by Sigrid Bathen posted September 9, 2005


Rose King has seen it all.

A widely recognized expert on mental health issues, she has served in the trenches of the mental health wars for more than 30 years–even before the 1969 suicide of her husband, who suffered from what was then called manic depression. Years later, her son also committed suicide—after suffering from the same illness, known now as bipolar disorder.

She saw the emptying of the state hospitals during the 1960s–ultimately, some 87 percent of 36,000 patients were “deinstitutionalized”–that began under Gov. Ronald Reagan and continued through the 1970s by Gov. Jerry Brown. She saw the legions of homeless mentally ill roaming the streets, passing through temporary shelters and jails, victims of the state’s failure to pay for community mental health care as promised when the state hospitals were shuttered.

Today, only 4,700 mental patients remain in state hospitals.

She saw families struggling with health insurers and public mental health programs to get help from a failed system plagued by lack of money, understaffing and disorganized services. The hard lesson learned: Care is often available to the mentally ill only when they are in a state of severe crisis.

“It hasn’t really changed since my husband became ill,” says King, who lives in East Sacramento. “It remains crisis-driven, crisis-perpetuating and fragmented.”

“We turn mental health clients away and tell them to return when their symptoms are so severe and persistent that they cannot meet their own needs, and may no longer even recognize that they need care,” the Little Hoover Commission noted in a 2000 report.

But last year, voters approved Proposition 63, the landmark mental-health initiative that taxes the wealthy at 1 percent of all income over $1 million. That means Californians will now see the first major infusion of money into mental health care in decades—an estimated $1 billion a year, specifically for community mental health care.

King and other activists hope that the money will transform the wretched conditions that blight urban streets and consign millions of afflicted Californians and their families to lives of poverty and desperation.

But the story of Rose King and her family is not just a story of the struggle for mental health care. It is the story of a system so flawed that it harms the very people it is supposed to protect.

Rose and Joseph King first sought help from their health insurer–Kaiser–as Joseph began to experience frightening symptoms of depression and paranoia in 1968. Joseph “saw the doctor who had treated him for asthma, and was told there was no psychiatrist on staff in Sacramento,” Rose recalled. An urban planner who worked for regional planning agencies in California and Alaska, Joseph soon became so disturbed that he could no longer work.

Desperate, they drove to DeWitt State Hospital in Auburn–which was in the process of closing.

“They wouldn’t accept him at DeWitt,” she said. “He didn’t look ill, and they said he ‘didn’t meet their criteria.’ We had no idea where to go.” He was finally admitted “for a couple of weeks” to a mental health clinic run by Sacramento County, where his wife said he was seen by a psychiatrist twice, and sent home on a weekend pass. That night in 1969, at age 36, Joseph King killed himself.

Grief-stricken and now a single mother to 8-year-old twins and their 6-year-old sister, King, who had been a homemaker and volunteer political activist, went back to college, earning a Bachelor’s in government-journalism at California State University, Sacramento, and a Master’s in journalism at the University of California-Berkeley.

She interned in the Capitol for Democratic Sens. George Moscone and Mervyn Dymally, and worked for $25 a week in the unsuccessful 1970 gubernatorial campaign of Assembly Speaker Jess Unruh. She later worked in paid jobs for a succession of powerful Democratic legislators–including Assembly Speaker and Lt. Gov. Leo McCarthy, Senate Leader David Roberti and Assembly Speaker Antonio Villaraigosa.

But her first introduction to mental health issues had been in 1967, the year before her husband became ill, when she ran an unsuccessful but well-publicized campaign to recall Reagan, in which many of the core activists were medical and psychiatric workers infuriated by conditions for the mentally ill.

As she became more involved in the issue, she pressed politicians, pollsters and the media to lift the heavy curtain of ignorance and stigma that has long surrounded mental health policy. She helped staff a statewide task force on mental health issues under McCarthy when she was his chief of staff in the lieutenant governor’s office.

“Nobody even asked what public opinion was on the subject,” she says. “I asked Mervin Field to start putting [questions about mental health] in his surveys, and there were two statewide polls done for the [Senate] Rules Committee when I was working for Roberti in the 1980s. The importance of the subject of mental health to citizens was first in one poll, second in the other.”

