A man in his 60s, with long, filthy hair and beard, sits on a bench in Santa Monica's Palisades Park, lost in an overwhelming depression. On Wilshire Boulevard, a middle-aged woman wearing dirty rags pauses from her rambling conversation to address a nearby building in a series of high-pitched noises.
They are part of an underclass on the streets, the estimated 1,500 to 2,500 mentally ill homeless in the Santa Monica-Venice area. As many as half of all homeless people are mentally ill, according to mental health workers.
Dr. Paul S. Joseph, a psychiatrist with the county Department of Mental Health, and a team of social workers from the Ocean Park Community Center work separately in Santa Monica's streets and parks to help people who are prisoners of their own minds. They try to gently persuade the mentally ill homeless to accept psychiatric treatment and join programs that will give them a place to live while they work to pull their lives together.
People suffering from severe mental illness, often living in isolation on the streets, are very fearful and suspicious, Joseph said.
"You may have to go back to them week after week," he said. "You have to get them to trust you in order to get them involved in any sort of treatment program, and that is very hard to do."
The Ocean Park Community Center's program is one that follows clients all the way through the shelter and rehabilitation system, making sure that they do not return to the streets. The center's three-member team also tries to help homeless people who are not mentally ill but are using drugs or alcohol.
"This is more or less an up-and-coming way to deal with the homeless," said program coordinator Elena Popp. "We provide complete case management . . . help the client follow through on every stage . . . and intervene if there is some conflict and smooth things over."
From July, 1986, to July, 1987, the most recent period for which there are statistics, the center's outreach team contacted about 800 homeless people, Popp said.
About 250 of those contacted by Popp's group have agreed to accept assistance and were tracked through the social service system. Of those, half dropped out of the program and may be back on the streets. About 25% made it through various treatment programs and now have permanent residences. Another 10% are in short-term programs. Most of the remainder have agreed to accept some help, perhaps from an outpatient program, but have yet to get off the streets.
Program workers also visit the Santa Monica municipal jail, offering help to homeless inmates jailed on minor charges who are due to be released.
On Monday mornings, Joseph can be found on the streets of Santa Monica.
"Most people don't care" about his street patients, said the 34-year old psychiatrist. "So I feel I have to do it."
Joseph attempts to gain the trust of mentally ill street people and persuade them to accept help. That help may take the form of a prescription for drugs to treat the symptoms of mental illness, which the psychiatrist may write on the spot.
Or it may be persuading someone to go to a county mental health clinic for treatment, finding someone a bed in a treatment program or sometimes taking someone to a mental hospital.
With his dark curly hair and beard, jeans, sunglasses and running shoes, Joseph looks more like a graduate student on his way to class than a doctor who uses a park bench as a psychiatrist's couch.
On a recent morning, one of the first people Joseph approached was a young black man who was calmly talking to himself on Santa Monica's Third Street Mall.
Joseph asked the man if he needed help. The man, who when asked his name replied that his first initial is B., said he was a native of Oman, a country in the southern Arabian peninsula.
"I was taken out of the country 10 years ago by persons unknown to me," B. said.
"Why were you taken?" Joseph asked.
"I imagine the motive was greed," replied B. "I am the chief licensing physician, medical officer and research equipment designer in Oman.
"I've had all my internal organs removed," B. continued. "I've been sent here piecemeal . . . in a lot of pain."
During a half hour of conversation with Joseph, B. said he arrived in Santa Monica about a month ago but was not sure where he had come from.
B. refused Joseph's offer of help, but agreed to meet the psychiatrist in the same place next week for another visit.
"These patients are really by themselves," Joseph later said of B. "He could clearly benefit from some help, and that might work out over time."
Spotting Familiar Faces
Joseph said he will try to visit with B. and give him some cigarettes or bus tokens as an inducement to talk to him again until B. decides to accept some help.
Continuing his rounds, Joseph found a familiar patient sitting on a bench several blocks from Palisades Park.