Exercising Control on the Out of Control : Health: County’s Psychiatric Emergency Team responds to calls about crises involving the mentally ill. Offering on-the-spot counseling is sometimes dangerous.

The mental patient had been terrorizing his Carson neighborhood with a lead pipe--smashing cars, banging on the sidewalk. A call went out to Richard Russell, a member of the Los Angeles County Psychiatric Emergency Team.

By the time Russell arrived, the troubled man had retreated indoors. Russell stepped into the house along with a sheriff’s deputy and the patient’s worried mother. The man saw them, raised an ax and charged. “Insane anger,” the veteran psychiatric worker recalled. “I grabbed the mother and threw her out of the way . . . (and) ran the other way.”

The scene ended in a whirl of violence--the deputy firing his gun, the patient going down in a spray of blood. He was whisked to an emergency room for surgery and later transferred to a psychiatric hospital. Russell, meanwhile, went on to the next case--another memory filed away.

“It was scary,” he said of the incident a few years ago. “It seemed like time stood still when that gun cracked.”

The chilling moment was unusual--but not without parallel--in the lives of those who work the PET team, as the specialized psychiatric emergency unit is called. The squad consists of about 20 specialists ranging from psychiatrists and social workers to nurses and psychiatric technicians.

They fan out on the streets of Los Angeles each day, defusing mental health crises that flare up in neighborhoods, schools and office buildings.

Like troops in an outmanned infantry, PET workers struggle to patrol a region of 10 million inhabitants. They operate from seven far-flung Los Angeles County mental health clinics, racking up thousands of miles a year as they crisscross the territory responding to calls from police or concerned citizens.

They face guns, knives and job burnout. They are expected to bring cool rationality to situations where rationality has all but disappeared.

Traveling in pairs for safety, the unarmed team members offer on-the-spot counseling in the streets. Where possible, they arrange appointments for patients at mental health clinics. Where necessary, they are empowered to use physical force to confine a patient who is considered dangerous to himself or to others, or who is so impaired he cannot care for himself.

Under orders of the team, such patients can be held at a psychiatric hospital for up to 72 hours of evaluation.

The Los Angeles PET network, initiated in 1970, was considered a model for similar programs now operating in other large urban areas, including Orange County. Last year, the Los Angeles team handled 26,017 calls and made 6,200 trips into the streets, according to figures compiled by the county Mental Health Department.

But this year, because of reductions in personnel and working hours, these numbers are expected to fall by 50%.

PET members say their task has been made tougher in the last two years by cuts in state funding for local mental-health programs. Today, the team is half the size it was a few years ago.

“It’s like losing half your police department,” said Dr. John S. Wells, the county’s assistant medical director for mental health. “We’re not dead, but it has wounded the system.”

The reductions have made it nearly impossible to respond to marginal calls or to follow up on cases, Wells said. Instead, PET workers “put out fires,” as one veteran member described it.

Many of those fires burn on Skid Row in downtown Los Angeles, where mental illness is rampant, according to team members. In a 1982 study, the county estimated that 30% to 50% of Skid Row’s escalating homeless population was severely mentally ill. Team members say the afflicted can be found today on nearly any corner.

“It gets sort of frightening,” said Skid Row team member Karen Palermo. “There’s only so much we can do to keep the lid on the kettle.”

The problem is compounded, Palermo said, by a high incidence of alcoholism and drug abuse among the homeless.

To a large extent, the mentally ill have been unable to get the medication, counseling or hospital treatment they need to function normally, according to Dr. Rodger K. Farr, a retired county administrator who in 1981 founded the first public mental health clinic on Skid Row.

“The mental illness problem is the main contributor to the homeless population in the Skid Row area--there’s no doubt about it,” Farr said. PET members “couldn’t see one in 10 people they need to see,” he added. “There’s just so much need.”

The five-member squad assigned to Skid Row is responsible for a geographic area typical of the emergency network--a swath containing 2 million residents, extending from East Los Angeles to Hollywood and West Los Angeles.

On a recent morning, the squad’s case list included the usual daunting challenges: a woman nine months pregnant who had begun smashing windows and attacking members of her family; a woman living in a clump of bushes west of the Harbor Freeway who had been reported looking ill; and a man living in a Los Angeles board-and-care home who had been accused of setting fires in an upstairs hallway.

So on a cool, blustery day, with those and other cases waiting, team members took to the streets. Sharen Reed and Shirley Wright cornered one of their targets--the alleged arsonist--in the board-and-care home near MacArthur Park. He was seated at a lunch table, a gaunt, white-haired man with a hawkish face and thick glasses.

