Category: Uncategorized (Page 3 of 5)

Published July 20, 2020 on Capitol Weekly.

Calls to ‘defund’ police gain traction, as protesters — and public officials — contend that money would be better spent if clinicians, social workers responded to mental-health 911 calls. Police say many such programs already exist, and that they need more staff and funding.  (First of two parts. Part 2 can be seen here.)

On the afternoon of May 8, 2017, the family of 32-year-old Mikel McIntyre called 911 for help in dealing with his increasingly erratic and threatening behavior. The former high school and college athlete, who lived in Antioch and had briefly played baseball in the minor leagues, had been showing signs of serious mental illness, and his mother was concerned. She hoped a visit with family in Sacramento might help.

The first call, shortly after 3 p.m., indicated a possible mental-health crisis: McIntyre had locked himself in a vehicle and was being “slightly combative,” but the firefighters who responded decided he was not a threat. When family members called again to say McIntyre was becoming increasingly volatile, Sacramento County sheriff’s deputies responded at 3:32 p.m., and they determined McIntyre’s behavior did not meet the criteria for him to be detained on a 72-hour mental-health hold, as a danger to himself or others. The deputies suggested he leave the house, which he did.

McIntyre fled on foot toward the Zinfandel Drive onramp to westbound Highway 50, then on the freeway shoulder.

Later that same day, at 6:47 p.m., McIntyre was observed hitting and choking his mother in her car outside a Ross store in Rancho Cordova, near a busy intersection at Zinfandel Drive and Highway 50. Several witnesses called 911, and deputies again responded.

This time, the confrontation rapidly escalated.

McIntyre walked across the parking lot, ignoring deputies.  There was a scuffle, and a deputy fell while attempting to detain McIntyre, who threw a large rock, hitting the deputy in the head. Dazed and bleeding from a head wound, the deputy fired two shots, but missed, as McIntyre fled on foot toward the Zinfandel Drive onramp to westbound Highway 50, then on the freeway shoulder. Officers from several agencies quickly swarmed the area.

At one point, McIntyre threw another, smaller rock from the piles of river rock near the freeway, that hit a sheriff’s deputy and a canine.  According to a highly critical Sacramento County Inspector General’s report on the incident, three deputies fired a total of 28 rounds at McIntyre as he fled the scene, running alongside the busy freeway during rush hour. He was hit by seven bullets in his torso and limbs, six of them in his back.

Several rounds were found embedded in the roadway, and Inspector General Rick Braziel, a former Sacramento police chief who consults for law enforcement agencies throughout the U.S., said vehicles were passing on the freeway as shots were being fired.

“There are instances where the number of rounds fired at McIntyre were excessive, unnecessary and put the community at risk,” Braziel concluded in the detailed, 27-page report. The report infuriated Sacramento County Sheriff Scott Jones, who barred him from further investigation and issued a statement describing the findings of Braziel, a highly regarded former police chief, as “a lay opinion.” The county board of supervisors took no action to prevent Braziel’s precipitous firing, despite intense public pressure and demonstrations.

McIntyre was not armed and Braziel concluded “escape was unlikely,” and that officers had options other than lethal force to detain him.

“There were adequate resources on the ground with three officers on foot, six officers driving marked vehicles, and a canine, for a total of nine law enforcement officers, to isolate and contain McIntyre without firing additional shots,” Braziel wrote. There was also a sheriff’s helicopter and a CHP aircraft hovering over the scene.

The graphic videos of the pursuit are difficult to watch. They show McIntyre, who was Black, running alongside the freeway, pursued by multiple police vehicles and officers. The canine, which bit him, and several officers can be seen descending on McIntyre as he drops to the ground.  He was transported to UCD Medical Center, where he died shortly afterward.  In a detailed, May 28 Sacramento Bee account following release of the sheriff’s report and videos, a sheriff’s photo of the aftermath at the scene shows a pool of blood where McIntyre’s body had been, a pair of sneakers nearby.

“He did nothing but run for his life,” his mother Brigette McIntyre told reporters. “His death was senseless.” Sacramento District Attorney Anne Marie Schubert ruled the shooting justified.

McIntyre’s family sued, and the county settled for $1.725 million earlier this year, while not admitting fault. Despite a new state law requiring law enforcement agencies to release reports and videos of incidents that result in death or serious injury, Jones had refused to release the McIntyre reports or video, saying the case occurred before the law became effective in January 2019. The CHP released a redacted video, but the sheriff’s video was only released by Jones this past May, after the Sacramento Bee and the Los Angeles Times went to court, and more than three years after McIntyre’s death.

One in four
According to a 2015 study, “Overlooked in the Undercounted: The Role of Mental Illness in Fatal Law Enforcement Encounters,” by the nationally recognized Treatment Advocacy Center, “the risk of being killed during a police incident” is 16 times greater for people with untreated mental illness. “By all accounts – official and unofficial – a minimum of 1 in 4 fatal police encounters ends the life of an individual with severe mental illness.”

“We would never send a social worker to a bank robbery. Why would we send a police officer to a mental-health emergency?” — Maggie Meritt

The McIntyre case – and many like it, frequently involving the deaths of Black men at the hands of police — have become flashpoints in growing calls for major changes in police use of force and in the way law enforcement responds to mental-health crises. Black Lives Matter protesters and civil-liberties groups, including the American Civil Liberties Union, are calling for “defunding” the police, slashing police budgets to fund more social services and redirecting mental-health calls to social workers and clinicians better qualified to help.

