Restoring Dignity

A leader of a mental-health group serves diverse constituencies

It’s 6:15 on a warm Wednesday evening, and Kathryn S. Farinholt is chatting animatedly with visitors, volunteers, and board members as they file into the offices of the National Alliance for the Mentally Ill’s Baltimore affiliate. People are arriving 45 minutes early for a lecture on coping with the intractable situations that often face families of people with psychiatric illnesses. They are hungry to learn some useful tips to help them get their loved ones into hospitals during a crisis and to calm them down during psychotic episodes.

Many people coming into the group’s offices on the second floor of the Govans Boundary United Methodist Church are familiar faces. Ms. Farinholt, the group’s executive director, greets each one warmly, giving her rapt attention. A visitor hears snippets of stories about why people are here — an abusive husband, a neighbor looking for information to pass on to the children of a schizophrenic parent.

A pair of newcomers are asked if they would like to sign up for the alliance’s mailing list. At first, they decline, fearing it would upset their mentally ill family member. As it is, they say, they had to fabricate stories to get out of the house to attend the lecture.

Have it sent to a friend’s address, advises Ms. Farinholt. “People do that all the time.”

‘A Personal Mission’

Ms. Farinholt’s high energy that early evening belies the long day she has already put in at the office. Ten hours earlier, she was sipping her morning tea in the few quiet minutes before the office came alive with volunteers. As leader of one of the National Alliance for the Mentally Ill’s busiest local affiliates, she spends her days juggling many responsibilities — running programs for mentally ill people and their families, guiding office volunteers, and sitting on committees that advocate for people with psychiatric disorders. The alliance, whose national headquarters is in Arlington, Va., was founded in 1979; its Baltimore affiliate, which registered as a charity under the alliance’s umbrella in 1983 after five years as an informal support group, serves both the city and county of Baltimore. Its $250,000 annual budget covers the salaries of its two paid employees and its programs. (The group recently hired a third employee for its long-vacant program-coordinator slot.)

Ms. Farinholt got involved with the National Alliance for the Mentally Ill gradually, drawn in at first for personal reasons and then because she saw how her skills could help further the group’s mission. She says she has a relative with paranoid schizophrenia, and her family members have used the alliance’s services. Ms. Farinholt had been a lawyer at a Baltimore firm, and because of this legal background, her experience raising money for her children’s school, and her relative’s illness, a friend asked her in 1994 to become a trustee of the group’s Baltimore affiliate. Ms. Farinholt agreed, and four years later, when the executive director stepped down, she became the organization’s leader.

“I saw that there were things to be done, so I was able to jump in,” she says. “I like a challenge. I like to figure out how to do things from scratch. It’s also my way of doing something useful when I can’t solve my relative’s illness. I’m a classic example of a NAMI volunteer getting sucked in more and more because the job needs to be done and there’s no one else to do it — and not wanting other people to go through what we’ve gone through.”

During the first year and a half, the organization’s budget was so tight, Ms. Farinholt worked without a salary. Five years in, she now makes $53,000 annually — and fund raising has grown from revenue of $79,209 in the 1998 fiscal year to about $237,000 for the fiscal year that ended in June.

Managing Volunteers

As executive director, she says, no two workdays are alike. She sometimes comes in on weekends after working Monday through Friday, but other days she works 9 to 5 or takes time off. “You need to create boundaries when you have a personal mission,” she says. “You need to build time for yourself.”

As Ms. Farinholt settles into the office this morning, the cubicles in the rooms down the hall begin to fill with volunteers — most of them mentally ill people. They will be calling a list of several hundred program participants to update records, ask if the services provided were helpful, and gauge their interest in volunteering.

April White, the charity’s office manager, spends much of her day supervising them, but Ms. Farinholt doesn’t want to insulate herself from the people her organization serves. Despite the chatter and the constant comings and goings out in the hall, her door is always at least ajar, if not all the way open.

When Ms. White goes on vacation, as she did a few weeks earlier, much of Ms. Farinholt’s day is spent with the volunteers. That week, she recalls, “there were seven volunteers in the office at very different levels of capacity. I spent a good bit of the morning trying to break the tasks down so people could do them. That takes time.”

Innovative Programs

On a table in the long hallway outside Ms. Farinholt’s office sit fliers promoting the many programs, support groups, and services the organization offers. Mentally ill people and their family members are trained to conduct classes, workshops, and support groups to teach coping strategies. The Baltimore affiliate has tested several programs for the national organization that ended up being adopted at other alliance offices across the country.

Among them is In Our Own Voice, in which people with mental illnesses go out and talk to groups about what their lives are like. Another popular program, Virtual Voices, which originated with another nonprofit group but has been picked up and adapted by the alliance’s Baltimore office, is designed to enhance understanding of the struggles faced by people who hallucinate. Participants — police officers, clergy members, and others — don headphones and try to do simple tasks while hearing “auditory hallucinations,” then try to apply that experience to their interactions with the mentally ill.

“Police officers are often the first responders to behavioral problems that may or may not be mental illness,” says Ms. Farinholt. “They come into situations that can often be dangerous, and their goal is public safety.”

Virtual Voices, she says, can help them recognize and deal with people they may encounter who may not follow their commands because they are hallucinating or delusional. The knowledge may help save lives: The Baltimore metropolitan area has seen incidents in the past few years in which police have responded to disturbances and wound up shooting mentally ill people, she says.

Other alliance programs add a touch of creativity in their efforts to foster empathy for mentally ill people. For instance, the Baltimore group sponsors an annual mask competition that is designed to raise awareness of the organization and of psychiatric disorders. Artists, students, and local residents are invited to create masks showing the many faces of mental illness. The winning creations are displayed in an exhibit that travels to local libraries, galleries, and bookstores.

Volunteer Help

The alliance’s programs operate with the help of many people with mental illness, but the Baltimore office wasn’t always bustling with such volunteers. The influx started about five years ago, with the first program in which mentally ill people were invited to take part in a workshop to help the public understand psychiatric disorders, says Ms. Farinholt: “We recruited and trained [mental-health care] consumers to do this workshop, and afterward, they started coming by the office and saying, ‘I need something else to do. I need something to occupy my time.’”

She welcomed volunteers who could enter data in the charity’s computers, update files, photocopy newsletters, and stuff envelopes. But the Baltimore affiliate, with its small staff and limited work space, is not equipped to take on the responsibilities of helping people make the transition to regular paid employment. So she has to turn many would-be helpers away.

“We became known by some [health-care] providers as a good place for these people to transition into the community by doing volunteer work,” she says. “In some cases providers were writing us into the treatment plan. But we don’t have that kind of coordination and supervision.”

In midmorning, Beth Prodey comes in to discuss a project she is working on. Ms. Prodey is a volunteer, though she is being paid temporarily for her work. She says she has bipolar disorder and a history of substance abuse. Despite her extreme ups and downs, she graduated summa cum laude with a master’s of fine arts in creative writing from the University of Maryland at College Park. She taught English composition at the college level, but because of her illness and addictions, she also spent long periods in lower-income jobs or unemployed.

Finally, in her 30s, she was diagnosed with bipolar disorder. Now on medication that has reined in her symptoms, she is able to work again. Her project today is to call people who have participated in the alliance’s Baltimore programs and update their files. “The work in general, after being unemployable, is in itself a reward, but especially at NAMI,” Ms. Prodey says. “It’s a really nice place to work. It doesn’t have a high stress level, like at a business office. It has a totally different feel.”

Also this morning, Ms. Farinholt meets with the head of the alliance’s affiliate in nearby Carroll County to discuss ways the two groups could collaborate. Then she spends a few minutes with an intern who is writing a press release inviting guests to a public lecture on tips for job seekers who have psychiatric illnesses.

It’s lunchtime, and Ms. Farinholt realizes she left her sandwich at home. A visitor steps in the office and quietly offers to pick up some lunch for her. But Ms. Farinholt has a deep-seated belief in treating everyone equally. “If you get something for me,” she says, “you’ll have to ask everybody.”

Strengthening the System

After finding a Power Bar in her desk and sharing a visitor’s yogurt, Ms. Farinholt drives across town to the meeting of a citywide committee that is working on ways to improve police response to people with psychiatric disorders. The group includes representatives of the police department, hospitals, and city mental-health services.

As programs for people with mental illnesses have been cut back throughout Baltimore and its suburbs due to lack of funds, she says, more hospital emergency rooms are filling up with psychiatric patients. One committee member reports that patients can spend as long as 36 to 48 hours in the city’s emergency rooms waiting for a bed.

The group’s goal is to recruit and train some members of the police force to be first responders to calls involving people with psychiatric disorders. Eventually, it hopes fewer mentally ill people will end up in the criminal-justice system and in emergency rooms.

Under the new system, Ms. Farinholt says, a police officer who brings someone into the hospital would also notify the Baltimore mental-health system, which would then connect that person to care and services. “The officers quite often know who the repeat customers are, they know the families, and they know who lives under a bridge,” she says, “but the mental-health system sometimes doesn’t.”

Ms. Farinholt, who conducted a survey of police-training programs across the country, is now in charge of the committee that will be developing the training curriculum. The alliance will handle some of the instruction, asking mentally ill people to tell their stories and using the audio Virtual Voices exercise to help the police officers understand what some people with psychiatric disorders face.

Searching for Answers

After the meeting, Ms. Farinholt stops at home for an hour or so before heading back to the church building for the evening public lecture. The auditorium is filling with a mix of families, mentally ill people, alliance trustees, and other volunteers, all eager for advice to help them through the tough days of having a psychiatric disorder or living with someone who does.

As people walk in, Ms. Farinholt asks for help carrying snacks and soft drinks downstairs from the office to the auditorium. Between greeting newcomers and acquaintances, she answers the phone and checks her e-mail. A caller is asking for directions to the lecture, and a psychiatrist wants her to help him find family members who can give him comments on his new Web site about treatment of mental illness. Another caller wants to compliment the staff for being so nice and helpful over the phone.

It’s past 7 p.m., and the lecture is starting. About 50 people have taken their seats in metal folding chairs in the aging auditorium with worn brown floors and narrow stained-glass windows.

After a few minutes, audience members interrupt the speaker, a specialist in crisis intervention, requesting answers to some of their toughest questions. For example: How could a mother have stopped her daughter from trying to jump out of the back seat of a car moving 60 miles an hour?

Ms. Farinholt picks up on the disparity between the speaker’s general discussion and the audience’s hunger for specific advice. She intervenes to try to get both parties on the same track, and the speaker confesses that some situations don’t have simple solutions.

A few minutes later, while the lecture continues, she slips into her office to quickly meet with a board member. Then, 13 hours after she first arrived that morning, she departs for home.

The National Alliance for the Mentally Ill has far more visibility than it did a decade ago, she says, when people often shunted the subject of psychiatric disorders aside. Now she is doing work that would not have been possible in years past. And for that she credits those who came before her.

“We at NAMI are regularly invited to raise our voices on issues,” she says. “We are on [health-care] provider lists. We’re invited to be on committees. But we stand on the shoulders of all those people who came before and who were loud and irritating and got themselves invited to the table in the first place.”