The women waited and approached him carefully in a secluded hallway.

“I don’t know you,” the patient said defensively, in thick, halting speech. “I suggest you leave right now!” He had his own psychiatrist, he said. He was being careful--he knew the communists were after him.

“What are these communist people doing to you?” Reed asked.

“I do not fool with the county! If you bother me, I’m going to take it up with the police or the FBI!”

The building manager arrived, talking to the team out of his earshot. She wanted the man taken away--now. “I’ve seen him . . . get out there (in traffic) and do all kinds of gyrations,” she said. “I hold my breath!

“The other night he lit a matchbook on fire on the second floor. With a flaming matchbook, he threw it on the carpet! That was observed!”

Had the manager seen it herself, Wright asked.

No.

Wright shook her head.

“I think he’s a danger,” the manager asserted.

The two team members shrugged. Someone would have to keep watching him. Besides, they told the building manager, the 1,800 psychiatric beds available to Los Angeles County patients were--as usual--filled.

Cases can drag on for days, even weeks. Eventually, the suspected arsonist was transferred to a smaller board-and-care home where he could be watched more closely. Meanwhile, the missing homeless woman who had been living in the hedges turned up and was placed in a shelter. As for the runaway pregnant woman from Highland Park, she made a surprise appearance at the hospital, delivered her baby and--to the chagrin of team members--disappeared again.

Once more, the search for her was on.

“She’s doing the same thing--breaking windows, attacking her family,” Reed said. “We’re trying to find her. We’ve been out to her house five or six times . . . (but) she’s never there. She’s even faster than before she was pregnant.”

Such problems preoccupy the team day in and day out. “The typical case is not very exciting. It’s mostly sad,” said Ron Klein, who heads a PET squad in Van Nuys.

Klein cited one case of a pregnant woman who had begun hallucinating.

“And she was very scared,” he said. “She had three other children. (She asked,) ‘What’s going to happen to them? What’s going to happen to my baby?’ And she started crying.”

“What the team does well,” Klein said, “is to interrupt that. (They) assure families . . . ‘We’re going to help you through this.’ ”

But PET members have to be prepared for danger. For Reed, a three-year veteran, the point was rammed home--repeatedly--while she was assigned to Arcadia. One day a patient’s family summoned the team, then took violent exception upon realizing the patient would be hauled away.

The task was carried out, but Reed couldn’t flee quickly enough.

“The family followed us from Pasadena to Arcadia on the freeway, ramming our car,” she recalled. “They kept chasing us. We finally went directly to the Arcadia Police Department.”

Joe Mackey, a 10-year veteran based in Santa Monica, recalled a time when a mentally disturbed woman leveled a cocked shotgun at him. He dove behind a station wagon, circled it and managed to blindside her and take away the gun, he said. She was then taken away, with police help, to a psychiatric hospital.

“The shotgun made no difference about the (involuntary) hold,” Mackey said. “Even if she hadn’t pulled the gun, we had decided she was going to the hospital.”

Whenever possible, cases are screened by phone, and if there is the chance of violence police will accompany the team.

In the past, the team functioned as an around-the-clock emergency service. But since last fall, calls received after 5 p.m. or on holidays are forwarded to a central screening office at Metropolitan State Hospital, a state-run psychiatric facility in Norwalk, which rarely dispatches people into the field. Callers generally are urged to wait until morning or, if a danger exists, to notify police.

“In San Gabriel, we used to do 175 to 250 after-hour calls a month,” county official Wells recalled. “Now, zero.”

The problem has thrust a greater share of the burden onto police.

Meanwhile, there are other difficulties. One is what team members call “Greyhound therapy”--the practice by other states of dealing with their mentally ill by putting them on a bus to Los Angeles. They disembark at the Greyhound terminal near Skid Row, adding to the caseload. Almost invariably, they are without family, doctors or adequate insurance.

Russell, 51, a 20-year PET veteran, called the practice just one more cause of job burnout.

“It comes not just from having a lot of work to do, but from having a lot of work that can’t be done the way it should,” he said. “. . . You want to do something and just can’t. You get up against four or five of them a week, or 10 or 12 a week, and it starts getting to you.”

Russell noted that, in most cases, PET members never know the ultimate fate of their patients, “because we send them off somewhere, and you never hear from them again.” But every once in a while, walking Skid Row, he sees a familiar face--one that’s cleaned up, looking a little more proud.

“You’ll holler, ‘How you doing?’ ” Russell said. “He’ll say, ‘I’m doing fine! I’m taking my medication. I’m going to a board-and-care home.’ They’re off the streets . . . they have a destination, rather than just walking around.”