Connecting With Reality : Program Helps the Mentally Ill Cope, but It Doesn’t Coddle Them

It’s Wednesday morning. Lisa Mansouri plops down in the wagon-train circle of chairs in a halfheartedly partitioned section of Step Up on Second, Santa Monica’s day center for adults with a history of mental illness.

More than a dozen members--they are never called “patients”--wait. Half of them wisecrack; half stare, their faces so blank they capture the madness of a Van Gogh self-portrait.

Mansouri, Step Up’s program director, lays it on the line.

“There have been an awful lot of people in this building asking for cigarettes or money. That’s panhandling. Believe it or not,” she says.

“I’ll put you out (of Step Up) for a whole day if I catch you.” Her voice is stony.

Shopping carts are taboo, too, Susan Dempsay, founder and director of Step Up on Second, reminds the members, most of whom are homeless.

“They’re the private property of the stores, and besides, they’re an excuse for not getting a real home,” Dempsay explains.

Members wail that their prized possessions will be stolen if left unattended in the alley, as Step Up requires. Dempsay’s face erupts in a devilish smile. A missing shopping cart might be just what it takes for the whining member to be forced into living life the way most do. That’s what Step Up is about, Dempsay says.

For almost a decade now, Step Up on Second has been trying to provide the mentally ill with the basics to reconnect with the world. It offers an untraditional mix of services, refined over the years by trial and error, that focus not just on treating the mental disturbances, but also on vocational training, grooming, money management and even employment opportunities.

Santa Monica is noted for its extensive array of social service programs, and particularly for the help it offers the homeless, but few programs are held in as high regard as Step Up on Second. Police and city officials have nothing but praise for it, and Dempsay has been showered with awards on the national, state and local level.

The acclaim is not without a price, however. A vocal segment in Santa Monica contends that the homeless services have made the city a magnet for transients, and a far more dangerous and less pleasant place for everyone else. As the embodiment of what is good about Santa Monica social services, Step Up is thus also a target; it provides genuine help to the homeless, therefore it is part of the problem.

While the political debate rages on, there is upheaval of a different sort these days at Step Up on Second. This month, it moved from its longtime home, an aging warehouse-type structure on 2nd Street, to temporary headquarters on Lincoln Boulevard. The 2nd Street building will be gutted to make way for a four-story complex with greater space, comfort, cheer and, most important, 36 apartments to house mentally ill adults.

Step Up is the creation of Susan Dempsay, and it is also her personal therapy. In 1978, her son, Mark, changed almost overnight from a college-bound 18-year-old into a schizophrenic whose torment was expressed in wordless screams.

Four years later, Dempsay had put Mark through the conventional treatments, but he was not healed. Doctors couldn’t cure him, nor could they tell Dempsay how to provide the support he would need just to get by. Frustrated, Dempsay designed her own safety net for people whose mental illnesses weren’t so severe as to require hospitalization, but who were not well enough to function like most people. That was Step Up on Second.

The center doesn’t force members to see doctors or even require that they take their prescribed medication. Staffers, however, do give treatment and medication a hard sell as they constantly remind people to take care of themselves, whether that means getting a job or taking a shower. There are no locks or bars, and nothing that smells or looks like a hospital. Step Up never worked for Mark. Unable to cope even in the special environment his mother built, he has gone to New York in search of mental peace. Yet, Step Up is there for more than 800 people a year whose illnesses make it difficult for them to hold a job, apply for Social Security or, in some cases, even buy a bus pass.

What Step Up isn’t is a place to vegetate, a place to be baby-sat, to wallow in self-pity or to be coddled by do-gooders. In fact, Dempsay and Mansouri say the rules are tougher than when Step Up opened in 1984. The cots for napping have vanished, for example; members were using them to recover from boozing and drugging all night. Dempsay’s bottom line with members is “take responsibility for yourself.” When they do, Step Up gives them job training by working at the center, cooking, cleaning or selling in the thrift shop at the entrance.

The ones really making it help set up for the city’s farmers market on Wednesdays and work for the Santa Monica Sanitation Department. Some sell hot dogs on the Third Street Promenade. Dempsay dreams of opening a restaurant staffed by Step Up.

Almost 70% of Step Up’s members are white males between 20 and 50 years old suffering from schizophrenia, extreme depression or multiple-personality disorders. Some are well-dressed, articulate and functional if they are medicated. Others reek of urine and filth.

Jerry, white, male and 35, is in many respects typical. In several years as a regular at Step Up, he has learned how to schmooze just a little, and he no longer eats everything with his hands.

