My alarm goes off at six. Like every morning, even the weekend. I want to lie still and savor the soft bed, but I push myself up to a sitting position quickly; it wouldn’t do to doze off again. The consequences for such a minor infraction aren’t too bad, but still uncomfortable. Besides, I’ve done quite well this week and I don’t want to screw up now. So I grab my hairbrush from the nightstand, pull my straight brown hair into a ponytail and start putting on the clothes I laid out last night.
Washing my face is next on the list, and as I rinse off the soap I realize that I actually feel pretty good today. It’s amazing what taking my meds properly, having a regular sleep schedule, eating a balanced diet and getting consistent exercise does for my mood. It doesn’t solve everything, but it really helps, and for the thousandth time I wish that I could just do these things on my own. But I’ve proven to myself too many times that I can’t. That’s why I’m here. I’m lucky to be here. Really.
“If we want to improve the overall quality of life for those who struggle with mental illness and/or substance abuse, something must be done about all who are falling through the cracks. These are people who do well in settings that provide structure for them: they tend to be cooperative and make good progress in treatment facilities. But when this structure is removed, they quickly or slowly deteriorate, and eventually turn up for emergency services to start the cycle over again.”
Down the stairs to help with breakfast and getting the kids off to school. They’re nice kids, actually. I was worried that there’d be drama there, but after a little initial awkwardness we get along pretty well. Kayla’s cute and funny, and as long as I laugh at her seven-year-old jokes she likes me. Brendan, at 11, is more distant toward me but basically respectful. I think he has the idea that he’s too old now to bond with a “girl” but he forgets it when I help him with math.
“This forward-thinking program provides benefits to all involved. Clients get the structure so vital to their well-being, along with the opportunity to feel useful by performing needed work in a safe environment tailored to their individual strengths and needs. Hosts receive services that help their household function better, along with training in managing a client safely and supportively.”
I’m wiping off the kitchen counter when I hear Mr. and Mrs. Carson chatting on the stairs. “Good morning,” I say, reaching for two coffee mugs. “Morning, Tina,” Mrs. Carson replies. I finish pouring her Sumatran blend and hand it over. “Schedule OK?” she asks as I start Mr. Carson’s cup. I glance at the printout tacked onto the kitchen cork board and nod. “It’s fine, Mrs. Carson, the morning’s a normal Wednesday and at noon I leave for my check-in appointment.” I always appreciate that she’s friendly. After all, it would be understandable for her to treat me with some coolness.
Mr. Carson is preoccupied, as he usually is at this hour. We tend to interact more at night. He just gives me a quick, acknowledging glance and half smile as I deliver his Jamaican Blue Mountain, cream and sugar. I head to the locked cupboard by the sink, where Mrs. Carson is placing her thumb to the print pad. I match her, and the cupboard clicks open to reveal the med modules. Each day’s morning and evening assortment, neatly portioned out by the agency. She watches me swallow them all, looks into my mouth when I’m done, and recloses the cabinet.
“It’s time to be realistic. Society can no longer afford to keep paying to give expensive psychiatric medications to patients who are not going to be compliant in taking them. Waste, misuse, and illegal sale are rampant. Our program provides the newest and most effective medications, to clients who are being held accountable for taking them properly and consistently. Our hosts are trained to understand the purpose, action and side effects of a drug, and strict documentation procedures give psychiatrists all the data needed to evaluate and adjust a client’s treatment.”
Soon everyone’s off to work and school, and it’s just me and the surveillance cameras. Wednesday morning schedule is fairly typical: breakfast (documented,) workout, shower, then a half hour break I spend reading. Two loads of laundry and some dusting later, it’s time to get ready to go. My wristband beeps at me, as it has done to remind me of every scheduled event this morning.
I get out of the house at least once a day. It’s on the schedule–after all, the mental health benefits of fresh air and sunshine are well known. But many of my outings are just errands or a walk around the neighborhood, so this twice-monthly trip into the city is a treat.
“Client safety and well-being is our priority. Because of our program’s reduction in client emergency services and inpatient stays, we have the resources to provide them with excellent individual and group support. Each client works with a coordinator who monitors their progress and gives them an opportunity to share any feelings or concerns that arise.”
The bus lets me off three blocks from the agency office, and I walk fast to get there the required fifteen minutes early. “Hello,” I say with studied clarity to receptionist at the polished wooden desk in the main lobby (was that mahogany? The program must be doing well.) “I have a one o’clock with Sandy Kane; my name is Tina Munoz.” I wait until she says what she always says, “Down the hall, second door on your right,” and then head to the waiting room.
There are about 15 people scattered in the straight brown chairs. I pick a chair and start checking through my documents one last time: activity log, daily mood inventory, meds data…thank God for smartphones, because I would have to carry a briefcase here otherwise. I make sure the Carsons have viewstamped everything; it all looks good. One time I arrived with an incomplete set and they rescheduled my appointment. Not good: it disrupted my schedule and thus the Carsons’, and I got Level Two discipline.
