Cafe 54 in Tucson Is the Real Face of Mental Illness in Arizona, Not Jared Loughner

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A big man has a small cut on his finger.

The boss is concerned.

Work on a prep line in a restaurant and sooner or later, you're going to cut your finger. But we're not talking about any ordinary restaurant, and this employee's no ordinary prep line guy.


New Times cover story

Shadow Dwellers: A Series

What's the one image you took away from the Tucson shootings? We thought so. That mugshot of Jared Loughner is haunting. And for the world, it has become the face of mental illness in Arizona. Here, we know that's not true. A picture may be worth a thousand words, but the story of what it's like to be mentally ill in this place cannot be told in a single photograph.

Tens of thousands of seriously mentally ill people live in Arizona. Some of them look just like you.

Other stories in the series:

Phoenix's Most At-Risk Homeless Find Their Way, Thanks to a Team of "Navigators", by Paul Rubin

Meet Raven, a Homeless Man with More Community Than Many of Us Have, by Paul Rubin

Why Did the Arizona Department of Corrections Put a Mentally Ill Man in Cell with a Convicted Killer?, by Paul Rubin

Mental Illness Hasn't Stopped Chris Shelton from Becoming a World-Class Boxing Historian, by Paul Rubin

Jan Brewer's Response to Jared Loughner: Slash More Than 35 Million in Services from an Already Beleaguered Mental Health System, by Paul Rubin and Amy Silverman

He's a "trainee" working at Cafe 54, a restaurant in downtown Tucson that hires the seriously mentally ill.

On those Food Network shows, the chefs are always cutting themselves. They wrap their wounds in dishtowels and hold them overhead, continuing to cook and bleed.

That doesn't happen in Mindy Bernstein's kitchen. The founder of Cafe 54 sends anyone with more than a paper cut to urgent care.

Most (if not all) of her trainees take a daily cocktail of strong psychotropic medications with a chaser of lots of therapy — their balance is precarious on a good day. Something as simple as a cut finger can start a downward spiral.

And so when this man returns from the doctor with three stitches and a bandage, Bernstein stops him as he hustles back to the kitchen.

"You're not in pain now?" she asks. "Right, they gave you something. But later you will be. You'll need Tylenol and ice. Come and find me. Okay? Promise?"

He promises.

The concept of using food service in vocational rehabilitation efforts for the seriously mentally ill is nothing new. Typically, you'll find such programs housed in hospital cafeterias; one mental-health program in Phoenix used to have its clients prepare and serve food at its functions.

But Cafe 54 is unique (in Arizona, anyway) in its unwillingness to be anything less than a fine-dining establishment. For starters, it's got a great location — walking distance from the über-hip Hotel Congress, as well as to high-rise buildings housing law firms and other big businesses, and just a few doors down from one of the city's most popular restaurants, Cafe Poca Cosa.

Then there's the menu. You'll have fond memories months later of the curry special, and the beet salad is as good as any around. Ingredients are fresh — organic and sourced locally whenever possible. And the atmosphere's a match to the granola Tucson vibe. In fact, the only thing that separates this little cafe from others nearby is the slightly lower price point (no entree costs more than $10), an incentive to customers.

Like many on her professional team at Cafe 54, Mindy Bernstein has more experience working as a clinician with the mentally ill than in the kitchen with beets and carrots. But this daughter of an egg rancher from Fontana, California, had a lifelong dream of opening her own restaurant, and her touches are everywhere — from the kibbutz-like attitude she was raised with to the periwinkle-blue paint (her favorite shade) on the wall behind the cash register.

The high ceilings and exposed pipes, painted cement floors, funky art on the wall — everything is to her specifications. (She also made sure there's more space in the kitchen, so trainees don't get claustrophobic.) More than once in conversation, Bernstein fingers the tabletops, pointing out that she searched all over for an exact match with the brown exposed-brick walls, laughing about her own obsessive-compulsive tendencies.

But she is careful not to use words like "crazy" in jest. For almost 20 years, she has served as executive director of Our Clubhouse, an advocacy and service organization based on a national model that's been around since the 1940s, housed in the building next door to Cafe 54, where Our Clubhouse participants created all the art on the walls. The restaurant is just the latest in a series of projects (if not its most ambitious yet) she's designed to make life better for at least a few Tucsonans hit hardest by mental illness.

Our Clubhouse offers therapy sessions, free meals, a place to use a computer; some clients work at an adjacent thrift store.

Next door, from 11 a.m. to 2 p.m. Monday through Friday, Cafe 54 hums with activity, as artsy types and businesspeople linger at tables, dining on menu items that might include a butternut squash mac 'n' cheese or a Greek beef salad, with treats like chocolate ganache hazelnut tart for dessert. Fresh-baked rosemary rolls are a constant.

Trainees mingle among them, serving food and clearing dishes. It's not easy to qualify to be a trainee. You must be sober, and anger management can't be an issue; only a few can do it.

