FCL NEWSLETTER -- June, 2000

Over the last several years, it has become clear that California wastes hundreds of millions of dollars every year, causing untold suffering, because jails and prisons are used to house people who have not been adequately treated for their mental illness. While it has long been known that significant numbers of prisoners suffer from serious mental illnesses such as schizophrenia, bipolar disorder, or severe depression, the dimensions of the problem, and the value of solutions have only begun to emerge.

A recent study pointed out that offenders with untreated mental illness cost the criminal justice and corrections system at least $1.2 billion every year. (Pacific Research Institute for Public Policy, "Corrections, Criminal Justice, and the Mentally Ill: Some Observations About Costs in California," September 1966) Part of the problem is that people are sent to county jail when their mental illness leads to a series of violations of the law, often quite minor. Although untreated mental illness is often directly responsible for the offenses that lead to arrest, people are often released without treatment, without regard to their mental condition, and without services or support. All too often, they re-offend, and too many end up in prison.

[Illustration: Someone Who Showed Me the Ropes]

Why Jail Instead of Treatment?

One reason so many of the mentally ill are sent to jail is that most cities rely too much on minimally trained police in coping with people who are mentally ill. Currently, law enforcement officers can receive as little as 6 hours of basic training in how to deal with persons with mental illnesses and developmental disabilities, and there is no continuing education requirement.

As a result, many officers tend to see mental illness as a compliance problem, too often with the result that incidents escalate into resisting arrest charges, or even into the use of deadly force. To avoid such problems, several cities have established special training programs lasting up to 40 hours, and inter-disciplinary teams have been created both to bring services to mentally ill people on the street, and to improve interactions between persons with mental illness, law enforcement and mental health providers.

The long-term decline in availabile public mental health services has also left police with few options. Whether because of poor forsight, or inadequate fiscal incentives, at some times of the day, in some parts of the state, a "mercy booking" into the jail may be the only way an officer can protect a vulnerable person during a mental crisis.

When a mentally ill person is arrested for a minor offense, the case is frequently passed on to a sequence of different attorneys, prosecutors, and judges, none of whom have the time or skill to consider the person's mental condition. To avoid these problems, several counties have established a mental health court where misdemeanor defendants with mental disabilities are offered court-ordered treatment and support services in return for a diversion from prosecution, a reduced sentence, or a term of probation. Mental health specialist probation officers with reduced caseloads are assigned to this court, to provide intensive supervision to people with substantial needs.

How Do We Respect the Mentally Ill?

Most people with a severe mental illness need a community of support to maintain functionality, to notice when medication regimes should be adjusted, and to prevent a crisis from growing into a permanent disability. Low-cost residential rehabilitation and recovery programs have been established in several cities, including Davis, San Francisco, Long Beach, and Escondido to provide such support. These programs have somehow managed to survive the tight mental health budgets that have devistated so many of the people with mental illness who cannot afford private care.

When a person comes to the attention of authorities due to a mental crisis, hospitalization may be a temporary strategy, but a rehabilitation and recovery program may be just as effective, and better over the long term. The problem at this point is often one of re-establishing communication, and motivation. Whereas a hospital-based therapist may consider medication to be a key to recovery, the field staff at a recovery program is in a position to empathize with a client who dislikes the medication, who may be self-medicating with street drugs, and who may simply want to be left alone.

Because a relationship of trust between the therapist and client is essential, voluntary therapy is normally preferable to forced treatment. Involuntary treatment is a last resort, reserved for a person who is dangerous or gravely disabled. Until we know what can be accomplished with adequate voluntary mental health services, it seems unwise to expand the scope of forced treatment.

What You Can Do:

If you or a family member have ever been affected by mental illness, this is the year for you to tell your legislator the story of your experiences with the mental health system. As a taxpayer, you have an interest in these bills, even though you have not personally suffered a mental illness.

