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Lawmakers send historic mental-health bills to Newsom

 

 

 

Published September 3, 2020

Landmark legislation to improve California’s notoriously fractured mental-health system has been passed and sent to the governor in the waning days of a chaotic legislative session disrupted by the COVID pandemic.

“This package of legislation is a game-changer,” said Maggie Merritt, executive director of the Steinberg Institute,  a mental-health advocacy and policy nonprofit established in 2015 by Sacramento Mayor and former state Senate Leader Darrell Steinberg, a longtime advocate and author of major mental-health legislation spanning decades.

The fact that significant bills were passed in the middle of a pandemic – when the Legislature was  forced to curtail hearings and sharply limit the number of bills they could consider – “shows that our elected leaders understand how important mental-health services are at this vital moment,” Merritt added.

“It means that for the 13.4 million people who get insurance on the open market or from employers, the promise of parity will finally be true.”  — Julie Snyder

Steinberg said the legislative package “once again puts California at the forefront of mental health policy reform, requires more from the health insurance industry, and helps to address the mental health crisis that is taking such a devastating toll on our state and our country.”

Perhaps the most important measure,  passed after years of fierce opposition from health insurers, and many failed (or vetoed) bills, would require insurers to provide treatment for mental health and substance abuse based on the same standards as treatment for physical conditions.

So-called “parity” laws  have existed in both state and federal law for years, but insurers have used a complex determination of “medical necessity” to deny care for mental health and substance abuse — which is commonly a mental-health issue, a form of “self-medication.”

Senate Bill 855, by Sen. Scott Wiener, D-San Francisco, “is in itself historic,” said Julie Snyder, government affairs director for the Steinberg Institute. “It means that for the 13.4 million people who get insurance on the open market or from employers, the promise of parity will finally be true.” The bill also toughens enforcement by the state Insurance Department and the Department of Managed Care, which Snyder said will add 19 new positions provided in the governor’s budget.

“It’s an important change,” Randall Hagar, legislative advocate for the California Psychiatric Association, said of the new parity law. “It allows enforcement, clarity, and it’s going to make it harder for plans to deny care, which they’re really good at. . .The value of this bill is that it sets out criteria that plans have to use when making decisions. It levels the playing field.”

Strengthening ‘Laura’s Law’
Also approved was a bill to strengthen – and finally make permanent — California’s 18-year-old “Laura’s Law,” which gives family members legal recourse to get help for mentally ill relatives.   The original 2002 law is named after 19-year-old Laura Wilcox, who was killed in 2001, along with two others, when a deranged client of a Nevada County mental-health clinic, where she was working during her winter break from college, came for an appointment and opened fire. His family had for months warned clinic staff that his condition was seriously deteriorating, but they refused to listen, citing patient confidentiality.

The current bill, AB 1976 by Assemblywoman Susan Eggman, D-Stockton, would remove a “sunset” provision that required new hearings every five years, add judges to the list of family members and clinicians who can refer people for treatment, and require counties to hold public hearings when they decide not to adopt Laura’s Law.

One bill in the package supported by mental-health advocates would require the state to collect data on board-and-care homes.

Twenty of California’s 58 counties currently have Laura’s Law/Assisted Outpatient Treatment (AOT) programs — which have shown significant success in reducing homelessness, hospitalizations and incarceration — but other counties have quietly “opted-out” of Laura’s Law with little or no public discussion.

“This bill will finally require counties to make that decision in a public setting,” said Hagar, which will make it more difficult for counties to justify not adopting a program that has been shown to help families and save public funds. Counties opposed that provision of the Eggman bill, saying it amounts to a mandate.

One bill in the package supported by mental-health advocates would require the state to collect data on board-and-care homes, which have been closing in many cities because of high housing costs, and another would create a system of “peer certification” for people who have “lived experience,” but may not have clinical degrees, and often work in local programs.

Still others would expand the scope of practice for nurse-practitioners working without physician supervision and require insurers to cover consultations with psychiatric clinicians by physicians treating pregnant women and children. Two bills would create a Secretary of Homelessness in the Governor’s cabinet and an Office of Suicide Prevention in the state Department of Public Health.

None of the bills that passed  in this session, however, seriously addressed the “third rail” of mental-health care in California – the badly outdated 1967 Lanterman-Petris- Short Act (LPS)

While broad, substantive police reform legislation largely failed, one bill survived which would establish a pilot program to expand – and test – community-based responses to various crises, including those caused by mental illness. Law-enforcement response to mental-health calls, which often result in injury and death, have increasingly come under scrutiny as protests of police misconduct escalate around the country.

Widespread calls to “de-fund” the police have generally failed legislatively. But community programs have emerged that utilize mental-health experts rather than police (or paired with officers) in responding to and de-escalating potentially volatile crises.

The “third rail” in mental health law
None of the bills that passed  in this session, however, seriously addressed the “third rail” of mental-health care in California – the badly outdated 1967 Lanterman-Petris- Short Act(LPS), which has dictated state mental health policy for more than half a century.

Passed at a time when California’s archaic and often dangerous state mental hospitals were closing, the LPS law sought to prevent the grotesque human rights abuses of the hospitals, where mentally ill and developmentally disabled “residents” – many of them children – were locked up, often for years, with little recourse, hardly any treatment, and virtually no due process. Many were injured or died in the overcrowded, understaffed facilities.

One measure that failed would have made possible somewhat longer involuntary holds for severely mentally ill individuals who are detained, usually for a maximum 72 hours.

But the statewide system of “community care” that was to replace the hospitals never happened, leaving thousands of mentally ill people homeless and without treatment, wandering California streets and warehoused in jails and prisons ill-equipped to house, much less help them.

Several bills proposing minimal or technical changes to LPS were introduced this session, with little fanfare and varying results.

One measure that failed would have made possible somewhat longer involuntary holds for severely mentally ill individuals who are detained, usually for a maximum 72 hours, as a danger to themselves or others, under the so-called 5150 hold (named after the LPS section in state law that established a limited system of involuntary holds).

A less utilized section of the law, 5250, allows for 14-day holds under strict conditions. But most people are detained on the more common 5150 hold, ending up in overcrowded hospital ER’s, where they are often discharged well short of 72 hours, without the treatment they need or any follow-up care.

AB 2015, by Assemblywoman Eggman, was passed by the Assembly in June with a bipartisan vote of 76-0, but stalled in the Senate and was withdrawn by the author in mid-August. The bill would have allowed 14-day holds for individuals unable to care for themselves, whose physical deterioration results from their mental illness. A relatively minor technical change to LPS, which is vague on the definition of “grave disability” involving health conditions, the bill will likely be reintroduced next session.

A highly critical July 28 State Auditor’s report helped to revive legislation that would otherwise have been a casualty of cancelled or truncated legislative hearings during the pandemic.

Requiring consideration of physical as well as mental health in LPS holds would be a significant departure from LPS requirements that only mental health be considered in determining “grave disability.”  Advocates say the LPS law’s lack of clarity on the definition of “grave disability” has resulted in widely varying interpretations by hearing officers attempting to determine whether someone should be detained for care on an involuntary hold.

