Although psychiatric services are not offered directly at Fountain House, Ralph Aquila, M.D., sees members a few blocks away. Working for St. Luke’s-Roosevelt Hospital Center and as a consultant for Fountain House, Aquila coordinates members’ psychiatric services, provides second opinions, answers medical questions, oversees psychiatric services for three of Fountain House’s 24-hour supervised residences, and supervises a staff of five psychiatrists and two nurses. In addition, 100 members receive treatment from Aquila, whose title is director of residential community service at the center.

Almost all of Fountain House’s members—99 percent—have schizophrenia; 60 percent of those with schizophrenia have comorbid substance abuse problems, and 10 percent to 20 percent have comorbid depression and anxiety. Most have been in and out of state hospitals for years, many are homeless, and some are violent.

"Psychiatry has historically seen patients like these as helpless and hopeless. . .stagnant and unable to improve. . . .Many psychiatrists just try to keep them out of the hospital and symptom free. In fact, there used to be a philosophy that you shouldn’t push people with serious mental illness because they would have psychotic flareups. That’s baloney."

One reason that many of those who suffer from persistent and serious mental illness have been unable to progress is the dearth of psychiatric services, said Aquila. "Fifty percent of people with schizophrenia get substandard care, and only 10 percent get any kind of rehabilitation at all, according to the 1997 Schizophrenia PORT [Patient Outcomes Research Teams] study," he noted.

"With these new atypical medications and rehabilitation programs, people can dramatically improve their lives. That’s what most psychiatrists don’t get and don’t see. That’s the challenge I struggle with every day—to change the accepted belief that this population can’t improve."

He continued, "Yes, this is a horrible illness—and I’m not downplaying it—but people can rise to the occasion. With the right kind of psychiatric treatment and the right kind of rehabilitation, like Fountain House, the sky’s the limit. And when you see someone doing well—someone who has not worked in 10 to 15 years—and they say, ‘Here’s my first paycheck,’ that’s an exciting moment. . .and you helped them achieve it."