A Haven at Risk : State Budget Woes Jeopardize Future of Camarillo State Hospital

As psychiatrists escorted Chris Olsen into Camarillo State Hospital two years ago he saw overhead wires dripping sewage and heard voices telling him he was the Antichrist.

Schizophrenia had struck Olsen in his late teens, scrambling his reason and polluting his mind with hallucinations. Doctors and drugs had failed.

Then he was committed to Camarillo State Hospital, home to one of the nation’s top schizophrenia research facilities and workplace of world-renowned psychiatrist Robert Liberman.

For more than 20 years, Liberman had led the research clinic there--a joint project with the UCLA psychiatry department--pioneering treatments now used around the globe that focus on managing incurable mental illness.

Liberman and his staff led Olsen back to mental clarity.

Now Olsen is living in a group home, applying for landscaping work and fending off the hallucinations with Risperidone, a new potential miracle drug for some schizophrenics that is being tested at Camarillo State Hospital.

“I’m doing real good now,” Olsen said. “They really helped me.”

Yet despite Camarillo State Hospital and Developmental Center’s steadily growing reputation as a national mental health research institution, it faces the same uncertain financial future today that has been closing state mental hospitals nationwide.

Massive hospitals from New York to California have emptied to a fraction of their original populations, drained of revenue as thousands of patients are sent to less costly outpatient clinics and board-and-care homes.

Central Islip Psychiatric Center on Long Island, N.Y., once the largest in the nation with 10,000 patients in the 1950s, has downsized to 362 patients today and is headed for closure in 1995, officials there said.

Gowanda Psychiatric Center, 30 miles south of Buffalo, N.Y., once housed 3,600 patients in 18 buildings, officials say. Now only 12 patients remain. They will be moved to nearby general hospitals by year’s end.

Boston State Hospital, a leading East Coast research center, closed about eight years ago. Philadelphia State Hospital at Byberry followed in 1990.

Those are but two of a dozen or more hospitals throughout the Northeast to fall in recent years, said Harry Schnibbe, executive director of the National Assn. of State Mental Health Directors.

“The damn things are so costly to run that it is outrageously inefficient to operate a place like Byberry, with millions of dollars in oil and air-conditioning costs,” Schnibbe said.

“Nobody except the real extremists go around saying you don’t need hospitals,” he said. “It’s just that you don’t need inefficient hospitals, and you don’t need 2,000- to 3,000-bed hospitals.”

Camarillo State Hospital housed 7,000 patients at its late-1950s peak.

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Now, with barely 1,100 mentally ill and mentally handicapped patients, the annual cost of keeping it open and paying 1,800 employees is edging toward $100,000 per patient.

While Camarillo State Hospital remains one of the best marriages of state hospital and university research center in the nation, state budget cuts pose “a clear and present threat” to its future, said one official at the National Institutes of Mental Health, or NIMH.

“All the states are searching for ways to trim their budgets,” said Dr. Darrell Kirch, acting scientific director at NIMH. “And, unfortunately, I think these programs can become a target.”

They already have.

Camarillo State Hospital and Developmental Center has announced 90 layoffs, while state mental health officials are weighing Gov. Pete Wilson’s recommendation to close at least one of California’s five state hospitals.

Like Metropolitan State Hospital in Norwalk and Napa State Hospital in Napa County, Camarillo treats psychiatric patients committed by civil courts.

Like Atascadero State Hospital in San Luis Obispo County and Patton State Hospital in San Bernardino, it also admits forensic patients committed by criminal courts.

But, unlike the rest, it also treats the mentally handicapped and runs a psychiatric research unit. That makes it “the most flexible” of the five, said Ruben Lozano, a spokesman for the state Department of Mental Health.

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A panel of regional mental health officials is working to retool the sprawling 57-year-old facility and preserve its future.

The Southern California State Hospital Task Force wants to carve out a more stripped-down, interdisciplinary profile for Camarillo State Hospital and Metropolitan State Hospital in Norwalk, said task force Chairman Randall Feltman.

“There’s a lot of energy behind maintaining Camarillo--not as a state hospital for $100,000 a bed, but (as) a resource for the mentally ill of all of Southern California,” said Feltman, director of the Ventura County Department of Mental Health.

Everything needed to duplicate community-based health care, from houses to locked wards, from psychiatrists to social workers, is there.

Money is the key, Feltman said.

The task force has been dissecting California’s health insurance rate structure, looking for Medi-Cal and Medicare reimbursement for as many mental health treatments as possible, he said.

