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California recently passed into law a historic measure to expand proactive mental health treatment programs as a test effort for the homeless mentally ill in three communities. Mental health advocates hope that these programs can reverse the damage caused when the state deinstitutionalized its mental health care system.
"It was a grass-roots effort. We collected more than 3,000 signatures and delivered them to the governor, lobbied state legislators, urged newspaper editors to write editorials in support of the bill, and held a press conference to get this bill passed. It was an organized campaign we hope delivers on its promise," says Rusty Selix, JD, executive director of the Mental Health Association in California and the Council of Community Mental Health Agencies, both in Sacramento.
"When we held our press conference, we were careful to keep mental health advocates in the background," notes Selix. "Instead, we asked law enforcement officers to carry the message about why we needed this bill. We believe that was a key step in getting this bill passed. The arguments of the law enforcement officers had more authority for legislators than the arguments they had heard many times from mental health advocates.
"Officers explained how many mentally ill people ended up in trouble with the law because they didn’t have the medications and support services they needed," notes Selix. "They argued that these untreated mentally ill people were placing a huge burden on the state’s law enforcement system."
To support that argument, Selix says the Mental Health Association used grant money from pharmaceutical companies to sponsor a study that showed the amount of money spent in the criminal justice system on the mentally ill. "We found that the amount spent was more than the entire state budget for mental health care," he notes.
California bill AB 34 specifies how $10 million will be spent on community-based mental health programs. "These pilot programs will help get people back on their feet early, rather than waiting until they have a run-in with the law and end up serving time in jail in order to get proper treatment," says Selix.
"The need to address this population has been under discussion for a long time in California," notes Vince Mandella, BS, chief of adult systems of care in the California State Department of Mental Health in Sacramento. "It wasn’t hard to gain support from law enforcement agencies," he adds. "Law enforcement at the local level sees the impact of this group and is called upon to intervene with the mentally ill, homeless population regularly. They have been disappointed to find that there is this hole in the human service agency structure that these folks don’t fit. AB 34 is designed to try to plug that hole.
"Another key element in getting this landmark legislation passed was an early recognition of the constituency groups that would have to come together and present a unified front of support. Those included law enforcement, mayors from California’s major cities, mental health advocacy groups, and the professional associations, such as the state chapters of the American Psychiatric Association."
The pilot programs set up under the new bill take an intense, integrative service approach, he adds. "The miracle of new modern medicines has made it possible for many people who previously needed intensive treatment to become virtually self-sufficient and lead productive lives. However, we believe that medications alone are not enough. These people need a variety of support services, including housing assistance, life skills training, and treatment for substance abuse. If you don’t treat and train, you won’t succeed. You have to take an integrated approach. (See related story on how these integrated mental health pilot programs have hit the ground running on p. 7.)
"This bill is a major step towards ending the criminalization of the mentally ill," says Selix. "It’s our first real step in the direction of helping someone get treatment before they break the law, not after. Not only is that good public policy, but it is the right thing to do."
A bill passed by the California state Legisla-ture about 10 years ago established state-funded pilot programs to treat the severely mentally ill.
"What we need to prove now is that the integrated approach used by those programs can work for the homeless on the street who may be resistant to help, and that by doing so we can make a dent in the incarceration rate for the mentally ill. And, of course, that it translates into cost savings for the criminal justice system," says Selix.