“We would never send a social worker to a bank robbery,” says Maggie Merritt, executive director of the nonprofit Steinberg Institute in Sacramento, which was founded by former state Senate Leader Darrell Steinberg, now Sacramento’s mayor, to advocate for improved mental-health policy and programs. “Why would we send a police officer to a mental-health emergency?”

But Merritt and other mental-health policy experts caution against removing police officers entirely from the equation.

“There is a need for somebody in the process of responding to a call to do a threat analysis and public-safety assessment,” says Randall Hagar, legislative advocate for the California Psychiatric Association. “There is no doubt that we need a lot more clinicians on the street responding to crises that are derived from a person’s mental illness, but sometimes a clinician needs backup” by law enforcement, especially in incidents where a weapon is involved. “There always has to be a determination of whether a public-safety issue is involved.”

Hagar and others want more training for police and 911 dispatchers on how to respond to mental-health crises, perhaps with a clinician involved in screening the calls. A former president of the Sacramento chapter of the National Alliance on Mental Illness (NAMI), which advocates for families, Hagar said he once surveyed his members and found that more than half had experienced “some sort of law enforcement in the last year, and those were not always happy situations.”

Many law enforcement and mental-health professionals argue that existing programs already use clinicians and counselors who work with officers to respond to mental-health calls, often de-escalating potentially volatile situations. They emphasize that follow-up contact is essential to avoid future crises, and that the presence of mental-health professionals frees up officers to focus on violent, serious crimes, saving limited public funds by preventing incarceration, hospitalization and homelessness.

In reality, the 5150 statute is widely regarded as ineffective and outdated.

“Officers didn’t sign up to be social workers, or to determine people’s mental-health status,” says veteran San Diego police officer Brian Marvel, president of the influential Peace Officers Research Association of California (PORAC). For many years, Marvel worked as an officer in the San Diego Police Department’s Psychiatric Emergency Response Team (PERT), in which officers are paired with mental-health professionals to respond to and follow up on mental-health emergencies. “I’ve long been an advocate of sending mental-health calls to others first – let the people who are skilled in this area handle these calls,” he said.

“I don’t think we have to re-invent the wheel in California,” he adds. “It’s a matter of evaluating what the best program would be. But it’s really incumbent on elected officials to be sure it’s adequately funded. Elected officials have set up law enforcement to fail, because they’ve failed to properly fund services for homelessness and mental health.”

Officers are required to respond to so-called “5150” calls, a reference to the state Welfare and Institutions Code that sets criteria for detaining someone for 72 hours who is deemed “a danger to self or others.” In reality, the statute, which is widely regarded as ineffective and outdated, too often means an individual who is detained under a 5150 goes to an already overburdened hospital emergency room. There, an officer must stay with the patient, who frequently is released without treatment, medication, or a referral to overwhelmed mental-health programs and largely nonexistent housing. It’s an expensive, time-consuming and frustrating process for all concerned.

The SMART unit also has 60 clinicians, whose salaries are paid through the county’s Department of Mental Health with some funding from the state Mental Health Services Act.

“I’m very limited in what I can do in a 5150,” says Marvel. But when clinicians are involved in the response at the outset, as in San Diego’s PERT program, “that literally opens up all of the services available in the county.”

The Los Angeles Police Department, which has 9,000 sworn officers and 3,000 civilian employees,  has long had a mental-health unit that pairs officers in civilian clothes (a uniform of tan khaki’s and a black polo with the LAPD insignia, designed in consultation with NAMI) and clinicians – social workers and psychologists – to respond to mental-health calls.

Headed for the past five years by Lt. Brian Bixler, who was a youth pastor before he became a cop, the SMART (Systemwide Mental Assessment Response Team) unit currently includes 68 officers and 18 supervisors, also sworn officers, some with advanced degrees in social work and psychology, and 60 clinicians, whose salaries are paid through the county’s Department of Mental Health with some funding from the state Mental Health Services Act.

“We run it like a patrol division,” Bixler said, “with four shifts” around the clock. Like San Diego’s PERT program, they also partner with community programs that provide mental-health treatment and suicide prevention.

Depending on the time of the call and its location, regular patrol officers may be the first responders to a mental-health call, Bixler said, with SMART teams either joining them at the scene or following up soon afterward. Bixler has long believed “there’s gotta be a better way” for police to respond to mental-health crises, and current calls for major change “may be the impetus to do that.”

“I’m asked if we want more police officers (in the SMART program),” he adds, “and I say I’d rather have more clinicians [who can intervene] before someone gets to the point where they call 911. My whole goal is to work us out of a job.”

Some local agencies send mental-health and other “non-criminal” calls directly to community mental-health programs.

In Sacramento County, the Division of Behavioral Services has a Community Support Team – which includes licensed mental-health clinicians and peer-support specialists (lay counselors with personal experience) — who provide phone and community-based assistance, connecting people with mental-health and housing programs. Using state Mental Health Services Act funds, the county also has six Mobile Crisis Support Teams, consisting of licensed mental-health clinicians who work with local law enforcement to respond to calls and help de-escalate mental-health emergencies.

Mobile crisis teams expand
The Mobile Crisis teams, which the county is expanding to 11 teams, each include a senior mental health counselor paired with an officer or deputy, as well as a “peer navigator” (a lay counselor with personal experience) who helps to ensure connections with ongoing services.  As in other agencies throughout the state, staffing and funding are inadequate, and mental-health clinicians are spread thin in a large county with multiple police and fire agencies asking for help.

