Family Help Crucial as Clinics Close

Anticipating the closure of eight outpatient clinics, the Los Angeles County Department of Mental Health last month notified nearly 5,000 clients they would be reassigned to other county facilities. An 11th-hour decision by the state Supreme Court postponed the closures on Feb. 27, but left a lot of clients wondering where to go for help.

About 5% are still awaiting clinic reassignments and the prospect of additional disruption looms. Now designated for closure are clinics in North Hollywood, Carson and Wilmington.

Family and friends can be crucial in helping mental-health patients cope with changes and remain in the services loop, experts say. Here is their advice for easing the transition:

-- Be reassuring, said Joel Foxman, director of Coastal Community Mental Health Center in Carson. “Tell the patient there will always be services available,” although perhaps not services the client would prefer. For immediate problems, a client may have to visit an emergency room or attend a self-help group instead of seeing a therapist. To handle the stress, Foxman urges family members to join a support group as well.

-- If there’s a lengthy lag between the last appointment and a scheduled one and the client is experiencing difficulties, “go ahead and contact the new clinic,” said Ambrose Rodriguez, assistant director of the Los Angeles County Department of Mental Health. If an earlier appointment cannot be scheduled, the client will be referred to another service, such as a drop-in group. Those who feel they’ve gotten lost in the system should call the department’s information and referral service, (213) 738-4961.

-- “Be sure the client has gotten a referral,” said Richard Van Horn, chief executive officer of the Mental Health Assn. in Los Angeles County, a nonprofit information, referral and advocacy group. “Call both the old and new clinics to verify (the transfer) and ask, ‘Who’s the primary therapist?’ And call us ((213) 413-1130) if there’s a problem.”

-- Try to reduce anxiety about the change, said Dr. Thomas K. Ciesla , medical director for mental health services at St. John’s Hospital and Health Center, Santa Monica, and immediate past president of the Southern California Psychiatric Society. “If you can help get them back into a familiar, non-threatening routine quickly, you’re taking the sharp edges off the world around them.”

-- Self-help groups can prove helpful, too. Among those recommended by the Mental Health Assn.: Recovery Inc., (714) 542-3834; Project Return, (213) 413-1130; Manic Depressive and Depressive Assn. of Los Angeles, (213) 370-0629. “We’re going to be turning more and more to volunteer and self-help groups both for families and clients,” noted Foxman.

-- Those who want to express opposition to future closures of county outpatient clinics should start with their representatives, said Donald Richardson of the California Alliance for the Mentally Ill. “Don’t jump over layers of bureaucracy,” he advised. For more information, call (818) 577-6697.

‘Controlled Smoking’

For hard-core cigarette smokers, “controlled smoking” might be a reasonable alternative to abstinence, says an Oregon researcher who recently compared the tactics.

In the study, smokers enrolled in a traditional cessation program were informed of their “quit” date while those in the controlled-smoking program were told that quitting was the best approach but that program directors would also support reduced smoking.

Long-term cessation rates produced by both programs were comparable, said Edward Lichtenstein, a clinical psychologist at the University of Oregon and the Oregon Research Institute who co-directed the study with Russell E. Glasgow and Karen Morray. At six-month follow-ups, 22% in the traditional program and 20% in the controlled program had quit.

“Controlled-smoking approaches offer a number of potential advantages,” the Oregon team writes in the current issue of the journal Behavior Therapy. The controlled approach, controversial among smoking-cessation experts, might attract smokers who would otherwise bypass abstinence-based programs.