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Psychiatry Newsletter - Whatever It Takes
Whatever It Takes
Date: March 11, 2009
Creative Alternatives refuses to let illness define patients.
There’s a groundedness about Quentin Fisher that’s disarming, a quiet certainty about where his life is going that would be uncommon even outside of a place set up for some of a city’s sickest patients.
The Baltimore man wouldn’t hesitate to say that he’s centered, in large part, from his connection with Creative Alternatives, a program that, for 14 years, has wrapped around people with enduring mental illness, resolutely blanketing them with support until their lives improve.
The Hopkins program defies the usual approaches nationwide.
Fisher had been living with a foster family when his schizophrenia led to a five-year stay at Spring Grove state psychiatric hospital. He grew better under therapy and the constancy of medication; his illness was attended to. “But I didn’t have anything to hope for,” says Fisher; “they weren’t so interested in where my life was going. I wanted to work. And I wanted to do something.”
When he’d improved enough for discharge, a Creative Alternatives interviewer laid out the benefits of coming to their voluntary program, which now serves 175 “members” from Baltimore city. “Creative Alternatives is based on hope,” says Program Manager Sheila Goldscheider, R.N. As its name implies, CA offers a change from the constant cycle of hospital visits, returns to psychiatric institutions, being on the street or in jail that often dogs those with persistent schizophrenia, bipolar disorder or unrelenting major depression.
“We’re the proverbial one-stop shopping,” Goldscheider explains. When Fisher first came to CA in 2006, for example, a personal service coordinator sat him down: What do you want to do with your life? Then she and other staff united as Team Fisher, working with the 42-year-old to lay paths to his goal: to live independently and have a job.
CA has a Hopkins psychiatrist and psychotherapist to keep Fisher and other members on an even keel, medically. There’s substance abuse therapy. A housing coordinator aims for the best fit between living quarters and personal need. An entitlement coordinator helps members with Social Security, medical assistance and such. The community integration person engineers ways to let members grow roots, arranging shared dinners or TV evenings, for example, if they live close to each other. Other staff teach life skills: getting along, shopping, cooking, keeping house, sticking to a budget. CA once set up a tab for a member at a lunch counter in Fells Point and got him a subscription to a nearby community theater. “We have fun,” says Fisher.
“We try to be ‘real world,’” Goldscheider says. “And we do whatever it takes.”
As for Fisher, his self-esteem shot up after he took and passed a community college course in real estate. Then CA’s employment staff helped him find and hold a job. Currently, some 17 percent of members work—good stats for that population.
CA began in 1993 as a demo project within Hopkins Community Psychiatry program at Bayview, a response to a request from the state of Maryland for capitated services for the slip-through-the-cracks group. It hasn’t disappointed. “In addition to meeting our goals to turn peoples’ lives around,” Goldscheider adds, “we’ve saved the state money hand over fist.” State hospitals are hugely expensive to run.
A required independent review each year gives CA highest marks. Do more members live independently? Are they content? Are hospitalizations down? Success comes from the relationships built with members, Goldscheider says. “We often see if things are wrong before they can themselves. We become family.” Fisher says it best: “I’ve been helped every moment I’ve been here.”
For information: 410-631-6021.