There are other, similar programs around the country, in which police collaborate with mental-health professionals on crisis calls. Some local agencies send mental-health and other “non-criminal” calls directly to community mental-health programs, with police backup if necessary.

Many point to the 30-year-old CAHOOTS (Crisis Assistance Helping Out on the Streets) program in Eugene, Ore., a collaboration between the police department and a 50-year-old community program, the White Bird Clinic, in which non-emergency and 911 calls that do not involve an extreme threat of violence or bodily harm are routed to a medical-crisis team (usually a nurse or EMT and a mental-health professional) trained in de-escalating mental-health crises and connecting individuals with services.

Myriad proposals have been made in cities and counties throughout California and the U.S. in the wake of massive national protests against historic police mistreatment.

As a result of national protests, the CAHOOTS program is getting a lot of press in recent weeks. According to a “Media Guide” on the White Bird Clinic website, CAHOOTS teams responded to 24,000 calls in 2019, about 20 percent of total non-emergency and 911 calls, and only 150 required police backup. The program is estimated to save the city about $8.5 million annually in public safety costs, plus some $14 million in ambulance trips and ER costs.

The coronavirus epidemic in many ways has served to shine a bright light on the historic lack of coordination between police and mental-health professionals, with growing national demands for changes in how police respond, particularly to calls involving people of color.

“When we have a loud response from a diverse community, there is this opportunity for looking at different ways of doing things,” says Jennifer Reiman, a licensed clinical social worker who is Sacramento County’s Mental Health Program Coordinator for the Community Support Team and Mobile Crisis programs. “Providing a spectrum of response is really important.”

Myriad proposals have been made in cities and counties throughout California and the U.S. in the wake of massive national protests against historic police mistreatment – and many deaths – of Black citizens, especially Black men and boys who are arrested and incarcerated at numbers far disproportionate to their numbers in the general population.

Some proposed changes involve nomenclature as well as pandemic-driven cuts and redirecting police spending. The Davis City Council is considering a proposal to rename the Police Department, calling it the Department of Public Safety. In Minneapolis, where the gruesome death of George Floyd under a policeman’s knee spurred national protests, the City Council has proposed the creation of a Department of Public Safety and Violence Prevention.

“We must reduce our reliance just on caging people.” — Supervisor Sheila Kuehl

New York’s City Council recently voted to shift $1 billion from policing to education and social services in the coming year. In Los Angeles, the City Council cut the LAPD budget by $150 million, ostensibly redirecting more funds to social services. The LA County Board of Supervisors proposed cuts of $162 million to the 2020-21 Sheriff’s budget, also with an eye to redirecting services from incarceration to treatment.

And LA Supervisors are revisiting plans to close the dangerous, cramped Men’s Central Jail, to focus more on diverting the huge percentage of mentally-ill inmates in the system into treatment and diversion programs. LA County’s jail system, overseen by the Sheriff’s Department, is often referred to as the largest mental-health facility in the world.

“We must reduce our reliance just on caging people,” said Supervisor Sheila Kuehl, a former state legislator, public-interest attorney and law professor. The once-controversial proposed closure of the 57-year-old Men’s Central Jail is no longer a “revolutionary concept,” she added, but rather “simply logical, fiscally prudent and another opportunity for community healing.”

In Sacramento, Mayor Steinberg, who has long advocated for more funding and resources for mentally ill Californians and their families, last month proposed hiring an Inspector General to provide oversight and investigation of Sacramento police, as well as a plan for “triaging” 911 calls from individuals and families in mental-health crises. The plan would shift police funding to create a new unit comprised of mental-health professionals who would respond to calls involving mental-health emergencies, homelessness and other “non-criminal,” non-violent issues.

“We are the 24/7 crisis call line,” she said. “You call, we come, regardless of the level of crisis the individual may be in.” — Bridgett Dean

“We’ve been hearing calls for ‘de-funding’ the police,” Steinberg said in a press release, “but I think it’s more productive to talk about the function of the police and let the money follow the function.”

Sacramento Police Chief Daniel Hahn recently hired a licensed clinical social worker, Bridgette Dean, to oversee a Mental Health Unit in the Police Department. Dean, who has worked in law enforcement for the past decade, filled a similar role in the Roseville Police Department when Hahn was chief there. She is one of the few – possibly the only — social-services administrators in Northern California with direct authority over police officers whose primary focus is on mental-health calls.

Dean heads a team of five officers with intensive training in how to deal with mental-health crises, as well as a homeless outreach team. They work with patrol officers to assess mental-health emergencies and help people in crisis get services. “We’re not going in to do an enforcement model,” she said, “We want to close the gap, get the services they need.” She stresses the importance of training for officers and dispatchers, who are “trained and experienced in listening to key words to understand that it’s a mental-health call.”

“We are the 24/7 crisis call line,” she said. “You call, we come, regardless of the level of crisis the individual may be in. If it’s a priority call – ‘I’m going to kill myself’—we go right now. If it’s not an emergency crisis on the patrol side, they will refer the call to the mental-health unit for follow-up.”

‘Major Issues’ at state level
Collaboration is the key to the success of programs like Dean’s, and state support.