On your first visit to Cafe 54, you might not notice anything unusual, though the T-shirts, which read "Fresh Cuisine with a Side of Hope," might give it away, or maybe it's that the number you're given to put on your table after you've ordered at the register will bear the photo of a famous person (Sylvia Plath or Teddy Roosevelt, for example) who suffered from mental illness, along with their story. Those were Bernstein's idea, too.

In the kitchen, things run just as smoothly as up front, though it can get crowded with case managers and other social-service types crammed back there with the chef. Everyone takes part in the food preparation; they all look out for one another, too. If someone's having a bad day, they can sit out a shift. At most jobs, you'll get docked for being late; not so here.

There are thousands of people in Pima County diagnosed with serious mental illness — and tens of thousands more in the shadows. So training 18 people at a time seems almost pointless. But the trainees at Cafe 54 put a face on mental illness for their community in an important way. The point is that people with these diseases — schizoaffective disorder, bipolar, clinical depression — can get better. They can be a part of the community.

Even Cafe 54's tiny numbers are in jeopardy. This fall, Bernstein changed the sign on the tip jar on the front counter at Cafe 54. Instead of taking money to support the Clubhouse's arts program, she's raising money to support the trainees' employment. The restaurant is successful but far from self-sufficient, and the government funds that help support each trainee are dwindling.

Those funds are vital. Traineees are paid only minimum wage, but although the cafe does a brisk lunchtime business most days, it's not nearly enough to pay the bills.

Staffing is expensive. For the 2010-11 fiscal year, restaurant sales accounted for about $160,000 of funding; vocational rehabilitation programs and other government funding accounted for the remaining $470,000.

Not long ago, Bernstein came up with a plan to supplement revenue by offering dinnertime meal deliveries. But another byproduct of the business is high turnover among staff. She lost five key employees (including Cafe 54's chef) in about six weeks' time. Those spots have been filled, but the dinner concept is on hold.

Don't be mistaken. This is still a feel-good story. Hang out at Cafe 54 for a day, and it feels pretty darn Utopian.

And that's probably its greatest challenge.

No trainee is supposed to work at Cafe 54 longer than about six months before leaving the nest for a job in the community. Yet some of those interviewed for this story have been there far longer.

Like Leisha Coca. She's worked at Cafe 54 for three years. "I"ve worked here the longest, and know everything," she says with pride.

Her first three months, all she did was wash dishes. Finally, someone asked her whether she could do more. Since then, she's bused tables, baked, done bread service, and worked as a prep cook. Once a week, she serves food.

Before she came to Tucson, Coca worked for Goodwill in Las Vegas. She came here to get sober and to be with her family. She's got three great-grandnieces, and she lives in her mother's guest house.

Coca loves the people at Cafe 54. The other day she started a new medication, and she hasn't been feeling right. Even before she could mention it, someone asked if she was okay and told her to warn them if she was dizzy.

"Everybody's on the ball and good," she says. She's not ready to leave, so Cafe 54's staff has made an exception. It's not the only one. The program employees a job-development specialist, but it's been hard to find outside work for trainees once they are ready. When they do find jobs, they often don't last. And many don't want to leave Cafe 54 in the first place. Hard to blame them.

Bernstein's giant, gray eyes crinkle with laughter. "We have to be meaner," she says ruefully.

And then she gets serious. She understands why trainees don't want to leave: "The world out there is a scary place."

A year ago next month, a young man named Jared Loughner took aim at a crowd at a Safeway, killed a federal judge and a 9-year-old girl, and killed or wounded 17 others, including his target, Congresswoman Gabrielle Giffords. Instantly, Loughner's became the face of mental illness in Tucson — even though, technically speaking, that Safeway was outside the city's limits and Loughner himself lived in another town. A year later, there's still debate over just what sort of signs of mental illness he'd shown before the shooting.

No matter. That infamous mugshot — beamed around the world — became the symbol of a crazy man with a gun in a lawless, heartless state. The tragedy stirred up feelings a lot of people in Arizona (indeed, America) have about isolation — a lack of community, not knowing your neighbors, living without adequate government support and oversight.

In so many ways, Jared Loughner does not symbolize Tucson at all. The city struggles with cuts in government funding but has a long, rich history of reaching out to the seriously mentally ill — by voting in 2006 to fund a state-of-the-art mental-health crisis-response center that opened its doors a few months ago; by supporting its nonprofit regional behavioral-health authority (in contrast, Maricopa County's is run by a for-profit); and by filling Cafe 54 most days at lunch time.

After the January 8 shooting, Tucson didn't just hold a couple of meetings. Foundations have been created, books written. In April, a community forum called "A Delicate Balance: Creating a Better Post-January 8 System to Protect the Public and Help Persons with Serious Mental Illness" included national experts like Thomas Insel, director of the National Institute of Mental Health, and Ken Duckworth, medical director of the National Alliance on Mental Illness (NAMI). Local experts spoke, too, including Clarke Romans.

