California Mental Health System Needs ‘Fundamental Reforms,’ State Report Finds

California's mental health system fails to serve up to 1.5 million people with mental illness and is in need of "fundamental reforms," according to a state-commissioned study released Nov. 20, the Los Angeles Times reports. The result of more than a year's work by the Little Hoover Commission, an independent oversight agency created by the state Legislature, the report found that the state provides inadequate mental health services, including housing, drug treatment, job assistance and psychiatric care. In addition, the report states, California essentially "criminalizes" people with mental illness, "sending thousands of them into the state's jails and prisons for mostly minor offenses," without providing the care they need, the Times reports. "Absent adequate mental health services, the cop has become the clinician. The jail has become a crisis center," commission Chair Richard Terzian wrote. A "generation ago," California emptied its mental institutions after patient advocates argued that the mentally ill were entitled to "lead their own lives on the outside" with assistance from community-based organizations. But the commission found it "painfully clear" that the state has failed to provide such services, noting that "uneven and unstable" funding for local mental health agencies has created a "patchwork" system and led to care rationing. The report makes several "sweeping" recommendations to improve the state's mental health system, including the following:

Create a California Mental Health Advocacy Commission, comprised of representatives from business, labor, taxpayer and education groups, to push for reform and provide "direction to policy makers;"
Create a "stable funding base" that encourages organizations to provide better services;
Expand early treatment and crisis intervention services to keep patients out of the criminal justice system, and improve coordination between law enforcement and mental health organizations for those mentally ill patients who are arrested (Marquis, Los Angeles Times, 11/21);
Redesign the state Department of Mental Health to "take more of a leadership role," including advocating for local mental health organizations and ensuring enough people are trained as mental health providers statewide;
Set standards so policy makers know "when and how mental health services are inadequate."

Commission members conceded that the report does not resolve one issue that has divided state mental health advocates: whether to make it easier to legally commit seriously ill patients for involuntary treatment. A bill permitting broader use of involuntary treatment (AB 1800) was blocked in the Legislature this year, but sponsor Assemblywoman Helen Thomas (D) has said she will reintroduce the measure next year. The report says only that "involuntary treatment should be understood as the last and final resort in a continuum of care that prioritizes voluntary treatment" (Bazar, Sacramento Bee/Contra Costa Times, 11/21). Terzian said the commission felt it best to first see what effect improving voluntary services had on patient care before weighing in on the debate, a decision that "dismayed" some mental health advocates. "In the throes of their disease, [some patients] have no recognition of their illness," Brian Jacobs, president of the California chapter of the National Alliance for the Mentally Ill, said, adding that expecting such patients to seek voluntary treatment is "like asking a person with two broken legs to walk to a hospital" (Los Angeles Times, 11/21). The Little Hoover Commission report is available at http://www.lhc .ca.gov/lhcdir/report157.html. This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

California Mental Health System Needs ‘Fundamental Reforms,’ State Report Finds

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