MENTAL HEALTH: Some Fall Between Cracks, Times Says

     Beginning July 1, 1991, then-Gov. Pete Wilson and the state Legislature, facing an ailing economy and a $14 billion budget deficit, ceded control of the roughly $1 billion annual budget for mental health care to the counties. At that time, 2,509 mentally ill men and women were released from state-run hospitals -- left in the hands of county officials, who were to provide them care. The second in a series of Los Angeles Times reports attempted to track those patients and found a disturbing trend: The state still "routinely fails to care for its most vulnerable citizens" despite 30-year-long efforts to enhance patient care. The Times reports that after counties assumed control of the mental health care funds, they failed to establish an adequate system to keep track of some of the most severely ill of California's 630,000 mentally ill residents. Counties began to pull patients out of the more costly state hospital system and place them in private locked facilities in an effort to save money. Higher-functioning patients were placed in board and care homes, which have an annual price tag of $3,600 per patient compared to $100,000 in state hospitals. Counties then used the extra money to establish counseling centers, shelters and housing. Although many patients made the transition successfully, others were allowed to fall through the cracks. Despite recent efforts by the county mental health directors and state Mental Health Director Stephen Mayberg to track those patients, the lack of detailed record-keeping has made the task daunting. Using statistics for 1997, the latest year for which the numbers are available, more than 40% of those released in 1991 have not fared well. Of the more than 2,500 patients released, 158 have died -- more than a third of whom died within one year of their release from the hospital. At least 214 have returned to hospitals, unable to cope with the outside world, and hundreds more remain unaccounted for, as 284 in Los Angeles county alone have not had contact with their mental health worker since 1996. Approximately 384 were transferred to cheaper locked nursing homes, where abuse and neglect are frequently reported. Statistics from Los Angeles County show that of the 948 patients in hospitals in 1991, 27% had been jailed since their release and 20% had been homeless at least once. Dr. Joyce Sutton, a psychiatrist at Napa State Hospital said, "The ones who are missing may well be the sickest" (Morain/Marquis, 11/22).

All For the Money
      After the shift from hospitals to privately owned asylums, many patient advocates fear that the mentally ill are not receiving proper care. Oversight by the state Health Department is considered "spotty," although they have issued 200 citations and fines against 35 of the state's 45 certified facilities since 1992. Of the homes receiving citations, eight have complied more than half of all the citations issued. Problems such as patient neglect and abuse -- physical and sexual -- have been reported numerous times. Advocates contend that facilities are often staffed with employees who are not properly trained to deal with severely mentally ill patients. Many facilities are understaffed and employees make as little as $6.50 an hour. The Times reports that the state health department has "no central repositories of citations it issues," but the California Advocates for Nursing Home Reform, a not-for-profit group, gathers the information. Having looked at the list of citations, Mayberg said that he was "taken aback" at the number of cases of staff abusing patients. He said, "The most troublesome was the physical and sexual abuse. We need to address that immediately. We have a zero tolerance. When the institution causes people to get worse, that is upsetting." He has ordered the Department of Health Services to send him a list of any future citations. While tracking abuse has remained problematic throughout the state system, advocates argue that investigation of suspected abuse is difficult, as patients are often viewed as "less than competent witnesses" (Morain/Marquis, 11/22).

Hold That Thought
      Adding to the growing debate over mental health care, Assemblywoman Helen Thomson (D-Davis) has proposed legislation that would expand the state's involuntary treatment law. Her measure would update the 1969 LPS Act that gives law enforcement agents and designated mental health professionals the authority to hospitalize someone if they are deemed suicidal or dangerous. Her bill would allow officials to take into consideration a person's mental history, not just their present condition when deciding to order them into treatment. The bill also would streamline hearing procedures and establish involuntary outpatient treatment. The debate has some well-established mental health groups at odds with civil rights advocates, who have worked together for mental health reform for the last ten years. Randall Hagar, president of the Sacramento chapter of the National Alliance for the Mentally Ill, argued that expanding the law was the only way to get people who refuse treatment the help they need. However, the California Council of Community Mental Health Agencies will only support an expansion of the law if improvement to current programs was not feasible. Tom Sullivan, the Sacramento County mental health director, argued that the state should wait on expanding the commitment law until the recently passed mental health financing measure is given a chance. That law, sponsored by Assemblyman Darrell Steinberg, provides millions of dollars to enhance current mental health programs. Sullivan said, "We believe that having enough services and outreach and giving clients choice about their lives can really go a long way to solve the problem. I don't have the facilities to treat the people who want help, much less the ones who don't" (Griffith, Denver Rocky Mountain News, 11/18).