Helping Hands for Mentally Ill

For so many years so much has been so wrong in Timothy Wilson’s life.

He is an ex-con who used to get high on speed, a mental patient diagnosed with psychotic symptoms, a homeless outcast who is hobbled by a bad back. He lives under a blue tarp in a secluded patch of the Tujunga Wash, where mice are apt to clean him out of his meager food supplies and rattlesnakes can scare him out of his sleeping bag.

But one recent sun-washed morning the possibility of something better bloomed. Two outreach workers from the Hillview Mental Health Center came by.

Join us, they said, and we can give you psychiatric drugs and counseling. We can find a doctor to treat your back and offer you a place to shower and have a meal. Maybe even help you find a stable home.

They are part of a pilot project that began in Los Angeles, Sacramento and Stanislaus counties in November. The program draws its participants from county jails, hospital emergency rooms, shelters, parks and other areas where homeless people congregate.

The mission is to redress one of the major gaps in California’s mental health system: the lack of services for the homeless and the incarcerated.

About 50,000 people living on the streets in California suffer from severe mental illness and, when exhibiting bizarre or violent behavior, confront other citizens with an urban nightmare. They swell state and county jail populations--about 15% of jail and prison inmates in California suffer severe mental illness--and cost the criminal justice and health systems millions of dollars each year.

Yet, when properly medicated and given support systems, most of them could lead stable lives, mental health experts believe.

As evidence, they cite the progress under the pilot AB34 program--named after the number it carried in the state Legislature.

More than 1,200 men and women--900 in Los Angeles--have voluntarily enrolled in the program. Based on early data, officials estimate the number of those hospitalized has dropped 64%; the number of days spent in jail has declined 73% and the number of days spent homeless has fallen by 58%.

The $10-million experiment has garnered across-the-board support from Democrats, Republicans, mental health experts, patients’ advocates and law enforcement that is rare in Sacramento. Gov. Gray Davis was so encouraged that he increased the funding to $62.5 million in this year’s proposed budget to expand the program to additional counties.

The problems are long in the making. In 1967, California enacted the landmark Lanterman-Petris-Short Act, which was intended to reform laws that made it too easy to commit people to mental hospitals against their will. Tens of thousands of patients--many of them perfectly sane--were released from institutions, and the legislation provided that people could not be involuntarily confined unless they posed a danger to themselves or others. (The Legislature is now debating a proposal to make it easier to commit an unwilling patient.)

Over the last three decades, state mental hospitals were supposed to be replaced with less restrictive community treatment programs, but most of those never materialized. Many of the truly sick stopped taking their medications and wound up on the streets.

AB34 represents the “rebuilding of the mental health system in California,” said its author, Assemblyman Darrell Steinberg (D-Sacramento).

But cases like Wilson’s point up the daunting challenges. Some patients need much persuasion to be convinced that treatment is in their best interests.

“As much as we want to help him, he makes the choice,” said Hillview outreach worker Robert McAlpine.

A church group that feeds the homeless in parks led him to Wilson, a Santa Claus of a man, slightly paunchy, with a red face, a snowy beard and long, bedraggled blond hair. An occasional smile races fleetingly across his lips, but his eyes mostly are wary and sometimes sad.

He has lived for two years in a brushy expanse near Hansen Dam, only a few hundred yards from a busy street and balconied houses.

“It’s out of the way and no one ever bothers me; horse riders use the paths over there,” says Wilson, pointing a few yards beyond the sage bushes to a gravelly trail.

His daily routine proceeds with the regularity of an assembly line worker: up in the morning, brush teeth, comb hair. A few miles’ walk to Ralphs for the day’s provisions. Doughnuts at Winchells and then a visit to a friend who lives behind a dumpster. Jack-in-the-Box for lunch. A stop in the park for an hour or two to escape the heat. Back to the tent. Read for a few hours until daylight falters. “And that’s about it,” he tells visitors.

As he speaks, the sun glows, birds tweet and a slight breeze ruffles the grass. It almost seems reasonable to stay.

A distorted sense of well-being is a hallmark of people suffering from paranoid psychosis, schizophrenia, major depression and other serious conditions, mental health experts say. If the mentally ill are homeless and without money for private care or medication, they frequently may drink or use drugs to ease their torment, becoming entangled in a web that is nearly impossible to escape. They also are at great risk of being arrested on drug charges and other offenses stemming from addiction and untreated mental problems.

