The Challenges at Genesis

The primary focus is patients not targeted by other programs. Patients with Major Depression, Bipolar Affective Disorder and Schizophrenia can be seen at Guest House (a Sacramento County Mental Health Clinic run by El Hogar). Our patients have Adjustment Reactions, Post Traumatic Stress Disorder, Atypical Anxiety Disorders, etc. They often are more transient and have literally "fallen through the cracks." About a third are classically homeless; i.e., they live by themselves in a van, sleeping bag or near the river.

Many are in transit, either passing through or recently estranged from family or significant others and living in temporary housing or with a friend. Well over half are recovering from lifelong drug and alcohol problems. Most are severely mentally ill and don't trust or tolerate any closeness. All are very grateful for their care at Genesis. Often this is the first time they have been able to get support and counseling and be on medication consistently. Some are old patients of mine who have come on hard times. Many of the women are trying to achieve sobriety and mental stability in the hopes of getting their children back from foster home care.

This has been an excellent training site for Sutter Family Practice residents on their psychiatric rotation. Many patients have "triple" diagnosis: medical (hepatitis, chronic infections, hypertension, diabetes), drug abuse and mental illness. It is an eye opener for most residents.

Some of the stories are incredible: A 24-year-old man recently tried to re-establish ties with his 3-year-old son. Unfortunately, he and his ex-wife got into one of their usual conflicts and he reacted by getting drunk. He ended up stabbing himself in the abdomen. Now he recalls this with grief and mourning, seeing his own young son in his arms covered with his blood. He cannot see his son again and has to deal psychologically with the colostomy brought about by his-self inflicted stabbing. We have helped him try to get his whole life back on line.

Another is an older man who "escaped" from the Northwest. He was always very dependent on his mother, but she was becoming disabled and his family tried to put him under a conservatorship. He arrived in Sacramento homeless, depressed, confused and unable to take care of himself. He had a trust fund, which he was unable to access but which prevented any public assistance. A MSW intern took him on as his personal project and got me involved. He was started on medication, housing was obtained and we set up a system for him to receive payments from his trust fund. He even called his mother from my office. He is an interesting "exception" to the expectation that the homeless do not follow through with care. He has come in weekly for therapy and has seen me for 10 medication visits. This is the first time in his 50 years that he has been able to get and respond to consistent mental health care.

Several recovering methamphetamine addicts appear to be adult Attention Deficit Disorder patients. We are working with a pharmaceutical company to obtain a safe and therapeutic form of stimulant medication via its medically indigent program.

This is a very needy, but gratifying group of patients. Our "pay" has been the thanks and praise we get from them and seeing their progress. It also helps to have such a supportive and grateful staff. Unfortunately, we can only provide coverage three mornings a week.

We could use at least five more volunteer psychiatrists. If interested, please contact me at (916) 386-3846 or Sister Libby at (916) 669-1536.

jamadapa@earthlink.net