(Paul Seeman was a member of the California Judicial Council’s Task Force on Criminal Justice Collaboration on Mental Health Issues, and founder of the Alameda County Juvenile Mental Health Court)
The Rand Corporation recently published an evaluation of the Mental Health Services Act implementation in Los Angeles County since the passage of Proposition 63 in 2004 – the “millionaire’s tax.” The MHSA generates more than$2 billion annually for mental health care in California for programs ranging from early intervention and prevention to full-service care for people with serious brain illnesses. Among the key findings:
- From 2012 through 2016, the L.A. County Department of Mental Health provided prevention and early intervention services to almost 130,000 youth and intensive clinical and social services to stabilize those with serious psychiatric illnesses to almost 25,000 youth and adults.
- Rates of homelessness and inpatient hospital stays fell dramatically while rates of employment and connection with a primary care doctor markedly improved.
- Children and young adults enrolled in full service partnership programs tended to be low-income and suffering from depressive disorder, schizophrenia or other psychotic conditions. Their overall rates of homelessness and inpatient hospital stays were significantly reduced over the course of treatment.
Taken as a whole, the report underscores the remarkable benefits of early intervention efforts both in terms of the human toll and as a cost-effective public investment. The other core services measured in the RAND analysis involved full service partnership programs that offer intensive services to people who suffer from serious mental illness that have progressed to the point of severe dysfunction. Most of these individuals are homeless,making them harder to engage and treat with any regularity.
California State Senators Scott Wiener (D-San Francisco) and Henry Stern (D-Canoga Park) have proposed a bill to expand the use of conservatorships to deal with the issue of mental illness and homelessness. The bill would allow local governments to conserve individuals “who suffer from chronic homelessness, accompanied by debilitating mental illness, severe drug addiction, repeated psychiatric commitments, or excessively frequent use of emergency medical services.”
There are currently two kinds of conservatorships in California: Lanterman-Petrie-Short (LPS) conservatorships for individuals who are “gravely disabled” and thus unable to care for themselves, and probate conservatorships for individuals unable to care for themselves due to physical health issues, cognitive impairment, or elder abuse. The legislation, if successful, would create a third category specifically targeted at the at-risk homeless population. According to the authors:
“California faces an unprecedented housing affordability crisis, accompanied by significant untreated mental illness and drug addiction. These conditions, coupled with the limitations of our state and local social services, have left some counties searching for more tools to provide help and support to those Californians in the most need. In San Francisco, many of the successful programs and services have still fallen short of providing meaningful rehabilitation to a small population of residents with severe mental illness and drug addiction who are deteriorating on the city’s streets. Los Angeles faces similar challenges. The Los Angeles County Board of Supervisors is currently evaluating the efficacy and reach of their conservatorship system pursuant to a motion coauthored by Supervisors Mark Ridley-Thomas and Kathryn Barger.
Many of these people routinely use social and emergency services and find themselves in law enforcement custody, effectively converting a health issue into a criminal issue. By allowing greater flexibility to conserve these extremely disabled individuals – who are unable to make decisions for themselves – we can keep people out of the criminal justice system and focus on their health and well-being.”
The LA Times reports on an apparent surge in arrests of homeless individuals in Los Angeles in the past two years, despite official efforts to reduce quality-of-life citations — restricting sleeping on the sidewalk, living in a car or low-level drug possession, for example — from misdemeanors, which can draw jail time, to infractions.
Officers made 14,000 arrests of homeless people in the city in 2016, a 31% increase over 2011, the Times analysis found. The rise came as LAPD arrests overall went down 15%. Two-thirds of those arrested were black or Latino, and the top five charges were for nonviolent or minor offenses. In 2011, 1 in 10 arrests citywide were of homeless people; in 2016, it was 1 in 6.
The problem of “quality of life” law enforcement is compounded by the financial penalties attached to infractions. California has enacted fees and assessments that make the state’s ticket penalties among the stiffest in the country, according to a study in May by the Lawyers’ Committee for Civil Rights of the San Francisco Bay Area.
