Isaac Brown has a story to tell. “I was diagnosed with schizophrenia and told that I would never work and never live on my own again,” he explains. That prognosis could easily have come true. But, it didn’t.
Through multiple hospitalizations, three years in a day hospital and seven years in supportive housing, Brown believed in and worked toward the goal of his own recovery. “Today, I own my own home in New Jersey. I have been married for 15 years and have a 14-year-old daughter,” he explains.
Brown is also President/CEO of Baltic Street A.E.H., Inc., the largest peer-led mental health agency in New York State. And, in that capacity the story of his successful struggle to manage his mental illness and live a happy, independent and productive life as part of the larger community is particularly important. Brown’s story … and similar stories which can be told by the 90% of Baltic Street’s employees who also have been diagnosed with mental illness …serve as an inspiration and demonstration to 5,000 men and women annually that recovery is both a realistic goal and a very achievable possibility.
Baltic Street A.E.H., Inc. was founded in 1996 with creation of the Brooklyn Peer Advocacy Center. The idea was to see whether peer advocates – men and women who themselves had successfully received services for severe mental illness – could be effective in helping others to do the same. With $96,000 in funding from the NYC Department of Mental Health and support from South Beach Psychiatric Center, a team of six part-time Peer Advocates was assembled. Brown, the Program’s Director, was the only full-time employee.
“There were seven of us, all packed into one office with just three phones,” says Brown. “We were stepping over each other. It was really primitive.”
But, it was also exciting. “It was an experiment. We had something to prove. This was new. There was no clear guide to what we were going to do and how we should do it,” says Brown.
The Peers were there to help clients with severe mental illness put the pieces of their lives back together -- access entitlements such as Public Assistance, Medicaid and Food Stamps; find housing and legal services; connect to other community programs; obtain employment assistance and vocational training; etc. Perhaps most important, however, they were there to be one person who clearly understood and could relate to what the client was going through – because they had gone through it themselves. “Been there and done that!” is a mantra of the Peer Advocacy movement. The peers were walking, talking proof that there really was light – in the form of recovery – at the end of the tunnel no matter how dark it might seem at the moment.
By year’s end, the program had proven itself to be successful. “We served 400 people in that first year. They were coming from all over Brooklyn.”
Today, Baltic Street has grown from that one office and a handful of peers to a $4 million agency, with a staff of almost 100, serving 5,000 unduplicated individuals every year with advocacy, housing and employment programs across New York City.
The Brooklyn Peer Advocacy Center -- that very first pilot – continues to serve at least 500 new clients with severe mental illness who require multiple visits and multiple services. In all, the program probably sees closer to 1,000 individuals. Most clients are referred by their treatment team – psychiatrists, psychologists or other therapists. Some walk in having heard about the program from other individuals with mental illness who have been helped there.
“People come to us in the worst possible situations,” says Zena El-Etr, the Program Director who supervises a team of 10 Peer Advocates. Clients represent a broad range of situations, from previously well-to-do professionals whose lives are suddenly devastated by the onset of mental illness to those who may have lived homeless on the streets between multiple psychiatric hospitalizations for a dozen years or more. Almost always, their lives are a shambles.
“We do whatever we have to do to help the client become self-sufficient,” says El-Etr. Each client develops an Individual Recovery Plan in collaboration with their Peer Advocate. The plan incorporates the individual’s goals and outlines steps to achieve them.
“We help them apply for entitlements across the board – Social Security Disability, Food Stamps, Medicaid,” says Peer Advocate Fred Muniz. “We even help them with immigration and legal services.”
The list of issues that Peer Advocates work on seems endless. “We never give up,” says Peer Advocate Hylema Aiken.
“We give them the feeling that they have someone who cares,” says Muniz.
“Every time we help somebody stand on their feet and come back as close as possible to their normal life it is a success for all of us and that is how we keep going,” say El-Etr.
Clearly, the Peer Advocate’s own history with mental illness can serve as a natural bond between them and their clients.
“We suffer from the diagnoses just like they do,” says Anthony Sgarlato, who joined the agency 12 years ago and is now a Peer Advocacy Supervisor. “We are just in different stages of recovery. They trust us because we have been through it.”
The Baltic Street philosophy allows peers to disclose as much or as little of their own personal histories as they see fit. “Sometimes it is a good tool,” says El-Etr. “Sometimes it is the opposite. It can work both ways, depending on the individual and sometimes the culture he is from.”
Soon after its first-year’s success in Brooklyn, Baltic Street won funding to launch replications in other boroughs. Both the Staten Island and Bronx Peer Advocacy programs serve over 500 unduplicated new clients each every year.
The agency has also created an Older Adults Advocacy program for individuals aged 65 and up with severe mental illness, which is located at the 250 Baltic Street headquarters. Serving 90 individuals annually who reside in three Brooklyn Community Districts (5, 16 and 18), the program may be the only peer-to-peer program that offers services to seniors with psychiatric disabilities.