“The motivation of our clients is high, as evidenced by the large amount of applicants for our completely voluntary program. Both positive and negative reinforcement are necessary, however, in shaping responsible behavior day to day. The question of negative reinforcement has always been a controversial one, and we have been criticized at times. But we must look at what works, not what is politically correct. Pain has been an effective deterrent throughout human history, and when applied responsibly can be far more effective and less traumatic than deprivation of privileges or liberty, which can increase depression and feed isolation.”
“Discipline, Tina?” Sandy asks, glancing down at her clipboard. “Nothing since last time, Ms. Kane,” I answer. I’d overslept three weeks ago. I could take a Level One like that pretty well; it was more embarrassing than anything else. “Well, you look great,” she smile, scanning my body. “Healthy, good muscle tone. I see here there weren’t any changes in your meds at your last visit with Dr. Jarin?” “No, ma’am, it’s been stable for four months now.”
Sandy leans back in her chair with a satisfied sigh, placing my phone back onto the desk between us. “You’re doing so well, Tina. It’s hard to believe you’re the same girl I met two years ago…or even the same one who sat here last year!”
I look down at my hands in my lap, remembering how I couldn’t keep them still then. I’d rehearsed for the interview for a week, after trying to get it for six months. What did they want to hear? What could I say that would get me a chance? Sure, I’d heard the stories from people who were uncertain about staying or who chose to leave. But how could it be worse than the shelters and streets? After strike two at county rehab, no place would take me any more unless I were actually bleeding.
The thought of blood reminds me of my wrist scars and I self-consciously check to see that my sleeves are pulled down. Don’t know why I bother, it isn’t as if Sandy doesn’t know about them. My sleeve also covers the small tattoo on the outside of my upper left arm, the one I had to be talked into getting two years ago. They’re not mandatory, of course not, but Sandy had been so persuasive. ”I’d just hate to see you miss the perfect placement because someone else has dotted their i’s more thoroughly,” she’d said. “Host families know that this will protect and identify you even if the worst happens; that they won’t have to worry and wonder…and especially being an M1Dual, dear…”
She was speaking nothing but the truth, I know. She genuinely cares–and she knows how hard it is for Duals to find good placements. M1s have it worse than A1s, too. When addiction presents before or with the mental illness, there’s always the hope that the mental health issues are caused by the substance abuse and will go away in recovery…but an M1, like me, with a diagnosis older than my acting out, is another story.
Focus! It won’t do to be drifting off here. Forcing myself back to the present, I see Sandy’s fiddling with her gold bracelet. She does that when she’s nervous, so I know what’s coming next. She clears her throat. “And…is all well with you and…” I know my role, to spare her further embarrassment, so I nod quickly. “No real changes, Ms. Kane. Still about twice a week.”
“Good. I’m glad you’re…coping well, Tina. You really are a star here, you know. An M1Dual, performing so well. Of course, I knew you were special when I met you. And you’re helping to give others hope, though of course, not all placements have the advantages of yours…” she trails off, looking uncertain again. It’s time to end, so I say the rest of what I’m supposed to say, and we shake hands on my way out. I walk through the lobby, imagining how I would have been received into this clean building two years ago. Contrasting my clean clothes and sensible shoes, calm steps and steady hands, with what I was. Reminding myself how lucky I am.
I do that a lot on check-in days. Positive thinking’s an important part of mental health, and I certainly have a lot to be grateful for. I’ve learned to appreciate the simple things…tastes and textures of foods, clean sheets, showers. Sleeping in a safe, quiet place. Walking or getting on a bus without being an automatic object of suspicion. On the bus back to the suburbs, I fall into a reverie just looking at the sweep of my ponytail falling forward over my right shoulder, gleaming in the descending sun. It’s so clean. So healthy looking, and the light glints off tiny strands of it. Who wouldn’t want to touch it?
Back at the house, homework time goes smoothly. Dinner’s calm, and Mr. Carson drinks sparkling water with his meal. Mrs. Carson goes to bed right after she tucks in the kids and supervises my evening meds, murmuring about a sinus headache. I give the kitchen counter a last rubdown as Mr. Carson heads into his study off of the living room, then wash my hands and brush my teeth in the downstairs bath. No point in going upstairs yet.
Mr. Carson’s study is paneled in rich wood, with a luxurious brown leather armchair and an elegant desk set. He’s seated in the chair, as I know he will be, a magazine in his lap. He lays it aside when he sees me, but says nothing. There’s an unspoken pact of silence in this room. It makes it easier. The thick, soft carpet is familiar under my knees as I sink into my accustomed position in front of his armchair, my hands deftly finding what they must. The room is warm, the carpet is kind to my once-scraped knees, and he always smells clean. As his hand twines firmly (but not too roughly) into my ponytail, I remind myself again that I’m lucky to be here.