IN THE MOVIE, "ONE FLEW OVER THE CUCKOO'S NEST," Jack Nicholson was locked up in a state mental hospital, strapped to a table, given electric shock treatment and, eventually, a lobotomy that turned him into a vegetative state. Those were the bad old days of mental health treatment.
The movie locale may have been Oregon but it wasn't much different in California for people with mental illness.
"If someone was really bad, they'd be sent away to a state hospital. A lot of times they were just locked up at home sometimes in a closet, hidden from view," said Gladys Strope.
Strope, a Humboldt County native, has a unique perspective on mental health issues. Although retired from most of her volunteer duties on committees, commissions and boards, she continues to be a tireless advocate for those who suffer from mental illness. She was on the first county mental health committee formed after Congress passed the Short-Doyle Act in 1957 that began what is today's mental health care delivery system and she has served on every committee since. For more than 40 years Strope worked elbow-to-elbow with county supervisors, governors, state and federal legislators as the treatment of the mentally ill moved slowly out of the darkness.
Strope said she has seen tremendous advances in mental health care and treatment as well as some setbacks. Mental health care has never been better and yet serious gaps remain, she says. State officials estimate fully half of the mentally ill are not receiving treatment "the walking wounded," Strope calls them. Some programs are at capacity or underfunded. And then there is the persistent perception that mental health issues should remain in the closet.
"Some of us feel we have devoted our lives to getting rid of the stigmas (of mental illness)," Strope said. "But even with all our knowledge and advances in psychopharmacology, the stigmas remain."
Although the Short-Doyle Act went into effect in 1957, there really wasn't any money for mental health for another 10 years. That didn't stop the county's mental health advocates. In 1958 Strope chaired the first Mental Health Committee to investigate and propose legislation. And the new Mental Health Society began sponsoring educational programs and inviting noted mental health leaders, including Dr. B.F. Skinner, to Eureka to speak. The county's first mental health clinic opened its doors in 1964, expanding to outpatient services the following year.
1968 was a landmark year politically for the country and financially for mental health. The passage of the Lanterman-Petris-Short Community Mental Health Services Act finally provided public funds for mental health.
Strope said she will never forget picking up Dr. William E. Mayer, the founding director of the county's mental health facilities, at the airport on his arrival.
"He said to me, `This is by far the most exciting time to be involved in the field of mental health in the past 100 years.'"
Sempervirens, the county's first inpatient facility, opened with 16 beds in 1969 and mental health services continued to expand. An alcohol and drug-abuse program was added in the early 1970s.
It was also in the early 1970s that former Gov. Ronald Reagan and the Legislature began emptying the state mental hospitals. More than 35,000 patients had been housed in those facilities. It rapidly dropped to 3,500. Today that number is about 4,000.
Stope said she supported the concept, but not the execution.
"That was a grand plan gone awry!" she said. "The point was that the money was supposed to follow the clients home. They were supposed to be treated in community mental health facilities. It never happened. We really had to struggle to fund mental health services."
A major turning point came in 1991.
"We were working with (U.S. Sen.) Pete Wilson in Washington before he declared his candidacy for governor," she recalled. "We were working on the idea of getting a stable funding source."
The plan, signed into law by Gov. Wilson, is what's now known as realignment funding.
"They call it the kiss of death to the general fund," Strope said with a laugh. Realignment takes the money out of the county's general fund and puts it into a dedicated fund specifically for a health or social service program.
"It has made all the difference," she said, but there have been setbacks. There is a clause in the realignment legislation that allows the county to take up to 10 percent of the mental health funds for other purposes. For the last three years the Board of Supervisors has taken advantage of that clause to cover budget deficits in other departments.
"They took $250,000 the first year, $465,000 the second and about $200,00 again this year," Strope said. "It's my big gripe. It seems pretty sad that because we have been a good shepherd of our money, we got penalized."
Because of the stable funding, the county has been successful in attracting federal grants that require matching funds.
Strope and others credit County Mental Health's new administrative director, Linda Hartman, for aggressively pursuing additional funding.
"She's doing a wonderful job," Strope said.
And the county has had some success in attracting new psychiatrists. The staff is now up to five including the new medical director, Dr. Kate Bell, who came on board in August.
New legislation continues to improve services to the mentally ill. Three weeks ago Gov. Gray Davis signed into law a bill, called the "parity" bill, that will require health care insurers to treat mental and physical illness the same.
"It's a great bill," Strope said. "It really shouldn't matter if you come in with a broken arm or broken connectors in your brain."
