TUPELO • With three young boys and three small dogs dancing around her, Nicole Wiggins patiently manages the controlled chaos of dinner at her Lee County home.
She and husband Jeremy Wiggins navigate between kitchen and dining room table, handling requests for milk and sending Bennie the hamster back to his cage. Their teenage children join the fray for family Bible study. The little boys will head to bed soon, and Nicole Wiggins will prepare for her overnight shift as a professional caregiver.
The domestic scene defies the stereotypes of life with schizophrenia. A 38-year-old married mother of six, Nicole Wiggins works full time, homeschools two of her children and is working toward becoming a licensed practical nurse.
She isn’t disabled or homeless. She continues to make a home with her husband, Jeremy, and care for their children, ages 3 to 17. Her schizoaffective disorder – schizophrenia combined with depression and/or bipolar disorder – is controlled with medication, and she has been in remission for 19 months without hearing voices.
“I love my life. I love being a mom. I love working,” Nicole Wiggins said.
The Lee County PACT program has been an essential lifeline for Nicole Wiggins and her family as they have moved through recovery from her mental health crisis and hospitalization.
“I thank my lucky stars,” Nicole Wiggins said. “PACT has been super supportive.”
PACT, which stands for Program of Assertive Community Treatment, is a national, evidence-based model that provides comprehensive services to people recovering from serious mental illness. It has proven to be particularly helpful for those with multiple hospitalizations.
“PACT is not for everyone, but the people who are served through the program tend to be more independent and have lower rates of unemployment,” said Wendy Bailey, chief operations officer for the Mississippi Department of Mental Health. “They have lower rates of inpatient hospitalization, and if they do need to be hospitalized, they have shorter length of stays.”
For Nicole Wiggins, that’s meant help with medication management, counseling for herself and the family, peer support and encouragement to go back to school. She has an emergency plan in place in the event she starts hearing voices.
“I love that my (family) has something like PACT to lean on if I become ill again,” Nicole Wiggins said.
The Lee County PACT, overseen by Life Core, is one of 10 PACT programs funded through the Mississippi Department of Mental Health. It currently has 70 people enrolled in the Lee County program, and Nichole Wiggins is not the only success story, said clinical therapist Kim Sistrunk, who serves as the supervisor for the Lee County PACT.
A number of the people in the program are in school or working. Others are reclaiming the basics of daily living and working through the trauma that comes with mental illness.
“Success isn’t the same for everybody,” Sistrunk said. “Although not everyone is where Nicole is, it is possible for people with mental illness to function more independently.”
Serious, but treatable
Schizophrenia is a serious mental illness that can be disabling, but also can be successfully managed. It typically causes auditory and visual hallucinations. People with schizophrenia suffer from delusions – beliefs that conflict with reality. Speech and behavior can become disorganized. With schizoaffective disorder comes the additional burden of either depression or bipolar disorder. Schizophrenia most commonly emerges in the late teens and early 20s for men and 20s and early 30s for women.
“A lot of what people know from movies is not accurate,” Wiggins said. “We are more likely to hurt ourselves than other people.”
Nicole Wiggins had her first symptoms at age 36 about a year after her youngest son was born.
“It was like somebody flipped a switch,” Nicole Wiggins said. “One minute I was a homeschool mom, the next I was hearing voices and delusional.”
The voices in her head, which were hallucinations, were overwhelming, Nicole Wiggins said.
“It’s like a best friend is telling you something,” she said.
She was convinced she had been microchipped, that people were trying to hurt her children and that her husband was lying to her. Her mind chipped away at her insecurities.
“It’s very scary,” Nicole Wiggins said.
Over the next eight months, Nicole Wiggins was largely able to function as a mother and hold down a job as a waitress when her husband was laid off from his job. But those closest to her realized something wasn’t right.
“It didn’t seem like her,” said Jeremy Wiggins. “Her eyes would dart off like she was looking for cues from someone who wasn’t sitting there.”
Conversations wouldn’t quit connect.
“I would say ‘You need to go to the doctor,’” Jeremy Wiggins remembered. “She would say ‘I went to the doctor and my leg is fine.’”
Because of her delusions, she tried to drive to her parents’ house, but became lost three hours away.
