Thursday, December 01, 2005


Treatment Advocacy Center Newsletter


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November 25, 2005


1. MENTALLY ILL GET A CHANCE - Los Angeles Times, July 1, 2003

2. LESSONS IN SURVIVAL - The San Francisco Chronicle, May 23, 2003


1. LOS ANGELES TIMES, July 1, 2003

[Editor’s Note: The Treatment Advocacy Center works at developing, promoting,
and initiating interventions that provide intensive, supervised and, in most
cases, mandated care to those most incapacitated by severe psychiatric
disorders. These treatment strategies are used when there is no other way in
which to wrest someone from the control of the most acute or chronic symptoms of
a mental illness.

Such assisted treatment is not meant to be an end but rather an eventual
entrance to voluntary care. For many of the most acutely ill, the benefits of
PACT, supportive housing, or vocational rehabilitation can only be attained
after the use of a mechanism like assisted outpatient treatment and will
continue long after the expiration of a court’s influence.

For many of those rescued from illness, we hope that a place like Cafe Phoenix
is an available stop on their path to societal reintegration.]


At A San Francisco Cafe, Nearly Every Worker Is Battling A Disorder.

For Some, It's A Last Chance To Prove They're Employable.

By John M. Glionna, Times Staff Writer

SAN FRANCISCO -- In the eyes of many employers, James Flannery would be damaged

As the lunch rush packs a tiny restaurant here, he stands timidly behind the
cash register, dressed in his red apron, fighting off the doubts that he will
ever be able to keep all these orders straight. He avoids eye contact, convinced
that every stranger is staring at him, laughing at him, assuming that he's
somehow stupid when he knows that he is a very smart person who happens to be
mentally ill.

For most of his 33 years, Flannery has suffered from depression. At times, he
has lain frozen in bed. The simple act of showing up for work can trigger a
debilitating fright.

And so, to rejoin the job force, he has placed his faith in Cafe Phoenix, a
bustling eatery that opened last month.

At the Phoenix, almost all of the employees battle mental illnesses -- from
delusions and schizophrenia to bipolar disorder to paranoia.

To say the least, Cafe Phoenix is no ordinary restaurant. Workers grapple with
their problems under the watchful eyes of counselors while dealing with
demanding customers, negotiating kitchen politics and juggling the never-ending
flow of orders.

Cafe Phoenix is the newest venture by a Bay Area nonprofit called Hire-Ability,
which runs a host of vocational training programs for the mentally ill.

Operating in the agency's converted cafeteria in a warehouse district south of
downtown, the restaurant is open for breakfast and lunch, catering to a mixed
working-class and white-collar crowd with such fare as a spicy catfish sandwich
for $5.95 and a grilled ham and cheese for a buck less.

The four tables inside and three outside are usually packed, thanks to recent
news reports and to the cafe's nearest competitor's being blocks away.

The cafe has become a proving ground for workers who are often heavily
medicated, but who long to earn paying positions -- and independence.

"This is a chance for me," Flannery said. "I can show I'm a capable person. But
even if I get nervous and mess up, that's OK; they're not going to fire me.
Around here, they almost kind of expect it."

Odds against a career comeback once were long for someone like Flannery. Federal
studies suggest that the unemployment rate nationwide for people with severe
mental illness is nearly 90%. More than 645,000 Californians suffer from "severe
and persistent" mental illness, with 100,000 of them so sick that they qualify
for state disability benefits, according to the Little Hoover Commission, a
watchdog agency that has done two recent studies of the state's mental health

Though state-funded agencies provide programs for an estimated 467,000 of the
mentally ill, between 500,000 and 1.7 million more go without services. "When it
comes to the mentally ill, the public health system is grossly underfunded,"
said Jim Mayer, the Little Hoover Commission's executive director.

Stepping into the breach are a handful of nonprofits such as Hire-Ability, a
subsidiary of Richmond Area Multi-Services, whose programs send a small but
steady stream of society's castoffs back to work. Mayer said: "To assume that
the mentally ill are too far gone to be trained is a dangerous and hurtful
misunderstanding. Programs like Cafe Phoenix should be the light, to show us
what we really can accomplish."

At the Phoenix, counselors are training the first round of cashiers, busboys and
cappuccino-makers. The workers know this may be their last chance to help set
their lives straight.

Working alongside Flannery are people such as Mark Tiedtke, 51,a Texas native
who one Valentine's Day checked himself into a hotel and tried to kill himself.
He was in a coma for three days. And there's Allison, who did not want her last
name used, a 48-year-old manic-depressive who still doesn't know what to say
when asked "So, what do you do for a living?"

