A PROFILE OF A COMMUNITY MENTAL HEALTH CENTER
More than 50 million Americans live with mental health disorders. In Birmingham, Ala., nearly 11,000 people live with a serious mental illness. The Piper Place Programs serve about 150 of them. Piper Place West in Bessemer, Ala. serves adults with mental illness with a focus on socialization and friendship. This is a story about Piper Place, its purpose, history and, most importantly, the people it serves. These people tell their stories in their own words, their own voices.
As the mental health industry works toward the deinstitutionalization of people with mental illness, more mental health consumers are being released from hospitals and other inpatient mental health facilities into the care of community outpatient programs such as Piper Place West.
The hope for this project is that it will expand understanding and acceptance of mental illness.
“That’s what I saw, you know. That’s what I thought I saw. My illness, you know,” he said, shrugging his shoulders. “That’s when my momma took me back to the hospital.”
That was several years ago. Now, Tart is an employee of the Crisis Center of Birmingham. He owns a candy-red truck. He collects car tags. He rents a small apartment. He also suffers from mental illness.
Tart purses his lips. A pair of wire-rimmed glasses hangs from his shirt. His eyes focus on the ceiling as his hand finds his mouth. He has told his story a hundred times, to students, doctors, coworkers and friends. He is not ashamed.
“I heard voices maybe once or twice in my whole life,” Tart said. “I saw things about once. You want me to tell you what I saw? I don’t mind.”
He does not flinch.
Tart is a mental health consumer and van driver at Piper Place West in Bessemer, Ala. Piper Place, located in Birmingham, and Piper Place West are outpatient day rehabilitation facilities for adults with serious mental illnesses. The programs are a division of the Crisis Center of Birmingham, and offer consumers a therapeutic environment in which they can acquire basic living skills while receiving psycho-education and social skills training.
The Piper Place Programs are certified community mental health providers with the Alabama Department of Mental Health.
According to Mike Falligant, executive director of the Crisis Center of Birmingham, the programs receive funding from Medicaid and the United Way, in addition to contributions from people in the community. Combined, the programs served about 150 out of the 11,000 people in the Birmingham area with a serious mental illness. The wait list is growing.
Tart is open about living with mental illness. He suffers from schizoaffective disorder, a condition in which a person experiences symptoms characteristic of schizophrenia, such as delusions or hallucinations, combined with mood disorder symptoms, like mania or depression.
He has also been diagnosed with obsessive-compulsive disorder, more commonly known as OCD, an anxiety disorder characterized by the need to repeatedly check things or perform rituals.
“You know how some people have OCD for washing their hands? Mine’s checking things. You know, like twisting knobs. Just checking things, you know,” Tart said, over and over.
“Twisting handles on doors,” he continued. “Like at my house, I twisted the knob on the faucet on my sink to the point that it broke the rubber washer in it. It broke it. I just kept twisting to make sure it was off.”
Because of his diagnoses, Tart takes a number of psychiatric medications. He explained that, as is the case for most people with mental illness, his doctors change his prescriptions frequently. He added that medications are often decreased, as well, in an effort to keep the patient stable.
“It helps you in one way, and it hurts you and harms you in another,” Tart said of frequently changing or decreasing medications. “If they can get you off of the medication, the better you are.”
Tart has been taken off of most of the medications he was formerly prescribed. He continues to take some. “Not the ones I was originally on,” he said. “There’s been a whole lot of switching around.”
As is true of most psychiatric medications, the pills required to control Tart’s conditions have side effects. Tart said that he struggles most with the tiredness his medications cause.
Tart said that he started noticing the changes in his personality while he was a student at Alabama A&M University. He became depressed and took up drinking.
“That’s when I got sick,” he said.
He returned home from school and began to seek psychiatric help.
After withdrawing from Alabama A&M, Tart was admitted to UAB’s Center for Psychiatric Medicine. “To be honest, I tried to commit suicide,” he said. “My head started feeling real tight. I went to UAB Hospital. That’s the first hospital I went to. Then I started hearing voices and seeing things, just for a short period of time. Then the doctor recommended that I go to Bryce.”
The doctors at UAB determined that he was not improving or responding to long-term treatment, so Tart voluntarily committed himself to Bryce Hospital in Tuscaloosa. “When I got there I didn’t know I was going to have to stay there for eight months,” he said, laughing.
