LONG BEACH — Dr. Mark Ragins thrusts his palm forward, like a traffic cop instructing cars to stop.
He's discussing the struggles of mental health treatment in California, and tells a story about a patient who reinforces Ragins' belief in a different way to offer treatment
Palm still extended, Ragins recalls: "He asked me, 'What do you see?' ''
"I said, 'C'mon man, I see your hand and your palm.' "
"He says, 'No. Tell me what you see. Be specific.' "
"I said, 'OK, I see your life line and your love line. I can't tell you which is which, but I can see them. I see the folds of your fingers.' "
Ragins, an award-winning psychiatrist and leading advocate of the so-called "Recovery Movement" in mental health, then pauses for effect.
"He tells me, 'When you can see knuckles, and nails and bones, then you will really be able to help me.' "
It is a cornerstone of Ragins' therapy to always see things from the patient's perspective, especially what they need to recover.
Patient-driven treatment is nothing new. But for the first time since Ragins began training mental health professionals in his methods more than two decades ago, one rural county has begun to utilize peers throughout its system.
Tulare County's efforts started here at "The Village," a three-story complex about 20 miles south of Los Angeles, where Ragins is founder, director and tour guide for a reporter during a recent hours-long interview.
Formally named the Mental Health America Village Integrated Services Agency, the nonprofit provides services for some 900 patients through contracts with the Los Angeles County Department of Mental Health and California Department of Rehabilitation. It has also received support from local foundations and charitable trusts.
The Village was recognized as a model program by a mental health commission of President George W. Bush in 2002. President Bill Clinton's Committee on Employment of People with Disabilities called its work training and job placement program a best practice.
Implementing a peer system as comprehensive as Tulare County's would prove nearly impossible in a population sprawl like Los Angeles County, he says. The culture of its mammoth mental health system would have to be reversed, something that took small Tulare County nearly five years to accomplish.
He says punitive, get-tough measures on the mentally ill are rarely warranted and often lead to patient isolation and violence.
But measures like Laura's Law, which give California judges greater power to commit mental health patients without their consent, are sometimes needed, he says.
To help define the difference between those who will respond to treatment and those who must be committed, The Village has trained more than 10,000 mental health specialists during its 25-year history. It has earned approximately $750,000 in revenue for the training, with countless hours of instruction simply given for free, administrators say.
The participants have come from 15 foreign countries, 30 states and 50 of California's 58 counties.
And Ragins, 53, is the man selling the cultural shift he believes is needed for a more refined approach.
Whitmanesque, with abundant hair and beard more salt than pepper, Ragins was raised in a liberal family in the affluent Los Angeles neighborhood of Woodland Hills, with car seats, gates and boundaries designed to protect him. He was a talkative child, constantly asking questions about what he glimpsed on the other side of the barriers.
"Can't you just fit in?" was a common refrain from classmates and authority figures. But Ragins says he turned the tables in adult life "to help other people fit in."
With buy-in from Tulare, and other California counties, he's taken it a step further to harvest untapped value from people who seem hopelessly lost.
"I think people on the edge," Ragins says, "can see things others can't."
Gonzales is a senior reporter with the Center for Health Reporting, an independent news organization that partners with news media to cover California health policy. Located at the USC Annenberg School for Communication and Journalism, it is funded by the nonpartisan California HealthCare Foundation.