Fundamental reforms are needed in California's mental health system, which rations care to those in most extreme need while leaving up to 1.5 million ill people untreated, according to a state-commissioned report released Monday.
"We spend billions of dollars dealing with the consequences of untreated mental illness--rather than spending that money wisely on adequate services," according to the report from the Little Hoover Commission. The panel--an independent state oversight agency created by the Legislature--spent more than a year studying the state's mental health system.
The commission found that California, in effect, "criminalizes" people with mental illness, sending thousands of them into the state's jails and prisons for mostly minor offenses, without giving them the treatment or services they need.
The report emphasized that essential services include housing, drug treatment and job assistance, as well as psychiatric care.
"Absent adequate mental health services, the cop has become the clinician. The jail has become a crisis center," wrote Richard R. Terzian, chairman of the commission.
The Los Angeles County Jail functions as the largest de facto mental health facility in the nation, John E. Anderson, a chief at the correctional services division of the Los Angeles County Sheriff's Department, said at a news conference Monday.
"People would be better served out in the community," he said.
That was the idea behind emptying the state's mental institutions, beginning a generation ago. Advocates argued that patients had a right to lead their own lives on the outside with the help of community-based treatment.
But according to the Little Hoover report, "it is painfully clear that we have failed to follow through with all that was required by this noble decision."
As a result of the dearth of community services, mental health patients have ended up behind bars, on street corners and in parks, the report says.
Terzian acknowledged that the report did not resolve one of the most divisive issues among mental health advocates in the state--whether the laws ought to be amended to make it easier to commit seriously ill patients for involuntary treatment. Although the divisions are not clear-cut, many patients rights groups oppose the idea, while many family members tend to support it.
Terzian said a majority of the commission decided it was best to wait until voluntary treatment services had been improved and given a chance to work.
Although mental health advocates generally lauded the report, some were dismayed that the commission did not weigh in more decisively in the debate.
"In the throes of their disease, [some patients] have no recognition of their illness," said Brian Jacobs, president of the California chapter of the National Alliance for the Mentally Ill. Expecting them to seek treatment voluntarily is "like asking a person with two broken legs to walk to a hospital."
The commission did make other sweeping recommendations, the most significant of which was to see that no one who needs services be denied them. The body estimated that 1.5 million Californians need help but do not receive it.
More specifically, the commission recommended creating a California Mental Health Advocacy Commission--including members from business, labor, taxpayer and education groups--to provide direction to policymakers and push for fundamental reform in the state.
The Little Hoover report decried what it called the uneven and unstable funding for local mental health agencies, which leads to a patchwork of services and rationing of care. It recommended creating a stable funding base that provides incentives for agencies to improve services and outcomes.
In addition, the report urged expanding early treatment and crisis intervention so that patients don't end up in the criminal justice system. For those mentally ill people who are arrested, the commission urged coordination of services between law enforcement and mental health programs.
In Los Angeles County, such efforts are underway, Anderson said. He cited the creation of a transition unit at the Los Angeles County Jail designed to connect inmates with community organizations and programs before they leave custody. That unit will have an open house for an expected 100 community organizations today.
Los Angeles County Mental Health Director Marvin Southard said that his agency has begun revamping the way it does business. Initial reforms include improving psychiatric care in community-based nursing homes that have been criticized for providing poor quality care to mentally ill people.
He said he was responding, in part, to a Times series last year, which found that abuse and neglect in these homes is all too common, and that oversight is spotty.