Staff Profile: Ralph Viau and Eugenie Medley, Manhattan FACT

CASES’ Forensic Assertive Community Treatment (FACT) [1] teams provide intensive mobile treatment services to people living with serious mental illness who have involvement in the criminal justice system. FACT uses a true team structure, with clinicians, peer advocates, case managers, nurses, and psychiatrists working together to offer flexible and comprehensive care to clients.

Like the rest of the team, FACT nurses spend the majority of their time in the community, meeting clients wherever they are to provide critical care. We sat down with Ralph Viau (RN) and Eugenie Medley (LPN) to hear more about their work on CASES’ Manhattan FACT.

Q: What is your role on the FACT team?

EM: We are both nurses, so our primary job is to administer injections, usually psychiatric medications. But really, we do what everyone else on the team does, which is whatever the client needs. If they need to go to HRA, we take them. If they need to go clothes shopping, if they need to go to a doctor’s appointment, if they need us to sit with them and hold their hand while they cry on our shoulders, we do that too.

RV: Every person on the team is so important. We are the only ones who can administer injections, but no person is more important than the other. With one person out, everyone feels the setback.

Q: You both work for Manhattan FACT, but do you only work in Manhattan?

RV: We go all over the place. We go all the way up in the Bronx, and we go out to Queens. We know where our clients spend time, so if they aren’t answering their phone, or if they don’t have a phone, we go out and look for them at all their usual places.

EM: And don’t forget about taking the ferry to Staten Island or going upstate on Metro North.

Q: What about this job has surprised you?

EM: There are no two days that are the same. Every day, something new happens, and there are no repeats . . .

RV: . . . even with the same client. You have to learn to expect the unexpected.

Q: Why do you work at CASES?

EM: I want to work for the company that everyone else follows.

RV: I agree. CASES has been one of the pioneers of the ACT model. I’m proud of the work our team does.

Q: What is something you’ve done at CASES that makes you proud?

EM: Working here is enough. Just the everyday.

RV: There are times when we visit a client at 8 AM, and they aren’t there, and we’ll go back at noon after seeing two or three other people, and they still aren’t there, and then after work hours, we’ll go back and see if we can find that client again, just to make sure they don’t decompensate. We try to go above and beyond to make sure the clients are taken care of. If we don’t do it, they don’t have anyone else. The other place they can go is the hospital, and we do anything we can to make sure they don’t have to go to the emergency room.

This year CASES’ FACT, ACT, and Intensive Mobile Treatment teams will make more than 20,000 community visits to people living with serious mental illness, almost all of whom have previous experiences of incarceration. These programs continue to prove that intensive, mobile treatment can help even persons viewed as having the highest risks and needs to progress toward recovery and wellness while remaining in the community.