During his stay at Bryce, Tart lost 60 pounds, shrinking from 254 pounds to 194 pounds. “I was so depressed,” he said. “I hated it. There were fights all the time. That was in 1989.”
After leaving Bryce, Tart spent nine years at a mental health program in Northport. “I just wanted to get away for a while,” he said.
While in Northport, Tart worked a number of different jobs, from janitorial work to restaurant service. He found all of the jobs on his own.
Tart decided to move back to Birmingham because he felt that he had stopped progressing in the Northport program. “I was getting better physically and mentally, but I was getting tired of doing the same old thing,” he said.
Once in Birmingham, Tart’s caseworker introduced him to the Claremont House program, an outpatient day rehabilitation program that has since burned down. That’s where he met Mike Falligant.
Falligant, the executive director of the Crisis Center of Birmingham, is affectionately known as “Big Mike” to the mental health consumers at the Piper Place Programs. His nickname does not suit him. He is a man of average build with an affinity for wool socks and riding bicycles through the office.
Tart and Falligant have been working together for a decade. “He said he liked the way I worked at the Claremont House,” Tart said. “That’s when he got me the job, driving.”Tart’s primary responsibility is driving a van for the Piper Place Programs.Tart’s primary responsibility is driving a van for the Piper Place Programs.
Tart’s primary responsibility is driving a van for the Piper Place Programs.
He transports mental health consumers from their boarding homes to the Piper Place Programs in Birmingham and Bessemer on weekday mornings and takes them back home in the afternoons. Additionally, Tart accompanies other consumers to doctors’ appointments daily. He also runs errands for Big Mike.
“I like working here,” Tart said. “To tell you the truth, this is the best job I’ve ever had. I’m being honest with you. It’s not just the job; it’s the people. I don’t make that much, but it’s the people. Everybody’s friendly and nice. Sometimes I have trouble with the vans, not too much though. But you can expect that of any job. Nothing’s perfect. I like the people I work with; it’s amazing how nice they are to me.”
A color-coded work schedule hangs on the kitchen wall at Piper Place West. A handful of consumers rotate jobs throughout the week, serving meals, doing dishes, cleaning the bathrooms. Andy McBrayer is one of them.
McBrayer is a man of football lineman stature. His soft voice is a stark contradiction to his thick neck and broad shoulders. He speaks passionately about the Piper Place Programs and the work he is doing with them.
“It’s an honor to work in the kitchen,” he said. “I have fun with it. It gives you a purpose.”
McBrayer’s kitchen duties include fixing lunch plates, cleaning tables and serving the other Piper Place consumers. He said his job helps him to learn skills he can apply to future jobs outside of Piper Place.
“[Working] gives me something to look forward to,” he said, grinning.
He gently fills Styrofoam cups with lemonade, careful not to spill a drop. The purple latex gloves are a tight fit to his big hands.
McBrayer has spent every one of his 30 years in Birmingham. He is a graduate of Tarrant High School and was once an extra in a low-budget religious movie. He likes to fish.
“Piper Place helps everyone talk about their problems,” McBrayer said, “what’s going on in their lives and helps deal with their illness.”
He added, “We’re going to have bad days and good days, but coming here and getting out of the house, spending time with friends, you make new friends everyday.”
While living in a boarding home in Birmingham, McBrayer was referred to Piper Place. He began coming to the program about six months ago “to get me out of the house instead of looking at four walls all day long,” he said.
The majority of the Piper Place consumers live in boarding homes across Birmingham. The group homes occupy what is left of Birmingham’s biggest and most beautiful historic houses, the kind of homes where a grown man could walk right into the fireplace without bumping his head.
Mike Falligant’s son, John Michael, drove by these reminders of Birmingham’s past every morning and afternoon for two years as a van driver for the Piper Place Programs. He is now a residential treatment instructor at another Birmingham-based nonprofit, but it hasn’t been long since he was picking up and dropping off Piper Place consumers at the boarding homes in north Birmingham.
“So a boarding home is just a large group home that houses multiple adults, in this case, adults with serious mental illnesses,” Falligant explained.
He added, “There’s usually a kitchen and typically a living room where they participate in leisure activities like watching T.V. or maybe playing cards.”
A house manager runs the boarding homes. Often, Falligant said, the house manager is a high-functioning consumer.
