Shelter Isn’t Enough to Aid the Mentally Ill : Health services: About one-third of O.C. street people have conditions they cannot control or cure.

They call him Crazy Bob. He has tried to kill himself so often he can’t remember how many times. But the pale, ragged lines on his wrists and arms--the result of dozens of razor slashes and bashings against glass panes--remind him that the “voices” want him dead.

“These voices are real as a person talking next to me,” said the 39-year-old paranoid schizophrenic, who lives in a tent near the Santa Ana River. “They tell me I have to kill myself. They tell me I have to hurt myself.”

Officials estimate that Orange County has 10,000 homeless--men, women and children who live in parks, cars and cheap motels, or curl up under bushes at Santa Ana’s Civic Center.

Most have problems that go beyond finding work or a place to sleep. These hard-core homeless--those who can’t think straight or are hooked on drugs--are on the streets the longest and are the most difficult to reach.

Bob is among the estimated one-third of the homeless who are mentally ill, county mental health experts say.

Often without friends, families, medication or counseling, they wander the streets tormented by illnesses they can neither control nor cure. They are shunned by other homeless and feared by passersby. And they need much more than a shelter bed and employment.

“They are the helpless homeless,” said Michael Bouchard, who manages the Lighthouse, a Santa Ana drop-in center that helps mentally ill street people. “They don’t know how to survive on the streets. Many times we find them curled up in a corner. They don’t eat, they don’t sleep. They don’t do anything until somebody finds them and tries to help them.”

Take Bob. He has been in and out of mental institutions since he was 13, he says. The hospitals released him as soon as he became stable from medication. Then he was back on the streets.

Most mental health programs for the homeless are not coordinated with services such as counseling and monitoring, said Fred Osher, acting deputy director of the National Institute of Mental Health in Maryland. While most homeless are directed to shelters and advised to apply for financial help, the mentally ill are often too paranoid or erratic to follow through.

“There are all kinds of opportunities for people to fall through the cracks,” Osher said.

Such is the case here, said Carol Burby, director of programs for the Mental Health Assn. of Orange County.

“On the whole, the homeless programs aren’t hooked up with mental health services and vice versa,” Burby said. “There is plenty of coordination that needs to be done here in the county.”

In 1985, Orange County started its mentally disabled homeless program for those who are ignored by other services, said Douglas C. Barton, deputy director for the county’s Mental Health Services.

Each year, the county receives $1.2 million from the state and federal government to pay for five full-time outreach workers, 88 shelter beds and two drop-in centers, in Santa Ana and San Clemente. The county’s outreach workers identify the mentally ill and try to find shelter, counseling and other services for them. Under the conditions of state funding, the county focuses on those with the highest risk for hospitalization--the “sickest of the sick,” Barton said.

But many do not benefit from the program because it is designed for emergency cases, said John A. Garrett, executive director of the Mental Health Assn.

They are left to fend for themselves, like Alan.

A former Air Force enlisted man, Alan, 32, says he was fearful of filling out disability forms and answering questions from strangers when he was living on the street.

He lost his apartment in Irvine after compulsively spending his family’s rent money and savings. Now living at the YMCA shelter in Santa Ana, he is trying to come to terms with manic-depression.

“I kept thinking, ‘Oh, this is not happening. I can’t be crazy,’ ” Alan said.

The county spends about $210,000 a year on beds specifically for the mentally ill homeless. But many are too ill to come in off the street to take advantage of the shelters.

Yvonne, a 43-year-old manic-depressive, says she did not realize shelter beds were available when she was on the street. And she says that even if she did know, she would been too afraid to seek help.

Yvonne was kicked out of her mother’s home in August for being disruptive. One day she was living in an upper-middle-class Santa Ana neighborhood. The next she was living in her car, a 1981 Chrysler Le Baron.

The first few nights were not bad, Yvonne recalls. She played the car radio and sang along with an oldies channel. But then the battery went dead.

“When the battery died, the music died, and then it got really bad for me,” she said.

She spent her days on a bench on Tustin Avenue, talking to strangers. At night, she went to bars, picking up drinks and men. She found help only after swallowing a bottle full of lithium pills. She was taken to St. Joseph Hospital’s emergency room in Orange, where she was referred to the Mental Health Assn.

“I don’t want to go back (to) being homeless,” said Yvonne, now in a shelter. “You cannot believe how scared I am.”

Dr. Ike Kempler, a psychiatrist who treats the mentally ill in the county program, said most suffer from schizophrenia--an illness that causes people to be unable to distinguish what is real or not--and emotional disorders such as manic-depression that cause dramatic changes in moods. There are no cures for these illnesses, but their symptoms can be reduced with medication. The problem is, an estimated 85% of the mentally ill homeless do not seek treatment.

Bob says he tried to control his hallucinations by drinking alcohol and taking illegal drugs such as speed. But a few months ago, he sought and received help from the county program.

He began taking medication prescribed by a county psychiatrist and would board two buses to visit the Lighthouse almost daily. Usually happy-go-lucky, he was liked by staff and other center clients, volunteered for chores and often led conversations.

But Bob admits he sometimes does not take his pills. Then he hallucinates, hears voices and believes that everyone is out to get him.

Last June he hid, naked, inside a drainage opening along a bike trail. He had not taken his pills. When two men passed by with a Labrador retriever, Bob tried to bite the dog. While police were called, Bob growled.

And he recently landed in the Orange County Jail, having allegedly resisted questions from sheriff’s deputy who stopped him on the street.

So why would Bob ever stop taking medication if it controls his illness?

“Sometimes I feel so good about myself that I don’t take the pills anymore,” he explained in a recent interview. “It gets to the point when you don’t hear the voices and you get to thinking, ‘I’m normal.’ I wanted to be normal.”

Bob says that since he cannot afford to rent, he would rather stay outdoors. He refuses to stay in a county shelter. It takes away his freedom, he says.

During a recent cold spell, Bob proudly showed visitors his “house,” a tent in a clearing off the riverbed. Bamboo shoots shield him from a freeway. And a winding path through a wall of bushes leads to the river, where he watches cranes and ducks feed.

Several coffee mugs hang from tree branches along with a knife, scissors and bags of aluminum cans. Scattered outside the tent are mystery and accounting books, empty beer bottles and pouches of Bulfinch tobacco. Inside are blankets, sleeping bags and two makeshift hampers: one for clean clothes, the other for dirty.

During the day he goes to the Lighthouse. At night he stays in the tent and reads his Bible.

“I used to beg to God, ‘Lord, please take my life, I’m so tired of being sick,’ ” he said. “It’s taken me a while to know that I have a disease that’s not curable. That scares me. But I’ve learned I’m not alone either. And there’s people willing to put up with crazy people like me.”