“We have some major issues we have to resolve at the state level,” she said, including reforms in an outdated, ineffective system created with the closures of state mental hospitals in the 1960s and 70s, which resulted in strict legal protections for the rights of the mentally ill. But those changes assumed that a robust system of “community care” would replace the hospitals – which never happened, leaving thousands of mentally ill Californians homeless and untreated, shuttling among hospital emergency rooms, jails and prisons, at tremendous public expense and incalculable human suffering.

“The structure we have in place is so antiquated,” Dean said, referring to the 1967 Lanterman Petris Short Act that drastically altered California’s system of mental-health care and has never been substantively changed or updated. And the ambitious proposals currently advanced throughout the country to reorganize and/or defund the police often fail to recognize the reality of services on the ground.

“All of this is good talk. . .until we realize we have 50 detox beds in Sacramento city and county,” and extremely limited numbers of beds for psychiatric patients in crisis, much less for those needing long-term care. “When we talk about the need to get somebody off the streets, we’re not able to do that because of the lack of beds.”

TOMORROW: Solutions emerge in national push for major changes in how police respond to mental-health crises (Second of two parts)
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Editor’s Note: Sigrid Bathen is a longtime Sacramento journalist and former Sacramento Bee reporter who has covered mental-health and related issues for several publications for more than 40 years. She has taught journalism and communications at Sacramento State since 1988. She has written for Capitol Weekly since 2005, on a variety of subjects, including education and health care. To see two of Bathen’s recent pieces in Capitol Weekly on mental health issues, click here and here.

Published January 28, 2020 on Capitol Weekly.

“California began emptying its mental hospitals 30 years ago (in 1967), when community based care was touted as the more humane alternative. As thousands of homeless mentally ill wander city streets, or end up in jail or prison, policy-makers wonder: Where is this ‘community care’, and isn’t there a better way?” – California Journal, 1997

“There are a lot of pieces to this puzzle, and we need to look at it as a whole – courts, prisons, police, state hospitals, community programs – and re-engineer a system that works better.” — Randall Hagar, California Psychiatric Association, Capitol Weekly, 2011

“The State of California is treating homelessness as a real emergency – because it is one.” — Gov. Gavin Newsom, State Budget Preview, Jan. 8, 2020

The modern history of mental-health care in California begins more than half a century ago with passage of the landmark 1967 Lanterman-Petris-Short Act, an ambitious — but ultimately disastrous —  overhaul of a draconian “system” of hoary old mental hospitals throughout California.

Most of the hospitals were closed, but the “community care” that was to take their place never materialized. Laws were changed to prevent forced institutionalization, and increasing numbers of mentally ill Californians wandered the streets, or languished in jails and prisons. Skyrocketing housing costs forced more people out of their homes, and California now leads the nation in the number of homeless people on its streets.

Residents – “inmates” was a more apt term – shuffled around in grimy “day rooms,” watched TV, or were confined to bleak dorms with few programs.

As Gov. Gavin Newsom, with great fanfare and reams of statistics, launches his ambitious $1.4 billion budget plan targeting mental illness and homelessness, there is both hope and a question: Will it really mean lasting change?

The odds are not good.

First, some history.

For decades, thousands of mentally ill and developmentally disabled residents were confined in chronically overcrowded, understaffed facilities  that often looked more like prisons than hospitals, where powerful antipsychotics were routinely dispensed, to “keep them quiet.” Residents – “inmates” was a more apt term – shuffled around in grimy “day rooms,” watched TV, or were confined to bleak dorms with few programs, little therapy, poor supervision, and hardly any future.

They were frequently confined against their will. The hospitals could be dangerous places, where hundreds of people, including mentally ill and developmentally disabled children and teens (the accepted term then was “mentally retarded”), were injured or died under questionable circumstances, prompting highly critical media coverage. Finally, sweeping state investigations were launched in the late 1970s into dozens of “suspicious deaths” in state hospitals going back years.

Some major staffing changes were made, but few, if any, criminal charges were filed.

“The state hospitals went from 35,000 to 5,000, and the community was expected to deal with it, without the expertise or the resources.” — Dr. Stephen Mayberg

As the hospitals closed during the Reagan administration, and into the first Jerry Brown term, only a few remained, primarily to house those deemed criminally insane by the courts.

For the legions of discharged residents without families willing or able to help or house them, the streets – and jails and prisons – of California cities ultimately became the default “homes” for thousands of mentally ill Californians.

The “community care” touted by the Lanterman reforms was largely nonexistent, and new laws limited institutionalizing or forcing people into treatment against their will. 

“The state hospitals went from 35,000 to 5,000, and the community was expected to deal with it, without the expertise or the resources,” Dr. Stephen Mayberg, who then headed the state Department of Mental Health, told a California Journal reporter in 1997.  “It was a recipe for problems, and we’ve spent a long time trying to dig ourselves out of that hole.”

Yet that “hole” Mayberg described in 1997 only seems to get deeper, despite multi-billion-dollar infusions of taxpayer funds, myriad executive and legislative fixes, critical state audits and frequent reorganizations — including the breakup of the massive state Health Department in the 1970s and, decades later, eliminating the state Mental Health Department in 2011.  As oversight responsibilities were spread among several state agencies, the “problem” has worsened exponentially, complicated by the lack of affordable housing and the Byzantine bureaucracy of “community care.”

More than 150,000 Californians are homeless (many of them mentally ill), according to recent federal estimates. Homeless “counts” are constantly changing, notoriously unreliable, and the numbers likely are much higher. In Los Angeles County alone, recent estimates place the number of homeless people at 60,000. A recent poll by the Public Policy Institute of California ranked homelessness as the No. 1 priority for immediate state action.

