A Deadly Group Home

Far too often, poorly regulated board-and-care facilities mistreat mentally ill people sent to live there. Five died this year alone while they were residents of the perversely named San Gabriel House of Independence. In a society with a conscience, ongoing reports of group-home abuse must spur revolutionary reform.

Throughout history, societies have abused and made scapegoats of people labeled as crazy, mere misfits as well as the truly mentally ill. By the mid-20th century, mental hospitals had become modern alms houses filled with rebellious teens and old people with nowhere else to go, along with people with serious mental illness--whom psychiatrists too often lobotomized, forced into electroshock or controlled with mind-numbing drugs.

In 1967, California addressed the outrages (and the cash drain) by passing the Lanterman-Petris-Short Act, which prohibited hospitals from involuntarily treating people unless they were an imminent danger to self or others. The late Assemblyman Frank Lanterman had hoped that his law would protect basic civil liberties and give rise to humane, largely unrestricted facilities for the mentally ill. His model was Fountain House, a New York City group home started in the 1940s that offered job training, counseling and housing.

Instead, state and local governments used the ideal of “independent living” as an excuse to shirk their obligations to the mentally ill. The fault wasn’t theirs alone. When Congress established the Medicaid program in 1965, it required states to provide a host of medical services for hospitalized patients without health insurance but specifically excluded payment for such services if a patient’s illness was mental. The seriously mentally ill were left to grub for survival on the streets and in facilities such as that deadly group home in San Gabriel, which Los Angeles County inspectors recently condemned for subjecting residents to “utterly deplorable and illegal” conditions.

The patients had been sent there by one of the 48 hospitals in Los Angeles County with the authority to involuntarily treat mentally ill patients. Next week the Board of Supervisors, in a vote on whether to terminate the mental health contract of the hospital that had referred patients to the San Gabriel facility, has the opportunity to put all hospitals on notice that they’ll be held responsible for the patients they send to group homes. Beyond that, the supervisors need to expand the county’s team of inspectors, then use it to shut down illegal group homes and more aggressively scrutinize those with licenses.

But the only way for this cash-strapped county to spur the sort of reform that can begin to end the mental health crisis is to get the federal government to finally pay its share. Fortunately, President Bush’s New Freedom Mental Health Commission holds its first public meeting in Los Angeles from Nov. 12 to 14. The president said he created the commission to “close cracks in the mental health system.”

Three decades after the Lanterman-Petris-Short Act triggered disaster, this commission needs to push for a major policy change. Diseases such as schizophrenia and major depression deserve the same assistance from Medicaid as leukemia.

Only when that money flows will county governments be able to shut down “snake pits” with confidence, knowing that rescued patients will find clean, well-staffed, independence-oriented alternatives and not wind up in jail or sleeping in a filthy heap of rags under a bridge.