By Jim Schutze
By Rachel Watts
By Lauren Drewes Daniels
By Anna Merlan
By Lee Escobedo
"Every time one of these consumers is positively impacted by this team...the community (city, county, and state) is saving significant tax dollars," states an ACT team report. "We know that ACT is effective because of the reduced hospital stays and quality-of-life indicators," contends Melody Olsen, coordinator of ACT/supported housing for TXMHMR.
However, according to Sue Burek, who collects and analyzes data on ACT teams across the state for TXMHMR, the only data that actually exists right now to judge the effectiveness of Dallas County ACT is the team's ability to keep people out of state hospitals.
Part of the outpatient care ACT provides is described in the agency's literature on specific job tasks for its case managers: "Actively reaches out to each assigned consumer to establish a relationship...provides advocacy which is sensitive to bureaucratic barriers...supportive, friendly conversation related to daily living problems the person is experiencing." It's difficult to make definitive evaluations of this type of service because the quality of something such as "reaching out" depends on the attitude, skills, and interest of each individual case manager. And it's further complicated by the difficulty in determining where a consumer's resistance to treatment ends and a case manager's lack of effort begins.
Based on repeated observations of Sammy Allen interacting with the Dallas County ACT team, conversations with both case managers and Allen, and regular monitoring of Allen's life since he was discharged from Terrell State Hospital, it seems apparent that, despite the expenditure of considerable manpower monitoring Allen and retrieving him from repeated admissions to Parkland Hospital's psychiatric emergency room, the ACT team did not know--or if they did know, did nothing about it--how Allen spends his days, how he ended up in Parkland's psychiatric ER, and whether he actually committed the violent acts he was accused of. Additionally, Dallas County ACT seemed ignorant of the facts that Allen was living in a room where people were smoking crack, that he didn't have a belt to hold up his pants or clean clothes to wear, and that he was sleeping on urine-soaked sheets for nearly a month.
Allen's main case manager on the ACT team did not even know what medication his patient was taking.
Allen was first admitted to Terrell State Psychiatric Hospital in Kaufman County on March 3, 1971, and was committed for three months. According to Terrell State records, he was brought into the hospital on a stretcher, bound in a straitjacket and handcuffs.
He was diagnosed with schizophrenia. Sixty-seven days and 13 rounds of electric shock therapy later, he was discharged to outpatient services with prescriptions for the antipsychotic Thorazine and for Akineton, a medication that addresses some of the possible side effects from antipsychotics (pacing, shaking legs, involuntary movements of the tongue and mouth).
In records scattered among a number of state and local mental health agencies--many of them made difficult to access as a result of Allen's reluctance to comply with anything, including putting his signature on a consent form--are a quarter-century's worth of documents, thousands of pages detailing how a disturbed, obese black man has been picked up on mental-illness warrants, court-ordered to outpatient services, and escorted into and out of boarding homes, motel rooms, psychiatric emergency rooms, psychiatric intensive-care units, and correctional facilities.
He's had his motel door kicked in by constables. He's been restrained and secluded countless times. He's been given thousands of milligrams of Haldol, Thorazine, Lithium, Prolixin, Mellaril, Olanzapine, Atavin, and other drugs. He's threatened to injure or kill children, doctors, mental health technicians, psychiatrists, caseworkers, and fellow consumers. His criminal history includes at least 46 arrests on various misdemeanor charges--everything from refusing to leave a McDonald's to bringing a starter's pistol into a psychiatric ER demanding admission--and six felony charges for crimes such as "unlawful carrying of a weapon" in a tavern (he was in a bar with a pair of martial-arts nunchuks shoved in his pants), and "aggravated robbery" (he chuckles about it today, noting that he was out of his mind at the time, when he stood in front of an information booth at a Greyhound bus terminal holding a knife).
In each felony case, he was found incompetent to stand trial and was sent to a psychiatric hospital until it was determined he had regained competency. Afterward, either his case would be dismissed and he would be released, or he would be sent for a short time to a correctional facility.
He's been repeatedly evaluated as homicidal, violent, and dangerous--an Yberpsychotic. "He's required so much medication that if we were to give it to one of us, it probably would kill us," one psychiatrist testified at a long-ago Allen competency hearing. "But to him it's just enough to sort of calm him down a little bit."
According to Dr. W. Miller Logan, the ACT team psychiatrist, there are no more than two or three places in the entire state that would be appropriate for someone such as Allen--facilities that offer long-term supportive housing for a mentally ill person who has never worked and therefore isn't eligible for disability benefits, and who has no private medical insurance. (Allen says he currently receives $485 a month in Social Security benefits. He has been on Medicaid in the past, but he is not drawing it currently.)