Another bill that easily passed, AB 3242 by Assemblywoman Jacqui Irwin, D-Thousand Oaks, would utilize telecommunications technology to assist health-care providers in determining whether someone should be admitted for treatment on an involuntary 5150 hold. Introduced in response to the pandemic and overcrowding in hospital emergency rooms, the bill was passed with strong bipartisan support.

“During the COVID 19 pandemic, many counties have turned to methods of telecommunications to conduct these [5150] assessments,” Irwin said in an Assembly bill analysis, “resulting in less egregious wait times for evaluation and less overcrowding in emergency departments.”

State Auditor helps to revive legislation
A highly critical July 28 state Auditor’s report helped to revive legislation that would otherwise have been a casualty of cancelled or truncated legislative hearings during the pandemic. The Eggman bill to strengthen Laura’s Law was essentially dead in the Senate, after passing 77-0 in the Assembly, until the auditor strongly recommended that California adopt AOT programs statewide.

Toward the end of the session, facing a statutory midnight deadline on Aug. 31, lawmakers struggled to prioritize and process hundreds of bills.

But the systematic overhaul recommended by the auditor is now left to future sessions, and advocates say the state has a long way to go in providing a coherent statewide system of mental-health care.

“It’s likely we will see much more on LPS, especially since the audit,” said Snyder, a veteran legislative staffer and advocate who recently joined the Steinberg Institute as government affairs director. “Most policy makers didn’t have time to address [the auditor’s report], but they’ll have an opportunity for a much more robust response in the coming session.”

She said “it just wasn’t the right year” for more comprehensive mental-health legislation, because of the pandemic. “It was very difficult to move legislation. Having been part of the legislative process for three decades, I’ve never seen anything like this.”

Toward the end of the session, facing a statutory midnight deadline on Aug. 31, lawmakers struggled to prioritize and process hundreds of bills. Members of the Senate Republican Caucus were largely forced to work remotely after one member tested positive, and tempers flared as the session sputtered to a chaotic end.

Nonetheless, the legislation that did pass makes significant, if incremental, changes, in how mental-health care is provided in California, at a time when voters are clamoring for solutions to a mental-health and homelessness crisis of epic proportions. Hagar, who follows as many as 100 bills for the California Psychiatric Association every year, said he is seeing “an increasingly larger portion” of bills in which mental health is either central or related.

“For the last three years, we have seen an increase in the number of bills that address both substance abuse and mental health,” he said. “Polls indicate that people want better health care, mental health care, solutions for homelessness.”

Hagar and other advocates are optimistic about even more substantive solutions in the next session. “A lot will depend on the shuffling of [committee] chairs,” he said. “As new legislators are elected and come into the process, we have an obligation to educate them and hope they will become advocates for sound mental health policy.”

Below are summaries of recently passed mental-health legislation, now awaiting action by the governor (Sources: Steinberg Institute, legislative records):

–SB 855 (Wiener, D-San Francisco), would expand the ability of Californians who buy insurance or get it from their employers to obtain treatment for w a wide array of mental health and substance use disorders. It would require commercial health insurers to pay for medically necessary treatment of any behavioral health or substance use disorder listed in the DSM-5, the American Psychiatric Association manual that defines mental health conditions. The bill is sponsored by the Steinberg Institute and The Kennedy Forum, a national mental health policy group founded by former Congressman Patrick Kennedy.

–SB 803 (Beall, D-San Jose), would require the state to establish statewide requirements for certifying peer support specialists –people who have personal experience with the mental health system who are trained to support and assist others who are going through mental health challenges. Counties that choose to do so would be responsible for implementing and managing the program and could access federal funds to partially cover the cost of employing peers, helping expand the workforce of people who can respond to the state’s mental health crisis.

–AB 1766 (Bloom, D-Santa Monica), would require the state Department of Social Services to annually report the number of board-and-care homes that serve low-income Californians living with a severe mental illness, track their closures, and notify county behavioral health departments within three days of receiving notice that an operator plans to close a home. Board-and-care homes are a crucial piece of the housing spectrum for people living with severe mental illness.  AB 1766 would provide policymakers statewide data to address the loss of these homes and help counties identify appropriate living options for people with severe mental illness.

–AB 890 (Wood, D-Santa Rosa), would allow nurse practitioners (NPs) to work to the full scope of their license by expanding their ability to treat patients, including those affected by mental health challenges, without a physician’s supervision. It would help address the large and growing workforce shortage of primary care physicians in California. The US Dept. of Veterans Affairs gives 6,000 NPs working in the VA system this authority, and the California Future Health Workforce Commission has urged California to do the same. California today is the only western state that restricts NPs from practicing without physician oversight.

–AB 1845 (Luz Rivas, D-Los Angeles), would create a Secretary of Homelessness in the Governor’s Cabinet to coordinate and consolidate multiple programs aimed at ending homelessness. The huge and growing number of Californians experiencing long-term homelessness includes a large number of people living with severe mental illness.

–AB 1976 (Eggman, D-Stockton), would amend the bill known as Laura’s Law, making it permanent and requiring all counties to implement the program, unless they formally opt out of doing so. The original 2002 law authorized counties to start programs to provide intensive assisted outpatient treatment (AOT) to people suffering from severe mental illness and enabled judges to order treatment for those who declined to accept offered services. (Editor’s Note: Most are voluntary)

–AB 2112 (Ramos, D-Highland), would create within the Department of Public Health an Office of Suicide Prevention to advise the state and regional partners on best practices for suicide prevention.

–AB 2054 (Kamlager, D-Los Angeles), would create a demonstration pilot grant program to expand and test community-based responses to all types of crises, including those caused by mental health challenges, for the state’s most vulnerable populations.

–AB 2360 (Maienschein, D-San Diego),  requires health insurers to develop telehealth networks for consultation with psychiatric clinicians by primary care physicians, pediatricians, and ob/gyns to support their provision of mental health treatment to children and pregnant women (up to one year postpartum).

Editor’s Note: Sigrid Bathen is a Sacramento journalist and former Sacramento Bee reporter who taught journalism at Sacramento State for 32 years. She has long covered mental-health issues, for several publications, and her writing has won numerous awards. She has covered health care, education and state government for Capitol Weekly since 2005. Her web site is www.sigridbathen.com. She can be reached at sigridbathen@gmail.com.

Auditor slams state mental-health system, revives Laura’s Law

 

 

 

Published August 8, 2020

A massive and highly critical state auditor’s report has given new life to legislation to deal with California’s notoriously troubled mental-health system. The shift comes as state lawmakers, convening amid the COVID-19 pandemic, face hundreds of bills in the closing days of the legislative session.

While a bill to strengthen and make permanent “Laura’s Law” in California sailed through the state Assembly in early June, it stalled in the state Senate, as legislative leaders clashed over how to manage the crush of bills awaiting action by the Aug. 31 deadline. 

But when state Auditor Elaine Howle unequivocally urged statewide adoption of Laura’s Law in California in her July 28 report – and after Assembly leadership complained that Assembly bills were not receiving fair hearings in the Senate – the measure was suddenly added to the agenda for a Senate Health Committee hearing on Saturday, Aug. 1.

