From Colleagues in L.A. System : New Mental Health Director Wins High Praise

Methodical. Kind. Tough. Tireless. Clear-thinking. Direct. Wonderful.

With such adjectives, people who have worked with and for Areta Crowell appear unanimous that Los Angeles’ loss will be San Diego’s gain--a county mental health director who knows where she wants to take a system and can inspire others to help move it there.

Crowell will take the San Diego job in mid-May, ending two decades of holding key positions in the Los Angeles County Department of Mental Health.

“She’s a remarkable person,� said Dr. Milton Miller, professor and chairman of the Department of Psychiatry at Los Angeles County Harbor-UCLA Medical Center. “Gentle, kind, polite, tough, meticulous, methodical. She will be a boss who believes in the job.

‘At the Top’

“Among a handful of people I have met in 40 years, I would say Areta Crowell stands at or near the very top on the credential of believing in the job and wanting to do it with class. Exclamation point.�

Crowell has developed a consistent image, Miller said.

“One of the remarkable things about Areta Crowell is that she is what she is. Everybody will tell you the same thing,� he said. “She’s a mix of the practical and the spiritual. She can hold a dream even in the face of all kinds of practical problems.�

“She’s wonderful to work for, because the directions are always clear. You know what’s expected,� said Phyllis Key, acting director of the La Puente Community Mental Health Center, in the eastern part of L.A.’s San Gabriel Valley, where Crowell was regional director in 1985 and 1986. “She also is very eager for input, in terms of planning and decision-making.�

San Diego ‘Really Lucky’

“You guys are really lucky,� said Dr. John Wells, director of services for the San Gabriel Valley area. He provided the closest thing to criticism that anyone seemed to have:

“She keeps you hopping,� Wells said. “She has got a lot of work on her mind for everybody to try to do and take care of. She’s not always fun to work for because she does make it clear what your work instructions are.�

Crowell surely will have plenty of those to give when she takes over as deputy director in charge of mental health services for the San Diego County Department of Health Services. It is a task as difficult as the title is long.

Having rebounded from serious allegations of substandard care at its Hillcrest mental hospital, the county’s mental health system for indigents nevertheless faces a tangle of problems with one taproot: a lack of money.

Critical Report

The system is poorly organized and loosely administered, and it suffers from a chronic lack of facilities for caring for the county’s mentally ill indigents, a task force of the San Diego Medical Society reported in November.

The 60-bed Hillcrest hospital can hardly begin to care for the people who need help, the task force said. Every month, police alone bring about 150 severely disturbed patients in immediate crisis for screening there.

“A high-ranking police official said that waits for evaluation of these patients in the screening area range from two to five and one half hours . . . The Task Force received especially disturbing reports of suicidal patients transported to the screening area only to be released and subsequently kill themselves,� the report said.

Faced with such problems, Crowell said she plans to focus on finding funding sources as well as on planning how to best spend what money the county does have.

Funding Top Priority

“I think the biggest problem in San Diego is the lack of state financing,� Crowell said. “I think everything we can do to support getting a better funding into the program is a top priority. I believe in being aggressive in going after all kinds of moneys and getting as much support from whatever source we can.�

She applauded the county for suing the state to get a fairer share of its mental health funds and resources. “That is just the kind of leadership that is needed on behalf of the citizens of San Diego,� she said.

The stigma of mental illness kept the country from spending the money necessary to succeed at deinstitutionalizing the mentally ill in recent years, Crowell said. She served on a state task force that in 1978 developed a plan showing how to care for the people released from California mental hospitals. The plan was never implemented.

“The state got too frightened of the money, although the money that it would have taken was actually no more than if everybody had stayed in state hospitals,� she said.

Mentally Ill on Streets

As a consequence, mental health administrators all over California are “struggling with how to find the right balance� as the mentally ill wander the streets because there are few community services to help them. It is estimated that 25% to 50% of the homeless are mentally ill, she noted.

In San Diego, Crowell said, she expects to work with community groups and members of the mental health community to set priorities. But she already has some ideas about the direction in which a mental health system should head.

“The system has to give priority to the seriously mentally ill adults and the severely ill children, but also to the geriatric population, which has not been served,� Crowell said. “Those three groups do need special program planning within the limits of funding.�

She also is committed to the idea of shifting the emphasis in treatment of the mentally ill to community services, rather than institutionalization. That is moving very slowly, she said.

“As long as there aren’t enough dollars, there will always be problems with the system,� Crowell said.

With that as a given, she said, she will rely on her experience in planning, administration and working with community groups to guide her along a challenging road.