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The Right Help, the Right Time

Maura McDermott

As a child, dark-haired, hazel-eyed Melanie Thomas had an ever-present best friend who was thin and pretty, with long, luxurious hair.

No one else could see her friend. And no one else could hear the whispering voices that seemed to follow Thomas wherever she went.

But that was OK.

Her invisible friend was a reassuring presence. "I've always had imaginary friends, and that's normal," Thomas, now 20, mused as she stood on the worn wooden balcony of her third-story apartment in Passaic.

She laughed. "When they stay with you when you get older, it's not normal."

* * *

Thomas spent her 13th birthday caring for the baby boy she gave birth to just seven weeks before.

Her mother struggled with drug and alcohol addiction and her father was nowhere to be found, she said. Twice, she said, she was the victim of sexual abuse by her mother's boyfriends. She got "jumped" into a gang at 10 and gave free rein to her urges to set small fires and break things.

After Thomas gave birth, her family felt her mother could no longer care for her so she moved from her native Arizona to her aunt's home in Clifton.

But the demands of motherhood and school never weighed Thomas down, she said, and her baby, Emilio, gave her a longed-for object of affection. "He's the savior," she said.

Then, at 16, she became pregnant again and, under pressure from her aunt, she had an abortion, Thomas said.

She began to feel her world breaking apart. "That's what hurt me the most," she recalled. "It's what made all my feelings come out. I was really sad for a long time; I tried to hurt myself. I would scratch up my arms, everything."

Her hallucinations, once little more than mild distractions, became full-fledged visions of mutilated bodies, vengeful spirits, and sewer rats.

Whispered voices in her head became screams.

* * *

Like many youths with mental illness, Thomas suffered her most serious symptoms as she shifted from childhood to the new pressures of grown-up life.

Early adulthood is when diseases such as schizophrenia, major depression and bipolar disorder-commonly known as manic depression-are most likely to appear. Yet it's also when troubled youths are unlikely to get the counseling and psychiatric medications that can make their terrifying symptoms fade.

Some have dropped out of school, or they graduated but do not have jobs and, as a result, lack health insurance. Many are caught in a foster care system that even officials acknowledge is ill-prepared to deal with mental illness.

Those over 18 often are no longer eligible for children's and teens' treatment programs, but they are poorly suited for programs that serve much older adults.

Many, like Thomas, get plenty of attention for their symptoms, but it's attention of the wrong kind.

Thomas saw an ever-changing cast of counselors at school. Doctors prescribed pills that Thomas calls "horse tranquilizers," but they did little to ease her hallucinations, and she never saw the same doctor long enough to find the right medication.

Interminable meetings with counselors to discuss the childhood abuse were the worst of all.

"I would tell them what happened, then they would say, 'I'm sorry,' like the sympathy thing," she said with scorn. "They make you tell your story so many times over, and you know what? That doesn't help."

* * *

The first time Thomas really got help was at the Mental Health Association in Passaic County in Clifton, which runs a small-scale program called Crossover. "Without them, I'd probably still be nowhere," she said.

The program, funded by $50,000 annually from United Way of Passaic County and the state Division of Mental Health Services, serves about two dozen youths, ages 17 to 21. it is aimed at those who slip between the cracks of the system, too old for children's programs, but still coping with adolescent issues like peer pressure and self-image.

Its strategy is called "intensive case management," and the way it works is simple: Prgram Director Gladys Yachouh oversees the youths' care, making sure they find treatment programs that suit them, enrolling them in school, signing them up for Medicaid and other benefits, trying to find affordable housing and checking in-as often as several times a day and in the middle of the night, if necessary-to ensure their health and safety.

Yachouh has begun organizing Monday nights-out, since many of the youths might otherwise have little opportunity to socialize. Plans for support groups and life-skills classes are in the works.

"The hope is that we can keep people from going into (a psychiatric hospital), keep people from going into the shelters or ending up in the streets," said Joanne Green, director of the county Mental Health Association.

* * *

There are plenty of so-called day programs for adults throughout the state, offering counseling, life skills training and sessions with psychiatrists to get medications.

The trouble is, youths who are just beginning to grapple with their newly diagnosed illnesses often flee from such programs, insisting to themselves that they are healthy.

That's what 20-year-old Alison Garcia once did.

Garcia is a bright, energetic young woman who dresses in a defiantly tomboyish style and keeps up a lively stream of conversation even when speaking of the depths of her depression.

But she suffers from mood swings so severe that, since the age of 16, she has tried numerous times to take her own life, swallowing chunks of lead paint, rubbing alcohol, bleach or handfuls of Tylenol.

"They didn't know if her liver and kidneys would survive," her mother, Carmen Valentin, said of one such episode.

Garcia traces those self-destructive urges to a strain of depression she says runs in her family, and to the stress of seeing her mother cope with a difficult marriage to Garcia's stepfather.

