A daily telephone call from Jim Keethers helps Diana feel she can make it on her own. For the past seven months the 35-year-old Wheaton woman, who did not want her full name used, has lived in an apartment rented for her by Keethers, her case manager.
"He empathizes the way a friend would and doesn't treat me in a condescending manner," said Diana, who has been hospitalized at Springfield six times for manic depression.
Seven days a week, often from noon to midnight depending on the needs of his 30 clients, Keethers makes his rounds in person or by telephone. Since 1975, when he founded Independent Living Service, he has helped recently discharged patients, most of them young adults like Diana with a history of multiple hospitalizations who haven't made it in boarding homes or halfway houses.
Diana is lucky. Although Maryland officials say every person discharged from a state hospital needs a case manager, few of Montgomery County's 4,000 chronically mentally ill residents have one. The county relies on two health department employes and on often-inexperienced graduate student volunteers who work for the Mental Health Association.
For Diana and others who can afford Keethers' monthly $100 fee, case management can make a crucial difference. His services are tailored to the needs of his clients and their families. He offers practical advice, rents apartments in his own name, takes those who are desperately lonely out for a fast food dinner, helps others negotiate the bureaucratic thicket. For all he provides a sympathetic, dependable presence.
A red-haired, chain-smoking ex-seminarian with a wry, unflappable manner, Keethers puts 2,500 miles every month on his battered ice blue Chevrolet, visiting clients from Capitol Hill to Gaithersburg. He carries a wrinkled grocery bag filled with psychiatric drugs prescribed for his clients, cartons of cigarettes and money, which he doles out frequently but in small amounts.
"The one thing I don't do is baby-sit," said Keethers, 45, peering into the refrigerator in a client's apartment to make sure he has food. "What I am is like a coach or adviser. I let people make their own decisions and they have to live by them. Let's say they and I agree they can handle their money. If they run out the second or third day, they'll just have to do without. Of course I wouldn't let anyone starve."
Keethers operates alone, relying primarily on instinct. He largely ignores hospital discharge summaries -- "they don't arrive for six weeks anyway" -- and the innumerable meetings to discuss the needs of the mentally ill, which he dismisses as "a lot of people sitting around . . . listening to how smart they sound to others."
Hospital and community workers say he is unique and usually successful. Diana credits Keethers and social worker Liz Farrell, who runs weekend recreational groups for ex-patients, with her success in staying out of the hospital.
Last August, after Diana had been discharged following four months at Springfield, Keethers convinced Diana's reluctant mother to let her live at home temporarily until he found an apartment. His name is on the lease but Diana pays the $418 monthly rent. Because she had never lived alone, Keethers met with Diana frequently before she moved in to help her devise a budget.
Now that she is settled and doing well, he stops by occasionally and talks to her daily. "Diana benefits most from talking," he said. "She needs a pat on the back."
She is taking medication, sees a therapist every two weeks, has completed a secretarial course and recently started a volunteer job.
Diana, a large, articulate woman, was forced to drop out of college at 19 when she first got sick. She was married briefly to an ex-patient who beat her. She tried two halfway houses but was kicked out because she was messy and couldn't tolerate the regimen. Hospitalization made her feel worthless, but she was afraid of being out because she feared rejection from the "normal" people whose approval she craves.
As an ex-seminarian, Keethers says he understands the difficulty of adjusting to the world outside an institutiton. "The worst placement in the community is better than the best hospital," he said. "I figure as long as they stay out of the hospital, there's always a chance they'll take that next step."