Piper Place West consumer Teresa Stewart, 56, experienced the same sense of isolation in the boarding home that McBrayer described before starting the program. “I used to didn’t go nowhere hardly,” she said. “I always did for people, but I didn’t get out.”
Feeling withdrawn is not uncommon for people with mental illness, said Mike Falligant. The programs put special emphasis on socialization and friendship.
“Being in an environment where it’s safe and they can talk to other people who have a mental illness and learn to develop those basic social skills that most of us have learned is very important and it gives them confidence, it gives them practice. We place a high value on that social interaction piece,” Falligant said.
For a person who loves to talk, like Stewart, the social interaction that the Piper Place Programs offer is golden. “That’s my favorite thing,” she said, “talking to the people here. I like people. I’m a people person. We act like family here. We act loving toward one another.”
Like McBrayer, Stewart helps out around Piper Place West. The self-proclaimed jack-of-all-trades takes pride in her job, cleaning the bathrooms.
“I try to keep it clean where it’ll be presentable to go in and out of,” she said, adding that the other consumers respect her hard work and try to keep the bathrooms tidy themselves.
“I enjoy doing for other people. I like working. I can handle a job and hold a job, but I can’t keep a job because I keep getting sick and having to go to the hospital,” she said. Piper Place West is changing that.
“I have improved with my illness since I’ve been coming here,” she said. “I never thought I’d make it this far. But, the thing is, I get around doing things better.”
For 28-year-old consumer Alicia Ingalls, Piper Place West is a place to learn. “I call this place school because it’s just like a school. You learn, you get information and you learn to use it,” she said.
Ingalls moved from New Jersey to Birmingham in 1992 to find a child-friendly psychological facility. “I had to get psychological treatment for my behavior because they couldn’t understand why I was doing the things I was doing. They wanted to put me in a facility, but the only facility they had in New Jersey was for adults. So my momma put her [apartment] up for sale and she moved down here with us, me and my brothers and sisters,” she said.
Ingalls added that all of her siblings were “diagnosed with this and diagnosed with that.” She was diagnosed with schizophrenia, bipolar, manic depression and anxiety.
At six years old, Ingalls was admitted to Hill Crest Behavioral Health Center in Birmingham, the only freestanding, full-service psychiatric hospital in the city. There, the children’s program serves kids between the ages of five and 12 who struggle with emotional problems or mental illnesses.
From Hill Crest, Ingalls spent two years at Brewer-Porch Children’s Center in Tuscaloosa, a program associated with the University of Alabama. Brewer-Porch provides model treatment for Alabama’s special needs children and adolescents, as well as their families.
As she got older, Ingalls said she bounced from mental health facility to facility, including another stint at Hill Crest, and a visit to Bryce Hospital in Tuscaloosa and Trinity Medical Center in Birmingham. “Ever since I was a child, six years old, I’ve been in and out of psych wards,” she said, shrugging her shoulders.
At Piper Place West, Ingalls works in the kitchen, mixing juice in big containers and running paper plates out to the other consumers at lunchtime. She likes it.
“I enjoy coming here and I enjoy my job,” she said. She added that she likes to use her job to do favors for the other consumers, like getting things they want or need out of the kitchen.
Her dream, Ingalls said, is to work at a greenhouse. She loves plants and said she has a green thumb that skipped a generation.
“I got it from my grandmother,” she said, laughing, adding that the gift bypassed her mom. She joked that her mother could not keep a poinsettia, her Christmas present from Ingalls, alive.
Crystal Colvin rests her head on the table. She doesn’t talk much. When she does speak, her voice is clear and smooth, an easy tell that, like Ingalls, she’s not from around here.
Colvin, a consumer at Piper Place West, encountered problems when she moved to Birmingham from Pittsburg, Pa. to be with family. “Nobody wanted me to live with them,” she said, matter-of-factly. “See I was thinking that family helps family. Nobody was willing to put me up. That’s how I ended up at Bryce.”
Colvin said that, because her family in Birmingham did not have room for her, the police took her to Bryce Hospital in Tuscaloosa. From there, Colvin moved to a group home back in Birmingham.
Through the boarding home, Colvin discovered the Piper Place Programs. This summer will mark her third year there.
At Piper Place West, Colvin helps out as much as she can. She serves plates at lunchtime and tidies up the kitchen. Her back gives her trouble.
