Los Angeles Times, by Alex Raksin and Bob Sipchen

By Alex Raksin and Bob Sipchen

The Legislature should revise the act that "protects" many mentally ill people from getting the care that they and society deserve.

Many street corners and other public spaces in California have come to resemble open-air insane asylums. Sometimes muttering obscenities and lashing out at invisible demons, the state's estimated 50,000 mentally ill homeless people often have just each other and the streets. Government pays attention only after they harm someone or otherwise break the law. Even then, the typical response--tossing them in jail, then releasing them without any required follow-up care--does nothing to redirect them into productive lives.

This week the Assembly Judiciary Committee will consider legislation by Assembly- woman Helen Thomson (D-Davis) that would solve a key part of the problem. AB 1421 would amend the Lanterman-Petris-Short Act, a well-intentioned but ultimately misguided law passed in the 1960s that bars doctors, judges and counselors from compelling seriously mentally ill people to be treated unless it can be proven they are at imminent risk of harming themselves or others.

The law was intended to protect what was seen as the civil right of mentally ill people to be free from the overzealous restraints that were common at the time--primarily medications like Thorazine and Haldol, with their harsh side effects like sedation, blurred vision, impaired memory and muscle stiffness. But today, highly effective medications with few adverse side effects greatly enhance patients' decision-making ability. The law, as outmoded as Thorazine, denies helpful medications to people who are too sick to recognize their need for care.

At a series of town hall meetings organized to support Thomson's bill in recent months, relatives of victims harmed by untreated mentally ill people have detailed how the act's original intention went awry. At a rally at UCLA earlier this month, Cindy Soto said she found little comfort in knowing that a paranoid schizophrenic who refused treatment is now in prison after plowing his Cadillac into 30 children at a Costa Mesa playground in 1999, killing Soto's daughter and another child. "Do you think [he] is better off in prison than he is in a treatment program?" Soto asked. "Am I better off without my daughter? There is nothing civil or right about that."

Last year, Senate President Pro Tem John Burton (D-San Francisco) successfully opposed a similar version of the bill out of fear that it would abrogate the civil rights of the mentally ill. Burton has not come out against AB 1421, however, in large part because this year's version includes due process rights and other safeguards to ensure that families and a range of mental health professionals are consulted before medication or other treatment is compelled. The state revenue drain caused by the power crisis makes it unlikely that the fiscal part of AB 1421 would be funded: a $50-million provision calling for "the delivery of community-based care by multidisciplinary teams of highly trained mental health professionals with staff-to-client ratios of not more than 1 to 10." Even so, changing the Lanterman-Petris-Short Act would allow public health workers to better serve the mentally ill using existing--if woefully insufficient--resources.

Adequately funding community services for the seriously mentally ill, using successful models like Long Beach's the Village and Wisconsin's PACT program, makes sense. Well-conceived continuing care--including group housing, therapy, daily supervision and job assistance--has been shown to reduce costly hospitalizations and incarcerations by more than half.

Although the fiscal crisis may have foreclosed legislative consideration of such long-term care, at the very least lawmakers should pass the cost-neutral portions of AB 1421. It is high time for Sacramento to recognize that the only civil entitlement the current law protects is the right to a future dashed by debilitating illness.

© 2001, Los Angeles Times

By Alex Raksin and Bob Sipchen

On any given day, about 50,000 severely mentally ill homeless people roam California's streets, rummaging through trash bins, doing battle with invisible demons and occasionally inflicting harm on very real citizens. They do so largely because laws crafted decades ago put their "civil right" to be free ahead of society's right to compel them to be treated.

These well-intentioned laws made some sense when they were passed, in the 1960s. Then, the awful side effects of some psychiatric medications turned patients into virtual zombies, blurring their vision, stiffening their muscles and dulling their memories. Better medications are available today; as a result, lawmakers will have a chance soon to make California safer and saner.

In and Out of Jail

Who are the new proposals aimed at? Meet 22-year-old Chris Hagar, who is now locked up in the Sacramento Mental Health Treatment Center. Since age 15 Hagar has cycled in and out of six jails and mental hospitals, tormented by paranoid schizophrenia. He'd steal food from mom-and-pop grocery stores and promptly get arrested. He'd assault his parents and others. He'd break into a car to escape shadowy stalkers.

