House calls let ill stay home Mental health: Visits by traveling nurse and counselor do more than check progress they keep some patients home, instead of in institutions.

September 05, 1996|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

Prowling the West Baltimore streets in a gray van, jazz purring on the radio, the two young men double-check their equipment: a cellular phone, a patient roster and a medical kit loaded with pills, liquid drugs and syringes.

They visit the mentally ill who are too depressed to get out of bed, too paranoid to leave their homes and too ill to take medication or get to a clinic.

Call it a mental health house call.

The traveling nurse and counselor, part of Liberty Health Systems, are like other health-care providers who must find ways to reach those who won't come to them. The University of Maryland Medical System and Johns Hopkins Hospital each have similar programs for the mentally ill, and experts say the approach is spreading across the country, from South Carolina to Michigan. New Jersey recently launched a $12.5 million statewide initiative to reach 1,700 patients.

In tough Baltimore neighborhoods, Liberty's team encounters threatening teen-agers who suspect the two are undercover police. They've chased reluctant patients through back yards. Once, they say, they negotiated with a drug dealer for the life of a patient who owed him money.

But this pair's territory is mostly inside rowhouses and apartments, among people struggling against internal voices and a heavy sensation that they have no control.

"How've you been feeling? Has the TV been talking to you?" asked Ron Jones, a registered nurse for Liberty Mobile Outpatient Services, cozying up to Millard Jenkins, 53. In the cool shade of the porch, Jones studied his eyes.

Jenkins, a schizophrenic who was once an accomplished songwriter, stared back blankly and gave a short answer. Jones sighed and patted Jenkins' leg. "I can look at my people, their expressions. I can tell if they're not feeling well."

He sometimes runs away from Jones and counselor Weldon Christopher, so they make surprise visits. This time, he let them in the front door and talked about the songs he wrote as if they were new releases.

"I'll Be By Your Side" and "You Are My Heart and Soul," he promised, are coming out this fall.

The patients' conditions include severe depression, bipolar disorder and schizophrenia, so progress can be erratic and slow.

But the reward is knowing that, without their help, Jenkins and many others would probably be institutionalized, Christopher said. Experts who have evaluated mobile treatment have found it keeps people from becoming homeless and out of hospitals, institutions and jail.

Nationally, the idea is being promoted as a model, said Neal Brown, director of community support programs for the Center for Mental Health Services, a part of the U.S. Department of Health and Human Services. The concept was born from frustration, as physicians watched the same patients go in and out of hospitals.

"We decided we needed to do something about this by going out into the community and seeing these people on their own turf," said Dr. Annelle Primm, director of the community psychiatry program at Johns Hopkins Hospital. She said the typical cost of mobile care is about $7,000, compared to $100,000 a year in an institution.

Liberty's mobile team ends up managing more than mental illness. Many patients, seeking relief, have become alcoholics or drug addicts and need referrals for treatment. The team also helps with housing and even buys and installs new locks to make people feel safer.

Just having someone stop in, though, means the most to the patients.

On one recent visit to a high-rise for the elderly, Jones settled down on a flowered couch next to one longtime patient, Frances Haywood. He scrutinized a row of her pill bottles. The 68-year-old woman, who has schizophrenia and is an alcoholic, had stopped taking her medication, including some for high blood pressure.

"Frances," he said disapprovingly, "we need to get you an appointment for this. When was the last time you took all of these?"

Sheepishly, she shrugged. "I felt so good, I just figured I could go it on my own. I know it's not right."

In general, half of the people given prescriptions fail to take their medicine correctly, said Dr. Orlando Davis, the psychiatrist who oversees the care of 38 patients in Liberty's program. The West Baltimore hospital has four managed care sites and other services.

Among the mentally ill, missed doses can be especially troublesome because the effectiveness of many of their medications depends on constant levels in the body. Some, like Jenkins, are given shots during the visits to eliminate the need for pills.

The house calls also enable health workers to spot developing problems. At Haywood's, Jones promised that he and his partner will return with a pill box to organize her medicines. He even noticed and checked a mosquito bite on her neck.

"It lets you know somebody cares," Haywood said, following the team down the elevator and watching them go out the door. "And that you're not alone."

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