"If I see somebody suffering, like my mother, that bothers me so much it's like I'm going though it myself," she said.

Each time Garcia swallowed poison, she was rushed to an emergency room and held in a psychiatric ward until anti-depressant medication took effect and her suicidal urges faded.

But each time she was released from the hospital, she stopped taking the life-saving medication. "I thought I had to be a big person and handle everything on my own," said Garcia, who lives with her mother and siblings in Passaic.

Her self-destructive urges would return, prompting her to swallow poison yet again.

She'd make an occasional attempt to get treatment, with little success. She once attended a mental health treatment program where the clients-all older adults with longstanding psychiatric illnesses, among them women who Garcia said did not bathe and a man who masturbated in a shared bathroom-frightened her. Certain that her illness was not that serious, she decided she'd be better off without any treatment at all.

"It didn't fit; it was for old people," she said.

Then a counselor referred her to the Crossover program. Now Yachouh calls her nearly every day and makes sure Garcia attends a new treatment program that serves adults her own age.

This April, for the first time, when Garcia felt the urge to take her own life, instead of picking up a bottle of poison she picked up the phone. "I reached out and called Gladys," Garcia said. "Right away, she said, 'I'm coming to pick you up.'" Garcia hasn't tried to harm herself since, and she credits that change to the attention she has gotten from Yachouh in the Crossover program. "When I first met Gladys I didn't want help," she said. "It seemed easier to keep it locked away."

Now Garcia attends treatment sessions five days a week and takes antidepressants every day, she said. "Now," she said, "I call Gladys every day; I bug her. We're always in contact."

Like Garcia, many young adults insist that they are perfectly healthy, even when suffering from a severe psychiatric illness, and find little solace in treatment programs that mainly serve adults in their 30s and up, according to mental health experts.

Barely out of their childhood, many are certain of their power over their illness, consumed with being cool and alienated from older adults. After dropping out of treatment programs, many go without counseling until a crisis hits.

"That age group is very much in denial about their illness," Yachouh said. "Some just kind of back off and get no services at all."

Youths suffering mental illness are often less mature than their healthier peers, said Dr. Mark Perrin, MD, president of the board of trustees of NAMI (National Alliance of the Mentally Ill) New Jersey, an advocacy group for people with mental illnesses and their families. As a result, Perrin said, they are often not well-served in catch-all programs for adults aged 18and up. "They just don't mesh," with the older adults, he said. "They do need their own program."

Even for doctors, finding the dividing line between a rocky adolescence and mental illness can be tricky.

"Parents and teachers will say they see an adolescent acting out and they ask, 'Is this because their hormones are surging and they're going through adolescence, or are these signs of serious mental illness?'" Perrin said. "I think it's difficult to tell, particularly when there's substance abuse, which makes things difficult to sort out."

Crossover is one of very few programs designed specifically for mentally-ill young adults. It can serve only about 25 youths per year, since its grant finding pays only for Yachouh's salary, although other Mental Health Association counselors pitch in.

Thomas and Garcia are among the fortunate ones receiving counseling and medications. The cost of allowing their peers to go without treatment is devastating, mental health experts say.

"If you don't reach people as children, they will revisit you in their adulthood when they will be harder to reach," said Kathy Wright, executive director of the New Jersey Parents' Caucus, an advocacy group for children with mental illness.

Troubled youngsters who give in to their violent or destructive impulses can end up in a juvenile facility or jail. "Then they get absolutely no help because it's a penal system," Wright said. "It's a horrible situation."

Even those who do not get in trouble with the law pose real challenges.

"They're quasi-adults and borderline children," Wright said. "They're young, they're feeling like they have an enormous amount of control, which they don't, they're living in the moment, they're not being forward-thinking, they're making decisions based on what feels good at the moment."

Learning to feel a powerful wave of anger-but not act on it-is among the good habits the young adults practice in Crossover.

"The people at the Mental Health Association tell me to think before I act," Melanie Thomas said, "and think of my son and how the consequences would affect him."

Getting the youths out of overcrowded family homes and into apartments with mental health staff on call is another goal.

Such housing is in short supply, but Thomas said counselors with Crossover has helped her get on a waiting list so she and Emilio can move out of the hectic three-bedroom they share with her sister and brother-in-law and their two children.

Catching up on academics is still another focus, since schoolwork is often among the last things on the mind of a teenager battling hallucinations or depression. Garcia's goal is to become a police officer, and she known that to get there she'll need a high school diploma.

"I don't want people to know me as a disability," she said. "I want to be known as a cop."

As for Thomas, she aims to get her high school diploma and continue her schooling so she can one day become a therapist and treat children who have been hurt as she was.

"I'm doing it for my son, I'm not even doing it for me," she said of Emilio, who just finished first grade. "If I can't take care of myself, who's going to care for him?"

Reprinted with permission of The Herald News.

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