Before the onset of his illness, Hagar was a smart kid with a keen sense of humor who excelled at life. When he was 12, he joined the San Francisco Boys Chorus and was quickly promoted to master singer because of his perfect pitch and musical memory. He toured Europe and won second place in an international competition against dozens of other nations; he ran a business airbrushing fine art on T-shirts.

At 15, his illness was diagnosed as schizophrenia with psychotic symptoms and agitated depression, but his dreams never died. Just last week he told his father how much he wants to work again.

The problem is that when he is not compelled to take his medicine, he doesn't. When he doesn't take his "meds," he gets wildly aggressive. Seventeen times Hagar has attacked his family. He once bashed his father with a chair at the suggestion that soldiers weren't really hunting him down. Two months ago, at a treatment center, he kicked a fellow patient in the face. He was expelled and spent a week in the Sacramento County jail.

Three Problems

Hagar and thousands like him are falling through California's increasingly tattered safety net because of critical flaws in the system. To start mending it, Assemblywoman Helen Thomson (D-Davis) has introduced three good bills, all of which will come up for crucial votes in the Assembly in the next two weeks. Each addresses a specific problem:

* Because Hagar is now on medication, he shows no imminent danger to himself or others and thus can't be monitored against his will or detained. Soon, a judge must release him. At best, the court will be able to supply him with the address of a good mental health clinic, which he's unlikely to use.

Thomson's first bill, AB 1421, would allow judges to compel Hagar to accept follow-up care and outpatient treatment and would provide for social workers and psychiatrists to administer it. Such treatment could be compelled only after judges, mental health professionals and family members decided that without it, a severely mentally ill person would be at "high risk" of injury to self or others.

* Often when Hagar gets out, he high-tails it to counties far from home. Judges and mental health workers there have no history on him. They don't know crucial details about the medication regimen that brings him back to reality: that one antipsychotic medication, risperidone, doesn't help him at all but another, olanzapine, does.

Thomson's AB 1424 would get at this problem by requiring courts to consider psychiatric histories when sentencing and would computerize and streamline an existing database of mentally ill people in the state who had been arrested for violent crimes. The database would replace the state's woefully ineffective, mostly paper-based mental health information system, rightly derided as the MISS system because it misses so much.

* Counties often fail to care for Hagar and others like him because their mental health, law enforcement and judicial systems are ineffective. Thomson's third bill, AB 1422, would bring business leaders together with doctors, law enforcement, psychiatrists, homeless advocates, and others in a new mental health commission. By reaching beyond the usual bureaucracies, this approach could better succeed in identifying the most cost-effective treatments for people like Chris Hagar.

Regaining a Balance

Economic considerations are important because Sacramento now spends $2 billion a year on mental health services without requiring counties to show they are using it prudently. AB 1422 would require state Mental Health Director Stephen Mayberg to come up with "best practices" and accountability measures. Taxpayers would have a much better idea whether the money is being used wisely.

It is a symptom of this nation's goodness that it protects the rights and liberties of the mentally ill. In this noble pursuit, we have granted some genuinely helpless individuals the liberty to harm themselves, and others, in never-ending cycles. Free people should always hesitate to diminish anyone's civil liberties, but in this instance there's good reason.

Chris' parents love him. That is why they take no joy in knowing that a Sacramento County judge is likely to release him any day now. They know it will be only months at best before Chris goes off medication and breaks the law again.

What will it be this time? Stealing beer and chips from a convenience store? Something more serious? As always, his parents pray no one is hurt.

There's not much more they can do--until our legislators approve these firm but ultimately compassionate measures.

© 2001, Los Angeles Times

By Alex Raksin and Bob Sipchen

Forty years of good intentions have left California's mentally ill in desperate--sometimes tragic--circumstances. You can see the desperate ones on the streets every day. If you haven't seen the tragic ones, consider the case of Scott Harlan Thorpe.

Thorpe, a former janitor, thought the FBI was ordering cooks to poison his meat and forcing him to see an incompetent psychiatrist.

