State Put Near Bottom in Care of Mentally Ill

Adequate care for people with serious mental illnesses is the “major failure” of U.S. medical and social services, according to a new report that ranks California near the bottom of the 50 states for quality of care.

The report was released Tuesday by the Public Citizen Health Research Group, a nonprofit organization affiliated with consumer advocate Ralph Nader. It cited misunderstanding about mental illness, failure of community mental health centers, oversale of anti-psychotic drugs and a “federal-state shell game” over fiscal responsibility as among reasons for the nation’s “abysmal” record.

In the first state-by-state ranking, the 105-page report said that California’s 42nd-place showing is on the downside of “a roller-coaster ride” on mental health care and called the growing number of homeless mentally ill people in Los Angeles “a national scandal.”

In an assessment that California officials vigorously disputed, the report said that the state in the late 1960s had a “nationally respected” system but that it “has returned to its former doldrums.” The report added that “the seriously mentally ill are a low priority” for California.

But California officials defended the state’s efforts. In Sacramento, Dean Owen, spokesman for the state Department of Mental Health, said the state is “embarking on a five-year effort” to improve the state’s facilities.

Citing a new $20-million program for the homeless mentally ill and three straight years of budget increases, he said: “We think our state hospital system is ranked better than 42nd.”

In Los Angeles County, Toni Delliquadri, acting director of program support in the Department of Mental Health, said that Proposition 13 caused a “steady decrease” in state funding to the county, which is “now just in the process of trying to implement programs for the mentally ill homeless.” The county’s share of the new $20-million state program is $7 million.

The report is the latest in a growing list of scathing indictments of the nation’s 20-year-old policy of “deinstitutionalizaton,” a plan under which large, deteriorating mental hospitals were emptied in favor of community-based centers.

“The greatest single reason why services for the seriously mentally ill are generally so abysmal is the failure of the community mental health centers to accept responsibility for this group of patients once their massive exodus from state hospitals began over 20 years ago,” the report said.

Factors considered in the study’s state rankings included adequacy of staffing, physical and neurological examinations, treatment plans, patterns for using restraint and seclusion and concern for the dignity of patients.

Wisconsin Highest

Ranked highest were Wisconsin, Rhode Island and Colorado. On the other end of the spectrum, Mississippi, New Mexico and Hawaii were ranked lowest.

Among the report’s recommendations for improving the quality of care are overhauling financing systems so that state funds “follow the patient,” decentralizing huge state bureaucracies and intensifying public lobbying.

Researchers estimated that there are 2 million seriously mentally ill persons in the country--the majority suffering from schizophrenia or manic depressive illness. About 200,000 are in mental hospitals, the report found, with another 300,000 in nursing homes and 800,000 living with their families.

Surprisingly, the report found “no correlation” between the amount of money spent on mental health programs and the success of those programs. Using 1983 figures, it said that the per capita state expenditure nationwide was $30.27. But the highest ranked state, Wisconsin, spent $20.32. It was followed by Rhode Island, $31.54, and Colorado, which spent $24.88.

Capital Outspends States

On the other hand, Washington, D.C., outspent all states, with $176.17 per capita, but ranked 43rd in quality of care. California spent $28.88, the report said.

“We found that spending more money does not get you better services,” Dr. E. Fuller Torrey, a co-author of the study, told a news conference.

He also criticized psychiatrists, saying that too few of them devoted their practices to the seriously mentally ill, preferring more lucrative practices.

Similarly, the report blamed part of California’s problems on this tendency, calling it “the land of psychotherapy and counseling for the ‘worried well.’ ”