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Decline of Mental Health System Accelerates : Medicine: Los Angeles County’s problems started long before massive cuts in the new state budget. Prospects for the future are frightening, experts warn.

TIMES STAFF WRITER

In about three weeks, Los Angeles County’s mental health system will start self-destructing. Many county clinics will be closed, already overcrowded psychiatric emergency rooms will be deluged and up to 26,000 severely disturbed patients will be stranded, officials said.

But the crisis facing the county’s most psychotic and suicidal citizens didn’t start last week when massive mental-health cuts in the state’s new budget prompted the county’s mental health director to declare a “state of emergency.”

The system started eroding in the 1970s, but for many it only became tangible last year. After blaming their problems on another year of meager state funding, county officials closed five of 28 clinics.

The consequences came swiftly.

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During the last year, for instance, physicians at Martin Luther King Jr./Drew Medical Center have released hallucinating patients if they do not appear to be suicidal to free scarce beds, according to Dr. Anna Smith, vice chairwoman of the hospital’s department of psychiatry, who compares the practice to “playing Russian roulette.”

With psychiatric admissions up 43% since April, 1989, severely mentally ill patients sometimes sit two or three days in a waiting room before a bed is free.

What has happened since the summer of 1989, mental health activists warned, is only a precursor to what can be expected in the coming months. And, they said, it frightens them.

“It’s hard to grapple with the enormity of the problem,” said Ann Brand, president of the Assn. of Community Mental Health Agencies.

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With no place else to turn, many disturbed people have ended up at County-USC Medical Center shackled to their beds with leather restraints. In recent months, 30 to 60 patients a day could be found tied to their beds, said many psychiatrists. They are sharing rooms with cancer patients, heart attack victims and others in the medical wards because the 116 beds in the locked psychiatric wards--where shackles are not needed--are filled.

Numerous psychiatrists, who asked not to be identified for fear of reprisal, told The Times similar stories:

Some County-USC patients have laid on urine-soaked sheets and waited three or four days to see one of the psychiatrists, who said they are overwhelmed with the crush of suicidal and psychotic people. Frightened or angry patients sometimes cut or bruise their limbs trying to escape from restraints. One man in his early 20s recently managed to free himself and was found standing on a 13th-floor ledge talking to God. He was rescued.

“You’ve heard of animal rights? You can’t put makeup on a rat and yet you can let someone sit in their own urine for many hours because there is no one there to take care of them. That doesn’t seem right to me,” said Dr. Nick Dewan, who until recently worked as a psychiatrist at County-USC.

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Richard Cordova, County-USC administrator, disputed that any mental patients are being neglected. He said that up to 75% of the psychiatric patients shackled to beds in the medical wings are there because they are physically sick and not because the psychiatric wards are filled.

The dimensions of the suffering, said Dr. Milton Miller, chairman of the psychiatry department at Harbor-UCLA Medical Center, “deadens people’s sense of the horror. When you take away one person’s doctor and he dies . . . you can encompass it in your mind. When you get to talking about 5,000 people, 10,000, 20,000, it’s hard for people . . . to encompass what that means.”

The current crisis was precipitated when Gov. George Deukmejian’s budget cuts resulted in a deficit of up to $45 million for the county’s mental health programs.

After last year’s closures, some patients waited three or four months to see a psychiatrist at county-supported clinics. About 8,000 patients couldn’t get any appointments. Calling it a “wrenching, wrenching experience,” Ford Kuramoto, who resigned as district chief of the Hollywood clinic in March, said many patients “begged and cried” when told they were no longer welcome.

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Some centers remained open with skeleton crews after massive layoffs and resignations. Last summer, there were 358 fewer doctors, nurses and other personnel on the payroll than two years before when there were 1,763 health workers. Many more have left since then. Under these conditions, physicians have relied more heavily on drugs to control patients, according to clinic administrators and psychiatrists.

With treatment at the clinics no longer guaranteed, more mentally ill grew sicker, concluded Dr. Smith and numerous other physicians.

A sicker population has placed a greater burden on the county’s four psychiatric emergency rooms, which are expected to treat the uninsured mentally ill when they become suicidal or a threat to someone else. At County-USC Medical Center, for instance, the psychiatric emergency room closes to the public almost daily because too many people are already inside.