The original 2002 law enables families with severely mentally ill relatives to access a program known as Assisted Outpatient Treatment  — AOT, or “Laura’s Law ” in California.

The bill, which gives family members legal recourse to get mentally ill relatives into treatment, easily passed 8-0.

“We were dead in the water,” said Randall Hagar, legislative advocate for the bill’s sponsor, the California Psychiatric Association, “and all of a sudden [the bill] was ‘pending’. It was the only bill added to the committee hearing.”

The Senate Health Committee’s required bill analysis was also expedited and it was joined with the Senate Judiciary Committee analysis.  The measure, AB 1976 by Assemblywoman Susan Talamantes Eggman (D-Stockton), now goes to the Senate Appropriations Committee and, if approved, to the Senate floor.

The original 2002 law enables families with severely mentally ill relatives to access a program known as Assisted Outpatient Treatment  — AOT, or “Laura’s Law ” in California. Experts say AOT has been successful in California and other states in reducing hospitalizations, incarceration and homelessness.

 

But California allows counties to decide whether they want to “opt-in” to the program of intensive treatment, and only 20 of California’s 58 counties have agreed to start Laura’s Law programs. 

Eggman’s bill would require counties to publicly state, in writing, why they choose to “opt out” of the program, would add judges to the list of those who can request treatment, and end a “sunset” provision which required renewal hearings every five years.

Many of Howle’s recommendations are not new. They have been addressed by legislation, reports and recommendations spanning decades.

Eggman agreed to extend the bill’s implementation for six months until July 2021 to give counties time to prepare.

Laura’s Law is named for Laura Wilcox, a 19-year-old college student who was working in a Nevada County mental-health clinic in 2001, when she and two others were shot and killed by a deranged clinic client whose family had repeatedly tried to get help for him, but were rebuffed by a clinic psychiatrist.

Laura Wilcox

“Laura Wilcox might be alive today if this program had existed then,” Eggman told the committee.

Laura’s parents, Nick and Amanda Wilcox, tirelessly lobbied state and local government for Laura’s Law and tougher gun legislation. Nick Wilcox testified at the Aug. 1 Health Committee hearing that the county programs have saved lives and reduced costly institutionalization.

“We’ve been approached many times by people who have told us that Laura’s Law saved the lives of their family members,” he said, by getting them into intensive treatment.

Most people voluntarily enter the program, but the law also provides for court oversight and intervention to ensure treatment.

Disability rights groups have long opposed the law, saying it infringes on civil rights, and county mental health directors – while supporting the concept of the law – dislike adopting it without more funding, and they say it places additional  burdens on already strapped local programs.

Decades of bills, reports, recommendations
Many of Howle’s recommendations are not new. They have been addressed by legislation, reports and recommendations spanning decades. But an increasing number of mentally ill Californians wander the streets, recycle through overwhelmed hospital emergency rooms, or end up in jails and prisons that have become de facto mental institutions ill-equipped to house, much less help them.

In the detailed, 120-page audit, in the works since last summer, Howle specifically addressed the 1967 Lanterman-Petris-Short (LPS) Act , the landmark law that has governed mental-health care in California with few changes for more than half a century.

The auditor did an in-depth analysis of involuntary mental health treatment procedures (LPS “holds” and conservatorships) in three California counties – Los Angeles, San Francisco and Shasta. Howle was particularly critical of state oversight of programs primarily run by California counties, which receive billions in federal and state funds for mental health, with little statewide coordination or comprehensive data collection.

Those detained on LPS “holds” frequently end up in overcrowded hospital emergency rooms, where they too often languish without substantive – or any – treatment.

Howle recommended no changes in the basic LPS criteria for involuntary treatment – originally designed to prevent the grotesque civil-rights abuses of mentally ill Californians who were confined, often for years and against their will, in aging state mental hospitals.

But her report slams the lack of follow-up care for those who are detained under LPS holds, usually no more than 72 hours. The auditor also studied people placed in conservatorships – the most restrictive and long-term commitment under LPS – and concluded they receive little or no community care after leaving conservatorships.

California’s mental hospitals, which also housed developmentally disabled residents, including children, often for decades, were largely closed in the 1960s and 1970s, with only a few facilities remaining, mainly for those judged criminally insane.

The Wilcox family, August 2000. (Courtesy, Wilcox family)

But the “community care” touted to replace them never materialized. Howle excoriated the state’s failure to provide adequate or even minimal follow-up care to those detained on LPS “holds,” who frequently end up in overcrowded hospital emergency rooms, where they too often languish without substantive – or any – treatment.

“Perhaps most troublingly, many individuals were subjected to repeated instances of involuntary treatment without being connected to ongoing care that could help them live safely in their communities,” Howle wrote in a cover letter to the governor and legislative leaders.

In Los Angeles County alone, she said, “almost 7,400 people experienced five or more short-term involuntary holds from fiscal years 2015–16 through 2017–18, but only 9 percent were enrolled in the most intensive and comprehensive community-based services available in fiscal year 2018–19.” 

Sacramento Mayor Darrell Steinberg described the auditor’s report as “compelling and spot-on.”

Mental-health professionals, advocates and families generally praised Howle’s report, while also recommending other changes in the law.

“It’s the first deep-dive that’s been done on LPS since it was passed,” said Hagar of  the California Psychiatric Association, which has sponsored much of the mental-health legislation that followed LPS. “It’s very impressive, and there is new life for mental-health legislation in part because of the audit.”

Sacramento Mayor Darrell Steinberg, as a state legislator  and Senate leader, authored significant legislation to improve mental-health care in California, including the 2004 Mental Health Services Act (MHSA), passed by voters as Proposition 63, the so-called “millionaire’s tax.”  He described the auditor’s report as “compelling and spot-on.”

“It’s a microcosm of what’s wrong with the entire system,” he added. “And an indictment of a system that, despite many gains and $2 billion-plus in [annual] MHSA funds, still has not become focused on outcomes, on prevention, early intervention and on integrating the multitude of funding streams that would help people get more timely help.”

But Steinberg, Hagar and others said the audit failed to recommend expanding the criteria for LPS holds and conservatorships to include physical health and deterioration caused by mental illness as part of the “gravely disabled” criteria under existing law.

Focused as it was on “those people who somehow make their way into the system,” albeit on involuntary holds, Steinberg said the report “did not address how we get more people into some care in the first place. At least they found their way into the system, flawed as it is, but what about all the people who don’t enter any kind of care?”

Redefining ‘grave disability’
While strongly supporting statewide adoption of Laura’s Law, Howle criticized the law’s requirement that it be used only for people in a current state of mental “deterioration,”  which the auditor said prevents the follow-up treatment necessary for individuals leaving involuntary holds and  conservatorships — who are deemed sufficiently “recovered” to live safely in the community.

But without continuing treatment, they often deteriorate rapidly. Hagar said he is drafting new legislation for the next  session to address that flaw in the law, noting that the auditor’s report “has given us the green light to do that.”

“It’s well-researched for those three counties, but we are a very big state.” — Sheree Lowe

Steinberg, Hagar and other mental-health advocates with long experience in legislative reform efforts, say the Legislature must address needed changes in the basic LPS criteria for involuntary holds, which they argue fail to protect people with severe mental illness whose physical health – and their ability to safely function in the community – are seriously impaired.