In 1984, her 23-year-old son Michael was diagnosed with bipolar disorder, which is often hereditary and can surface with frightening symptoms in late adolescence or early adulthood. Years later, after battling the disease for nearly two decades, Michael committee suicde. He was 42 years old.

In 1990, King worked on an initiative to raise the alcohol tax to fund mental health care.

“It was unsuccessful, but not because people didn’t think something should be done about mental health,” she says. She was chief consultant to the Joint Legislative Committee on Mental Health Reform convened by Senate Leader John Burton in 2000 and co-chaired by former Assemblywoman Helen Thomson, author of numerous mental health measures over the years and a former psychiatric nurse who is now a Yolo County Supervisor. Thomson was termed-out of the Legislature in 2002, and King, who was principal consultant to the Assembly Health Committee that Thomson chaired, retired the same year.

King’s oldest daughter, Michael’s twin sister, does not have the condition, says King, but her youngest daughter was diagnosed with bipolar disorder at age 30, following childbirth, which can be a “trigger” for emergence of the disease. King’s youngest daughter, now 43, a college graduate with two degrees earned before the onset of the disease, “manages her condition quite well and works in her profession,” her mother says.

Recently, a teen-age grandchild has shown symptoms of the disease, and the 66-year-old King once again finds herself in the mental health trenches, seeking help from a still-fragmented system of mental health care that has bedeviled California families like the Kings for decades.

As California gears up to put Proposition 63 into effect, former Assemblyman Darrell Steinberg, who authored the measure, King and other supporters are carefully following its progress.

“I’m hopeful,” King says of the flawed, crowded mental health care system. “It’s not like we don’t know what works or what needs to be done…It’s not unusual for a case manager to have a caseload of 120, all people in crisis.”

She adds: “The system today is really no better than it was in the late 60s when my husband became ill.”

Next week: The devil is in the details: putting the voters’ will into effect.


Sigrid Bathen teaches journalism and communications at California State University, Sacramento. She has covered mental health issues for 30 years, winning several California and National Mental Health Association awards–and a Pulitzer nomination–for her mental health coverage in the Sacramento Bee and the California Journal.


New money for mental health care; Families hopes rise

by SIGRID BATHEN posted 09.08.2005


 

Darrell Steinberg, whose crusade to help California’s mentally ill culminated in the passage of the landmark Proposition 63, got an early education in the power of grass-roots advocacy.

As a law student at the University of California at Davis in 1984, he led a successful student campaign to improve access for the handicapped at the law school. Two of Steinberg’s closest friends were quadriplegics who could not access the mock courtroom in their wheelchairs, and the students successfully forced the university to install a lift.

Steinberg, a Sacramento lawyer and Democrat who is running next year for a local state Senate seat, learned a lesson that he would remember years later when he successfully pushed for Proposition 63: Get organized, then get the money.

“We organized, involved the press and found the money, which supposedly was not available,” Steinberg recalled when, as a state Assemblyman, he returned to his former law school 20 years later to deliver the commencement speech.

Now, the money for community-based mental health care will finally become available.

Approved in November and still in its planning stages, Proposition 63 represents the most important changes to California’s mental health system in decades. The changes are desperately needed: More than half of those surveyed in public opinion surveys say they have a relative or close friend with serious mental problems. For the first time, the families of the mentally ill will be directly involved in deciding how to spend the mental health funds.

Proposition 63 will provide an estimated $1 billion annually through a 1 percent tax on all annual income above $1 million. The money will go to community-based mental health care programs, which can apply for grants following Proposition 63’s strict criteria. The money can be used only for local mental health care — including housing, training, therapy and counseling — and cannot be diverted to state correctional or parole programs. So far, $24 million has been allocated for the initial planning and review of local project proposals. By the end of the current fiscal year in June 2006, some $700 million is expected to be set aside for community mental health services.

The money has been a long time coming.

