A Tortuous Path for the Mentally Ill

For California’s most severely ill mental patients, the price of consistent care is too often a trip to the precipice of catastrophe.

At a time when medicine has more to offer than ever before, when more than ever is known about how comprehensive services can keep them safe and stable, many severely mentally ill people in this state are lucky if they can just stay alive.

One man, the much-loved son of middle-class parents, calls himself a “walking miracle.” He didn’t get the care he needed for schizophrenia until he tried to self-destruct three separate times--by hurling himself off a San Diego bridge, overdosing on medications and baiting police to shoot him.

Another schizophrenic man drew a life term in state prison after he killed a fellow mental patient, hogtying her, stabbing her and strangling her with an electrical cord. Behind bars, he’s getting his most consistent care ever.

A 28-year-old former surfer fears that he won’t see 29. Between sprees of mania, booze-guzzling and cocaine-snorting, he has landed in jail once and psychiatric hospitals seven times this year. Today, he is locked in a rehabilitation center, the only way his mother knows to keep him from dying on the streets.

This is not how it was supposed to be.

California, which boldly released patients from state mental hospitals beginning in the 1960s, has largely reneged on its promise to follow through with care and support in the community for seriously ill patients.

Spurred by concerns over civil rights, a desire to cut costs and grand hopes for new psychiatric medications, California cut its state hospital population by 89% between 1960 and 1999. It also revamped laws to make psychiatric commitment more difficult, but without appreciably expanding community resources for voluntary treatment.

Today, it’s not just psychiatric treatment that is spotty. There is a shortage of buoys to keep patients’ lives afloat: housing and employment assistance, counseling, social networks, rehabilitation programs, a means of tracking patients and connecting them to what they need.

By federal estimates, there are more than 630,000 severely mentally ill adults in California. Many don’t hook up with comprehensive treatment programs, or they reject their medications. They go on to dull their pain with alcohol and street drugs, commit suicide, engage in mostly petty crimes or become victims themselves of assault, harassment, robbery and rape.

The sickest frequently get their best care--sometimes their only care--in jails, prisons and hospitals, after they have hurt themselves or someone else. For minorities in particular, the criminal justice system is too often the main source of care.

“The crisis service most people get is a police call,” said Lori Holman, former president of the California Alliance for the Mentally Ill, a prominent family and patient advocacy group.

Critics curse “the system,” but it is really “systems”--plural--that they deplore: the private sector for shunting the most costly patients to government programs; the government for its tattered safety net; courts and cops for treating sick people like criminals.

In fact, there are vast gaps in services and substantial quality problems with those that are in place.

Substance abuse programs are not set up to treat the mentally ill, and mental health programs don’t know what to do with substance abusers. Abuse, neglect and inadequate staffing are all too common in facilities intended to help and protect the most severely ill.

In some board and care homes, for example, patients are cheated out of pocket money, keep drugs in their rooms or simply walk off, never to return. In locked private psychiatric facilities, poorly paid staff members sometimes abuse patients physically, verbally or sexually.

Thirty years after the state pledged to offer patients a better life outside state hospital wards, nearly half end up living with--and relying heavily upon--their beleaguered families.

“We have to be the caseworker, the therapist, the psychiatrist, the whole team for our loved ones,” said Louise Perez, a grandmother in Campbell, near San Jose, who has two children with schizophrenia. “Nobody is going to do it for us. Nobody.”

California’s shortcomings are part of a nationwide problem. By one estimate, 40% of the severely mentally ill in the United States are receiving no psychiatric treatment. But this state stands out because of its history as a leader in mental health policy, as well as its sheer size.

There are signs of progress. Thanks to improved medications, an economic boom and widespread horror at sensational crimes, the state is beginning to muster both the political will and the financial wherewithal for reform.

An array of highly successful community programs has cropped up in this decade, offering A-to-Z assistance, from medical care to housing and job training. Several are in Los Angeles County, though with limited resources they serve a small number of people.

Another recent milestone, from the point of view of mental health advocates, was enactment of insurance “parity”--a requirement that health plans cover severe mental and physical diseases equivalently. That battle took three years to be resolved in California, the 28th state in the nation to adopt such a law. Even so, the requirement applies only to people who have health coverage through a job--their own or a family member’s--or other private insurance. Many severely ill patients don’t qualify.