Since his release from prison, Wilson has had more brushes with the law, consisting mostly, he says, of being hassled because he is homeless. And yet, he is torn between the offer of shelter and a sense of independence that he relishes. And he is still not too sure that these do-gooders from Hillview can make a difference.

He talked to them once before, hoping they could help him secure federal Supplemental Security Income, a financial mainstay for those with mental or physical disabilities. He says he was turned down because the authorities thought he was still a drug user. He insists that he has not used drugs in years and now drinks only occasionally.

And he is not content with Hillview’s choice of housing. Right now the only thing they can offer is a bunk bed at the Pacoima center. The prospect of permanent housing is far in the future since there is more need than there is housing, especially transitional living quarters for addicts.

For Wilson, a spot in the wash costs nothing and he is saving $100 of his $224 monthly welfare check in hopes of buying a car.

But he has little company, he admits. Two puppies he kept were killed by coyotes.

“Most people out here don’t talk to other people--they’ve all been pushed around so much they want to stay by themselves.”

A few days after meeting with McAlpine, Wilson dropped by the Hillview Center and spent the night. The next day, he politely informed the staff that he was leaving.

But a bridge was laid with the rest of society. A few weeks later, he kept an appointment to see a doctor about his back and he checks in regularly with a new caseworker for treatment. For the Hillview workers, it’s a bud of hope.

Successful Odyssey

To see the depth of change the AB34 program has achieved in some lives, you have to get out on the road at 7 a.m. with case manager Brent Huff, who was a standout cornerback at Oregon State University, was drafted by the Chicago Bears and has coached at Cal State Northridge.

He grew up in Pacoima as one of 11 children of a single mother, ran with a gang, did drugs and was homeless for a time, living in a car near Hansen Dam, not far from where many of his clients now subsist. His background has helped him to gain their trust.

“I think they’re happy to see me,” says Huff, who is compact, quiet-spoken and dressed sharply in a houndstooth sports coat and dark tie. “I’m there to assist them, to help them score. It’s like a basketball team.”

He has 27 AB34 clients at Hillview, and sees or talks to all of them during the week. It is his job to notice the small things, such as a shift in behavior or a nervousness that might signal an impending crisis and a need to change or increase medications.

“When you have an illness you feel isolated,” he says. “We need to give them a sense of feeling worthy, a sense that they have a say-so in their own lives.”

Many days start out at the Los Angeles Family Housing Shelter, where a dozen or so men and women are housed, including Daniel Pauli, 27, who shares a room with three others, each sleeping on a single bed. Next to his is a small table with a television. When Huff walks in, the TV is turned to Sally Jesse Raphael with the sound off.

“I have enough problems of my own without watching the talk shows,” says Pauli, smiling.

Wearing a Tommy Hilfiger sweat top and knee-length black shorts, he is tall and lanky with a big kid’s disarming voice and grin. He is articulate and clearly intelligent and it is hard to believe that he would be a murderer now if a gun he had been holding to the head of a friend had not jammed when he tried to fire.

That was in 1993, in a misunderstanding about a drug deal.

He was charged with assault, spent three years incarcerated and then was promptly picked up for possession and sales of drugs. He served his time at California Men’s Colony San Luis Obispo, in the psychiatric ward.

When he was released in January, Pauli knew he had to change or spend the rest of his life behind bars.

As he lies on his bed, Huff in a chair beside him, he confides his fears and dreams.

They talk about saving money for an apartment and maybe a car. Huff helped Pauli enroll in Pierce Community College where he is a wide receiver on the football team.

Pauli talks about when to schedule a visit to the Department of Motor Vehicles (he’s been driving since he was 15 but never had a license, he admits,) and about letting his parole officer know that he’s planned a weekend outing with a church group.

Those living at the shelter are transported back to the center for group activities such as stress- and anger-management classes, social skills, discussions about hygiene and health.

“I don’t have it all together,” says Pauli, who wants to be a sportscaster. “I’m still hardheaded.”

“But it’s softening up,” cuts in Huff.

