Aid Cities by Aiding Mentally Ill

The seriously mentally ill people who wander through city parks and plazas in the state have long gnawed at Californians’ moral conscience. That, unfortunately, isn’t enough. They need a political champion who can energize business leaders and the general population to seek solutions.

This week, Assemblywoman Helen Thomson (D-Davis) will hold a meeting with legislators, policy analysts and business leaders in an effort to build that sort of broad statewide consensus on the moral and fiscal necessity for fundamental reform of the state’s mental health care system. This group needs to strongly make the link between successful treatment of the homeless mentally ill and the economic and civic health of downtown areas.

The problem is not limited to California, of course, but Washington’s ability to effect mental health reforms is limited because most federal mental health dollars are distributed by states to counties. Improvements must thus begin at the state level.

California’s system is hobbled by two reforms gone awry. First came “deinstitutionalization,” a process begun in the 1960s that freed seriously mentally ill people from overly restrictive state hospitals but didn’t give counties the resources they needed to offer treatment in the community. On top of that came “realignment” in the 1990s, which shifted responsibility for mental health care from the state to the county. The realignment was supposed to encourage innovation. Rather than guaranteeing each county a set per-patient allocation, it required them to file grants to compete for limited funds. But according to a report released last November by the Little Hoover Commission, funds are often distributed to the counties that file the most grant applications, not to the counties with the most needy populations. Counties also have disincentives to identify the seriously mentally ill, like a requirement that they pay up to $120,000 a year for each patient they send to a state mental hospital.

Thomson hopes to introduce a bill this month establishing a mental health advocacy commission to shepherd the implementation of effective solutions. These might include subsidies for stable housing for fragile populations and an expansion of community mental health services created in a 1999 pilot program that has proved successful.

At this week’s meeting, state policy analysts plan to point out that the revitalization of some downtowns has stalled because suburbanites hesitate to shop in areas populated by large numbers of untreated, seriously mentally ill people. The reforms Thomson proposes are about more than merely boosting state spending on mental health care. They are aimed at improving the overall quality of civic life in the state.