Working Their Way Back

On a day in 1995 that he recalls only vaguely, Bobby Frazier, a beefy sandblaster from Long Beach, Calif., took his diabetic mother to the hospital and, inexplicably, waited for her on a bench at a nearby bus stop. When he learned that she had died, he refused to leave the bench and remained there for 16 months. "My mind completely snapped," Frazier, 38, explains. "I slept sitting up and urinated on myself. My family brought food. Bus riders gave me blankets. I religiously believed that my mother would one day get off that bus."

Four years later, Frazier is well again. He has worked for two years on an elite longshoreman's crew that cleans up oil spills, and served for a year as president of his union local. He commutes to work from a new apartment, where he lives with his wife and four-year-old daughter. Frazier owes his stunning turnaround to medication that has brought his mental illness under control, but also to an underutilized treatment known as psychosocial rehabilitation. This approach aims to remedy what many see as a great failing of America's treatment of the mentally ill--once they are stabilized with drugs and released from the hospital, they are too often left to fend for themselves, with no one to counsel them, monitor their progress or help them find work. That has led to much private suffering but also to some public tragedy, as in the case of Andrew Goldstein, a New York City man suffering from schizophrenia who pushed a woman to her death off a subway platform. Goldstein's murder trial ended in a hung jury this month, but the public mental-health system's neglect of him as a ward has spurred calls for reform. Last week New York Governor George Pataki, whose administration has repeatedly squeezed mental-health budgets, proposed spending an additional $125 million for community services.

Instead of abandoning the recovering mentally ill when they leave the hospital, psychosocial rehabilitation nudges them toward jobs, apartments and increased responsibility. Individuals are assigned to treatment teams composed of psychiatric professionals and "life-skills" specialists, who see them as often as three times a day or as seldom as once a month, depending on need. These teams monitor medication and offer both practical help and psychological support in getting former patients back into the working world.