Jo Ann Rebane: How long should we wait to fix something that hasn’t worked and it isn’t working? | TheUnion.com

Jo Ann Rebane: How long should we wait to fix something that hasn’t worked and it isn’t working?

Jo Ann Rebane
Columnist

Jo Ann Rebane

Editor's note: This is the first in a series of columns discussing the impact of mental illness on the issue of homelessness in western Nevada County.

If you ask your neighbors, community leaders, law enforcement, community volunteers, most agree the growing number of mentally ill homeless people on our streets present a complex, monumental humanitarian challenge.

There's not a city or county in California that doesn't have this problem, mental illness among a growing population of the homeless.

This piece, the first of a four-part series, explores the history of mental health services in California and the unintended consequences of certain legislation. In the following weeks I will discuss the costs the state and counties bear in caring for and dealing with the mentally ill homeless, highlight some remedies, and urge specific actions.

Locally, our 2017 Nevada County Point in Time Count found 371 homeless persons. However local officials estimate the actual number of homeless is more than 500 persons, and roughly 30 percent of them also are mentally ill.

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California led the nation in ending involuntary, sometimes inappropriate, and often indefinite institutionalization of the mentally ill in 1967. The Lanterman-Petris-Short Act was intended in part to provide prompt examination and treatment of persons with serious mental disorders or chronic substance abuse; guarantee and protect public safety; safeguard individual rights; utilize existing agencies and public funds without duplication; and provide services in the least restrictive setting while reducing the cost of running state mental hospitals.

It was felt that the new psychotropic drugs would help people with mental illness live free and productively in their home communities. All this sounded good, very good.

But what happened in California? The immediate unintended consequences from the act were:

Fourteen of 19 state hospitals which formerly housed 35,000 people closed, leaving only the five institutions in Fresno, Napa, Los Angeles, San Bernardino and San Luis Obispo counties and returned 29,400 to their local communities for care.

With fewer state mental hospitals, funding for mental health was significantly reduced.

Local community mental health systems didn't exist, and few communities had resources to care for the people released from the state hospitals. The Legislature presumed that every county would have a local, locked inpatient psychiatric unit. In fact, today 27 counties of 58 still have no inpatient psychiatric beds. In the first year after the adoption of Lanterman-Petris-Short, the number of mentally ill persons entering the criminal justice system doubled.

Private hospital emergency departments and local jails became the default providers for people who were too ill to seek or accept mental health treatment. When discharged these impaired became revolving door patients, soon returning to the hospital or, if not, becoming a threat to public safety.

It turned out that medication wasn't the easy solution psychiatric professionals and proponents expected. Thorazine had serious side effects and although other drugs were developed, many patients complained that they didn't feel like themselves when medicated so turned to street drugs to quiet the voices in their heads.

Responsibility for caring for the mentally ill was shifted to the counties through realignment legislation and changes made to Medi-Cal regulations.

Today, the unintended consequences of the LPS Act of 1967 continue to impact the entire state, including Nevada County in how to deal with the mentally ill homeless population.

California's 2017 Point in Time Count of 134,000 homeless population is more likely 3 or 4 times greater or 402,000 to 536,000 homeless in the state, according to the Institute for Local Government, of whom 30 percent suffer mental illness and more have a concurrent alcohol or substance use disorder.

Locally, our 2017 Nevada County Point in Time Count found 371 homeless persons. However local officials estimate the actual number of homeless is more than 500 persons, and roughly 30 percent of them also are mentally ill.

Our homeless, and especially mentally ill, people pose a monumental problem in our community with the risk of starting forest fires, spreading disease, disruptive public behavior, crime, living in filth, personal misery, as well as having a negative impact on businesses and the quality of life here and often requiring massive encampment clean up.

The largest psychiatric institution in California is the Los Angeles County jail system. The Los Angeles Times reported in February that L.A. County incarcerates thousands of mentally ill people and the L.A. County Sheriff's Department reports that more than 70 percent of inmates who enter jail report a serious mental or physical illness. Nevada County Sheriff's Captain Jeff Pettitt, who manages our jail, estimates that more than half of those booked at Wayne Brown have some level of mental illness or substance abuse problem.

According to the findings of the California Hospital Association, each county has unique mental health infrastructure, program design and administrative procedures which result in a "significant diversity in the level and types of mental health services available." This leads to statewide fragmented and inconsistent application of the Lanterman-Petris-Short Act standards regarding stabilizing, evaluating, and the involuntary holding of persons who pose a danger to themselves or others.

In Nevada County, law enforcement is authorized to deliver a person involuntarily for evaluation to the Crisis Stabilization Unit or to the Emergency Department at Sierra Nevada Memorial Hospital. Some counties permit law enforcement to declare a person "dangerous to themselves and others", known as Code 5150. In Nevada County, the 5150 determination, if appropriate, is made by mental health professionals.

Michael Heggarty, director of Health and Human Services Agency, states that the standard used here recognizes "a healthy balance of protection of individual rights, and protection for the community and public safety. [Further] there is sufficient room in making the determination of "danger" to account for individual circumstance, past history, corroboration by family members, immediate threat and means to carry out the threat, etc."

Next week's column will detail financial and other challenges mentally ill homeless people present to counties.

Jo Ann Rebane is a member of The Union Editorial Board. Her views are her own and do not represent the views of The Union or its editorial board members. Contact her at editboard@theunion.com.

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