Mentally Ill Fall Victim to System Geared to Assist Them

The longtime patient who recently bounded into the mental health clinic in North Hollywood explained that he had won the lottery as he handed bogus checks of $20,000 and $30,000 to his friends.

But staff members at the East San Fernando Valley Mental Health Clinic knew better. The severely mentally ill patient, who had been doing well in his treatment, was deteriorating rapidly because of the threatened closure of the county-run clinic.

He was admitted to the psychiatric ward at Olive View Medical Center until he stabilized. But Tuesday he was back at the clinic, this time believing that he was a small animal.

“It was so sad. I felt like he was an infant,” said Gabrielle Williams, the clinic’s program director. “You just try to pacify them and say it’s all right, but you can’t because it’s not true.”

Disintegrating System

The client is one of thousands of casualties of a slowly disintegrating Los Angeles County mental health system that is crumbling because of a lack of money to keep clinics open.

The East Valley clinic is among eight county-run clinics operating on borrowed time. County supervisors have voted to close them, but a temporary ruling from the state Supreme Court has kept the clinics open until the court can study the matter further. However, the supervisors voted last week to try to close the East Valley facility and two others despite the court’s action.

County mental health officials said they hope to be able to close the three clinics within the next few weeks. But Jim Carroll, executive director of San Fernando Valley Neighborhood Legal Services, which joined three other legal aid groups in seeking to block the closures, contends that shutting the clinics would be illegal.

East Valley mental health professionals assume that the clinic--which provides many clients with their most important link to the outside world--will close. They say its imminent demise has triggered suicidal tendencies in some patients, terrified others who have begun hearing voices again and increased the burdens of an already overworked staff at the county’s Crisis Management Center in Van Nuys, where mental health emergencies are handled.

Once-Bustling Clinic

At one time, the clinic was bustling as a daily stream of clients received individual and group therapy. But the clinic stopped providing those services, and the clients started disappearing. In addition, the East Valley facility’s two Spanish-speaking therapists have quit, leaving the clinic’s 10% to 15% of Spanish-speaking clients without a way to communicate. Today the clinic’s primary function is handing out medical prescriptions and making referrals.

The inevitable closure has also left staff members embittered that they’ve had to impart the sometimes devastating news to emotionally unstable clients who believe that the bureaucracy “doesn’t give a damn.”

“You’ve got a lot of angry people around,” said Dr. Stanley Gurman, a psychiatrist at the East Valley clinic who has been giving patients two months worth of tranquilizers and other medication to help them through the period of uncertainty.

Meanwhile, other county clinics and private facilities that accept county patients are wondering how they will cope when the East Valley clinic’s clients begin arriving at their doorsteps.

Many of those clinics simply plan to offer fewer services, administrators said. A person who needs therapy and medication might get only the drugs. A person who requires individual counseling might be offered group therapy sessions instead.

Hundreds won’t receive any help at all. Faced with dwindling resources and staff, the county gradually has tightened its criteria for people trying to qualify for assistance. Only the most severely and chronically mentally ill will be eligible.

A person who thinks that his television is talking to him, suspects that his phone is tapped, doesn’t bathe or dress will still be treated, Williams said. But someone who has never been confined in a psychiatric hospital or requires only mild medications might be turned away.

‘Focus on Most Disturbed’

“We’re going to have to focus more and more narrowly on the most disturbed. The calls we’re getting now we’re going to have to screen more carefully. Those we might have served before might not get serviced,” said Ian Hunter, executive director of the San Fernando Valley Community Mental Health Center.

The tougher criteria have left 266 patients at the East Valley clinic with nowhere to go because they can’t meet the tighter standards, Williams said. Still others might end up in similar straits.

The clinic still has a patient list of 550 people. In August, the clinic served 1,650 patients, but many stopped coming after the county announced its intention last summer to close the facility. By January, 905 remained.

Anita Pace, 37, of Sherman Oaks is one of the clients uncertain about her future. Under the stricter criteria, she might not be considered sick enough to be helped any longer. But she doesn’t have the money to pay for visits to a private psychiatrist and pharmacy.

“I don’t know what’s going to happen to me,” lamented Pace, a college graduate whose severe agoraphobia has disabled her since her mid-20s. “At my worst, I was housebound, not even able to talk on the telephone.”

‘Hundreds of Baby Steps’

The drugs and therapy she has received at the clinic for six years have helped her take “hundreds of baby steps” forward. She is no longer afraid of the phone and she can drive a car. But she still can’t eat at a restaurant, elevators make her uncomfortable, and she feels antsy talking with another person face to face.

What will happen to people like Pace?

“Gosh, we really don’t know,” Williams said. “We’d like to think they will manage somehow, but we really don’t know.”

There already are signs that the transition is experiencing problems.

Eighty people, for instance, were referred three weeks ago to the Verdugo Mental Health Center in Glendale. But East Valley began getting complaints from the former patients who said the private clinic, which receives county funds, wasn’t accepting them.

Money Not Available

The Glendale clinic can’t begin treating those people because it doesn’t have the money, said Lynn Brandstater, the Verdugo center’s director of administrative services. Without more county funds, the clinic cannot provide the new patients with drugs or pay its physicians for their extra hours, she said. Whether the county will find the money remains unknown, she added.

“It’s really the clients who are caught in the middle of this,” Brandstater said.

Williams worries that private clinics will hesitate to treat some of the East Valley facility’s most difficult clients.

“It’s been my personal experience that many of our contract agencies are unwilling or unable to see the type of patient we see,” she said. “That’s why we have county outpatient clinics because they weren’t getting the services at private contractors.”

Williams spoke of her misgivings one morning when the clinic was eerily quiet. Boxed records and empty chairs lined the clinic’s corridors, far outnumbering patients. In some offices, nail holes are all that mark the former presence of social workers who have left for more stable jobs.

County Accused

Some angrily accuse the county of emptying the clinic of patients and staff so it would be easier to justify its demise.

Roberto Quiroz, the county’s mental health director, told the Board of Supervisors on Tuesday that East Valley’s anemic patient load and small staff no longer justify keeping the clinic open. He said he was also worried about the safety of his employees in the wake of the fatal stabbing of Robbyn Panitch, a psychiatric social worker at the county’s Santa Monica clinic.

But Gurman alleged that the dwindling number of patients was a self-fulfilling prophecy engineered by the county administration. He said mental health officials ordered the staff to provide only bare-bones services.

“It’s a farce to say we aren’t seeing patients--because we were programmed to see no patients,” Gurman said.

Ron Klein, program head of the county’s Crisis Management Center, said the consequences of the East Valley’s closure probably won’t be felt dramatically until the patients run out of medication, which could take a couple of months. The number of cases referred to the crisis team, however, did jump 10% last month.

The county first attempted to close its clinics in North Hollywood, Canoga Park and six other areas of the county in August for financial reasons. But a preliminary injunction issued by a Superior Court judge stymied the plan. A state Court of Appeal lifted the stay in January, but the state Supreme Court’s tentative ruling has so far kept the county from closing the clinics.

County Counsel DeWitt W. Clinton told county supervisors on Tuesday that they could legally shut the three clinics because the court order only prevented closures for financial reasons. The three clinics would be disbanded because of low staffing and safety reasons, he said.

Many people, including Barbara Kessel, a county social worker with clients who rely on the East Valley clinic, predicted that no money will be saved by the closure.

“I think the bottom line is people will end up flooding the hospitals,” Kessel said. “It will be much more costly to the taxpayers.”