Blueprint for Opportunity

California has a remarkable opportunity to turn a setback into an opportunity to correct the failure of its mental-health services to care properly for the thousands turned out of mental hospitals onto the streets in recent years. There is now an agreed blueprint. All that is missing is someone to take the lead and someone to provide the money.

The setback was the the failure of Los Angeles and Long Beach to win a grant in the national competition for special funding for projects to serve the chronically mentally ill. The contest was sponsored by the Robert Wood Johnson Foundation in cooperation with the U.S. Department of Housing and Urban Development. Each of the nine winning cities will receive more than $10 million.

But as a result of the competition there now exists a model for California. Not only is it a constructive proposal but also it enjoys the explicit support and endorsement of Gov. George Deukmejian, Mayor Tom Bradley of Los Angeles, Mayor Ernie Kell of Long Beach and the Los Angeles County Board of Supervisors.

And there is fresh impetus to get on with the work. In the weeks since the competition was concluded, Congress has passed and President Reagan has signed an omnibus health bill that, among other things, mandates the development by each state of comprehensive mental-health services to assure community-based care for the chronically mentally hill--including the homeless.

California has taken steps in that direction last year and this year with $20-million supplementary mental-health programs each year to improve services to the homeless. Dr. D. Michael O’Connor, director of the state Department of Mental Health, reports that there are no plans to ask for additional funds until an appraisal of the effectiveness of that program has been determined over the next 18 months. That is disappointing. It is disappointing because the evidence is clear now that present funding is woefully inadequate. That proof lies everywhere, but particularly in the Los Angeles-Long Beach pilot-program proposal that earlier this year received the endorsement of state, county and city leaders. That proposal noted that Los Angeles County alone needs to double its mental-health budget if the desperate needs of the mentally ill are to be met.

The Los Angeles-Long Beach proposal included innovations that address the most conspicuous weaknesses of the existing program--above all, the need for 24-hour crisis centers, with coordination of services in the centers where all needs of the chronically mentally ill could be handled quickly and effectively, be they medication, housing, jobs, training or emergency treatment.

As the application affirmed, there are “two major weaknesses” in the existing program: underfunding and “lack of a treatment philosophy emphasizing the coordination of the elements of care during the lifelong disability.” These weaknesses are not peculiar to Los Angeles County. They are a national problem. And that makes the proposals relevant for the state.

The crisis-resolution centers envisioned in the proposal go beyond anything currently in operation. They would never close, assuring continuous care and eliminating the present problem on weekends and at night, when patients in crisis have recourse only to costly hospitalization. They would include beds for short-term stays for those in crisis. In addition to the crisis-resolution centers there would be an expanded program to assure housing. The proposal notes that Los Angeles County alone currently has an unmet need for more than 15,000 residences for the chronically mentally ill.

There will be resistance in Sacramento to the cost of these innovations, just as there has been resistance to adequate funding for community mental-health services ever since the decision was taken to move most mental patients out of the state hospitals. Those calculations ignore, however, the higher cost of continuing to neglect the problem.