Redefining Mental Illness

Earlier this year California became one of 27 states to require equal health insurance benefits for mental and physical illnesses. As a U.S. surgeon general’s report on mental illness pointed out this month, the shift compels health plans to fully cover serious brain disorders like schizophrenia rather than shove them into stigmatized and limited separate plans.

The parity laws, however, primarily help well-insured or well-heeled patients who are often only mildly ill--and the mental health professionals who treat them. A larger, poorer and sicker but far less powerful group of mentally ill Americans has been slighted in the parity debates. Many of them lack not only insurance but stable housing and social supports. A welcome bill championing that population’s interests was introduced last week by Assemblywoman Helen Thomson (D-Davis) and Sen. Don Perata (D-Alameda).

The bill would broaden the criteria for determining whether a person is “gravely disabled” and thus entitled to state-paid mental health care. Current law says people are gravely disabled only if they literally cannot keep themselves fed and clothed. The bill would also overturn parts of a law called the Lanterman-Petris-Short Act, which prohibits doctors from forcing a seriously mentally ill person to comply with a treatment regimen, like taking antipsychotic medications, unless the person has displayed clear violent or suicidal intent while in custody. That is far too strict a measure of the need for intervention.

The current law was enacted with the best of intentions in 1969 to protect the civil rights of the mentally ill, including the right to refuse treatment. But as the act’s main author, the late Assemblyman Frank Lanterman, recognized in the late 1970s, the bill had come less to help the mentally ill than to “prevent those who need care from receiving it.”

Thomson and Perata’s bill will be the subject of several floor debates in Sacramento next month, but it faces two big hurdles.

The first is objections from some advocates for the seriously mentally ill who argue that overly zealous mental health workers could compel unnecessary treatments. These fears are overwrought. The bill requires that decisions to compel treatment be approved not only by mental health professionals but by judges, family members and social workers. These days, better medications also have fewer side effects and, when taken regularly, keep more people out of hospitals and jails.

The second hurdle facing the Thomson/Perata legislation is more formidable: adequate funding. The bill asks the Legislature to appropriate $350 million to provide community services for the seriously mentally ill. Among the models for these services are Long Beach’s the Village and Wisconsin’s PACT program, which offer well-conceived continuing care for the mentally ill, including group housing, therapy, daily supervision and job assistance. But last week Republicans in the state Senate called for no more than a $10-million increase in spending on the homeless mentally ill--a drop in the bucket of need.

State leaders also need to spend the money they already have more efficiently. Currently, most of it goes into the criminal justice system, which is where a high percentage of the homeless mentally ill end up. The cost of arresting, adjudicating and punishing Californians with severe mental illness is about $1.8 billion a year.

The Thomson/Perata bill would help shift more attention and spending to identifying and treating seriously mentally ill people before their lives unravel. It’s a start toward rebuilding a vanished mental health safety net and would benefit both the mentally ill and the state’s taxpayers.