To reform this vast, disjointed, erratic system is an enormous undertaking, and the effort is proceeding very slowly. Meanwhile, treatment and services are focused on crises.

“If you have a total breakdown, a hospital will take you and [society] will find money to pay for it,” said Rusty Selix, executive director of the Mental Health Assn. in California, another advocacy group. “If you commit a crime, you will not be left dangling because there’s no bed. But in the absence of those things, you get in line.”

Killing a Friend Amid a Raging Delusion

“I’m strangling her,” John Porcelli told the horrified 911 operator as he tightened the electrical cord around his friend’s neck.

Hogtied at his feet lay 25-year-old Michelle Klezco. He stabbed and choked her as he ranted into the phone.

He broke off, briefly, to get his victim some ice for her wounds, then resumed. “How long does it take for them to die?” he asked the operator impatiently. “It’s exhausting.”

“Someone please help me,” the young woman cried in the background.

Klezco had come to Porcelli’s house hoping that he would help take her cat to the vet. Instead, he ambushed her at the door, tied her with a curtain cord and began a profane interrogation about her supposed role in a Drug Enforcement Administration plot against him. She didn’t give the right answers.

“I had to kill her,” he told the operator. “I got sick of it.”

Though not a household name, Porcelli, 31, has something in common with Unabomber Ted Kaczynski. He embodies widespread fears about the mentally ill as volatile, deranged killers.

The fears are out of proportion to reality. The mentally ill are responsible for about 4% of violent crimes. If such a person abuses drugs or alcohol, that individual’s chances of committing violence soar.

Porcelli, a paranoid schizophrenic, represents what can happen when a major illness simmers and flares for years, insufficiently recognized or treated, until it explodes. Now he dwells where an ever-increasing number of California mental patients do: behind bars.

Porcelli, 31, had taken a long, slow slide through the system. Over 12 years he slipped from delinquency to paranoia to violence. His mother, Alice, knew he was dangerous--that’s why she moved into a new place and kept her lights off at night so he wouldn’t spot her in the window. Her son had beaten her up. He had attacked his wife with their son in her arms. He had been hospitalized for psychiatric illness at least 15 times, but never stayed longer than six weeks.

Alice Porcelli had “begged and pleaded” with prosecutors and psychiatrists to send her son to a state mental hospital. It didn’t happen. It took a killing to wake up the system. “Unfortunately, people have to die for [anyone] to listen,” she said.

At the California State Prison in Lancaster, Porcelli lives in abject terror. “Will you help me to find out about the DEA?” he asks a reporter over the telephone, in a desperate whisper. “I wish someone would investigate this.”

His mother doesn’t want to see him released, just placed in a hospital. Serving a life sentence for murder, he was in a special mental health unit in prison before he was severely beaten in a September fight. Now he lives in an isolation unit--torture, as his mother sees it, for a man plagued by cruel, disembodied voices.

Many experts agree that prison is the worst place for seriously ill mental patients. It’s too unforgiving a setting for psychotics who have trouble following rules and reading social signals.

“A prison is primarily concerned with managing people who are criminals,” said USC psychiatrist Richard Lamb. “It’s difficult to do that and keep a psychiatric point of view.”

Still, according to a recent U.S. Department of Justice report, 16% of inmates in the nation’s jails and prisons suffer from mental illness. Preliminary findings from a study of the Los Angeles County Jail suggest that the proportion there is nearly twice as high.

The cost is monumental. One 1996 study estimated that caring for the mentally ill in the California criminal justice system costs up to $1.8 billion annually.

That sum could be put to far better uses, says Assemblyman Darrell Steinberg (D-Sacramento), who with Assemblyman Scott Baugh (R-Huntington Beach) introduced legislation to fund more proactive community programs. But so far, just $10 million of the $350 million Steinberg proposed has been allocated.

Meanwhile, “they’re here, they need treatment and services and we should give it,” said Richard Kushi, district mental health chief at the Los Angeles County Jail. The county has built a new facility for such inmates and doubled staff assigned to them since the U.S. Department of Justice in 1997 deemed mental health care there “constitutionally inadequate.”