If there had been a way for the state to compel him to take his medications and accept therapy, Thorpe might be living a relatively normal life. Instead, on Jan. 10 he marched into the only public mental health clinic in the Northern California town of Nevada City and, according to eyewitnesses, opened fire. The fusillade killed two clinic employees, including 19-year-old Laura Wilcox, a high school valedictorian who was working at the clinic during college break.

Boasting that he was "the toughest man the FBI had ever tried to break," Thorpe, 41, drove to a nearby restaurant, where he allegedly shot to death its 24-year-old manager.

Thorpe's rampage, which left three other people seriously wounded, offers an extreme but pertinent illustration of why legislators must pass AB 1421, a sensible mental health bill that is working its way through Sacramento this week.

Thorpe's family saw his paranoia deepening and sought help for him. But no one could force Thorpe to accept treatment and stick with it, so the deck was stacked against his relatives. The bill is aimed at such cases, getting treatment to people when their actions suggest that they pose a threat to themselves or others. The legislation would give judges power to force people like Thorpe to take medications to modify their behavior or face confinement.

For two generations, California has been applying what now seems an extreme emphasis on the civil liberties of unfortunate people who cannot refrain from harming themselves and, occasionally, others. Thorpe's is an extreme case, but you'll find less violent (though still troubling) examples on the streets of every city in the state.

It's time to stop averting our eyes, because there's something we can do about it. But doing something means a reduction in the civil liberties of some of the mentally ill and a corresponding increase in the authority of the state. As a general rule, we like to see things go the other way. In this rare instance, Californians should proceed with eyes open and calibrate the adjustment very carefully.

If the Legislature and Gov. Gray Davis approve the bill--and provide enough money to make it work--AB 1421 would be a good first step toward a more balanced public policy.

With that goal in mind, the measure now needs fine-tuning. We commend the bill's author, Assemblywoman Helen Thomson (D-Davis), for persevering against civil liberty absolutists whose well-meaning resistance to the measure works against positive change.

We must not pretend, however, that what Thomson proposes is anything less than a significant widening of the state's authority. As such, it deserves the closest scrutiny. This week, Thomson should listen closely to mental health advocates who contend that the bill, as worded, is too broad in defining those on whom a judge could impose treatment. We encourage her to once again take full measure of the bill's civil rights protections. Then, with reasonable protections adopted, the bill should go forward. California owes it to Amanda and Nick Wilcox, Laura's mom and dad.

They saw in Laura an energetic and compassionate young woman. She was running for student body president at Haverford College and planned to work for a Quaker group after graduation. She might still be rushing toward that promising future had Thorpe's family been able to compel him to get help.

"Amanda and I understand that our daughter was a random victim in this tragedy," Nick Wilcox said. "We also believe that the events of that day were predictable and preventable."

Therein lies a revolting twist: Now, three deaths later, Scott Thorpe is locked up awaiting trial and the state can finally force him to take his medications. There is a better way, and Sacramento must make the start.

© 2001, Los Angeles Times

By Alex Raksin and Bob Sipchen

One good program has taken George Rivera from his cardboard-box home and made him a taxpayer. It's far more cost-effective than his stints in prison and mental hospitals.

To walk through parts of downtown Los Angeles is to negotiate urine-scented, open-air bedlam. Business owners, workers and stray tourists dodge and weave through sidewalk shantytowns inhabited largely by addicts and the homeless mentally ill, some of whom shout at the air as if tormented by demons.

LAMP Village is an oasis of peace within the cacophony and home to 48 people with addictions and mental illnesses--people who once cycled pointlessly among hospitals, jails and the madness of the streets.

Step inside and the chaos is replaced by the gurgling of a fountain and the aroma of detergent wafting from a profitable laundry service, run by the residents, whose behavior has been stabilized by medication, counseling and the comfort that comes from having a clean, well-lighted place to live.

The Times is campaigning to undo the tragedy that has been allowed to unfold since the late 1960s, when budget constraints and well-meaning concern for civil liberties emptied the state's mental hospitals onto its streets. This editorial page has urged Californians to stop averting their eyes from so conspicuous a problem and to do what it takes to help the homeless mentally ill, even if that means taking away some civil liberties from people incapable of making decisions on their own.

