Shifting politics pushes mental health care onto the agenda

Gov. Gray Davis visited the Los Angeles Times’ Sacramento Bureau in 1999 not long after he was sworn in and took questions from reporters who gathered in the conference room, me included.

When my turn came, I asked him what his plan was for the mental health care system. He paused to think and answered: The issue was not on the agenda. The response was direct and honest, and hardly unique.

Davis’s primary issue was public education. It was, his aides repeated, his first, second and third priorities–though public safety ranked high as well. If the words, mental illness, were uttered on the 1998 gubernatorial campaign trail, it is lost to history.

Ever since Ronald Reagan signed the Lanterman-Petris-Short Act in 1967 granting people with severe mental illness greater rights and speeding the emptying of state asylums, governors have been sidestepping the issue, until now.

It’s understandable. The issue is complex. The causes of mental illness are little understood, solutions, if they exist, will be costly, and success is hard to measure. If politicians needed another reason to dwell on almost any other topic, people most directly affected neither vote nor donate.

Ever since Ronald Reagan signed the Lanterman-Petris-Short Act in 1967 granting people with severe mental illness greater rights and speeding the emptying of state asylums, governors have been sidestepping the issue, until now.

“You’re just immediately criticized and protested, and the ROI on that often is pretty modest,” Gov, Gavin Newsom told me last year, explaining why few elected officials focus on the issue.

The calculation clearly has changed in California. If suffering on the streets isn’t enough to motivate politicians to confront the issue, voters’ attitudes toward homelessness and mental illness certainly are providing an incentive.

Campaign strategist Andrew Acosta commissioned a poll last year asking Sacramento voters: What are the one or two most important issues facing the city today?

Homelessness was listed by 71% of the respondents, far above housing costs, crime and the price of gas. A decade earlier, in 2012, only 2% of Sacramento voters listed homelessness as being a top concern.

A recent Public Policy Institute of California survey showed that 89% of likely voters believe there’s a mental health crisis, a view that cuts across party lines, income and education levels. Not all homeless people have a mental illness, but the best estimates are that a fourth of them have such a disability.

From his position on the Southern California Leadership Council, Davis now focuses much of his attention on homelessness. For voters, it’s an overriding issue.

“Politics are where the people are,” Davis said in a recent interview. Homelessness is an issue that “both scares people and creates a sense of guilt.” And it is driving politicians to act, none more so than Newsom.

Unlike governors before him in this state or perhaps any other, Newsom is confronting the issue of untreated mental illness. At his urging, lawmakers have approved significant changes to California’s mental health care law that seemed unattainable even a few years ago, and, if implemented, could represent a fundamental shift in the care of the most severely mentally ill among us.

Last year, the Legislature agreed to Newsom’s plan to establish a new court system in which judges will be able to direct that people with severe mental illness seek treatment.

This year, Newsom signed legislation by Sen. Susan Eggman, D-Stockton, to expand circumstances under which people with severe mental illness can be held and treated. Five earlier iterations of that bill stalled in past sessions. This year, no legislator cast a no vote as it passed 40-0 in the Senate and 75-0 in the Assembly.

Unlike governors before him in this state or perhaps any other, Newsom is confronting the issue of untreated mental illness.

Voters will have a chance to speak their collective minds in March when Newsom asks them to earmark $6.38 billion to pay for 11,500 treatment beds and other housing for people with serious illnesses of the brain.

To grasp the magnitude of the shift, step back to when Davis was new to the corner office, and Assemblywoman Helen Thomson, D-Davis, a psychiatric nurse by training, battled to pass legislation that would allow for a more aggressive approach to untreated mental illness.

From the time she was elected, Thomson pushed legislation to authorize judges to require that people with severe mental illness accept treatment. Her hope was that people would receive care in their communities–assisted outpatient treatment–not in jails or locked institutions or left to die on the streets.

“It was like lighting dynamite and throwing it down the hallway at the Capitol. The pillars all cracked,” Thomson told me in a 2021 interview, recalling the reaction to her proposal.

Opponents, some of whom said they were former psychiatric patients, crammed hearing rooms and demonstrated outside the Capitol, calling Thomson “Nurse Ratched,” a reference to the villainous character in “One Flew Over the Cuckoos’ Nest.”

