March 4, 2013
He couldn't hold a job for more than a few months before his major depression and paranoia would take over, causing him to lose the job, his friends and wherever he was living. Suicide attempts landed him in hospitals. He went on disability after a doctor determined he couldn't handle stress, and spent years in isolation, barely able to go to the grocery store.
Now Acker works 50 hours a week in a job that requires constant socialization. He's married. He leads camping trips, kayaks, and speaks publicly about mental health policies.
What changed?
"It took the system to change in order for me to change," he said.
Paul Acker
Now 48, Acker has lived through a significant shift in how the state addresses mental health -- one that has made Connecticut a leader in a national push to move from a "medical" approach to mental illness to a so-called recovery model.
In the old system, medication and therapy were seen as "the center of the universe," said Jim Siemianowski, a spokesman for the state Department of Mental Health and Addiction Services. He worked as a senior policy adviser in the department in the early 2000s when the shift began.
"The recovery model really looks at a person much more holistically, and says that people need stable housing, people recover by working, people belong to communities or want to belong to communities, they participate in church or religious services," Siemianowski said. "There is a much broader look at the whole person."
In the old model, Acker said, the top priority of his treatment was making sure he took his medications. It seemed to focus on his weaknesses. Although he loved radio, he was discouraged from pursuing a career in broadcasting, and eventually was told he wouldn't be able to work at all.
The recovery model flipped that. It's aimed at building on people's strengths and passions as a way to recover, and helps people develop skills to live independently.
"They stopped telling me what my goals were and what they should be, and they started asking me, 'Well, what do you want?'" Acker said.
Broken, but not sure how
Acker began seeing a psychiatrist and taking medication before he was 8. He had lots of energy, and thinks that today it would be considered ADHD. He says he can't think of anything positive that came from the years of his childhood spent in therapy.
"The major thing that I think I carried with me all these years is that I was broken, and I wasn't necessarily sure how because no one was telling me how," he said. "We would go to school meetings and all these people with master's degrees and professionals sitting around, and they would look at me and say, 'So what's wrong with you? What's the problem here? We're seeing this, this, this and this that's wrong, and we want you to fix it.'"
As a teen, he dropped out of high school. He worked at a bank, then as a short-order cook. Both jobs, like the ones that followed, lasted a few weeks. Inevitably, "the bottom would drop out" -- his illness would erupt, he'd lose the job, and become homeless.
Major depression means having no hope, seeing the worst in every situation. Having ham for dinner? Acker would immediately think he'd contract some horrible illness from it.
He felt it in his legs. Everything was exhausting, even rolling over in bed. He lost interest in everything, even listening to the radio.
The outside world fed it, too. Everyone's felt depressed -- most go through a rough time and get over it. "If you tell someone you have a diagnosis of depression, it's like, 'Ah, get over it! It's nothing!'" Acker said. "And so it's kind of like this public view that also feeds into, 'Oh my God, why can't I get over this?'"
Some people would imply that he was just lazy. And as much as he knew that he could work hard, there was always a shred of doubt in his mind. "When your self-esteem has been so brought down, it's like that's just one more thing to beat yourself with," he said.
The paranoia made him think people were looking at him, so he avoided going out. When he did, it could take three to four hours to get out the door.
In his teens and early 20s, Acker self-medicated with drugs. He attempted suicide, ending up in psych wards. In 1989, he took 45 Percocets and spent two months in a hospital. A psychiatrist told him he couldn't handle stress and should go on disability.
And that began what he calls "my time in isolation." He rented a room in Farmington and retreated from the world. He grocery shopped at night when fewer people were in the store. At times, he'd give his 89-year-old landlady his grocery list with some money.
Eventually, he moved back in with his mom.
Systemic change
While Acker was in isolation, the state's mental health system was changing.
The recovery movement grew out of research showing that many people with even very serious mental illnesses could recover. It also grew from a push by people with mental health diagnoses to have a say in their treatment.
By the early 2000s there was a growing body of research challenging the historic view that a mental illness was a life sentence, Siemianowski said. There was also a growing recognition of the importance of naturally occurring supports in the community, like family, friends and activities. The federal government was increasingly emphasizing the idea of recovery.
