‘Mall’ Markets Life Skills to the Mentally Ill

Six students sat in a semicircle in Scott Callender’s classroom. Holding newspaper clippings in plastic sleeves, they discussed the case of a smuggler of illegal immigrants who was appealing his conviction.

“Who knows the difference between a normal court case and the appeals court?” Callender asked.

A student in a baseball cap cleared his throat. “In a normal case, they decide if you are guilty or innocent,” he said. Then he hesitated. “But in an appeals court, it’s different.”

Callender nodded in encouragement. “Right,” the 39-year-old teacher said. “The appeals court is ... checking over everything that was done in the first trial to make sure it was done right.”

The class is not much different from a high school current events class -- except for one thing: It takes place behind the locked doors of the Metropolitan State Hospital in Norwalk. Callender is a rehabilitation therapist and the students are severely mentally ill.

Callender’s class is one of 457 offered each week in the hospital’s new “treatment malls.”

“The name comes from shopping malls because patients come with their desires in mind,” explained a Metropolitan spokeswoman, Catherine Bernarding. “They pick and choose among classes and choose what they want to participate in.”

Hospital officials said they started the program -- the first of its kind in California -- because it actively engages patients in their own treatment, putting them in a setting where they can practice skills needed in the outside world.

“Our goal is to have patients move back into the community successfully as soon as possible,” Bernarding said.

One 42-year-old patient, whose schedule includes a class on family dynamics, said he appreciates the learning opportunity. (Patients are not named to protect their privacy).

“People used to complain that there was nothing to do,” he said. “With the mall, I guess they can stop complaining. It gets you up, gets you going.”

Sylvia Gelber of Monterey Park said that her 43-year-old son, who suffers from schizophrenia and bipolar disorder, has bloomed in the mall program.

Although he still struggles with low self-image and loneliness, Gelber said that since the mall started, he has been “more social and more talkative.” He seems to like the mall, she said, “which makes a difference.”

She said that her son also shows more interest in his own recovery, and in subjects he didn’t care about before, such as current events.

Research shows that treatment malls, in use for about a decade in this country, have greatly shortened patients’ stays, hospital officials said. They hope their program will shorten the average six-month to one-year stays for Metropolitan’s adult patients too.

Metropolitan, a state hospital with 1,096 beds, cares for low-risk patients accused of crimes and for adults and children committed for mental health treatment. The mall program serves 214 adult patients who suffer from illnesses such as schizophrenia and bipolar disorder.

Psychosocial Recovery Director Katie Twohy said Metropolitan’s patients need such classes to survive on their own after leaving the hospital.

At the onset of a mental illness, she said, “The chemical activity in their brain ... can be so overwhelming that they may not experience normal development socially or academically.”

Twohy added that the disease also can wipe out skills patients had learned before. Other patients, she said, have not forgotten anything, but may just need to practice basic skills.

“Some patients have incredibly horrible histories,” Twohy said. “Poor parenting, biological predisposition toward certain problems and the fact that they meet the criteria for post-traumatic stress disorder interfere with their learning.”

Since late February, the hospital has run two malls in former dormitories where oatmeal-colored walls have been repainted in lavender, mint green and baby blue. Beds have been replaced with chairs, long tables and wipe-off boards.

The students follow a schedule they create with their caseworkers. They may attend as many as four 50-minute classes a day; they have breaks between classes and for lunch.

The hospital has arranged for shorter classes and sick bay rooms for those who cannot sit through 50-minute periods.

The classes, which range from horticulture to money management, serve many purposes. For example, Callender said, his current events class not only familiarizes patients with President Bush and the state budget, but it also helps patients learn to communicate clearly, improve reading comprehension and focus their attention.

“It’s really good for reality orientation, especially because a lot of our patients are delusional or paranoid,” Callender said.

Ronnie Morales, a hospital police officer, teaches a class on police procedure. It helps him get to know patients better. Before now, he just waved to patients as he drove by or met them for the first time when he had to restrain them.

Morales said he noticed that now, “when they see me on the units, they don’t think I’m more prone to side with the staff anymore. I think they realize I’m going to try to be fair.”

Patients attending the mall one recent morning said that, although many of the classes are not new, the restructuring of their schedules and the opportunity to get out of the hospital units create a much more enjoyable day.

Dr. Stephen Mayberg, director of the state’s mental health program, who visited Metropolitan in mid-April, said the program already is paying off.

“We’ve seen a dramatic reduction in seclusion, restraints, times that we need to call police or law enforcement, patient-to-patient altercations and unscheduled medication.”

The pilot program at Metropolitan has been so successful that Mayberg hopes the state’s other mental health hospitals will adopt it by 2004.

If patients “can’t balance a checkbook, they won’t succeed out there,” Mayberg said. “We don’t want them to come back.”