Allowing the Mentally Ill a Life of Their Own

Supporters Say Patients Prosper and State Reduces Hospital Beds in Strictly Supervised Program

Rafael Rivera sat comfortably in his neat, modest apartment off Route 1, talking to his caseworker, Carlos Estrada. Seated nearby was Parnell Cornet, a psychiatrist.

"So we're going to get you a job in the coming months, right? Looks like you're almost ready to work again," Estrada said, looking around the apartment.

Rivera nodded and replied in Spanish that he was ready. He had just moved in to the apartment, and he was eager, at 56, to start a new life.

"Well, we're going to do everything we can to make that happen," Estrada said. "It's up to you."

Rivera has lived with bipolar disorder and other mental illnesses for nearly 40 years. He was in a state institution for several weeks, hoping to recover from the debilitating confusion and illness that prevented him from taking care of himself. He had been left by a longtime companion to fend for himself in the fall, Estrada said, and soon a friend had Rivera taken to a hospital.

The daily one-on-one contact by Estrada and Cornet is part of an intensive program to help the severely mentally ill such as Rivera live on their own. The state-funded Program of Assertive Community Treatment seeks to move those with serious and persistent mental illnesses back into their communities and support them with round-the-clock services to help them be self-sufficient.

"The doctors in the hospital, they wanted to control me," Rivera said in Spanish with Estrada translating. Living outside, he said, allows him to "look for a future."

The PACT program was developed in Wisconsin 35 years ago and is considered one of the most effective ways to help those with significant mental ailments live outside of hospitals and within the broader society. Many mental health experts consider the program the next chapter in the decades-long effort to move people with mental illness out of institutional settings by giving them the structure they need. Supporters often call the programs "hospitals without walls."

"It gives people who have these illnesses a chance to live [with] some kind of normalcy," Estrada said, as he left Rivera's apartment. "We give them the opportunity to control their own life. We're just here to help."

Many of the participants in the program include people who have frequent episodes of very severe symptoms that are difficult to manage or who suffer from symptoms that never go away.

Their condition means they often have spent extensive time in hospitals or living on the streets. They often have abused drugs or alcohol or have been in trouble with the law.

State records show that about 77 percent of state clients in the 16 PACT programs throughout Virginia have schizophrenia. The majority have come from state hospitals after an average five-year stay.