But a job at Cafe Phoenix comes with the support of people like Daniel Michael,
Hire-Ability's director of vocational services. While in college, he started a
landscaping business staffed entirely by schizophrenics. His work-study
supervisor warned: "You can't just go around providing mentally unstable people
with sharp-bladed instruments." But the business thrived.

And there's Onnyx Walker, Hire-Ability's veteran chef who knows that the
drill-sergeant antics employed by most cooks wouldn't work in this kitchen.

"Doesn't make much sense to go around yelling and acting like a prima donna,"
Walker said, his blue-and-white chef's hat cocked to the side. "Underneath,
these folks are no different than anybody else. The way I see it, we're all
mentally or emotionally challenged at some point in our lives."


James Flannery's greatest fear is that he will suffer a nervous breakdown in
front of his friends.

He worried about it all through high school and during his first year at the
University of South Dakota, when his moods began to fluctuate and he became
frustrated and angry without ever knowing why. That's when the Minneapolis
native often locked himself in his room for a good cry.

But never in public. "I was afraid I'd look weak," he said. "I never wanted to
lose my cool in front of my friends."

After his illness forced him to leave school, Flannery moved to San Francisco in
1995 to work in his sister's catering business. Soon the darkness settled in
again. He had a breakdown and eventually, with his sister by his side, checked
himself into a psychiatric ward at San Francisco General Hospital.

He was briefly strapped to a gurney against his will. It was a low point in his
life, and caused him to avoid institutional treatment. He went on state
disability insurance and lived alone, leaving his apartment just once a week to
buy food and relying on talk radio as his lifeline to the outside world.

After years, he finally found the right medication. And he found Hire-Ability.
For months, he worked in the company warehouse manufacturing small decorative
tiles. Slowly, he found his confidence and then, Cafe Phoenix.

There he met Tiedtke, who looks more like a college professor than a newcomer
learning how to boil milk to make a cappuccino.

For Tiedtke, success means just having the ability to work again.

"I know that doesn't sound like a lot to most people, but for me it would be the
greatest thing on earth," he said.

"When I was 15, a psychiatrist told me something that I now realize is so very
true. For the mentally ill, work is the best therapy."

Even before Cafe Phoenix served up its first chicken pesto sandwich, vocational
director Michael prepared for the jokes and the insensitive quips like, "You've
got to be crazy to work there," or "Waiter, there's a Prozac in my soup."

"There's still the old stigma that these people are all dangerous," he said.
Movies often make their murderers criminally insane, he said, although there are
some signs of acceptance of the mentally ill. The new animated film "Finding
Nemo," for example, includes a character wracked by anxiety and an exaggerated
fear of the deep ocean and three sharks on a 12-step-type program to quit their
addiction to eating fish. "Even a few years ago, that kind of everyday nod to
people with emotional problems would have been unthinkable," he said.

When an employer hesitates to hire the mentally ill, Michael has a word of
advice. "I tell them, 'You've already done it. You just didn't know it.' " Then
he quotes a U.S. surgeon general's statistic: that one-fifth of all Americans
will have a diagnosed mental illness in their lifetimes. "Mental illness is all
around us," he said.

Before they put on their aprons, Cafe Phoenix workers are trained to deal with
difficult customers and how not to fall "into the weeds" -- a restaurant term
for getting behind in their tasks. Michael knows there is a chance for a worker
to have an emotional lapse. So there is always a psychiatrist -- or at least a
counselor -- in the house.

Not all customers know his staff's personal stories. "I want people to first be
happy with their food," Michael said.

"Then later on we can say, 'By the way, the money you spend here goes to helping
the mentally ill.' "

Customers give mixed reviews to the concept. "I advise them to keep their
kitchen open so people can see inside," said software worker Gary Nixon. "I want
to see if anyone is wiping the soles of their shoes before making my lunch."

Countered customer Kristin Groos: "I've been here five times and the food is
great. I know the philosophy behind the restaurant and I totally support them.
But the food comes first, and they're getting it right."

Fighting workplace stereotypes against the mentally ill will soon become a
national priority. In a program to start in January, employers will be
encouraged by federal officials to hire the emotionally disabled.

"The idea is to end the social distancing," said Ann Arneill-Py, executive
officer of the California Mental Health Planning Council. "The public wants to
keep a wide berth between themselves and the mentally ill. We're going to try
and make the workplace more accepting."

For Michael, the solution is simple. "With a restaurant staffed by the
physically disabled, people don't make snap judgments," he said. "My staff have
illnesses like any other and should be treated as such: with honor and respect."


