What makes Sammy run?

Huge and helpless, schizophrenic and hypertensive, Sammy Allen has fallen between the administrative cracks of a local mental health system that can't seem to get its ACT together

Sammy Allen stands meekly and hopefully outside the screen door of his family's house in South Dallas, calling out, "Daddy! Daddy! It's Sammy, Daddy!" Sammy's 11-year-old nephew comes to the door. "Hey, it's Sammy Tee," he tells the boy, trying to come across as a treasured relative, one who sets nieces and nephews to jumping up and down and squealing "Uncle Sammy's here!" But Sammy's nephew just ignores him, unlocking the door and walking away to get his grandfather, Sammy's father.

Sammy is allowed to come in only a few feet past the front door, his father mindful of his son's 26-year documented history of being tear-gassed by police on the house's front stoop, setting fires in the home, and threatening murder. Twenty-six years of Sammy accusing his father of trying to kill him and steal his money. Twenty-six years of Sammy phoning from prisons and psychiatric emergency rooms demanding and begging his family to take him back.

Sammy and his father exchange a few words, and then his father hands him the mail that he's come to pick up. Time for Sammy to leave.

Two weeks later, at the end of April, Sammy Allen is being thrown out of his latest boarding home. Members of the Dallas Mental Health and Mental Retardation Assertive Community Treatment team (ACT), a specialized unit that provides intensive outpatient care for the mentally ill, take him to a room at the Flora Motel, located just off Fort Worth Avenue, in an area lined with $80-a-week motels whose lobbies feature "No Prostitution" signs, the kind of places where guests must leave an ID at the front desk.

"I'm on my own. I don't have anything now. I'm on my own," Sammy says, repeating "I'm on my own now" over and over until he non sequiturs into a story about chains and handcuffs and mistreatment in the county jail, an incident from many years ago.

Sammy claims that he called every number in his "Patient Rights" book in an effort to report the ACT team for neglect, but couldn't get hold of anyone. He adds that he went to MHMR's Westmoreland Clinic in Oak Cliff, but that they just gave him an injection of the anti-psychotic drug Haldol and a ride back to the motel. The next night, he says, he called an ambulance, begging to be taken to Parkland Memorial Hospital's psychiatric emergency room.

He's stuttering badly now. He thinks people are coming to get him: "I'm tensed up. I'm scared to death. I'm not safe out here. I need to be in a protected environment." He says that he's lonely and hungry, that he needs to be taken care of, that he's a cripple. "Please have pity on me," he pleads desperately with equal parts demand and complaint, a telling one-line summary of the way in which Allen has related to the world for the past 26 years.

Now 48 years old, Samuel Tunson Allen Jr.--a 355-pound black man hobbled by degenerative joint disease of the knees, suffering from hypertension and incontinence, wearing someone else's prescription eyeglasses--has been intimately and regularly involved with the local mental health system since 1971, existing almost exclusively under some sort of case management. He's been in and out of state psychiatric facilities that serve Dallas County 46 separate times, 41 of those under an involuntary court order. In 1996 alone, he had 18 separate admissions to either a psychiatric emergency room or a psychiatric intensive care unit.

His most recent "presumptive" diagnosis is schizoaffective disorder bipolar type, which is, according to Starla Harrison, who serves as a psychiatric nurse for the ACT team, "a combination of both schizophrenia, which is more straightly delusional and includes hallucinations, and a mood disorder. People who have schizoaffective disorder, if they're not treated, have psychotic symptoms all the time, in addition to these mood swings that go up from mania all the way down to depression."

Allen also has been diagnosed with "personality disorder not otherwise specified," a combination of elements of several personality disorders; these include antisocial (primarily a lack of conscience), narcissistic (lack of empathy for others), and dependent (excessive need to be taken care of) personalities.

Sammy Allen represents a nagging problem that has vexed the mental health system since the nationwide advent of deinstitutionalization some 35 years ago, when patients were gradually moved out of psychiatric hospitals and into supported housing in the community. He is the chronic mentally ill recidivist who's not psychotic enough to remain in a state hospital; who hasn't done anything that would justify locking him up in a prison or a psychiatric hospital for any significant length of time; and who can't or doesn't choose to function well in the community.

His family support is extremely limited, and economic constraints keep him in substandard housing. His attitude and behavior sabotage most of his rehabilitation opportunities, and caregivers question whether he is really mentally ill, suggesting that he's merely an antisocial malingerer taking advantage of the system.

ACT is the agency within MHMR that deals with the estimated 600 people in Dallas County who fit Sammy Allen's profile. A 1996 fiscal study done by the local ACT team on its own program states, "The effectiveness of a program can be evaluated by the reduction of crisis services and hospitalization [for a consumer]." The most recent data available from Texas Mental Health and Mental Retardation (TXMHMR) indicates that one year before being serviced by the Dallas County ACT team, a consumer (industry lingo for "patient" or "client") had an annual average of 33 days in a state hospital; after a year in ACT, that average dropped to 10 days.

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