Reginald, who declined to use his last name for fear of losing opportunities, spent years in a harmful cycle of missed appointments, spiraling and then dealing with the consequences.
Reginald is paranoid schizophrenic. He said having to go into a pharmacy to get his long-acting injections, which treat people with severe bipolar disorder or schizophrenia, created a number of barriers that caused him to miss appointments.
“I don’t really like being in public and I don’t like people looking at me,” he said. “So I would just skip it, which caused me to spiral out of control. And then I would end up in some type of trouble before getting the injection and starting the process all over again.”
Like Reginald, many people with severe mental health illnesses struggle to keep routine appointments, according to mental health professionals and past research.
For patients who struggle with consistency, the injections can mean the difference between stability and relapse. To help address this challenge, Hayat Pharmacy expanded its in-home long-acting injectable program, adding more staff and a larger service area to help more patients keep up with their medications.
Hayat Pharmacy is a community-centered pharmacy with 18 locations throughout Southeast Wisconsin, including 14 in Milwaukee.
Nursing on the go
Without treatment for mental health people often spiral into crisis, leading to hospitalization, homelessness, food insecurity or incarceration, said Mara Ahmad, a nurse for Hayat Pharmacy. But receiving the medication regularly is not always easy.
That is where Ahmad comes in.
Ahmad’s day rarely begins in a clinic. It usually begins on the road.
Some mornings she drives to a small apartment where a man is living with schizophrenia. She’s also met with patients at a public library, a corner fast-food restaurant or a relative’s house across town. Once, she administered medication to someone who had no permanent address at all.
“Meeting patients where they are depends on their circumstances,” Ahmad said. “But if they’re a patient of ours and they’re really struggling to get an injection, we’ll go.”
A unique approach
For many of the people Ahmad serves through Hayat Pharmacy, circumstances are rarely simple.
She said some patients do not have transportation. Some are too anxious or unstable to leave home. Others are unhoused, drifting between shelters, family couches or temporary safe spaces.
Traditional health care systems often expect patients to navigate appointments, pharmacies, insurance hurdles and transportation on their own, she said.
Hayat Pharmacy decided to bring care to them instead. To help broaden access, the company also partners with other service providers. One of them is the House of Jacob Adult Family Home.
Shonta Anderson-Jackson, a nurse administrator at House of Jacob Adult Family Home, said it’s a matter of receiving or not receiving meds.
“It’s clients meds at essentially the click of a button,” Anderson-Jackson said of the support from Hayat. “It creates less room for errors or lapses in meds.”
Background on program
The long-acting injectable program itself began almost accidentally.
Ahmad joined Hayat Pharmacy during the height of the COVID-19 pandemic, helping administer vaccines and conduct testing throughout Milwaukee schools and communities.
She said it is not typical for pharmacies to employ nurses in large numbers, but the urgency of the pandemic created new opportunities and new questions about what community health care could look like.
As COVID demands began to ease, she started wondering whether those same outreach efforts could help another vulnerable population like patients who are prescribed psychiatric medications.
At the time, a few Hayat pharmacists were already conducting limited home visits for medication reviews. She suggested expanding the effort and they agreed.
What started as a combination of home vaccines, COVID testing and a handful of psychiatric injections quickly evolved into something much larger. Today, the team administers roughly 70 injections a week.
“It’s a game changer,” Anderson-Jackson said. “Hayat is doing what no other pharmacy is willing to do.”
Need keeps growing
While national pharmacy chains close locations and services become more limited, Hayat has absorbed many displaced patients.
Ahmad said awareness has also expanded among doctors and providers who once hesitated to prescribe long-acting injectables out of fear patients would never make it to monthly appointments.
Now, providers know someone will help bridge the gap.
“In a sense,” Ahmad said, “we almost kind of do case management.”
The relationships formed through the program often extend beyond medication treatment. Patients who once relied heavily on social workers or family members slowly regain independence.
For Ahmad, watching patients reclaim autonomy is one of the most rewarding parts of the work.
She believes the broader public should care, too.
When mental illness goes untreated, she says, entire communities feel the consequences as emergency systems are overwhelmed, which impacts homelessness, unemployment and public safety concerns.
Beyond the societal costs, she wants people to recognize something more human: mental illness is still illness.
“When someone has cancer, people rally around them,” Ahmad said. “They start meal trains. They offer support. But with mental illness, people tend to step away.”
Reducing that stigma, she believes, is one of the most important ways communities can help.
One way is to keep helping make treatment more accessible, Anderson-Jackson said.
For many patients, healing begins with something deceptively simple: someone willing to show up where they are.
“It really is life-changing work,” Anderson-Jackson said. “A lot of people wouldn’t get their needs met any other way.”
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