Mental Health Center Faces Crisis : Crowding: Patients have deluged the only Valley facility still open after a series of cutbacks. Clients have had to wait hours to see a counselor--if they go on a day that the center doesn’t close early.

The Crisis Management Center in Van Nuys was a model program when it opened in 1983, offering an alternative to destitute mentally ill patients not sick enough for a hospital but too sick for traditional outpatient care. Today, some workers call it bedlam.

They recall a recent afternoon when a 25-year-old man, homeless and desperate, arrived to find the doors already locked for the day. It was only 4:15 p.m., but the crisis center--one of just three county-operated clinics left in the San Fernando Valley--was so busy that it had stopped admitting patients early so doctors could examine the people already waiting.

Social worker Ken Stonebraker offered to help find the man a place to spend the night but because he detected no evidence of a psychiatric emergency, he told him to return the next morning for medication.

Instead, the man grew furious. He tore off his clothes, threw them around the parking lot and, wearing only his chartreuse boxer shorts, lay down in front of the center doors. When that didn’t win him entry, he cursed and screamed, “Send me to the hospital, send me to the hospital!”

“Normally we would do that,” Stonebraker said. “But he was being so threatening at that point I stepped back inside.”

The man threw a rock at a car, ran to retrieve it and hurled it through the window of the director’s office.

The police were called, but the man was gone by the time they arrived.

“That’s an example of what can happen,” said Al Smart, supervisor of the socialization program at the crisis center. “If they don’t get help, their lives are in danger and other people’s lives are in danger.”

But help is hard to come by in Los Angeles County today if you are poor and mentally ill. The county, dependent on the state for most of its mental health money, pins the blame on Gov. George Deukmejian and the Legislature, which county officials say has failed to adequately support public programs for the mentally ill.

Mental health programs throughout the region were curtailed this past year, and the Valley has been particularly hard hit. Two of its largest clinics have closed, and the crisis center has been deluged with their patients.

The Van Nuys center has added 1,000 people to its rolls in five months--500 when the East Valley Mental Health Clinic closed in June and 500 more when the West Valley Mental Health Center shut down last month.

The center operates in a grim, old residential nursing home along a stretch of Sepulveda Boulevard popular with prostitutes and drug dealers. Its waiting room is a hodgepodge of mismatched furniture lit by dark ceiling fixtures. “It’s like a dungeon,” said Glenn Comer, a former West Valley patient who suffers from depression and hallucinations.

The television is usually on, and the hallways are filled with the scent of incense to mask the odor of clients who do not bathe.

Examining rooms are stark, the walls are bare, except for an occasional calendar or poster. There are no lamps or plants because they could be used as weapons. Windows are partially blocked with boards so no one can be thrown through them.

Patients suffer a range of ailments. They are manic, psychotic, depressed or delusional. A woman can’t stop crying. A man walks in circles around the room. Another says he’s training for the Olympics, would love to play tennis at Wimbledon, is studying for his Ph.D. in music, recording an album, plans to teach high school and hopes to marry Linda Ronstadt.

“My parents think I’m crazy because I’m doing all this,” he said. “They’re right. I’m an overachiever.”

Security has always been a priority, more so since psychiatric social worker Robbyn Panitch was stabbed to death at a Santa Monica clinic in February by a transient she was trying to help.

Patients are seen with the doors open. Panic buttons are in all interview rooms. And a second security guard was hired three weeks ago as the center prepared for the onslaught of patients from the West Valley clinic.

“Just coming to work” has been the toughest part of all the changes for psychiatric social worker Connie Pack, “just coming to work to face the chaos.”

Despite the problems, county mental health officials say the crisis center offers an efficient and cost-effective way to cope with limited resources. Elsewhere, the county has turned traditional outpatient clinics into crisis-type operations at Harbor-UCLA Medical Center and Martin Luther King Jr./Drew Medical Center. A small crisis operation recently started at the San Pedro Mental Health Center. Two others, in Arcadia and Santa Monica, have been approved.

Crisis centers evaluate and stabilize patients, provide medication and help with problems such as food and shelter. But with few exceptions, individual and group therapy--mainstays of traditional outpatient care--have fallen by the wayside.

