November 21, 2018

The failure of L.A.’s mental health system

On a Thursday afternoon in March, Laurie Ritz, 44, sat on a sun-drenched patio in the heart of Long Beach. His piercing, blue eyes were slightly cloudy and framed by deep lines that hinted at his exhaustion. Ritz’s brown, shoulder-length curls were topped by a yarmulke, and he was in the midst of sharing a lunch of tuna wraps and fresh fruit with his older brother, Jonny Ritz. It was Purim, so Jonny had brought along a small gift box filled with snacks, which Laurie perused as the two talked about topics ranging from family to books, the Torah to gun control. They even paused to snap a smiling photo together.

The only indications this reunion was anything short of conventional were the barbed wire and locked gates that separated Laurie and the rest of the patients at La Casa Psychiatric Health Facility from the free world. Over the past decade, various doctors have diagnosed Laurie with schizophrenia and bipolar disorder, two mental illnesses that can be difficult to distinguish because of their often-similar symptoms. For Laurie, a tumultuous three years of homelessness, court hearings and jail time, as well as a court-mandated conservatorship, landed him in this locked mental health facility.

“Whenever he got into trouble in Los Angeles, all they ever did was throw him in jail,” said Jonny, 52, a jeweler by trade who lives in Beverlywood. “Seventy-two hours, [then] out of jail, onto the street.”

Laurie has been arrested at least six times in the past two years, on various misdemeanor charges, according to police records. The crimes include violating a restraining order and trespassing, Jonny said. The majority of Laurie’s arrests took place within what the Los Angeles Police Department designates as West L.A., near to the homes of Laurie’s family and friends, their synagogues and kosher restaurants, Jonny said.

Although the specifics of each arrest aren’t public, family and friends describe Laurie’s behavior when he’s not on medication as violent and unpredictable. They recall him throwing punches (and a can of open tuna) in shul, as well as pushing over a flowerpot and leaving odd items such as tomatoes or cauliflowers in loved ones’ mailboxes. Even Jonny, Laurie’s staunchest advocate, said he filed a restraining order against his brother about three years ago, during a bout of Laurie’s psychotic behavior. 

L.A. County’s mental health system’s limited resources, coupled with a societal stigma surrounding mental illness and an overwhelmed public defender’s office facilitated a downward spiral for Laurie, Jonny said. Within the L.A. Jewish community, specifically, there are “almost zero” resources, he said. This is despite research that suggests Jews suffer disproportionately from mental health issues. 

According to the Los Angeles Homeless Services Authority, L.A. is home to nearly 9,000 homeless people with mental illnesses. In L.A. County jails, there were more than 4,000 inmates with mental illness as of May 2016, the Los Angeles Times reported last month. Without access to proper treatment, housing or legal guidance, it’s all too easy for people to fall between the cracks or simply get lost amid the bureaucracy. In fact, Laurie himself was a casualty of this overloaded system, and without his brother’s diligence, he would have ended up standing trial instead of being recognized by the court as mentally ill and being placed under a conservatorship.

Indeed, Laurie Ritz’s story exemplifies the inadequacies of L.A.’s mental health system, in  which even someone with a zealously dedicated, educated brother advocating continuously on his behalf, can spend years cycling from the streets to jails and temporary treatment facilities. 

Jonny Ritz said in one of many interviews over recent weeks that his deep commitment to his brother’s well-being came from their father, who taught his sons to live selflessly in accordance with the Tribe of Levi, one of the tribes of Israel. 

“I am from the tribe of Levi, and the Levites are the tribe that cares deeply for other people, and it’s inherently in my nature,” Jonny said.

Laurie Ritz received his first diagnosis of mental illness almost a decade ago, when he was in his mid-30s and living in his native country of South Africa. In the United States, more than 18 percent of adults suffer from some form of mental illness, according to the National Institute of Mental Health (NIMH), the leading federal mental health agency. More than 2.6 percent of the U.S. adult population is believed to be living with bipolar disorder, specifically. And a 2013 study found Ashkenazi Jews are 15 percent more likely to suffer from bipolar and related disorders than the general population. 

