Monday, May 12, 2008

MH System Comes Full Circle

Mental health system comes full circle

By Ruth Sheehan, Staff Writer

Phil Wiggins' sister Louise Jordan covered her face and wept.
Sitting at a conference table on the eighth floor of a downtown Raleigh office building, Jordan was trying to convince the state that her 64-year-old brother, tormented by schizophrenia, needs more than a few dozen hours of one-on-one care every week. Representatives of the agencies trying to assist Wiggins talked about how his behavior has deteriorated as his hours of care have been cut. How he has begun eating cigarette butts, rifling through the possessions of his fellow group-home residents looking for chemicals to mix and light on fire. How the voices in his head are growing louder, more violent.

It was a compelling argument. In the end, though, it may be fruitless.
After spending his entire adult life in state psychiatric hospitals, Wiggins was released three years ago under the great promise of mental health reform. Now, because of the failings of mental health reform, he may soon be sent back.
If that sounds a bit, well, crazy, it is.

When I first met, and began writing about, Wiggins four years ago, Jordan was fighting his release from Cherry Hospital in Goldsboro. She cited his fascination with fire and chemicals, his tendency to hoard papers and flush them down the nearest commode.
But at the time, Wake County was still in the business of providing care directly to the sickest of patients. The county took Wiggins under its wing, making sure he had nearly around-the-clock care. It was costly but still less expensive than full-time hospital care.
And an amazing thing happened. For the first time in his adult life, Wiggins began surfacing from his mumbling, schizophrenic haze. He ate lunch at Ruby Tuesday's. He planted a garden. Occasionally, he cracked a joke.

Then the state forced Wake and other counties to turn the care of even their most severely mentally ill patients over to private providers.

Wiggins and other mentally ill patients found themselves bumped from agency to agency, with different firms providing different services.

Wiggins couldn't handle all the change. He spent a few months in Dorothea Dix to get stabilized.
After that, things went from bad to worse. No sooner had he returned to his group home in Zebulon than his sister learned his hours were being cut -- and cut again.
That's what led to the appeal hearing last week, and Wiggins' sister's desperate plea for more hours of care.

At the hearing, a representative of Value Options -- the state's gatekeeper, which decides, without ever seeing patients, what sort of care they need -- explained that under mental health reforms, community support is supposed to be withdrawn in increments over time.
The only problem is: A mental illness like schizophrenia does not just go away. At age 64, Wiggins will never "get better."

The Value Options representative, appropriately enough on speaker phone, suggested Wiggins be switched to a facility with a "higher level of care."

With the proper community support, Wiggins had been living a better life. It was a life unimaginable in the secure but hollow confines of a psych ward -- a life filled with bubble baths, trips to the library, coffee at Starbucks.

So what exactly is the "higher level of care" available to Wiggins after all of this?
A state psychiatric hospital. Right back where he started.

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