“Crisis work is being done for everyone,” said Ron Klein, who runs the Van Nuys center. “Medication is being given. But beyond that, we are not offering much.”

Comer said he recently waited 2 1/2 hours at the crisis center to see a doctor--for five minutes. “After you wait that long, you get to the point where time and space become a blur,” he said. “After a while, you don’t care if you live or die. You just give up.”

As many as 69 people have been seen at the center in a single day, up from an average of 30 a year ago. At the same time, the staff has dwindled from 40 to 31, and the operation has gone from seven days a week to five. New patients can wait up to six hours to see psychiatrists who sometimes can give them no more than 20 minutes of their time, compared to the hour that they might have received at the now-closed outpatient clinics.

For some former patients of the closed clinics, the transition to a new place has been difficult.

“I had just gotten adjusted to going there,” said a 49-year-old former East Valley patient who suffers from depression. “It was a few minutes from my house, and I could walk if necessary. I had just started group, and then it all ended.”

Stanley Gurman, a psychiatrist at the crisis center who worked at East Valley for 18 years before it closed, has observed similar reactions in many patients.

“It has increased their suffering, their anxiety and their depression,” he said of the closings. “It’s like they’ve had the rug pulled out from under them.”

Since the closures of East and West Valley, some patients have been forced to ride buses for up to two hours to reach the crisis center. “They don’t know their own name, but they find their way to this clinic,” said psychiatric nurse Paula Varblow.

The outpatient clinics typically had a handful of people in their waiting rooms, not 20 or 30. There were no armed guards and no police cars or ambulances delivering patients to the front door. And doctors had more time to spend with patients because there weren’t as many to see.

“I have a couple of patients who waited 10 minutes, ran out, panicked and called me from home,” said psychiatrist Dale Campbell, who, like Gurman, also came from East Valley. “ ‘I can’t come in a place like that,’ they said. I understood. They were frightened. Sometimes this place is like a zoo.”

Patients occasionally have to be restrained. They can become violent or verbally abusive. One woman grew so uncomfortable with the long wait that she stood up and started screaming about what an awful place she was in. “She didn’t know how lucky she was to have a scheduled appointment,” Pack said. “She didn’t have to wait three to five hours.”

Some patients become so irritated, they simply leave and go without their medication, Varblow said. “They eventually make their way back when they realize there’s not anywhere else for them to go,” she said. Others bring lounge chairs and soak up sun until their names are called.

Doctors have difficulty adjusting too. “The pressure is so great,” said Campbell, who was transferred to the center after 19 years at East Valley. “You just don’t have time to do as thorough an evaluation as I would like.”

When a homeless patient arrived just before closing one Monday, Campbell took 40 minutes to assess her condition. She was psychotic and depressed, with a history of suicide attempts. He wanted to see her again soon but had no time until Thursday. So he gave her a three-day supply of medication and careful instructions on how to administer it.

But the next morning, Campbell learned from a temporary shelter that she had taken 10 of the 12 pills in what he suspects was another suicide attempt. It was not a lethal dose and the woman was fine, although the shelter said she needed more medication. Without it, they said, they would be unable to keep her.

“So I’m phoning in a prescription for a lady I didn’t have a chance to talk to, but I have to because I want her to have a roof over her head,” Campbell said. “. . . I’m not used to treating people that way. That’s a crappy way to practice medicine.”

On Tuesday, after Comer appeared at a County Board of Supervisors meeting to complain about crowded conditions, board chairman Ed Edelman asked for a report on the crisis center. It is expected to be completed this week.

County administrators say they are trying to help. They have asked mental health agencies with county contracts to absorb more patients. But crisis workers say some of the programs already have waiting lists of up to five months. A deal has yet to be struck.

Still, Klein remains hopeful. He knows there are problems at the center but takes a more philosophical view than his staff, comparing their mission to that of victims in a natural disaster such as Hurricane Hugo, struggling to rebuild their lives.

“To say nothing happened is a misrepresentation,” Klein said. “To say it was devastating is probably true. But they’re putting it back together. They’re still doing a job, not just sitting there in the devastation.”