Bipolar disorder causes dramatic mood changes, which often swing from overexcited mania to hopeless depression and result in drastic behavioral alterations, as well, according to the NIMH. It can cause people to act impulsively, experience racing thoughts and engage in high-risk behavior. When the pendulum swings the other way, sufferers often feel tired or sluggish, find it difficult to concentrate and can experience suicidal thoughts. This type of mood disorder is highly treatable, experts say, with the right regimen of medication and therapy, supplemented by a stable lifestyle that includes restful sleep and regular exercise. 

Greg Spiegel is the director of strategic initiatives at the Inner City Law Center on Skid Row. For more than 35 years, this nonprofit law firm has been helping protect low-income families from eviction, developing strategies to end homelessness and placing veterans, the homeless and the disabled into secure, affordable housing. 

“Over the last 10, 15, 20 years, we’ve learned that the way to end somebody’s homelessness is housing first,” Spiegel told the Journal in an interview. 

It’s difficult for people to get clean or consistently take medication while living on the street, Spiegel said, so for individuals like Laurie Ritz with a serious mental illness, and/or those with drug addiction, the best first step on the road to recovery is permanent supportive housing. Such stable, long-term accommodations include built-in support systems that many homeless need, including doctors and counselors. 

But in this, Los Angeles is behind the curve, having only just started to invest in and provide permanent supportive housing over the last decade. In contrast, New York City and New York State have had an agreement to fund permanent supportive housing since the mid-1990s, Spiegel wrote in an email to the Journal. Today, the city of Los Angeles is about 10,000 units short of having enough permanent supportive housing to meet the current demand. This means people like Laurie remain stuck in cycles of incarceration and homelessness.

“I need a stable home. I need a living facility,” Laurie said. “If I have that, then slowly I’ll be able to start building up again.” 

Laurie Ritz (front), at age 10, poses with his parents, his 15-year-old sister and Jonny, then 18, in South Africa in 1982.

Given L.A.’s housing shortage and lack of other stabilizing resources, many individuals with mental illnesses end up in L.A. County’s Twin Towers Correctional Facility, making it one of the largest mental health facilities in the United States. In just the past few years, Laurie has been sent to the decrepit downtown L.A. jail on multiple occasions, for up to six months. Much of this time was spent waiting for a judge to decide whether he was competent to stand trial. 

“Each time is one too many,” said Laurie, who agreed to share his story with the Journal in an effort to help others avoid his same fate. “It’s not the kind of place anyone wants to go to, and certainly not go back to again.”

L.A. County’s inadequate treatment of its mentally ill inmates has been widely criticized by mental health advocates and the federal government alike. In 2014, the U.S. Department of Justice, which had been monitoring conditions within the jails for more than a decade, concluded “serious deficiencies” remain in the mental health care system. These are made worse by “inadequate supervision and deplorable environmental conditions,” such as insufficient cleaning of “feces-smeared cells,” depriving inmates of their constitutional right to mental health care. 

So, in 2015, after years of contentious debate over the size, scope and needs of a new men’s jail slated for downtown Los Angeles, the County Board of Supervisors approved a $2 billion jail plan prioritizing mental health care and substance abuse treatment in the new facility. Approved in September, the new jail will have 3,885 beds — fewer than recommended by consultants, but a reflection of the county’s plan to send more low-level offenders with serious mental illness into community-based treatment centers, instead of keeping them behind bars. 

In order to accomplish this, the county also approved an ordinance earmarking $30 million to create an Office of Diversion and Re-entry. Aimed at funneling homeless or those at-risk of becoming homeless into appropriate treatment programs in lieu of jail, this office strives to treat the individuals with the intention of stopping the cycle of mentally ill individuals rotating in and out of hospitals and jails.

“Diversion is humane and cost-effective, putting taxpayer dollars to much better use than incarceration does,” Supervisor Mark Ridley-Thomas said in a statement.

Despite these progressive plans on paper, the number of mentally ill inmates in L.A. jails has continued to grow. According to a June L.A. Times story, the average number of mentally ill incarcerated has grown 34 percent between 2013 and mid-May of this year. 

Like many people with bipolar disorder, Laurie’s symptoms developed in early adulthood. As a kid growing up in South Africa, he was a “very normal, sweet, very, very bright individual,” Jonny said, and it wasn’t until their father died of brain cancer in 1992, when Laurie was 20, that Laurie’s behavior began to change. 

“We didn’t really see really clear signs of mental illness, but we started to notice signs that Laurie was lost, that he was very withdrawn, yet he was still very functional,” Jonny said.

