Mental Health Clinic Closures Create Turmoil

The long-awaited closing Friday of three Los Angeles County mental health centers has permanently cut off hundreds of mentally ill people from treatment, triggering suicide threats, confusion and frantic calls by frightened mental patients to the overcrowded clinics that remain open, officials said.

Among the clients left stranded by the closings, only the “sickest of the sickest of the sick” will remain eligible for county help, said Dr. Milton Miller, chairman of the psychiatric department at Harbor-UCLA Medical Center, which is accepting 250 patients from one of the shuttered clinics.

“There has been a brutalization of the system,” he asserted.

Packed Up Records

Psychiatrists and therapists stopped seeing patients June 2, but the doors officially closed Friday when staff packed up records and cleaned up. The three clinics--East San Fernando Valley Mental Health Center in North Hollywood, Coastal Community Mental Health Center in Carson and Wilmington Mental Health Center--were slated for closure after the county won a contentious legal battle with mental health advocacy groups that wanted to preserve the clinics.

About 1,175 patients were still on the rolls at the time the three centers closed, but supervisors said the total is just a fraction of the caseload the centers once handled before the staff started leaving and threats of closures started surfacing.

Meanwhile, mental health providers throughout the county said they were shocked when county officials unveiled a new list of deeper cuts Thursday. Programs for the aged, children and minorities would be curtailed, and the San Fernando Valley would be left with almost no public mental health services. The $10.9 million in proposed cuts, along with others already in the pipeline, would force the closure of six of the remaining 28 clinics.

“What we are looking at at this point is a complete and utter disaster in the mental health system,” said Dr. Ian Hunter, executive director of the San Fernando Valley Community Mental Health Center. “The mental health system has gone insane.”

Among those stranded by the present closings are roughly 350 children, most sexually or physically abused, who had received counseling at the Coastal Mental Health Center. There was no other program that could absorb the large number of children needing help, said Joel Foxman, the center’s director and chief of the South Bay.

When asked what would happen to the children, Foxman replied, “I’m really afraid to consider the possibilities.”

In the San Fernando Valley, about 300 of the 800 patients from the North Hollywood clinic have been referred to two county-funded, privately run clinics that have placed them on waiting lists. Administrators at the two clinics said there is little hope most of them will ever receive appointments.

Clinic officials said they have been receiving lots of calls from “bewildered, frustrated” patients since the centers closed. They also report a rash of suicide attempts and suicide threats since preparation for the closings began, although no one could quantify that.

Begged for Help

Fernando Escarcega, the head of the Valley’s out-patient clinics, encountered one of the displaced patients at the closed North Hollywood center Friday afternoon. A couple with their mentally ill boy cornered Escarcega in the hallway and begged him to help.

The father cried as the mother pleaded and clung to the stunned official. Their son, who needed more medicine, slumped to the floor. Escarcega broke policy rules and obtained an appointment for the boy that day at the county clinic in San Fernando.

“It was the most disturbing event I have personally faced since this all began,” said Escarcega, who presided over three meetings Thursday where many North Hollywood clinic staffers cried.

The bulk of the Valley patients are being transferred to the county’s understaffed Crisis Mangement Center in Van Nuys, where psychiatric emergencies are handled. The center shut its doors several hours early Monday because of an overcrowded waiting room--a phenomenon that started earlier this year, said Ron Klein, the district chief of the center.

Dependent on the state for most of its mental health money, county officials said they reluctantly ordered the closures when the mental health budget plunged hopelessly in the red after the state failed to provide the county enough money to keep the system afloat.

County officials said further deterioration of the crippled mental health network could only be avoided with a large cash infusion. Another $15 million would spare all remaining programs. But under the cheeriest scenario, the county only expects at this point to receive an additional $5.4 million from the state, said Francis Dowling, deputy mental health director. Overall, the county spends roughly $300 million a year on mental health programs.

“This is not what we want to do, but we are forced to because of the failure of the state to come through with sufficient funds,” Dowling said.

Jim Carroll, executive director of San Fernando Valley Legal Services, who filed the unsuccessful lawsuit against the county, said it is “very likely” he will sue again in light of the new cuts that he called “incredible.” He suggested a state audit to trace where the county’s mental health money is being spent.

Meanwhile, the first round of closures has prompted the county to create tougher guidelines on who will qualify for help, officials said. It has also forced providers to cut back services to the bare bones.

A person needing individual therapy might only receive group counseling. A person who needs therapy and medication may only get drugs. Appointments could be spaced further apart.

One victim of the tougher guidelines is Mary, a 45-year-old woman who has been disabled by agoraphobia (an abnormal fear of being in open or public places) for 10 years. Unable to leave her house without someone accompanying her, she is subject to panic attacks and has never mentally recovered from an assault by an intruder in her home years ago.

Denied Help

By letter, Mary was referred to the San Fernando Valley Community Mental Health Center. But on Monday, a staffer told her she was not sick enough to qualify for assistance because she was not on medications and had never been hospitalized.

“I feel my well-being has been very, very severely threatened,” Mary said. “I am on a thin thread, not to just give up.”

Glenn Comer, a mentally ill plaintiff in the Legal Services lawsuit, said a suicidal friend ended up in the hospital after blaming herself for the clinics’ problems.

“She started burning herself with cigarettes when she heard voices that she was bad and that’s why the clinic was closing,” Comer said.

Mental health professionals say the closings have already resulted in more hospitalizations and are beginning to overwhelm the county’s emergency rooms and psychiatric wards.

That’s what Miller of Harbor-UCLA Medical Center said he dreads. Every night, physicians must turn away psychiatric patients who are not sick enough for a bed.

“We play a game of ‘Sophie’s Choice’ night after night after night,” Miller said. “It’s a horrible job.”