UNC program helps clients push through mental illness to success

May 04--CHAPEL HILL -- Antonio Prevatte wants to be "a regular person."

"Some people don't treat me like that," he said. "My thoughts (make it difficult). It's kind of hard working. Most of the people don't have bipolar there (at work), and I feel awkward (as) the only person who's got bipolar."

The disorder, also called manic-depressive illness, affects less than 3 percent of U.S. adults, according to the National Institute for Mental Health. The illness, which can be inherited, affects the brain, causing unusual shifts in mood, energy and the ability to do daily tasks.

The result, at times, is uncontrolled energy that causes people to stay up long hours, skip meals and act recklessly; their mind can jumble thoughts and emotions. Other times, it can be hard to communicate and the sense of hopelessness and exhaustion can be overwhelming.

Prevatte, 32, has suffered from bipolar disorder since childhood, but he's learning to live better with it through the Step Down program offered by the UNC Center for Excellence in Community Mental Health. The program is marking its first anniversary this month.

UNC's Assertive Community Treatment team runs the program, supporting clients with severe mental illness as they move from the hospital to the community. A second ACT team supports clients in Wake County.

The eight-member team -- a mental health professional, psychiatrist, nursing staff, and housing, job, substance abuse and peer support specialists -- serves 10 Step Down clients, said Carol Vanderzwagg, the UNC center's medical director for community services. It's a less-intensive service for those who might not actively seek ongoing care or might be at risk of future hospitalization, she said.

Step Down clients share a history of bipolar, schizophrenia or a psychotic disorder and may have been hospitalized more than once, she said. Their illness also puts them at a higher risk of homelessness.

"There's more emphasis on recovery and the broader aspects of care rather than just keeping someone without psychiatric symptoms, so they don't go to the hospital," Vanderzwagg said. "It's (looking at) what else do they need to have a fuller life."

Team members check in with clients anywhere from daily to weekly, depending on the need. They develop friendships with their clients, track the progress of their symptoms and medications, and help them apply for and keep jobs and housing, and develop healthy relationships.

"What we're doing with them comes from what they tell us they want," Vanderzwagg said. "The idea is that initially we try to help them identify what are the things they value, what are their goals for the next year and then longer term, and then we try to help them figure out what's getting in the way of achieving those goals."

About half of their clients also struggle with substance abuse, although they have to be stable and at least a year into recovery. Prevatte used crack when he lived in Roxboro, he said; mixing it with his medication is what landed him in the hospital.

He's been clean for over a year now, he said, living in a group home. He's on disability for severe bipolar disorder, and the ACT team is helping him find an apartment. They also help him find jobs -- he likes to wash dishes, sweep and mop, he said -- and remember to take his medication.

He just got his own bank account, he said, pulling a debit card proudly from his wallet.

"They've been nice to me," Prevatte said. "They helped me out when I needed help."

Finding clients a safe, affordable place to live is the hardest job, team members said, especially in Orange County, where housing costs are higher and the number of apartments available to those receiving federal Section 8 housing subsidies are few.

They've been nice to me. They helped me out when I needed help.

Antonio Prevatte, client

Finding work is another slow but critical process, Vanderzwagg said, because it gives clients a sense of belonging. Most are looking for something part time, with flexible hours.

Jobs also break down the stigma and marginalization of those with mental illness, team members said.

"A lot of people are very understanding," associate mental health professional Zack Felder said. "It differs from business to business and community to community ... but most people are pretty reasonable and understanding and willing to talk about it and open to it."

The Step Down program could grow in the future, Vanderzwagg said. Trillium Health Resources is looking at a program for Greenville, she said, while Alliance Behavioral Healthcare wants to expand the Wake County program into Durham.

Orange County's program is discharging one client this year; two others have returned to more intensive care. There's not a lot of data at this point, she said, but Step Down makes sense and is an easy addition to existing programs.

"This offers a nice alternative for a big group of people," she said.

Prevatte works part time at the Club Nova thrift shop in Carrboro and plays basketball and softball in his free time. He'll play on the Special Olympics softball team this year, he said.

Since playing for his favorite team Duke probably won't happen, Prevatte said, he'd like to get a job outside, maybe mowing. He has simple goals: Get an apartment, earn his GED and live independently.

"Then I'll be happy," he said.

Tammy Grubb: 919-829-8926, @TammyGrubb

More information

Learn more about the Step Down program and how to contact ACT team members in Orange, Chatham and Wake counties at unc.live/1r3voz8.

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