Individual Assistance for the Mentally Ill

In pockets of California, pioneers of small but aggressive programs are showing they know how to make the lives of people with severe mental illness better.

Medications are part of their strategy, but that’s not all. The idea is to wrap people in a blanket of services so snugly they can’t just slip away.

Experience has shown that very ill patients don’t just need pills. They need multifaceted, individualized assistance with the challenges of life: keeping a roof over their heads, earning a living, making friends.

“Basically, we ask people, ‘What do you want and need?’ ” said Martha Long, director of the Village, one of the best-known “wrap-around” programs in the state. “Most people with psychiatric illness have had the fight beat out of them. . . . What we want to do is give people a picture of what their life could be like” if they accept help.

More than medical services, the Long Beach program offers practical help in the form of job training, housing assistance, money management and general “life coaching.” Clients are assigned to a team of caseworkers that includes a psychiatrist.

The Village considers hospitalization a “failure” on its part, Long says. The agency doesn’t like to see people decline to that point.

Patients who find places in such expanded-service programs often turn their lives around--or at least stop their skids into homelessness and psychosis. The jobs they get are often entry-level clerical and service industry positions, but they get people back into the swing of working.

“They never gave up on me,” said Jay Hill, 36, who was a 98-pound panhandler with a ferocious drug problem when he joined the Village 10 years ago. Village employees repeatedly sought him out as he begged on the streets, and urged him to get into a drug treatment program.

Now he’s eight years clean, living in a group home that doesn’t allow drugs or alcohol use. He’s taking psychiatric medications for his illness, a condition that combines symptoms of schizophrenia and bipolar disorder. And he’s been working on and off, first at the Village office, later at a Target store and as a stock clerk for the Air Force.

The Village doesn’t work for everyone--”we’re not perfect,” said Long--but it has an impressive record.

In October, for example, 63% of the 276 clients lived independently in housing around the community. Most of the rest were in board-and-care homes or with their families. A quarter were employed. Ten percent were in school. About 2% were homeless or incarcerated and just over 3% were hospitalized.

That represents a positive change for most of the moderately to severely ill Village members, who often have spent considerable time in psychiatric wards, behind bars or on the street.

Relying mostly on public funds, the 10-year-old agency has drawn praise from California First Lady Sharon Davis, who is heading a push to create similar programs. The Village also recently earned a share of $10 million in state money for a pilot project to combat homelessness and incarceration among the mentally ill.

The Village has been so successful, in fact, that there are openings only every two months.

The program combines two time-tested concepts. It borrows in part from the notion that mentally ill people need nonmedical, social rehabilitation through a “clubhouse” of their own. That was a radical idea when it was initiated by a group of patients on the steps of the New York Public Library more than 50 years ago.

But the Village goes further. It also has borrowed from an approach pioneered in Madison, Wis. 24 years ago. Researchers there moved patients from hospital wards into the community and offered round-the-clock care. The Village doesn’t do that, but it does try to “wrap” its clients in the services they need.

Elsewhere in California, individual counties have forged ahead with variations of the “wrap-around” approach.

“What do people want?” asked Bob Egnew, Monterey County Mental Health Director for 16 years. “A decent place to live. A job, and friends.”

With that in mind, his county and a nonprofit corporate partner have placed 88 people in supported employment and more than 60 in colleges. The nonprofit corporation, Interim, provides job training and housing, including some in converted barracks at Ft. Ord.

Many reform advocates say the opportunity to expand such programs needs to be seized, lest it pass. Even bureaucrats with a traditionally cautious bent are pushing to pick up the pace.

“There’s a definite sense of urgency,” says James C. Allen, a deputy director in Los Angeles County’s Department of Mental Health. “I don’t think this [opportunity] will be around in 20 years. If we don’t do it now, we should all be fired.”

Many long-starved counties now have more money than ever for community programs, thanks to the buoyant economy and a shift in dollars away from acute care.

Los Angeles County, with a 20% increase in its budget this year alone, is looking to expand its network of more than a dozen intensive programs, which now serve more than 2,400 patients who tend to be the most costly to treat. Ultimately, officials say, they want to reach people before they become seriously ill, before they become expensive to care for, so the system isn’t driven by crises.

Still, the Village and other “wrap-around” programs are no substitute for locked institutions. They are not intended to be. The idea is to teach clients to take responsibility for their own lives.

That carries risks.

One 31-year-old client, for example, had trouble with roommates and craved privacy. The Village recently helped her move into a small apartment on her own. The agency even helped her get specialized therapy and a cat to keep her company.

But the client, Deana Kalmar, has a history of suicide attempts. She has been hospitalized four times in the past seven months. She regularly mulls the pros and cons of trying, again, to end her life.

“I drank what I thought was enough [insecticide] to kill me and it didn’t work,” she explained one day. “I still have not chosen life.”

Kalmar has been diagnosed with everything from schizo-affective disorder to bulimia. Her spirits soar and crash, sometimes within a single day. This month, when her mother visited her new apartment, Kalmar hadn’t taken her medication and was psychotic. Her voice was hoarse from screaming.

Rosalyn Kalmar vacillates between hope for her daughter’s improvement and dread that she will follow through with her suicidal impulses. But for now, she is entrusting her daughter’s life to the Village.

“I think they have as good a chance as anybody,” she says.

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Whom to Call for Help

STATE

* Mental Health Assn. in California, advocacy and education office (916) 557-1167 https://www.mhac.org

* National Alliance for the Mentally Ill/California Alliance for the Mentally Ill (NAMI/CAMI) (916) 567-0163; https://www.namicalifornia.org

* California Network of Mental Health Clients (800) 626-7447

LOS ANGELES COUNTY

* County Access Line: 24-hour hotline operated by the Department of Mental Health, for crisis and referrals (800) 854-7771.

* Friendship line for mentally ill people looking for someone to talk to, run by consumers under grant from the county. Seven days a week from 5 p.m. to midnight. (888) 448-9777

* Mental Health Assn. in Los Angeles County. Annette Tarsky, information and resource specialist (213) 413-1130 Ext. 126

* NAMI/Los Angeles County: support and education. Annette Tarsky (213) 413-1622

Los Angeles County Client Coalition (213) 738-4646

ORANGE COUNTY

* Mental Health Assn. of Orange County (714) 547-7559; https://www.mhaoc.org

* NAMI/Orange County (714) 544-8488

VENTURA COUNTY

* NAMI/Ventura County (805) 641-2426