Mind the Mentally Ill

As U.S. Surgeon General David Satcher reported earlier this year, the number of people with mental illness who go untreated is rising nationwide. California, with about 50,000 severely mentally ill homeless people, is at the epicenter of the matter.

On Thursday, Gov. Gray Davis took a significant step toward solving the problem by signing AB 1424, a bill by Assemblywoman Helen Thomson (D-Davis) that will close a big hole in the state’s safety net for the seriously mentally ill. Davis, however, is still debating what to do with an equally meritorious mental health reform bill, SB 1059, by Sen. Don Perata (D-Alameda).

The Thomson bill addresses a key reason why so many seriously mentally ill Californians don’t get the care they need: State law allows doctors, judges and hearing officers to involuntarily commit people for psychiatric evaluation and treatment only when they behave in ways that show they are in imminent danger of harming themselves or others. But many people with psychosis and other mental illnesses are adept at concealing their dangerously disorganized thinking. AB 1424 would require the people doing the evaluations to consider patients’ medical and psychiatric records, adding depth to what are too often cursory encounters.

Perata’s equally important bill would help reverse a destructive cycle. Each year, state prisons send thousands of convicts with histories of mental illness back into the communities in which they were arrested. Fewer than a third of those are referred to community mental health clinics for follow-up care, and only a fraction of those referred actually show up for treatment. Meanwhile, the people who are supposed to be tracking and treating these released convicts rarely communicate.

SB 1059 would compel prisons to tell counties when a mentally ill offender will be arriving. It would also bring together prison, law enforcement and mental health officials in a newly created Council on Mentally Ill Offenders. The council would be charged with such practical tasks as helping money-starved counties set up community-based mental health treatment programs using untapped federal Medicaid dollars. Its modest, $100,000 annual cost would be more than offset by the increased federal Medicaid funding it would bring in.

Perata, who speaks poignantly of helping his sister battle serious mental illness, and Thomson, a former psychiatric nurse who has seen the system ignore mentally ill people until they harm themselves or others, know better than most that their bills can barely make a dent in the state’s daunting mental health problems. But until politicians get the gumption to do the top-to-bottom overhaul of the system that’s needed, Davis should sign every good measure that comes his way.