FCL NEWSLETTER -- May, 2001

Repairing Mental Health

Several bills have been introduced this year in response to the Little Hoover Commission's scathing report on mental health care deficiencies in California issued last November and entitled Being There ? Making a Commitment to Mental Health. The document is the product of extensive research and a number of public hearings. (A review of this report and its relationship to the work of the FCL Education Fund appears elsewhere in this Newsletter.)

Advocacy

AB 1422 (Helen Thomson, D., Davis) creates a state mental health advocacy commission, recommended by the report as a first step toward assuring that "no one who needs care is denied access to high quality, tailored mental health services." The advocacy commission is intended to guide policymakers over the next five years. It would establish expectations for the mental health care system and outline strategies to realize those expectations. Members would come from all parts of the mental health care system. The Little Hoover report recommends a limited term for the advocacy commission, so that it does not become another layer of bureaucracy. AB 1422 stipulates sunset in 2007. FCL SUPPORTS.

Funding

The Little Hoover report asserts that current patterns of state funding for mental health services fail to provide incentives for local programs to adopt best practices, improve system outcomes, and generate long-term savings in the criminal justice and health care areas. SB 30 (Wes Chesbro, D., Arcata) responds to this concern by initiating a process to restructure funding arrangements. The bill establishes a work group including the Department of Mental Health, Department of Finance, and Legislative Analyst, together with mental health clients and their families. The group's responsibility is to develop practical options that would lead to improved access to support services, improved accountability, and cost- effectiveness. SB 30 seeks recommendations that would include options for publicly funded services to persons eligible under current law as well as expand services to others in need. FCL SUPPORTS.

Care

The Little Hoover report recognizes that a result of poor mental health service is that jails become the safety net for the mentally ill and their families in times of crisis. The report recommends focused efforts to ensure that no one ends up in jail or prison due to inadequate mental health care. To improve conditions for the mentally ill who are imprisoned, the report recommends establishment of a council on offenders with special needs. This council would work to identify the best treatment strategies for the difficult task of providing treatment in a penal institution, and to improve the transition from incarceration to the community.

SB 1059 (Don Perata, D., Alameda) establishes a Council on Mentally Ill Offenders, to promote cost-effective approaches to meeting the long-term needs of mental health clients in the criminal justice system. FCL SUPPORTS.

Supervision

The tragic killing of Laura Wilcox, of Grass Valley Friends Meeting, as she was working at the local mental health clinic, underscores the importance of improving mental health services in all communities. The man who shot Laura and two other people may well have been receiving inadequate therapy for a recognized mental condition, and he had access to numerous guns. It also appears that he was living alone and it is unknown whether he was taking prescribed medications regularly. Laura's death illustrates one of the dangers in California's failures to attend to mental illness. It poses classic questions concerning treatment of mental illness in the community and the value of closer outpatient supervision. Would court supervision of therapy and medication help in certain cases? If so, what tests can reliably be used to decide who needs this kind of supervision?

Currently in California, outpatient supervision for the mentally ill arises mainly through probation orders of criminal courts' special mental health court. In more serious cases, individuals committed to a state hospital may get outpatient treatment under a conditional release parole.

Just when and how to approach outpatient supervision in the civil arena is the subject of two different measures: SB 931 (John Burton, D., San Francisco) and AB 1421 (Helen Thomson, D., Davis). Both measures recognize that free access to quality counseling and therapy on a voluntary basis are essential before compulsory outpatient treatment is employed. The Burton bill seeks to put pilot programs in place next year, and to study the issue of compulsion as more quality services are demonstrated. The Thomson measure would establish pilot programs in several counties to test the value of a combination of services and compulsory outpatient treatment.

WHAT YOU CAN DO

Talk with mental health professionals in your community about the quality of services available and trends in response to developments at the state level. Let the authors of these measures know what you find out, and encourage people in the field to write as well. Send copies of your letters to FCL.

Resources on the Mental Health System

A Review of the Little Hoover Commission Report on Adult Mental Health

People experiencing mental illness are among our most fragile citizens. Their impaired judgment and poor reasoning abilities frequently make it difficult for them to relate to others and to take care of themselves.