The ACLU and Disability Rights California opposed Thomson’s efforts, contending that it would infringe on individuals’ civil liberties. The Church of Scientology, true to its dogma, fought Thomson’s legislation by claiming psychiatry is fraudulent and the bill would result in “forced drugging” and run-away spending. The three groups opposed the latest changes too.

The California Psychological Association was among the most effective opponents of Thomson’s bill, arguing people would resist being compelled to undergo treatment, and that a voluntary approach was more effective.

Reflecting a shift in attitudes, the psychologists took no stand on Eggman’s bill or on Newsom’s new court system, though each would go further than Thomson’s legislation two decades ago.

In her second term, in 2000, the Assembly approved a version of her legislation—and then Senate President Pro Tem John Burton, D-San Francisco, the Legislature’s most influential member at the time, stepped in.

Opponents, some of whom said they were former psychiatric patients, crammed hearing rooms and demonstrated outside the Capitol, calling Thomson “Nurse Ratched,” a reference to the villainous character in “One Flew Over the Cuckoos’ Nest.”

Burton was a young assemblyman in 1967 and recalled reports from that time of abuses in state hospitals. In 1967, he and fellow San Francisco Assemblyman Willie Brown introduced legislation that would have made it far harder for authorities to commit people to state hospitals.

That bill died when Assemblyman Frank Lanterman, a Republican from La Cañada Flintridge and the Legislature’s expert on the issue, big-footed the upstarts from San Francisco.

Supported by Speaker Jesse Unruh, Lanterman teamed with Democratic Senators Nicholas Petris of Oakland and Alan Short of Stockton to pass the more comprehensive – though flawed – Lanterman-Petris-Short Act.

“Forced medication? I’m against it and it won’t happen,” Burton told me in 2000 when I worked for the Los Angeles Times. “It took many, many years to deal with that issue . . . and I’m sure we’ll put any revision in for a long, long study to see what exactly should or shouldn’t be done.”

Burton proceeded to bury Thomson’s bill.

After winning reelection to a final term in November 2000, Thomson was planning to reintroduce her legislation when on Jan. 10, 2001, Scott Thorpe showed up at the Nevada County Department of Behavioral Health, with a 9 mm handgun. Thorpe, who had been amassing guns, was becoming ever more paranoid, believing that his county psychiatrist was conspiring with the FBI to poison his marijuana.

Laura Wilcox, the 1999 valedictorian at Nevada Union High School, was home for winter break from Haverford College. Wanting to earn money for a summer trip to Paris, she took a temporary job as a receptionist at the behavioral health department, which was housed in an old morgue and hospital in Nevada City.

By the time Thorpe was done shooting, Laura and another woman were dead. Unable to find his psychiatrist, Thorpe drove to a restaurant where he killed a third person.

A week later, Mike Bowers, a 37-year-old man who had been released from Patton State Hospital in 1999 against his psychiatrists’ recommendation, killed himself by plowing his 18-wheel truck at 50 mph into the south side of the Capitol. Legislators, staffers and lobbyists escaped injury. But as Thomson saw it, the crash made clear the need for her bill.

“What is so sad is that I get letters telling stories like this every day,” Thomson said, as quoted by the L.A. Times. “Now it is on the front door of the Capitol, very graphically and very tragically.”

The following month, Thomson reintroduced her bill, this time with a name, Laura’s Law.

Battle lines remained the same. The ACLU and Disability Right California opposed it, as did the psychologists.

Thomson also had significant allies, including the California Medical Association, the association that represents psychiatrists, the National Alliance on Mental Illness, and Nick and Amanda Wilcox, Laura’s grieving and determined parents.

Thomson also slipped into Burton’s home turf and secured a letter of support from Burton’s long-time friend, Willie Brown, who was in his second term as San Francisco mayor.

Like Burton and other legislators, Brown voted for the Lanterman-Petris-Short Act in 1967. As mayor, however, Brown grappled with homeless people, many of whom were mentally ill.

“It is clear that many severely mentally ill people are not receiving the necessary treatment that could prevent further deterioration [of] their mental and physical health,” Brown wrote in his letter urging passage of Thomson’s bill.

Burton remained opposed, as did several Senate Democrats. The Senate Health Committee held two hearings, one of which lasted three and a half hours. Thomson became so angry that she walked out of the hearing, leaving a staffer to defend the bill. The bill stalled in 2001, but Thomson revived the bill in 2002, made narrower by Senate amendments.

