Hearing The Voice Of Humanity Nurses Find A Way To Help Those With Mental Illness Live With Dignity

Hissing voices in Jimmy Ransier’s head sometimes are so loud he hears nothing else.

The devil is coming for you.

The voices often come at night, as he lies awake, alone, his room cobwebbed with shadows. Dolly Parton pinups and bedside bowling trophies are no comfort.

You are so evil. Kill yourself.

The voices - and the terror and confusion they cause - have kept Ransier locked up most of his 54 years.

During nearly four decades in mental hospitals, Ransier’s teeth rotted and he earned a reputation for being rowdy and flinging his feces when the voices got loud. Youth, then middle age, slipped by.

A year and a half ago, he moved into a different kind of place, a brownstone building on the lower South Hill called Raymond Court.

The doors weren’t locked. Ransier learned to do his own laundry. He became a regular at Frankie Doodle’s, a downtown restaurant.

The voices still come, telling him during dinner or an episode of “The Simpsons” that he’s bad, he’s silly. But, with help from a pair of nurses at his new home, Ransier realizes the voices aren’t real.

He hasn’t returned to the mental hospital - his longest stint of freedom since JFK was president.

The nurses who own and run Raymond Court, Jan Wheatley and Sue Napier, have gained national attention for their innovative work with Ransier and 13 others with severe mental illnesses.

Experts praise the program for its humanity and economy.

But, like most homes for the mentally ill, it’s judged by how seldom patients break down and require hospitalization.

One out of four residents in such programs nationwide require periodic treatment in expensive hospital wards, researchers say.

At Raymond Court, the success rate is twice the national average. In the last year, just two of the residents were returned to Eastern State Hospital.

“The residents at Raymond Court have been institutionalized most of their lives. That’s an undignified setting,” said Larry Jacobson, a nurse with the state Department of Social and Health Services.

“Treating those folks like they are able to make day-to-day decisions, as Jan and Sue do, that facility has given them back dignity.”

Dignity comes in the form of unlocked doors, private mailboxes, spacious rooms with private bathrooms and the social calendar of a debutante.

Supervised outings to bowling alleys, pizza parlors and movie theaters are frequent, as are visits from lively nursing students.

Halloween was celebrated with a costume party.

With good humor, Ransier dressed as a Hershey bar “with nuts.”

Around-the-clock nursing care ensures residents take their alphabet of medications, heading off delusions caused by their diagnosed conditions - usually schizophrenia or manic depression.

No, there are no spiders in the bathtub, Napier assured one patient recently.

Another, Patty Coil, fell into depression each fall. Talks with the staff unearthed the reason: Coil was haunted by a childhood memory of burning a baby during a Halloween party.

By patiently questioning her, they were able to show Coil that it was a cruel prank and the burned “baby” had to have been a doll.

This fall, the nightmare didn’t return.

“I think I feel safe, which is really important when you’re having suicidal thoughts,” said Coil, 45.

Residents are free to come and go between meals. There have been no complaints from people in neighboring apartment buildings or Sacred Heart Medical Center, a half-block away.

Smoking sessions on the front porch often turn into bull sessions.

A house joke, courtesy of a woman in and out of hospitals for 44 years: “What’s a schizophrenic’s favorite Christmas carol? Do you hear what I hear?”

Napier and Wheatley envisioned Raymond Court three years ago while working at Eastern State Hospital.

There, they witnessed a tragic cycle. Patients would be released, then break down, often winding up on the wrong side of the law, then be hospitalized again.

A lack of group homes in the area contributes to the problem. A lucky few get out of Eastern and move in with relatives. Many wind up in dingy downtown hotels.

“There’s a critical shortage of adequate housing for the mentally ill,” said Rick Sprague, mental health ombudsman for Spokane County.

The radical leap from structured hospital living to a freewheeling building shared by other mentally ill people is often overwhelming.

“That’s the option: Take it or leave it. Most leave it and go back to Eastern State Hospital because it’s a safer place to be,” said Napier.

The cycle is expensive. A stay at Eastern State Hospital costs about $355 a day. Raymond Court costs taxpayers a fraction of that - less than $60 a day.

At Raymond Court, Napier said, “they’re making it because they have a reason to stay well, to participate in staying well because they don’t want to lose (the freedom). They’re willing to work out the rough time.”

In getting their center off the ground, Wheatley and Napier scoured government coffers for money. An $860,000 federal grant to combat homelessness in Spokane pays the rent. Because the residents have medical problems, the state nursing home funds contribute about $55 per patient per day.

Napier and Wheatley expected another $7 a day in mental health funding, but county officials withdrew the money in July.

The nurses responded by filing a lawsuit against the county.

Despite the suit, Kasey Kramer, head of the county’s social services office, praises Raymond Court.

“Jan and Sue have made tremendous efforts to make this home-like,” said Kramer. “Instead of an institution, it’s a comfortable place to be.”

Six months after opening in March 1996, the American Psychiatric Nursing Association gave Napier and Wheatley an award for innovation.

In October, they won more honors - and $5,000 from a major pharmaceutical company. The pair changed from nursing smocks to ball gowns and flew to Washington, D.C., for a champagne dinner.

Wheatley and Napier recently launched a second assisted-living home, 43-bed Rowan Place in northeast Spokane. It will house some mentally ill people, but the focus is on Medicaid patients who require nursing care.

Ransier moved to Rowan Place last week.

He’s now looking for a new hangout, where he can sip coffee, make friends and remember his childhood in Yakima - when he had a horse and no voices in his head.

He’s considering returning to Yakima, convinced his high school friends will still be around. Napier thinks otherwise.

“Jimmy, you belong here with us,” she said.

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