Clinic Staff’s Nagging Fear Is Realized in Violent Act

Most of the men and women who walk into county mental health outpatient clinics are a danger only to themselves, casualties of private wars that rage only within their minds.

Every now and then, however, a patient will present a more tangible danger to the professionals who staff these psychiatric outposts. And, as word of the stabbing death of clinical social worker Robbyn Panitch spread among her colleagues Tuesday afternoon, many recalled their own close calls.

“Many times you don’t know who is sitting in front of you,” said Dr. Randall Firling, a psychiatrist with the County Homeless Outreach Program. “It can be someone who is very paranoid, either delusional or hallucinatory. To (her assailant), Robbyn may have been his mother, a girlfriend who booted him out, God, or who knows?”

Even as investigators were trying to determine just why an outpatient, identified by Santa Monica police as David Smith, brutally attacked Panitch on Tuesday, mental health professionals said they fear that there could be more such attacks after dramatic budgetary cutbacks in the county mental health system take effect on Monday.

“When I hear something like this, it confirms my worst nightmare,” said Julie Ann Hargaray, a psychiatric technician at El Camino Mental Health Center in Santa Fe Springs. “I’ve been kicked in the head, spat at, punched in the stomach. I’m concerned about what’s going to happen with the clinic cuts.”

County officials, however, said there was no reason to believe that the attack was related in any way to the cutbacks.

“This is a tragic incident and it’s important to note that people who have not had mental illnesses have committed such violence,” said Mental Health Director Roberto Quiroz. He said he saw no reason to believe that clinics will be less safe for workers or the public after the cutbacks.

County officials said the most severely and chronically mentally ill will continue to get treatment and medication, and that many other patients will seek care at private clinics.

Richard Van Horn, executive director of the Mental Health Assn., which represents patients, their families and workers, agreed that the assault Tuesday was an isolated case. But he expressed fear that some mentally ill people who are being deprived of care might respond violently.

Such patients “are getting frustrated and angry, and things are escalating,” Van Horn said. “The real tragedy is that the state is not recognizing the level of the problem that we’ve got.”

Because a lack of state funds for mental health programs, Los Angeles County ordered $18 million in budget cuts, which will force the closure of eight mental health outpatient clinics, affecting about 20,000 patients from the San Fernando Valley to the South Bay. Services will be drastically reduced at another five clinics.

Because of the cutbacks, mental health workers said, patients with borderline psychoses will be forced out of the outpatient system to make room for the most seriously ill. Consequently, more mentally ill people will either have no care at all or be forced to be hospitalized during their worst episodes.

“It is extremely likely that an identifiable percentage of these patients will become violent,” predicted Melinda Bird, a staff attorney with the Western Center on Law and Poverty that represents indigent, mentally ill patients.

‘They Will Direct That Violence’

“And they will direct that violence against those who are close to them. That will definitely include county mental health staff, and family members and people they bump into in the community as well.”

A dozen mental health care workers interviewed Tuesday said that most routinely have been exposed to dangers. But now, they stressed, they will have to deal with a greater percentage of seriously ill patients with fewer workers. Officials say between 240 and 280 mental health workers are to be laid off under the cutbacks.

“Our clients do not deal with stress and change very well,” said Paul Schettler, director of the San Pedro Mental Health Center. “Our concern is we’ll see more and more crises similar to this. . . . This is the only fatality, but we’ve had many other situations come close.”

Most of the patients come through the front door of the county mental health clinics quietly depressed or disoriented. But others draw knives tucked under pant legs, hurl ashtrays at receptionists and threaten to kill the very people who are trying to help them. In one case a few years ago, a distraught patient followed a worker into a clinic coffee area and tried to strangle her.

County officials in charge of security for clinics were busy investigating the assault Tuesday and could not be reached for statistics on previous attacks.

Security provisions vary from clinic to clinic, workers said. At some, workers have silent alarms under their desks. Because of the patients’ need for privacy, most interviews are done in private offices. In some clinics there is a security guard. But in most clinics, including the site of the slaying, staffers must call police if they need help, workers said.

Because the drop-in clinics must remain open to serve clients who need help, the ranks of mental health workers on duty after hours is likely to drop, reducing the protection that workers feel from other staffers.

In the past, workers said, the county offered workers optional self-defense courses.

“We’re going to be turning down sex offenders, we’re going to be turning down wife-beaters, we’re going to be turning down all sorts of people who need help,” said one veteran psychiatric worker who asked that his name not be used. “How would you like to be a woman working late at night with only a receptionist between you and the front door?”