How Bay Area mental health services fall short

Jul 29, 2013


If someone you loved was suffering from a serious mental illness, or seemed like they were on the verge of a psychotic breakdown, you might think you could turn to a psychiatric hospital for help. But in California, that might not do you much good. Institutions have the right to turn a person away unless they’ve been taken into custody. More than ninety percent of patients in California psych hospitals have dealt with police first.

Mother Jones reporter Mac McClelland learned how the California health system worked after a tragic incident in her own family. She wrote about it in a recent issue of Mother Jones magazine. KALW's Casey Miner spoke with Mac McClelland about that story and about the gaps in our mental health care system.

MAC MCLELLAN: In the case of my cousin, a couple of years ago – about a year and a half ago – he had a psychotic break and he murdered his father. And at the time nobody really knew what was going on for several months before that. Almost to a year, he had been exhibiting symptoms; nobody really knew what was wrong with him. There was just something sort of off and they tried to get him into treatment and to take him to a psychiatrist, and the psychiatrist noted that he had possible schizo-affective disorder, and put him on antidepressants because he thought maybe that he was just sad.

They were trying to figure out how to get him into a facility, into an actual hospital, but pretty much the only way to do that – and they live in Santa Rosa which is in Sonoma County – and the only way to do that there, which is true of a lot of counties in California, is to call the police. So if you want to go to a psych hospital because you’re having a nervous breakdown, somebody would have to call the police and they would have to decide that you were a danger to yourself or to others and the bar for that is very high. So, if you were actively homicidal, the police would, you know, get you into a facility somewhere. But, that wasn’t what was going on with my cousin so his parents didn’t want to call the police, and they didn’t, and he had his first psychotic break and unfortunately, it involved a lot of extremely violent delusions. And, he ended up killing his dad. 

CASEY MINER: So, at that point, a person becomes involved in the criminal justice system, anyway. And I wonder if you can talk a little about what happens next at that point when you have somebody who has committed a violent act, because they’re severely mentally ill.         

MCLELLAN: Well, then you end up in jail, which is, the Department of Justice thinks that there’s about 55 percent of all of the inmates in our state prisons are mentally ill. One of the experts that I talked to for this story, he’s the Director of Government Relations for the California Psychiatric Association and he said that $2,000 to $3,000 worth of treatment saves $50,000 worth of jail time. But the calculations aren’t done that way, you know, you don’t sort of make a spreadsheet with the resulting cost of cutting health care when you’re cutting mental health care.

And so California is at the top of the states that have made just massive, huge cuts to services, we don’t have a lot of preventive care. We have Proposition 63, which was passed several years ago, to sort of shore up some of the funding that was missing, but as that funding came in we also continued rolling back all the normal state and local services. And so, we’ve regressed in the amount of treatment that’s available overall. I mean, you live in California, you see the effects of this. There are so many mentally ill people on the streets, and if you talked to anybody who worked in any of our jails or prisons they would tell you that they are becoming basically mental health facilities. 

MINER: One of the neighborhoods that you focus on in your piece is the Tenderloin in San Francisco, where there is a high homeless population and high mentally ill population and I am wondering if you can talk a little bit about what you have seen there and the kind of conversations that you had with folks that are working in that neighborhood, trying to deal with this population on a day-to-day basis.

MCLELLAN: It’s hard to get people into treatment and into regular treatment when they are homeless, when you can’t take of that problem first. Emergency housing lists have been shut down in San Francisco because they are so overfull and so they’re kind of doing damage control for a lot of people because they don’t have the resources that they need. A lot of the patients there though are not what is termed severely mentally ill, which would be schizophrenia, very serious bipolar, things that you associate with people who might need help forever. A lot of our patients are suffering from depression, non-psychotic, non-major depression, PTSD – things that are theoretically treatable and so if they just have the money to be able to get these people the resources that they need and the treatment that they need then they could cure them and sort of get them off these welfare rolls that people are always freaking out about how much they cost. And if they had preventative services they would not have ended up in the Tenderloin in the first place. If they would have gotten treatment 20 and 30 and 40 years ago when they had the onset of trauma or depression then, they wouldn’t have ended up on the streets in that neighborhood and in this outpatient clinic that doesn’t have the resources to serve them. California was the pioneer in the de-institutionalization, we were the ones who started the trends of getting everybody out, but we didn’t put the services in place to take care of those people. You could probably solve a lot of these problems, obviously, if you had the mental health centers in communities that were set up to take care of people in the way that they were supposed to be in the first place but they never were. In this economy it doesn’t look like they are going to be anytime soon. 

MINER: Why do you think that is? Because if often seems like – and especially recently – we will see people committing these horrible crimes or horrific acts whether that is something like a school shooting or a murder of an intimate partner or family member. And it seems like that would galvanize people to actually try to put some money into these services to avert these tragedies in the future. 

MCLELLAN: Most mentally ill people will never hurt anybody except for themselves and so it’s kind of not your problem until it is. And when its sort of rare and spectacular and people talk about it – you know we really need to shore up this mental health services gap. All these problems that we have, but actually getting the money to follow, huge amounts of money would have to follow. In the end it would be cheaper than not doing it, but getting someone to bankroll that up front, you know, getting congress to pass all the funds for that up front, it just doesn’t seem realistic.

Click the audio player above to listen to the interview.