“I don’t particularly like it,” Colvin said of her job. “But then I go in there for a few minutes and I forget all about not liking it.”
After the group therapy session, Colvin plays bingo. A mixture of plastic beads and small squares of paper line her two bingo cards. The game du jour at Piper Place West is “blackout;” the goal is to cover the entire card.
“I won blackout three times,” she said proudly.
Colvin dreams of going on a short trip with the other Piper Place West consumers. She suggests visiting the dog track, then scrunches her face in thought. “We’d have to have a lot of money for hotels and everything, wouldn’t we?” she asked.
Mike Latham, “Little Mike,” is the programs director at Piper Place West in Bessemer. He earned a master’s degree in counseling from the University of Alabama at Birmingham. He plays guitar in a Birmingham-based band. In his opinion, the media unfairly represents mental health consumers.
“What you see in the media is totally inaccurate,” Latham said. “It doesn’t represent in any way the mental health population. People always talk about that movie A Beautiful Mind and, ‘That’s so close to the real thing.’ I would totally disagree. And I was taught that throughout my whole school career, that A Beautiful Mind is the way it is, and that that’s a good representation. I don’t think it comes anywhere close.”
Mike Falligant agrees. “Oh absolutely there is a stigma,” Falligant said. “People, I think, through media and entertainment venues [think] people who have a mental illness are violent, [that] they’re a risk to the community. And generally speaking, nothing could be further from the truth. They are very peaceful and generally withdrawn and aren’t a risk to themselves or to other folks.”
He continued, struggling to find the right words. “Because it is something that people don’t understand and the differences in their [people with mental illness] behaviors, it sometimes makes it hard for people to feel comfortable with the population,” he said.
“You see it nationally, you see it in the media,” John Michael Falligant said of the stigma associated with mental illness. “While you see it nationally, you definitely see it in the communities as well. A lot of times it’s obvious. Whenever people in the community might see someone on the street who it’s obvious that they’re mentally ill [the community member] will appear uncomfortable. And it can be uncomfortable if you’re not used to it because, a lot of times, people with mental illness look different than us, they sound different than us, they think differently
than we do. So it can be really uncomfortable. But once you get over that… you realize that there really isn’t anything that they should be stigmatized about.”
Latham added, “I would encourage anyone who has ever guessed or wondered [about mental illness] to spend some time with a person with mental illness. I think that the only way you can really know is to spend time with people.”
Little Mike sits in his office chair, swiveling in time to the classic country music he plays on his acoustic guitar. Across the room, Ralph Baker sings along. Baker wears a 10-gallon hat. Most people know him as “Cowboy.”
William Bailey, 47, another consumer at Piper Place West, bought himself a guitar for Christmas. He admires the way Latham plays.
“That’s one good thing that I’m learning here,” Bailey said of Piper Place West. “Mike, he’s in a band. He knows all the chords on the guitar.” Bailey talks like Latham is Hank Williams. He’s pretty close.
“Sometimes we’ll have a class where we just learn music,” Bailey said, adding that the Piper Place West staff will pass out keyboards for consumer use. Imagine the music.
Bailey keeps a thin red notebook with his name on the cover. In it, he records the group therapy sessions. Its pages are filled with words like “self-affirmation,” “inspiration” and “karma.”
“I’m going back and picking up where I left off in life as far as learning and education and stuff like that,” Bailey said. “I’m kind of catching up on my reading and writing.”
Bailey dropped out of school when he was in the fifth grade in Seattle, Wash. and ran away from home.
Years later, Bailey found his way to Kansas. There, he married a woman named Amanda. They have long since divorced. He still carries their wedding photos in his backpack.
Bailey made his way to Birmingham. Initially, he had little luck in the Magic City.
“When I first met J.B.S. I was homeless and living under a bridge in the winter,” he said.
J.B.S., the mental health authority for Jefferson, Blount and St. Clair Counties, helped Bailey find housing and Piper Place West. “I used to camp out and live outside,” he said. “I don’t live like that anymore since I got people to help me.”
Bailey’s gratitude toward the Piper Place Programs is apparent. He said that he has improved with his mental illness since he started coming to Piper Place West. He loves the people there.
“I like to be around people. I can talk to people; that’s one of the reasons I come here,” he said. He added, “The people that work here have been a big help. If I have any problems, I can talk to them and they’ll listen to me.”