Under tremendous pressure to take sweeping action, Newsom earlier this month unveiled one of the most ambitious state reorganizations yet, committing more than $1 billion in state funding and prioritizing homelessness and mental health in his 2020-21 state budget proposal, which includes a $750,000 fund “to get individuals off the streets and into supportive services quickly.”

“Californians are demanding that all levels of government. . .do more to get people off the streets and into services, whether that’s housing, mental health services, substance abuse treatment or all of the above.” — Gavin Newsom

Released Jan. 10 in an unprecedented three-hour briefing that featured the governor alone, Newsom cited reams of statistics and budget figures, displaying a rare command of the mind-numbing details typical of a new state budget, as reporters’ eyes glazed and policy-makers watched, astonished.

“In more than 20 years of working in and around state government, we’ve never had a governor who was such a champion of mental health issues, and as knowledgeable about even the minutiae of mental health policy,” said Sacramento Mayor Darrell Steinberg, a veteran champion of mental-health reforms. Steinberg, the former leader of the state Senate, authored major legislation, including the 2004 Mental Health Services Act.

Passed by voters as Proposition 63, which boosted taxes on those with $1 million or more in taxable income, the so-called “millionaire’s tax” has raised billions for mental health programs, while at the same time homelessness has become the scourge – and the shame – of California. The state has more homeless people roaming its streets, living in cars, languishing in jails and prisons than any other state, at tremendous public cost and personal pain.

“Californians are demanding that all levels of government. . .do more to get people off the streets and into services, whether that’s housing, mental health services, substance abuse treatment or all of the above,” Newsom said in his Jan. 8 budget preview. “That’s why we’re using every tool in the toolbox – from proposing a massive new infusion of state dollars in the budget that goes directly to homeless individuals’ emergency housing and treatment programs, to building short-term emergency housing on vacant state-owned land.”

The budget proposal must now wend its way through the Legislature, emerging in the spring and with final approval in June. “It’s heartening,” Steinberg said of Newsom’s proposals to radically restructure – and prioritize – California’s historically fraught, extremely complex system of mental-health care, “and will surely help our state improve the lives of people suffering from mental illness.”

Steinberg co-chairs, with Los Angeles County Supervisor Mark Ridley-Thomas, the governor’s Council on Regional Homeless Advisors, which on Jan. 13 issued an “interim report” generally praising the governor’s proposals, while also urging more focus on the prevention of homelessness.

“Prevention should focus particularly on the growing number of Californians becoming homeless due to economic displacement,” the council recommended, “as well as those discharging from our institutional settings into homelessness.”

“We were disappointed that the governor did not include a proposal to create a certification program for Peer Support Specialists in the budget proposal.” — Steinberg Institute

The advisory council, which includes local and state officials and advocates, urged the governor to “create a single point of authority for homelessness in California” – a “high-level” official and team “to coordinate housing, health and human services and other state responsibilities relating to homelessness,” answering directly to the governor.

Despite campaign  promises that he would appoint a “homelessness czar,” no such appointment has yet been made. When reporters again raised questions about the position during the budget briefing, Newsom rather testily responded that he is the homelessness czar.

In a separate statement issued shortly after the governor’s Jan. 10 budget briefing by the Steinberg Institute on mental health policy, the former Senate leader generally praised Newsom’s proposals.

But Steinberg, who founded the institute, also criticized the governor’s veto last year of a bill widely supported by mental-health advocacy groups to fund a  program of “Peer Support Specialists” – people with personal and family experience in mental health issues – to help the mentally ill get access to critical services.

The measure has passed the state Legislature unanimously three times, and last year Newsom told advocates that “he wanted the process to be handled through the 2020 budget.”

Thus far, that hasn’t happened.

“We were disappointed that the governor did not include a proposal to create a certification program for Peer Support Specialists in the budget proposal,” the institute said, adding that, “We will take him up on his offer to work with us on this important issue and are determined to add this program to the budget.”

The ‘invisible’ families bearing the brunt of care
Limited peer-support programs have long been used successfully in local programs. They can cost far less than other staffing and support services for mentally ill individuals and their families, who bear the brunt of care for mentally ill relatives with little government support or even consultation.

“We knew the conversations were happening, and we tried to get involved.” — Jessica Cruz

Failure to include peer-support funding in the budget (a cost which the Steinberg Institute says is “modest”) highlights a historic policy misstep in efforts to restructure and improve the state’s convoluted and poorly monitored mental-health bureaucracy – failing to include the mentally ill and their families in policy discussions.

Families and many clinicians, social workers and administrators who work in well-regarded local programs, have long said that ignoring, or giving short shrift to, families in policy and budget discussions often torpedoes effective restructuring of the fractured system, with its long history of massive reorganizations, huge infusions of taxpayer funds – and limited accountability.

“We are going to advocate very heavily for family and consumer representatives” to be included in the budget discussions, said Jessica Cruz, California CEO of the influential National Alliance on Mental Illness (NAMI), which provides advocacy and support for families of people living with mental illness, who say they were not actively consulted in the run-up to the budget proposal.

“We knew the conversations were happening, and we tried to get involved,” Cruz said, attending several informational and “stakeholder” meetings and hearings. At one legislative hearing, she said dozens of mental-health advocates, including family members, were present, saying, “Hey, slow down, let us be part of the conversation.”