Past editorials have advocated the passage of a law that would make it easier for the courts to force dangerous, severely mentally ill people to take medications and receive treatment. But the majority of the state's 50,000 homeless mentally ill are a danger only to themselves and in most cases are beyond the reach of that important measure. LAMP is an example of the sort of cost-effective program that has proven successful in getting these people to move voluntarily off the sidewalks and toward productive lives.

Since 1999, legislation by Assemblyman Darrell Steinberg (D-Sacramento) has been a key source of money for this sort of innovative nonprofit program. We encourage Gov. Gray Davis to double the amount he has budgeted for the efforts supported by Steinberg's bill, to $110 million, as recommended by an Assembly committee.

This week Senate and Assembly leaders will decide whether to push Davis on this. Faced with a plunge in revenues due mostly to rising energy costs, they have plenty of reasons to be timid about spending more money on anything. In this case, though, they should pay attention to a legislative study released this month showing that the Steinberg legislation dramatically reduced homelessness and that for every tax dollar spent on treatment, $2 in jail and hospitalization costs is saved.

To understand how LAMP and programs like it save not only lives but money, lawmakers might pay a visit to George Rivera, a friendly, energetic man whose job is trying to talk mentally ill people off the streets and into treatment.

A paranoid schizophrenic and drug addict, Rivera spent most of the 1970s and '80s living in the 40-block squalor of tarps and tents that is downtown L.A.'s skid row. About the only time he was off the streets was when he was in jail or a mental institution. In 1976, for example, he was sent to Metropolitan State Hospital in Norwalk after "giving a lickin"' to his girlfriend. There he threw a chair at a psychiatrist, which led to four months at Atascadero State Prison.

The cycle was broken in 1994 when an outreach worker persuaded him to give LAMP a try. Rivera left his cardboard-box home, removed his clothes from the razor-wire security fence he used as a closet and moved into a bright and airy 50-unit apartment complex owned by LAMP. He decorated his room with pictures of the flower and vegetable gardens he tended at the organization's nearby "village." Today he works for LAMP, walking the streets not to score heroin or PCP but to encourage other mentally ill people to take advantage of the showers, food, laundry, medical attention, peer counseling and job training that LAMP offers.

Rivera's brushes with what he calls "the system" cost taxpayers tens of thousands of dollars but did nothing to cure his mental illness. Today he is a taxpayer.

Even in this lean year, Gov. Davis needs to understand that budgeting $110 million for programs like the one that helped Rivera would be a smart investment.

© 2001, Los Angeles Times

By Alex Raksin and Bob Sipchen

While leaders dither and pass the buck, the psychiatric emergency room at Los Angeles County-USC Medical Center has degenerated to the point that it resembles St. Mary of Bethlehem, the 18th century London madhouse that gave us the word "bedlam."

The scenes described in Monday's Times story about a grand jury investigation into the overcrowded facility make it sound as if lunatics are running the asylum. The story described a place where one patient jumped off a gurney and onto a doctor drawing blood; where a psychotic man attempting to escape crashed through the ceiling into a trauma room; where a young woman who'd been raped cowered in a corner while older male mental patients ogled her.

The grand jury report concludes that the psychiatric ER "creates unsafe conditions for patients, visitors and staff" and recommends that the county come forward with money for extra beds to alleviate the crisis. That money will not be easy to find in a county health care system that teeters on the brink of collapse due to overwhelming deficits. But given the chaos at County-USC, everyone involved had better start looking in new places in the county health department's $2-billion-plus annual budget. Fast.

Hospital administrators say that in seven years they will open a replacement hospital with a more spacious psychiatric emergency room. Seven years? Another 2,555 days of bedlam? County leaders should have created more space seven years ago , when the Northridge earthquake shuttered County-USC's main psychiatric ward, cramming everyone from the dangerously delusional to severely depressed teenagers into the hospital's single, eight-bed psychiatric emergency room.

Ultimately the county will need Gov. Gray Davis' help. Just as he loosened the red tape manacling power plant manufacturers, he should prod city, county and state bureaucrats to streamline permitting and building code laws that essentially bar counties from using existing facilities to expand psychiatric wards.

