The hush-hush world of psychiatric hospitals has inspired films like Girl, Interrupted and One Flew Over the Cuckoo's Nest, both of which threw light on a human drama most people never experience firsthand. But when the real-life practices in such institutions are pushed into the spotlight, how far will those in charge go to save face?
Too far, according to Erica Loberg, a former Los Angeles County psychiatric crisis ward employee who faced serious consequences for publishing a book detailing her graphic experiences working at two county hospitals she has chosen not to name.
In one violent passage of her book, Inside the Insane, she writes, “An Ecstasy junkie thrust a tiny Cambodian nurse's frontal lobe into a cement wall and ripped her hair out. … She was not ready but no one was ready for any of this.”
In another, Loberg describes the aftermath when a patient attempted suicide in a Burger King bathroom:
“She said she left the bathroom and there was blood all over her blouse from Walmart. She said when the ambulance came with the police they 'way overdid it.' And that it was a 'waste of taxpayers' money.' ”
Dramatic words — read by very few people. In 2010, Loberg released her book through U.K.-based Chipmunka Publishing, which specializes in stories of mental illness. It made the list of the million top-selling books on Amazon in the U.K.
In reaction to the book, Loberg's bosses in the Los Angeles County Department of Mental Health reassigned her for months to a basement desk job, with no daily human contact. Eventually, she says, she couldn't take it, and the county offered her an undisclosed settlement for her ordeal.
Loberg, 34, grew up in Westwood, graduated from Columbia University and worked in television, deciding in her late 20s to apply for a position at the Department of Mental Health.
She's outspoken and talks plainly about her past struggles with drugs and personal problems. The county hired her in July 2008 as a medical caseworker. Among other things, she helped determine what happened to patients in the psych ward — ranging from discharges to being sent, against their will, to a psychiatric hospital.
Loberg was so shocked by her first day at work that she wrote in her journal that night about a patient smearing feces on the wall, a blaring “code blue” emergency alarm and an encounter with a patient who had tried to kill her own mother.
But Loberg was not just an employee keeping a journal. She was diagnosed with bipolar II disorder in 2005, after years of struggling without treatment. Before she began taking medication, she lived an accelerated existence where extreme multitasking was standard. “I just thought it was normal,” she recalls.
Working in psychiatric wards, Loberg came to believe that patients were being mistreated. She taped a reminder on her refrigerator: “These people need a voice.”
When Inside the Insane was published, an email about it circulated among county workers. “There was a lot of fear,” she says. “No one had read the book yet.”
One dramatic section was about a patient who was a Scientologist: “She didn't like black people. She didn't like much. … It was not clear to me if she was poisoned by the craft of Scientology bullshit-driven acid forming nitrates on the soul, or was lost and off to begin with. … The doctor came into my office to inform me that … 'We don't treat Scientologists.' 'Oh, OK.' 'They don't believe in medication so there's no point.' … So if Scientologists reject people, and they end up on the ward, and the ward shuts their doors to them, where do they go?”
It wasn't until months after the book was published, in August 2010, that Loberg suddenly was ordered to report to the central office. There, she says, Mental Health officials informed her that they had launched an investigation into whether her writing violated privacy laws or department rules.
Until the probe was completed, she says, she was ordered not to speak to previous co-workers or supervisors and not to visit any county hospital. Instead, Loberg says, she communicated solely with an assigned contact in human resources.
The county's probe, incredibly to her, wore on for six months.
“People were really scared to have anything to do with me,” she says.
She then was assigned to review seemingly endless stacks of often decades-old policies in the basement below department headquarters. Loberg, entirely alone, dubbed the surroundings the “holding cell.”
“It was such a joke,” she says, and she began to rebel by taking four-hour lunch breaks and bringing her laptop to work. County officials, she says, didn't say a word.
Mental Health Department officials tell L.A. Weekly that Loberg's case was handled properly and that sticking Loberg in the basement was not punishment.
“We wanted to be sure that … she wouldn't be involved in situations where a breach of health care information might continue,” says Dr. Roderick Shaner, medical director of the Department of Mental Health and part of the executive management staff who reviewed her case.
But he says another reason for assigning her to the basement was “simply education on what PHI [protected health information] is, because it might not be immediately clear. And then we could restore her to service dealing with clients.”
PHI includes 18 identifiers, such as patient names, specific geographic areas and dates, that cannot be publicly released. The department investigated whether information in her book was “de-identifiable”— meaning written in such a way that those reading the book could not reasonably determine the patients' identities.
“We do not think that it met the standards for full de-identification,” Shaner says.
Shaner means Loberg didn't do a perfect job — but he also stresses that he is not suggesting patients in Inside the Insane weren't “sufficiently protected.”
Loberg says the months wore on with no word of when the county's investigation might end. After reading stacks of county policies, she ultimately was assigned to “update” just one item in the massive materials — a task that took a single day. Finally, in February 2011 she went on leave — for depression.
Six months later, Loberg says, she notified the department that she had hired lawyers to represent her; within 24 hours she got a call from county officials. Last summer, she settled and agreed not to sue the county over how she was treated.
Shaner says the Mental Health Department values Loberg as an employee. “We thought that the best thing to do was to be able to have the benefit of her services,” he says. “She's an employee of the department, with clinical skills that we need.”
Even with settlement money and a new job in the huge L.A. County workforce, Loberg says: “You can't put a price tag on depression or what they put me through. It was a check to get rid of me, to silence me. [But] it wasn't about the money.”
Loberg is left wondering who is behaving in strange ways — the patients she once cared for, or a county system in which higher-ups turned her modest publishing dustup into a costly, months-long ordeal.
Loberg says her book was meant to open a cultural dialogue about mental illness, and to show that it should be discussed without shame. “I have no qualms about the ramifications from my book,” she says. But “The way the government and the county handled this is not OK, and that's the story that people need to know about.”
Loberg now works with mentally ill homeless people — a county job. She would like to see changes in the Mental Health Department — including an end to what she says is overmedication of patients, and more funding to educate patients and families in ways to reduce the “revolving door” pattern at mental health facilities.Her greatest desire, she says, is to “tell the truth about our current state of mental health treatment.”
Reach the writer at TaylorFreit@gmail.com.