The California Mental Health System and the Death of Mentally Ill Kelly Thomas

In California, it is playing out with relentless familiarity: the death of Kelly Thomas at the hands of Fullerton police has led to the usual criticisms of the police and calls for better training and more compassion.

But Carla Jacobs, founder of the California Treatment Advocacy Coalition founder, and California's most astute mental illness advocate, notes in an interview that while police could always use better training in how to handle dangerous mentally ill individuals, the police are not always the villains: "When it comes to treating people with the most serious mental illnesses, the police will react where California's mental health system won't. Police are almost never out on a call regarding mental illness unless one condition is met: the mentally ill person has been abandoned by the mental health system. That's when they deteriorate, become psychotic, delusional and dangerous."

That happens too often. Ms. Jacobs remembers when mentally ill Edward Charles Allaway killed seven individuals on the Fullerton campus of California. "It was police who tracked him down." Ms. Jacobs' own sister-in-law was abandoned by the mental health system and shot her mother. Again: the police stepped in.

As Randall Hagar, Director of Government Affairs for the California Psychiatric Association who has been a relentless advocate for better care for the most seriously ill observed, "About 50% of people with schizophrenia suffer from anosognosia, the inability to recognize they are ill because the illness eliminates the capacity of the brain to exercise insight. Medications can provide the type of symptom reduction that can prevent violence."

California's mental health system needlessly and intentionally created their own horrific and violent catch-22: it refuses to provide any treatment unless the mentally ill person is well enough to recognize their need for it. All others are turned over to the police. And even their hands are tied until after the individual becomes danger to self or others. Mr. Thomas's family made multiple attempts to get California's mental health system to help Kelly. On the KFI John and Ken show, Kelly Thomas's sister said, "We tried everything... I feel it is the law that has kept us from keeping him in a place on his medication and healthy." The system refused to budge.

Law enforcement is desperate to return treatment of the seriously ill to the mental health system. Untreated seriously mentally ill not only put the public at risk, they put officers at risk. Michael Biassotti, Vice President of the NYS Chiefs of Police wrote movingly on police and mentally ill after an incident in NYS:

The last thing any police officer wants to do is pull out a gun. It's a sign that something has gone terribly wrong. But increasingly officers are being forced to pull out their guns, and often it's to protect the public from someone with untreated mental illness.

Chief Biasotti believes a big part of the solution is returning treatment of the mentally ill to the mental health system through greater use of Assisted Outpatient Treatment ("Laura's Law" in California). The National Sheriff's Association agrees.
Laura's Law allows courts to order certain individuals who are too ill to recognize their need for treatment to accept treatment as a condition of living in the community. It returns care of the mentally ill to the mental health system. Research in Nevada County, the one California County to implement this optional law shows it works and saves money.

Californians should stop blaming law enforcement for the failure of the mental health system. Put the blame where it really belongs: on a mental health system that refuses to focus its resources on treating the most seriously mentally ill.

The mechanism -- Laura's Law, and the funding, Prop 63 is available. What's lacking is leadership.