Davis should also fund "Assertive Community Treatment" teams, in which police officers and mental health professionals join to ensure that seriously mentally ill people get the counseling, medication and other outpatient treatment they need to lead stable lives. Recent studies have shown that these teams dramatically reduce demand for inpatient psychiatric services. Yet Davis is reportedly balking at the modest $10-million increase for these programs that the Legislature allocated last week.

Given the needed money, such programs will eventually ease the burden on psychiatric emergency rooms statewide. But County-USC needs more beds and better health standards today. If a society is measured by how it treats its most vulnerable, then Los Angeles must be judged harshly for deepening the despair of frightened and fragile people.

"It is nuts, and it's unacceptable," the hospital's chief executive, Roberto Rodriguez, said of conditions at the psychiatric emergency room last week before stepping down from his post. Anyone who disagrees should have his head examined.

© 2001, Los Angeles Times

By Alex Raksin and Bob Sipchen

Inefficient? Mollycoddling? Wrong. The state pays more than $500 million a year just to house mentally ill lawbreakers in jails and prison.

This week, as television cameras zoom in on celebrities ladling Thanksgiving gravy to lines of street people at Los Angeles rescue missions, consider a story Mayor James K. Hahn tells. He was leading a Chinese delegation around the grounds of City Hall when a visitor inquired about one of the many seemingly deranged, often filthy people who sleep on sidewalks or in bushes in the shadows of the Civic Center's city, county, state and federal office buildings. Hahn offered his guest an impromptu lesson on why a democracy must value individuals' right to make free choices. When he was done speaking, the Chinese delegate looked again at the man sleeping on the sidewalk and said, not just to Hahn but figuratively to all Americans: We think you don't know what to do or don't care.

If there is one thing that liberal advocates for the "homeless" and conservative critics of "bums" agree upon, it's that America's streets should never have become bedrooms to so many of its citizens. Los Angeles has public and private organizations that provide food and places to stay for people temporarily down on their luck. But the region fails the majority of the people who, year in, year out, sleep on city and suburban sidewalks, behind hedges and under freeway overpasses. Most of those have mental illnesses, addictions or both.

This benign neglect must end, for the sake of the sick who live in squalid conditions, and for the sake of the well who pay a high economic and civic price for ignoring the problem.

Society used to lock up "lunatics," subjecting people with such diseases as schizophrenia, depression and bipolar disorder to involuntary brain surgery, shock treatment or sterilization. Such treatment was shameful. But life on the streets is anything but humane. It's time that we all squarely face the fact that some people who cannot act in their own best interests must be nudged off the streets and into treatment even when they don't think they need it.

Who among us has not walked past or stepped over a person sprawled in the middle of the sidewalk, hair matted, ranting? Do we hand him cash or avert our eyes? Too many of us see these lost souls as part of an intractable problem. But the last decade has produced ways to help these people live healthier and more productive lives, while returning public sidewalks to the uses they were made for--walking and legitimate commerce.

Los Angeles' jails are full of mentally ill people arrested for nuisance crimes: stealing, vagrancy, fighting, trespassing. When they finish their time, they recycle back to the only place they know to go--the public street. "Mental health" courts are a new--some say revolutionary--approach that recognizes that for more than 30 years judges have been wasting taxpayers' money by simply slamming mentally ill lawbreakers behind bars without offering the kind of help their diseases demand.

In several cities nationwide such "problem-solving" courts have begun to undo the catastrophe that began here in 1957 when California passed a measure known as the Short-Doyle Act. It was one of the first in a series of state and national measures that emptied public mental hospitals, leading to a drop from 550,000 institutionalized patients in 1955 to 60,000 today. The idea, which gained momentum over the next 15 years, was to take advantage of new psychiatric medications that were supposed to free the mentally ill from oppressive psychiatric "snake pits." Policymakers opined that these medicated patients would thrive if liberated to cheaper and less restrictive settings in their own neighborhoods. But little of the promised money materialized, and far too many of the psychologically wounded wound up on the streets, where illicit drugs were far easier to get than the prescription kind.

Ever since, many of these people have been caught in a cycle: Mental disease, often coupled with addiction, lands them on the street, where they wind up in regular confrontation with police--usually for minor crimes that get them jailed or hospitalized and finally dumped back in the environment they couldn't cope with in the first place. Mental health courts can ease people off that hamster wheel.