But if he tries too long to be sociable, his back begins feeling creepy-crawly, he says. His crossed leg begins a slow twitch that in a flash becomes a jackhammer pounding. He bolts for the door.

Jerry is a schizophrenic who was abused by his mother and turned violent in junior high when he could no longer cope with his peers, who made him the butt of their jokes.

Step Up has helped him edge back toward the real world. “It’s sort of a sanctuary,” he said in an interview, daring to nudge his green baseball cap up and talk eye-to-eye. “Before, I couldn’t talk. I’d sit in a corner. I got real scared when anyone came near me. People thought I was stuck up. I’d eat instead of talking. I’d sleep all day to avoid people. . . . I was a basket case.”

The comfortable setting and support at Step Up, he said, have helped him emerge.

“You have to be sociable,” he said. “That’s good for you. It makes you come out of your shell.”

Step Up has found Jerry housing several times. It never lasts long, because he begins to feel that the walls are squashing him and sucking out the oxygen.

But he has made a half-step of progress. He has a “house” now, even if it is only a carport. The roof provides shelter, and there are none of those walls that terrify him.

For Jerry and many other members, Step Up’s move this month is extremely unsettling. For many, program director Mansouri says, Step Up is the closest thing they have to a home. Even those who just drop by for 10 minutes a day to brush their teeth can count on someone saying “hi” and calling them by name.

At the recent Wednesday session, Mansouri tackled the dreaded disruption head-on, telling those who found the chaos too upsetting to stay away for a bit.

But then she zeroed in: “It’s kind of a curse (to move), but it’s kind of a blessing. We will be farther away, so I’d like to sit down with you and talk about getting you housing or at least talk about why you don’t want housing.”

Mansouri said it matter-of-factly, and then asked for a show of hands of those who are homeless.

“Good, come see me after the meeting, and we’ll talk.”

She also talked about learning how to manage money and where to eat while Step Up was moving. Mansouri reminded her listeners to behave if they ate dinner at the Salvation Army.

“We have to be good neighbors,” she said.

At first glance, Mansouri and Dempsay seem blase about the potential for violence that is always present if certain members do not take their medication. But in fact, both women’s eyes are often flicking left and right like windshield wipers.

“I’m always ready,” Dempsay admits. She and Mansouri know that a wrong word here or an accidental gesture there can set off an explosion. If it happens, neither hesitates. They dial 911.

Members who are drunk or high are sent away until they are sober. Dempsay has called the police to turn in drug dealers.

The Santa Monica Police Department actually takes people to Step Up.

“It is a benefit to the community,” said Sgt. Gary Gallinot, the Police Department’s press information officer. “We’ve definitely seen a decrease in (street) violence over the last several years because of Step Up,” because it supervises members’ medication, he said.

For all the praise and success, Step Up hasn’t been showered with funding. Dempsay says money is getting tighter, in part because there is a backlash against helping the homeless. The annual budget runs about $950,000, the bulk of it provided by the Los Angeles County Department of Mental Health, which is contributing $780,000 this year. The State Department of Rehabilitation and the city of Santa Monica each add $60,000. Fund raising, grants and private donations bring in about $50,000 more.

The $4 million for refurbishing the 2nd Street building is coming from a mix of tax credits, public housing funds and low-interest loans. The city of Santa Monica and Dempsay are negotiating how much the city will lend. The Los Angeles County Mental Health Assn., which helped start Step Up, will also provide some help.

Year in and year out, Step Up also must contend with a certain level of community criticism. Much of it comes from community activist Leslie Dutton, whose organization, the Citizens Protection Alliance, regularly reminds city officials of the public safety threat created by unruly members of the city’s large homeless contingent.

Dutton has fought the center for years and still ardently maintains it has made downtown Santa Monica more dangerous. She says she doesn’t contest that the mentally ill need services, but she is adamant that 2nd Street “is not a compatible location.”

Step Up’s next-door neighbor on 2nd Street is the Laemmle Theatre Monica-4 Plex, managed by John Baron, who says the center is just plain bad for business. He and Dutton question Dempsay’s ability and integrity.

However, city officials who deal daily with crime, the homeless and mentally ill disagree strenuously.

“It’s a model program,” said Wendy Talley, the city’s homeless services coordinator. “The self-help model works.”

Step Up “plays a vital role in reducing the risk to the community rather than increasing it,” said Larry Wicker, service area chief for the Santa Monica Public Health Department.

“I would adamantly say that it reduces street violence,” Wicker said. “It’s kind of spooky to think what would happen if Step Up weren’t there.”