It wasn’t until six or seven years after his father’s death that Laurie had his first psychotic episode, Jonny said. Meanwhile, in the mid-’90s, Laurie had moved to Los Angeles to be close to his brother. He took some classes at Santa Monica City College and eventually transferred to UC Berkeley, where he graduated with a degree in business. He quickly landed a job but was laid off in the early 2000s when the tech bubble burst, Jonny recalled. Laurie became depressed, withdrawn and very religious. Working only intermittently, he bounced among New York, South Africa and Los Angeles, as well as Israel, where, for a brief time, he studied at Mir Yeshiva, an Orthodox Jewish seminary that’s one of the largest in the world. 

When family friend and lawyer Craig Ackermann first met the Laurie in 2010, the younger Ritz was on medications and “doing very well,” Ackermann said. He hosted Laurie at multiple Shabbat dinners, where Ackermann described him as funny, helpful and overall a “delightful guest.” So charming in fact, that other guests tried to set him up on dates with their friends. 

“At that point, I felt very comfortable having him in my home and around my kids and wife,” Ackermann said.

At the time, Laurie was taking medication that managed the symptoms of his mental illness. However, the often-prohibitive cost of the drugs, his lack of access to continued medical counseling and side effects such as weight gain and excessive drooling made it hard for him to stick to the medication regimen, Laurie admitted. While cost varies greatly from prescription to prescription, the antipsychotic Invega Sustenna, which Laurie is currently on, costs about $2,000 per injection, and he needs the shot once a month, Jonny said. This hefty price tag doesn’t include the additional costs of drugs needed to manage the many side effects.

These are all reasons why Laurie recognizes his need for long-term housing with built-in infrastructure to help him continue to improve.

“If the medication is available and affordable, I’d be a fool not to take it,” Laurie added.

Ackermann visited Laurie during his most recent stay at La Casa, and emphasized that since he’s been consistently medicated, he’s been coherent and apologetic. 

“He can remember everything that he’s done,” Ackermann said. “It’s really heartwarming to see my old friend is back.”

Far from La Casa on one recent Monday evening, a group of about 15 Jewish community leaders, mental health professionals and legal experts gathered in Jonny Ritz’s living room to discuss and debate how to collaborate in creating a mental health service provider for the Jewish community.

While establishing a long-term housing facility is its ultimate goal, the group is hoping first to start a crisis center, hotline or even simply a collection of resources for families with loved ones who have mental illness. In the meantime, Jonny has been gathering inspiration from various models of mental health care from throughout the country. In June, Jonny, along with Ackermann and a psychologist, visited the Chesed Home in San Diego, a residential care community that aims “to provide a safe and nurturing environment with Jewish Values for adults with mental illness.” Jonny said he was impressed by the facility, including how well maintained the space was, the quality of the staff and clinicians and the “delicious” kosher food that was provided by a kosher kitchen. 

“The Los Angeles Jewish community needs better care for their mentally ill patients,” Jonny wrote in an email to the Journal. “Many require a kosher diet, Sabbath observance and other religious practices. Our Los Angeles Jewish community must provide a dedicated crisis center as well as care facilities for their mentally ill.”

But until this happens, the fight for Laurie Ritz’s health and safety continues on a daily basis. Because of lengthy waitlists caused by a severe shortage of housing options, Laurie was stuck at La Casa for about four months. After an arduous process to get him transferred, Laurie is now living at the Meadowbrook Behavioral Health Center, a residential facility that’s only 15 minutes from Jonny’s home. It’s still a locked space and Laurie is barred from leaving — “it’s not a hotel,” Jonny emphasized — but they anticipate his stay will be temporary and should be the last step before he’s released back into the general population. 

Laurie is expected to stay at Meadowbrook for three to six months, Jonny said, after which he’ll likely head to a “step-down” facility, a place that provides patients with freedom to come and go as they please but with a built-in support system of counselors and/or mental health professionals who will help ensure Laurie stays on track.

Jonny is “cautiously optimistic,” about Laurie’s future, he said, but no matter what happens, he’s going to continue to fight for him. 

“When my brother hurts, I hurt more,” Jonny said. “This being my biological brother makes it a lot closer to home for me. And I will never turn my back on a brother.”