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Mental Health Care : A System on the Verge of Collapse

June 24, 1989|CLAIRE SPIEGEL and LYNN O'SHAUGHNESSY | Times Staff Writers

The 10-year-old boy had been running away from his home in the San Gabriel Valley, setting fires, scraping paint off building walls and then eating it.

In desperation, his family called county mental health workers this month when the boy, who was also hearing voices, jumped out of a moving car. A psychiatric emergency team arrived, but there was nothing it could do. The boy needed hospitalization, but there were no available beds.

"It's a miracle if we can find a bed for a child," says Bonnie Jones, a county mental health worker. "I've had times when I've made 30 calls and not been able to find a bed."

Public psychiatric hospitals are so full that, night after night, patients clog emergency rooms awaiting a bed that rarely becomes available.

Sleep on Clinic Floor

At County-USC Medical Center's Psychiatric Hospital, which houses the county's largest psychiatric emergency room, dozens of patients nightly sleep on the floor in a big room "wall to wall with mattresses, that smells like a urinal," says Dr. Thomas Ciesla, former president of the Southern California Psychiatric Society, about a recent visit to the facility.

"There was a sea of disheveled, malodorous bodies, some of them babbling to themselves. . . . A guy would wake up . . . and urinate on the person (on the mattress) next to him."

The doctors, according to Ciesla, have the "sad task" of deciding "who gets admitted to a (hospital) bed, who got the floor and who got the street. Most people got the street."

Young and old, suicidal or psychotic, tormented by inner demons or disabled by neuroses, they are the sickest of the mentally ill. In Los Angeles County, their numbers have overwhelmed a mental health system on the verge of collapse.

Every day they jam the county's four psychiatric emergency rooms, which have become the last outpost for these troubled people who typically lack the health insurance necessary to gain admission to private hospitals. Patients routinely sleep on the floor, waiting for days to be admitted for treatment. But because of an acute shortage of hospital beds, they are often stabilized temporarily and then discharged into the street.

"Instead of hospitalizing these patients, we make arrangements we are not in any way proud of," concedes Dr. Milton Miller, chief of psychiatry at Harbor-UCLA Medical Center.

Officials openly acknowledge that the county's system for delivering care to the mentally ill is in a state of crisis. The latest blow came June 9, when the county, after a months-long court battle, shut down three outpatient clinics in the South Bay and San Fernando Valley. At one time these clinics served about 3,000 patients, providing medication and therapy designed to head off a psychotic collapse that is likely to land a patient in crowded psychiatric emergency rooms.

Los Angeles County has an estimated 95,000 mental patients in need of varying degrees of treatment. But, more than 20% of the staff of the Department of Mental Health has left because of layoffs, demotions or voluntary terminations in the face of looming budget cuts. The murder on Feb. 21 of social worker Robbyn Panitch by a deranged client at the county's Santa Monica clinic decimated staff morale.

'Worst Outpatient Services'

The county was rated as having "among the worst outpatient services for the mentally ill in the United States," according to a 1988 survey by Ralph Nader's Public Citizen Health Research Group and the National Alliance for Mental Health.

Compounding that problem is an acute shortage of psychiatric hospital beds. "Los Angeles is now the most deprived urban area in the country, as far as available acute care in the public sector is concerned," says Dr. R. W. Burgoyne, medical director of the county Department of Mental Health. "An increase in acute-care in-patient psychiatric beds is our current most crucial need for the system as a whole."

"Nearly every day," adds county Mental Health Director Roberto Quiroz, "our emergency services have more than 60 patients awaiting acute placement" in a hospital bed.

In testimony at budget hearings earlier this year, Quiroz warned that the state's mental health system needs a massive infusion of cash to pull it back from "the edge of disaster."

'History in the Making'

For at least 10 years, Quiroz said in an interview, the county's mental system has sustained "cuts and then modest increases, cuts and then modest increases. This has been history in the making."

As Richard Dixon, the chief administrative officer of Los Angeles County, puts it: "The crisis in mental health did not appear overnight. It has developed over numerous years." The crunch is statewide, he adds. This year, the counties of San Diego, Monterey and El Dorado, for example, have all made significant cutbacks in outpatient mental health services.

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