What do we do about Olivia? Olivia is a 50-year old African-American woman who has schizophrenia, a Fountain House member who is currently homeless. She also has an assisted outpatient treatment (AOT) order which legally mandates her to take her medication and go to treatment. And yet, two days ago, Olivia was sitting on a nearby stoop on 47th Street with thirty bags of stuff spread out over all the stairs, talking to the voices in her head, ignoring any entreaties from passers-by.
It’s disheartening, because we have seen her be so much better.
We’ve spoken to her psychiatrist, but she doesn’t really have an answer except to tell us to call 911. We have called 911 many times in the past, and Olivia has gone to the hospital many times in the past – at least three times this year alone. When she enters the hospital, they help stabilize her medicine, but they only keep her for a short time. When they release her, she is once again on the street. She is lost to her intensive case manager because she has no phone and no address.
The face of healthcare, especially mental healthcare, is changing. Many of the new integrated care scenarios rely on computer tracking systems to manage cases and coordinate service delivery. However, these solutions will not work for someone like Olivia. Computer systems can neither develop relationships nor attract people to them.
Even though her illness doesn’t allow Olivia to trust anyone right now, she continues to show up on 47th Street because she has friends at Fountain House. When we see her, we try to reengage her into our working community as the first step toward getting her to slow down, take her medicine, and find a place to live. Ultimately that’s what will reach Olivia: one good, solid relationship with a worker or member of Fountain House who will take the time to convince her to do what needs to be done. And she’ll do it because, even through the haze of her illness, she trusts that person.
Kenneth J. Dudek
President, Fountain House