Particularly important for these clients are the socialization groups that help keep increasingly frail individuals with mental illness in touch with networks of friends and acquaintances in the larger community. “Clients are always happy to have a phone call or a visit from those who are concerned about them,” says Janice Jones, one of Baltic Street’s six original Peer Advocates, and now Chief of Operations at the agency.
Another significant component of Baltic Street’s Advocacy work are its Bridger Programs which assist consumers to make a successful transition from psychiatric hospitals or other supervised residential programs back into the community.
“These programs are extremely cost effective,” says Isaac Brown. “The Bridger Program at South Beach, for example, is funded for less than $300,000 per year. Last year, the seven Peer Bridgers were able to help over 100 people leave the hospital – at a cost of approximately $220,000 per year each -- and remain in the community. That is an enormous savings for the taxpayers of New York. And, it is a tremendously important for the people who are able to sustain their recovery and live at home in the community.”
Bridgers, specially trained Peer Advocates, begin working with clients, individually and in groups, while they are still in hospital. While most of these incoming consumers are referred by hospital treatment teams, some are self-referrals. Bridgers’ bring a unique perspective to the treatment environment, having a primary responsibility to advocate on the client’s behalf, while also being a member of the hospital staff.
Bridgers ensure that proper linkages to treatment and support are established in communities to which clients are returning. They will accompany consumers to their initial appointments as a way of providing travel training and support. Bridgers also accompany clients to Social Security/Medicaid offices to help ensure that they successfully enroll in entitlement programs to which they are entitled. Often, individuals coming out of hospital may need help gathering or reapplying for crucial pieces of personal documentation – birth certificates, drivers licenses, Social Security Cards, immigration papers – that are key to winning approval of entitlement benefits.
Once back in the community, Bridgers continue to provide follow along services for at least three months to ensure that consumers adjust to life on their own. In some cases Bridger’s may be the only link between ongoing serves while clients are waiting to connect to treatment clinics or receive benefits. These supports and services are essential to effective community integration and are crucial for preventing relapse and possible re-hospitalization.
In addition to one-on-one support, services include Peer Bridger-run groups on a variety of topics, including recovery, pre-discharge planning and life skills.
Once again, Peer Bridger programs are premised on the “If We Can, You Can Also” mantra designed to inspire and empower consumers to believe in and work toward their own recovery.
Baltic Street runs three Bridger Programs which together serve a total of 336 new consumers every year. The Kingsboro Bridger Program serves individuals transitioning out of Kingsboro Psychiatric Center in Brooklyn. On Staten Island, Baltic Street runs both the South Beach Bridger Program, for individuals leaving South Beach Psychiatric Center, and Lodge Bridgers. The latter program services clients who have elected to come to the Lodge, a supervised residential program, rather than being immediately discharged into the community.
Rounding out Baltic Street’s advocacy services are two Self-Help Programs.
Manhattan West Self-Help offers mutual support and self-help groups in CDs 1, 2, 4 and 7 in Manhattan. It is located at 163 W. 125th Street. Brooklyn Peer-Self-Help and Socialization Program is based in the agency’s 250 Baltic Street headquarters.
While staff facilitate groups initially, the goal of these programs is to train the participants to run the groups by themselves, making them truly mutual support and self-help groups. Gaining skills and confidence around running the groups is empowering and people can use that knowledge to move forward in other areas that will enhance the quality of their lives.
Attendance at Baltic Street’s Self-Help Groups is strong, with more than 600 individuals enrolled for a total of 30 groups in Manhattan and almost 400 enrolled for 130 groups in Brooklyn.
In 2000, Baltic Street took its first steps towards addressing one of the most critical barriers to recovery for many consumers – a lack of housing. “We got approval from NYS Office of Mental Health to open ten beds of scattered site supportive housing,” says Brown. Soon after, that was followed by another 17. Subsequently Baltic Street was awarded another contract to operate 60 additional scattered site units in the Bronx.
“Next to medication, stable housing is the most important thing in our clients’ lives,” says Steve Simpson, Director of Housing Services. As with most other staff at Baltic Street, he knows from personal experience. “I was in supported housing and it was very good for me. It helped me get myself back on my feet permanently.
Consumers live in apartments to which they hold a sub-lease. Baltic Street tries to ensure that the apartment locations truly are “scattered” so that consumers are thoroughly integrated in the community. “We don’t want to create a ‘mental health slum’,” says Simpson. Clients pay 30% of their monthly income towards the rent. Housing Specialists visit consumers on a monthly or as-needed basis to check in and assist them in accessing services or address any other problems that may arise.
