Con: We Lack Resources, Data to Act

More than 1.5 million Californians have serious or severe mental illnesses. This year, after decades of neglect and broken promises, mental illness is receiving new attention in the state Capitol, with dramatic funding increases and promising new programs being developed and expanded.

Part of the attention this year involves a well-meaning but insufficiently thought-through bill--which was recently highlighted in a Times editorial--that would tear a hole in the state’s safeguards against forced treatment by expanding the conditions and length of time a person may be involuntarily detained and forcibly medicated.

Though the intentions of the bill--AB 1800 by Assemblywoman Helen Thomson (D-Davis)--are good, there is serious disagreement over its approach to the problems of mental illness. Because of this, I informed the author from the beginning that the Senate would not address the bill until we had more information that could help resolve concerns and spur compromise.

I am aware of the pain mental illness can cause for those who need treatment and for their families. Yet there are serious problems with rushing to a program of forced treatment. There are not enough resources to provide services for mental health clients who want treatment, let alone those who do not; the judicial system lacks the resources to handle more involuntary confinement cases than it already has; insufficient, fragmented support services will lead to a revolving door for clients who may function when strapped down and medicated but can’t get help to function in the community. When we have a safety net that is tangled and too small, it does not make sense to just cast that net over a wider area.

The very basic protections we have now resulted from many years of hard work by legislators, clients, families and the medical and legal communities to find common ground. The Senate has contracted with the Rand Corp. for a study that asks three simple questions to yield important, evidence-based data: How effective is involuntary treatment compared to other types of intervention and treatment? What has been the experience of other states with implementation of involuntary treatment laws and programs? Who is potentially impacted by a change in involuntary treatment criteria?

This study will be completed in December, a reasonable time to wait before making a tectonic shift in involuntary treatment. Approached properly, consensus on mental health reform is possible. For instance, the bill creating the informed consent hearing process we have now was hugely contentious at the start, but passed unanimously the next year. After I see the Rand study, I will work with all the parties to find consensus on involuntary treatment issues and personally will introduce the resulting legislation.

In the meantime, there is much we can be doing on mental illness. The Legislature asked that the state budget include an additional $221 million for mental health. The budget that Gov. Gray Davis signed cut $52 million, including $10 million for respite care and $5.5 million for suicide prevention. These programs make a difference and deserve energetic support to have the additional funding restored.

Important legislation is being considered to fix the system we already have. A bill (SB 1858) by Sen. Martha Escutia (D-Whittier) improves discharge planning and follow-up. Another bill (AB 2034) by Assemblyman Darrell Steinberg (D-Sacramento) expands a highly successful voluntary outreach program that has resulted in a 64.2% drop in hospitalization, a 73% decrease in incarceration and a 58.9% drop in days spent homeless.

I am proud to be considered a leader in making mental health a priority, and I am committed to keeping the momentum going. We all want to get treatment to people who need it and to ease the burden on families, communities and the criminal justice system. We all want to bring mental illness into the mainstream and take away the fear and stigma. But we need to agree to do it right.