Deputy Medical Director of Los Angeles County’s Mental Health Department Discusses System in the Times

The Los Angeles Times yesterday featured an interview with Dr. Milton Miller, deputy medical director of the Los Angeles County Mental Health Department and the chair of the department of psychiatry at Harbor-UCLA Medical Center. Here are some of the highlights from the interview, in which Miller discussed the state of Los Angeles' mental health system:

• Discussing the recent problems at Los Angeles' County-USC Medical Center -- Harbor-UCLA's "counterpart" on the east side of the city -- Miller said that a lack of a permanent psychiatric chairperson, the 1994 Northridge earthquake that "destroyed" the hospital's psychiatric facility, County-USC's location in an "intense inner-city area" and the large proportion of patients who come from jail for treatment have combined to create a "terrible situation" at the hospital, which has struggled to handle a "growing" mental health population, a "growing indigent population [and] more drug and alcohol use."
  
• Asked about the apparent perpetual "cycle" of "cris[es]" in the county's mental health department, Miller said, "The cycle is not every two years, the cycle is each week. You try to determine which of the impossible crises to tackle first."
  
• Discussing why the county has not moved to place more mental health patients in community settings "before they end up hospitalized or in jail," Miller said that the county, primarily due to inadequate state funding, "start[s] out with about one-third to one-half of the resources it would take to do a reasonable job," and that "[c]ompared with New York or other large metropolitan areas, we have maybe 75% of their resources."
  
• Commenting on an Assembly bill (AB 1421) that would "force compulsory outpatient treatment for severely disturbed patients," Miller said, "What is at issue is whether [involuntary treatment] would work where the authority is vested not in family and loving friends, but in some bureaucratic agency." Noting that it also is unclear who would pay for involuntary hospitalizations, Miller said he favored a "limiting testing period" in California and Los Angeles.
  
• Asked what "quality" mental health care would "look like," Miller said that an ideal system would entail 24-hour-a-day services, safe housing for patients, "supportive employment" and ways to ensure that patients continue taking their medication.
  
• Finally, asked, "Have we as a people failed the mentally ill," Miller responded, "Yes. What we leave unfinished in one generation becomes twice the problem in the next" (Holland, Los Angeles, 7/15).