While the auditor concluded those criteria do not require change, critics say the report contained little analysis of how that conclusion was reached. “What is the basis for the conclusion?” Hagar asked.  “We didn’t find anything [in the report]. And that’s not enough.”

Some local mental health directors also disagreed with the auditor’s conclusion, pointing to individuals with severe mental illness whose physical health and safety are impacted. 

In Los Angeles County’s response to the auditor’s findings, the county Department of Mental Health said LPS criteria should be expanded to “redefine grave disability.” The county suggested legislation that “at a minimum. . .should address the capacity of an individual to make informed decisions and include criteria regarding the need for significant supervision and assistance, risk for substantial bodily injury, worsening physical health as well as significant psychiatric deterioration.” 

Sheree Lowe, vice-president of behavioral health for the California Hospital Association, praised the report, but said its scope was limited. “It’s well-researched for those three counties,” she said, “but we are a very big state. And one of the big problems with our county-based delivery systems is that the array and amount (of mental-health services) vary county by county and city by city, and there is little continuity.”

“Despite the billions of dollars the state invests in the county-based mental-health system each year, stakeholders do not have the information they need to assess the effectiveness of these funds on people’s lives.” — Elaine Howle

Nor did the report address the huge burden shouldered by hospital emergency rooms, Lowe said, which is where thousands of people experiencing mental-health crises, including 5150 holds (a reference to the law governing mental-health holds), end up, often brought there by a police officer.  And, as the auditor did note, data collection on the number of involuntary holds is limited and inconsistent, with no reliable statewide database.

While the state Department of Justice maintains confidential data on involuntary mental-health holds, the DOJ said in its written response to the auditor’s findings that its use of mental health records “is very limited to the purpose of determining someone’s eligibility to purchase or possess firearms and/or ammunition.”

Largely nonexistent statewide data collection on mental-health programs was a major criticism by the auditor.

“Despite the billions of dollars the state invests in the county-based mental-health system each year, stakeholders do not have the information they need to assess the effectiveness of these funds on people’s lives,” the auditor concluded. “Public reporting of dedicated funds [for mental-health programs] is disjointed and incomplete.”

The audit was originally requested in the summer of 2019 by the Steinberg Institute, founded by Mayor Steinberg to advocate for mental-health reform, and by legislators concerned about the lack of data on the state’s vast mental-health system, which is largely administered by the counties. And efforts to reform the aging LPS law were stymied by the lack of reliable statewide data.

The history of legislative efforts to address mental health in California is long and tortuous…

“What we found was that information being shared [about LPS reforms] was anecdotal,” said Maggie Merritt, the institute’s executive director. “There was no sound research or data. And there were legislators at the time who had bills on the LPS Act. We thought it was time for an audit to better inform the efforts that were in play.” She said the auditor’s report will help to inform future legislation.

Lack of treatment, ‘tragic deaths’
In a June 3, 2019, letter to the Joint Legislative Audits Committee requesting the audit, Sen. Henry Stern, D-Calabasas, and five other legislators said the audit was needed in order to support LPS reforms.

“The criteria for making a determination that a person is considered ‘gravely disabled’ [under LPS] has been subject to varying degrees of interpretations in jurisdictions across the state,” they wrote. “These subjective interpretations have created unequal application of the law from county to county,” resulting in lack of treatment and “tragic deaths.”

“By better understanding how and when the LPS Act is applied by the counties, we will come to understand how we might improve the LPS Act or other areas of the law to prevent these tragic deaths,” they concluded. The request was quickly approved, and the audit undertaken soon after.

The history of legislative efforts to address mental health in California is long and tortuous, and the LPS Act was a reaction – many critics have long said an over-reaction – to the blatant civil rights abuses of mentally ill and developmentally disabled Californians, who were often locked away in state mental hospitals, sometimes for decades, with limited treatment and little recourse.

The end result was no consistent community care and a patchwork of programs, with vast differences across the state, and thousands of mentally ill Californians recycling through hospital ER’s, wandering the streets or incarcerated.

The detailed 2012 task force report noted that inpatient psychiatric beds have been “substantially reduced” in California, and emergency rooms are overwhelmed by people in mental-health crises.

“Deinstitutionalization was the beginning of the difficult times,” Dr. Stephen Mayberg, former director of the state Department of Mental Health, which has since been absorbed into other departments in the constant bureaucratic juggling that characterizes the state mental-health system, told a California Journal  reporter in 1997.

“The state hospitals went from 35,000 to 5,000, and the community just was expected to deal with it, without the expertise or the resources.  It was a recipe for problems, and we’ve been digging ourselves out of that hole ever since.”

More than three decades after LPS was passed in 1967, the first of two community-based LPS Reform Task Forces was formed in 1998 to examine the law and recommend changes.

Comprised of prominent mental-health clinicians, judges, law enforcement, family members and advocacy groups (the California Psychiatric Association and the National Alliance on Mental Illness-California were major supporters), the task forces were not convened by any governmental agency. Both raised serious questions about the effectiveness of LPS and proposed some of the same legislative changes addressed in the state Auditor’s report.

The second task force report, in 2012, “Separate and Not Equal: The Case for Updating California’s Mental Health Treatment Law, has since served as a blueprint for legislative reform.

The detailed 2012 task force report noted that inpatient psychiatric beds have been “substantially reduced” in California, and emergency rooms are overwhelmed by people in mental-health crises. At the same time, state prison realignment policies dictate that more mentally ill parolees be treated in the community, with “little consideration…given to the failure of the mental health system to prevent their initial incarceration.”

At that time, the then 10-year-old Laura’s Law was operating in only two California counties.

“A person with severe mental illness is now four times more likely to be in jail than in a hospital bed,” the report concluded. “The LPS Act is 45 years old (in 2012), and it has not changed in response to an evolving mental health delivery system.”

“Mental illness is a disease of the brain” – Dr. Steve Seager

The first task force report, released in 1999, titled “A New Vision for Mental Health Treatment Laws,”  lambasted the failures of LPS, and made recommendations to change the law that are similar to the recent state Auditor’s scathing report.

Noting that LPS “was written 30 years ago, before scientific knowledge advanced, recognizing mental illness as a physical disorder of the brain,” the task force said flatly that the law’s purpose was primarily “to depopulate the state hospitals.” The “community care” that was to replace the hospitals was disjointed and inconsistent throughout the state, and the LPS Act was amended “piecemeal,” resulting in an involuntary treatment system that is “adversarial, costly and difficult to administer.” 

The report included summaries of testimony by families, clinicians and advocates at a remarkable 1998 Los Angeles hearing on mental health reform convened by L.A. County Supervisor Mike Antonovich and then-state Assemblywoman Helen Thomson, D-Davis, a former psychiatric nurse who authored major mental-health legislation, including the 2002 Laura’s Law.

The testimony reflected the makeup of the LPS Reform Task Force itself, and the accounts are instructive, thoughtful, wrenching – and more than three decades before widespread recognition of the need for substantive change.

Some of the dozens who testified are identified by name, mostly advocates and clinicians; others, mostly family members, are identified by initials. All called for change in the then 30-year-old LPS law, detailing horrific experiences in the state’s desperately broken “system” of community-based mental health care.

