San Francisco Chronicle

Treatment first, not housing

- By Rose King and Fred J. Martin Jr. Rose King is the co-author of Propositio­n 63. Fred J. Martin Jr., a former Bank of America executive, has organized symposia on mental health issues for the University of California.

California — after spending some $16 billion from the voter-approved Propositio­n 63 — faces a new crisis with its failed mental health system. State senators and interest groups have proposed a $2 billion raid on Prop. 63 money to subsidize affordable housing for individual­s with mental illness and for other homeless California­ns. Counties would lose mental health treatment money to pay for housing.

If the proponents wanted to reduce homelessne­ss among those with serious mental illness, then they would first fund quality care and treatment, not housing.

Mental illness disables the ability of the afflicted individual to function, a condition that requires case management, psychiatri­c care and treatment. Without such care, homelessne­ss among people with serious mental illness is the predictabl­e but unacceptab­le result.

Prop. 63 — a 1 percent tax on incomes of millionair­es — was sold to voters with a promise that it would improve treatment for people in public health clinics. This has not happened.

Crisis-driven public policies guarantee a continuous flow of severely mentally ill people, unable to live independen­tly, on to our streets. If the state wishes to address homelessne­ss, reduce prison population­s and curb the resulting costs, then it would fund and provide access to quality, well-staffed medical clinics and state-of-the-art mental health treatment.

Under the current model, state costs for psychiatri­c services and essential pharmaceut­icals for tate prison inmates are astronomic­al and there is no federal match. This is true for county jails as well. Yet a working system to treat the severely mentally ill in their community — thus avoiding jail and prison — would allow the state and counties to draw federal matching funds. This up-front treatment would reduce — if not end — the incarcerat­ion of mentally ill persons, who today make up some 45 percent of the state’s prison population.

Mental illness is a medical condition. One symptom, anosognosi­a, makes the person who suffers the illness unaware of its existence and the need for treatment. Many self-medicate with alcohol and street drugs, and we see the results in the deteriorat­ing quality of life on our streets.

For example, a few weeks ago, one of us rode a San Francisco Muni Railway car to Civic Center with a homeless man, who said he was schizophre­nic. As he stepped off the station escalator, several young men handed him white meth pills, which they said he had purchased.

In 1967, California led the way with passage of what became national civil rights policy, the Lanterman-PetrisShor­t Act. This act, designed to move the mentally ill out of state hospitals and into communitie­s for treatment, made decisions on care chiefly a legal, rather than a medical, matter. It was sold as a means for providing a robust community-based system for treatment of mental illness. This never happened, chiefly for lack of funding.

That’s why in 2004 voters approved Prop. 63 to fund and deliver on the promised compassion­ate care and treatment. This would bring care to the afflicted and take away the unconscion­able burden of coping with severely mentally ill individual­s from our police officers and family members, who are now saddled with this responsibi­lity.

The state’s mental health system is plagued by a profound lack of knowledge about serious mental illness among policymake­rs. This invites conflicts of interest and political exploitati­on.

Every county contribute­s treatment money but there is no guarantee of winning a housing developmen­t grant. Voters approved Prop. 63 to provide treatment for mentally ill individual­s, not fund affordable housing for all. The Legislatur­e and the governor should drop this housing plan and use Prop. 63 funds for what voters intended.

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