New program strives to keep mentally ill teens out of institutional pipeline

Albert Garcia's first psychotic break was bizarre — he awoke from a night of drinking and meth use 10 years ago to hear angry voices coming from people on the other side of a living room mirror — but it gives him credibility as he counsels others with severe mental illness.

"I can see it. I can feel it," said Garcia, 57. "I can actually feel the kind of fear they are going through."

Garcia is the most unorthodox member of a project created to help Twin Cities teens struggling with severe mental illness. The idea is to bring a team of professionals such as psychiatric nurses and drug counselors to teens' doorsteps, but also to connect them with "peer support" specialists such as Garcia who can relate to their struggles.

At a time when most counties in Minnesota suffer chronic shortages of mental health services and long waiting lists at residential psychiatric facilities, the goal of Assertive Community Treatment, or ACT, is to intervene early and keep teens from needing institutional care.

"This is really to see if we can catch those young people before they are inundated with the system, before they are in state mental health hospitals or … incarcerated," said Diane Ferreira, ACT program manager for People Incorporated, which is running one of four Minnesota teams formed to help young patients.

The ACT team approach has been used nationally to keep mentally ill adults from needing institutional care, or to expedite their moves out of institutions by giving them support back home. The latest Minnesota data show adults spending 60 percent less time in institutions the year after they receive ACT support compared with the year before.

"It isn't passive — someone saying 'I think I'll go see my social worker today.' It's the social worker going out to see them," said Sue Abderholden, executive director of the Minnesota chapter of the National Alliance on Mental Illness. "In a sense, it's a one-stop shop — but the shop is coming out to you."

People Incorporated got state approval to form a youth ACT team after lawmakers voted in 2011 to allow public programs such as Medical Assistance to pay for it. A similar team for youth in Ramsey and Dakota counties has been formed by Guild Inc., and two other agencies have created teams in northeast and southeast Minnesota. Youths served by ACT are supposed to receive at least three weekly visits from treatment team members — with half being outside any office or clinic — and 24-hour access to crisis services.

Garcia was raised by an abusive father, who made him work as young as age 7 in the back of his open-top garbage truck, until he left home at 17.

Looking back, he says, he suffered depression but didn't recognize mental health problems until he was in his 40s — after a long history of failed relationships and drug abuse.

When the voices emerged, he was frightened by their tone and intensity — and the warnings that someone was coming to kill him. Drinking and meth use, he says, helped him escape.

He was diagnosed with schizophrenia, which qualified him for disability payments that bought him time to stay with friends or relatives. But when money ran out, he often found himself on the streets and sleeping under bridges — fearing that the killer his voices warned him about was around each corner.

"Walking the street at night, my feet hurting, too scared to sit down anywhere because I was feeling that anxiety, that fear, I can't even express today what that was like," he said. "But knowing how I came to my recovery, they will ask me and they will pick up some coping skills for themselves."

Medical research is still emerging about the effectiveness of peer support. But a federally funded review, published just this February, found that the empathy of people who could say they have "been there" appeared at least as effective as peer support when it was added on to existing clinical programs such as ACT teams.

Minnesota law now requires that a youth ACT team include a peer support specialist who has completed certification training. They can make a big impression on teens whose mental illnesses are compounded by their lack of maturity and coping skills, said Glenace Edwall, director of children's mental health for the Minnesota Department of Human Services.

"The combination of having the similar life experience, but then being a little farther ahead developmentally, really provides a nice way to support youth," she said.

At 57, Garcia is more than "a little" ahead of the teens he will be helping. Through People Inc., he has already been providing peer support to homeless adults — particularly those who hear voices. With kids, he expects he will need to listen more and pick his spots to talk.

After completing treatment for drug abuse, Garcia eventually stopped taking prescription antipsychotics — against doctors' orders — because he believed they were worsening certain symptoms. He won't recommend that for others.

Without medications, Garcia says, his voices grew stronger and louder. But over four years, he discovered that their threats weren't coming true. He still hears the voices, but has learned over time how to control them and ignore what they are telling him.

"My voices were always trying to kill me," he said. "After four years, nothing happened to me. So I figured, you know what, this is not real. The scary part was trying to be able to not feel that fear, because it just did not go away."