Try to picture yourself in a vulnerable situation related to a particular bill, and describe how you would have been affected if the measure had already been enacted. (See the list of bills below.) While people with schizophrenia, bipolar disorder, or severe depression may be capable of committing some crimes, in most cases it seems counter-productive for us to use imprisonment as a penalty. It is time to bring more compassion and fiscal responsibility to the mental health system.

by Steve Birdlebough

AB 1718 (Robert Hertzberg, D., Van Nuys) requires the Commission on Peace Officer Standards and Training to establish continuing education programs for peace officers that will enable them to intervene more effectively and safely in cases involving people who might be mentally ill. FCL SUPPORTS.

AB 1800 (Helen Thomson, D., Davis ) abbreviates the process for subjecting a person with a serious mental illness to involuntary treatment (including medication) and allows the hearing officer to consider a person's deterioration prior to admission, as well as the likelyhood that family, friends, and other members of the community can and will support a voluntary treatment plan. Because the bill expands options for forced treatment, there is some concern that it could compromise efforts to create attractive voluntary mental health programs. FCL OPPOSES.

AB 1969 (Darrell Steinberg, D., Sacramento ) establishes a long-term mental health care working group to further coordination of the State bureaucracies that monitor treatment for mental illness in long-term care facilities and hospitals. FCL SUPPORTS.

AB 2034 (Darrell Steinberg, D., Sacramento ) - appropriates $10 million to continue and expand the community mental health programs established under AB 34 (Steinberg), Chapter 617, Statutes of 1999. Extends these services to transition youth and families living with a severely mentally ill adult. FCL SUPPORTS.

AB 2228 (Dion Aroner, D., Berkeley) provides mental health screening for juvenile offenders. as a first step in developing an appropriate continuum of service responses for juvenile offenders. FCL SUPPORTS.

SB 1534 (Don Perata, D., Oakland) expands the scope of the mental health patient's rights advocacy program, increasing the number of mental health patient advocates per capita, revising the responsibilities of advocates, expanding advocate access to information, and establishing data collection and reporting requirements. It changes the process for imposing civil penalties on facilities or persons found in violation of the rights of a mental health service recipient or in violation of prohibitions of discrimination and retaliation against residents, patients and advocates involved in a complaint, and authorizes county mental health directors to impose penalties. FCL SUPPORTS.

SB 1769 (Wesley Chesbro, D., Arcata) provides a statutory framework for mental health courts to handle cases involving defendants that have a mental disability, providing court-ordered treatment and support services in connection with diversion from prosecution, a sentencing alternative, or a term of probation. The bill is designed to encourage counties to develop a specialized mental health courts with related community-based programs, and monitor defendants' compliance with prescribed treatment programs. FCL SUPPORTS

SB 1770 (Wesley Chesbro, D., Arcata), requires the Department of Mental Health to provide grants to county mental health departments for programs that expand the role of clients and family members in the development of local policy, establish and expand self-help and other client-run programs as well as family-to-family support activities, or improve decision making and choices of clients and family members. FCL SUPPORTS

"A good quality residential care home for mentally ill adults saves the county and the state a lot of money, and saves the people with mental illness and their families a lot of pain and despair," according to Pat Williams, recently retired operator of the Pine Tree Gardens residence in Yolo County. She points out that serious mental illness devastates the family and friends, as well as the the person who has it, but that a supportive homelike setting can give hope of significant recovery.

Sheltered residences with job placement and social services, such as Pine Tree Gardens enable most people to make amazing progress with their illness, avoid homelessness, hospitalization, suicide, and be much happier. Most are able to work part time. Some will be able to manage in an apartment of their own at times, and most will always need the support, structure, social support, and sense of security that comes with access to a good residential care home.

Residents tend to be happiest in a group home with 10 to 15 people that operates like a big family. A 1997 cost analysis of the Pine Tree Gardens home, which serves 15 adults, showed that it saved Yolo County about a quarter of a million dollars per year, due to reduced hospital and crisis house admissions.