“Mental illness is a disease of the brain,” Dr. Steve Seager, a psychiatrist and author of several books on mental illness, testified at the LA hearing.

“It is not mystical, it is not demon possession, it is not punishment from God. It is a disease like heart disease, liver disease. . .The three most common admitting diagnoses from a study in San Francisco [of] homeless mentally ill were scabies and lice; starvation; and major trauma, either beatings, stab wounds or gunshots. . . The homeless mentally ill are murdered at ten times the rate that normal people are murdered. A third to one-half of homeless mentally ill women have been raped.

“The whole system is wrong.”

Editor’s Note: 
Sigrid Bathen is a Sacramento journalist and former Sacramento Bee reporter who taught journalism at Sacramento State for 32 years. She has long covered mental-health issues, for several publications, and her writing has won numerous awards. She has covered health care, education and state government for Capitol Weekly since 2005. Her web site is www.sigridbathen.com. She can be reached at sigridbathen@gmail.com.

Dangerous Mix: Law Enforcement and Mentally Ill Suspects

 

 

 

Published July 21, 2020 

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

Police response to mental-health calls often ends – again and again – in chaotic, noisy hospital emergency rooms, where staff is stretched thin, and a heart attack is likely to take precedence over someone in the throes of a mental-health crisis.

“Traditionally, people would be dropped off at the ER, and the only option was to transfer them to a psychiatric facility,” says Dr. Scott Zeller, a nationally known emergency psychiatrist and former president of the American Association for Emergency Psychiatry.

“There is finally some recognition in the halls of government that there are solutions out there.” — Scott Zeller

Zeller is vice president of acute psychiatry at Vituity, a physician-led organization that provides staffing and consulting services to medical centers nationwide. Too often, he says, patients in psychiatric crises “would be stuck for days at a time in the ER, with very little treatment.”

The widely known author of articles in professional journals and the subject of news stories,  Zeller has long pioneered, with growing success, a different kind of ER for mental-health emergencies, called EmPATH units (emergency psychiatric assessment, treatment and healing unit). In that model, patients are diverted to a specialized psychiatric ER with supportive clinical staff who assess the patient’s needs – which often means simply listening, talking, adjusting medication – and frequently leads to faster recovery and fewer subsequent hospitalizations, at considerably less cost than in a traditional hospital ER.

“There is finally some recognition in the halls of government that there are solutions out there,” says Zeller. He developed the approach – now in use in dozens of hospitals around the country and in other countries  — as chief of psychiatric emergency services at John George Psychiatric Hospital in Alameda County, where he began treating patients in crisis in a separate, supportive, home-like setting, a far cry from the tumultuous environment of a hospital ER, particularly in the time of COVID.

Like other experienced clinicians, Zeller supports changes in how law enforcement handles mental-health calls.

Dispatchers take emergency calls. Photo: Gorodenkoff, Shutterstock

“We have to look at new ways of reducing police involvement,” he said, with more mobile crisis teams that utilize social workers and other clinicians as well as police officers trained in how to deal with mental-health calls. “The devil is always in the details.”

Even with additional training, police officers and 911 dispatchers must make difficult decisions in determining whether a mental-health call requires an armed police response or an unarmed social worker skilled in deescalating confrontational behavior. Often, it requires both.  “What happens if you get there, and the person is violent, threatening family, neighbors?” asks Zeller. “There has to be coordination. You’re not going to eliminate the police altogether [from mental-health calls]. . . But there are models, really good police squads, well-trained, paired with mobile crisis teams. De-escalation is always the preferred intervention.”

Like Zeller, Dr. Amy Barnhorst, a psychiatrist who is vice-chair for Community Mental Health at UCD Health and former medical director of Sacramento County’s crisis unit and inpatient psychiatric hospital, has long been on the front lines of California’s fractured emergency response to psychiatric crises. She applauds efforts to include more clinicians in police response to mental-health emergencies. But she also knows from vast experience that’s only part of the system that has failed the thousands of homeless mentally ill people wandering California streets.

“I’ve talked to a few families who say the best thing that has happened is when they got arrested.” — Amy Barnhorst

“A lot of the patients I work with don’t have homes,” she said, “and are not receiving treatment for their mental illness. Some have been arrested for vagrancy, public urination. A mom who takes her child to the park for a birthday party doesn’t want to see a transient urinating in public, but what can we do besides throwing him in jail, when it was really that he was just trying to survive?”

Homeless people struggling with untreated mental illness, which is often accompanied by substance abuse and “self-medication,” for decades have gone to the ER – or to jail – as a default response in a grotesque system with little coordination, inadequate resources and high cost.

“I’ve talked to a few families who say the best thing that has happened is when they got arrested,” says Barnhorst, because in jail they at least have shelter and a chance at treatment. “That shouldn’t be what it takes.”

“We need more services, more funding, better coordination,” she adds, “at all levels.” Like Zeller, she advocates more “respite care,” a place for people to go for short-term treatment, rest, a path to sobriety. “They may have a suicidal break, go back to using meth. They need to have  a few nights of a safe, sober place to sleep, get into a therapy program with a counselor, drug rehab. But all of these services are underfunded, underenrolled.”

Cops as first responders
Meanwhile, cops are more often than not the primary responders to mental-health crises. “Law enforcement has a lot of other things on their plate,” says Barnhorst, echoing the widely held view of both clinicians and officers. “It’s great to have trained mental health professionals involved in the response, but I’m not sure whether law enforcement should not be there. It’s not always clear whether it’s a mental-health emergency. They may get out there and find that it is, but that’s not always clear in the call.”

““This is an absolutely appropriate time to take a look at the links between the criminal justice and behavioral health systems.” — Stephanie Welch

Barnhorst, Zeller and others point to the success of mobile crisis and community support teams of social workers, clinicians and “peer support” workers – people who may not have clinical degrees but have “lived experience” — that now exist in many counties and accompany police officers on mental-health calls. “They understand the families,” says Barnhorst, “how to de-escalate, [while] police officers are trained to neutralize a threat.”

Capitol Weekly interviewed dozens of public officials, law enforcement officers and clinicians about how to improve police response to mental-health calls, and all emphasized that law enforcement is only one piece of the puzzle, that a coordinated, collaborative approach is essential, involving community members, families and allrelevant government agencies.

“The most important thing is not to look at just solving this aspect of it – police engagement and crisis response,” said Stephanie Welch, who has two decades’ experience in local and state mental-health programs and is executive officer of the Council on Criminal Justice and Behavioral Health in the state Department of Corrections and Rehabilitation, which works to prevent incarceration of people whose underlying mental illness is the root cause of their involvement with the criminal justice system.

“Otherwise, we’re missing an opportunity to take an overarching look at our overall system so that we don’t have so many people in crisis on the streets,” she said.

“This is an absolutely appropriate time to take a look at the links between the criminal justice and behavioral health systems,” Welch added. “And one thing in the COVID crisis is that we are not putting people in jail who need social services. To some extent there is an opportunity to do right by people.”