But that's not happening the way it ought to in Los Angeles. A decomposing, nearly 100-year-old former pickle factory in Cypress Park is the major local version of mental health court. Judge Harold Shabo ably manages it with a feeble budget. Now the people who wield clout and divvy up the cash that pays for courts--primarily state and county judicial administrators--should assign themselves an immediate field trip to San Bernardino, where a full-fledged mental health court has been up and running successfully since 1999.

Here's what they would see: judge, prosecutors, public defenders, probation officers and psychologists working together to keep the mentally ill and drug-addicted on their prescribed medications, off street drugs, in housing and on track toward leading sane, sober, law-abiding lives.

Men and women stand one by one before Judge Patrick Morris, who alternates between his roles as Judge Judy and Oprah. Last Wednesday, for instance, a husky man with tattooed arms wept as he told the judge about "the stress" that makes methamphetamine a continuing temptation. The judge, like a father the man probably never had, told him that everyone has good days and bad days. Then Morris directed the former car thief to stay off drugs: "The alternative is jail or prison." The tattooed man chose treatment.

Inefficient? Mollycoddling? Wrong. The state pays more than $500 million a year just to house mentally ill lawbreakers in jails and prison. Morris sums up what makes his court different: "We use the powers of the court to effect change--we don't just pass along problems to others."

Take note, Los Angeles: Mental health court is one way to stop the revolving door that keeps pushing the mentally ill back onto the streets.

© 2001, Los Angeles Times

By Alex Raksin and Bob Sipchen

On a corner in downtown Los Angeles, a man sprawls unconscious, genitals exposed, one shoe on the sidewalk beside a foot covered with oozing sores. Blood and spit gurgle in his open mouth. A man in a fruit company uniform walks by, unmoved. Speaking in Spanish and gesturing, he makes it clear that he sees no point in calling paramedics: There are too many of these people--drunk or on drugs or crazy. "Perdido," he says. Lost.

As it happens, just around the corner, in the middle of San Julian Street, paramedics from Los Angeles City Fire Station No. 9 are already pounding another overdosed man's bare chest. A few feet away, a hot dog cart blares music and at least 85 people, many with wild, unfocused eyes, mill about watching, yakking, even dancing. A man slumped with several others against a graffiti-splattered wall lets out a slurred shout: "Let him go to heaven."

As late as the 1960s, people with mental illness and addictions were tossed into institutions with little concern for their civil liberties. Today many such people wander the streets. This is no more humane. It's time to help those who cannot act in their own best interests to move from the urban and suburban sidewalks and parks and into treatment for their ailments. It is for the sake of the sick, and also because the costs to taxpayers and civic pride are simply not acceptable. The firefighters and paramedics at Station No. 9 alone respond to about 70 calls a day, sometimes juggling as many as five simultaneous cases of drug or alcohol overdose amid the city's skid row sidewalk encampments. One way to slowly stop this senseless and relentless rescue operation is to put more teams of specialist public servants on the streets to ease people with mental illnesses and addictions off.

Craig McClelland and his partner, Suzanne Newberry, have been trained to do just that and to coax and cajole people from under bridges and out of the shrubbery caves they inhabit from East L.A. to the Westside.

Newberry is a nurse supplied by the county Department of Mental Health. McClellan is a deputy sheriff. The partners are one of the mental evaluation teams put together by the Los Angeles County Board of Supervisors in what Newberry calls "the joining of totally foreign agencies--public health and law enforcement." The Sheriff's Department and the Los Angeles Police Department have between them a total of about 30 such teams.

Dressed in civilian clothing, McClellan and Newberry drive their unmarked Crown Victoria through some of the county's least desirable real estate. McClelland summarizes the team's mission: "We try to find real solutions, long-term solutions, not just a quick fix."

To see how this works, walk with the partners into a ragged enclave of weather-beaten blue tarps, tents and cardboard boxes in an industrial area just east of the Civic Center. As some inhabitants stare glumly from a cluster of old mattresses that reek of body odor and urine, a middle-aged man in a black gaucho-style hat steps out to greet them.

