor of the trailer, the newspaper spread before them. They've got their eyes out for roaches.

Grandpa is sitting quietly at the nearby table while Grandma prepares the meal. She sets Grandpa's plate on the table, then turns back to the girls' plates. She mixes the food together in one big clump and puts the plates down on the newspaper.

Sandy and Jennifer (not their real names) look at each other. Who's gonna get it this time? they think. Please don't let it be me.

Sandy and Jennifer were made to eat on the floor like 
Sandy and Jennifer were made to eat on the floor like dogs.
Without consistent care, clients lose track of their 
Without consistent care, clients lose track of their meds.

By the time Grandma reaches the table, the girls are devouring the food. They've got to eat fast. For some reason, Jennifer usually does better. She can handle eating that much that fast, as proved by her pudgy frame. She eats so well that Grandma makes her eat everyone's leftovers but Sandy's.

Sandy, she can hardly eat. During meals, she sometimes breaks out in hives. The food makes her nervous, eating fast makes her nervous, the roaches scurrying across the newspaper make her nervous. It's too much for her tiny stomach; the kid is skin and bones to start with.

Sandy looks at her sister, watches her lift a spoonful of mush to her lips, force it in her mouth, swallow and reach down for a refill.

It's all too much. Sandy begins to gag. Grandma hears the retching sound, turns to look. Sandy vomits onto her plate.

Grandma won't have this. She slides her chair back, stands up and walks to Sandy.

"Eat it," she says.

Sandy looks at the mess on her plate, to Jennifer, then back up to Grandma.

The other night, Sandy blamed God for making her have to eat.

She opens her mouth and closes her eyes.

When she opens them, 20-some years later, she fixes them to the TV. On the screen, a judge is banging her gavel and restoring order to the court. Sandy is in her favorite chair, wrapped in a blanket. This is how it is, day in, day out. Her children go to school, come home, play with the few toys she could afford to buy. Her boyfriend works, drinks, hits her, sleeps.

She figures it's safer inside. Outside are the What Ifs. The What Ifs will get you. Like this thing she saw on the news. A woman driving her car got creamed by a chunk of concrete falling from an overpass. So Sandy doesn't drive. Because what if? You never know -- you're just driving along, and the next thing you know, you have no head.

She doesn't leave the house, which is the way her boyfriend and mother want it anyway. There's no way she can seek help. So she's stayed inside for two years. She doesn't eat, because maybe one day she'll just disappear.

And then, she sees this thing on the news. A mother suffocates her child. The broadcasters mention something called the Harris County Mental Health and Mental Retardation Authority. She calls the number and tells the voice on the other end that she wants help, but there's no way she can leave her house.

It's okay, the voice says. We can come to you.

And in the office of Houston's new Mobile Crisis Outreach Team (MCOT), Sandy's name is written in black marker on a dry-erase board, right by 40 others.

The names on the board are a chart of color-coded tragedy.

Members of the city's year-old crisis outreach team sit facing the board, as Dr. Tracie Dejarnette-Holly runs through the patients' statuses: There's the 16-year-old boy with a six-month-old baby whose parents found the teen hanging, still alive. There's the man who grieves for his dead wife and kids, though they never existed. There's the young woman who's been suicidal ever since surgeons removed her brain tumor.

The team's nerve center is a relatively small office space on the first floor of the NeuroPsychiatric Center (NPC), next to Ben Taub Hospital. It's an extremely dull-looking room. The eye can't help but gloss over the smattering of desks and file cabinets and go straight to the names on the wall.

These are the people you hear about when someone says "they fell through the cracks." Except that's not really true. If they truly fell through the cracks, they'd disappear, and they wouldn't stumble into emergency rooms at 2 a.m. screaming about invisible demons trying to butcher them. Taxpayers wouldn't have to cover their jail time and hospital stays.

That's where the mobile crisis team comes in, thanks to a $1.9 million grant from Harris County Commissioners Court. The first of its kind in Texas, the team links the mentally ill and substance abusers to clinics, counseling and residential facilities. The idea is that a little money spent up front will save a fortune in the future.

The approach is similar to MHMRA's Assertive Community Treatment program, but cranked up to hyperspeed. Developed in the 1990s, ACT provides long-term outpatient care for the mentally ill. The program is still successful; it was just never designed for crisis care. The program is also bound by MHMRA regulations to work only with people diagnosed with schizophrenia, schizoaffective disorder, major depression and bipolar disorder.

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