“We can laugh about certain things now,” Nicole Wiggins said. “We’ve really grown as a family. At first, it seemed like the situation was going to break us.”
Nicole Wiggins actively pushed back against attempts to get help because the voices warned her that if she went to the hospital or sought help, she would be hurt. She was so high functioning and didn’t have some of the most classic outward symptoms of schizophrenia, it took months to convince health care professionals that something was seriously wrong.
“He had a really hard time,” Nicole Wiggins said of her husband. “There should have been a way to have gotten help sooner. I definitely was unable to help myself.”
Jeremy Wiggins tried to manage the family and his wife’s growing illness on his own for most of the eight months her symptoms were escalating. He finally sought counsel from their pastor at Christ Church in New Albany.
“It was like a weight was lifted off me,” Jeremy Wiggins said.
Their church family helped with babysitting and meals during the time Nicole Wiggins was hospitalized first in private hospitals and then committed to the state hospital.
Unlike many with schizophrenia and schizoaffective disorder, Wiggins responded well to medications immediately. The voices and delusions receded. In April, she will celebrate two years in remission.
She applied to be part of the PACT program before leaving North Mississippi State Hospital in Tupelo without realizing how beneficial it would be.
“PACT has been a blessing for our family,” Jeremy Wiggins said. “They didn’t just abandon us once she was stabilized. They came alongside our family.”
With help from the PACT team, Nicole Wiggins has been able to try new medications with fewer side effects. She receives therapy sessions, and counselors are also available for her entire family.
“Even though I’m high functioning, I need PACT,” Wiggins said. “I need to know they are there.”
The PACT team helped her access training to become a certified nursing assistant at Itawamba Community College. They’ve encouraged her to continue her education to become a licensed practical nurse.
Seven months ago, she began working as a direct support person for people with intellectual and developmental disabilities. She has also worked as a nursing assistant at a nursing home.
“It is humbling, because I remember I, too, could have been very helpless if things had gone differently,” Nicole Wiggins said. “I’ve truly walked a mile in their shoes. I’ve been dependent on others.”
In early September, U.S. District Judge Carlton Reeves ruled that Mississippi had failed to deliver adequate mental health care, relying too heavily on inpatient care state hospitals. In response to the case brought by the U.S. Department of Justice, Reeves found Mississippi had unlawfully discriminated against people with serious mental illness with the lack of community-based services contributing to cycles of hospitalization.
Even before the ruling, Mississippi had been working to rapidly expand access to PACT and other outpatient programs that don’t require a person to be deemed a threat to themselves or others to access care, Bailey said.
In the 2014 fiscal year, Mississippi only had two PACT programs. For the 2019 fiscal year, 10 PACT programs were able to serve 500 people in 20 counties.
“The goal is to increase the number of people served by PACT by 25 percent each year,” Bailey said.
The Department of Mental Health shifted funding to expand crisis stabilization units, where people can go for nine to 10 days to receive care. Some still need to go on for inpatient care, but many others are able to return home and receive outpatient services.
The state also has developed an Intensive Community Outreach Recovery Team program that has fewer staffing requirements than the PACT program, but provides 24 hour access to care that people can receive in their own homes.
“We piloted the first one this year,” Bailey said. “For the 2020 fiscal year, the plan is to get four programs up and running.”
That doesn’t mean there isn’t a need for the state hospitals and inpatient care for mental illness, Bailey said.
“You need services available on a continuum of care,” Bailey said.
The Department of Mental Health is in the process of developing its request to expand community-based services for adults. The federal court has yet to appoint someone to oversee Mississippi’s response to its ruling.
As community services expand, it’s important to understand that recovery from mental illness takes time and rarely moves in a straight line, Bailey said.
“Recovery is personal and different for every person,” Bailey said.
With support, people with mental illness can and do become more independent.
“It’s so amazing watching people bloom,” Sistrunk said. “It’s so rewarding.”
Nicole Wiggins wants to be a part of that change. Her goal is to be able to work at the state hospital one day and help others find the path back to their lives. She wants to advocate for a robust mental health system that is equipped to handle people with severe mental illness.
“They deserved to be cared for the best way they possibly can,” Nicole Wiggins said. “We can’t minimize their humanity.”