When the Board of Supervisors meets on Monday to begin budget hearings, it will have few options to soften the blow of a deficit of $43 million to $45 million from assorted state cuts. Officials will propose clinic closings, cuts in programs for disturbed children and adolescents and the abolishment of emergency teams often called when a deranged person is threatening to kill himself or others. The board also will have to eliminate or cut funding to many of the 70 or so private mental health agencies that serve county patients.

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The county would begin closing clinics within two weeks of the board’s approval, said Francis Dowling, chief deputy director of the county’s mental health department.

Those centers are in northeast Los Angeles, La Crescenta, San Fernando, Santa Fe Springs, San Pedro, Compton and an emergency center at Metropolitan State Hospital in Norwalk. The Inglewood clinic also will be closed if problems with the lease can be resolved. In addition, an undetermined number of private clinics that receive county funds are expected to close or reduce services.

County officials and mental health advocates blame their problems on historic underfunding by the state, which provides 90% of the money for the county’s mental health network.

By law, the county pays the other 10%. For the last four years, the state’s contribution to the clinics, the psychiatric hospital wards and other basic mental health services has remained at $129 million, said Gurubanda Singh Khalsa, the mental health department’s financial officer.

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With inflation eroding its buying power, the Board of Supervisors for the last four years has contributed a total of $31.4 million--beyond its mandated obligation--to keep the system afloat.

Initially, the county anticipated another $129-million appropriation in fiscal 1990 which would have left it with a $10.2-million shortfall. But officials were shocked when they learned earlier this summer that Deukmejian was proposing much deeper cuts.

Supervisor Ed Edelman said he would recommend that the board once again kick in extra money. But he acknowledged that, as in previous years, the county has too many needy causes to completely bail out the department.

“I’m really angry about this,” said Mental Health Director Roberto Quiroz of the governor’s cuts. “It’s not a situation where you could stop building a road or building an airplane. This is a situation where we are telling people who need care we don’t have the resources to treat them. It’s damn inhumane.”

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But a state finance official said Deukmejian had little discretion when he pared mental health funding. Wanting to maintain a $1.3-billion reserve for emergencies, the governor had few places to cut, said Theresa Parker, program budget manager for the state’s Department of Finance.

The governor had to dip into the 8% of the state’s budget that can be touched and that includes the mental health monies, she said.

Everyone agrees that as the system crumbles further, the county’s psychiatric wards and psychiatric emergency rooms at County-USC, King, Harbor-UCLA and Olive View Medical Center will be taxed even more. But among the four facilities, only 265 psychiatric beds exist. In comparison, New York City has 1,700.

The psychiatric emergency rooms are often jammed with delusional patients because there is no other place to put them, Quiroz said. Ideally, these patients would get a bed in one of the hospitals’ psychiatric wards. But these wards are filled with people who really need to be in a state hospital for long-term care. An empty bed at a state hospital, however, is a rarity.

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At County-USC, 127 physicians and other health professionals signed a petition this spring asking that 100 new psychiatric beds be created in the county. Saying they were “distraught and enraged,” the physicians said they could not properly treat the crush of mental patients.

County-USC’s Cordova agreed that the lack of sufficient psychiatric beds has created problems, but is not endangering the patients’ health.

As the county’s mental health system has eroded, no one is keeping track of the system’s dropouts, but Los Angeles police say they are bringing more disturbed people to emergency rooms.

County officials believe that some people who were barely hanging on are now wandering the streets or sitting in jail.

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Richard Van Horn, head of the Mental Health Assn. of Los Angeles County, predicts that the collapse of the mental health network will prompt the doubling of the county’s homeless population.

Roslyn Perry, a 46-year-old with a raspy voice and sad eyes, is already a casualty. The streets of South-Central Los Angeles swallowed her up when she couldn’t cope with the hassle of getting seen at a clinic.

“If I have 20 or 30 bucks, I forget all about schizophrenia,” Perry said. “I forget all about epilepsy. I get in my own little world. It’s so nice, but you can’t stay there forever.”


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