Medicaid helps heal the mentally ill

I am a doctor serving Medicaid patients in rural North Carolina, and I’m worried. Given the new tax plan and the looming national financial deficit, I am concerned about the future of Medicaid. This column is my effort to increase awareness of a little known but vital program targeting our most vulnerable. And which Medicaid makes possible for almost all of our patients.

Assertive Community Treatment teams provide home health care for patients with severe mental illness. I work as the psychiatrist on my team. Services include 24/7 crisis availability, visits at least weekly and often more frequently if needed, psychiatric and nursing care, peer support and therapy, substance abuse counseling, assistance with housing and jobs, and coping skills training.

Our work is about love and compassion, the defining qualities of my team members. We serve many people who are disabled, downtrodden and live in dire poverty. Is this work easy? No. Are all of our patients responsive and grateful? No. Is Medicaid imperfect and sometimes abused? Yes. Yet we love this work; we find deep fulfillment in serving some of the most vulnerable and defenseless in our society.

On a typical day for me, the team first meets in the office to review each patient’s situation. Our patients often live in remote, hard-to-find places. It takes me and Joan, a nurse, an hour to reach the first patient. And there are so many dirt roads going off the main road, that we have to look for a landmark; in this case, it’s an old bathtub in Harvey’s yard.

Harvey’s five dogs surround our car; when we leave the car, the dogs nip at us but are easily brushed aside. We mount the rickety stairs to his trailer. The front door is a large piece of cardboard crammed into the doorway, and we push it aside after we are invited in. Harvey has schizophrenia and is disabled, but because of his monthly anti-psychotic injections he no longer hears voices or is paranoid. We chat for a while, and I evaluate him for symptoms and side effects. He is stable and I make no changes.

Our next patient, Linda, lives a half hour away and we are eager to see her as she has refused to take any medications for her schizophrenia and we want to make sure that she is OK, getting food for example; very often on our visits we stop off to get a hamburger for her. She doesn’t have a phone and today, unfortunately, she is not at home. We drive to a couple of places where we know she hangs out, a grocery store and a barber shop, but she is not there either. Another team member will try to see her tomorrow.

We see three other patients that day including Tonya who has a history of severe depression; we know from previous visits that her trailer is roach-infested so we meet with her on her front porch. She is doing well with the help of therapy and medication and coping skills training.

We also visit a brand new patient, William, just discharged from a mental hospital for his bipolar disorder, who is over-medicated and sedated. I begin the very slow and gentle process of reducing one of his medications and we agree to check in on him frequently.

Our last patient is Matt, whom we don’t find at home, but Joan knows where he likes to meet up with his buddies in the woods. Joan parks our car where she knows that Matt can see it and, sure enough, out he comes. We all stand beside the car while I assess him. He is getting his monthly anti-psychotic injections for psychosis and is doing well with no apparent side effects.

I am grateful to Medicaid; it gives very sick people a chance to heal as much as possible and to have an improved quality of life. I wish that everyone could witness this: a person with schizophrenia previously disabled by paranoia and by the voices he hears in his head, now responding to medication and in-home support; the voices have disappeared and he possesses a new-found calm and the ability to interact with others and to enjoy his life as much as possible.

Caring for our country’s most vulnerable is rewarding work and it brings honor to our society.

This story was originally published December 23, 2017 at 10:30 AM with the headline "Medicaid helps heal the mentally ill."