She had mastered the art of institutional life. If her caretakers wouldn't give her a match to light a cigarette, she knew how to use a gum wrapper and a light socket to set fire to a tampon. She wore studded dog collars and shredded stockings, and her hair, once as wispy as the crown of a dandelion, had been hacked off and dyed.

None of that changed the fact that she was a wealthy kid from the suburbs whose bedroom, back home in a pocket of horse ranches and eucalyptus groves in San Juan Capistrano, was waiting for her.

She was scared at Metro, and perhaps she was right to be.

Past the red sign at the door of Unit 410 -- "HIGH AWOL RISK" -- was a prove-yourself hierarchy of bulimics and cutters and patients known as picas, who swallowed staples and keys and whatever else they got their hands on. During her six-month stay, three patients attacked her. One tried to rape her.

She called home, again and again, begging to get out.

Her parents refused.

Cynthia and Michael Sitton believed they had no choice. Before she could start getting better, they thought, she had to hit bottom.

The strategy seemed to work. When Tiffany was ready to leave Metro six months later, she seemed finally willing to embrace treatment.

"I don't ever," she told her mother, "want to be in this place again."

So, one year ago, they made a pact. Tiffany would quit sabotaging her treatment, getting in fights, snorting other patients' meds. She would remember why it was good to be alive. Her parents would find a top-of-the-line hospital. When she was able, she could visit at home. They would keep her safe. They would keep her out of Metro.

The next year would be a test -- of Tiffany and her parents, and also of California's mental health system, which so often fails the toughest cases.

Unlike most who suffer from severe mental illness, Tiffany had everything going for her.

Her doctors had found the right cocktail of pills to ease her symptoms. She had a full-time advocate in her mother. Wealthy through Michael's flooring company, the Sittons had spent more than $250,000 on her care. Now they pledged to redouble their efforts.

Would it be enough?

It came out of nowhere.

Tiffany tugged on the sheets next to her mother's head and whispered into the darkness. She'd seen dogs in her room, menacing dogs with red eyes. Cynthia told her she'd had a nightmare.

"She insisted," Cynthia said recently, "that she had been awake."

And she had been.

Breakdown: Full coverage
Read more stories in The Times series by Lee Romney and Scott Gold on California's mental health system, plus related links and more.