Mentally Ill Who Abuse Drugs Find Helping Hand at The River

Lisa Scales smiles shyly as she chops celery sticks for dinner in the mess hall kitchen. But her cautious self-assurance hides an eight-year struggle with severe depression and addiction to cocaine, PCP and alcohol.

The 21-year-old had already been shuttled through eight months of drug and psychiatric programs at various hospitals before she arrived at The River recovery center about a month ago.

Tucked away in the Angeles National Forest north of Glendora, the 26-bed hillside facility opened two years ago. It was the first residential center in California to serve chronically mentally ill substance abusers.

What makes The River’s program different, Scales says, is the sensitivity of the counselors to her dual problem.

Funded through a unique collaboration of Los Angeles County’s drug, alcohol and mental health administrations, The River is the only facility in the county providing integrated care for patients suffering from both substance abuse and mental illness, a population referred to as the dually diagnosed.

Programs administered by the county Mental Health Department and the Department of Health Services’ offices of alcohol and drug abuse provide $500,000 of The River’s $750,000 annual budget.

Key Figure

A key figure in The River’s creation was Christopher Spencer of Monrovia, a recovering alcoholic whose 23-year-old daughter suffers from schizophrenia.

“These people were falling through the cracks,” the 44-year-old developer said. “I know how it hurts.”

So in 1986, he bought 70 acres in the Angeles National Forest with the idea of opening a facility for the dually diagnosed. He fixed up the abandoned California Conservation Corps camp that now houses the facility. Together with Bud Hayes, now executive director at The River, Spencer went to the county with the proposal. Spencer, who is a member of The River’s board of directors, recently had a satellite dish installed so residents could watch cable television.

“I felt it would be a good place for healing, up in the mountains,” he said. “For the mentally ill, it’s real nice because we don’t have to use locked wards. People actually do cooking, go on hikes.”

Because of the facility’s remote location, residents would have to take a long walk for a beer.

Location Crucial

Hayes noted that a major reason that the project was launched so smoothly was the site’s location.

“There’s no community anywhere that’s not going to fight this type of project in the neighborhood,” he said.

The River is just one of Spencer’s many forays into the recovery field.

In 1985, he renovated a dilapidated hotel in downtown Monrovia, transforming it into a 32-bed treatment and extended-care center for alcoholics.

Today, that facility, a 25-bed facility for men in Covina, a 14-bed women’s home in Arcadia, and a 25-bed center in Silver Lake for both men and women make up the Spencer Recovery Centers for recovering alcoholics. The River is the only facility run on a nonprofit basis.

Spencer, who will receive the Monrovia Chamber of Commerce’s Citizen of the Year award next month, volunteers at the Weingart Center for the homeless on Los Angeles’ Skid Row. And he is the Friday cook at the Union Station Hospitality Center in Pasadena.

Services Lacking

Substance abusers have been identified as among the most under-served of California’s homeless mentally ill in a February, 1988, report by RAND Corp., a Santa Monica-based think tank.

Providing assistance to the dually diagnosed is a growing issue nationwide, said Fred Osher of the University of Maryland School of Medicine. He visited The River last year as part of a national survey of services available to this group, which has been reported to be as large as a million people.

“The River is at the forefront of developing residential facilities” throughout the United States and is a model system within California, Osher said. His study was partially funded by the Alcohol, Drug Abuse and Mental Health Administration, an agency of the U.S. Department of Health and Human Services.

An estimated 60% to 90% of mentally ill adults between the ages of 16 and 40 are believed to have drug or alcohol problems, according to Hayes. Because of the lack of services for the dually diagnosed, he said, many patients have been put through a frustrating revolving door, referred back and forth between drug abuse and mental health programs.

Personal Challenge

Hayes said he is thriving on the challenge of designing an integrated program and cross-training a staff that has never tackled the problems of mental illness and substance abuse simultaneously.

