Central North Carolina is flat land interspersed with pine forests. On a Thursday in April a chill rain is falling on it. And downtown Raleigh, composed of the North Carolina State capitol, office buildings, and other edifices, seems gloomy as well.

But perched on the corner of Edenton and Dawson streets in downtown Raleigh is the Edenton United Methodist Church—an uplifting sight to any passersby, but especially to those with mental health needs and little money. For on the third floor of the church’s annex can be found a free mental health clinic—very possibly one of the only few free mental health clinics in America.

Four years ago, Clarence Boyd, a retired Raleigh social worker, was watching a news segment on television with his wife, Samantha. It was about several retired physicians who had opened a free medical clinic for needy patients in South Carolina. Clarence and Samantha looked at each other and said, "Hey, we could do something like that in the mental health area."

Boyd then contacted Nicholas Stratas, M.D., a Raleigh psychiatrist in private practice and an old friend whom Boyd describes as a "solid Greek—that means the warmth, the compassion, the intelligence, all those ingredients rolled into one person." Boyd asked Stratas whether he would like to join them in setting up a free mental health clinic in Raleigh.

Stratas was enthusiastic about the idea. "Our local mental health center was not really offering psychotherapy," he recalled. "They had just done away with the free service. So there were certain dynamics in the community that made the time right."

Or as Boyd, a rangy, casual, 65-year-old with a kindly face, puts it: "Nick and I were the ringleaders in this thing."

They found a home for their clinic in downtown Raleigh—Sunday school classrooms on the third floor of an annex to the Edenton United Methodist Church. They then spread the word throughout the Raleigh mental health community that they needed volunteers for their clinic. A number of psychologists and social workers came forward. They also found that they could count on the generosity of pharmaceutical company representatives for free supplies of prescription medicines for their clinic and arranged with a local pharmacy to house the medications. The clinic then got under way on Thursday evenings, and word was spread throughout Raleigh that it was open for business.

Now, four years later, clinic volunteers include 16 psychologists and social workers, four administrative support people (one of whom is Samantha Boyd), a clinical chaplain, and four psychiatrists in addition to Stratas. One of the psychiatrists is Thad Barringer Jr., M.D., a compact, friendly son of a psychiatrist who joined the clinic "because Clarence asked me to." Another is James Bellard, M.D., a bearded, bespectacled, young doctor who also gives his admiration and affection for Boyd as one of the reasons why he decided to work at the clinic. Even back in the 1980s, Bellard said, Boyd had "developed a reputation as a bit of a guru for family therapy and other behavioral approaches that were very different from what I was trained in during my residency. And every time I met him, I found him to be an interesting person. He always had a different spin on individual psychopathology, but also about how organizations work."

So far the clinic staff has seen some 400 patients. Currently they are seeing 35.

Here is how the clinic works: A patient is referred by a private psychiatric hospital, county medical center, company employee-assistance program, or other source or simply hears about the clinic by word of mouth. He or she makes an appointment for a visit. When the patient arrives, a psychiatrist conducts an evaluation and makes a diagnosis. The psychiatrist and a psychologist or social worker decide how often each should see the patient in the future. If the patient needs medication as well as psychotherapy, the psychiatrist writes a prescription, which the patient then takes to the pharmacy that houses medications for the clinic. The medication is free, but the patient must pay the pharmacy’s $5 handling fee.

The goal of the clinic, Boyd said, is to see people for six to 12 months so "they can move on with their lives." However, this is not a quick-fix clinic, he stressed. The staff does not provide patients with medication unless they are also willing to undergo psychotherapy.

"If you are going to be in the clinic and be on medication," Stratas explained, "you have to be working on your life—that is sort of our orientation. It is goal oriented; it has to do with learning how to manage your life. It’s not just going to be, ‘We’re going to treat your depression.’ Depression has to do with you managing you, you managing your relationships."

And indeed, the clinic staff is helping people get their minds and lives together. For example, a middle-aged woman came to the clinic a year ago with a variety of problems. She had been diagnosed with attention deficit/hyperactivity disorder and was depressed, not working, and in debt. The staff provided her with both medication and psychotherapy. As a result, she managed to get a good job and recently decided that she was doing well enough that she could stop coming to the clinic for psychotherapy.

Another case concerned an immigrant from South America. He was hard working, but anxious and depressed and had "a terrible marijuana habit," according to Bellard. Bellard provided him with medication for his anxiety and depression and talked with him about his marriage problems and his difficulties in adjusting to life in the U.S. Now, a year later, he has graduated from the clinic. He no longer uses marijuana and has a job in construction with good fringe benefits.

Still a third case involved a very depressed young woman whom the clinic staff helped wean from an overdependency on medication, doctors, and therapy. "Although I am still struggling, this is one of the best places I’ve been," she told Psychiatric News.

On certain occasions the clinic staff even offers family therapy. For instance, a young woman started visiting the clinic for help with her dependency needs. Then she married a young man who came from a violent background and occasionally hit her. He is now coming to the clinic with her. While he is still "scared to death of his anger," reported Frances Katz, the social worker counseling the couple, he no longer hits her.

Barringer has this to say about the patients they see: "People are very appreciative, very motivated." Stratas agrees: "We’ve such a small-time operation, but our patients are doing phenomenally well! . . .These are all motivated people . . . .It’s amazing. Most of them come in without a job, and before they’re done, they’ve got a job, and any number have graduated to jobs with fringe benefits."

It’s not just patient drive, of course, that makes the clinic such a success, but the staff’s dedication and willingness to give their expertise for free, from their hearts. One former patient, in fact, credits the clinic with rescuing him from serious depression and even suicide. "This clinic saved my life," he told Psychiatric News.

What does the future hold for the clinic? It could easily be open two evenings a week since there is such demand for its services, said Boyd.

Although "the local papers have been wanting to do a story about the clinic, we’ve discouraged it," Stratas said. "We want to grow in a systematic way. We do not want to be inundated, nor do we want the evil eye put on us! Sometimes publicity works adversely."

And as Bellard sees it, "We have to be careful that we don’t get so big that we lose the personal touch. It is a very friendly place to work."