“Jamie,” a 23-year-old man struggling with Schizophrenia, Paranoid Type and Borderline Intellectual Functioning was having a particularly hard time between April 2009 and the present. In this period, he received 19 crisis services (ranging from MET calls to PEC visits), 4 inpatient hospitalizations and 2 criminal charges resulting in his arrest and time spent in jail. In addition, Jamie had two outstanding criminal warrants for his arrest dating from 2007 and 2008. We later learned that Jamie experienced recurring problems related to his misuse of prescription medications (his own and family members) and illicit drugs acquired on the street. The frequency and the unregulated manner in which, Jamie took psychiatric and other medications and street drugs interfered with medication efficacy. Complicating matters even further, Jamie’s family members also abused substances and medications making this behavior “normal” for him and leaving with little natural support to change.
In the first contact with Jamie, the observation that most struck me was his candor. He readily confided that several of his overdoses where intentional attempts to take his life. In this initial conversation, he acknowledged not having a real plan for how he would like to see his life progress and frankly, that he used drugs recreationally because, he had few alternatives or other interests he could verbalize.
The nature of Jamie’s auditory hallucinations and delusional beliefs involved violent themes with recurring threats to act violently against family members including his aging mother. Because the chemical abuse pattern was so ingrained in the family, and Jamie’s insight to the affect these behaviors had on his overall sense of happiness and well being appeared so low, the team concentrated at first on educating Jamie and family members about the role substances were playing in frequently escalating his psychiatric symptoms and the corresponding behaviors. The family itself saw little correlation between drug use and elevated levels of danger in the home. As the family was highly substance involved, there where few sources of regular income from employment. The family had become reliant on Jamie for the income associated to his SSI benefits. His mother served as Representative Payee, she managed Jamie’s finances.
The second task was getting Jamie to agree to change the status of his Rep Payee to an agency that could provide accountability and oversight to the income derived from his public benefits. Once this was accomplished, the family’s resistance to a more supportive housing placement lessened. During Jamie’s last hospitalization at KMC, he was successfully persuaded in discharge planning to transition from the only home environment he had ever known to the enhanced board and care facility where he now resides.
In November 2010, Jamie was placed in an enhanced Board and Care Home. This placement enabled him to make a fresh start. The staff at Sycamore Board and Care in Arvin assists him to take his medications consistently and regularly attend all psychiatry appointments. In conjunction with Assertive Community Treatment (ACT) staff and Jamie’s psychiatrist, Dr. Padhy, the staff at Sycamore helps him to moderate his intake of certain foods, caffeinated beverages and illicit substances that have historically exacerbated his mental health symptoms and to reduce the frequency of cigarette smoking. Jamie is also working with the ACT team to resolve his legal issues. With patience and persistence, several of his arrest warrants were lifted and he is preparing to attend court to resolve the remaining legal issues. Jamie is hopeful that reducing time spent in the hospital or in jail will open doors and present new opportunities for him to enjoy a more meaningful and productive life in the community. With increased improvement in functioning Jamie may look forward to participation in vocational or educational rehabilitation services in the near future.
Submitted by: Ruben Varela, BS/RS III MHSA-ACT, CCISC Coordinator