“We have a once-in-a-lifetime opportunity to demonstrate to the state and the country that people with mental illness can lead productive lives, be part of our communities, live independently–and that with a decent system of supports and services, people do not have to be relegated to lives of hopelessness,” Steinberg said.

Steinberg, a former Sacramento City Council member, made mental health care one of his principal campaign platforms when he ran for state Assembly in 1998.

Shortly after he took office, Steinberg introduced AB34, which initially provided $10 million to fund pilot projects for community services to the mentally ill. The bill was the direct progenitor of Proposition 63 and marked the first significant investment in mental health in decades.

One year after the pilot projects were funded in 1999, Steinberg said, “we found that the 1,000 people helped under AB34 were showing the beginnings of real success, with decreased hospitalizations and reduced homelessness.” He points to impressive statistics from the AB34 projects: Participants had a 56 percent reduction in hospital stays, a 72 percent reduction in jail stays and a 65 percent increase in full-time jobs. The success of the pilot projects prompted Steinberg to push for more funding, and to take the matter directly to the voters during his final year in the Assembly, where he was termed-out in 2004.

Thus, Proposition 63 was born.

Steinberg and Rusty Selix, the longtime executive director of the Mental Health Association of California, led the Proposition 63 campaign, organizing a coalition of supporters who included the mentally ill and their families – people who historically were excluded from mental health policy-making. The coalition raised $5 million to place Proposition 63 on the ballot and secure its passage.

Officially called the Mental Health Services Act, it was approved with 53.4 percent of the vote. The mentally ill and their families are specifically included in the planning, implementation and staffing of the new law. Steinberg, meanwhile, chairs the 16-member Oversight and Accountability Commmission for Implementation of Proposition 63, which will be administered by the state Department of Mental Health.

Polling for the measure showed that a majority of people had a relative or friend with severe mental health problems, although the stigma against seeking care remained. “Public acceptance has been proven,” says Selix. “But the willingness to talk openly about it among average people is another matter. Not every school, nor every employer, understands.”

Clearly, after decades of neglect, the available funds will be stretched thin.

“The law was pretty specific,” says Dr. Stephen Mayberg, a psychologist who has been director of the state Department of Mental Health for 12 years. “They wanted to make sure to expand services, not to duplicate or backfill services, and specific populations are targeted.” Funding cannot be used for jail and prison or parole populations, and must avoid what Mayberg calls “the fail-first system” of previous years.

“The first time they have contact is when they are institutionalized or arrested–that is probably not a good introduction,” Mayberg says.

Mayberg’s department employs more than 10,000 people, many working in the remaining state hospitals which house some 4,700 people–mostly individuals who have been judged criminally insane or incompetent to stand trial. It is a much different population than was housed in 1961, when 36,0000 mentally ill were kept in state hospitals throughout California, before the “deinstitutionalization” of the hospitals under Govs. Ronald Reagan and Jerry Brown.

Those hospitals were plagued by scandals ranging from unexplained patient deaths to persistent reports of neglect, abuse, misdiagnosis and over-medication. But when they were closed, little was left in their place. Mental health care activists say the promise of community care has been little more than a cruel hoax on the mentally ill and their families, leaving increasing numbers of homeless mentally ill on the streets or in jail.

Proposition 63 backers hope that community care, at least, will markedly improve with significant money and staffing under the new law. The state Department of Mental Health recently added more than 80 employees specifically to work on improving and expanding community programs under the new law.

Experts say housing is the most urgent need – and the initial funding priority — for the chronically mentally ill (who often avoid shelters), as well as for families of the mentally ill and former foster kids who are kicked out of the foster care system.

“It’s very hard to provide services if people don’t have stable housing,” says Tim Brown, longtime executive director of Sacramento’s Loaves & Fishes, which does not accept government funding but has been actively involved in local planning for use of the new money. “But people need a lot of support in housing. It’s certainly preferable to their going in and out of jail.”


Sigrid Bathen teaches journalism and communications at California State University, Sacramento. She has covered mental health issues for 30 years, winning several California and National Mental Health Association awards–and a Pulitzer nomination–for her mental health coverage in the Sacramento Bee and the California Journal.