The governor’s veto of the peer-support legislation – and his failure to include it in the budget proposal – especially troubles family members.

She said families are often “the hidden, invisible population,” providing the bulk of housing and care for their mentally ill family members, with little support – or even acknowledgement — from public agencies. “When we don’t provide treatment for loved ones, everybody suffers. God forbid something happens to their family.”

She said that concern is particularly acute for aging family members caring for mentally ill relatives, often their adult children. “Many of our members are this invisible population that nobody sees or talks about,” Cruz added. “The family voice is so important, as 99 percent of the time we’re the caretakers, the ones providing housing, treatment, transportation.”

The governor’s veto of the peer-support legislation – and his failure to include it in the budget proposal – especially troubles family members.

“Peer support is huge for families,” Cruz said.  Individuals with “lived experience” as someone living with mental illness or as a family member “can help families navigate through difficult times. We are not trained professionals – we are experts in our own experience. We have to be taken seriously, thoughtfully and strategically as a part of these conversations.”

Kaino Hopper is an artist and former college art teacher – and a longtime Sacramento NAMI volunteer who leads family support groups. Her severely mentally ill adult daughter lives at home with her parents, who are in their 60s, when she is not hospitalized or temporarily institutionalized (there are few long-term, or even adequate short-term, facilities for the mentally ill). “We work 24/7 with no breaks,” Hopper said.

Under current law – which many experts say is an over-reaction to past, forced institutionalization — mentally ill people in crisis can only be detained on a 72-hour “5150” hold.

After horrific media accounts of mentally ill patients being discharged to the street, often with disastrous consequences, recent legislation now prohibits health-care facilities from discharging mentally ill patients without housing, which usually comes down to “a bed” that is often hard to find. Addressing the closure of many so-called “board and care” homes for the mentally ill in California cities because the state reimbursement rates are too low – particularly in urban areas where housing costs have skyrocketed — is part of the governor’s budget proposal, but with few details.

“When the person is released from a hospital, we [family members] become ‘the bed’,” Hopper said. “We need help at that point. . .There are ‘stepdown services’ (post-discharge services) after acute care, but they’re few and far between. It’s hard to get on the list.”

Under current law – which many experts say is an over-reaction to past, forced institutionalization — mentally ill people in crisis can only be detained on a 72-hour “5150” hold, a reference to a provision in state law affecting individuals deemed a threat to themselves or others.

Too often, that has meant languishing on a gurney in an overcrowded hospital emergency room. 

Exhausted family members often step in, with devastating results. When they try to get help, restrictive confidentiality laws routinely prevent consultation with families of adult relatives.

“It’s an impossible situation for families,” Hopper said. “The way the system is set up right now, our family members will receive more services” if they refuse to “house” their mentally ill relatives. “It’s emotional blackmail, and families find ourselves in the crosshairs.  We want to be part of the recovery process, but we are not allowed to be part of that process, although we are pressured to provide housing, with no support. Our homes become burnout zones.” Many parents work, many others are single parents, and there are frequently other children in the home. “Families could do more if we had a way to call for help in the home,” says Hopper.   

An explosive state audit in 2017 found that California counties were often “hoarding” millions in MHSA funds ($126 million in Sacramento County alone).

Cruz praised the governor for “prioritizing mental health and homelessness,” but cautioned against “lumping all people with mental illness together as homeless,” although mental health and substance abuse “are a big piece” of the puzzle.

Cruz and other mental-health advocates are also concerned about tapping into funds raised by the landmark 2004 Mental Health Services Act, from which money already has been diverted by California’s Proposition 2, a legislative measure passed by voters in 2018 to use MHSA funds for housing.  “We have to be extremely careful how we use MHSA funds,” Cruz said.

While vague on the details, Newsom’s budget recommended revisions to both Lanterman-Petris-Short and the MHSA, which the Steinberg Institute supported in concept, saying the MHSA funding should focus more on “the soaring number of people with serious mental illness who are also grappling with homelessness or have been involved in the criminal justice system, as well as the rising number of at-risk children and youth who are coping with mental illness.”

And there is widespread agreement that more accountability and state oversight are essential to tracking both funding and progress.

An explosive state audit in 2017 found that California counties were often “hoarding” millions in MHSA funds ($126 million in Sacramento County alone), and the flow of funding has subsequently, though inconsistently, increased from the counties to expand local programs.

Newsom’s budget urges better accountability. His advisory council recommends legal remedies, including sanctioning local governments that fail to move quickly to meet state benchmarks. Many critics and advocates blame the lack of oversight on the 2011 elimination of the state Mental Health Department, during the administration of Gov. Jerry Brown – a reorganization which dispersed the responsibility for monitoring mental health programs and spending among multiple state agencies, making accountability difficult

“We really need to synchronize mental-health services with housing and shelter services.” —  Steve Watters

The governor’s advisory council is adamant that a cabinet-level appointee – a “single point of authority” (e.g., a “homeless czar”) — be named by and report directly to the governor.

‘Shelter’ vs. ‘Housing’
Advocates also emphasize the distinction between “shelter” and “housing,” and Newsom attempts to address both in his budget proposal.

Short-term shelter – like the 100 travel trailers from the “state fleet” and an unspecified number of “complementary modular tent structures” that Newsom proposes be deployed throughout the state – are by definition not permanent housing, which takes much longer to realize and is much more expensive.