The register is jammed and the man in the backward baseball cap isn't happy.

"Did you fix it?" he sighs, waiting for change.

"I don't know," comes James Flannery's tentative response

"You don't know?" the customer snaps.

Flannery watches the man lean close, invading his personal space. This is
precisely the kind of person he must politely face up to, to confront his own

"No, I don't," he answers softly. "But I'm going to find out."

The brief exchange is typical of Flannery's first days on the job. He remakes a
latte when a woman complains that she wanted soy milk. He explains to an
insistent woman that the cafe has run out of the soup of the day. And no ma'am,
the restaurant doesn't yet accept credit cards.

He knows his medication may slow his handling of even simple tasks. But he
recalls the advice from chef Walker "that it might take us a bit longer to serve
our customers, but give us a little patience and we'll get the job done."

Then six firemen storm the counter. At once, they bark out orders, requiring
Flannery to repeat the three types of cheese and choices of sliced bread or
rolls. They want separate checks and they peer over his shoulder as he writes
out the order ticket.

Only once does Michael have to rescue him. Flannery runs the orders back to
Walker, who looks up from his chopping block to offer him a reassuring "Thank

There are no breakdowns, no tears and no loss of face. Flannery might not be
ready yet for the big time: a job at a McDonald's, Starbucks or even a fancy San
Francisco restaurant. But he knows he's one important step closer. "A few times
I felt like a complete idiot, like some guy just trying to play cashier," he
says. "But I did it."

Then a fellow Hire-Ability client walks in. Flannery stands statue-like at the
register, his face expressionless.

"James, you know what?" the friend says. "You look good working here. You look
real professional."

Flannery remains silent. But his face beams.



[Editor’s Note: A woman sleeps on a park bench; she is lost to the streets,
obviously delusional, too sick to find even one of San Francisco’s relatively
numerous soup kitchens. A discussion over the advantages and disadvantages of
intervening in such a case most often centers on the person’s competency, the
cost of the necessary treatment and related services, or the general moral
obligation to the less fortunate.

Less often mentioned is what society may lose should mental illness be allowed
to continue smothering the capabilities of the person. We should consider that

Diana Grippo slept on that park bench less than ten years ago; imagine what is
waiting to be unlocked from within the person who sleeps on it now.]


Dealing With Bipolar Disorder Helps Formerly Homeless Teacher Relate To
Peninsula Students

By Demian Bulwa

At her lowest, Diana Grippo was frightened, delusional and even dangerous, a
ragged stitch in the tattered fabric of San Francisco's Tenderloin.

When she wasn't on an involuntary psychiatric hold, she slept in parks, and when
she was hungry, she dined-and-ditched at Zim's restaurant or conned men into
believing she was a desperate tourist. She protected cars from spontaneously
combusting with her Medicine Woman Finger. She could never locate the Flying
Church, which offered free meals; she realized later she had confused the name
of Glide Memorial United Methodist Church.

At her best -- well, Diana Grippo is herself.

She is 38 and happy, a lively, unconventional English teacher at Menlo-Atherton
High School's Computer Academy, a woman who has survived the most savage attacks
of bipolar disorder, a mental illness marked by strong and damaging mood swings.

Now she is using her experience -- and talking about it openly for the first
time -- at the academy. Conceived as a dropout-prevention program, the school
within a school stresses job skills to 140 sophomores, juniors and seniors,
mostly from East Palo Alto and Redwood City, and pairs them with professional

Grippo has chosen to work with teenagers whom she says she identifies with, not
only because they have had trouble succeeding within the system, but because
they don't trust the system.

"She's a star teacher," said Principal Eric Hartwig. "She brings a real sympathy
to the job. We do have kids who are homeless or come from real destitute
backgrounds. She understands their needs."

"She's more like a mentor for us, like a best friend," said Duane Tangatailoa, a
junior who wants to write screenplays for a living. Fellow junior Omar Fuggs, an
aspiring athlete and/or rapper, added, "She came up from the bottom. She's
telling us that with perseverance you can make it."

Grippo's dream is to expand an after-school media program at the academy, called
Youth Outreach Media Mentor Program, into a regional or national nonprofit.
Teens in the program are working on a documentary about homeless people in San

"These kids fall through the cracks, they don't graduate, and people say, 'Oh,
they're just at-risk kids,' " said Grippo, who lives in Los Altos. "No, they can
do it. We just need to get them engaged. Same with people on the street. They
can come back, but they need help."