Although violent offenders like Porcelli get most of the public attention, the vast majority of mentally ill inmates are incarcerated for minor, nonviolent crimes--nuisance offenses such as petty theft and intoxication. Many are easy targets for arrest, repeat offenders who often receive severe penalties.

Consider the case of schizophrenic substance abuser Odie Armstrong. The Covina man broke into two homes in the mid-1980s, looking, he says, for food. Caught red-handed in one case, he handed the homeowners a gun he found in the house and waited for them to call police. He served more than four years in state prison.

In June, he was jailed for possession of $10 worth of rock cocaine and stealing a pair of tennis shoes. Under the state’s three-strikes law--which snares an increasing proportion of mentally ill offenders--he faced 25 years to life in prison. When his public defender successfully bargained for six years’ probation in a locked mental facility, a Pomona judge warned him sternly: “This is the last stop for this train . . . your last chance.”

Armstrong has trouble just making sense of what has happened. “I don’t think I should be here,” he confided in one jail interview. “I think I should be a lawyer or something, or a big-time tycoon.”

Snorting Cocaine, Guzzling Wine

Chris Falzone, a handsome, charming former surfer, accepted his psychiatric medications from an aide in a Canoga Park board and care home and tossed them in the trash. The aide didn’t seem to notice.

A short while later, Falzone took a telephone call. It was, he said, from a rich john who wanted to pick him up for a date--a fast way for Falzone to make some extra cash.

While he waited, another board and care resident ran in, giddy. She’d just scored some cocaine. With the aide in the next room, she and Chris snorted the coke on her bed. To take the edge off, Chris guzzled some wine in the driveway.

As the coke and booze wore off, he became more and more manic. His eyes darted back and forth; his leg jiggled up and down. He talked compulsively of suicide, showing marks on his arms of various episodes with razor blades. One large scar is from the time he tried to bite his veins out when he couldn’t find a razor.

“I found out it’s stupid to cut your veins,” he said. “It doesn’t work.”

Falzone, 28, has rapidly cycling bipolar disorder, a condition that causes his moods to soar and plummet within hours. He also has a potentially lethal substance abuse problem. He’s far from unique.

Research suggests that more than half the people with mental illnesses abuse drugs or alcohol, yet the system is often unprepared to treat both problems at once.

Psychiatrists have told Falzone’s mother that they can’t treat his mental illness until he stops using street drugs. Falzone says that he needs the drugs to keep from crashing--that they extend his highs and forestall his lows.

For years, he has flirted with danger and death, taking to the streets of Hollywood whenever he’s on a high, calling his mother from a pay phone when he comes down. He awakens beaten and bloody and can’t remember why.

He bounces from board and care homes to hospitals, from jail cells to the streets. He has been in more than 60 facilities in 15 years.

His mother, Elizabeth Svitenko, spends a lot of time by the telephone in her Tehachapi home, praying that she won’t “get the . . . call I have been dreading for years . . . telling me that he is dead.”

In October, Falzone was arrested on a Hollywood bus bench on suspicion of being under the influence. Three weeks later, the charges were dropped. After being released from jail, he became psychotic and called his mother. She had him admitted to an Antelope Valley hospital. From there, to her utter relief, he went to a locked rehabilitation center in Sylmar.

Where he will go next is a question she doesn’t even want to contemplate.

Falzone’s most recent living arrangement, at the Canoga Park board and care facility, allowed him to lead his life of self-destruction virtually undeterred. Yet it was better than many other places he had been: dingy, dirty homes where drug use was even more blatant. At least the Canoga Park facility was clean, Svitenko says, and the staff seemed to care.

“This is the best [board and care] I’ve seen,” she said before Falzone’s arrest. “Where else can he go?”

Housing and treatment for mentally ill people in the community are lacking both in quantity and quality, particularly for those in need of close supervision. More than 13,000 patients--over three times the number in state hospitals--live in unlocked group homes or small community facilities in California. Sometimes, the experience causes them to unravel.

“There are very caring facility operators, some that really want to do a good job, and there are some definite outright abuses,” said Lyn Goldinger, a former client advocate for the Los Angeles County Department of Mental Health.

