Care for the Mentally Ill Emerges as Key Issue

Care for severely mentally ill people, long relegated to the legislative equivalent of a back ward, is emerging as a significant issue this year as key legislators vow to seek major spending increases and push bills to overhaul the struggling system.

While Gov. Gray Davis has proposed only modest budget increases for mental health care, Senate President Pro Tem John Burton, the Capitol’s most powerful legislator, has adopted the issue and promises to seek sharp funding increases in coming budget negotiations.

To add weight to his effort, Burton, joined by Assembly leaders, established a special committee on the mental health care system. The committee begins meeting today at the Capitol, and will convene in Los Angeles, Oakland and Santa Rosa in coming weeks. Burton expects a report detailing the system’s problems by May 1, in time for budget negotiations this spring between Davis and legislative leaders.

“This issue has moved to the forefront,” Burton said. “. . . I do not believe the administration is going to want to find itself behind the curve.”

By federal estimates, California has 630,000 severely mentally ill adults. While the state spends $2.5 billion a year to care for mentally ill indigents, state and county programs reach no more than half the people in need.

Experts estimate that as many as 20,000 homeless people suffer from schizophrenia, major depression and other similarly disabling conditions. Many receive treatment only after they commit a crime. Roughly 15% of the jail and prison inmates in California are severely mentally ill, costing the state more than $1 billion a year.

The problems have existed for decades. But this year, several of the Capitol’s most influential legislators, some of whom tell compelling personal stories about the lack of treatment for family and friends, are turning their attention to the long-neglected system.

“It is not a sexy issue designed to get votes,” said Scott Baugh of Huntington Beach, the Assembly’s Republican leader. “It’s an issue designed to help the truly needy. . . . There will be a bipartisan solution.”

There are several reasons for the interest: A recent surgeon general’s study detailed the pervasiveness of mental illness and lack of treatment nationally; Vice President Al Gore’s wife, Tipper, and Davis’ wife, Sharon, have adopted the cause; and news accounts, including reports in The Times, have detailed many of the system’s failings. Legislators also see an opportunity to boost funding, given that state coffers are bulging with billions more than budget experts had anticipated.

“This has been the most focus and most interest in all the time I can remember,” said California Mental Health Director Stephen Mayberg, a veteran of 20 years in system. “It is excellent.”

Last year, Davis signed one bill to create a small project to bring homeless people who are mentally ill into treatment, and another requiring employers who provide health care insurance for their workers also cover severe mental illnesses. This year, Davis will receive many more:

* Several are aimed improving oversight of people housed in private asylums, a focus of Times reports. And the Senate Office of Research has embarked on a study of the facilities.

The state Department of Health Services has fined nursing homes in the deaths of 23 mentally ill patients since 1992. Overall, the homes, which house more than 4,700 severely mentally ill people, were cited 200 times between 1992 and 1999.

Assemblyman Darrell Steinberg (D-Sacramento) has proposed legislation, AB 1969, to increase oversight of private asylums that care for severely mentally ill people. Sen. Don Perata (D-Alameda) has a related bill, SB 1534, dealing with facilities that house more than 4,700 people.

* Perata, who talks of his sister’s mental illness, hopes to use the new state budget to earmark money for counties that provide treatment for juveniles who commit crimes but are diagnosed as mentally ill. Currently, Perata said, thousands of such youths in county and state facilities for delinquents receive little or no mental health care.

* Two bills are aimed at improving police handling of incidents involving severely mentally ill people. The measures, AB 1762 by Speaker Antonio Villaraigosa (D-Los Angeles) and AB 1718 by incoming Speaker Bob Hertzberg (D-Sherman Oaks), were introduced in response to Times reports documenting 25 shooting deaths of mentally ill people by Los Angeles police since 1994.

* Sen. Wesley Chesbro (D-Arcata) is carrying legislation, SB 1769, to establish mental health courts. Mentally ill offenders would be diverted to such courts, where judges, with the help of therapists and other experts, would order various types of treatment, instead of sending the individuals to prison.

* Chesbro also is carrying a bill, SB 1770, that would require people to receive detailed treatment plans when they are released from state hospitals. In many instances, people are released from locked wards only to find themselves with little or no care.

* Under a bill, SB 1858, by Sen. Martha Escutia (D-Whittier), mental health care workers would be required to offer patients who are stable the option of signing so-called advanced directives authorizing treatment if they fall back into psychotic states.

The most far-reaching bill is one by Assemblywoman Helen Thomson (D-Davis) to alter landmark 1967 legislation that granted mentally ill people greater rights and helped speed the emptying of state hospitals.

Thomson’s measure, AB 1800, would allow authorities in extreme circumstances to treat severely mentally ill people who refuse care--something that alarms patients rights activists, many of whom tell of being mistreated by psychiatrists and psychologists.

“It’s a violation of the rights of a whole group of people,” said Sally Zinman, active in the patients rights movement, who helped organize a demonstration against the measure earlier this week in Sacramento.

That bill’s chances are uncertain, at least for now. Burton has commissioned a study of the issue, suggesting that a major overhaul to the 1968 Lanterman-Petris-Short Act may not occur this year.

“It will always be a lightning rod. It is a tough issue,” said Thomson, a former psychiatric nurse.

Perhaps the biggest issue of the year will be money. Burton said he hopes to one day turn mental health care funding into an entitlement, much like public schooling and welfare, for which government spending rises as the need increases.

For now, mental health care spending is capped. The state gives counties $1 billion a year to care for severely mentally ill people, but does not automatically increase funding as the number of recipients rise.

The price tag for such a change would run into the hundreds of millions. Davis has told legislators privately to scale back their money demands. However, several other states spend far more than California’s $2.5 billion a year. New York spends $4 billion annually on mental health care, and boosted funding by $400 million last year.

In his $88-billion proposed budget for fiscal year 2000, Davis’ main mental health offering was a $10-million increase for a program aimed at bringing homeless mentally ill people off the streets and into treatment.

In its first four months of operation, the program, started with an initial $10 million, has been credited with helping move more than 1,000 people off the streets in Los Angeles, Sacramento and Stanislaus counties.

Assembly Republican Leader Baugh, who along with Steinberg authored the bill creating the program, called it “an unmitigated success,” and said Davis “needs to get well beyond $10 million.”

Burton agreed: “We’re going to make it somewhat difficult for [Davis] not to give us more than he wants to give us.”