New Paths in Mental Care

In the early 1960s, California, like many other states, agreed to stop warehousing the mentally ill in what civil rights advocates called a needlessly restrictive setting--hospitals where many were heavily sedated and deprived of the chance to live more normal lives. In the last four decades, the state has, for both idealistic and budgetary reasons, cut its mental hospital population by 89%.

California, however, also promised to continue caring for the mentally ill with community-based counseling, job training, housing assistance and general “life coaching.” As Times staff writers Julie Marquis and Dan Morain have shown in a series that concludes today, the state has disgracefully failed to live up to that commitment. Instead, far too many of the severely mentally ill are ignored until they lash out against themselves or others. The series described suicidally self-destructive acts, delusional attacks on others and lives lived in squalor for lack of support and treatment. One father--whose violent adult son was set free from a state hospital against doctors’ advice--underwent the agony of having to kill his own child in self-defense. Less dramatic but far more frequent is the deterioration, even death, of a mentally ill loved one for lack of treatment.

Many state legislators argue that California simply cannot afford to spend more than the $2.4 billion it currently provides for mental health care through public insurance like Medi-Cal and county-based mental health clinics. That explanation misses the point, because the state ends up caring for the mentally ill one way or another. Of the approximately 30,000 severely mentally ill people who are homeless in the state on any given day, most end up cycling in and out of the criminal justice system--arrested mostly for minor, nonviolent crimes like stealing food or creating a nuisance by abusing alcohol or drugs in public. Studies estimate that caring for the mentally ill in the criminal justice system costs California up to $1.8 billion a year.

Earlier this year, Assemblyman Darrell Steinberg (D-Sacramento) introduced a bill that charted a middle course between prisons and hospitals on the one hand and homelessness and abandonment on the other. Steinberg’s original measure would have spent $350 million on “wrap-around” programs like Long Beach’s the Village and Wisconsin’s PACT program, which offer a well-funded, well-conceived continuum of care for the mentally ill, including group housing, therapy, daily supervision and job assistance.

This fall, Gov. Gray Davis signed a much-diminished $10-million pilot version of Steinberg’s bill. Some legislators had argued that wrap-around interventions were unproven and needed testing. That’s not true. Studies over the course of a decade have proved the efficacy of both PACT and the Village. In a Baltimore study of individuals with severe psychiatric disorders, those treated under the wrap-around model doubled their medication compliance and cut by half their time in the hospital, living on the streets or in jail.

Programs like PACT and the Village are not expensive, draconian interventions like incarceration or hospitalization, which relatively few patients require on a steady basis. They trod a sensible middle ground, helping the mentally ill find the housing, medication and other wrap-around support they need to live productive lives.