Mentally Ill.

Many don't want to participate in government programs, and funding is hard to come by

D'ANNE Skinner remembers Stephanie well.

The 43-year-old homeless woman often walked barefoot and carried a blanket past Portals South Central Opportunities Center on Slauson Avenue, where Skinner works as an administrator of homeless programs.

When Stephanie was convinced to come inside for a meal and a shower, the staff quickly realized that she suffered from mental illness and drug addiction -- problems they could try to treat.

They made sure she received the appropriate medications and got her sober. When she was stable, Stephanie left the program, seemingly a new person. At one point, she returned for a visit -- all smiles and driving a new car -- and told the staff she was taking classes at UCLA.

"At first I didn't recognize her," Skinner says. "She had changed that much."

But two months ago, Skinner saw Stephanie once again -- back on the streets with her blanket. "She's the kind that breaks your heart," Skinner says.

Stephanie's saga embodies the cruelty of mental illness and illustrates why, in spite of good economic times, so many people like her remain unable to function in society.

Hospitals shut down

The problems began spilling into the streets in the 1970s when numerous state mental hospitals were closed and thousands of mentally ill Californians were put out on their own.

"When the hospitals were shut down, mental health resources were supposed to have followed in the communities," says Marvin Weinstein, president and chief executive of Portals, which caters to the segment of the homeless population that is mentally ill and suffers substance-abuse problems. "But it didn't happen. The resources didn't follow in the communities."

Social workers recognize that the disease comes in cycles, and a person who seems on the road to recovery one day can be back at ground zero the next.

Agencies that assist the homeless mentally ill are primarily dependent on government funding. Yet for the past two decades, such services have been a low priority for many elected officials who had hoped that private funding would take care of the problem. When that support didn't materialize, agencies began warning of a public health crisis.

In response, lawmakers passed AB 34, which went into effect in October and directed $10 million toward grants for mental illness service organizations, with a focus on preventing recidivism among the mentally ill released from prisons.

Half of the money will be allocated through the Los Angeles County Department of Mental Health, and already has boosted the budgets of several outreach organizations.

But money isn't the only problem. Dr. Dolly Anderson, program director of the Portals No-Fail Community Center, says there are now enough resources to at least find a bed for every homeless person in Los Angeles. But getting those people to take advantage of the services is another story.

"It becomes a matter of getting through to people when their brain says 'I don't want to live in this society anymore,'" she says.

Hard to hold a job

Social workers say it's impossible to track the number of mentally ill homeless people in Los Angeles because of the way they live. Statewide, officials estimate that the number has remained fairly constant at about 50,000, even though the makeup of that group is shifting from veterans to recent immigrants.

Even with recent advances in psychotropic medicines, it's exceedingly difficult for them to hold onto a job. There always are side effects to the medications, and when they don't work perfectly, patients often attempt to self-medicate by turning to narcotics and alcohol. Some find that their medication works, but after the symptoms start to subside they assume they've been cured and stop taking it. It isn't long before the illness returns.

It's now estimated that one in three homeless people in L.A. County have some kind of mental illness. Many have schizophrenia, a disease that takes hold in the late teens or early 20s and causes people to suffer delusions of persecution or to hear commanding voices in their heads. Bipolar disorder is also common, an ailment in which patients haphazardly fluctuate from fits of mania to despair.

Because of the nature of these illnesses, people often are reluctant to come forward for help. They fear the structure of a shelter, or simply don't understand there are free services available.

Convincing mentally ill

"The question is not whether or not there are services able and willing to help them," says Jerry Liner, administrator of the Anne Sippi Clinic, a private mental health center in Los Angeles. "The question is, do they need services in their own mind?"

It falls to people like Rico Evans to convince the mentally ill homeless to come in for help -- or at least a shower.

Evans has worked with Portals for over three years. He travels around Los Angeles County in his minivan, seeking out the mentally ill in parks, at the beach, and under freeway overpasses. Certified as a rehabilitation therapist -- and a recovering addict himself -- Evans draws from his own experience.

"If you give them respect, you receive respect," he says. "These people do have 'streetology.'"

For two years, Evans has been talking to someone he calls the "Plastic Man," a home-less 53-year-old who has used heavy-duty plastic to create an igloo for himself in a landscaped patch at the Slauson Avenue entrance to the Harbor (110) Freeway. Evans has yet to convince the Plastic Man to visit the shelter, although he believes he is wearing down his resistance.

"Two years ago I would bring food to him, and he would throw it back at me," Evans says. "I would bring him blankets and leave them beside him, and he wouldn't use them just because he knew they were from me. He was afraid to take things from people because he thought they were giving him things that would hurt him."

Now the Plastic Man talks to Evans and wants him to help find his family. He said he was attacked two years ago in a forest somewhere north of Los Angeles and left for dead. He doesn't know his real name, the location of his family, or anything about what his life was like before the injury. Most of his time is spent wandering or watching a color television that he has hooked up to a car battery inside his igloo.

"He's a real nice guy," Evans says, explaining that he is never afraid when he goes out to talk to mentally ill homeless people, "I don't even have a weapon. My weapon is God."

Such persistence is key to breaking through the barriers that the mentally ill create around themselves, according to Mollie Lowery, executive director of Lamp Inc., an organization that provides care for mentally ill denizens of Skid Row.

Tiered system

At Lamp, there are different opportunities for care. The homeless can stop by the center for a drink of water or to use the phone. There also is a program for transitional living in which the mentally ill can adjust to their medication and lead a somewhat structured life while receiving assistance with day-to-day. living. Then there are apartments available where patients can provide for themselves as they work in Lamp's commercial laundry facilities.

A sense of community is helping the recovery of Stephen, 38, who is undergoing day treatment at the Portals Center on Western Avenue. He smiles and shifts excitedly in his chair as he talks about the past four months.

Stephen just got word that he's been accepted into the transitional residential program, so he was preparing to move into a house where he can live while improving his job skills and learning to deal with his bipolar disorder and addictions.

"I'm ecstatic," he says. "I haven't had my own place since I was diagnosed as being bipolar."

Stephen has been homeless off and on for years. Because of his mental illness and mood swings, he had a falling out with his mother and left home. In the four months he's been at Portals, he has started to work in the clerical department, been appropriately medicated, and attended meetings on stress management.

"It's like a family here," he says. "I'm a lot calmer and I've been living sober...my mother is ecstatic."