“Many  people ended up in prison because of, or largely a result of, their mental illness —  some very serious crimes, multiple murders, and others who just couldn’t function on the outside.” — Steve White

The concept of social workers and other clinicians working in law enforcement agencies is not new, but never has the public sentiment been so strong to make major changes in the way police respond to mental-health and other emergencies.

Sacramento Superior Court Judge Steve White was Sacramento’s elected district attorney in 1989 when he made the then-controversial decision to hire social workers in the DA’s office, in part to help deal with cases that involved untreated mental illness – and to support victim-witnesses in domestic violence cases who were often afraid to testify against their abusers.

White had made prosecution of domestic-violence cases a high priority at the outset, significantly increasing both staffing and prosecutions, going before the county Board of Supervisors to get additional funding for the two social workers, which at that time was highly unusual in a local prosecutor’s office. The volume of successfully prosecuted domestic-violence cases increased significantly.

As Inspector General of the state prison system (which then included both adult and juvenile corrections programs in the Youth and Adult Correctional Agency), from 1999-2003, White investigated a state prison system rife with abuse and mismanagement. “I was struck by the thousands and thousands of inmates who had mental-health issues that ran the gamut from serious to criminally insane,” he recalls. “Many  people ended up in prison because of, or largely a result of, their mental illness – some very serious crimes, multiple murders, and others who just couldn’t function on the outside.”

The man with the banana
He recalls the case of a man “going up and down K Street with a banana.” Clearly mentally ill, he was not feigning a gun, “just holding a banana and demanding money.” Despite efforts to dissuade him, some counseling, he was eventually sent to prison for robbery. “That was a failure.”

Several police reform bills are currently before the state Legislature, but none propose comprehensive changes in how law enforcement handles mental-health crises.

Appointed to the Sacramento Superior Court by then-Gov. Gray Davis in 2003, White continues to see the toll that untreated mental illness has on the criminal justice system — “the massive number of people with significant mental-health issues who are part of the criminal justice system.” He says current efforts throughout California to reform how police handle mental-health calls, with an aim to preventing incarceration, constitute “a moral and economic imperative.”

Like many judges and attorneys who work in the criminal justice system, White strongly supports including social workers and other clinicians in law-enforcement response to mental-health calls, as well as the increasing use of mental-health courts in many counties, to divert mentally ill defendants from the traditional criminal court system. But, like others, he said any real reform needs to be statewide.

Several police reform bills are currently before the state Legislature, but none propose comprehensive changes in how law enforcement handles mental-health crises. Continuing COVID restrictions and a dire state budget picture are likely to severely disrupt the remainder of the legislative session, which is scheduled to end Aug. 31.

AB 1506, by Assemblyman Kevin McCarty, D-Sacramento, would establish a separate unit within the state Attorney General’s office to investigate officer-involved use of force resulting in the death of a civilian. AB 1196, by Assemblyman Mike Gipson (D-Carson), would place a statewide ban on the use of carotid artery holds.  Both bills passed in the Assembly and now go to the state Senate.

The only bill directly addressing police response to mental-health emergencies is AB 2054 by Assemblywoman Sydney Kamlager, D-Los Angeles, which would establish pilot programs to eliminate police response to a wide range of crises involving homelessness, mental illness, natural disasters and domestic violence. It was passed by the state Assembly with bipartisan support, is sponsored by the ACLU and supported by numerous community organizations.

Substance abuse is a common cohort of mental illness, often reflecting efforts to “self-medicate.”

Called the C.R.I.S.E.S Act (for Community Response Initiative to Strengthen Emergency Systems), the measure would establish a three-year pilot program administered by the state Office of Emergency Services with grants to “no more than 12” community organizations. “We need to get away from police as first responders,” says ACLU legislative advocate Dennis Cuevas-Romero. And while he praised law enforcement “for trying to shift the narrative” with local programs that include clinicians, he said police “should focus on the real issues of danger to the community,” leaving other crisis response to clinicians and community groups.

One family’s nightmare
Rarely consulted about policy changes in how police respond to mental-health calls, family members of mentally ill relatives often tell the most compelling – and tragic — stories.

Susan Shaw Goodman – a former teacher who became an attorney, a school board member, a prosecutor and chief counsel to the Assembly Committee on Public Safety – is the mother of a 32-year-old son with severe mental illness who lives with her in Folsom.

As a former board member of the Sacramento chapter of the National Alliance on Mental Illness (NAMI), the nation’s most influential mental health organization representing families, her knowledge of the fraught state of mental-health care in California is both professional and deeply personal.

Her son, who was adopted as an infant, was a “meth baby,” the child of a methamphetamine addict who used meth during her pregnancy. He had learning difficulties in school and was placed in special education classes. His mental illness worsened in middle school, and his desperate parents spent thousands of dollars on treatment programs, at one point sending him to a highly regarded boarding school and therapy program for teens and children in Utah. Nothing seemed to help.

Using her legal skills and knowledge of the system, she has been able to get (her son) some treatment, but care is “very, very limited.”

In his early teens, he started smoking marijuana and stealing from his family – money, jewelry, family heirlooms – and getting arrested for minor crimes like petty theft. He tried different drugs – Ecstasy, heroin – and in his early 20s, he started using methamphetamine, which is highly addictive, widely available, relatively cheap and extremely destructive.

Substance abuse is a common cohort of mental illness, often reflecting efforts to “self-medicate.” He was diagnosed with depression, anxiety, anger-management issues and, ultimately, with paranoid schizophrenia, one of the most devastating of mental illnesses, often diagnosed in the late teens and early adulthood.

In telephone interviews with Goodman, her son can sometimes be heard yelling in the background. Other times, he would answer the phone, calm and courteous. “He’s not yelling because he’s angry,” says Goodman. “It just comes out.”

In 2016, he was homeless, living on the streets after another stint in jail, when he came to his mother’s Folsom home and started hurling bricks from the yard, breaking 22 windows. He was arrested and went back to jail. “I told him he couldn’t come home until I was sure he was not on drugs.”

“It’s a nightmare,” she says, “a terrible illness. . .He has very few filters, no sense of other people having feelings, no empathy – but not in a rude, nasty way. His brain just doesn’t go that far.” Using her legal skills and knowledge of the system, she has been able to get him some treatment, but care is “very, very limited.”

“To me, any officer is worth his weight in gold if he tries to keep the person out of jail.” — Susan Shaw Goodman

He sees a psychiatrist through TCORE (Transitional Community Opportunities for Recovery and Engagement) and the Hope Cooperative, nonprofit programs that partner with Sacramento County Behavioral Health to provide mental-health care and other services.

Many psychiatric medications have serious side effects, and one of the medications he is taking is known to cause involuntary yelling, which – in dangerous combination with methamphetamine use — has sometimes led to arrests. “He was arrested once while he was on meth, standing on top of a building, yelling, throwing things,” Goodman recalls.

There have been many experiences with the police. “I’ve had cops coming in and out of my house for about 15 years, including just a few weeks ago,” says Goodman. “The neighbors have called the cops twice because of my son’s yelling.”

When the police are called, Goodman says, officers’ responses “run the gamut,” from “bad attitude, telling me I need to leave town. . .” to others who engage her son in conversation, spend time with him, congratulate him on completing a drug-rehab program, come back to see how he’s doing. The latter, she said, “is so, so helpful, not to be treated like you’re the enemy and not to be trusted.”