The bill takes effect in next July. By next May, Davis is also requiring the state to develop a grant structure that would make it easier for counties to apply for mental health funds.
Humboldt County, one in seven statewide, is also in line to receive a $2.2 million grant to serve the mentally ill in jail. The grant from the California Board of Corrections will establish a rehabilitation program to provide
24-hour substance abuse counseling and services to inmates.
Modern brain research and the advancements in psychopharmacology drugs to treat psychotic disorders like schizophrenia and mood disorders like depression have contributed to a better outlook for the mentally ill.
"We're the furthest we've ever been with respect to medical therapies," Hartman said.
In spite of the advances, those working in mental health agree the system still falls short. The mental health walk-in clinic every Thursday continues to be at capacity. Often clients are lining up at 10:45 a.m. to get in to see mental health care workers and the clinic doesn't open until 1 p.m.
"There's a lot more we could be doing in terms of case management," Hartman said. The department has been able to boost children's services in recent years, but adult services fall far short of the demand.
There are quite a few marriage and family counselors in the county today, which health care workers say takes pressure off the system. But all agree there is still a shortage of psychiatrists and clinical psychologists.
"We have a very limited supply of therapists," said Martin Love, chief executive officer of General Hospital. There are six psychiatrists on General's on-call list, but many times they are unavailable.
And, Love said, there is constant pressure to contain costs and reduce benefits from insurers including the state's MediCal and the federal government's Medicare programs.
Patients who suffer from chronic pain, for instance, often have associated psychological symptoms.
"They need more than medicine and physical therapy. But MediCal only reimburses $12 a hour for psychological services. There just aren't any takers at $12 an hour," Love said.
And while there is a long-term care facility for the mentally ill, Crestwood Manor in Eureka, many point to the lack of an acute care facility in the county.
"There is no acute inpatient facility except for Sempervirens," the county's 16-bed lock-up unit, Love said.
Strope agreed. "You have to be a `5150,' to get into Sempervirens" she said, referring to the police code for the mentally disturbed who are in danger to themselves or others.
"We shouldn't have to wait until someone is violent to others or themselves to get them help," she said.
But in reflecting on the shortfalls of the current mental health care system, Strope and others keep returning to the issue of stigma.
"There's still a lot of shame that's associated wit
h mental health particularly for older adults seniors," she said.
They just don't realize there's help out there.
Top: photo of Candlelight Vigil by TrishMcGraw
IN 1993 BARRY GERDTS, 56, drank a concoction of alcohol, grape juice, antifreeze and sleeping pills, parked his truck in the barn on his old 40-acre farm near Garberville and tried to finish himself off with carbon monoxide poisoning.
His ex-wife found him and called 911.
Barry Gerdts and his wife, Gaye, in their Eureka home.
(Photo by Brandi Easter)
Today Gerdts says it was a build-up of work and marital pressures, adding to his clinical depression, that almost pushed him over the edge.
"I had such tunnel vision. I tried to pray, to say (positive) things to myself, but I didn't know what to do. Then I said, `I can't take it anymore.'"
Gerdts a computer engineer from Minnesota, now living in Eureka ended up in Sempervirens, the county's lock-up facility for those who are a danger to themselves or others. While there he began to sort his life out. His marriage ended and eventually he met his new wife, Gaye, through a dating service. They wed last May.
"He told me right away about his depression and brought material for me to read," she said, giving him an affectionate pat on the back. She said she was impressed by his honesty and recalled her own six-month experience with the illness in 1991.
Of the state's 58 counties, Humboldt ranks among the top 10 for incidence of suicide per capita averaging 25 per year, according to Public Health Officer Ann Lindsay. More than 17 million Americans 6 to 12 percent of the population suffer from depression, a condition that affects both mental and physical health.
There are at least four known types. Major depression is the most common, characterized by at least five of the key symptoms for more than two weeks. It can last six months to two years, but every case is different. Dysthymia is a milder, more chronic form of depression that lasts for more than two years. Bipolar disorder is a manic-depressive illness, responsible for extreme mood swings. And Seasonal Affective Disorder follows seasonal rhythms and usually occurs in winter, when there's a lack of light.
Only one-third of those suffering from depression are diagnosed, health officials estimate. Women are diagnosed more often than men because they are more likely to seek help although men are more likely to commit suicide, often with guns. Seniors are especially at risk of going undiagnosed of depression, the suspected cause of up to two-thirds of the suicides in older adults.
