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At home with mental illness: Treating trauma to curb homelessness

This article first appeared in the St. Louis Beacon, Oct. 27, 2010 - Trauma first struck Peggy Webb at 3 years old when a family drive ended with a head-on collision into a Mack truck. Jolted awake in the backseat, she saw her father decapitated and her mother's legs cut off, an injury complicated by gangrene that would kill her a short time later.

Before the age of 10, she was raped repeatedly by a neighborhood boy and was raped again as an adult. But it was the horror Webb endured 11 years ago, when she was attacked in her home and nearly strangled to death that was the hardest to work through.

Addicted to prescription opiates by the age of 14, and suffering from untreated depression, Webb, 58, plunged into a world of constant fear after the assault. Being among people -- in a grocery store, on the street and especially in large groups -- was terrifying. The former bartender could no longer work. She became homeless, rotating among friends' houses for a decade and trying in vain to sleep at night.

"I would be up at all hours, checking the locks on the windows and the doors," Webb said. "I was scared to death of men's voices and their breathing because I remember hearing him breathing heavy when his hands were on my throat."

Innovative Trauma Therapy Expanding

To avoid jail time for a drug possession charge, Webb sought help two years ago from St. Louis' Queen of Peace Center for women. Last January, as part of her treatment, she participated in cutting-edge group therapy. The group was composed primarily of formerly addicted, mentally ill women. All had experienced trauma.

Trauma Recovery Empowerment Model groups began on a limited basis at Queen of Peace just over two years ago. Starting next year, trauma recovery, a therapeutic practice supported by research, will be used more widely at Queen of Peace and for the first time through homeless providers Community Alternatives, Places for People and the St. Patrick Center.

The funding comes through a $3.6 million St. Louis Partnership for Mental Health and Housing Transformation grant from the federal Substance Abuse and Mental Health Services Administration.

The trauma recovery model, developed by a mental health agency in Washington, D.C., in the 1990s, helps individuals work through trauma and lessen its negative impact on their lives.

"We realized we can do everything we can to find housing or get someone psychiatrically stable, but if we don't address the aftereffects of the trauma, we can't create anything that's going to help someone in their recovery sustain it," said Rebecca Wolfson, trauma educator atCommunity Connections, the agency that developed the protocol.

Community Connections practitioners will train a contingent of St. Louis therapists this January. One example of a trauma recovery exercise for women involves understanding and setting boundaries on personal space.

"You have different shapes on the floor around the room in different spots," Wolfson explained. "We tell the women to find a spot that looks comfortable and then we ask them why they chose that space. They may say, 'Oh well, it had my back up against the wall and I can see everybody in front of me,' or 'It's close to the door,' or 'It's in the center of the room and I like to be getting all the attention.'"

Through this exercise, a therapist can understand a woman's coping mechanisms even if the client is unable to articulate them. That goes a long way toward working through the trauma. And working through the trauma helps people remain in their homes.

"Some of the reasons people are homeless or will become homeless are unsafe behaviors," Wolfson said.

Queen of Peace program manager Lee Burnett has overseen seven 24-week groups of six-to-11 women each, and has witnessed participants emerge with new strengths.

"Afterward, clients seem to feel more confident and less fearful about some of the things they've gone through in their lives that are impacting them now," Burnett said. "And they see connections between their drug use and their trauma."

Webb says that this approach has changed her life. She is clean and being treated for her depression, while working and living as a caretaker for a kidney patient.

"I was using drugs to cover up the pain; now I can talk about it. I'm not alone and I don't have to be ashamed of my trauma," Webb said. "I walk tall and speak up for myself -- and I can sleep with the windows open."

Too Much Help for Some, Too Little for Others

Fifteen years ago, Derek Fletcher's bed was his backseat. Back then, with his schizophrenia running unchecked, Fletcher, 53, never imagined he'd be where he is today: living in his own place, working a full-time job detailing cars and managing his own medications.

"I feel great about that," Fletcher said. "I feel more independent."

Community Alternatives shepherded Fletcher through his life-altering transition. Fletcher participated in its intensive Assertive Community Treatment program for those with serious mental illness. He was diagnosed, trained for his job and set up on a schedule for his 20 daily medications.

In the beginning, it took a four-person team to help Fletcher learn to manage his life. Every day a staff member came by to make certain he took his meds. But more than a decade later, Fletcher no longer needs the rigorous program and gets by with someone stopping in a few times a week.

The problem is that no step-down process is in place to help ease him out of the program. People like Fletcher get "stuck in this level of service" according to Community Alternatives' executive director, Joe Yancey.

"You have people who are doing better but are scared to leave those services because there's a real fear of returning to the state of health they were in at one time," Yancey said.

The need for a lower level of services will also be met by the five-year "transformation" grant. The award funds programs that prepare people to thrive with reduced services.

These step-down programs will free therapeutic teams to help others who've had to limp along with no services at all while other clients received more services than they required.

Nancy Fowler Larson, a freelance writer in St. Louis, frequently covers issues of health and mental health. 

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