A Boost for Mental Health

Last December a report on a year-long study commissioned by the state Assembly documented the tragic flaws in mental-health care in California. Many of the report’s findings have now been written into legislation to correct problems in a system that has suffered too long from indifference in Sacramento. The legislation should become law, both to help victims of mental illness and to place the subject of mental health back on Sacramento’s agenda.

The bill, sponsored by Assembly members Bruce Bronzan (D-Fresno) and Sunny Mojonnier (R-Encinitas), first would give enough money to the state mental-health system to make a difference. State funding has dropped from $16 per resident in 1978 to $13 today. One thing that the bill would do with new money is provide $35 million over three years to equalize spending on mental health, which varies widely around the state.

The legislation (AB 2541) also calls on the state Department of Mental Health to provide some leadership to the counties by specifying the services that they must offer. A good chunk of the money should go to help strengthen the community mental-health care that was promised but never delivered when the state reduced the number of patients in state hospitals 15 years ago.

The bill also addresses the fact that people cannot use the mental-health system if they don’t know that it exists, particularly if all of their time must be spent in seeking food, clothing or shelter. So the legislation also would provide $3 million to help counties actively seek out the homeless who are entitled to government assistance but don’t receive it because the system is too complicated for them to penetrate it on their own.

It will be unfortunate if counties establish separate bureaucracies to accomplish this mission; the money would be best spent hiring mental-health social workers within existing agencies to go out to the welfare offices, missions and other places where the homeless already come for services. Once a worker gains a person’s confidence by helping to provide basic necessities, a person with mental problems may be more willing to seek treatment.

The legislation also would increase help for the elderly and for troubled children, enable state officials to require outpatient mental-health care for prisoners being released, and increase insurance coverage for mental-health treatment.

One shortcoming of the bill is that it deals with commitment laws only around the edges, never addressing the real problems of those laws. There are far too many people wandering the streets of every California city who cannot care for themselves but cannot be committed for long enough periods to be helped. The current limit for commitment is 72 hours on an emergency basis or, at most, 14 days. Psychiatrists generally say that it takes about a month both to alleviate the symptoms and to establish treatment for schizophrenics or people with severe depression. In addition, the law needs a broader definition of the “grave disabilities” for which people can be committed involuntarily, with all such commitments subject to the strictest review procedures.

Today’s laws were written in sincere reaction to the often arbitrary commitment procedures of decades ago. They aren’t working, and should be changed. But, before they can be, the beds and the personnel must exist so that people who are hospitalized will get humane, helpful treatment. As Bronzan says, “This bill is just the beginning. The whole system needs to be built up.”

The legislation carries a big price tag--about $58.35 million--in addition to increases that Gov. George Deukmejian has already proposed in this year’s budget. The Deukmejian Administration has pledged to spend more than $133 million over five years to upgrade state hospitals, for example. The Administration and the Legislature can show that they truly understand the scope of state mental-health needs by supporting this bill as well. Only with true bipartisan support can California start keeping its old and well-intentioned promises.