It has been a long time since I have contributed to the ACA Blog.  Corrections Behavioral Health is busy during the spring and early summer months. 

I had the experience of spending time yesterday with a young man who suffers from schizophrenia, who is attempting to navigate his way through mental health court/ drug court for a class D Felony.  The court proceedings are very confusing to him.  His psychotropic medications are not working for him at all and a change in his medication is being considered.  This client has failed a trial of every anti-psychotic medication on the market and now the psychiatrist is considering the “drug of last resort” Clozapine.

Clozapine is now the drug of last resort first introduced in Europe in 1971.  The manufacturer voluntarily withdrew the drug from the market in 1975 because it causes a condition that can drastically decrease the number of white blood cells in your body.  This decrease in white blood cells can lead to death.  In 1989 the FDA again approved the use of Clozapine.  A patient’s white blood count is monitored weekly during the first six months of use.  If there are no low white blood counts the patient is monitored every two weeks for the second six months.  Then a patient may qualify for a one time monthly blood draw/monitoring. 

Working with this client is very difficult.  The words in his head come out all jumbled, we call it “word salad.”  The client is very frustrated that he can’t make himself understood.  The Judge handling his case says that this client has taught him all about chronic and persistent mental illness, medications, residential care facilities, and community resources.  The Judge has also developed skills to work with this client that he did not have before. 

Mental Health Court/Drug Court has been a positive experience for this client.  He is living in a structured environment learning skills of daily living, medication management, and sobriety.  Yes, he is sober, which is probably his biggest accomplishment to date.  Now, if only his mind could get organized enough to help him to be understood.

The one thing I have not told you is the age of this client.  This 24 year old young man could be our son, brother, a father or friend.  If Clozapine works for him he will spend the rest of his life having blood draws monthly to make certain that his white blood count is normal.  The trade off will be that his mind will be organized enough for him to function in the community and live a normal life.  If Clozapine, the drug of last resort does not work for him, well I really don’t want to think about that right now because the only answer I know is that he might possibly live confused, misunderstood, psychotic, and possibly in prison for not making good decisions.  Not a very pretty picture for a man so young.  Those of us who work in Corrections Behavioral Health cannot give up hope and cannot give up trying.  Some folks depend on us!
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Nancy White is a counselor who has spent much of her professional life working in corrections.