By On the occasion of our 20th anniversary
By Gustavo Arellano
By R. Scott Moxley
By Alfonso Delgado
By Courtney Hamilton
By Joel Beers
By Peter Maguire
By Charles Lam
Until there is change in the system, Jennifer believes time is simply ticking—to what end, she doesn't know. "We're the ones screaming danger, danger, danger," she says. "My responsibility to keep him safe hasn't changed—I'm his mother, and he's disabled. But the controls I have to ensure his safety have ended. So I'm doing everything I possibly can to knock on every single door and ask the same questions: 'Why can't I keep my son safe? Why can't I keep the community safe from my son?'"
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In the 1950s and '60s, mental asylums were ready to crack. Plagued by overcrowding, filthy conditions and abuses within the system (as memorably depicted in the Oscar-winning One Flew Over the Cuckoo's Nest), activists condemned institutions and argued patients should be integrated into society rather than isolated. One California organization, the Keep America Committee, put out a pamphlet that described mental-health treatment as a Communist plan "to transform a free and intelligent people into a cringing horde of zombies."
The Lanterman-Petris-Short (LPS) Act, therefore, was considered a victory for human rights. Signed by then-Governor Ronald Reagan in 1967, the California law put massive barriers on those who wanted to treat people without their consent. New medications restored reality in mentally ill patients without throwing them into a stupor, and the law gave them the right to take or refuse them as they desired.
But for the most severe patients, freedom ended up looking like abandonment. Today, three times as many mentally ill people stay in jails as in hospitals. According to the National Treatment Advocacy Center, people with untreated psychiatric illnesses make up one-third of the homeless population. Carla Jacobs, coordinator of the California Treatment Advocacy Coalition, says that while the LPS Act had "excellent intentions," it "became a bastion of neglect for the most severely ill."
"What had been overlooked was the fact that some people with severe mental illness don't have the ability to recognize they're ill," she says.
The medical term for this is anosognosia, also called "lack of insight," a symptom of brain diseases such as schizophrenia or bipolar disorder; stroke patients sometimes experience a similar impairment. "When the brain is sick, you can lose your mind and not know it," explains psychiatrist William Callahan. "We can actually measure a loss of cell volume in the hippocampus, the center for short-term memory. We all learn to trust what the brain tells us. If the brain says you're fine, you won't [seek] treatment."
With bipolar disorder or schizophrenia, most patients first experience clear symptoms in their late teens or early 20s, the Aliso Viejo-based doctor says. As patients near the age of 18, he says, there is a "feeling of urgency" to get them proper treatment to "save their brains." With the right care, people can and do improve, but serious mental illnesses are cyclical in nature, and when a disease calms down, some patients get tired of the side effects and stop taking their medication. That's when outside pressure is needed.
"With Alzheimer's patients, families have to step in and say, 'No, you're not safe' before they leave the stove on and burn down the house," Callahan says. "With children, parents need to drag them to the doctor's office to get their shots. Yes, it's coercive and against their will, but that's what we have to do."
While working as the facility manager at Orange County Children's Foundation, a county-funded home in Placentia for foster and troubled boys ages 10 to 17, Carmen Hugh often dreaded the day when residents would "age out" at 18. The six-bed house was a capsule of security for the young men, many of whom were diagnosed with ADHD, bipolar disorder and schizophrenia. They adjusted to routines of themed dinner nights, chores, supervised outings, mandatory psychiatry sessions and 9:30 p.m. bedtimes, she says. For patients on medication, employees would hand them their pills and a cup of water.
While not being able to offer specifics due to disclosure laws, "I can recall a couple of young men whom we just knew at age 11 or 12 that they needed serious help," Hugh says. "It was like, 'What's gonna happen when they get older?'"
She has followed the lives of residents years after they moved out. Many went on to find jobs or attend college. But others did not. One such patient was killed after becoming involved with gangs, she says, and another is serving a 20-to-life sentence for being connected with a murder.
"As much as you try to prepare them, sometimes they're just not ready [to face the real world]," Hugh says. "They go from 'I can't wait until I'm 18 and can get out of here' to 'Please don't make me leave.' They're overwhelmed, scared, on medication. We've seen it time and time again."
For some family members, after the clock strikes down on a patient's 18th birthday, it becomes a race against time. Philip Camacho, who lives in Santa Ana, says when he heard the story of Kelly Thomas, a homeless man with schizophrenia who died of injuries inflicted by six Fullerton police officers (one of whom was subsequently charged with murder, another with manslaughter), he thought, "That could be my son."