Treatment first, not housing
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.