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California Eliminating Mental Illness Treatment

My co-author, Mary Ann Bernard, and I documented some of the ways counties in California are intentionally diverting MHSA funding away from helping people with "severe mental illness."
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An article in California's Capital Weekly (that I co-authored) lists several examples of California police shooting people with mental illness. The article argues that the reason this happens is California's mental health system has stopped treating people with the most severe mental illnesses. This is surprising, because California's Proposition 63 generated $7 billion in funding for the Mental Health Services Act (MHSA) and specifically earmarked it to fund services for "severe" mental illness so the "severely ill" wouldn't be turned over to police.

What happened to the money?

Rose King is a veteran political and legislative consultant who was intimately involved in formulating MHSA legislation, and she is now trying to see it helps the most severely ill. In an interview, she provided the following explanation:

Sacramento perverted the intent of MHSA by using it to create a two-tiered mental health system: A separate and unequal system of new programs for new clients, while people with diagnosed with severe mental illness treated in the "old" system continue to go underserved. Instead of improving services to the most severely ill, MHSA money goes to serve any population in the path of favored local programs -- no diagnosis necessary. Meanwhile, people with severe mental illness in the "old" system continue to be denied access to doctors, medications and therapy.

My co-author, Mary Ann Bernard, and I documented some of the ways counties are intentionally diverting MHSA funding away from helping people with "severe mental illness":

As we wrote in Capital Weekly:

Los Angeles 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.

Counties -- and the programs that benefit from the diversion of funds -- will argue that these efforts "prevent" mental illness. That is false. No one knows how to prevent "severe mental illnesses" like schizophrenia. These are the individuals who need help the most, are least likely to get it, and most likely to need police intervention to get them care.

Meanwhile, programs that could really help the "severely" mentally ill -- those who are foraging dumpsters for food, and screaming at voices only they can hear -- are going unfunded.

Only two counties have adopted Laura's Law, which allows courts, after extensive due process, to order a small subset of people with "severe" mental illness (those likely to become violent without a court order) to accept treatment as a condition for living in the community. It's one program that does what voters wanted Prop 63 to do: help the really needy get really better.

According to Carla Jacobs of the California Treatment Advocacy Coalition, research in New York State shows the program reduces danger to self, 55 percent; danger to others, 47 percent; arrest, 8 percent; incarceration, 87 percent; number of hospitalizations, 77 percent; length of hospitalizations, 56 percent; and improves almost every barometer of wellness. In Nevada County, Laura's Law saved $500,000. Noting that Orange County is considering implementing Laura's Law after the death of Kelly Thomas following his arrest by Fullerton police, Ms. Jacobs asks, "Why aren't the other counties being forced to use MHSA funds to implement this? Whose death are they waiting for?"

Mental Health Services Act money should go to help severely mentally ill people and so should money in the "old" system. The reorganization of mental health services being contemplated by Governor Jerry Brown should not go forward if this doesn't happen.

A majority vote of the legislature can and should stop this misuse of funds immediately. Ms. Bernard believes the legislature should clarify that MHSA funds should be used for severe mental illness, and require illegally diverted funds to be repaid. By two-thirds vote, the money can then be directly allocated by the legislature to programs that prevent relapse into "severe mental illness" as the voters intended. These services would include outreach, crisis beds, medication management, therapy and other programs that are targeted exclusively to people with the most severe mental illnesses.

Ms Bernard also believes counties should fully implement Laura's Law and the legislature should make it mandatory. MHSA funds should be used to help evaluate and get medications and services to the thousands of mentally ill inmates soon to leave California prisons as a result of Brown v. Plata, which determined that California's failure to care for mentally ill prisoners was cruel and unusual punishment.

California has the funding (MHSA) to improve services for people with severe mental illness. What is lacking is the leadership needed to see this funding goes to severe mental illness instead of anything but.