Mental Health Agencies Forever on a Tightrope : L.A. County: Cutbacks have kept the system in crisis. The human toll is heavy. Uncertainty may end today.

Millard J. Ryker’s second-floor office in an old church in west central Los Angeles is not what most executives aspire to. The plaster is cracked. The desk is industrial strength. None of the chairs match, and the plant on the bookshelf is dead. Ryker admits he has not watered it since August, when the latest round of mental health funding cuts targeted his Community Counseling Service. The months since have been a scramble to save the service.

More than 3,000 seriously ill people are now being helped through the service’s programs. They are people like Joe, who threw himself in front of an RTD bus last summer to escape a deep depression. Or the refugee from El Salvador, tortured and imprisoned there for his politics, who is being treated for post-traumatic stress disorder. Or the psychotic woman who, at the urging of voices, drove her car through the side of her daughter’s house, intent on killing her. Or the company president who lost his family, home and business in the grip of manic depression.

Ryker himself is discouraged, if not depressed, these days. In eight successive proposals put forth since August by the county Department of Mental Health to cope with a massive funding shortfall, the Community Counseling Center has been slated to be cut, restored, cut again, and, in the latest version, wiped out.

“I feel terrible about this. I feel terrible for my staff, for our clients, for myself,” Ryker, 47, said last week. “But I’ve got to keep fighting as long as we have a chance with the supervisors.”

For three weeks, county supervisors have put off a decision on the cuts--as much as $41.9 million--trying to come up with some combination of new taxes, belt-tightening, and alternative funding to salvage the mental health system. Today’s meeting of the supervisors may finally bring an end to the uncertainty, though certainly not the crisis.

The fact is, mental health care has operated in a state of crisis in Los Angeles County for several years because of annual and deep cuts in state funding for mental health.

In 1988, the funding shortfall in Los Angeles County was $18 million, and the testimony then was similar to what the supervisors have heard in recent weeks: suicidal patients unable to get timely care; severely ill patients strapped down but untreated for days in hospital emergency rooms because there were no beds available in county psychiatric units; thousands of prisoners in the County Jail with severe mental illness, and increasing numbers of homeless people whose illness poses danger to themselves and others.

In 1989, the shortfall was $10.9 million. This year, as Gov. George Deukmejian chopped an additional $71 million in mental health aid to counties, the deficit is $41.9 million.

The result, local mental health advocates say, has been devastation. The National Alliance for the Mentally Ill agrees. In a searing report last September, the Alliance said California has gone from a position of progressive leadership to become a pioneer in “squeezing (mental health) services, progressively decreasing their state funding as local demand for the services has grown.” The lack of adequate services in Los Angeles County, the Alliance said, has turned the County Jail into the “largest de facto mental institution in the nation.”

Those in jail are only part of the human toll. The streets are filled with thousands of others abandoned by the mental health system, unable to work and getting worse from lack of medication. Four years ago, 102,000 mentally ill adults and children were treated in clinics such as the Community Counseling Service, about 80% of them kept from acute breakdown and hospitalization by psychotropic drugs and counseling dispensed at the clinics. But the steady curtailment of programs and the outright closure last year of five county-run clinics have reduced that number to 58,000.

Of the thousands of patients abandoned as a result of the cuts, officials say many have ended up in jail or on the streets. With county hospitals jammed and waiting lists at the remaining clinics, there simply has been no place else for them to go.

The proposed cuts would shutter 19 county clinics, force the closure of 14 of 42 private, nonprofit clinics under contract to the county, leave whole areas such as the San Gabriel and San Fernando valleys with no outpatient mental health services and leave 27,000 patients stranded.

“Devastating, disaster, crisis, horror--after a while you just run out of adjectives to describe it,” said Ian Hunter, director of the San Fernando Valley Community Mental Health Center, a multiservice agency for emotionally disturbed adolescents and adults that will close if the funding cuts go through.

The Community Counseling Service, one of the private contract clinics, has survived by a combination of fiscal austerity and private fund raising. It has been forced to absorb funding freezes for five years, but no direct cuts.

The service also diversified its programs in order to qualify for matching funds from the United Way and the Los Angeles community development agency.