As cities like San Francisco look for ways to coax sufferers off the streets,
Grippo is living, thriving proof that recovery is possible -- but is
staggeringly difficult and complex. She was homeless for nearly two years in her
early 20s and was hospitalized more than 15 times before she found a course of
medications that helped bring her back.


The average person with bipolar disorder waits 10 years and sees four doctors
before being correctly diagnosed, according to the Depression and Bipolar
Support Alliance in Chicago. Most become addicted to drugs or alcohol. Nearly
one in five commits suicide; Grippo recalls making a list of pros and cons.

"It's an amazingly heroic act to get well," said Sue Bergeson, vice president of
the alliance. Bergeson's sister, Barbie, killed herself three years ago at age
49 -- just three weeks after a correct diagnosis -- after struggling for decades
with the illness. "It's usually a matter of patients persevering through
different cocktails of medication."

More than 2 million people in the United States are bipolar, or about 1 percent
of adults. The brain disorder is in part hereditary and causes massive mood
swings -- from depression to an excessively "high" manic episode -- that can
last anywhere from days to weeks.

Symptoms of a manic period include racing thoughts, irritability, hypersexuality
and poor judgment. Sufferers may use foul language or go on spending sprees,
leading family members to freeze bank cards. Depressive episodes are marked by
feelings of hopelessness and helplessness, fatigue, difficulty concentrating and
making decisions, chronic pain and suicidal thoughts.

Grippo said she felt it all. Her homelessness was the bottom floor in a long and
confusing descent.

Grippo, who is petite, dresses conservatively, collects trolls and slightly
resembles Cheri Oteri of "Saturday Night Live," said she had an idyllic
childhood in Los Altos. She played soccer and piano and was a Girl Scout. Mother
Nancy, a retired teacher, and father Joe, who worked in management consulting,
were financially secure and provided a loving household for Grippo and her
younger brother, she said.


Adolescence was different. At age 14, Grippo started descending into depression,
but didn't let on. "I played the game, and I was a great actress, but I was a

Her mother recalled, "There seemed to be a shadow, a private part of her I
couldn't get to."

Still, she was intelligent and got high enough marks at Los Altos High School to
earn a partial academic scholarship to UCLA. She studied economics, joined a
sorority, felt hopeless and drank heavily -- "self-medicating," she says.

She quit drinking before her senior year, sensing she was losing control of it.
But alcohol was not her problem. Several months after graduating in 1986, Grippo
had her first manic episode. She felt euphoric and charged. "If you've been
depressed for five years, it feels great. It's a total relief, but it keeps

After a few sleepless nights, she started hearing things. "It would start the
way a baseball game sounds on the radio. Like a cadence," she recalled. "Then I
would hear voices. I would hear things like, 'Go to San Francisco.' I wouldn't
know if it was in my mind or if someone was in the room. It's pretty

Nancy Grippo remembers her daughter going to a Grateful Dead concert at the
Oakland Coliseum with a friend around Christmas time, and not coming home. At
age 21, Diana had spent her first night on the streets. The next afternoon,
workers from Nordstrom in San Francisco called to report that Diana had been
acting psychotic in the store. Her parents picked her up, and on the way home,
she tried to leap out of the moving car.

"That's when I knew something was very wrong," Nancy said.

Thus began a cycle of homelessness, of hospitalizations, of hospital escapes, of
failed attempts to coexist in her parents' home, and of medications that often
felt worse than the confusion. She remembers scuffling with police, being
assaulted by others on the street, and being "never lucid enough to go to a
shelter." She was, however, resourceful: She once played the piano at a posh
hotel while the usual player was on a break, then split with the tips.

In writings she has titled "Diary of a Bag Lady" and keeps on her home computer
as a way of confronting her memories, she recalls telling a concerned stranger,
"I am part of the Light Brigade. I'm helping the people cross the Intersection
of Confusion by pointing clear light at them."

All the while, Nancy and Joe agonized and wondered what to do. They joined the
National Alliance for the Mentally Ill, where they were taught to be aggressive
with treatment. When Diana was hospitalized, they pleaded with authorities to
hold her a little longer, to see if she would come around.

And Nancy, not knowing what else to do, sometimes just drove around the
Tenderloin, looking for her daughter's silver Honda Civic.

It was not a unique ritual in San Francisco. Studies have shown that anywhere
from one-quarter to one-half of homeless people are mentally ill. In the
2001-2002 fiscal year, authorities in San Francisco placed 7,624 people on
72-hour psychiatric holds.

