The rare mental-health fixers
Peer bridgers use the power of mental health recovery stories to reduce psychiatric hospitalizations, writes Seattle Times columnist Jonathan Martin
Times editorial columnist
Crystal looked down at her bowl of handmade pasta like she expected it to suddenly disappear.
You can understand her hesitation. The day before, she was in a West Seattle psychiatric hospital after being committed for wandering Seattle streets, suicidal. This day, she lived in a downtown Seattle homeless shelter, a 57-year-old woman adrift, without a phone, clothes or identification.
Enter Dennis Villas and Mary McDonald. Their job for the day was to make sure Crystal got a square meal — the pasta at an Italian bistro downtown — and a phone. Then they would get her a first appointment with the public mental-health provider across the street.
“We’re not going to leave until we have a case manager,” said Villas, 43, with inspiring confidence.
Mary and Dennis’s job title — peer bridgers — is new to the local mental-health system, but so intuitive it is a no-brainer. Mary and Dennis help ease patients out of Navos, a community psychiatric hospital in West Seattle, and, for up to three months, help to plant them in new lives firmly enough that they won’t quickly need readmission.
After a day with them, I came to see the peer bridgers as fixers. When a reporter is on assignment in an unfamiliar land he or she hires a fixer, a well-connected local to translate and navigate and make sense of what is happening.
In this case, the strange land is the government human-services system. Getting someone like Crystal onto federal disability benefits takes six weeks. Getting her into scarce local mental-health housing? That takes a fixer.
What’s unique about peer bridgers is they have to know the territory and be in recovery themselves. Mary was an office-supply saleswoman before she nearly died from untreated bipolar disorder and alcoholism. Dennis had a good career in the investment industry before losing it to methamphetamine and meth-induced psychosis. Their shared struggle offers a quick inroad to gain their clients’ trust.
Crystal, at first, wasn’t interested in help. But when Mary and Dennis shared, she opened up. They spent weeks just helping Crystal gather documents to get an identification card, which is necessary for her to get other help.
“When you’re released [from the hospital] you drop off a cliff into the system, and it’s so complicated,” said Mary, 47.
That’s the human part of their job. The fiscal part makes just as much sense.
Fact: The cost per hospitalization for a patient with mental-health problems averages more than $22,000, according to the Washington State Institute for Public Policy. At least 11 percent of psychiatric patients are rehospitalized within 30 days, according to national data, mostly due to sparse follow-up care.
Slow that revolving door and it’s better for patients, whose illnesses get worse with each crisis. And it’s good for taxpayers. OptumHealth, the behemoth managed care firm, hired peer bridgers when it took over Pierce County’s public mental-health system in 2009. The result: In the first year, rehospitalizations plunged, saving $550,000.
Enter Mary and Dennis.
In April, King County got a two-year, $1.7 million grant to hire peer bridgers at the 68-bed Navos and at Harborview Medical Center. It is fitting that the money came from the state’s settlement with Janssen Pharmaceuticals for deceptive marketing of the antipsychotic drug Risperdal, which Mary takes.
Mary and Dennis are intended to help relieve the county’s crisis-level shortage of psychiatric beds, which causes dozens of patients each night to be left stranded in emergency rooms.
It will help, but let’s not kid ourselves. A few teams of peer bridgers are drops in the bucket. Mary carries a caseload of four patients; there were 3,401 civil commitments in King County last year.
It’s also troubling that peer bridgers make so much sense, yet are still rare in the mental-health industry.
As I see it, that is because of the way society views mental illness — as a permanent disability rather than a health problem from which one can recover. We focus on the second descriptors for Mary and Dennis — their illnesses — rather than the first: their skills.
Earlier this month, I tagged along with Mary as she drove a Navos patient to Greenwood to interview for one of the too-rare spots in a mental-health housing unit. In the movie version of Mary, she’d be the wisecracking, self-deprecating bridesmaid character.
That effect hides a harrowing personal story: she lost a good sales career to untreated illness, was hospitalized three times, saw a brother die to a similar illness and spent 16 months in intensive treatment before re-entering the workforce via peer support.
“You couldn’t tell me then I’d be working, be driving, that I’d be paid for helping people based on my past history,” she said. “I rebounded faster than I thought I could.”
Jonathan Martin's column appears regularly on editorial pages of The Times. His email address is firstname.lastname@example.org