Getting Out

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

MCOT is not restricted to these specific diagnoses. And since the team is funded by the county and not billing Medicaid, they can spend as much time as necessary with a client. Still, staffers try to close cases within one to three months.

Team director Tom Mitchell was the head of ACT for seven years. He and other ACT staffers made the jump to the new crisis team last February.

"Part of it was just [I was] ready for a change," Mitchell says. "I've been in the system 26 years. Things go through cycles, and we're in one of our low ebbs now, as far as community services, because of all the cutbacks. And this seemed to be the way, I thought, [to] have the greatest impact on as many people as possible."

Sandy chose a movie about a woman in an insane 
Sandy chose a movie about a woman in an insane asylum.

Simply put, the difference between MCOT and ACT is, in Mitchell's words: "It's more of a marines-on-the-beach type [of] mentality as opposed to the troops in Iraq, who are there for long hauls."

According to MHMRA, 80 of the crisis team's first 100 clients were linked to outpatient services and four were admitted to the Harris County Psychiatric Center. Sixteen either refused service, were jailed or just disappeared.

MHMRA estimates that 55 of those clients would have been hospitalized or jailed, at a cost of $2.3 million a year. If those numbers are accurate, the county has saved about $400,000, after subtracting MCOT's budget.

Other states implemented this approach years ago.

California's state-funded mobile crisis units cover about two-thirds of the state's population, according to Dr. Steve Mayberg, director of the California Department of Mental Health. While some units were created 15 years ago, that state only recently formed units to deal exclusively with the homeless mentally ill.

In 1999, the year California's homeless mentally ill program started, crisis teams oversaw 4,900 people, according to a department spokesperson. In four years, psychiatric hospitalization of that group dropped 56 percent, incarceration dropped 72 percent, and the number of days spent homeless dropped 67 percent.

Moreover, the number of days of full-time employment increased by 65 percent, and the number of days of part-time employment increased 53 percent.

Wisconsin, which has mobile units in 34 counties, has seen a 20 to 30 percent reduction in hospitalization in the 15 years since its program started, according to George Hulick, clinical consultant for the Wisconsin Bureau of Community Mental Health.

Dr. Hunter McQuistion, chief medical officer for New York City's Division of Mental Hygiene, has no hard numbers, but says his city's 20-odd mobile units have considerably cut down emergency hospitalizations and jail time.

And now, in Houston, the team's 20-person staff of doctors, social workers, psych techs and nurses covers the entire county, 40 people at a time. (As of January, the team's staff expanded to 28 and their caseload grew to 60.) They work in shifts from 7 a.m. to 11 p.m. during the week and from 9 a.m. to 9 p.m. on the weekends. Clients come through the hot line and via referrals from law enforcement, family members, schools, apartment managers, hospitals and homeless shelters. They never run out of names. As soon as one is erased, there's another to take its place.

Psychiatrist Dejarnette-Holly, whom everyone calls Dr. D.J., is the team's medical director. Tall in heels, bespectacled and solemn-faced, Dr. D.J. is the consummate professional. She's seldom solving fewer than five problems at once. She can maintain the same unfettered expression whether she's driving a manic, babbling client in one of the team's white vans, taking a crisis call on the hot line, or ordering a Whopper.

Dr. D.J. leads the staff through the daily afternoon rounds, the only time all the staffers are in the office together.

Today, she brings up Mark and Warren (not their real names), two men who are at the Star of Hope men's shelter, who were MIA yesterday, Wednesday, when staffers conduct assessments there. Mark is back and has taken a turn for the worse -- he's talking to Satan. This is what is called decompensation, the process of retreating from reality.

Warren turned up at the Star of Hope late last night, after the staffers left, on a tip from R&B singer Luther Vandross. Warren's out a lot of money from a barbershop burglary, and Vandross advised him the culprits were at the shelter. Warren disrupted a church service in his quest for the missing cash, insisting there'd be hell to pay when Vandross showed up.

Dr. D.J. also says to keep an ear out for the elusive Voodoo Man, who's been calling the police complaining about the misalignment of his neck. Unbeknownst to Dr. D.J., Voodoo Man called MCOT the previous night, hanging up before giving his name or location. All he could say was that his neck was "to the left," and he suspected an ex-girlfriend of dabbling in black magic. Helping him may be as difficult as helping the man who called the hot line expressing paranoid delusions of people in white vans coming to get him. How, then, to drive a white crisis van to that guy's house?

By 3:30, rounds are over, and the office is mostly empty. None of the staff likes to be inside. Paperwork is saved for the end of the shift. The real work is conducted outside, face to face.

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