The team's approach is to lift up tent flaps and tuck in gallons of water that McClelland talks the Sparkletts company into donating and hand out canned goods contributed by his church in Huntington Beach. They talk to those who will listen, suggesting shelters, offering to make contact with drug treatment programs.

Then they move on to the next spot where people hang their clothes on razor-wired-topped chain link or sleep beside dumpsters overflowing with rotting trash.

Slowly, people get to know them. One afternoon "Black Hat" approached. "Can you help me?" he said. "There's something wrong in my head."

Newberry is a short, red-haired woman who spent 20 years working in psychiatric emergency rooms. McClelland is a veteran of 13 years with the Sheriff's Department and an expert on substance abuse. When "Black Hat" bridled at the mention of going to a hospital, they knew how to quickly wrangle a psychiatrist and get him to the encampment to prescribe antipsychotic medication on the spot.

This middle-aged man still lives on that sidewalk, but a fog has lifted from his mind. Earlier this month McClelland and Newberry persuaded him to go with them to tour a facility that could provide housing and long-term treatment. They're hopeful he'll soon join the 5,000 people statewide whom such teams have moved off the street and into some sort of treatment and housing. It certainly beats jail, where locking up a mentally ill person can cost up to $600 a night--about the price of a suite at the Four Seasons.

What Newberry and McClelland do takes compassion, toughness and persistence. More such teams are needed. The alternative can be seen in the emergency medical madness that unfolds 24 hours a day in Los Angeles, where the paramedics at Station No. 9 alone go through five cases of latex gloves a month as they pump the chests and patch the wounds of people who will live and die on skid row streets.

© 2001, Los Angeles Times

By Alex Raksin and Bob Sipchen

For years, Kevin Lamar Evans pushed a shopping cart brimming with his possessions through the streets of Lancaster and Palmdale, bedroom communities that were supposed to be immune to such notorious signs of urban blight. His death in 1999, while clutching a baloney sandwich in the Twin Towers jail downtown, helped spur Los Angeles County Sheriff Lee Baca to radically rethink law enforcement's approach to the seemingly intractable problem of mentally ill and addicted people living on public streets.

Evans had been born with cerebral palsy, in South-Central Los Angeles. At age 18, he hissed at his sister. His mother and godmother thought he'd been possessed by Satan. The schizophrenia only got worse. By 23, he had drifted to the high desert, where he often stayed in shelters at night and wandered the streets by day, talking to his voices. His death, while he was strapped down in jail, stemmed from his 13th run-in with the law in two years. Suddenly the newly elected sheriff found himself trying to understand the other role thrust upon him: warden of a jail that is, in fact, "the world's largest mental institution." Los Angeles has public and private organizations to help people down on their luck and without a place to stay. But most of the people who wind up living on the streets have mental illness, addictions or both. Now Baca and his staff are spearheading a plan to start breaking the jail-to-streets cycle that continues to ensnare thousands of people like Kevin Evans, while exacting an unacceptably high price on civic pride and public services.

In part because of federal pressure, the jail has already begun screening inmates for mental illness and referring them to services once they get out. Next, Baca hopes to give these people a place to sleep and wash and take advantage of services from job training to counseling that will help them move toward more productive lives. His Public Safety Center for the Homeless would put 150 tent-like living spaces in an area close enough to downtown that many of the 500 people released from Twin Towers each day would choose the camp over the filthy, drug-rich encampments on skid row or in nearby industrial areas.

Baca has done his homework, learning from the county's handful of successful nonprofit shelters and drop-in centers. He knows that even if there were enough shelter beds in the county--which there are not--many of the people camped out on the city's sidewalks would remain outside, because their delusions and paranoia make the rules and confinement of shelters and missions a form of torture. An open center, with guaranteed safety measures, would appeal to some of these people. In the 1980s, then-Mayor Tom Bradley's "urban campground for the homeless" became a magnet for crime. But Baca makes a persuasive case that with law enforcement at the core of the effort that problem won't arise.

Now the state should come up with the $8 million the sheriff has requested to build the center, and the Board of Supervisors should direct the county Department of Mental Health to oversee it as a pilot program, while working toward better coordination of services countywide.