And clients pushed for changes. "Some of what we were hearing from them was they simply wanted a life in the community, just like you or I," Siemianowski said. "They wanted relationships. They wanted to work. They wanted to feel like they were contributing to their towns."
All that spurred a multi-year process at DMHAS to move from a medical focus to one based on recovery, to identify housing resources and how to link people to work and tap into natural supports.
"It really was a systemic change," Siemianowski said.
The department worked with clients and mental health providers, who he said were hesitant to make changes, concerned that it was just "the flavor of the day." DMHAS trained case managers and therapists on how to use recovery principles in their work.
The concept is about more than the premise that a person can get better. It also assumes that each person has some expertise about what works for him, and that the relationship between a client and clinician is a partnership.
Under the old model, people would be discouraged from working until after they were stable on their medications. The new model treats work, or pursuing any passion, as a way to help spur recovery by tapping into what motivates a person.
There's an emphasis on helping people develop the skills to live independently.
"If you're someone who's needing to live independently, I can go out, make a shopping list for you, take you shopping, and bring you back home," Siemianowski said. "I think in a recovery model, we're looking at how do we build the skills, so that you identify what is it you want to eat, how do you plan your meals, what do you put on your shopping list and while we may take you, the idea is helping people to do for themselves rather than me doing something for you."
Going back
By 2005, more than a decade after giving up on the mental health system, Acker realized something had to change. He sought job assistance, and was told he'd first need to get help.
He was skeptical when he first went to InterCommunity, a private mental health care provider in East Hartford.
"Oh great, another psychiatrist," he thought. "What are they going to tell me that's different this time?"
But it was.
At the first session, the clinician asked Acker what his goals were. He realized that he didn't have any.
But he thought of three: Get an apartment so he could move out of his mom's house. Get a part-time job to pay for the apartment. Make some friends after 14 years in isolation.
"Ok, those are good goals," the therapist said. "Let's work on those."
It's a simple statement, but to Acker, it was a tremendous change -- being asked what he wanted, and supported.
"It gets people excited," Acker said. "It gets people wanting to do things, which is a huge change."
Hope
Eight years later, Acker has "obliterated" his initial goals.
"When people have the proper supports and encouragement, they can blow through goals and do stuff that people never thought they would be able to do," he said. "And when they don't, they don't."
In his case, support meant therapy, medication, vocational training and case management.
The gap on his resume would have made finding a job tough, so he participated in a transitional employment program to help build his work skills, serving as a receptionist. He got a part-time job doing technical support for the state's distance learning consortium. Two days later, he was offered a full-time job at Intercommunity, as a rehab counselor.
Three months later he was promoted to manager of the agency's social club.
It's not the most obvious job for someone who isolated himself for years, who used to go outside only if he was mowing the lawn and wearing headphones -- tools for keeping people away. But Acker says the job forced him to be social, to model social skills for others. And he treasures being in a position to help others facing the things he once did.
The workplace is supportive, helping him to build up his confidence.
But he still has ups and downs.
After three years at Intercommunity, the bottom fell out again. Acker emailed his boss to say he quit. I don't know what's going on with me, he wrote, but everything feels messed up.
She wouldn't let him quit.
"They supported me through it," Acker said. "They didn't say, 'Oh well, this is what people with mental illness do, see ya later.'"
Acker went on medical leave for three months. But this time, it was different. He'd learned skills, ways to reframe the way he saw the world, to push back against the "Armageddon's coming" feeling. Now he just needed to tap into them.
"It's like someone turns out the lights and changes the furniture in your room," he said. "You know your same furniture's there. You just gotta find it now."
After three months, he went back to work. The bottom hasn't fallen out since.
Along the way, Acker has accepted that there's no cure for his mental illness, that recovery is a continual process, not being free from depression. It means there are ways to make it better, like having a three-year stretch of working with no crashing and burning, something he never thought would be possible.
"There's a part of me that's like, 'Oh my God, the bottom's going to drop out soon,'" he said. "But there's a part of me going, 'No, I've learned some more skills so I can go a little further this time.'"
"And I don't know how much further that is. It could be tomorrow, it could be another five years. But I feel more hopeful that I'm able to do it."
Follow Mirror health reporter Arielle Levin Becker on Twitter @ariellelb.