“Our goal is to help them integrate into the community and advance their recovery,” says Simpson. “We want to make sure that their quality of life is equal to or better than their neighbors.” He notes that for many consumers, who may have been institutionalized for much of their lives, living independently is not easy.
For many individuals with mental illness, the ultimate recovery goal is to re-enter the workforce and find the fulfillment and self-sufficiency that comes with having a job. And, work itself has a powerful therapeutic value. “It really got me going,” says Anthony Sgarlato. “I never missed a day. I worked here two-and-a-half years before taking a day off. I loved it.”
To address this need, Baltic Street operates two Assisted Competitive Employment Programs in Brooklyn. The Network Plus programs assist mental health recipients with their search for meaningful employment. “Our range of services help clients assess their strengths and barriers, set realistic goals, improves job skills, and find the job that’s right for them,” says Steve Duke, Director of Employment Services. “With our support, clients are empowered to take better control of their lives, both on and off the job.”
Services range from initial work readiness assessments, through job search, and follow up services such as on- and off-site job coaching and strategies for job retention and long term career development.
Network Plus East, located at 25 Flatbush Avenue, and Network Plus West, at 1080 MacDonald Avenue, together serve 140 consumers annually. Approximately 44% of program participants have been able to obtain competitive employment, while another 9% are provided with transitional employment opportunities, such as internships, paid training or volunteer work.
Resource & Wellness Center
In 2010, Baltic Street opened a Resource and Wellness Center at 882 Third Avenue in the Sunset Park section of Brooklyn. “It is a place where people can gather to be at ease, get help with basic needs, socialize, learn new skills or practice old ones, and help one another move towards a more satisfying life experience,” says Sara Goodman, the program’s Director. “Center staff can guide people as they learn to become better problem-solvers and decision-makers, to set and identify strategies to meet personal goals, and to develop networks of natural supports so that they can become active participants in the community of their choice.”
“It’s like a community center where the creative arts is a major thrust,” says Isaac Brown, who is himself an artist. “There is a real therapeutic value to the arts. It is cathartic as a way of letting things go, and it is creative as a way of moving ahead. It has really helped me.”
The Center also reflects Baltic Street’s strong new emphasis on holistic treatment and the importance of wellness as part of all its programs. Many agency staff have recently been trained in the Eight Dimensions of Wellness. “A client may come in for help with one problem because he is in crisis, but we want to help him identify any other issues he has so we can help him to avoid future crises as well,” says Brown.
Baltic Street’s newest program, Community Links, is an effort to meet the needs of young adults – ages 18-25 – who are aging out of youth services.
“Our mission is to help Community Links participants improve their quality of life by achieving independence and self-sufficiency, through community participation and integration,” says Program Director Yasmine Kamel. “We will work with individuals to link them to non-mental health resources to meet their needs and aspirations, so that they may achieve true inclusion in the community beyond the mental health system.
“We want to ensure that these young people do not end up as career mental patients,” says Brown. “We want to help them get back into school and build a future for themselves.”
Community Links is based at 1111 St. Johns Street and hosts two events each month, showcasing resources in the community and providing clients with an opportunity to utilize them. “Our events will take a variety of forms and will often involve speakers, presentations, panels, workshops, shows, and interactive groups, along with an atmosphere conducive to socialization and networking,” says Kamel.
Baltic Street, like all other mental health service providers, operates in an environment that is changing radically and rapidly. The State’s move to transition virtually all Medicaid recipients – including those with Serious Mental Illness – into managed care is certain to have implications for the role played by peer advocacy services.
Baltic Street’s new Optum Bridger program offers a peek at one possible vision for the future. “We have a one-year contract with Optum to help individuals coming out of Maimomedes and Kingsboro to re-integrate into the community,” says Brown, who argues that Peer Bridger services are effective in helping keep consumers in the community and out of high-cost hospital beds. “Managed care companies are all about managing costs. We think this is going to be successful.”
A lot has changed since Brown and those six Peer Advocates began the Brooklyn Peer Advocacy Center in 1996. In those days, the concept of Peer Advocacy was still new and far from accepted by the broad majority of mental health professionals. “When you went into the hospitals, nobody knew anything about peers,” says Brown, who had been trained as an Advocate while at South Beach and then directed a Clubhouse program before coming to Baltic Street. “It was unheard of for someone with a diagnosis to come in and talk to professionals.”
With quiet persistence and demonstrable success, however, peer advocates have proven their value and effectives as part of the mental health treatment system.
“Clinicians don’t have time to get housing for clients,” says Robert Sanchez, who joined the agency 12 years ago. “They rely on us to do that. They have come to accept our role as important.”
“We have gained their respect,” says Zena El-Etr.
“It takes 20-30 years for something new to become part of normal medical practice. We are finally coming to the point where peer services are seen as an integral part of the mental health system,” says Brown. “If you want proof that peer support works, just look at what we have been able to do at Baltic Street.”