Sound expensive? Consider: The Sheriff's Department spends $10 million a year just on psychiatric medicine for the sick people who cycle incessantly though the Twin Towers. California shells out $1.8 billion a year arresting, trying and imprisoning the mentally ill.

There are critics who think "Sheriff Moonbeam" is unrealistic--and on plenty of issues he is. On this one, though, Baca has shown solid leadership, attacking a problem that most elected officials dodge or pass on to others. Jail cells should be used to lock up serious criminals, not to house trespassers with mental illness. And letting people live and die on the sidewalks ought to be a crime.

© 2001, Los Angeles Times

By Alex Raksin and Bob Sipchen

A recent University of Pennsylvania study found that the average person with mental illness living on the streets of New York used emergency medical systems, jails and other public services such as community psychiatric clinics--sporadically and ultimately ineffectively--to the tune of just over $40,000 a year.

Brad Swenson was having a bad week. He and his wife were bickering. He didn't get along with his supervisor at the Lucky distribution center in La Habra where he processed orders. On the way home from work one Friday, he stopped for a beer at Cliff's Hideaway in La Palma.

The beer got him thinking how unhappy he was and that led to a few double Bloody Marys. "I got wasted," he says, "then I decided I wanted to go get high." Swenson got a motel room and hit the crack pipe for two weeks straight. "I smoked up my savings, checking account, overdrafts. I lost everything," he says.

It wasn't the first time. With nowhere to sleep, Swenson found an old carpet behind a karate studio in Artesia and rolled up inside. After a few days, he wandered into an encampment of fellow crack addicts under a Long Beach freeway overpass, where he slept on a stained mattress. One night he wound up crashing at a nearby crack house. He was there when the Long Beach police kicked down the door. For the next three months and 20 days, Swenson had a place to stay, the same place that houses hundreds of people with mental illness on any given day: Los Angeles' Twin Towers jail. While he was there, recovering-addicts-turned-counselors from a place in Long Beach called the Village invited him into their program. Ever since, he says, his life has begun to make sense.

Most of the people who wind up living on the streets have mental illness, addictions or both. Because society doesn't know what to do with them, or doesn't care, these sick people are battered by disease, criminals and their own demons. The rest of us pay a high price in social services they use, while we also endure an ongoing assault on civic pride. Plenty of public and private organizations grapple with the problem of people temporarily left without housing by poverty, abuse or bad luck. Swenson lucked into one of the few places that take on the hard-core cases.

The Village is headquartered in a three-story building not far from Long Beach's bustling upscale heart. There's a laundry in the basement, a deli, catering business and drop-in center at street level, and counselors on the top floors. It's clean, well-lighted and cheerful throughout--despite the fact that human misery is its stock in trade. Here, teams of social workers, psychiatrists and counselors offer "menus" of housing, employment, treatment and social activities to "members" who span the spectrum of society's psychologically wounded--from severely mentally ill adults to disturbed young people who've just begun to cycle in and out of jails.

For Swenson, the first menu course was obvious. He enrolled in a place called "Wisdom House," where he wrestled down his addictions. Even more important, it was at the Village that a psychiatrist told him for the first time that the lifelong mood swings that had repeatedly left him enraged and impoverished had a biological cause and a name: bipolar disorder. Swenson began taking medication. A counselor helped him find an apartment. Another helped him find a job as a maintenance worker. Few people with the "dual diagnosis" of mental illness and addiction climb straight back to stability, and Swenson, indeed, tumbled into relapse. But this time he had a safety net to catch him, and the Village put him back on course.

Each person like Swenson accepted into the Village costs Los Angeles County $18,000. That's not cheap, but neither is letting people set up camp on sidewalks. A recent University of Pennsylvania study found that the average person with mental illness living on the streets of New York used emergency medical systems, jails and other public services such as community psychiatric clinics--sporadically and ultimately ineffectively--to the tune of just over $40,000 a year.

The alternative to such waste is the Village, a model program that Los Angeles County needs to replicate widely so that people like Swenson get the support that helps them hold their lives together and strive for an independence that lets them disappear back into the mainstream. Indeed, Village members like Swenson may have handed you a canape at a catered civic event or sold you groceries. Where you won't find them is on a public sidewalk, growling at imagined demons.

© 2001, Los Angeles Times