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A New Day

After four years of slow change, a mental-health residential program could be poised for a revolution.


Still, she’s been in the assisted-living program for nearly five years. And for Broughton — who people at Gateway call an excellent communicator — it’s too long.

Gateway Farms of Greater Richmond Inc. is a transitional living program for individuals who suffer from schizophrenia, bipolar disorder and depression. The program’s primary goal is to help residents to become as self-sufficient as possible. This description and the mission it implies are new.

Four years ago, Style published a cover story on Gateway and how it appeared to offer people with mental illness a far more attractive alternative to other private or public facilities and, especially, to the state’s much-maligned mental hospitals. (At the time, the U.S. Justice Department was investigating the state’s nine mental hospitals for widespread regulations infractions and abuse.) Since, those in the mental-health field say that not enough has changed. The state of mental-health care in Virginia remains among the poorest in the nation. Meanwhile, mental illness is rampant. Worldwide, one in four people will suffer from some form of chronic depression. One in 100 suffer from schizophrenia. And locally, community service boards are witnessing an 8 percent to 10 percent increase in the number of people needing services for mental illness.

According to the regional chapter of the National Alliance for the Mentally Ill, Virginia ranks 12th in the nation in per-capita income but 43rd in per-capita spending on community-based, mental-health services. With the economic downturn and subsequent state budget cuts to mental-health programs totaling 15 percent, prospects for the 300,000 people who acknowledge suffering from chronic mental illness in Virginia aren’t promising. NAMI-Virginia had this motto for the 2003 General Assembly session: “43rd and falling: How low will Virginia go?”

But a recent proposal by Gov. Mark Warner, called the “Community Reinvestment Project,” will redirect $22 million annually from state mental-health institutions to the state’s 40 community service boards in an effort to turn the tide. The plan stems from legislation emerging from the 2002 General Assembly session. And what it could mean is that private nonprofits like Gateway and other community-based programs could benefit from $4 million in 2004.

Lynn Brackenridge, Gateway’s president and former executive director, is hopeful the money will come and will make a difference. Valerie Marsh, executive director for NAMI-Virginia, isn’t sure it will. Already, she points out, 12,000 people with mental illness in Virginia are not receiving the treatment and services they need. “I’m a little more skeptical than [Brackenridge],” Marsh says, explaining that, so far, no money has specifically been earmarked for mental-health needs. What’s more, she says, existing programs throughout the state are suffering as public mental-health facilities close wards and eliminate beds.

“Thank God Gateway’s out there,” Marsh says, representing a private facility and model that seems to work. “There could be a thousand, probably two thousand Gateways,” she says, before Virginia’s mental-health system would significantly improve. And still, she offers this caveat: “There’s no magic bullet of housing. One size does not fit all.”

While it’s not yet clear whether Gateway will be eligible for the promised funds, the message and timing of any money set aside for mental health could provide pivotal. If Gateway doesn’t get it, its staff says, maybe its model could be replicated elsewhere. At the very least, the money could be used to strengthen private-public partnerships to ensure that already hard-to-come-by services aren’t duplicated, they say.

Apart from the addition of Estes House, a supported-living apartment cluster that opened last month to eight residents, Gateway looks mostly the same as it did four years ago. Same 30 acres of woods and grass in the rural outreaches of Chesterfield County. Same quiet. Even some of the same residents. But the routine, as with much of its staff, has changed.

A year and a half ago, Gateway underwent a comprehensive study to examine if it was achieving its mission to make residents more independent. Gateway discovered that it wasn’t. Instead of motivating residents to get help and move on, it was fostering an environment that made it difficult to leave. Residents came and stayed.

Not so anymore. Atypical of its field, Gateway has undergone a swift and significant turnaround in the year since its review. A clinical director, David J. Prybock, formerly a forensic expert at Central State Hospital, was hired. Three additional staff positions were created: a director of development, a director of communications and a director of health and wellness. And next week kicks off its Healthy Minds/Healthy Bodies program, which aims to create a kind of holistic approach to mental illness that combines clinical treatment with vocational training, nutrition and exercise.

Staff maintain that such a change is revolutionary. “So often people only see the mental illness, not the whole person,” Brackenridge says. “It wouldn’t be fair to say we promote independence without giving residents what they need to make it in the community,” by way of comprehensive treatment and the tools to succeed, she says. “No other programs in Virginia do this.”

But what may be most compelling about Gateway’s methodology and, ultimately, its change in mission, is that it plans to help residents achieve their greatest level of independence in a relatively short period of time: 12 to 18 months, in most cases.

“Our focus now is on being transitional, not long term,” Brackenridge says, acknowledging that four years ago, Gateway thought it was transitional but wasn’t.

In part, it’s up to Prybock to make it so now. It’s taken him a year to put his system, his staff, in place. “We’re trying to implement massive change,” he says. Prybock’s plan includes combining advances in medications with a psychiatric component and “augmenting that with therapy, coping skills, stress management and developing social relationships and boundaries,” he says.

Some at Gateway — residents, family members, staff — have resisted the change, skeptical of anyone “rocking the boat,” Prybock says. He assures it’s a resistance based on fear that, once faced, will produce results. After all, he and others at Gateway point out that treatment of mental illness has a 60 percent to 80 percent success rate.

Still, seeing results — increased levels of independence — relies on the residents’ motivations and goals. “They have to want to come here, and they have to want to leave,” he says. To ensure this, Prybock applies what he calls “constructive tension” to move residents forward. It means more structure and strict adherence to goals — albeit with the flexibility required in treating mental illness. “We’re not going to start wearing white lab coats and saying this is what you’re going to do, now do it,” he says.

For some, self-sufficiency could come in a matter of months, for others a few years, and for the rest, it may never come. But the new comprehensive approach offered at Gateway affords people with mental illness the greatest chance of reaching their personal best, Prybock says. It’s a best that Mimi Broughton plans to be living proof of by next year, she says, when she “reaches the third level” and moves back into the community. And if money is made available for Gateway and places like it, it could mean Broughton would never come back. S

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