Opinion: In California’s system of care for the mentally ill, leadership is lacking

California is killing people with mental illness. Not for lack of money, but for lack of leadership. Earlier this month in Fullerton, police fatally beat mentally ill Kelly Thomas after he was abandoned by the mental health system. In January, Los Angeles police shot mentally ill Earl Rhodes; in February San Mateo police shot mentally ill Robert Caron. In June, Bakersfield police shot mentally ill Adam Horttor.

But don’t blame the police. They are being forced to tread where the mental health system refuses to go to the aid of people with the most serious mental illnesses. These are often homeless, delusional, psychotic, and yes, sometimes dangerous individuals. Almost all could be helped with treatment. Almost all were abandoned by the California mental health system so they could fund ‘services’ to everyone else. On almost every occasion police take these severely ill individuals to hospitals without incident to see they get care. But they rarely get it. The mental health system releases them and they inevitably deteriorate to become a police responsibility again.

In California you are almost four times more likely to be incarcerated for severe mental illness than treated for it. Thousands of these severely mentally ill prisoners may be released because of the U.S. Supreme Court’s order in Brown v Plata, which decided that the treatment of the mentally ill in California prisons amounts to “cruel and unusual punishment.”

Pre-2004, California counties could claim they didn’t have enough money to treat people with “severe” mental illness. But in 2004, voters chipped in to raise over $800 million annually via Proposition 63, now the Mental Health Services Act (MHSA) for the repeatedly stated purpose of addressing “severe mental illness.” Legal restrictions on use of MHSA prevention funds were particularly specific: such programs must be effective in “preventing mental illnesses from becoming severe” or “successful in reducing the duration of untreated severe mental illness.”

County mental health commissioners have accepted the funding, but not the requirement to spend it on the “severely” mentally ill. With the acquiescence of the almost-defunct Department of Mental Health in Sacramento, they have intentionally diverted funds away from severe mental illness.

San Francisco County is spending money earmarked for prevention of “severe” mental illness – for yoga, line dancing, drumming and Soul Chi (soulful movement), for individuals with ‘sub-clinical’ depression.

King County spends MHSA funds on “equine [horse]-facilitated psychotherapy” and “drumming” for Indian youth reading below grade level or merely “exhibiting … problems.”
Butte County is funding a “Therapeutic Wilderness Experience.”

Contra Costa County is using MHSA funding for a hip-hop carwash, family activity nights, creative learning circles, school programs to reduce dating violence bullying and sexual harassment, outings for the isolated elderly, and a homework club.

Orange County is using MHSA funding for programs specifically limited to those “who have achieved a high level of recovery” and programs that intentionally “focus on the person rather than the disease.” They run groups to improve “personalized socialization,” relationship building, and exploring educational opportunities.

Los Angeles County is funding “emotional recovery” centers, ‘stigma’ campaigns, tuition reimbursement programs, market research, employment offices and a host of other services that arguably benefit the least “severely” ill but inarguably don’t benefit the most “severely” ill. Los Angeles is eliminating a proposal to use MHSA funds to start a Safe Haven Program that would provide a safe environment for chronically homeless individuals with “severe” mental illness because it “has been unable to find a qualified contractor.” But Los Angeles County is still expanding hotlines, warm lines, suicide lines, and referral lines leading to more and more organizations referring to fewer and fewer services. It’s a shell game that’s not helping people with “severe” mental illness and is creating a danger for all of us. Not what voters wanted.

And then there are the enormous amounts of public money being spent on administration. Counties are hiring expensive consultants, enlarging their bureaucracies and even awarding themselves grants, like the $83,000 Contra Costa County gave itself for “stigma reduction and awareness education.”

The reorganization of the California mental health system should not be allowed to proceed without taking into consideration the impact on the most severely mentally ill. By simple majority vote, the Legislature has the power to enact a “clarifying” amendment to get Proposition 63 funds back on track. Laws and regulations should be put in place to insure services that help the severely ill like Laura’s Law, crisis beds, and outreach services go to the front of the funding line, rather than the back.
In some states it is criminal to misallocate earmarked funds.  In California, it’s standard operating procedure.