For more information about Pine Tree Gardens, contact:

Pat Williams
718 Oeste Drive,
Davis, CA 95616
(530) 753-2006

Ironically, it was in May of last year that the governor rejected clemency pleas from psychiatrists and veterans groups and proceeded with the execution of Manny Babbitt, the Vietnam War vet who suffered from post-traumatic stress disorder. If adequate funding for public mental health programs had been available in the years leading up to Babbitt's murder of Leah Schendel during a combat flashback, perhaps his life would have taken a different course. Even Governor Davis acknowledged in his Mental Health Month decree that "lack of access to mental health care has driven many...vulnerable citizens ...into the criminal justice system."

One of the most powerful forces pushing Davis to support mental health spending and reform is Senate President Pro Tem John Burton (D., San Francisco). Burton told the Los Angeles Times earlier this year, "The issue has moved to the forefront.... I do not believe the administration is going to want to find itself behind the curve."

Burton, joined by Assembly leaders, has established a special committee on the mental health care system. After taking 22 hours of testimony at hearings in Los Angeles, Oakland, and Santa Rosa, as well as extensive research, the committee is currently finalizing its report.

Meanwhile, the Little Hoover Commission, the state agency devoted to making government more effective, has convened a series of meetings of a special mental health policy advisory committee. Its members include FCL staff members Steve Birdlebough and Ken Larsen. The commission will be issuing its own recommendations in the fall.

Also driving the governor's proposed funding increase is the recently released favorable evaluation of the first phase of implementation of AB 34. By spending $10 million in 1999-2000 for integrated community-based housing and treatment services for mentally ill homeless persons in Sacramento, Los Angeles, and Stanislaus counties, AB 34 saved the state $21 million in hospitalization and incarceration costs, according to California Department of Mental Health calculations.

Proponents of expansion of AB 34 programs estimate that a statewide system of community-based care would cost a minimum of $350 million annually. That's a lot of money, but it currently costs about $700 million per year to treat and house mentally ill individuals in prisons and state hospitals and at least an equivalent amount for similar individuals incarcerated in local jails. Another $2.5 billion a year is used to care for mentally ill indigents, reaching about half of the estimated 630,000 Californians in need.

The governor's spending plan goes one step along the way toward reaching the funding levels needed to realize the promise made over thirty years ago when the Lanterman-Petris-Short Act closed down state mental hospitals. At that time, mental health consumers and their families and friends were led to believe the state would develop community-based services. But support never materialized.

Enthusiasm for an increased mental health budget and improved mental health programs is widespread in the legislature. The State Senate has passed a preliminary budget with an even larger augmentation than the governor has proposed. Its proposed $2.8 billion for mental health adds $300 million to Davis' plan. However, the Assembly version of the budget fell more closely into line with the governor's proposed mental health spending levels. Trimming $110 million from the Senate mental health budget, the lower house chose to boost other health care programs, such as pay raises for nursing home workers and fee increases for doctors and dentists who treat poor people. As a result, many of the two dozen mental health reform bills wending their way through the legislature may come out without funding, leaving them little more than shells even if they are signed into law.

"I'm not pleased at all," said Assembly Member Helen Thomson (D., Davis), one the legislature's leading mental health care advocates. "Again, mental health takes a back seat to health care, even though mental health should be a part of the overall system." Nevertheless, Assembly Minority Leader Scott Baugh (R., Huntington Beach) has said about mental health, "It's not a sexy issue designed to get votes. It's an issue designed to help the truly needy...There will be a bipartisan solution."

That bipartisan solution will be forged in the next few weeks, as legislators and the governor work to meet the June 30 deadline for agreeing on a 2000-2001 budget. Key to those decisions will be the members of the joint budget conference committee (see sidebar for contact information). And, with his clearly-established position as a fiscal conservative, Governor Davis will need to hear from a wide range of mental health advocates if he is to be persuaded to go beyond the modest improvements he has put forward.

-Ken Larsen

Governor Gray Davis included the following augmentations in his proposed revision of the 2000-2001 state budget: