Go Big or Go Home.
The practical side of my brain can list all the reasons why it is impossible to replicate anything that remotely resembles the world-acclaimed Triestino mental health system in the United States. I listed the “top ten” reasons in a blog I wrote while visiting Trieste in March.
In a few weeks, our county mental health department, under the leadership of Dr. Jonathan Sherin, will make a case to a state oversight committee that we are ready to embrace a bold vision to show what is possible in L.A. County. This is the definition of “go big or go home.” There is no incremental change envisioned here. We have a humanitarian crisis playing out in our streets and in our jail and nothing short of a radical approach is required.
The brain can wax poetic about why this won’t work. But the compassionate heart must override the practical brain.
Here is a link to the proposal we are presenting on May 23, 2019 to the Oversight and Accountability Committee (OAC) for the MHSA. It is a proposal for a five-year Innovations Pilot here in LA County, centered within a defined boundary in Hollywood. The proposal is open for public comment until May 18 and I invite my readers to click in and read it. It is titled: The True Recovery Innovation Embraces Systems That Empower (TRIESTE).
So this week, as my rational brain kept surfacing “stop signs” as to why this system is so impossible to change in Los Angeles, I had four things happen that kept my heart tender and hopeful. I remain resolute in my conviction that we have no choice but to try. Go big or go home.
To begin, yesterday I had a 10 a.m. meeting scheduled downtown, to discuss the TRIESTE proposal with the homeless services deputy for one of the county supervisors. I decided to take the subway and as I walked toward the escalator heading underground at the Wilshire & Western station, during the busy morning commute, I noticed two people, sadly left to fend for themselves, impaired by their untreated mental illness. One was a woman dressed in a long, stained and dingy dress, wearing slippers. She had her arms wrapped inside a dirty gray sweatshirt; almost resembling a straitjacket. She had a blank look on her face and was wandering aimlessly.
The second person was a man who was acting very erratic and seemed oblivious to the path he might cross as he approached you. I have learned to be cautious in the presence of someone like him, because everything about his demeanor suggested unpredictability. He was asking the sidewalk vendors for food and people were stepping out of his way.
I went down into the platform and just missed the train heading downtown. Just like the 90’s movie “Sliding Doors” with Gwyneth Paltrow, life took on a different trajectory because of a missed train. In the 11 minutes we had to wait for the next train, two things happened.
First, both the woman and the man I had seen above ground came down the escalator. The woman just wandered through the platform, but the man continued his erratic demeanor. Riders waiting on the platform pretended to eye their phone or look away, but it was clear that everyone was on heightened alert for his behavior.
I was watching him and silently praying for him, which is all I feel empowered to do in situations like this.
Another man approached me, nicely dressed in a gray business suit and carrying a briefcase.
Wilshire Western station where people experienced frustration of train coming to a halt because of a man left to fend for himself in our city with untreated mental illness.
This is the second twist of fate that occurred this week. It turned out he recognized me – not because we had ever physically met – but because we had an email exchange in February when he reached out to me, referred by a national mental health advocate, to express his frustration about caring for his adult daughter with bipolar disorder. At that time, I was preparing to leave for Italy, but I felt the weight of his burden and encouraged him to not lose heart. He followed my blog and recognized me from the few photos posted online.
We got on the train together, and to keep this blog brief, I will share that we never could progress much beyond the Wilshire and Normandie station. The man I had been observing had evidently frightened the people on his car and, at the Normandie station, they all entered our car. As the train attempted to head east toward the next station – Vermont -- apparently, he, left alone in the car, kept trying to open the door of the train, which triggered the emergency brake to stop the train. This happened about ten times.
Never made it to the meeting this week to brief the staff of one of the LA County Supervisors about our Trieste proposal. Will attempt again next week, but the scenario speaks to the inadequate care we provide for people with severe mental illness in Los Angeles County.
I texted the supervisor’s deputy that I would be missing this meeting as I was stuck in a tunnel. The conductor announced that we would be heading back to Wilshire and Normandie and everyone exited the train. My friend had to get on the next train to head to work and we parted. He had tears in his eyes as he had been sharing concerns about his daughter, and I hugged him and told him that we were meant to meet today. There are no coincidences.
At that time, I observed the raw frustration expressed by several stranded passengers who challenged two METRO security guards on the platform. “Why didn’t you protect us?” “What good is it if you have guns and you don’t protect the passengers?” These were people, likely trying to get to work, who felt powerless by this turn of events.
The METRO guards, demonstrating extreme patience, explained that they were not in a position to take him off the train. He had not committed any crime, and the conductor did not ask for assistance. As I watched this frustrated interchange, I realized that we are in this strange twilight zone where the public does not realize that something better, something more humane, is even possible. The best they can hope for is that a couple of security guards with guns will remove or arrest this person who so clearly is in need of help.
In quick succession, the other two things that happened this week were as follows: my friend Mr. B, a formerly homeless individual, who suffers from schizophrenia and is on a perilously low dose of meds, gave 30 days’ notice to the operator of the board and care home he has lived in for the last five years in Hollywood. He intends to walk out so that he can have access to all his cash (his SSI funds). This is the third time he has done this, and I cannot get his FSP case worker to call me back. Fourth, I met a woman today, similar in age to me, who described the situation she is currently facing with her 40-year old son, suffering from bi-polar disorder, who, though living in an apartment, remains isolated and disconnected from other people. He refuses to meet with his caseworker, and such lack of compliance may result in him being evicted from the program he is enrolled in and ending up homeless again. I felt her anguish and felt conflicted. Conflicted because this is not my reality as a mother, but also resolved that we have to keep pursuing a better way forward.
So, back to the TRIESTE proposal. There are three things you can do. First, read it. Second, provide your comments before May 18. (Even my readers in Italy are encouraged to share your comments: what are the strengths, what are the challenges? After all, we are in a collaborative partnership and your comments are worth hearing. Write in Italian and let Google translate figure it out.) Third, there will be an opportunity to hear a presentation on the proposal and engage in a live dialogue on May 13 at the Peer Resource Center at DMH.
Let’s keep our hearts tender. Go big or go home. We have to figure this out Los Angeles!