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The separation between physical and mental health is not as distinct as it once was. Marlin Ivey is evidence of that.

Ivey, of South St. Paul, is diagnosed with schizoaffective disorder, a mental illness that affects up to one in 100 people. It's a complex disease: It can couple the delusions and hallucinations of schizophrenia with mood disorders like depression.

About four years ago, Marlin's symptoms led him to an attempted suicide, but he says he's come a long way now from where he was then. Ivey's recovery story began with a case manager who was assigned to him because of serious physical health problems.

"I like to say that I'm someone who sets my alarm clock these days. Now I wake up in the morning and I turn my alarm clock off and I reset it. Because not only do I have things to today, I have things to do tomorrow," he said.

Now, Marlin lives on his own in a trim South St. Paul duplex.

"I am someone who lives with mental illness and pretty much has, not really overcome it, but learned to control it and live with it. I went from someone who is unemployed and someone who was scared to go outside and be around people, to someone who has a job now. Someone who thought about suicide every day to someone who doesn't think about it at all," he said.

At one point, Marlin was forced into hospital treatment. But it was after he left the hospital he began to gain control over his disease. He credits his improvement to a health insurance case manager who was assigned to help him deal with his physical ailments, and admittedly didn't know much about his mental health diagnosis. Marlin recently spoke with MPR's Tom Crann.

Below is a transcript of their conversation, edited for length and clarity.

 When I went to case management, they didn't focus on what my diagnosis was. They kinda like took all that off the table, and they concentrated at me as a person. You know, "How we gonna get him to go to his appointments?" Cause I was dealing with physical health, plus I was dealing with the mental health issues. And, if you don't care about yourself mentally, you're not gonna care about yourself physically. That's important to know, because it all goes hand in hand.

But, once they got me going to the doctors and start caring a little bit more and a little bit more that's when you see a difference, and I always say that. My case manager, she [was] like, "Don't worry about schizoaffective syndrome, don't worry about that. I don't know what that is. They keep saying this and saying that, don't worry about that. We're just going to concentrate on you as a person, and [take it] day by day."

 Give me an idea of how far you've come here and what your life might have been like four or five years ago, or even maybe a couple of years before that.

 The path I was on four or five years ago, before I started with case management, I woke up every morning crying, pretty much in tears. Just pretty much cause I woke up. I didn't want to get up; I didn't want to wake up at all. Physically, I had sleep apnea, I had high blood pressure, I had diabetes, I was shooting insulin up a couple times a day. I wasn't going to the doctor, I wasn't doing anything to improve my situation. I felt like a waste of skin almost. I just kind of woke up and was there and felt like I was a burden on everybody. But, compared to today, it's like night and day.

 Is there one single thing that you can attribute that made the difference?

  When I was first diagnosed with schizoaffective syndrome, maybe like eight, nine, 10 years ago, through that diagnosis, they sent me to a therapist and counselors and different things like that. And, the only problem with that for me was insurance only approved me to see a therapist once a week. I recall the first time I went to a therapist they told me it was a very serious mental health issue. And, he gave me his card and he said, "Call me anytime, anytime you need something, and I'll be there for you," or however he put it.

A couple days later I had an episode where I woke up pretty much like I did all the time, sad, depressed, feeling like I didn't really want to be here. And, I reached for that card and I called that number and I got an answering machine and I left a message. Waiting on him to call back, it took two, three days later after I left this message, I got a call back from a nurse, and it was the therapist's nurse, and she didn't even know who I was, I didn't know who she was.

She asked me my name, she asked me what the situation was, what I was diagnosed with. And, it was kind of like a slap in the face in a way. It's like, this man gave me his card, told me to call him when I need him, and when I took the steps he told me to take, it's like there was no connection there, there was no help for me.

When you're dealing with people with mental health issues, they don't have four or five days for people to get back to them. When you're dealing with somebody with depression, who's suicidal, they don't have that time for somebody to get back to them.

 There's a whole lot of talk about continuity of care, where a doctor gets to know you, and gets to know what you need and you see them on a regular basis -- it sounds like you're saying this is important in mental health too.

  That was very important -- that was key to me getting better. I remember the first time when I got connected with case management, and I made that first phone call to my case manager, she called me back within two hours. And, then before I woke up the next day, she had already called me again to make sure I was okay, and to see if there was anything she could do for me. It kind of felt like she cared about me more than I cared about myself in a way, at the beginning.

That was the biggest difference to me, having someone there who I could call on every day if I needed anything, if I just needed to talk or whatever, someone who could deal with [those] issues that I dealt with on a daily basis. These issues didn't come to me once a week. These issues I had to deal with on a daily basis, hour by hour sometimes. And, having somebody there everyday on a daily basis like that, really, really kinda brought me out of my shell.

Because we [were] able to deal with issues as they came along, they [weren't] able to stack up on us, and then when I got to the therapist, I had so many different things to talk about in an hour and to figure out.

  I got connected with my case manager because of my insurance. I was on state insurance, [Medical Assistance], and because of the type of insurance I was on, it came with a wellness coordinator/case manager. It was a kind of backdoor thing, because it wasn't for my mental health, it was through my physical health, that's how I got connected.

My case manager was my quarterback. She coordinated [with] all my doctors, she knew if I was going to the doctor, she knew if I wasn't going to the doctor. She knew about my medications. Everything I wasn't taking care of myself, she managed for me. [But], I don't need it now.

 You say you don't need the case management. But I'm assuming you still see doctors regularly, and see a therapist regularly, because when we first started talking, you talked about mental illness in the present tense.

 It's never over with. I'm going to have to live with it for the rest of my life. It's always going to be there. And, I'm not saying I'm completely over case management, but now I'm at a different stage with it. I'm not using up as [many] of the resources I used up before.

It's kinda like taking medication, you get to a point -- everybody who takes mental health medication when they start feeling better, they get to a point where they feel like, "Hey, you know what, I don't need this medication anymore." I crossed that point a couple times throughout the years, and as soon as I stopped taking that medication, I just fell right back to the beginning.

 Marlin, I want to thank you for talking about these events in your life and these situations and taking us on this journey. It's really an amazing story.

  I'm very open about my life. I always tell people I'm very open, so be careful what you ask me. You know, I'm okay with telling this story. A lot of people will be like "Well how could you talk about stuff like that?" Because I don't do it for me anymore, I do it for people [who are] in a situation [like] I am. I want to let them know they should never, ever give up. If you have a bad day yesterday, you still got tomorrow. But you can only change it if you're still here. If you're not here, there's nothing you can do about it.

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About four years ago, Marlin Ivey's symptoms led him to an attempted suicide, but he says he's come a long way now from where he was then. He credits his improvement to a health insurance case manager who was assigned to help him.

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