All psychiatrist Loren Crabtree wanted to do was help one patient succeed after discharge from a mental hospital in 1982.
Convinced the man would "lose his game" if he went home, Crabtree tried to find him a community program. When he learned the wait would be more than a year, he set the man up in an apartment and found him a roommate.
Project Transition, which now serves 180 seriously mentally ill "members," was born. Those members live in apartment complexes in Philadelphia, Montgomery, Bucks, and Berks Counties. The staff, who live elsewhere, do their work from apartments in the same complexes.
The central idea is that what patients need most to succeed on their own is friends and community.
"When you're mentally ill, you are lonely," Crabtree, 79, said recently at the program's headquarters in Chalfont.
Crabtree's approach earned him the exemplary psychiatrist award from the National Alliance on Mental Illness/Pennsylvania, an advocacy group for patients and their families.
James W. Jordan Jr., NAMI Pa.'s executive director, said Crabtree was being recognized for creating a cutting-edge alternative to long-term institutionalization at a time when large numbers of mental patients were being released from Pennsylvania psychiatric hospitals.
"He is a pioneer and a visionary," Jordan said.
Crabtree, who cofounded Project Transition with social worker Paul Keisling, said he had also given many informational talks for NAMI.
His son, Loren H. "Luke" Crabtree III, a lawyer, is now CEO of Project Transition. His father considers himself semiretired.
He didn't have a plan at the beginning. Word got out that there was an alternative to going home, and his program grew with the demand.
Crabtree, who had worked in hospitals, had given a lot of thought to why so many patients seemed to do well while institutionalized but then fall apart soon after going home. "People went home and smoked cigarettes and watched television until they were hospitalized," he said. He put more emphasis on behaving in job and school settings and functioning while sick.
In Project Transition communities, members are taught skills that many take for granted, such as how to make and sustain friendships. They live in groups of three so there will still be company if one roommate has to be hospitalized. They're spread out among tenants without mental illnesses to raise the bar on behavior.
"If I'm a patient," Crabtree said, "immediately I can't do what I did at the state hospital. I can't get up at 3 a.m. and scream and expect to be nurtured."
Crabtree said even programs that provide similar services - Project Transition's staff does the usual therapy, medication management, and the like - tend to focus on "illness intervention" rather than helping a patient become "whole and thrive." That's a more challenging goal.
"I prescribe four units of [emotional] human nourishment," he said. "You just don't write a note like that."
Project Transition says the vast majority of its members stay out of the hospital, go to work or school, and follow through on health-care management after they're discharged from the program. It has data for only 30 days, said Ian Shumard, marketing coordinator.
Crabtree said he recognized why outcome data were necessary, but that's not what interests him.
"I just want you to have a rich life," he said.
To reach Project Transition in Chalfont, call 215-997-9959 or go to www.projecttransition.comEndText