‘Cuckoo’s Nest’ Revisited

The people lined up at soup kitchens and rescue missions today will get free turkey and dressing. And by dark many of them will be curled up in ragged tents and cardboard boxes, trying to sleep while their neighbors scream at imagined voices. Tomorrow, well-meaning citizens will hand some of these same people money or a sandwich, affording them the opportunity to spend yet another night on the sidewalks they call home. It doesn’t need to be this way. And perhaps this day for counting blessings is as good a time as any to ponder: What went wrong? What can be done?

The answers to both questions can be found, in part, in the legacy of author Ken Kesey, who died this month. “One Flew Over the Cuckoo’s Nest,” his 1962 novel about a sadistic psychiatric ward that squelched individuality with brain surgery and zombifying medications, accelerated a growing reform movement against such abuses in all-too-real psychiatric “snake pits.” By the early 1970s, state institutions had released hundreds of thousands of mental patients. Tragically, the housing and services that were supposed to help them flourish in their own neighborhoods never materialized, leaving many to live on sidewalks or under freeway overpasses.

This is wrong. There are ways to fix it. If legislators would now show gumption and back these fixes up with carefully prescribed laws to compel the treatment of those who cannot or will not help themselves, this civic shame could be remedied. Here’s what it takes:

HOUSING WITH BUILT-IN SUPPORT:

The Village in Long Beach, a project of the Mental Health Assn. of Los Angeles, is a model of “supportive housing.” A staff of professionals and former “members” walk people with mental illness and sometimes addictions through ways to kick their drug habit, get proper medication, find a place to live and work [(562) 437-6717].

Other successful examples include the Salvation Army’s shelter in Bell [(213) 896-9160] and LAMP, a downtown organization that, in addition to running a drop-in center and offering housing and treatment options, now gives a lucky few people with mental illness and addictions the chance to escape to a donated ranch near Bishop, complete with a working garden, horses, llamas and views of the eastern Sierra [(213) 488-9718]. Other worthy groups are listed at www.lahsa.org, the Web site for the Los Angeles Homeless Services Authority, which coordinates homeless services for the city and county.

TEMPORARY SHELTER:

Before most people with severe mental illness are ready to move into treatment and long-term housing, they need places to stay for a few nights or weeks. But many with mental illness have a deep fear of traditional shelters, some of which can be hellish even for those who don’t hear voices. That’s why Sheriff Lee Baca’s idea of opening an open-air homeless safety center near downtown is a pilot project worth supporting.

Even in these tough budgetary times, state representatives should find the money to build Baca’s center, because study after study shows that simply letting mentally ill and addicted people cycle from jail onto the streets and back is far more expensive than taking solid steps to help them find a place to live, get treatment and work.

REACHING OUT AGGRESSIVELY:

Many mental health organizations send workers who have wrestled their own mental illnesses and addictions under control out into the streets to cajole people to make use of services. This is important. But law enforcement agencies have the most contact with people living on the streets, and can have the biggest impact.

The county Department of Mental Health has joined with the Los Angeles Police Department and the Sheriff’s Department to create 30 teams of law officers and trained clinicians who work to coax people out of their encampments. One team, Deputy Craig McClelland and nurse Suzanne Newberry, is paid for, in part, by the Metropolitan Transportation Authority, whose administrators are eager to confront the problem of mentally ill indigents sleeping at bus stops and causing problems on buses. Most of the money, however, comes from the state. Legislators and Gov. Gray Davis should be encouraged to continue to support--indeed to increase funding for--bills sponsored each year by Assemblyman Darrell Steinberg (D-Sacramento). This provides money annually for the teams, supportive housing and similar mental health programs.

MENTAL HEALTH COURTS:

Los Angeles’ mental health court, located in a former pickle factory north of downtown, falls far short of what it could be--and what model courts in other places have already become. To fix it, Los Angeles’ judicial bureaucracy must replace conveyor-belt justice with a true “problem-solving court” designed to keep people with mental illness and addictions from being arrested for nuisance crimes, jailed and then spit back onto the streets in a sad, expensive cycle.

San Bernardino County has such a court, where a no-nonsense judge joins with prosecutors, psychologists, people who run board-and-care homes and even jailers to help mentally ill and addicted “clients” get treatment, housing, jobs and ongoing support.

This week, Congress authorized $4 million as seed money for more of these courts. The president and Congress should be encouraged to keep that money flowing. And James A. Bascue, supervising judge of the Los Angeles Superior Court, should snatch a share and work toward a full-fledged “problem-solving” approach at the “pickle factory,” the satellite Van Nuys court that handles mental health cases and a new court that is in the works for skid row.

CHANGING ATTITUDES AND LAWS:

On some corners where people have set up makeshift camps, the smell of urine and garbage is so strong that shop owners and passing schoolchildren hold their noses. Vermin thrive, and so do diseases such as hepatitis and tuberculosis. Yet when Los Angeles Councilwoman Jan Perry pushed to have the city regularly hose down the streets of skid row, civil libertarians rushed to stop her, clamoring that a cleanup could dispossess those who dwell on the sidewalks. Perry has persevered. But too often elected officials cower at the first hint of resistance--and too bad about the people, mainly poor, who have to live, work and play in the midst of chaos.

Dirty streets are not the worst of it. Laws, as now written, make it virtually impossible to force even the most obviously deranged people who live on those streets into treatment unless they are a grave and immediate danger to themselves or others.

Fortunately, people are slowly beginning to realize that mental illness often prevents those who have it from understanding they’re sick and that when they are incapable of acting in their own best interests, government has an obligation to step in.

Political courage does exist. Early next year Assemblywoman Helen Thomson (D-Davis) plans to reintroduce a bill that would allow judges to compel a relatively few severely mentally ill people to accept outpatient treatment, including the sort of medication that can usually help even the most severely ill return to some semblance of a normal life. “Laura’s law” is named after a young woman killed by a man whose mental illness went untreated because existing laws left his family, the police and psychological professionals impotent to intervene. But civil libertarians have defeated the bill twice now, by persuading legislators--notably Senate President Pro Tem John Burton [D-San Francisco, (916) 445-1412]--that no one should be forced to take medications against his will.

Thomson’s legislation has built-in civil liberties protections. But it also recognizes that the balance between rights and responsibilities has tilted so far toward preserving supposed freedoms that some people are now enslaved by the symptoms of their mental illness. They suffer because the rest of us--who don’t have the excuse of impairment--won’t do whatever it takes to make sure they get treatment.

Psychiatric medication and treatment facilities have come a long way since the days of the despotic Nurse Ratched of “Cuckoo’s Nest.” The scandal is no longer that people are locked up in repressive snake pits. The scandal now is reflected in a challenge a delegate from China once put to Mayor James K. Hahn, and to Americans in general, upon seeing a deranged-looking man sleeping in the shadows of Los Angeles City Hall: We think you don’t know what to do, or don’t care.

We do know what to do. So the only question is, “Do we care?”