“The proposal we have been advocating is for the state hospital to close as a state hospital but open the next day as a regional resource center,” he said. “It’s really a question of moving Cam from where it was to a new role.”

Its dormitories, offices and research clinics stretch across 350 acres of lush, mountain-edged farmland just south of Camarillo in Ventura County.

It has its own fire station, power plant, courtroom and laundry, plus swimming pools, a bowling alley, a petting zoo and three chapels--Catholic, Jewish and Protestant.

And it already plays many roles--hospital, school, laboratory, counseling center and rehabilitation program.

Camarillo State Hospital opened Nov. 1, 1936, to 410 psychiatric patients, sent by chartered train to the Spanish-revival-style campus from overcrowded state hospitals around California.

It has seen the scandals of patient abuse, the triumphs of experimental treatments embraced by institutions worldwide and the occasional celebrity patient such as jazz great Charlie (Bird) Parker, who composed “Relaxin’ at Camarillo” after an outburst of violence landed him there in the ‘50s.

And it has evolved, propelled by its own research and the nationwide patients-rights movements of the 1960s and ‘70s, from a long-term, overcrowded asylum to a short-term, multiuse hospital.

Patients once slept in big, noisy dormitory wards divided by lockers, a far cry from the quiet single and double bedrooms built in the latest renovations.

Neva Nickerson, now supervisor of an acute psychiatric unit, remembers her baptism by fire 32 years ago in such a ward.

Fresh, scared, she faced up to 120 acutely mentally ill women at a time who sometimes screamed and assaulted the staff, one flinging a lunch tray that narrowly missed her head.

“Three months of psychology, three months of nursing and I was a psych tech,” she says now with a shrug.

She fainted the first time she saw a strapped-down patient jolted with electricity during shock treatment, which was mostly discontinued at Camarillo in the late 1960s.

She saw the advent of Valium, experiments with antipsychotic drugs such as Prolixin, and more novel treatments such as the nutri-pack, wherein patients were wrapped in cold sheets to calm them.

But clinical therapy in the thickly populated wards remained primitive at best.

“We spent time on basic services, getting them bathed and administering medications,” she said.

The staff held dances and ballgames, offered counseling, stopped fights and generally tried to make sure the patients were taken care of. It never seemed enough for people so severely ill, Nickerson said.

Doctors used drugs to control patients’ symptoms, yet did nothing to repair their scarred psyches and broken lives, said Dr. Timothy Kuehnel, clinical director of the research unit.

“They were still trying to do individual psychotherapy, talking about their problems from week to week and eventually putting it all together,” Kuehnel said. “If they can’t remember your name from 9 o’clock to 10 o’clock, they’re certainly not going to get any insight into their illness in a weekly counseling session.”

Today, patients get lighter doses of drugs than once thought necessary, and heavier doses of reality.

Programs on communication, courtesy and hygiene work at repairing damage that psychosis did to their social skills. And programs on psychosis teach that patients must be wedded for life, like diabetics, to drugs that keep them healthy.

As Camarillo State Hospital’s skills grew, so did its mission.

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In 1947 it opened wards for mentally ill children. Now, 74 children aged 8 to 16 live in airy, sunlit dorms, where psychiatrists work gently to break down the disorders that walled off the young patients from normal life.

A few have classical mental illnesses such as schizophrenia. But most suffer from conduct disorders--self-destructive and assaultive behavior, suicidal tendencies and violent outbursts born mostly of deprivation and sexual and physical abuse.

Nearly all of the children distrust adults.

“That has become one of our challenges, to rebuild that trust, to place them in a non-threatening environment and build some kind of trust,” said Curtis Thompson, a program assistant there for eight years.

As staff use therapy and medicines to dissolve the children’s disorders, they also teach classes from math and English to computer science, as required by law.

Patients who stay long enough to graduate earn diplomas from the anonymously-named Mountain Valley School. The same name appears on grade transcripts to protect their identity when they are discharged--as about 80% are after an average 18-month stay.

“Hopefully, we’ve given the child some coping skills, we’ve helped them address the problem that brought them here in the first place and brought them some self-awareness,” Thompson said.

By 1967, Camarillo State Hospital was ready to take another leap.

Advances in medicine, federal funding for community treatment centers and moves by Presidents Kennedy and Johnson to offer welfare to the mentally ill had emptied the wards enough to make room for a new class of patient--the mentally handicapped.

They come from all over California, transferred from the state’s 21 regional centers, where destructive, self-injurious or antisocial behavior made most of them unable to fit in.