One of these programs is a gang-deterrence effort at three junior high schools in South-Central and Southwest Los Angeles, where Community Counseling Service bases most of its programs. Called the Youth Advocacy Program, it sends social workers and counselors to Berendo, Virgil and Adams junior high schools to talk to youngsters identified by teachers as truants, potential dropouts or gang members, or as showing signs of drug or alcohol abuse.

Last week, the counselor assigned to Adams was there when a boy was threatened on the playground by a gun-wielding classmate. No shots were fired, and the police quickly disarmed and arrested the boy with the gun.

But his intended victim was hysterical. The counselor worked to calm the boy and help him talk through his fear. “We were able to get to him right away instead of him bottling it up all day and then talking about it to his homeboys and working them up to a revenge killing,” Ryker said.

The Youth Advocacy Program is funded by the city, not the county. But it is one of the hidden victims of the program cuts proposed by the county Department of Mental Health. Without the county contracts that support the Community Counseling Service’s two major programs and much of its overhead, its other programs, including youth advocacy, will also have to shut down.

The county-funded programs are Compass House, a residential psychiatric facility for 12 homeless adults, and Amanecer, an outpatient bilingual clinic catering to Los Angeles’ large Central American immigrant community. The total amount of the county contracts is $835,000, representing a little over half of Community Counseling Service’s annual budget.

Compass House, situated in a 1930s-style cottage on a quiet, residential block of Portland Street, acts as a short-term, overflow psychiatric unit for county hospitals. It includes a full staff of counselors and psychiatrists, but also provides a homelike environment for patients disoriented by their illnesses and, in many cases, by living on the streets.

The care of each patient costs about $142 a day, compared with $500 a day at the hospitals. Ryker estimates that closing Compass House actually will increase county costs by $1.3 million because of the loss of this economical option. Amanecer, Spanish for “sunrise” or “new beginning,” was started four years ago to help stabilize distressed families.

The Youth Advocacy Program is run here. So is a bilingual, court-mandated program for sex offenders, post-traumatic stress counseling for the many Central Americans who have fled war and political violence, a battered women’s group, parenting classes and a program to help Spanish-speaking mental health professionals earn California credentials.

In addition, the program’s counselors follow severely mentally ill patients to make sure they get needed medication and treatment, and get them into hospitals if their conditions become dangerous.

Amanecer’s offices at 2675 W. Olympic Blvd. are no more glamorous than Ryker’s. The clinic is in the heart of Pico-Union, where gang graffiti--in multiple colors, languages and alphabets--deface every wall. For the past week, the clinic’s plate-glass window has had a big hole, apparently the handiwork of someone with a brick and a strong arm. “We’ve got someone coming to fix it any day now,” Joe Ramirez, a therapist at the clinic, said matter-of-factly to a visitor.

Another of the service’s programs is the Pacific Center, a clinic in mid-Wilshire for middle-class patients whose health insurance has run out. The center offers a sliding fee scale that enables these patients to continue treatment without financial ruin.

Because private health insurance policies have such limited mental health coverage, virtually every family with a mentally ill loved one eventually comes to depend on county services.

Ryker notes that many private insurance plans cover only 30 days of hospitalization as a onetime, lifetime benefit. Someone stricken with schizophrenia or severe depression or other chronic disorder will usually exhaust private insurance benefits in less than a year.

“Mental illness is no respecter of social class--the rich and poor all get it in this country and everywhere else in the world, too,” he said. So Ryker does not accept the voters’ defeat of the Proposition 134 liquor tax, which would have funded the mental health deficit, as a mandate of anything but ignorance. He wants the supervisors to see that, and to use their taxing powers to the limit to preserve the system.

“It is difficult for them politically; I know that. I understand that the funding is the state’s responsibility and they blew it,” Ryker said. “But the supervisors have got to come up with the money. The patients live here, not in Sacramento.”

And as someone who has worked for 20 years in mental health and child welfare, Ryker is stoic about the loneliness of his fight in these shaky economic times when the public seems to have little sympathy for the needy.

“You could call me a masochist for staying with this,” Ryker said, chuckling. “But it is my profession. It is something I believe in, and you don’t quit that because times get rough.”