Debra is 24 years old. She says she has already tried to kill herself once for each year of her young life. She wears the scars on her arms from self-inflicted wounds like badges.
For now, she lives in a downtown Ventura motel, but she has lived on the streets off and on for the five years she has been in Ventura County since moving from Palmdale.
"It's, like, really bad news on the streets," she said, blinking her brown eyes hard and hesitating between phrases. "When you're a girl, you always have to carry a knife."
She was homeless when both her two children were born. One has been adopted and another is under foster care.
She hopes to get her second baby back someday, when she is more stable, but exactly when that will be remains unclear.
Debra suffers from schizophrenia, a disabling disorder that keeps her on the edge of society, out of work and away from her children.
With a complete shake-up under way at the Ventura County Mental Health Department, a reorganization that officials say will revolutionize the way they serve their mentally ill clients, at least some of Debra's troubles should be eased, officials said.
They hope the new system will help Debra and about 2,000 other adults with serious mental illness who depend on the county.
The county plan is to find them stable homes, some of them jobs, and for many, a way to re-enter the mainstream of society.
"The difference is like night and day," said Randall Feltman, director of the county Mental Health Department. "Almost nothing is the same."
Ventura is the only county in the state to win a $16-million grant over four years under a state law co-written by Assemblywoman Cathie Wright (R-Simi Valley) and Assemblyman Bruce Bronzan (D-Fresno). The money substantially augments the department's annual budget of $21 million, Feltman said.
He said officials hope to create a prototype for mental health care systems that could be used statewide.
"We will have four years to develop a better system of care than anything ever done before in California," Feltman said. "At the end of that time, the state will evaluate us."
Under the present system, clients must find their way through the maze of clinics and treatment programs, each offering a different service at a different time, with different staff, some within different departments. Each mental health worker carries a caseload of 75 to 100 people, an unmanageable number, officials say.
Under the new system, each client will be assigned to a team of 10 people. Each team, including a psychiatrist and other mental health care professionals, will follow about 75 clients. And each mental health social worker will be responsible for about 25 clients.
Two teams will be located in the Ventura area--one will be downtown and one on North Ventura Avenue.
Four teams will serve Oxnard's mentally ill, two at the county offices in east Oxnard and two in its poorer downtown section. The county will use its existing buildings in Simi Valley and Santa Paula and is searching for a location in Thousand Oaks.
The teams are forming now, Feltman said. The Santa Paula team may be the first to be operational, in May, but all will be set by the end of June, he said.
The teams will take care of a client's medical and counseling needs and the logistic problems in meeting them. They will shepherd them through the welfare system, if they need assistance, or help them get priority to receive the $640 per month in Social Security disability insurance to which they may be entitled.
In addition, the county is setting up support and resource groups. One will concentrate on finding jobs, probably part-time work, for the mentally ill. Employers will be assured that job coaches will help their clients get to work. The coaches will also find replacement workers for clients on the days when they cannot work or complete a shift.
Another support group is developing a program to find alternatives to county jail for those who commit minor crimes. The effort will include county probation officers working with the mental health workers to keep clients on the right track.
A third group will provide support for the mentally ill who are alcohol or drug abusers. A crisis team will be on call 24 hours a day for emergencies. A fifth group is assigned to find stable homes for the mentally ill, in community board and care homes or shared apartments.
A new home for the county's emergency shelter program for mentally ill homeless people is among the first visible signs of the county reorganization and influx of state money.
The program, which had been operating in offices scattered countywide, moved into a stately old Victorian house across from the privately operated Turning Point drop-in center for the mentally ill on Thompson Boulevard.
"It's a godsend," said Vikki Smith, coordinator of the emergency shelter program. "We deal with the people who are most resistant to county services. It's our job to entice them into the system."
Debra said she looks forward to the new way of doing things at Mental Health. She spends a lot of time at the drop-in center on Thompson Boulevard, where she can watch television, play pool or just hang around. The atmosphere is warm and friendly.
But for counseling, medication, day programs or other treatment, she must find a way to get to the department offices on Hillmont Avenue.
"The homeless people especially don't have the money to go out there," she said. "Now they'll be closer to the people out on the Avenue."
Mike, a manic-depressive, has lived in the county for 20 of his 37 years. "It will be great to have a place close by to be able to just stop in," he said. "Now I stay in touch mostly by phone."
But he has reservations about improved services the reorganization is supposed to bring. He has had manic depression for 20 years and is acquainted with the mental health system and the people who depend on it for help.
"I have guarded optimism," he said. "I have seen a lot of people who are getting worse instead of better."
Michael M. Amey, a county Mental Health Department employee and a patient rights advocate, is skeptical.
"I have been in the mental health field for 30 years, and they change the system every few years," he said. "This time, if we've gone in the wrong direction, it will be wrong for the next five years."
Amey is worried about what he called the "mass reassignment of clients to physicians," and the possible confusion it may cause clients.
He also wonders what the ultimate consequences will be of accepting the state grant money.
"It's been my experience in dealing with the state that any time they give you something they take something else back," he said.
But like others in the mental health field, Amey would like to see the new system succeed.
"It will be really good if it happens," he said.
Some members of the Ventura County branch of the Alliance for the Mentally Ill are also skeptical. Lou Matthews, a member of the Alliance's legislative committee, has a son who suffers from schizophrenia. He is in a hospital in Sylmar, where the county contracts for some services.
As long as there are mentally ill people on the streets or in transient lodgings, she said, even the best-planned program will not work.
"You can have all the teams in the world and it isn't going to help if people don't have stable housing," Matthews said.
"Look at your life," she said. "I look at my own life, and if I were on the streets, I don't think medication would help me much."
Duane W. Essex, deputy director of the county Mental Health Department, agrees.
"She's quite right," he said. "We have not delivered yet on the housing."
With money from the new grant, 150 beds should be made available for the mentally ill by summer, Essex said. The county has plans to rent several apartments that will house 20 people. It also has funds set aside to pay board and care homes to house 24 clients who need more than the minimum level of care, a level for which the county previously would not pay.
The county also plans to lease two- and three-bedroom homes where another 75 clients will live.
Over the next few years, the county plans to add another 16 beds to its hospital unit for the mentally ill and it is working on building duplexes near Camarillo State Hospital for those who need some limited supervision.
So far, the county has hired about 15 of the workers needed to fill the positions created by formation of the teams. But it still needs to recruit and hire 50 more. It's a difficult task for a public agency in a county where the cost of living is high.
But hopes are high for the experimental program.
"If a client needs help, he won't have to worry about who to go to or where," Essex said.