It Can Take a Village to Help the Mentally Ill

The middle-aged man was eating an apple with his head tilted back, as if he expected the ceiling to cave in at any moment. He wore dark shades and a red ball cap, and on top of the ball cap was a straw hat the size of a lampshade.

I walked past this guy and into the office of Mark Ragins, a psychiatrist at the Village, a revolutionary referral and treatment center for the mentally ill in downtown Long Beach. My visit was part of a continuing education that began the day I met Nathaniel, a former Juilliard student playing a two-string violin in downtown Los Angeles.

Nathaniel, who like 1% of the population has schizophrenia, sleeps on the sidewalk on skid row. His misfortune is to have the one disease for which there’s no poster child, let alone a national telethon. I keep thinking there’s got to be a better life for him, which is why I went to Long Beach.

Ragins told me an unscheduled drop-in was waiting to be seen. The doctor offered to have the guy cool his heels for a while, but I asked him to please go ahead and take care of business. What better way for me to see how Ragins works?

A moment later, in walked the man with the lampshade.

David seemed to be about 50. His head was still tilted skyward, but I realized it might be for the sake of keeping his sunglasses on. Both earpieces were missing. His ensemble included boots and a pair of gym shorts with the number 15, and he had tied a black shirt, white towel and red kerchief around his neck despite the heat.

“You have a very strange appearance,” Ragins observed.

“I do what I can,” David said dryly, and the ice was broken.

David might have been put at ease by the doctor’s shaggy-haired, casual appearance, or maybe it was the feel of the room, which was more like a bus station than a doctor’s office. Ragins shares space with staffers who reach out to mentally ill people on the streets.

“Well,” Ragins said to David, “how can we be of help to you?”

I had read Ragins’ booklet on the Village, in which he argues for turning the traditional treatment process on its head. Instead of diagnosing, medicating and abandoning people with mental illness, his first move is to draw out their stories. Rather than tell them what they ought to do, he asks them what they want.

The Village is full service. They can hook people up with housing, food, medication, financial management -- whatever it takes to help them begin their return to lives with meaning.

It might take weeks or months for Ragins to gain their trust. Even then, there’s only so much that can be accomplished with people who are severely disabled, and the Village doesn’t have the resources to help everyone. You don’t “recover” from paranoid schizophrenia the way you recover from a broken leg. But Ragins is convinced that a lot of the people we cross the street to avoid don’t have to be on the streets in the first place.

The Village has helped hundreds of people off skid row and into apartments. Proposition 63, the 1% tax on Californians who earn more than $1 million a year to pay for services for the mentally ill, was written with the Village model in mind. Now, county mental health officials throughout the state are mapping out plans for the hundreds of millions of dollars that will become available beginning in January.

“I’ve had, like, schizophrenia,” David told Ragins, volunteering that he had been on anti-psychotic drugs in the past, but not in the last year or two. He said he didn’t want any drugs now; he just wanted help getting out of the Los Angeles skid row hotel he was living in.

It’s wretchedly hot there, David said, with lots of noise and pollution pouring in. The neighborhood is overrun with addicts and pigeons, he added, saying the straw hat was protection from birds and insects. He wondered if the Village could get him some housing in Long Beach, and said he has a federal Supplemental Security Income check to pay his way.

David learned of the Village through his mother, who lives in Georgia and is a member of a parent support group affiliated with the National Alliance for the Mentally Ill. She heard about the program and flew out west, but David resisted trying the Village for weeks, saying he didn’t want to see any doctors. A Village staffer named Richard Hart finally talked him in.

“Do you find reasons to move all the time?” Ragins asked after hearing that David had bounced around a lot after being homeless for a while.

Not really, David said. He spent seven years living with a woman in San Francisco, but she turned into a heroin addict.

“I was with her for way too long,” David said.

“Were you in love?” Ragins asked.

“I think that’s what they call it,” David said, and they both laughed. “I was stupid.”

“Maybe being stupid and being in love are the same thing,” Ragins said.

“You tell me, doctor.”

David, despite getting more comfortable, kept one hand in front of his face at all times, switching from left to right. Ragins saw things that suggested schizophrenia, and other things -- such as David’s self-deprecating awareness of himself -- that didn’t.

Medicine might help him at some point. But Ragins first wanted to know why an intelligent man, with a sharp sense of humor, was still so dysfunctional, particularly after stints at Step Up on Second and Portals, two of the better recovery programs in the area.

David told him he’d been depressed lately and still hears voices occasionally. When he lived in San Francisco, he thought about killing himself.

“I’ve been to the bridge,” he said, “but never jumped.”

Ragins asked what kept him from taking the leap.

“I’d still like to live,” David said.

He said he’s been studying Chinese lately because it’s stimulating and “opens my mind.” He’s been out of work for a while and would like to find a job, too.

“I’d like to have a girlfriend, maybe,” he added.

I suggested a Chinese girlfriend, so he could kill two birds with one stone. If she’s got a good job, Ragins said, that’s three birds.

David was getting a kick out of this. I’d have to say he was the most normal-sounding guy I’ve ever seen in such a wacky get-up. He took both hands down from his face, and after dropping his glasses, kept them off for a while.

“Do you think the way you dress will scare off women?” Ragins asked.

“Maybe the gold-diggers,” David said.

Ragins told David they’d work on getting him into a Long Beach hotel, for starters, and get him in to see a doctor about a foot problem. Then he asked David if he’d like to come back and chat again.

“Definitely,” David said enthusiastically, and they made an appointment.

When he stood up to leave, a paint-stirring stick fell out of David’s shorts. It’s to scare the pigeons away, he said.

Ragins suffers no illusions. He doesn’t yet know the extent of David’s illness. He doesn’t know if David will be back, or how long it might take to help him.

I know how he feels. That’s how it is with Nathaniel. But what I saw in Long Beach gives me a little more hope.

As I was leaving the Village, Ragins motioned toward the several staff members who were in the room while he talked to David. All of them, he said, once sat in the same chair David did.

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