In the amended version, participation by counties was voluntary, and the state would provide no funding. Nor would there be a penalty if individuals failed to comply with judges’ orders that they accept treatment.

Like Burton and other legislators, Brown voted for the Lanterman-Petris-Short Act in 1967. As mayor, however, Brown grappled with homeless people, many of whom were mentally ill.

In its weakened form, the bill passed the 40-seat Senate 27-8, with eight Republicans joining 19 Democrats in support. Burton remained a no-vote. Five other senators didn’t vote, among them the Senate Health Committee chairwoman, Deborah Ortiz, D-Sacramento. The Assembly gave final approval by a 73-4 vote, sending it to Gray Davis’s desk in September 2002, as he faced a tough reelection.

The governor’s bill file, housed in the State Archives, offers a window into the crosscurrents facing Davis as he mulled over whether to sign the measure.

The ACLU remained steadfast in its opposition. Echoing civil libertarians’ view, Sen. Ray Haynes, of Riverside who was the Senate GOP’s whip, sent a letter urging that Davis veto the bill.

“This is an issue of personal liberty,” Haynes wrote. “This bill would allow people to be required to take medications based on anything from an inaccurate written statement from someone other than an untrained professional or by vague determinations with no real basis. … Let’s use these funds for voluntary outpatient treatments for individuals who need help and have made their own choice to seek it in this way.”

Davis’s staff prepared two veto messages. One prepared by the Department of Finance amid a budget deficit said state costs could rise to $60 million annually.

The second proposed veto message spelled out philosophical arguments against it, saying “implementation of a program that is highly controversial, whose efficacy has not been clearly demonstrated, and that may have constitutional and human rights issues without adequate resources for the provision of the necessary increased treatment services, monitoring and oversight, may have unforeseen consequences.”

On the final day to take action, Davis signed the bill. In an interview, he explained why.

“My main interest was public safety. The safety of the mentally ill person and the safety of the people around him,” Davis said. The system, he said, was failing, and “doing nothing was not an option.”

During his years in office, Davis signed other significant bills related mental health care including one intended to force insurance companies to grant parity in their coverage of treated mental and physical illness–an issue that continues to bedevil individuals and regulators.

In 2002, he held a summit on homelessness and signed legislation that placed a $2.1 billion bond on the ballot to provide low cost housing. “Californians can no longer afford to avert their eyes,” he said at the time. Davis also cautioned that there was no silver bullet, an understatement given the ever worsening homeless crisis.

Gavin Newsom, a young San Francisco supervisor who was planning a run for mayor, attended Davis’s summit, focusing then as now on dealing with untreated mental illness and homelessness.

Newsom lamented then about the impact of homelessness on business and its human toll. In 2000, he had said, 183 homeless people died on the streets of San Francisco. As fentanyl overdoses multiplied 20 years later, 331 people died on the streets.

For all the attention and emotion surrounding Laura’s Law, its impact has been limited. At first, only semi-rural Nevada County, where Thorpe went on his rampage, provided the more intensive care envisioned by Thomson. Los Angeles, San Diego and San Francisco counties didn’t begin participating until 2015.

For all the attention and emotion surrounding Laura’s Law, its impact has been limited.

In a report dated May 2022 assessing results of the law, the California Department of Health Care Services said that among people who participated in a one-year period in 2019-2020, homelessness, hospitalization and contact with law enforcement decreased significantly.

But the report also made clear its reach is limited. Authorities in 23 counties referred a mere 2,420 individuals for intensive care, the report said. More than 1,300 of them either were deemed to be ineligible or could not be found. Some people referred to courts agreed to participate voluntarily. Courts directed more intensive care for a mere 258 people.

In a recent interview, Ortiz, the former Senate Health Committee chair, said the politics and more importantly the reality on the streets has changed.

“We as a society failed on all fronts. I’m not a conservative but we have failed,” Oritz said. “We have to stop ignoring it.”

Back to Newsom’s comment about how for politicians who dare to focus on the issue, the return on investment is not high. The issue is complicated, solutions are elusive, and victories are hard to come by. But times and politics have shifted. And now mental health care is on the agenda.