In about three weeks, Los Angeles County's mental health system will start self-destructing. Many county clinics will be closed, already overcrowded psychiatric emergency rooms will be deluged and up to 26,000 severely disturbed patients will be stranded, officials said.
But the crisis facing the county's most psychotic and suicidal citizens didn't start last week when massive mental-health cuts in the state's new budget prompted the county's mental health director to declare a "state of emergency."
The system started eroding in the 1970s, but for many it only became tangible last year. After blaming their problems on another year of meager state funding, county officials closed five of 28 clinics.
The consequences came swiftly.
During the last year, for instance, physicians at Martin Luther King Jr./Drew Medical Center have released hallucinating patients if they do not appear to be suicidal to free scarce beds, according to Dr. Anna Smith, vice chairwoman of the hospital's department of psychiatry, who compares the practice to "playing Russian roulette."
With psychiatric admissions up 43% since April, 1989, severely mentally ill patients sometimes sit two or three days in a waiting room before a bed is free.
What has happened since the summer of 1989, mental health activists warned, is only a precursor to what can be expected in the coming months. And, they said, it frightens them.
"It's hard to grapple with the enormity of the problem," said Ann Brand, president of the Assn. of Community Mental Health Agencies.
With no place else to turn, many disturbed people have ended up at County-USC Medical Center shackled to their beds with leather restraints. In recent months, 30 to 60 patients a day could be found tied to their beds, said many psychiatrists. They are sharing rooms with cancer patients, heart attack victims and others in the medical wards because the 116 beds in the locked psychiatric wards--where shackles are not needed--are filled.
Numerous psychiatrists, who asked not to be identified for fear of reprisal, told The Times similar stories:
Some County-USC patients have laid on urine-soaked sheets and waited three or four days to see one of the psychiatrists, who said they are overwhelmed with the crush of suicidal and psychotic people. Frightened or angry patients sometimes cut or bruise their limbs trying to escape from restraints. One man in his early 20s recently managed to free himself and was found standing on a 13th-floor ledge talking to God. He was rescued.
"You've heard of animal rights? You can't put makeup on a rat and yet you can let someone sit in their own urine for many hours because there is no one there to take care of them. That doesn't seem right to me," said Dr. Nick Dewan, who until recently worked as a psychiatrist at County-USC.
Richard Cordova, County-USC administrator, disputed that any mental patients are being neglected. He said that up to 75% of the psychiatric patients shackled to beds in the medical wings are there because they are physically sick and not because the psychiatric wards are filled.
The dimensions of the suffering, said Dr. Milton Miller, chairman of the psychiatry department at Harbor-UCLA Medical Center, "deadens people's sense of the horror. When you take away one person's doctor and he dies . . . you can encompass it in your mind. When you get to talking about 5,000 people, 10,000, 20,000, it's hard for people . . . to encompass what that means."
The current crisis was precipitated when Gov. George Deukmejian's budget cuts resulted in a deficit of up to $45 million for the county's mental health programs.
After last year's closures, some patients waited three or four months to see a psychiatrist at county-supported clinics. About 8,000 patients couldn't get any appointments. Calling it a "wrenching, wrenching experience," Ford Kuramoto, who resigned as district chief of the Hollywood clinic in March, said many patients "begged and cried" when told they were no longer welcome.
Some centers remained open with skeleton crews after massive layoffs and resignations. Last summer, there were 358 fewer doctors, nurses and other personnel on the payroll than two years before when there were 1,763 health workers. Many more have left since then. Under these conditions, physicians have relied more heavily on drugs to control patients, according to clinic administrators and psychiatrists.
With treatment at the clinics no longer guaranteed, more mentally ill grew sicker, concluded Dr. Smith and numerous other physicians.
A sicker population has placed a greater burden on the county's four psychiatric emergency rooms, which are expected to treat the uninsured mentally ill when they become suicidal or a threat to someone else. At County-USC Medical Center, for instance, the psychiatric emergency room closes to the public almost daily because too many people are already inside.