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March 2009 Issue

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Author Visits UC to Tell Tale of Divided Mental Health System

Published March 2009

It came as somewhat of a surprise to Steve Lopez that College of Medicine students actually have time to read books other than “Theory and Practice of Histological Techniques” or “Peripheral Vascular Interventions.”

In fact, about 30 students—many clutching copies of his book, “The Soloist: A Lost Dream, an Unlikely Friendship, and the Redemptive Power of Music”—attended a noontime talk at the Medical Sciences Building to hear Lopez discuss his remarkable experience with Nathaniel Anthony Ayers, a street musician on Skid Row in Los Angeles, and a mental health system that often seemed divided on how best to address Ayers’ needs.

The talk was sponsored by the Psychiatry Student Interest Group, which has regular meetings and outings. Aurora Bennett, MD, a professor in the psychiatry department, is faculty adviser for the group and the department’s vice chair for education.

Lopez was in town for several appearances in connection with On the Same Page Cincinnati, the community-wide reading program of the Public Library of Cincinnati and Hamilton County. His book, this year’s selection, has been adapted into a movie starring Robert Downey Jr. as Lopez and Jamie Foxx as Ayers. It opens this April.

Lopez, a columnist for the Los Angeles Times, first encountered Ayers four years ago on Pershing Square—“kind of your version of Fountain Square,” he told the students— in downtown Los Angeles. Standing next to a shopping cart containing his belongings, Ayers was playing classical music on a violin missing two of its four strings. Lopez struck up a conversation with Ayers and began visiting him regularly.

Ayers told his story in bits and pieces—including the revelation that he had once been a music student at the prestigious Juilliard School in New York. And while that startling bit of information checked out, it also became clear to Lopez that Ayers was mentally ill.

“He’d say some incredible things that were really poetic, and other things that sounded kind of nonsensical,” Lopez said. “It was as if his head was full of broken glass.”

Lopez wrote about Ayers and readers responded overwhelmingly, sending instruments for Ayers to play and asking via letters, phone calls and e-mails if Lopez would be able to help him get off the streets—something Ayers adamantly resisted at first.

“They were rooting for him and rooting for me to be able to help him,” Lopez said. “It was a lot of pressure to be under for somebody who knew virtually nothing about mental health.”

Lopez has learned plenty in the last few years as his life has become intertwined with Ayers’. Still, he knows there’s no one-size-fits-all answer to mental illness.

Skid Row, he said, is “a snapshot of our collective failures—that’s what happens when you shut down mental hospitals and never follow through on the promise of community clinics. And we did that across this country.

“It’s easy to dismiss them and to think that somebody’s made a choice to be there, but then you meet somebody like Nathaniel and you find out that they’re not strangers.

“It’s brothers and sisters and sons and daughters, and they were struck down through no fault of their own—especially those who are dealing with mental illness, especially those who are dealing with a genetic predisposition to alcohol or substance addiction.”

So how can society in general— and the medical community in particular—react to the problem?

One psychiatrist told Lopez that the best thing he ever did was “forget everything he learned in medical school,” where he said the approach was all about medication and institutionalization. The important thing was building trust, he said.

Another psychiatrist sent Lopez an e-mail saying, “(Ayers) will never get better without medication. It’s not gonna be about hugs and sunshine and friendship.”

Lopez recognizes the value of medications that can be targeted to specific needs without robbing a person of energy or creativity when used in conjunction with programs such as Project 50 in Los Angeles, where 50 particularly vulnerable homeless people were given complete services to change their lives, including housing.

“You have to do more of this outreach and intervention and more of this supportive housing,” Lopez says, adding that such programs can actually save taxpayers money by reducing hospital and criminal justice costs.

As for Ayers, he agreed to move into supportive housing about a year after meeting Lopez—initially lured by access to the musical instruments that were donated for him and stored at Lamp Community, a downtown Los Angeles agency that works with mentally ill homeless people.

“He’s got greater access to the thing that he loves most, which is the music,” Lopez said. “And from day one he’s been a challenge and an inspiration and just a great gift in my life.”

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