Reshaping Services for Mentally Ill

With an expected influx of $280 million in new funding over the next three years from a tax on wealthy Californians, Los Angeles County is set to launch a radical transformation of mental health services that will focus not simply on controlling symptoms but on providing clients with the housing, substance abuse treatment and other services needed to remake their lives.

With the money from Proposition 63, county officials also hope to curb mental illness, reduce the stigma and discrimination associated with it, and vastly expand culturally sensitive services for the county’s underserved ethnic communities.

“It’s a little bit scary but also very exciting,” said Marvin J. Southard, director of the county’s Department of Mental Health. “I would hope that there will be an observable difference in the lives of people with mental illnesses and their families, and that anyone involved with this program will be able to say my life is better than it used to be.”

The proposals are included in a plan that was aired at a public hearing last week attended by hundreds of community members. It will be taken up by the Board of Supervisors next month, then submitted to the state for review. Officials said the county could begin receiving funds by January.

The plan generally won praise from advocates, mental health professionals, patients and family members who attended the crowded public hearing, held at a conference center at the Cathedral of Our Lady of the Angels downtown. Several speakers cautioned that the county should be monitored closely to ensure that promised changes are implemented.

Others urged that the county adopt policies to warn people about the dangers of psychotropic drugs such as antidepressants and tranquilizers and give troubled people more options.

“Use the least intrusive, most life-affirming methods first, because they’re less expensive, more effective and you’ll get people back into the community in a productive way,” said Nancy O’Meara, a member of the group Better Choices for Mental Health Recovery, whose brother has received mental health services for years.

Though the department has experimented with different ways of providing mental health services, the proposed Community Services and Support plan would expand those efforts and cultivate a host of new programs, including:

* Safe havens open 24 hours a day for homeless mentally ill people, with each facility providing up to 25 semiprivate rooms.

* Client-run support centers that would be open to the general public and provide peer counseling.

* Housing specialists who would help youths and adults negotiate housing laws, clean up bad credit, help prepare for landlord interviews and find shelter.

* Urgent care centers located near hospital emergency rooms to provide substance abuse services, medicine refills and employment and other referrals for people who do not require admittance to psychiatric hospitals.

* Drop-in centers open evenings and weekends for those 16 to 25 years old with emotional disturbances, particularly foster children.

* Respite care, parenting education and couples therapy for caregivers of children with emotional and mental illnesses.

Officials estimated that the new programs would provide treatment for more than 45,000 children and adults over the next three years, with special services for about 100,000 family members and individuals with less severe conditions. The department hopes to eventually expand programs to all of the nearly 250,000 people it serves each year, Southard said.

The plan necessitates hiring and training new staff members, but a bigger task could be reorienting doctors, nurses and social workers who have become accustomed to a frequently frustrating system.

“I’ve been in the field for 30 years, and one of the things that has amazed me is that a lot of people who worked in the field of mental health care really couldn’t stand people with mental illnesses,” said Southard. “They dislike them and almost punished them. My impulse was to blame workers, but over time I came to think the real issue is that they feel impotent and frustrated. It’s not the fault of the workers but of the system, and this is really a vehicle to change that.”

Proposition 63 -- the Mental Health Services Act -- was passed by voters in November and imposes a 1% surcharge on taxable income in excess of $1 million. The new tax will raise an estimated $600 million each year for mental health services statewide. The act also established a Mental Health Oversight and Accountability Commission to ensure the funds are used properly.

Each county must develop separate plans for community services, prevention and early intervention, education, training, and improvements to technology, facilities and other infrastructure.

One of the centerpieces of the Los Angeles County community plan is partnering with neighborhood agencies that provide a panoply of recovery, support, housing and employment services under one roof. A local model that has won national renown is the MHA Village in Long Beach, run by the National Mental Health Assn. of Greater Los Angeles.

The program focuses on treating the severely mentally ill and those struggling with substance abuse, homelessness and repeated jailings. It emphasizes a collaborative approach, with clients creating their own recovery plans, working as equals with the staff and receiving round-the-clock support.

“Our approach is getting to be standard,” said Dave Pilon, an executive vice president for training at the Mental Health Assn. “I can’t say most people are getting this level of treatment, but with MHSA funding, it’s going to be available to a lot more people.”

Nearly 490 people are served at the three-story brown stucco building on Elm Street. Many have been homeless, hospitalized or incarcerated.

Steve Hrenak was homeless and starving when he walked through the doors on the promise of a sack lunch. Seven years later, he still comes and goes, but now as a staff member who does outreach with similarly troubled, seemingly lost-cause cases like his.

“I was homeless, severely depressed, suffering from alcoholism and drug addiction, and I couldn’t seem to stop getting arrested for things like drinking in public, drug use, vagrancy,” Hrenak, 41, remembers. “I got a very good feeling as soon as I walked in and was treated with dignity, respect and compassion instead of the typical runaround you get when you go into a social services facility.”

At the Village, staff members spend 65% of their time in the field, visiting with clients in their apartments or going along to doctor’s appointments, said information director Joe Ruiz. The facility runs its own deli and mini-mart and operates a bank for clients.

Eric Snaer, 47, had spent three years in state prison in Chino when he enrolled in the Village. He has been clean for four years now. He works at the program’s employment center and is also a groundskeeper at a local hotel. One of his proudest moments was boarding an airplane for the first time to go to Sacramento to address the Legislature about how his life has improved.

Snaer said he applauds the prospect of creating more programs like the Village.

“It’s important to me that other people get the same opportunities that I got,” he said.