The Crisis Management Center in Van Nuys was a model program when it opened in 1983, offering an alternative to destitute mentally ill patients not sick enough for a hospital but too sick for traditional outpatient care. Today, some workers call it bedlam.
They recall a recent afternoon when a 25-year-old man, homeless and desperate, arrived to find the doors already locked for the day. It was only 4:15 p.m., but the crisis center--one of just three county-operated clinics left in the San Fernando Valley--was so busy that it had stopped admitting patients early so doctors could examine the people already waiting.
Social worker Ken Stonebraker offered to help find the man a place to spend the night but because he detected no evidence of a psychiatric emergency, he told him to return the next morning for medication.
Instead, the man grew furious. He tore off his clothes, threw them around the parking lot and, wearing only his chartreuse boxer shorts, lay down in front of the center doors. When that didn't win him entry, he cursed and screamed, "Send me to the hospital, send me to the hospital!"
"Normally we would do that," Stonebraker said. "But he was being so threatening at that point I stepped back inside."
The man threw a rock at a car, ran to retrieve it and hurled it through the window of the director's office.
The police were called, but the man was gone by the time they arrived.
"That's an example of what can happen," said Al Smart, supervisor of the socialization program at the crisis center. "If they don't get help, their lives are in danger and other people's lives are in danger."
But help is hard to come by in Los Angeles County today if you are poor and mentally ill. The county, dependent on the state for most of its mental health money, pins the blame on Gov. George Deukmejian and the Legislature, which county officials say has failed to adequately support public programs for the mentally ill.
Mental health programs throughout the region were curtailed this past year, and the Valley has been particularly hard hit. Two of its largest clinics have closed, and the crisis center has been deluged with their patients.
The Van Nuys center has added 1,000 people to its rolls in five months--500 when the East Valley Mental Health Clinic closed in June and 500 more when the West Valley Mental Health Center shut down last month.
The center operates in a grim, old residential nursing home along a stretch of Sepulveda Boulevard popular with prostitutes and drug dealers. Its waiting room is a hodgepodge of mismatched furniture lit by dark ceiling fixtures. "It's like a dungeon," said Glenn Comer, a former West Valley patient who suffers from depression and hallucinations.
The television is usually on, and the hallways are filled with the scent of incense to mask the odor of clients who do not bathe.
Examining rooms are stark, the walls are bare, except for an occasional calendar or poster. There are no lamps or plants because they could be used as weapons. Windows are partially blocked with boards so no one can be thrown through them.
Patients suffer a range of ailments. They are manic, psychotic, depressed or delusional. A woman can't stop crying. A man walks in circles around the room. Another says he's training for the Olympics, would love to play tennis at Wimbledon, is studying for his Ph.D. in music, recording an album, plans to teach high school and hopes to marry Linda Ronstadt.
"My parents think I'm crazy because I'm doing all this," he said. "They're right. I'm an overachiever."
Security has always been a priority, more so since psychiatric social worker Robbyn Panitch was stabbed to death at a Santa Monica clinic in February by a transient she was trying to help.
Patients are seen with the doors open. Panic buttons are in all interview rooms. And a second security guard was hired three weeks ago as the center prepared for the onslaught of patients from the West Valley clinic.
"Just coming to work" has been the toughest part of all the changes for psychiatric social worker Connie Pack, "just coming to work to face the chaos."
Despite the problems, county mental health officials say the crisis center offers an efficient and cost-effective way to cope with limited resources. Elsewhere, the county has turned traditional outpatient clinics into crisis-type operations at Harbor-UCLA Medical Center and Martin Luther King Jr./Drew Medical Center. A small crisis operation recently started at the San Pedro Mental Health Center. Two others, in Arcadia and Santa Monica, have been approved.
Crisis centers evaluate and stabilize patients, provide medication and help with problems such as food and shelter. But with few exceptions, individual and group therapy--mainstays of traditional outpatient care--have fallen by the wayside.
"Crisis work is being done for everyone," said Ron Klein, who runs the Van Nuys center. "Medication is being given. But beyond that, we are not offering much."