In 1991, the Friends Committee on Legislation Education Fund received a bequest from the Eggers family. With the assistance of that bequest, the Education Fund in 1996 commissioned Mary V. Clare and later, in 1999, commissioned Michael Garabedian to carry out research on the conditions experienced by mentally ill individuals incarcerated in our state's prisons and jails. In 1999-2000, Steve Birdlebough and Ken Larsen, Legislative Advocates for the Friends Committee on Legislation of California, joined the Little Hoover Commission (LHC) Adult Mental Health Advisory Committee. The Committee assisted the Commission with its study of the quality and availability of mental health services for California's adults. LHC is an independent, non-partisan state agency charged with responsibility to "promote efficiency, economy and improved service" in state government operations. Steve and Ken were able to bring to the Commission some of our findings. Although our research focus was Southern California, the existing conditions applied to the entire state of California.

The Commission discovered something that sets mental health policies apart from others: despite programs and promises, California explicitly rations care to those with the most extreme needs ? and even then we turn people away.

The FCL Education Fund's research found that mentally ill individuals' impaired reasoning and actions that are unacceptable to others brings these individuals into contact with law enforcement agencies. Because of police intervention in these community and family incidents, many are arrested, incarcerated in county jails, convicted of a crime and confined. In this manner, behavior caused by mental illness can become defined as criminal, and result in criminal sanctions, even though criminal intent may not exist.

The Commission discovered that Californians spend billions of dollars dealing with the consequences of untreated mental illness ? rather than spending that money wisely on adequate services. We have, in effect, criminalized mental illness. State law instructs counties to turn away those in need because funding is limited. Nevertheless, law enforcement is expected to respond to every call, to keep every peace, and to ensure everyone's safety. In the absence of adequate mental health services, the police officer becomes the clinician. The jail becomes the crisis center.

The Commission's report runs over 125 pages and confirms the findings of the Friends Committee on Legislation Education Fund research. The report very specifically brings attention to the status of the 1.5 million Californians who need help, but do not receive it. They point out that the Lanterman-Petris-Short Act removed "need for treatment" from the criteria under which people could be involuntarily hospitalized.

Under the Act, only those gravely disabled as evidenced by lack of food, shelter and clothing or danger to self or others as a result of mental disorder can be involuntarily treated. Adopting the Act meant thousands of people could not be forcibly hospitalized.

Community-based, voluntary treatment was expected to replace institutional care. But funding did not follow clients from the state hospital system into communities to provide services. ( Being There, p. 17)

The Commission confirms the Education Fund's findings on Criminal Justice ( Being There, p. 2). California's local and state criminal justice systems have become a secondary mental health system, and state psychiatric hospitals have become a branch of the criminal justice system. The merging of mental health and criminal justice reflects the priority given to public safety. It also reflects the mental health system's inability to adequately care for those in need and prevent the nuisance crimes of survival ? vagrancy, public drunkenness, trespassing ? that are actions of people with no allies and no options

The Little Hoover Commission Report recommends that the State "decriminalize mental illness by ensuring that no one ends up in the criminal justice system solely because of inadequate mental health care." Some immediate steps recommended:
(1) Determine how and where clients come into contact with the criminal justice system;
(2) Document the local needs for programs to prevent incarceration and fund them;
(3) Evaluate the benefits of various programs and make improvements to assure their effectiveness;
(4) Establish a California Council on Offenders with Special Needs; and
(5) Investigate and promote cost-effective approaches to meeting the long-term needs of mentally ill offenders.

Extensive appendices and notes provide documentation and names of organizations and individuals who were involved in these findings as well as mental health information sources and organizations.

The Little Hoover Commission Report concludes that "the Com- mission's . . . findings and recommendations articulate the need to establish broad public expectations for mental health policy and an obligation for providing mental health services. The Department of Mental Health and state funding need to be aligned to the goals of helping communities provide comprehensive mental health care. Finally, the State must end its reliance on the criminal justice system to serve as a surrogate for community- based mental health services" (Being There, p. 91). We could not agree more.