FREDERICK, Md. — It’s a little after noon. Usually by this hour, David Weiss would be waking for the second time, still groggy from his antipsychotics. He’d have gotten up once at dawn, maybe made himself an egg with toast. He might have gone into the back bedroom to scan his ham radio or played a few chords on his guitar. Then he’d go back to sleep.
But on this day, he had somewhere to be. It’s easier to get up on days like this, days with a purpose.
And so at noon, he is sitting in an abnormal-psychology class at Shepherd University in Shepherdstown, W.Va., his arms crossed and a plate of pizza balanced on his lap. At 64, Weiss still has a full head of wavy silver hair and a broad, kind face and a bulbous nose that make him a dead ringer for a mall Santa. He wears a Hawaiian shirt that smells faintly of incense.
He’s giving a talk to the students about life with mental illness.
Weiss talks about his hallucinations. He’s seen tigers in the trees and black triangles in the sky. He’s heard his late mother’s voice and ringing bells. He makes a motion like he’s stabbing himself with a pitchfork. “The devil was on my ass,” he says.
There was a time in the United States that a person talking about visions and voices may have been condemned as crazy and removed from society. But in 1963, President John F. Kennedy set in motion the deinstitutionalization of patients in psychiatric hospitals and called for community-based programs to take their place. An unintended consequence has been that people with mental illnesses have increasingly ended up without access to services at all, living on the streets or in jail.
This was the case for Weiss, who for a time was homeless. But eventually, Weiss wound up lucky.
Weiss is a client — there are no patients, only clients — at Way Station Inc. run by Sheppard Pratt Health System in Frederick, one of the first programs of its kind in the country to use social support systems to integrate people with mental illnesses into their communities. Way Station gave him his own apartment as well as a case manager who checks in with him daily. It even helped him enroll in community college, where in 2010 he realized his teenage dream and graduated with an associate degree in music.
But slowly, funding has stalled for the program he has come to rely on, and a part of it that was improved by the Affordable Care Act is threatened by the Trump administration’s plan to dismantle health-care reform. And so Weiss, who has been emboldened as an advocate by his experience with Way Station, feels even more urgency on this afternoon as he tries to explain to these college students what the program has meant to his life.
He shares the accumulation of experiences that brought him here: Depression as a child. Obsessive-compulsive disorder as a teenager. Major depression and paranoia in his 40s. Then, recently, bipolar disorder. He checked himself into the hospital five times last year with mania. Depression makes you loathe yourself, he’ll say, while mania makes you rage at the world.
There’s no hint of self-pity. Way Station has given him a voice. It’s given him a life.
“The inmates ran the asylum, and I loved that. We had a hand in our own future. I liked it. I liked the freedom,” he recalls of his first impression of the program. “This is a good time for mental illness, if there ever is a good time.”
As the psychology students pack up after class, a male student approaches Weiss and shakes his hand. “Thank you for everything,” he says.
“Good luck, brother,” Weiss says, placing a hand on the undergrad’s shoulder. “That’s a great thing to help people out of their suffering.”
Way Station is part of the fabric of the community here. Local businesses hire its clients. Tree-lined residential neighborhoods are dotted with houses and apartments occupied by people with mental illness. A community center where some clients gather for a day program is located just several blocks from the bustling downtown of antique shops and boutiques.
“We all need to feel like part of a community. We need to feel meaning in our life. These programs acknowledge these basic human needs,” said Jackie Goldstein, a retired psychology professor at Samford University in Birmingham, Ala., who spent years traveling the United States identifying programs that take a similar approach. She found them scattered in places big and small — from New York City and Chicago to Cuttingsville, Vt., and Crozet, Va.
No matter the severity of clients’ illnesses at Way Station, they can have jobs, real homes and control over their lives. Jim Kreuzburg, who was diagnosed with paranoid schizophrenia and depression, lives alone in his own basement apartment and clears carts in a supermarket parking lot twice a week. On days off, he’ll go to work anyway just to see his co-workers. Susie MacMullen, who has serious cognitive disabilities in addition to her mental illness, prepares trays once a week for kids’ night at Roy Rogers restaurants. For the first time in her life, she sees herself as a winner, she said.
Over the years, there has been some resistance, particularly from those wary of living in a neighborhood with Way Station housing.
Joe Fitzgibbon, his two children then quite young, was devastated when Way Station converted a house in his neighborhood into one of its group homes.
To win his acceptance, Scott Rose, Way Station’s chief executive director, met with him for monthly breakfasts and gave him his personal cellphone number.
“Looking back on it, it was ignorance on my behalf,” Fitzgibbon now says.
It’s difficult to quantify how many programs there are across the country that implement some or all of these social supports, but it’s far fewer than it should be, according to Howard Goldman, a Maryland psychiatrist who participated in the surgeon general’s first critique of the U.S. mental health system in 1999.
There’s little appetite to invest in them, and it’s still an uphill battle to convince insurance companies that covering a jobs-placement program is a health issue, he said.
Way Station, which serves more than 5,000 people across Maryland, is fortunate that Maryland strongly supports these types of programs, but funding has become precarious.
The program receives 84 percent of its $37 million annual budget from local, state and federal funds, with a majority coming through Medicaid spending. Since 2004, the state’s spending per person on mental-health services has fallen 27 percent when adjusted for inflation, according to the Community Behavioral Health Association of Maryland.
There’s high attrition among Way Station staff seeking higher-salaried jobs. They’ve had to cut popular programs, like a horticultural unit where Weiss once worked.
There’s also the looming threat of a repeal of the Affordable Care Act, which made Medicaid funds available for coordinated care, also called health homes. Way Station has taken advantage of this program, allowing its clients access to primary care nurses and doctors in conjunction with their mental-health services.
It’s through this program that Weiss has managed his physical ailments. He has chronic obstructive pulmonary disease from years of smoking — although Way Station helped him quit — as well as diabetes and heart disease.
Without Way Station, he says, he’d most likely be dead.
Practicing coping skills
On a warm fall afternoon, Weiss is in his one-bedroom Way Station-owned apartment, sitting cross-legged on the twin bed he keeps in his living room. A flat-screen television stands alongside it, barely a foot from where he sleeps. It’s hooked up to the Internet, and he uses it mostly to watch jazz musicians on YouTube. If life had gone differently, maybe he could have been one of them.
His case manager, Jim Williams, walks in, as he does almost every day around this time. Even with Way Station’s financial burdens, Weiss is among the more fortunate. Staff turnover is quick, but Williams and Weiss have had 3 1 /2 years together.
Williams tells Weiss that he sounds tired, and Weiss says he is. Williams asks him if he’s still working on his coping skills — playing music and using deep breathing to lessen negative thinking.
“Yeah, it works like magic, too,” Weiss says of the meditation.
“Pull a weed, plant a flower” is a favorite mantra, a reminder to replace a negative thought with a positive one. Weiss is a spiritual man, a practicing Buddhist from his days as a pot-smoking hippie hanging out in Dupont Circle. During the good times in the 1970s and 1980s, he worked as a champion of affordable-housing issues in Arlington, Va., and later took his advocacy to Jackson, Miss., and — for a brief time — Maui, Hawaii, all while raising his son, Damien, as a single father.
It’s difficult for him to square his anger with the inner peace he strives for. He likes to walk the quiet grounds of a secluded, wooded Tibetan meditation center 20 minutes from his home, talking to the monks and kneeling in prayer in the shrine hall.
His medication exhausts him, or he’d go more often. But at least the pills are working to halt the mania.
“It keeps me from going up, not from going down,” Weiss says to Williams.
“This goddamn illness,” he mutters to himself with a sigh.
For now, his depression is mostly under control. After his son left home in the early 1990s, the anguish had built up like piles of weights on his chest until he could no longer lift himself up out of bed to go to work.
He lost his job as computer bench technician. Without a paycheck, he couldn’t afford rent. He slept in his truck, parked in campgrounds and under trees. He became paranoid. He wanted to die.
In 1999, after years of homelessness, his younger sister, Faye, who lived in Frederick, told him he should come check out this program called Way Station.
A passion for music
Way Station is not a panacea. Weiss’s mania emerged only recently. When he’s been manic, he tried to wrestle guards at the hospital, drove with his eyes closed for seconds at a time, and called Faye, the person he’s closest to in the world, and threatened to “[defecate] on her lawn, kill her dog and burn down her house.”
But the program has offered him a chance to lead a meaningful life, in part by helping clients like him identify their passions and interests and helping them pursue them.
For Weiss, that’s meditation. And it’s his music. So when he expressed a desire to earn a college degree in music, Way Station helped him enroll. He graduated, feeling an emotion he hadn’t in many years: pride.
His professor, Anita Thomas, an Australian jazz musician, has a gig most Thursday nights at a local restaurant. Weiss has an open invitation to join her to play any time.
On this night, Weiss drags his amp and acoustic-electric guitar inside the dimly lit restaurant. He sits at a round table with Thomas and the other professional musicians she plays with. Weiss sips a soda and listens to them talk about jazz.
None of them, other than Thomas, knows he has a severe mental illness.
After a few songs, Thomas motions for Weiss to come join them. He sits on a chair facing the room of beer-slugging strangers. To them, he’s just a guitar-playing middle-aged man in a Hawaiian shirt jamming with the band. It would be, Thomas would say later, the best she’d ever heard him play.
He strums the opening notes of Irving Berlin’s “Blue Skies.” It’s just an instrumental, but the lyrics are there in his mind.
I was blue, just as blue as I could be
Ev’ry day was a cloudy day for me
Then good luck came a-knocking at my door
Skies were gray but they’re not gray anymore