“This is the most exciting thing that’s ever happened to me,” he said. “It’s an opportunity that somebody in the nonprofit field hardly ever gets a chance to do.”

At The River, residents are involved in designing their own recovery programs. Instead of concentrating on drug therapy and psychoanalysis, the focus is on group interaction and developing social support systems. All residents participate in community self-help groups, such as Alcoholics Anonymous and Narcotics Anonymous.

Residents also learn about thought and mood disorders, and they are taught independent living and coping skills. In addition to being assigned chores, they are given lessons on day-to-day living, such as money management and applying for discounted bus passes.

Patients who qualify for federal Supplemental Security Income contribute their board-and-care allowance of $572 monthly. The remainder of the $3,000 a month it costs to treat each person comes from the county. Few can afford to pay their own way.

Many Turned Away

While six extra beds remain empty for lack of funding, about 10 dually diagnosed patients are turned away daily, Hayes said.

Clients, 90% of whom are homeless, may stay up to a year, but most leave after four months, Hayes said.

About 40% of the 134 who have left The River are now abstinent, program director Julie Boynton said.

“That’s very good for this population,” about double the usual success rate, said Al Wright, director of the county Department of Health Services’ Office of Alcohol Programs. He acknowledged that alcohol programs “traditionally are not structured to deal with people with mental problems. We’d refer them to the mental health system.”

Boynton described her clients as often “young, middle-class individuals whose families have just run out of the ability to deal with them.”

‘God’s Gift’

One 21-year-old resident, declining to give his name, described the program as “God’s gift for those who have my problem, and there’re lots like us.” A student in English and political science before his illness interrupted his studies, he arrived at The River two months ago addicted to marijuana and cocaine and suffering from manic-depressive illness.

Although he received psychiatric help in other programs, he said, his substance dependency was ignored. “I had another problem and they couldn’t do anything about it, and I didn’t know where to go,” he said.

“Such fragmentation of treatment is very difficult for this population,” Boynton noted. State funding policy dictates that separate programs only handle the problems that they were created for. A more fundamental obstacle, she said, is the rigidity of each program.

The mentally ill are often turned away from drug programs because the programs forbid them to take any drugs, including their psychiatric medication.

Drug abuse counselors are unable to distinguish between the drugs’ life-support properties and their narcotic-abusive properties, Boynton said.

More basically, she said, those counselors do not know how to interact with the mentally ill. “If you confront a paranoid schizophrenic any way but gently, you run the risk of being hit,” she said.

Drug-Free Environment

Dr. Irma Stantz, director of the county Department of Health Services’ Drug Abuse Programs Office, said programs funded by her office aim for a drug-free environment.

As long as patients are stable enough to participate, they can remain in a program, but there is no physician to oversee dispensing of drugs “if they need a strong tranquilizer or medication for manic depression,” she said. “We’re not a psychiatric facility. . . . If it’s clear they’re mentally ill, they are referred” to a mental health center.

Meanwhile, mental health programs are reluctant to test for drug abuse because to do so is considered an invasion of privacy, she added. In contrast to the traditional approach, in which discussion of the mental illness is not encouraged, The River’s clients are educated about their problems and treatments.

As part of its contract with the county, The River staff shares its experiences with county workers at in-service training sessions.

“Policies need to change, and the way to change those policies is to get people educated,” said Gary Stansberry, intake coordinator at The River. He recently gave a lecture to drug and alcohol counselors undergoing training.

Others Interested

Others are tapping The River’s expertise as well.

A private foundation gave the facility $5,000 last year to provide training toward developing similar programs in the San Francisco Bay Area.

This year, the facility received $34,000 from the California Community Foundation--which manages charitable contributions by major corporations in the state. The funds are being used to develop services for the county’s dually diagnosed, including as many as 30 long-term housing units.

That project should be realized within nine months, Hayes said, adding that the facility will provide accommodations for patients’ dependents.