Many Inmates Misdiagnosed

In Los Angeles County, a full quarter of the jail population--25.6%--exhibit some form of mental disorder, making the jail psychiatric unit the largest local inpatient mental health facility, say sheriff’s officials.

Psychiatrists who treat AB34 participants say many have been misdiagnosed in jail mental wards or prescribed outdated medications because they are cheaper than newer drugs.

Their crimes are usually small--petty theft, trespassing, trying to skip out on a lunch bill. But sometimes there is violence, such as assault with a deadly weapon triggered by drugs or drink. A requirement of the program is that the participants have no history of repeated violent acts, says Debbie Innes-Gomberg, who coordinates the AB34 program for the county Department of Mental Health.

Under an agreement with sheriff’s officials, AB34 outreach workers can come into the jail and enroll inmates near the time of their release.

Armed with a sheaf of records, Gomberg, along with Ingrid Scott and Anthony Oliver from the San Fernando Valley Community Health Center, have come to Twin Towers to talk to an inmate.

The mental health workers have been given a short training session on how to behave inside: Watch what you bring in--even the cap of a pen could become a lethal weapon. Talking about yourself could enable a disturbed inmate to track you down later and threaten you.

The jail’s mental ward is hierarchical: The most severely mentally ill inmates are housed at the top of the seven-story, octagonal building and as they become more stable, they move to successively lower floors.

The man they have come to see, Owen, is buzzed out of his fourth-floor, glass-walled cell to a large visiting room just outside. He is 30ish, pale and thin-faced with wispy brown hair and a mousy mustache. He smiles when he sees Scott, whom he met in another program.

Owen, in fact, used to be a peer counselor for other mental health patients and, in a barely remembered past, earned a college degree and a teaching credential. For the last 15 years, he has suffered from a bipolar disorder and has endured a numbing cycle of mental hospitals. Last summer, broke, lonely and off medication, he stole a car at knifepoint to go see his girlfriend.

He didn’t want to hurt anyone, he says, and Scott suggests he probably was in a manic state.

“It’s possible because I hadn’t taken my meds in two weeks,” Owen says.

He tries not to weep as he recounts to visitors his suicide attempt a few months ago when he jumped headfirst from the top bunk of his cell, intending to break his neck.

His shoulder is still sore, but medications seem to have stabilized his behavior. Now, he listens intently and then signs all of the releases to enter the program.

A few weeks after this visit, a judge at a court hearing decides that, because of his condition, Owen can be released only to a residential treatment program.

Scott finds a highly regarded center north of Azusa that seems just right. A month after his court hearing, Owen remains in Twin Towers waiting for his freedom and trying to stave off despondency. Finally, last week, he is released to the center to begin treatment.

Owen’s own hopes are simple: “I just want to be able to walk down the street. To be able to go to the store.”

Counseling and Medication Regimen

In the story of another San Fernando Valley participant, Owen might find some hope.

Robbie Mills has been out of jail only since October but was chosen to appear before the Legislature’s Joint Committee on Mental Health Reform in March to talk about his experiences.

Mills has wrestled with immense hardships. Years ago, just out of military service, he was so badly injured in a car accident in his native Arkansas that doctors told him he’d never walk again. But somehow, he did.

He came to California in 1994 to try to extricate his sister and her children from an abusive relationship. He eventually did, but found himself dragged onto Los Angeles’ skid row, into addiction and drug dealing.

Diagnosed as a paranoid schizophrenic, he spent the years in a succession of mental hospitals--Patton State, Metropolitan, Delano and Tehachapi.

One day he snapped and led police on a high-speed chase. He was arrested and imprisoned. His time in Twin Towers--where he witnessed frequent violence--seemed to snap something back and he resolved to clean up his life, entering the AB34 program upon his release.

At the San Fernando Valley Community Health Center in Van Nuys, he flourished on a daily regimen of counseling and medication and grew fit enough to become a peer counselor.

He lives now on his own in a single room in downtown Los Angeles, traveling back to the Valley daily by bus to maintain his treatment schedule.

From the center’s clothing bin, he selected a new suit and tie to appear before the packed hearing in Los Angeles that included Steinberg, AB34’s coauthor. When Mills finished his testimony, his smile was as broad as an ocean.

“I had a speech ready, but I just started talking from the heart,” he said. “It made me realize that people do care and that I can change from a life of crime to being a productive citizen.”