Treatment versus punishment for mental illness
It was a beautiful April day in Washington, D.C. in 1991. Two men, one a Democrat, one a Republican were meeting to agree on a proposed new federal law. A law that would add to the cost of all public buildings and cost trillions of dollars all to the benefit of only a minority of citizens. When signed by President George Bush the Americans Disability Act would dramatically change the lives of the disabled. The law would add nearly 20% to the cost of all new buildings and be cursed and hated by builders and developers, but in the scorecard of human values it is a triumph of the human spirit; an unselfish act on behalf of those more fortunate to aid those less fortunate and our nation is better for it.
But the job is only half done. The Act includes those disabled by reason of mental illness. The law, strengthened by court decisions including the U.S.Supreme Court, requires states, counties and cities to treat those with psychiatric disabilities as disabled persons. The existence of several hundred such persons in our community is clear to any observer of our streets and homeless encampments and it is clear that our treatment of this group of disabled persons fails to meet any minimum standard of care.
This failure is manifest in the failure to address, evaluate and treat a gravely disabled person who is unable to care for his or herself. An extreme, but not entirely unique, case is that of Dana James whom Oroville police found incoherent and unable to care for herself and she was abandoned at the County landfill. In the past year in Butte County 915 people were identified as gravely disabled under Welfare & Institutions Code section 5150 and only nine were admitted to a crisis facility. The default is to place an incompetent person in the Butte County jail, and there is no treatment available in the jail.
The cry to treat these disabled persons exists on many levels. There is the desire for the community to have streets and parks free of incompetent, homeless persons. There is the cost of jailing or imprisoning a person at more than $100,000 a year without treatment. There is the suffering of a mother or father who wants help for a son or daughter. A disabled person may not recognize his or her illness, a condition called anosognosia, but treatment even given involuntary can relieve symptoms and change the disability.
We cannot accept the current process. The forces of change will come in many ways including changes in the laws and court action. Proposition one will add housing. Senate Bill 43 will increase conservatorships and aid parents and others to intervene. Care Court will expand the role of parents and others to help in treatment. Some changes will require stronger measures. Several counties have been sued in the United States District Courts for failure to meet minimum legal standards. The LLC, Wellpath that provides services to the jails, including Butte County was found by the District Court to be in contempt for failure to comply on fortythree requirements at issue and given six months to comply or face imposition of a fine of $25,000 for each requirement.
In some counties judges and the courts have taken the lead in developing holistic programs such as “Stepping Up” adopted in more than 500 counties nation-wide. Some District Attorneys have redirected their efforts away from incarceration of the disabled and toward treatment. Some Public Defenders are using the Constitution and laws to move disabled offenders from jail toward less restrictive placements. Some County Behavioral Health Agencies are actively moving the disabled homeless toward “board and care facilities. But there is little evidence of such activity in Butte County. The truancy of these entities is obvious and disappointing.
The problem cries for bold and courageous leadership. There is evidence of such on the state level. Governor Newson and legislators like Susan Eggman have shown a determination to find solutions. And the American people that developed the Americans Disability Act still exist with the same determination to aid the disabled. Change will come and this change will make the world a better place.