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Column: A half-century after failing to reform mental health care, California tries again

There’s a bipartisan attempt in the state Legislature to finally finish the mental health reform that Gov. Ronald Reagan and lawmakers began 56 years ago. They botched the job back then.

Their failure is a major reason why so many homeless people are living on California streets today.

The 1967 reform was a splendid idea. It just didn’t get implemented as promised. Now it needs to be updated — altered to address the realities of mental health care — and given more money.

The reforms under Reagan eliminated warehousing of mentally ill patients — frequently against their will — in depressing, oft-oppressive state hospitals. Everyone was told that the patients could be better treated in their local communities, close to family and friends.

Great concept — except that neither the state nor local governments kicked in enough money for the treatment. Former patients — and thousands who should have been patients — wound up sleeping on downtown streets or in city parks or under freeways.

The reform also worked against mentally ill people getting treatment because it became much more difficult to force them into care. They had to volunteer for it in most cases. And many refused to acknowledge — or didn’t even know — that they were sick.

The 1967 act’s bipartisan authors — conservative Assemblyman Frank Lanterman (R-La Canada), liberal Sen. Nicholas Petris (D-Oakland) and centrist Sen. Alan Short (D-Stockton) — were well-meaning. But as usual in Sacramento, legislation was enacted and there was virtually no followup. Mental health care was dumped in the laps of counties that couldn’t handle it.

I suspected then and still do that Reagan’s main motive was to cut state spending. He was quick to close state hospitals. But he wasn’t about to send lots more state money to counties for local care. The rookie governor was fighting a budget deficit, and he even raised taxes.

Plenty of succeeding governors also have failed to pour needed money into local mental health treatment.

But Gov. Gavin Newson wants to change that.

He’s proposing a bond measure — in the $3 billion to $5 billion range — that would create housing and treatment facilities for 10,000 more people with behavioral health problems. The measure, if approved by the Legislature, would go on next year’s state ballot.

Newsom also proposes to redirect $1 billion annually from the so-called millionaires’ tax to operate the new facilities. That comes from a 2004 ballot initiative designed to help fund local mental health services. It generates about $3.3 billion a year.

Republicans had a better idea last year than Newsom’s bond measure, which would require interest payments. They proposed spending $10 billion of the then-nearly $100-billion state surplus on facilities that would provide mental health and substance abuse treatment for homeless people. But the GOP had no clout, and now there’s a projected deficit.

Last year, the Legislature did approve Newsom’s proposed CARE Court. It will allow family members and medical professionals to petition a judge to order an evaluation of a mentally ill or addicted person and suggest a treatment plan. But it won’t compel anyone to undergo treatment. That would be voluntary.

A coalition of disability and civil rights groups asked the California Supreme Court to throw out the CARE Court program, saying it violated constitutional rights of due process and equal protection. The court recently rejected the request, and the program will be launched this fall.

The leading legislative advocate for re-reforming California’s mental health care programs is state Sen. Susan Talamantes Eggman (D-Stockton), new chair of the Senate Health Committee.

She jockeyed Newsom’s CARE Court bill through the Legislature and will also handle his bond measure.

But her main bill this year would make it easier for people in extreme psychological distress who need treatment to be detained against their will by police, crisis teams and mental health providers. The measure, SB 43, has passed two Senate committees with unanimous votes.

Under current law, people can be detained involuntarily only if they’re deemed to be a danger to themselves or others, or “gravely disabled.” But all that is difficult to prove. Eggman’s bill would significantly lower the bar “so the sickest of people don’t fall through the cracks and splatter on the sidewalks,” she says.

The same coalition that fought the CARE Court also opposes SB 43, contending it would deprive people of their “fundamental rights and liberty.”

“I’m tired of people dying on the street with their rights on,” Eggman counters.

“Oftentimes they don’t even understand something is wrong with them. If they don’t want treatment, they don’t have to take it. They go back and live off the dumpster. These are folks being victimized on the street — abused, beaten up, raped.

“It is not progressive, it is not compassionate to allow people to suffer to the degree we see them on the street. It’s not good for public health. It’s not good for the general population.”

Eggman’s aunt Barbara was one of the sufferers. “That was part of my childhood,” she recalls.

Her aunt would be held for observation for 72 hours and then be released, never getting long-term help. That’s common. After one short-term detention, she was gang-raped and soon died of AIDS.

Eggman’s bill is strongly supported by the Legislature’s two Republican leaders: Sen. Brian Jones of Santee and Assemblyman James Gallagher of Yuba City.

“The goal is to get people stabilized and ultimately back into productive life,” Gallagher says. “They need shelter and services — treatment, job training, transitional housing — as opposed to just putting somebody in a hotel room without services and expecting them to get better.”

What we’ve been doing for decades hasn’t worked very well. We should try something different. It’s long past time for the state to keep a half-century-old promise.



This story originally appeared on LA Times

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