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PEP, the Incarcerated and the Mentally Ill
Helping the Incarcerated and Chronically Mentally Ill Return to the Community
Rama Reddi, M.D.
People Encouraging People (PEP) has a variety of programs serving people with severe mental illness and substance abuse issues, including those who are incarcerated or homeless. For over two decades, PEP has been awarded many contracts and grants for its behavioral health and psychosocial programs.
I work with the Forensic Assertive Community Treatment Team, a part of PEP and the first such program in the state of Maryland. The team includes a psychiatrist, a program manager, two nurses, two housing specialists, a psychologist, two vocational specialists, a substance abuse specialist, a peer counselor and an administrative assistant. This group focuses on reintegrating patients with chronic mental illnesses and forensic histories into the community.
The main challenge for our clients is re-acclimating to the community after having been incarcerated for years to decades for offenses ranging from trespassing to murder. In addition to providing psychiatric care, assessing safety and obtaining housing, our team often has to help with very basic needs such as shopping for food and clothing. I remember one client who had been discharged from a state hospital after thirty-six years. She had no personal belongings and was astonished by cell phones, pagers, computerized cash registers, and many of the other innovations we now take for granted.
My work as the psychiatrist includes therapy and medication management, as well as a range of other activities. The therapy aspect often involves helping clients define goals, while building and sustaining hope – a difficult endeavor for our clients with no clothing, food, housing or social support. Many of them have lost contact with their loved ones because of prolonged hospitalization or incarceration. Others have become estranged from family and friends because of the nature of the crimes they have committed.
Medication management can be very challenging after transitioning to the community from confined, highly supervised settings such as hospitals and jails. Compliance or adherence with prescriptions, interactions between various medications, early identification of side-effects, substance abuse and other co-morbid medical conditions, as well as battles with significant others who advise against taking medicine are some of the more obvious issues. One case involved a middle-aged, unmarried male who had been incarcerated for more than twenty years before returning to live with his elderly parents. Our team was convinced that this patient was suffering from paranoid schizophrenia and needed to remain on anti-psychotic medication. His parents, on the other hand, attributed all of his symptoms to his experiences in the prison. The patient had to reconcile his parents’ insistence that he not take medications and our concerns that stopping them would lead to serious consequences.
Despite these obstacles the team has succeeded in re-integrating more than 60 clients into the community over the past two years. I have personally been inspired by their day-to-day struggles. It has been a wonderful learning experience for me to leave a traditional office setting and to help the chronically mentally ill return to the community. I have also relished the opportunity to work with the other members of the PEP team because of the commitment and passion they bring to this work.