Many local agencies and nonprofits around the state work to provide permanent housing, and many others are focused on temporary shelter. Both, however, emphasize the importance of “wraparound services” for residents facing myriad physical, mental-health, social-services and substance-abuse issues.

“We really need to synchronize mental-health services with housing and shelter services,” says Steve Watters, a longtime CEO of Sacramento-area nonprofits (Safeground Sacramento and, more recently, First Step) that provide shelter, housing and other services for the homeless, many of whom are mentally ill.

“It should be easy, but it isn’t. . .Affordable, permanent housing takes a long time to develop. We’re trying to develop interim housing, a form of shelter, and wraparound services. We can’t wait for affordable housing. Our clients can’t wait,” he said.

The specter of epic tensions between the Newsom and Trump administrations also haunts the governor’s ambitious plans to tackle homelessness and mental illness in California.

On Jan. 1, First Step opened an 80-bed shelter on North A Street in Sacramento, funded through the county, and is working with the Sacramento Housing and Redevelopment Agency and the Sacramento City Council to establish “villages” of tiny homes, sleeping cabins — collaborating with other organizations to provide medical and other services.

“It’s much easier to engage clients [in services],” he says, “when you know where they are.”

State and federal funds are often distributed by the cities and counties, and navigating the funding maze can be an exercise in frustration even for the most experienced nonprofit administrators. 

“The city and county have funds coming from the state, with some requirements, and then the city and county decide how to spend the money,” Watters says. “There needs to be more involvement from the service providers [at the local level]. We actively campaign for solutions that involve sheltering and services that can be helpful – intensive case management for each individual, tied in with collaborators on the medical side for mental health counseling and primary care. . .But it’s difficult to navigate the system.”

The specter of epic tensions between the Newsom and Trump administrations also haunts the governor’s ambitious plans to tackle homelessness and mental illness in California, as federal funding is a key element, particularly in Newsom’s lofty plan to “transform Medi-Cal.”

“That three-hour press conference is one-way, directional. The only way you get to a solution is through communication, negotiation.” — Barbara O’Connor

The Los Angeles Times recently revealed that Los Angeles Mayor Eric Garcetti has been quietly negotiating with federal officials for funding to address the especially visible and acute homeless crisis in L.A. The efforts initially appeared to be bearing fruit, until the Trump administration placed myriad, but vague, “conditions” on actual funding, which included more involvement by law enforcement and reducing regulations on housing construction. Those conditions appear to have stymied the negotiations.

“But at least they’re communicating,” says Barbara O’Connor, a longtime political adviser and commentator and former communications professor at Sacramento State University.

“These are all great ideas,” O’Connor says of Newsom’s proposals, “but the coordination is lacking, with so much money and nobody to really run it. [Newsom] is not interactive, too much into one-way communication. That three-hour press conference is one-way, directional. The only way you get to a solution is through communication, negotiation. And there must be a project manager, which is true of any project — someone must be fully in charge of it. The homeless problem is not one solution for all. Modesto is not L.A., and the governor hasn’t even talked about federal money. The fact he hates Trump is not an excuse.”

Increasingly criticized for “big ideas,” and few actual accomplishments in his first year in office, the governor’s current proposals have enormous consequences for Newsom’s political future. O’Connor points to recent columns by influential L.A. Times political columnist George Skelton, who has both chastised the governor (for too many big ideas, too few actual accomplishments) and cautioned him (the current budget proposal initially appeared to be more focused on a few key issues, but the three-hour budget “briefing” should have been condensed to 30 minutes max.).

On the day after a preview of the 2020 budget, Skelton quoted two political veterans about prospects for Newsom’s second year:

From Republican political lawyer Steve Merksamer, who was chief of staff to Gov. George Deukmejian: “This governor made more promises than any governor I’ve seen. . .This is not a criticism, but it’s the time to put up or shut up. Taking on issues other people haven’t is fine, but that’s not the question. It’s taking them on and solving them. It’s time to fish or cut bait. It’s the second year.”

From Democratic political consultant Steve Maviglio, who was communications director for Gov. Gray Davis (like Newsom, Davis was a former college baseball player): “When you swing at a lot of pitches, you hit a lot of foul balls. He should focus on hitting a few out of the park.”

Advocates for the homeless mentally ill, meanwhile, always hoping for more state funding, are hesitant to publicly criticize public agencies.

Daniel Zingale, a top political adviser to two previous governors and former senior vice president of the California Endowment, reportedly has worn many hats in the Newsom administration, although his title was director of strategic communication and public engagement. He announced his retirement last week, but said he would stay on through Newsom’s State of the State message next month and may continue in an advisory capacity.

In his previous, equally high-profile jobs, Zingale was accessible, often quoted in news accounts, though less so during the first year of the Newsom administration.

Earlier this month, Zingale spoke to Skelton about the 2020 budget – and, perhaps, attempt some damage control over all of those reports of unfocused governing. He told Skelton that Newsom would be focused this year on three priorities: homelessness, health-care affordability and wildfires.

And then, a day later, Newsom delivered that marathon, one-man, three-hour budget “briefing,” showing a remarkable command of governmental minutiae, going well beyond his three “priorities” into the wonky details of the vast state bureaucracy. Not a good sign for actually accomplishing those priorities.

Advocates for the homeless mentally ill, meanwhile, always hoping for more state funding, are hesitant to publicly criticize public agencies and elected officials who help pay for their programs, although many are distressed by what O’Connor called Newsom’s “one-way communication.”