The base fine in L.A. for sleeping or lying on the sidewalk, for example, is $35, but fees take the total to $238. If that initial amount goes unpaid, an additional $300 “civil assessment” and other levies can be added, more than doubling the financial stakes.
A three-year study of a Florida mental health court program found that the rate of recidivism dropped “significantly” after participants completed the court-ordered treatment program that the court offered as an alternative to jail.
The study’s authors, Julie Costopoulos and Bethany Wellman of the Florida Institute of Technology (FIT) suggested that the findings demonstrate the effectiveness of collaborative courts in helping end the “revolving door” which cycles many mentally troubled individuals between jail and the streets:
“The ‘revolving door’ has been exhaustive of institutional resources, resulting in such a poor system of treatment that many argue that the system …treats offenders with mental health challenges to the extent that recidivism is inevitable,”
The study followed 118 participants in an unidentified Florida mental health court. Three months after release, 90% had not been rearrested. After six months, the number dropped to 81% remaining free of any charges; and three years after release, 54% had not recidivated.
Perhaps almost as significant, the study found that participants were typically re-arrested for much lesser offenses than those which originally sent them to the mental health court.
The Los Angeles Times reports that the LA Police Protective League has joined more than a dozen other police unions, including those in New York, San Jose and Chicago, asking for federal funding for crisis-intervention training, less-lethal devices and officers who team up with mental health professionals to respond to emergency calls. The proposal, “Compassionate and Accountable Responses for Everyone,” will be formally unveiled at a news conference Thursday morning in New York. Most police department already offer some training in how to appropriately respond to someone who has mental health issues — LAPD officers receive 15 hours of training specific to mental health while in the academy — but the issue continues to draw attention, particularly after several high-profile police shootings of people who were diagnosed with mental illnesses. In New York, for example, a police sergeant was charged with second-degree murder after fatally shooting a mentally ill woman who had a baseball bat.
Louis Dekmar, the police chief in LaGrange, Ga., and first vice president of the International Assn. of Chiefs of Police, commented: “We’ve taken what should be a public health issue and we’ve turned it into a criminal issue. And the sad commentary is, of the 900 and some fatal police shootings a year, about 25% are affected by mental illness.”
In Los Angeles, four of the 28 people struck by police gunfire in 2016 showed signs of mental illness, according to LAPD data. The previous year, nearly a third of the 38 people shot by police were perceived to be mentally ill.
In Seattle, a pregnant woman with mental health issues was shot and killed by police after calling to report an attempted burglary, then “displaying” a knife when the police arrived.
Meanwhile, in Washington, the Supreme Court agreed with a convicted murderer held on Alabama’s death row for three decades who argued he was entitled to an expert independent from prosecutors to gauge his mental health and possibly help him avoid execution.
The justices ruled 5-4 in favor of inmate James McWilliams, who was convicted of the 1984 rape and murder of a convenience store clerk in Tuscaloosa. It is the third recent case in which the Court has ruled in favor of a convicted inmate on death row, all involving African-Americans, a fact that civil rights advocates say points to problems in America’s criminal justice system that disproportionately affect minorities.
A new law in Texas, the “Sandra Bland Act” , requires jailers to immediately determine whether inmates suffer from mental illness and divert those who do to a mental health facility. The law is named after the Sandra Bland, who in 2015 was found dead in a Waller County jail cell after she was pulled over by a state trooper for a routine traffic stop, then arrested and jailed when the officer said she had become “uncooperative.” Her death was ruled a suicide, and later it became clear that Bland might have suffered from depression and had a history of mental health issues.
Or, who are you calling crazy? Congress votes down common-sense regulations requiring background checks for people with mental health diagnoses for which they are receiving SSI. The House by a 235-180 vote on Thursday eliminated regulations that required the Social Security Administration to report people who receive disability benefits and have a mental health condition to the FBI’s background check system. The NRA and other critics of the rule objected that the regulation could unnecessarily interfere with the Second Amendment rights of people with minor mental health issues such as eating disorders or mental disorders that prevent them from managing their own finances. That position begs the question of how to keep guns away from people with mental disorders like schizophrenia and severe anxiety.