Romans has headed the local NAMI chapter for decades. He's a big fan of Cafe 54. He likes both the food and the concept.

"It's really a cool place, both conceptually and the way it's managed," Romans says. "It's a portal, I think, back into the real world for a lot of people who had worked and are trying to get back into it or who had never worked."

Word of Cafe 54 has made its way to Phoenix, as well. Romans says a contingent from the Phoenix NAMI chapter came down recently to check out the model, and Chick Arnold, the godfather of mental healthcare — certainly mental health law — in Arizona praises the concept.

"The notion is fabulous," Arnold says, comparing Cafe 54 to a highly successful record-and-tape business begun in Denver in a similar fashion many years ago. "My sense is that with appropriate seasoning and timing and support, Cafe 54 could be a  . . . self-sustaining business."

Instead of creating innovative programs, much of the mental-health community in Arizona has been in crisis mode for years, trying to deal with statewide budget cuts that directly affected the seriously mentally ill.

Those cuts didn't entirely eliminate services, but thousands of people lost access to name-brand medication, therapy, and case managers. Arnold says a lot of numbers have been tossed around, but most local experts agree that there are about 2,000 seriously mentally ill people in Maricopa County who have been lost since July 2010; no one knows whether they are getting help.

More numbers: In November 2010, the Arizona State University Center for Applied Behavioral Health Policy and the Morrison Institute for Public Policy released a report that estimated that 35 percent of the state's adults with serious mental illness do not qualify for AHCCCS (Arizona Health Care Cost Containment System, the state's Medicaid program). That was before the latest cuts this past July. Eddie Sissions, executive director of the Arizona Foundation for Behavioral Health, estimates that in the past two years, state funding for the seriously mentally ill, general mental health/substance abuse and children fell by $114.2 million dollars and affected 36,500 people.

Arnold's caseload is higher than ever, as families struggle to get help — often in emergency situations — for mentally ill loved ones.

In Tucson, it's a similar situation.

"Our call volume is up by about 50 percent from before July 2010," Romans says. NAMI's Tucson office has reached out to the criminal justice system, faith-based organizations, and groups such as Bernstein's Clubhouse. And, as has happened in Maricopa County, the response has been tremendous.

But it's not enough, Romans cautions. Who is going to pay for a seriously mentally ill person's $700-a-month prescription for Abilify, the only medication that works for many people and is now not covered by the government?

Just days after the Tucson tragedy, Governor Jan Brewer announced her plan to make additional cuts to services by eliminating AHCCCS services to childless adults. Her original plan was estimated to affect almost a quarter-million people. It was revised three times to bring the number down to anywhere from 5,000 to 12,000 statewide, Romans says.

Brewer has dealt a cruel blow to the mental-health community, which feels abandoned by her. In the 1990s, as a state legislator, the Republican, who has a mentally ill son herself, championed mental-health issues, helping Democratic colleagues push measures through the conservative Legislature. As governor, she's dropped the issue, and the Legislature has followed her lead.

"Large numbers of individuals, including some with the most severe illnesses and among those most vulnerable, are being left out in the cold," according to a report from NAMI's national office.

"I have a person that works here," Romans says of a seriously mentally ill colleague at the Tucson NAMI office. "And he says to me frequently, 'If I lost my AHCCCS, I don't know what I'd do.' He says, 'I do know what I'd do.' He doesn't say the words, but I know what he means. He'd take his own life."

It's the beginning of her work day, but Cafe 54 trainee Alison Sakariason is already dozing off.

It looks that way, at least. The staff and trainees have gathered on a Wednesday in mid-November in a room at the front of the restaurant for their daily morning meeting.

Today, they are asked to go around the room and talk about what they like best about their jobs — obviously for the benefit of a reporter present.

All but one of the trainees is happy to comply — happy, in fact, to talk in more depth with New Times later that day about their experiences and to have their names used. (Their stories are told alongside their portraits, which accompany this article.)

As the meeting progresses, they are quiet and respectful, waiting their turns and then describing their tasks for the day (dishwashing, baking, prep line, front-of-the-house) and then their favorite part of the job (the other trainees, the atmosphere, the staff).

When it's Sakariason's turn, her eyes open just before her name's called, as though she has been watching everything from behind closed lids. A tiny woman with a kerchief on her head, she's ready with her answer, delivered in a thick Boston accent: "Definitely the people."

Not every workplace would be so understanding about a drowsy employee, but the staff at Cafe 54 gets the effects of the strong medications most (if not all) of the trainees take.

No surprise that there's a waiting list to work at Cafe 54. And so many more who don't even know about it, but could benefit.

As Clarke Romans puts it, "It's a pinhole in a big sheet of paper."

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