So they are waiting in the wings, hoping for the best, focused on keeping their clientele off the streets, connected with services.

“If you’re going to navigate the system and put things in place to help people,” says First Step’s Watters, “you can’t stand on the corner all the time with a bullhorn.”
—
Ed’s Note:  Sigrid Bathen is a Sacramento journalist who teaches at California State University, Sacramento. She has written about mental-health issues for more than 40 years. Her investigative reporting has appeared in many publications, including the Sacramento Bee and the California Journal.  She has received several major awards, including a Pulitzer Prize nomination and recognition from the state and national mental health associations. Bathen has written about mental health, education, health care and state government for Capitol Weekly since 2005.

Professional Activities, April-June 2019

Sigrid Bathen, Communication Studies, was the guest speaker for the California Writers Club (Sacramento area chapter) on March 1, speaking on the topic, “Magazine Writing: Then and Now, Print to Digital,” describing her experiences “then and now” as a longtime journalist who has been a writer and editor for many local and state newspapers, magazines and other media, both print and online, including the Sacramento Bee, the Los Angeles Times, California Journal, Capitol Weekly, Sacramento Magazine, California Lawyer, the American Lawyer Newspapers Group, Comstock’sMagazine,California MedicineMagazine, the Sacramento Business Journal, the California Health Care Foundation, and many others . She also recently completed a major oral-history project – a 90-minute video interview with legendary former lobbyist Clay Jackson, who for many years was one of the most prominent, highest paid lobbyists in California, and later served more than five years in federal prison following a massive “ Capitol Sting” investigation of political corruption in which many legislators, staffers, and one lobbyist were convicted on federal corruption charges. The oral-history series is funded by the Institute of Museum and Library Services through the California State Library, and is posted on the Capitol Weekly website http://capitolweekly.net/oral-history-project-clay-jackson/  Jackson had declined all interviews since his release from prison in 1999, and he was last interviewed by Bathen in prison in 1995, for a lengthy article published in the California Journal, a magazine about state politics and government where she was senior editor. That article received a first-place award for “enterprise reporting” from the Society of Professional Journalists, Central California chapter, and is linked in the oral history. https://sigridbathen.com/wp-content/uploads/2016/01/Clay-Jackson-1.pdf And Bathen recently wrote an in-depth article for the California Health Care Foundation, which publishes a variety of online health-care media, about the accomplishments of the late Herrmann Spetzler, who for decades directed (and vastly expanded) the “Open Door” health-care clinics in rural Humboldt and Del Norte Counties, which have become a national model for effective rural health care https://www.chcf.org/blog/herrmann-spetzler-visionary-rural-clinics/  The article was recently cited by the foundation as one of its “top ten” 2018 blogs.  Bathen has been an adjunct professor of Journalism and Communications at Sacramento State since 1988, and was also communications director for three state agencies.

Clay Jackson, right, with his attorney, Donald Heller, in 1994 outside the federal courthouse in Sacramento. (Photo: Rich Pedroncelli/Associated Press)

Clay Jackson was once the most powerful lobbyist in Sacramento, representing the insurance industry and overseeing hundreds of thousands of dollars in campaign donations to politicians. His firm billed $2 million annually. But Jackson, along with 11 others, was caught in the FBI’s undercover corruption investigation of the state Capitol and wound up going to federal prison. The probe came to light in August 1988 following the FBI’s nighttime raid on the Capitol. The fallout of that investigation, one of the darkest episodes in the Capitol’s history, continued for years.

Here we present a two-part interview with Clay Jackson, once one of Sacramento’s most powerful lobbyists until he was convicted of federal political corruption charges and served more than five years in prison. He was interviewed by Sigrid Bathen, a journalist and lecturer at California State University, Sacramento

Clay Jackson, Part 1: Holding off the Future from Capitol Weekly on Vimeo.

Full transcript of Holding off the Future here

Clay Jackson, Part II: The Fall and After from Capitol Weekly on Vimeo.

Full transcript of After the Fall here.

For more information:

Sigrid Bathen’s 1995 interview, “Clay Jackson in Prison,” originally published in California Journal, is here.

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Published May 1, 2018

In 1977, idealistic young people were moving to California’s strikingly beautiful but impoverished Humboldt County to escape urban congestion and do good works. One of them was Herrmann Spetzler, who came to the tiny city of Arcata to run a small counterculture health clinic called Open Door. Spetzler, a tall, bearded man with a German accent, wanted a safe, uncomplicated place that would suit a young family just starting out. He got that — and then he stayed for 40 years to pursue his vision of a health care system accessible to everyone regardless of income. Because of Spetzler’s leadership, thousands of people of all income levels in California’s rural northwest region receive medical care in an expanded network of modern facilities.

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Debra Johnson vividly recalls the day she met her future husband, Mario Gutierrez. She was a young physician interviewing for a position in an Indian health clinic in Mendocino County, and he was working for the California Rural Indian Health Board. It was 1982.

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Former California Legislative Analyst Liz Hill, Renowned Straight Shooter, Turns Her Focus to Health Policy

Published April 20th, 2016

Elizabeth Hill became the first woman to head the California Legislative Analyst’s Office in 1986 when she was eight months’ pregnant with her second child. For 22 years, she held one of the most important positions in state government — advising the 120-member legislature during fractious times and sometimes clashing over policy recommendations in an increasingly partisan environment beset by the passage of term limits, deep budget cuts, and recession.

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