“To me, any officer is worth his weight in gold if he tries to keep the person out of jail,” says the former prosecutor. “It can be, ‘You’re drunk, you’re high, I’m just going to take you downtown’ (to jail). That’s happened. Or, ‘Hop in the car, I’ll take you home.’ That has happened too.”

In one recent interaction, she said, in response to a complaint from a neighbor, the officer was accompanied by a social worker from Sacramento County’s Mobile Crisis Support Team, which partners with local law enforcement in responding to mental-health calls. “She listened,” says Goodman. “She showed empathy, creativity, compassion.”

Then the social worker went next door to talk to the neighbor who had filed the complaint. “About a week later,” Goodman recalls, incredulous, “the neighbor came over and handed my son a note in an envelope, and it said something to the effect, ‘Thank you so much for trying to work on your voice and keeping your windows closed, and we wish you well on your journey’.”

Goodman said she and the neighbor “hadn’t spoken in years, and my son had been a slime ball in their lives. I think it was the social worker who changed that.”

Ed’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.

Pressure Mounts on How Police Handle Mental-Health Crises

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.

The scene along Highway 50 in Rancho Cordova where deputies shot and killed Mikel McIntyre on May 8, 2017. Three years after McIntyre’s death, Sheriff Scott Jones released videos and documents related to the case. (Photo: Sacramento County Sheriff’s Department)

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.

Mikel McIntyre (Screen capture, Fox40 News)

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)

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.

Stronger ‘Laura’s law’ wins Assembly approval

 

Legislation to strengthen California’s 2002 “Laura’s Law,” which gives family members a legal tool to get treatment for their severely mentally ill relatives, has been approved 77-0 by the state Assembly, despite opposition from some California counties, behavioral health directors and a labor union representing employees in local mental-health programs.

The Assembly’s approval on Wednesday for the bill, AB 1976 by Assemblywoman Susan Eggman, D-Stockton, would also make “Laura’s Law” permanent, ending the sunset provision which required “reauthorization hearings” every five years. The measure was sent to the Senate.

The action comes nearly two decades after contentious hearings on the original law, by then-Assemblywoman Helen Thomson, D-Davis, which had intense opposition from disability rights groups and county mental health directors.

Some counties are balking at a key provision of the Eggman bill that would require them to publicly explain — in writing — why they are “opting out” of participation in the program, which has had considerable success in reducing hospitalizations, homelessness and incarceration in the 20 counties where it has been adopted.  Under current law, county participation is voluntary.

The bill earlier sailed through two major Assembly committees, despite opposition, and was unanimously approved in recent weeks by the Assembly Health Committee (15-0) and Appropriations Committee (18-0).

Laura’s Law is named for 19-year-old Laura Wilcox, who was a college student working in a Nevada County mental-health clinic during her winter break in 2001, when she was shot and killed by a severely mentally ill man who went on a shooting rampage that killed three and injured three others.

“Now is a good time. We are passing things we’ve never passed before.” — Susan Eggman

“This bill would bring it full circle,” said Laura’s mother, Amanda Wilcox, who with her husband Nick became tireless legislative advocates for mental-health and gun-control legislation in California.

A similar bill to strengthen Laura’s Law, also by Eggman, failed in 2015, but she is optimistic about the current legislation. Likening the mental-health crisis playing out in plain view throughout California to “a wildfire in our streets,” she said there is growing support for major policy improvements in the state’s historically fractured mental-health care system, brought into even sharper relief by a global pandemic — as thousands of mentally ill Californians cycle in and out of emergency rooms and jails, or wander the streets.

“How is that dignity for anybody?” said Eggman, a former social worker and Sacramento State professor, in an interview with Capitol Weekly. “The human rights and public-health crisis is not fair to families, and I think it has become a stark reality for everybody. Now is a good time. We are passing things we’ve never passed before.”

In a May 29 letter to Assembly Appropriations Chair Lorena Gonzalez, the California State Association of Counties and the County Behavioral Health Directors Association, said they were not opposed to making the nearly 20-year-old “Laura’s Law” permanent, eliminating the five-year sunset provision that has dogged the law since its inception. A subsequent letter June 8 from the behavioral health directors and the Service Employees International Union said they “regretfully” oppose the bill because it “would place a virtual mandate on counties to participate [in Laura’s Law],” and would “increase staff workload.”

The sweeping, bipartisan vote in the Assembly – with one abstention, by Assemblyman Ash Kalra, D-San Jose – clearly sent a message to the counties that Laura’s Law is here to stay in California.

“At the end of the day, the opposition was not compelling,” said Randall Hagar, longtime legislative advocate for the California Psychiatric Association, which supports the bill, along with the California Medical Association and the California Hospital Association.

The 20 counties that have “opted in” to start Laura’s Law programs account for an estimated 70% to 80%  of the state’s population, but some county mental health directors and employees continue to oppose the bill’s requirement that counties choosing to “opt out” of the program must state their reasons in writing after public discussion.

“The notion that [the law] interferes with the counties is bogus.” — Judge Thomas Anderson

They also dislike adding judges to the list of individuals – which currently includes family members, health-care professionals and law enforcement – who can ask the local mental-health director to file a civil court petition for treatment under Laura’s Law, which in many cases is voluntary and does not require judicial intervention. And advocates point to statistics that show the law saves court costs by reducing incarceration and preventing costly conservatorships and criminal interventions.

Farah McDaid Ting, health policy representative for CSAC, argued that the existing “opt-in” provision of the original law, constitutes a public declaration.

“The ‘opt-in’ process is on the record,” she said. “The county has to budget for it, and the board [of supervisors] has to do this in public session.” While ‘Laura’s Law’ has proven to save money in reduced hospitalizations, incarceration and homelessness — and is partially supported by state funding from the Mental Health Services Act, the “millionaire’s tax” passed by voters as Prop. 63 in 2004 — there is no state budget appropriation in the original law, or the current bill. Counties argue there are “up-front” costs to establish such programs, and have long been opposed to any perceived “mandate.”

“The notion that [the law] interferes with the counties is bogus,” says Nevada County Superior Court Judge Thomas Anderson, a former public defender who was the defense attorney for Laura’s killer, has long supported Laura’s Law and helped start Mental Health Courts in Nevada County, one of the first counties in California to adopt the law. “And they’re wasting money by not having these services.”

“We always listen to the concerns of opponents or other members,” he said, “but we think [Laura’s Law] has proven to be effective.” — David Stammerjohan

Hagar says some counties that have chosen not to adopt “Laura’s Law” programs – including Sacramento County, which is surrounded by other counties with successful programs —  have done so quietly and behind the scenes, with little or no public discussion. “All we’re asking is that the counties have a public dialogue, put it on the record, explain their reasons for ‘opting out’,” he said. “It’s not a mandate.”

In the lead-up to the floor vote, David Stammerjohan, Eggman’s chief of staff, said the the “opt-out” requirements would remain in the bill, despite opposition from the counties. “We always listen to the concerns of opponents or other members,” he said, “but we think [Laura’s Law] has proven to be effective. Let’s have the counties actually have a conversation [about opting out], examine it from a public perspective, and then make a decision.”