Like Bailey, 56-year-old Evan Powell’s story extends far beyond Piper Place West. Powell earned a political science degree from the University of Alabama in Huntsville and worked for almost 30 years in product inventory control management. He has been married and had one son. Powell said he recently died of a drug overdose.
At 17-years-old, Powell was diagnosed with manic-depressive psychosis, also known as bipolar disorder. He said that he was unable to hold down a job or maintain a romantic relationship.
Powell decided to travel to Europe. He had studied abroad in high school the year before.
“So, I just took off and went to Europe and hitchhiked around Europe and came back and drove my car around the United States and traveled around and met different people,” he said, like it was no big deal.
When he returned, Powell enrolled in UAH. It was there that he was again diagnosed with a mental illness. This time he began taking medication.
Powell was able to keep his mental illness under control until the company he worked for laid him off. He spiraled into a deep depression, and went back into the hospital. He now lives in a boarding home.
“People will deny that they need help and they get in trouble,” Powell said. “It snowballs until they come to the realization that they need help. You can get help and receive help and grow and get better. This program is part of that step, of realizing you need help. There are people that can help you here at the program.”
One of the ways the Piper Place Programs helps consumers deal with their mental illnesses is through group therapy. Each morning, consumers gather around tables and Piper Place staff lead them in a therapeutic activity.
“I had isolated myself before,” Powell said. “Now I’m around more people. They do interactive groups. We made Valentine’s Day cards for everybody yesterday.”
Bailey adds that they also had a Valentine’s Day dance.
McBrayer explains that group therapy is a team effort at Piper Place West. “[We] see if we can get everybody to relate to each other and see if everybody can help each other out, even the workers,” he said.
At Piper Place West, the consumers decorate bright sheets of cardstock with foam shapes. They pass the sheets around, and with each pass a new compliment appears scrawled on the paper. Consumer John Thomas’ page says, “always smiling.” It’s true.
John Michael Falligant grew up with John Thomas. He said he did not realize that his comfort with people with mental illness was anything out of the ordinary until he got to college.
“For me, growing up with consumers, having them over at the house, going with my dad to work and hanging out with these people who have a serious mental illness, I never thought anything different about it. I never really thought that was weird because that’s what I was exposed to,” Falligant said.
He added that his peers’ reaction to being around people with mental illness confused him initially. “They’d act really uncomfortable or even surprised and I couldn’t understand what the deal was,” he said.
For Falligant, who has also spent most of his life working alongside people with mental illness, like Tim Tart, it is not challenging to develop a personal or professional relationship with a mental health consumer. It just takes some getting used to.
“A lot of times, people with serious mental illnesses may look differently, talk differently and act differently than the people that you’re used to,” Falligant said. “You kind of have to get over your initial comfort/discomfort level because they are different from you and they’re different from the people you’re used to being around. At first, you don’t know how to act, what to say, what’s appropriate for discussion. But the more you work with a person, like I work with Tim, you get more comfortable with them. You forget what makes you different. After a while, you start to think about what makes you similar. When that happens, you stop thinking of them as your co-worker with a mental illness and you start thinking of them as just a co-worker.”
Falligant said that working closely with a person with mental illness has taught him valuable lessons about employment and the workplace. “I think it’s a great thing and noble thing to try to employ mental health consumers because there are a lot of hard working individuals who have mental illness out there who would be an asset to an organization,” he said.
He added, “They often do not have as much success by no fault of their own because they tend to be scapegoated by other employees. Typically, they’re easy to blame and they don’t advocate for themselves. That’s why they can’t really hold down long-term jobs. Of course there are challenges, but mental health consumers find meaning in work that other people generally don’t.”
He added that working for the Crisis Center and its programs, such as Piper Place, have changed Tart for the better. “Tim’s own self confidence and autonomy have increased a lot. He’s gotten a lot more independent and self-reliant. He’s gotten a lot more comfortable with his mental illness. He’ll go give talks on college campuses to spread awareness about people with serious mental illness. As nervous and introverted as he is, it’s hard to imagine him doing that several years ago.”
Tart believes that his success helps to encourage other consumers in rehabilitation programs. “If you work hard and do what you’re supposed to, the program will work for you,” he said. “It worked for me.”