'We need this for people': FACT team provides daily support for those suffering profoundly from mental illness

Slouched in the back seat of a minivan, a wooden cane propped on one leg, Bill Morrow was eager to tell his story.

"I suffer from very serious problems," he said matter-of-factly at one point in a fractured conversation that changed topics often.

With a dry, slightly mumbling delivery, Morrow said he "gets off track sometimes" and needs a little extra help.

Once, he said, he believed eight men were after him.

"Are these new thoughts, Bill?" asked Lauren Humphries as she quickly tuned into the conversation and glanced at Morrow in the van's rearview mirror.

He said they weren't; that he was just retelling an old story.

Humphries is one of the clinicians on the local Florida Assertive Community Treatment, or FACT, team. On Thursday she was shuttling Morrow, one of the team's clients, around town as she made other stops.

Earlier that morning, she explained, she had met Morrow coming out of a doctor's appointment with his caseworker. He was riding with Humphries while she worked with a few other clients before taking him to another doctor. There, he would meet back up with his caseworker, who would shuttle him back to the assisted living facility where he lives in Putnam County.

Humphries and Morrow have both been with the FACT team almost from the beginning - when it went to work last year serving St. Johns and Putnam counties.

Brought to the area with the help of state Rep. Cyndi Stevenson, St. Johns County Sheriff David Shoar and others, the team is meant to provide support for the 100 most severely mentally ill in the two counties.

Diagnoses include severe bipolar disorder, severe depression, and schizophrenia.

Shoar has said the support that a FACT team provides its clients not only keeps them out of his jail - where he says they don't belong - but also protects those suffering by helping them avoid dangerous, and potentially deadly, interactions with law enforcement officers.

It also takes pressure off the local hospital and emergency room.

Dennis Pettigrew, the administrator of Flagler Hospital'sDepartment of Behavioral Health - which is one of the team's leading sources of referrals - told The Record on Friday that he has definitely seen a drop in recidivism rates among patients that he called "high utilizers" of the hospital's services.

"Some of the ones that would cycle back in and out, or be on the wait list for the state hospital for months on end on the inpatient side, are now still in the community because of the FACT team," he said.

Typically, Pettigrew said, such patients would be having issues with medication management or dealing with some other sort of crisis. But with the FACT team for those patients to rely on, many of the hospital visits are avoided altogether.

"The FACT team's there to really provide that guidance," he said.

What that guidance looks like from day to day is not necessarily anything that Humphries said she imagined as she finished grad school to become a mental health counselor.

Shortly after meeting up with Morrow, Humphries picked up five more clients at a local food bank.

She chatted with each of them and jotted notes after loading their boxes of food into the back of the van.

"I can't imagine going back to sitting in an office every day," she said as she headed out to drop off the first client at home.

Humphries chatted with clients on a variety of topics as she drove between stops. They ranged from the quality of Dodge trucks versus Chevrolets - something Humphries said she couldn't weigh in on - to the correct phone number for the FACT team's crisis line - something she was happy to help with.

Days like Thursday, she said, allow her to check in with clients in an informal setting and get a general feel for how they are doing. Stops at their homes also allow her to check in on living conditions to make sure they are keeping up with housework, bills and personal hygiene. If some are slipping, she can come up with a course of action.

Other days, she said, she may make rounds in the morning to make sure clients who have trouble keeping up with their medications are taking their morning doses. Some clients need only weekly check-ins; others need stops multiple times in a single day, she said.

The ultimate aim of the FACT team's program is to get the clients living more independently.

"The goal is for them to be able to live without us," Humphries said. "Not without support, but without us."

But because the team is so new - it just received its second round of funding from the state Legislature - so too are the clients. That's why, Humphries said, she and other members of the team spend so much time these days focusing on life's most basic skills, which can be incredibly time-consuming.

It's one of the many challenges for the new team, according to Cynthia Pinion, the local FACT team leader for Stewart-Marchman-Act Behavioral Healthcare, which manages the team for the county.

She sat down with Humphries after she had dropped off her clients. Later, the two were headed to a larger meeting with team members to discuss how all clients are doing.

Pinion said that, fully staffed, the FACT team consists of three nurses, five clinicians, one "provider" or an advanced registered nurse practitioner who examines clients and writes needed prescriptions, two "peer support specialists," a team leader, and an administrative assistant.

While the goal is to eventually serve 100 clients, the team is serving 64 right now.

Pinion said she wanted others to know about what the team is doing in the community, not only because it is truly helping people, but also because the county needs more resources to better serve them.

For instance, she said, there is no assisted-living facility in the county like the one Morrow lives in in Putnam County. There's also a lack of affordable housing in general for their clients. Finding a place for them to live that is safe, clean and affordable has been a real challenge, according Pinion and Humphries, who said she has even had to put clients in motel rooms temporarily.

"We are trying to make the best of what we have with the very little we have to work with," Pinion said.

Despite the challenges, they seem to be doing well. Many of the clients that rode with Humphries on Thursday took the time to stop and say how helpful it was.

"It saved my life," said one woman, who shared that prior to working with the team she was heavily abusing drugs and alcohol.

A young man who had just gotten out of the state hospital after more than five years said he was looking forward to working with the team and getting a job at the nearby Winn-Dixie.

And Morrow, who said he would likely have to "do time at a facility" without the support he receives, couldn't say enough about the team.

During one bad episode, he said, he placed a call saying he needed help, "and they were there, boom, like that."

"I trusted them because I had come to know them," he said. "I see them every day; they come with my meds.

"We need this for people."