Told of Grippo's story, mental health experts said early, aggressive treatment
is critical. More than 80 percent of mentally ill patients recover with
treatment, but just one-third get treatment at all, according to the National
Alliance for the Mentally Ill.

"An individual has to be ready -- beyond the denial -- because they're going to
be fighting a lot of side effects (from medication) and a lot of stigma," said
alliance spokeswoman Elizabeth Adams. She said support from loved ones is vital.

Homeless advocates said more money is needed for comprehensive outreach, dealing
with medical, housing and job needs. They stressed that, in many cases, mental
illness can be treated like diabetes.

But getting patients to stick with medication is a formidable obstacle. On Jan.
1, a state law went into effect allowing for the forced outpatient treatment of
some unwilling, dangerous patients. But the costly "Laura's Law" has not been
implemented in most counties, including San Francisco, San Mateo and Santa


Near the end of 1998, Nancy and Joe got another call. Diana, who by this time
had been diagnosed with bipolar disorder, had been running in her bare feet and
a summer dress on Highway 101 in Marin County. An officer had talked her into a
squad car.

At Good Samaritan Hospital in San Jose, Nancy said she tapped into her
support-group training and was forceful with a doctor, who decided to try
massive doses of medications. The treatment took, and after a couple of weeks,
Nancy walked into her daughter's room and was met with two words: "Hi, mom."

Something in Diana's eyes was different, normal. "It was like someone coming
back from a long voyage," Nancy said.

Diana moved into the family home in Los Altos, worked as a waitress to save
money, and earned a full scholarship to get her teaching credential at Dominican
University in San Rafael. She earned straight A's. She taught at Redwood High
School in Larkspur for one year, then at Campolindo High School in Moraga for
two more.

Her past was a secret at the schools and at the two technology companies, Intel
and Saba, where she worked in marketing and communications through most of the
1990s. A teacher at heart, she started thinking about the media mentor program
while working at Intel. She believed that she could, by exploiting kids'
interest in mass media, "get kids who don't like English to read and write

But she needed kids for her nonprofit. "You can't just walk through East Palo
Alto shouting, 'Hey, kids, want to put on a show?' " Laid off by Saba in early
2001, she applied for teaching jobs, and turned down six mainstream positions to
work at the computer academy.

The academy, founded more than 20 years ago and featuring smaller classes than
the larger high school, has a 93 percent graduation rate over the past three
years, Grippo said. She believes the kids -- many of whom don't have any family
members who went to college, have had attendance problems and might be
overwhelmed in mainstream classes -- can thrive if engaged.

"These kids don't know how to play the game," Grippo said. "They can feel like
they're going to a job they suck at and can't quit." She encourages them to
think and write about topics that interest them, such as racial discrimination.
During a recent class she allowed Omar Fuggs to perform a rap:

Oh we love to be black

But hate to be associated with the guns we tote

And the dope we smoke

How dare we not create jobs for ourselves

And still wonder why we broke

Douglass called it

Wanting the rain without thunder and lightning

"She's the one you go talk to," Fuggs said of Grippo after his performance. "She


But at the academy, Grippo nearly slipped. In her first week, she found out that
Menlo-Atherton High pays its employees at the end of each month. It was early
September and she needed money for rent and medications to help her sleep.

"I didn't understand and I couldn't sleep. Bottom-line, I got a mild manic, the
first one since the streets," Grippo recalled. She wrote an angry,
profanity-laden e-mail and fired it off to Principal Hartwig's secretary. The
following week, after she had slept and recovered from the episode, she was
called into Hartwig's office.

"I don't really know what to say," Grippo told her boss. "I'm bipolar and I had
a manic, but I'm fine now." Hartwig pulled out his checkbook and said, "Would a
loan help?"

With that, Grippo started to open up about her past to fellow teachers and
students, who have been shocked but supportive -- and say they have since looked
at homeless people with different eyes. "There's still a little bit of
embarrassment," she said. "But now the fear is gone, the fear that my life will
be ruined if people find out. Now I think people just need some knowledge and
they'll understand."

Student Sandra Pena, a junior from Redwood City who wants to be a math teacher,
said, "I was surprised. Who would have thought? Then I was amazed. If a person
wants to move out of that, they can. Then I was happy. She says kids make her

Although she appreciates the small acts of kindness, Grippo suffers from what
she calls "survivor's guilt." She figures she might not have made it if she
wasn't a white woman -- she was always hospitalized, never arrested -- and if
she didn't have her parents' home as a place to rebuild her life.

"Most people on the streets don't have advocates," she said. "That's the only
difference between them and me.”


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