Her office encountered everything from financial abuses--unscrupulous operators withholding clients’ money--to harried, inadequate psychiatric care, to sexual abuse and violence.

One of the worst cases of violence occurred in a board and care home in El Monte in 1995, when a 34-year-old schizophrenic resident beat another patient to death with a rock. At the time, a housekeeper--the only person on duty for 73 residents--was washing dishes in another building. Cited 150 times since 1987 for poor supervision, filth, inadequate nutrition and failure to dispense medication properly, the home was not closed by the state until after the slaying.

Though Goldinger helped write state legislation that improved training requirements for home operators, she and other patient advocates say meager funding still hampers supervision by aides, who are spread thin and paid poorly. It also impairs oversight by state inspectors, whose caseloads Goldinger described as staggering.

She and other advocates are all for the idea, mandated by law, that patients be placed in the “least restrictive” environment possible; they endorse the goal of independence for their clients.

But “that doesn’t mean no care and no support,” Goldinger says.

Schizophrenia Strikes One Family Twice

Thirteen years ago, when Louise Perez’s daughter was diagnosed with schizophrenia, Perez had “never heard of the dang word.” She looked it up, then ordered books and brochures. Several years later, her son, a former high school basketball and track star working at IBM, developed the disease too.

“Now I consider myself an expert,” said the Bay Area resident. “I’m living it.”

“Living it” meant rescuing her son from a dank, filthy board and care home that smelled of marijuana, offered little but hot dogs and macaroni for dinner and left residents painfully idle. It meant rushing to deliver leftover anti-psychotic drugs to her daughter, who was released from jail without medication and left to wait in the sun outside a homeless shelter.

It meant, at the age of 71, typing out long, pointed letters to the Santa Clara County director of mental health, giving fiery speeches to the Sheriff’s Department and leading support groups for similarly afflicted Latino families.

She tells everyone who will listen: The system is rife with discrimination. “It’s a real ugly thing. If you’re mentally ill and Latino, they just want to lock you up and throw away the key.”

Like many older parents, Perez worries about what will happen to her mentally ill children when she is gone. Her daughter, Connie, now 33, and her son Mark, 29, are doing well for now, but what if they go off their medications? Who will step in then?

Parents, spouses and other relatives are the system’s battered backstop, “the treatment provider of last resort,” said Chris Amenson, director of Pacific Clinics Institute in Pasadena, the largest nonprofit psychiatric clinic in the country. They take patients who are too sick for outpatient treatment and too unruly for board and care homes.

“It’s as though, if I break my leg, I go to the hospital, but if I break my leg in three places, they send me home,” Amenson said.

Nearly half the people with serious mental illness in California live with their families, according to the state Department of Mental Health. Many more patients count family members as their only die-hard advocates.

The results: lots of strained marriages; anger among well siblings who feel ignored; frustration among patients who feel a loss of autonomy; social isolation of stigmatized family members. Not to mention the financial strains that emerge when private insurance lapses or public services prove insufficient.

“We lost our retirement, our savings--everything,” said Paula Fitzgerald, an Orange County mother whose 23-year-old schizophrenic daughter made frightening attempts at suicide. “You’ll do anything. You’ll sell your soul for one night of your child’s safety.”

In some cases, the issue is the family’s safety. One Huntington Beach woman became terrified when her 57-year-old paranoid mother began stalking her 84-year-old grandmother. One day, after drinking heavily, the mother hit the grandmother, pulled her hair and threw things at her. Still, the grandmother resisted placing her daughter in a hospital.

“She felt my mother was her responsibility and she should be able to help her,” the woman said. “It came down to my grandmother realizing my mother was capable of killing her.”

To the grandmother’s regret, her daughter was placed in a locked psychiatric facility.

Although families in the last 20 years have developed strong political and support networks--including the National Alliance for the Mentally Ill and its local chapters--many continue to be leery of discussing their plight with anyone.

“It’s probably because you think people will look down on you,” said one 74-year-old Pomona woman, who doesn’t confide in friends about the 47-year-old schizophrenic son who lives with her. “You feel that you haven’t succeeded [as a mother].”

