This is a long and complicated story; difficult to condense to a few paragraphs. So even this abbreviated version of Mr. R’s story will take up an entire blog post. Meet #5 on our list of 14.
Mr. R was a wiry and strong man, 30 years old, from Virginia. He was raised by his mother’s parents, as he was born out of a rape. Though a gifted musician, his anger and fighting in high school resulted in juvenile confinement. It was there he may have experienced his first psychotic break. When released, he was connected with mental health services, but also started using drugs. His grandparents grew fearful of him due to his violent outbursts. He left for California to become a rapper. His Hollywood chapter begins in 2012. Because of his violent tendencies, he was subjected to a stay-away order from a large part of Hollywood. On September 25, 2015, he was placed under the care of the Public Guardian (OPG) by the mental health court. After a year, he was released but he was not following a treatment plan or stable enough to live independently. However, through yeoman’s effort of Anthony Ruffin, formerly of Housing Works, and now DMH, and with the help of some committed people at L.A. County Department of Mental Health (DMH), he got housing in 2017, and remains there today.
The Whiteboard Session
On September 22, 2015, after receiving news that Mr. R had been placed under conservatorship, the Hollywood 4WRD Top 14 team convened a group of everyone representing the various organizations who had had any interaction with Mr. R during the past three years. The room was full of people representing LAPD Mental Evaluation Unit, city attorney, business improvement district (BID), local church, DMH, paramedic, and two local nonprofit agencies, Housing Works (his payee) and PATH. It was a group case study to document the road toward conservatorship. Why was this so hard to help someone like Mr. R, and how could we work together more effectively? Everyone consulted their proprietary notes or files and we pieced the story together. What emerged was that he had been ricocheting through nearly every corner of our community and there was no viable plan (nor any accountability) to come alongside and help him.
During this session, we captured 15 arrests over two years for assault, battery, controlled substance, parole violations. A three-year stay away order had been issued by the City Attorney for the period of August 2013 to August 2016 impacting his ability to enter the heart of the Hollywood BID and he was ordered to take 12 anger management classes. Among other things, our notes showed that he had been referred for Assisted Outpatient Treatment (AOT) and was determined ineligible.
A Less-than-ideal Conservatorship
Conservatorship represents a time when a person can be housed, treated, stabilized. It is managed by the Office of the Public Guardian (OPG), who, admittedly is saddled with huge caseloads. Ideally, when a person is ready to come out from under the OPG, the hope is that this time of stabilizing will lead the person down a recovery path. In our Hollywood Top 14 case studies, we have seen some positive outcomes after that year. Mr. R arguably was stabilized, but he was not on a recovery path.
For months, he was waiting for an IMD bed (for which there is an acute shortage in Los Angeles County). He hung out at the hospital and also at a locked facility known as Penmar.[A side note about Penmar. I had always heard about Penmar. I was told about “the cage” which was where residents could go to “be outdoors.” When we hosted five visitors from the Trieste mental health system in September 2018 here in Los Angeles, we took them to see Penmar. As I drove up, and saw the cage, it was worse than it had been described to me. Our Italian friends were understandably stunned, as they come from a place of no restraints and no locked doors.]
Mr. R was not doing well at Penmar – and it is not hard to understand this reaction, given no money, no friends, no fresh air. He managed to reach out to Housing Works and Anthony arrived to visit and put cash in his account so he’d have some money to spend. Mr. R. was finally moved to Landmark IMD, and it was there that a patient rights advocate connected with him and prodded him to challenge his conservatorship. (That’s a story for another day – how does that conversation happen without understanding the entire context of Mr. R’s history?)
A hearing was scheduled, but Anthony encouraged him to not contest the conservatorship and promised he would do what he could to find an acceptable step-down (not locked) facility for Mr. R.
In July 2016, Mr. R is moved to Pico Rivera Gardens and with this newfound freedom, his substance abuse re-surfaces. August was the one-year date with Department 95, the mental health court, to reevaluate whether Mr. R should come out from under his conservatorship or remain. Is he following his treatment plan and stable enough to live independently? According to Anthony, who attends the hearing, Mr. R appears to be high and the psychiatrist from the facility does not show up to testify. A second hearing is scheduled for a week later, and again the psychiatrist doesn’t show up. Mr. R is released from his conservatorship.
At this point, Mr. R is free to walk away from Pico Rivera, and despite Anthony’s best attempts to encourage him to stay while Anthony researches other living options for him, Mr. R. walks out on November 16 and returns to Hollywood. Mr. R. is homeless again and as his meds wear off and he self-medicates with meth, his situation deteriorates.
As this story is unfolding, it is clear that Anthony is Mr. R’s lifeline. However, during this time, Anthony is not “officially” connected to a team that can work with Mr. R to discuss his future and work collaboratively to create a supportive plan.
This is one of the key distinctions between the Trieste model and the American model. In Trieste, a person is attached to a team who will do everything in their power to support the user’s path toward recovery. They do not give up.
Anthony stays engaged, even though technically this is not his “case.” He works with staff at DMH to see what housing options might be available. Meanwhile, Mr. R is referred to Assisted Outpatient Treatment and is placed in a local hotel by Housing Works and that is where he is at the end of December. In March of 2017, he is placed into supportive housing in the heart of Hollywood. He has been there ever since.
This story reveals so many aspects of our current system that differ from the Trieste model. Here are just five:
- If you are in the community with a severe mental illness, you will not be left to ricochet through the various systems without intervention and support. You will not be left to drift, as was the case with Mr. R for three years.
- People representing these various systems will talk to each other in the context of how to help you become stabilized and back on the road to recovery.
- You will have a voice in the plan (it is actually is your plan) and true supports will be identified to help you on this journey.
- “Outsiders” (like Anthony) are welcomed as part of the team – and, in fact, outside supports (friends, peers, family) leverage the team’s efforts.
- You will have a place to live. It is impossible to stabilize one’s life while homeless.
Today? Mr. R has been living in the same supportive housing complex in Hollywood for two years. I understand there have been some challenges. I hope to have an opportunity to go visit him in the next week or so with Anthony.