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Helping those who don’t know they want it

JIM RANDALL is a former president of the National Alliance on Mental Illness, L.A. County Coordinating Council.

PROPOSITION 63 -- the Mental Health Services Act, approved by voters in 2004 -- has prompted great hope in the mental health community. It pumps needed funds -- about $70 million for Los Angeles County this year, with an estimated $180 million to $200 million in subsequent years -- into a cash-starved system in which, for far too long, a shameful number of people with a mental illness have gone without needed outpatient services. This law will take a significant step in redressing some of the inequities.

But if you look closely, you can see some cracks in the paint.

Emergency regulations recently issued by the state Department of Mental Health declare that “programs and/or services provided by MHSA funds shall be voluntary in nature.” This means, apparently, that the state of California has decided that no money can go toward involuntary outpatient care or inpatient hospital beds -- a policy that voters did not validate. Proposition 63 made no such restrictions. This is especially galling because even the best outpatient treatment does not help a large number of people with a serious mental illness. Many of these people are simply too sick to recognize their illness and accept treatment.

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With no involuntary treatment, literally thousands of people will continue to be “treated” in prisons and jails or left to fend for themselves in the back alleys of our city streets. They will be ignored by the rest of society, at least until their illness demands attention in the form of police, ambulance, hospital or jail services. Currently, it is estimated conservatively that more than 25,000 people with a mental illness are locked up in California prisons, according to the Department of Justice. And in Los Angeles County alone, more than 25,000 people with a mental illness reside on our streets. The problem is breathtaking.

And to tie the system’s hands by saying that more hospital beds, which are generally used for involuntary patients, cannot be offered is a cruel joke on the most ill among us. There is some logic in the justification of only spending money on outpatient services, but only some.

The argument goes like this: If we pay for care early in the illness, we can catch it before it progresses, thus saving people with a brain disorder and their families from untold misery. This is only partly true. There are also many people who need more intensive care that can only be delivered in a hospital-like setting to give them time to respond to treatment. The state Department of Mental Health’s interpretation of Proposition 63 offers nothing to this population.

This is plain wrong. The most ill among us, not the ones who are the easiest to treat, are the ones who deserve the most help. Regrettably, when voluntary outreach does not work, involuntary services are required.

And it’s common sense. If any of us were afflicted with the most severe form of these disorders, where our thoughts are dominated by hallucinations and delusions, where our capacity for human connection is destroyed, where our judgment is rendered useless, would we not want someone to at least give us a chance at better care and treatment?

Civil libertarians say no -- that it is our right to commit crimes that land us in prison, that it is our choice to be so ill that we prefer to forage through garbage and live on the streets, that it is our prerogative to let voices in our heads torment us into sleepless nights. But something tells me that the people locked up in San Quentin with a mental illness, and the people roving the back alleys of skid row, are not singing “God Bless America.”

These are our sons and daughters, our brothers and sisters, and they need our help.


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