U.S. Sen. Harry Reid, whose father committed suicide in 1972 after suffering from depression, has arranged a hearing before a Labor, Health and Human Services subcommittee on the topic Oct. 28. Scheduled to testify among others are authors Danielle Steele, whose daughter took her life, and Dr. Kay Redfield Jamison. The Johns Hopkins School of Medicine professor of psychiatry concluded in her book "Night Falls Fast: Understanding Suicide" that up to 95 percent of people who commit suicide had a diagnosable psychiatric illness.
In some, depression is triggered by an obvious stressful life event like the loss of a loved one. In others, it seems to occur spontaneously, usually between the ages of 24 and 44. There's even a genetic link, scientists have found.
Depression occurs in up to 20 percent of those who have had a heart attack and 27 percent in stroke survivors. Having an underactive thyroid has also been linked to depression. County mental health officials test for hypothyroidism during examinations of Sempervirens patients.
No specific cause has been identified for bringing on symptoms of depression, but there is a list of possibilities. These include personality, diet, alcohol, nicotine and drug abuse, certain medications and other chronic illnesses.
Psychiatrists are more convinced than ever that depression is a disorder that originates in the left side of the brain. It's associated with a chemical imbalance in neurotransmitters that carry communications between nerve cells that control mood and other basic bodily functions. The known ones include serotonin, norepinephrine and dopamine.
It's still uncertain whether changes in these neurotransmitters are the cause or result of depression. But whatever the trigger, it's much more than a bout with the blues.
The development of antidepressant medications and mood-stabilizing drugs in the last 20 years has revolutionized the treatment of depression. The drugs take from four to eight weeks to take effect. Side effects of the meds include dry mouth, muscle spasms, changes in sleep patterns, restlessness, nausea, constipation, bladder problems, sexual dysfunction, dizziness and drowsiness.
The drugs include:
Selective serotonin reuptake inhibitors (SSRIs), which include Prozac, Paxil and Zoloft, have become the first line of treatment for depression because they have fewer side effects than their predecessors. These are the new drugs that apparently improve the availability of the neurotransmitter serotonin in the brain.
Serzone, Effexor and Desyrel are similar to the SSRIs but also affect the neurotransmitter norepinephrine, while Wellbutrin affects the transmitter dopamine.
Tricyclic and tetracyclic antidepressants are used to treat moderate to severe depression by affecting neurotransmitters in a different way than SSRIs. They include: Elavil, Endep, Norpramin, Aventyl, Pamelor, Ludiomil and Remeron.
Monoamine Oxidase inhibitors (MAO), Nardil and Parnate, prevent the breakdown of neurotransmitters but have been known to have serious side effects. They're rarely used and only for severely depressed people.
Lithium and mood-stabilizing medications are used to treat bipolar disorder. They are Lithium, Depakene, Depakote, Epitol and Tegretol.
Depression may also be treated through psychotherapy, phototherapy and electroconvulsive therapy. Light therapy has been used with SAD patients because scientists believe fewer hours of sunlight may trigger melatonin, a brain hormone thought to induce sleep and depress mood.
Alternative treatments have taken a portion of the spotlight in the treatment of depression. They range from biofeedback and acupuncture to exercise and homeopathic remedies. Independent research discovered that St. John's Wort, an herb with a long history of folk medicine, contains a compound that is effective in the treatment.
Beginning in 1991 Barry Gerdts experimented with different antidepressants and combinations of drugs. He found Prozac and Effexor to be the most effective for him because they tend to counteract each other. The first elevates mood and the second makes him sleepy.
"Sometimes I wake up not wanting to be here. That still happens, but not as often," he said.
He serves on the county's Mental Health Advisory Board.
EARLIER THIS MONTH, MENTAL HEALTH officials conducted four clinics across Humboldt County as part of National Depression Screening Day. Only 25 people showed up.
John Anderson, a licensed therapist who organized the effort, said he was disappointed in the turnout but not surprised.
Those who suffer from depression are embarrassed by the stigma attached to the illness. And often they lack motivation to do anything about it.
"They are told, `If you just get out there and mow the yard, you'll get over it,'" Anderson said.
"We are talking about people (with a chemical imbalance) who can't think clearly, are unable to focus and who may have memory problems," he said.
For those who missed the screening clinic, here's a test many in the psychiatric community use. It's called the Beck Depression Inventory named after Dr. Aaron T. Beck.
[The Beck Depression Inventory test is no longer available online. ]
For information about the Beck
Depression Inventory, please contact :
Harcourt Assessment, Inc.
19500 Bulverde Road
San Antonio, Texas 78259-3701