Culture and ethnicity can make a difference. Luis Garcia, who directs Latino services at Pacific Clinics, says many Latino families see the illness as taboo. They often delay treatment, encounter language barriers after they enter the system, and fight vigorously to keep their loved ones at home instead of in a hospital.

Perez and others see inequities in treatment and services, noting that a disproportionate number of Latinos and African Americans receive their mental health care as inmates, and that many never get the medications they need.

“It’s a problem that’s broader than just mental health--a matter of social inequality . . . deficits in services to poor people,” said Harold Shabo, presiding judge of the mental health department of the Los Angeles County Superior Court. “But it particularly impacts on minorities with mental illness, because of the lack of consistent care, which results in them being criminalized.”

For all the problems families of the mentally ill endure, it is patients with no family support who seem to suffer most. Many are homeless, having lost touch or long ago worn out their welcomes with loved ones.

“I never intended to get stranded,” said Pam Wilson, 47, who lives at LAMP Village, a shelter for the mentally ill on Los Angeles’ skid row. She still writes letters to a cousin and an aunt out of state, but she hasn’t heard back for months. She’s taken to calling the LAMP director and a supervising staff member “Mommy” and “Daddy.”

Her voice quivering, she says: “I feel it’s time to abandon my family once and for all, because they can’t even write me a letter.”

After 3 Suicide Attempts, a ‘Miracle’

In March 1988, Brian Black threw himself nearly 300 feet off the Coronado bridge, hoping to silence forever the demonic voices that hounded him. Instead, he was plucked from the water by Navy SEALS training beneath the span, and woke up in a hospital bed.

He shuttled in and out of treatment, on and off medications, for the next five years. In 1991, he tried to kill himself with a fistful of pills and beer. His life was saved by his landlady.

In 1993, he staged a jewelry store heist--though he says he never meant to escape with the loot. He only hoped that, by sitting on the display counter and waving kitchen knives, he could force the police to shoot him. They did, three times, but he lived anyway.

“I am a walking miracle,” he said.

He is referring not only to his physical survival.

Black is now more mentally stable than ever. He has a volunteer job, was married in May and landed an apartment in San Diego County with a view of Mt. Helix and Mt. Miguel. Grateful for his new life, he credits his medications, his family and his religious faith.

His parents are grateful as well, but call his journey through the system needlessly horrifying and inhumane.

“Over the past 20 years, in some way, Brian has touched every aspect of all the systems that are broken and now need changing,” said his mother, Natalye.

Black, 37, took dramatic measures, but he was not so unusual in his intentions. Ten to 13% of schizophrenics kill themselves. Many more give it a try.

Like quite a few people with his disease, Black didn’t always see the need for medication. He kept thinking, “Why? I’m not crazy.”

A harrowing pattern developed. When he was under court-ordered treatment, under the watch of a conservator, he would take his medication and emerge from psychosis. When the conservatorship lapsed, he would toss the pills and become suicidal. He was hospitalized 21 times.

Black now accepts his need for psychiatric drugs. He’s on Clozaril, the first of a new generation of antipsychotics touted as both more effective and safer than their predecessors.

Still, medications are no panacea for what ails Black or the state’s mental health system. Beyond prescriptions, advocates are clamoring for housing, job training and social services--not isolated offerings but linked programs built around patient needs.

Some programs in Los Angeles County and elsewhere are producing promising results--fewer hospitalizations and arrests. But they serve just a fraction of the population in need.

“I think these services can be offered on a much wider basis,” said Shabo, the Los Angeles County judge.

The idea is not just to keep patients like Black alive, but to help them find something to live for.

Black figured out what he needed, mostly by himself. Several years ago, he looked around his board and care home and decided it was a warehouse. He wanted a life of his own, just as his healthy older brother and sister had. He wanted to work and live and love in the real world.

Now a volunteer for the San Diego Mental Health Assn., Black isn’t cured. He can’t be. But his mind, at least, is crowded with plans and possibilities, not lethal messages.

“I’m not a bad person, or weird or strange,” he said recently. “I’m functionable. I can do the things other people can do.”

Times staff photographer Robert Gauthier contributed to this story.

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NEXT: What happened to the last wave of patients released from state hospitals.