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California and the West

Overhaul of State Mental Health Care Stumbles

Medicine: Assembly trims proposed spending for the troubled system, and lawmakers debate whether to grant authority to force treatment in some cases.


SACRAMENTO — Efforts to overhaul California's long-troubled mental health system are faltering as the Assembly pares back proposed spending for a variety of improvements and Democratic lawmakers struggle over how much authority government should have to treat severely ill people who refuse care.

A bill by Assemblywoman Helen Thomson (D-Davis) that would make it easier to treat people against their will in extreme cases is heading for a vote in the Assembly as early as this week. But before sending the measure to the Assembly floor, the powerful Appropriations Committee stripped it of its funding.

Thomson's legislation, AB 1800, is sure to divide legislators and mental health advocates for the rest of the year. Meanwhile, the fight over funding is coming to a head as legislators and the governor turn their attention to the budget for the new fiscal year beginning July 1.

The state Senate is pushing for a $300-million increase beyond the $2.5 billion that Gov. Gray Davis proposes for California's mental health care system.

However, in its $100-billion version of the new state budget, the Assembly fell in line with Davis' plan by trimming $110 million from an array of programs. For example, the lower house cut back the expansion of a program operating in three counties that seeks to persuade homeless mentally ill people to enter treatment.

In another instance, the Assembly eliminated all funding for a proposed program that would offer outside help to people who care for mentally ill family members.

The Assembly action last week came despite statements by several lawmakers at the start of the year that they intended to greatly boost funding for mental health care. Their statements followed news accounts in The Times and other publications detailing long-standing failings in California's mental health care system.

"It's still record money," Assembly Speaker Bob Hertzberg (D-Sherman Oaks) said. "It is a balancing, in terms of what we can do against other priorities."

As the Assembly was limiting increases for the care of mentally ill people, it boosted other health care programs. The lower house proposes to pay doctors and dentists more for treating poor people, increase health coverage for children of parents whose employers don't offer insurance, and grant 10% pay raises for nursing home workers.

"I'm not pleased at all," Thomson said. "Again, mental health takes a back seat to health care, even though mental health should be part of the overall system."

About two dozen bills aimed at overhauling the system are wending their way through the Legislature. But without money, many of them would be little more than shells even if they are signed into law by Davis.

Sen. Martha Escutia (D-Whittier), for example, has introduced a bill to create a "respite" program for people--generally parents--who care for mentally ill family members. The price tag is $10 million, a fraction of the overall budget, which will approach $100 billion.

In such programs, outside workers care for an ill person for an evening, or for a few days or weeks, while family members take a break. The Senate's budget includes the $10 million; the Assembly stripped the money. The difference will be resolved in the coming weeks as legislative leaders and Davis negotiate final details of the spending plan.

"Some people are saying wait till next year," said Bruce Saltzer, an advocate of the respite idea. "No way. Am I going to tell families in the mental health system to wait another year? It's not fair to them."

In a bit of irony, the Assembly proposed to grant a 33% wage hike for respite workers who help parents or siblings who care for relatives who are mentally retarded or have other developmental disabilities, at a cost of $25.7 million.

"My sense is that mental health took an exceptionally large hit," said Saltzer, executive director of the Assn. of Community Mental Health Agencies, representing 52 nonprofit mental health care providers in Los Angeles. "We thought the Assembly was going to be very supportive."

Meanwhile, lawmakers are locked in a fight over the question of involuntary treatment. The issue has so flummoxed lawmakers that they have delayed releasing a report detailing problems and needs in the system.

Senate President Pro Tem John Burton (D-San Francisco) pushed to establish the committee and asked that it produce the report by May 1. He had hoped the report would support his argument that the system needs far more money.

Committee members are battling over one section in the lengthy report that includes a recommendation that the committee endorse new programs for "involuntary patients."

As the report describes the concept, courts would order that such people undergo treatment after concluding that they are a danger to themselves or others. They would be living on their own or with family members, rather than in locked institutions.

Thomson, co-chair of the select committee, refuses to embrace the report if it ignores mention of involuntary treatment, something she sees as a key part of any overhaul of the system for treating severely mentally ill people.

However, Assemblyman Darrell Steinberg (D-Sacramento), another committee member, opposes Thomson's approach and has voted against her bill, which would revise the state's 30-year-old commitment law by making it easier to impose treatment on the severely mentally ill.

Steinberg is the leading proponent of a program that seeks to persuade homeless mentally ill people to agree to treatment by offering them housing and other help.

"The problem is not the law," Steinberg said. "The problem is that we have been living with an underfunded and fragmented system which has turned people away. AB 1800 could and would catch people in the involuntary system who are amenable to treatment on a voluntary basis, if we provide the service."

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