Who closed our mental health hospitals? It wasn’t Reagan

Given the UDJ’S series on the homeless-mental health-substance abuse issue, I thought it would be timely to take a look at one chapter of mental health history in California that I’ve written and spoken about for many years. It should help shed light on why it is so difficult to provide mental health care for those in the most dire need of it.

There is a longstanding belief that when Ronald Ragan was governor in the 1960s, he “closed down” the state’s mental hospitals, thus leading to today’s epic mental health crisis that includes a large component of the mentally ill who wander homeless in our cities and rural areas.

So-called mental health care professionals to this day scapegoat Reagan for the abysmal failure of a system that has never experienced any kind of success. But one thing Reagan didn’t do was “close down” the state’s mental health hospitals located in all of the 58 counties. He didn’t close a single hospital. He never even closed a single room in a single hospital.

So who closed the hospitals? The patients in the hospitals did by exercising their new freedoms under a landmark California law enacted 50 years ago that created a “Mental Health Patient’s Bill Of Rights” that became the model for many other states in this country. You could say mental health patients after the law was passed, voted with their feet: They left their rooms and walked out the hospital’s front doors, never to return.

Two legislative forces actually determined the fate of mental health care in this state. You might call them acts with unintended consequences. Here’s the history.

In 1967, the Lanterman—petris—short Act (LPS Act) a socalled “bill of rights” for those with mental health problems passed the Democratic-controlled Assembly 77-1. The Senate approved it by similar margins. Then-gov. Reagan signed it into law.

It was co-authored by California State Assemblyman Frank Lanterman, a Republican, and California State Senators Nicholas C. Petris and Alan Short, both Democrats. LPS went into full effect on July 1, 1972.

The bi-partisan law came about because of concerns about the involuntary civil commitment to mental health institutions in California. At the time, the act was thought by many to be a progressive blueprint for modern mental health commitment procedures, not only in California, but in the United States.

Its main purposes were:

• To end the inappropriate, indefinite, and involuntary commitment of mentally disordered persons, people with developmental disabilities, and persons impaired by chronic alcoholism, and to eliminate legal disabilities;

• To provide prompt evaluation and treatment of persons with serious mental disorders or impaired by chronic alcoholism;

• To guarantee and protect public safety;

• To safeguard individual rights through judicial review;

• To provide individualized treatment, supervision, and placement services by a conservatorship program for gravely disabled persons;

• To encourage the full use of all existing agencies, professional personnel and public funds to accomplish these objectives and to prevent duplication of services and unnecessary expenditures;

• To protect mentally disordered persons and developmentally disabled persons from criminal acts.

Initially, mental health advocates pushed for community-based mental health facilities that would replace the closed mental hospitals.

But that never happened because even though post-reagan the legislature was still controlled by Democrats, no major funding for new community-based mental health facilities ever occurred. And that situation basically is still the case today.

The second force at work in the mental health care issue were the courts and what is known as “deinstitutionalization.”

During the 1960s, many people began accusing the state mental hospitals of violating the civil rights of patients. Some families did, of course, commit incorrigible teenagers or eccentric relatives to years of involuntary confinement and unspeakable treatment.

To get the picture, think of the movie “One Flew Over The Cuckoo’s Nest” and the sadistic Nurse Ratchett. The new law ended the practice of institutionalizing patients against their will.

By the late 1960s, the idea that the mentally ill were not so different from the rest of us, or perhaps were even a little bit more sane, became trendy. Reformers dreamed of taking the mentally ill out of the large institutions and housing them in smaller, community-based residences where they could live more productive and fulfilling lives.

A mental patient could be held for 72 hours only if he or she engaged in an act of serious violence or demonstrated a likelihood of suicide or an inability to provide their own food, shelter or clothing due to mental illness. But 72 hours was rarely enough time to stabilize someone with medication. Only in extreme cases could someone be held another two weeks for evaluation and treatment.

As a practical matter, involuntary commitment was no longer a legal option that created a whole new dilemma: How do you make a sick person better who refuses help? By definition a mentally ill person is incapable of making rational decisions concerning their health.

The LPS Act emptied out the state’s mental hospitals but resulted in an explosion of homelessness. Legislators never provided enough money for communitybased programs to provide treatment and shelter.

Lanterman later expressed regret at the way the law was carried out. “I wanted the law to help the mentally ill,” he said. “I never meant for it to prevent those who need care from receiving it.”

But that’s exactly what has happened for the past five decades.

There’s no argument that the mental health care system is in shambles in California — well, the whole United States for that matter. Disregarding federal funding for the moment, looking solely at California, last year $7.2 billion was targeted to address homelessness, and $6.7 billion was spent on mental health. Last year, there were an estimated 172,000 homeless statewide, which equates to spending nearly $42,000 per homeless person, and $9,718 was spent per mental health client.

Of course, in all likelihood not a single homeless person or mental health patient received anything close to those amounts. So where did the money go? Well, it went to feed the voracious, ever-expanding Homeless-mental Health Industrial Complex, notwithstanding the fact that the worsening crisis signals that nothing we’re presently doing is ever going to work.

Isn’t that sort of the definition of insanity?