Many of the 585 mentally handicapped patients work in occupational therapy, at simple jobs that engage them, pay them and improve their self-esteem, said Vocational Services Director Virgie Yates, a Camarillo employee since 1949.

“We give them on-the-job training in the paint shop, the upholstery shop, stores, the laundry, on groundskeeping, to try to get as near as possible to those things they could do in the community,” he said.

About 32 patients have moved into the real world for jobs such as lawn care and house painting, he said.

But most remain at the hospital, assembling simple electrical plugs for the defense industry, doing quality-control checks for a makeup manufacturer and shrink-wrapping provisions for earthquake survival kits--simple tasks that help them progress a step at a time.

In one room, patients strip computer tape from plastic hubs, recycling the hubs for nearby 3M.

Downstairs, dusty-fingered patients roll out pancakes of porcelain clay. They cut out clouds and flowers, color them with glaze, fire them in a kiln and string them together into tinkling wind chimes for sale at the Solvang farmers’ market.

Each does a simple task that, in the end, produces a more complex product than one patient might make alone.

“You can say, ‘Move the chair, sweep the floor and put all the chairs back,’ but they have to have it broken down in the individual steps,” Yates said. “Through training, you’d be surprised at the progress they make.”

Yet while some at Camarillo State Hospital can struggle through mental illness and handicaps to independence, others stay trapped between powerful psychoses and limited drugs.

Patients in Neva Nickerson’s unit range from a manic-depressive San Pedro man who wants to be James Bond to a woman who believes she already is Queen Victoria.

Another is an admitted killer.

Bruce Saggers was transferred in 1990 from Patton State Hospital, found not guilty by reason of insanity for stabbing his stepfather to death and nearly killing his mother in Altadena in 1983. His stepfather, he believed, was going to grind him and his mother into dog food.

“The food and the drugs are killing me,” said Saggers, a 36-year-old schizophrenic, legs tensely knotted beneath him in the locked ward’s lounge. “I got sisters and uncles and aunts that can take care of me. I don’t need the help of the state of California, they’re making me mentally ill.”

He pointed to his thinning hair and a scarred scalp that grew angry red as he spoke. “They’re serving hamburger out of the bald spot. This red spot. That’s been eating at my brains. Who wants to go through life looking like Gorbachev’s son?”

Later, Nickerson said quietly, “He’ll be here for a long time.”

Severely ill patients such as Saggers could be hospitalized for life, and more are being committed as jails grow overcrowded, said Jeri Castronova, the unit’s clinical psychologist.

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Meanwhile, the hospital’s research unit continues to push the boundaries of psychiatry, refining known techniques, publishing treatment programs as far away as Japan and digging for possible cures.

“You can’t satisfactorily treat a disease like schizophrenia exclusively with medications,” said Liberman. “Pills don’t give you skills that you’ve never developed before.”

Yet Liberman concedes that medication, particularly Risperidone, is the key that opens some patients’ minds to the behavioral treatment that can help rebuild their lives.

One patient called the experimental antipsychotic a wonder drug.

“It’s 10 times better” than Haldol, said Robbie Buchan, 38, of Agoura, whose schizophrenia was triggered 11 years ago by using LSD. “It seems like it clears up the hallucinations. It has mild side effects like nervousness, but you can function on it, you can talk clearly.”

Recently, the research unit signed a contract with Janssen Pharmaceutica, the Belgian manufacturer of Risperidone, to expand the study to 75 patients whom other drugs failed to help, Liberman said.

Meanwhile, Camarillo State Hospital researchers also are trying to expose the very core of mental illness.

Research at the hospital has found that mental illness hits those with genetically defective nervous systems, people whose minds are more frail and stress-prone, Liberman said.

Liberman has been working on a national task force of physicians and psychologists seeking ways to diagnose and prevent mental illness before people turn psychotic. Impaneled by the National Academy of Science, the committee plans to report to Congress in October, he said.

In the meantime, he has been lobbying hard to stop Camarillo State Hospital from going the way of Byberry, Boston State and other late, great psychiatric institutions.

“When you are able to marry academic people like myself with the patients you have here, you can have a great impact,” Liberman said. “In a capitalist society, we have the implicit belief that it’s survival of the fittest. This is a little bit of a safety net that society was willing to pay for.”

’ Nobody except the real extremists go around saying you don’t need hospitals. It’s just that you don’t need inefficient hospitals. ‘

Harry Schnibbe

Executive director of the National Assn. of State Mental Health Directors