As Assisted Outpatient Treatment (AOT or Laura’s Law in California) has gained supporters throughout the country – and shown widespread success in providing needed treatment, reducing hospitalizations, homelessness and incarceration, with significant cost savings – it nonetheless remains a little-known option for families of the mentally ill, who are often desperate to get treatment for family members but are generally barred from helping, even to warn of potentially volatile behavior, although they often are expected to serve as de facto caretakers.

Before Laura’s Law, the only real resource for families under existing law was the so-called “5150,”  a reference to that section of the state Welfare and Institutions Code governing 72-hour mental-health holds for someone deemed a danger to “self or others.” But invoking that provision involves law enforcement and usually means that an individual is soon released back to the streets, long before being stabilized on medication, or getting any treatment at all. Often, they return to families ill-equipped to help them, with sometimes tragic results.

Following their daughter’s tragic death, Laura’s parents, Amanda and Nick Wilcox, were determined to see legislation passed in California to give families options to get mentally ill relatives into treatment.

The valedictorian of her high school class, Laura Wilcox was a college sophomore on Jan. 10, 2001, working in a Nevada County mental health clinic during her winter break from Haverford College in Pennsylvania, when she was killed by a delusional clinic patient whose family had repeatedly tried to alert local mental-health authorities about his rapidly deteriorating condition – but they had refused to listen.

Scott Thorpe, then 40, a former school custodian, showed up at the clinic for an 11:30 a.m. appointment, and opened fire with a 9 mm semiautomatic handgun, killing Laura and a caregiver who had brought another patient to an appointment, and causing serious injury to two other clinic employees. He then drove to a nearby restaurant – which he thought was poisoning him – and killed the assistant manager, severely wounding a cook who tried to flee.

Thorpe’s brother, Kent, then a Sacramento Police sergeant and hostage negotiator, and his wife Sharon, had repeatedly attempted to alert clinic therapists about Scott’s increasingly alarming behavior, to no avail. “They wouldn’t listen,” said Kent Thorpe, who ultimately helped convince his brother to surrender peacefully later that day.

Scott remains in Napa State Hospital for the criminally insane, where he was sent after pleading Not Guilty by Reason of Insanity in Nevada County Superior Court.

“Some of those early hearings were uncomfortable. We were personally accused of  being ‘violence mongers’ and ‘spreading stigma.’” — Nick Wilcox

Following their daughter’s tragic death, Laura’s parents, Amanda and Nick Wilcox, were determined to see legislation passed in California to give families options to get mentally ill relatives into treatment. The resulting “Laura’s Law” has since been adopted by 20 of California’s 58 counties, including several of the state’s largest counties. But it has always been a voluntary process for California counties to “opt in” to start the Assisted Outpatient Treatment (AOT) programs that have been widely adopted in various forms, with considerable success, in 46 states throughout the U.S.

It was based on a similar law in New York, “Kendra’s Law,” passed in 1999, following the horrific death of 32-year-old Kendra Webdale, who was pushed in front of a subway train by a deranged man who had been hospitalized at least a dozen times, including six weeks before Kendra’s death. Unlike California, the New York Legislature made the law mandatory throughout the state, with state funding and stunning results.

In California, the path to adopting “Laura’s Law” was arduous at best, although it was strongly supported by the families of the mentally ill – including Scott Thorpe’s – and by victims, like Amanda and Nick Wilcox. Counties balked – many still do — at what they saw as an additional burden on already overwhelmed local mental-health systems.

Disability rights activists opposed the law, saying it infringed on the rights of the mentally ill to refuse treatment, and held noisy demonstrations on the Capitol lawn and in hearings on the original bill, many wearing yellow t-shirts with the triangular symbol for concentration-camp inmates deemed “mentally defective.” Then-Assemblywoman Thomson, a former psychiatric nurse who is the author of the original law, was heckled and called “Nurse Ratched,” after the abusive nurse in Ken Kesey’s “One Flew over the Cuckoo’s Nest,” about a fictional psychiatric hospital.

“Some of those early hearings were uncomfortable,” recalls Nick Wilcox, then an environmental scientist for the state Water Resources Control Board. “We were personally accused of  being ‘violence mongers’ and ‘spreading stigma’.  The first time I testified in 2001, I told the Assembly Judiciary Committee that I believe in civil rights. But when your civil rights interfere with someone’s right to live, it’s gone too far. Laura had a right to live.”

Now experienced legislative advocates, responsible for helping to pass dozens of bills on mental-health and gun-control issues in California, the Wilcox’ are optimistic about the current bill. “Bills grow legs,” Nick Wilcox said, “and this has very sturdy legs.”

Editor’s Note: UPDATES earlier and RECASTS lead with Assembly approval, EDITS throughout to conform. Sigrid Bathen is a veteran 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. 

Mental health care: From the snake pit to the streets

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.

Sacramento State News

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 TimesCalifornia JournalCapitol WeeklySacramento MagazineCalifornia Lawyer, the American Lawyer Newspapers GroupComstock’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.

Herrmann Spetzler Remembered as “Visionary” Who Developed California Rural Clinics

The CHCF Blog

Herrmann Spetzler

Herrmann Spetzler built a small clinic in a remote corner of California into the region’s primary care anchor. Photo courtesy of Open Door Community Health Centers

May 01, 2018

by Sigrid Bathen

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.

On March 12, Spetzler died suddenly at age 70, shocking the sprawling community that coalesced around his charismatic personality and irresistible vision. Colleagues and friends say Spetzler’s reach extended far beyond California’s North Coast, although he often described himself in meetings and speeches as “Herrmann Spetzler, RURAL,” to underscore his commitment to providing health care in remote locales.

“He had an amazing ability to build coalitions among the huge diversity and types of clinics,” said former state Senator Wes Chesbro of Arcata, Spetzler’s friend and supporter. “He built a broad political base.” The longtime CEO of Shasta Community Health Center, Dean Germano, who attended many conferences with Spetzler, said he “was often the smartest guy in the room.”

Modeled on a free clinic in San Francisco’s Haight-Ashbury neighborhood, Open Door began in 1971. “It became a clinic serving the broader low-income community in Humboldt County, then became the default clinic system for all citizens as mainstream primary care [physician] practices began to disappear,” Chesbro said. Today, experts say it is a national model for primary care.

Dramatic Expansion

Herrmann and Cheyenne Spetzler
Herrmann and Cheyenne Spetzler. Photo courtesy of the Spetzler family.

Spetzler and his wife, Open Door Chief Operating Officer Cheyenne Spetzler, are widely credited with expanding one tiny Open Door clinic into a string of 12 clinics and three mobile vans. Altogether, they provide a broad range of health services to an economically diverse and growing patient base in Humboldt and Del Norte Counties.

“Herrmann was the visionary, while Cheyenne provided the pragmatic assistance needed to implement those visions,” Chesbro said, “and they built a structure that would continue to grow.”

Chesbro was one of many elected officials who spoke to an overflow crowd of more than 500 at a memorial service for Spetzler in Arcata on April 2. The turnout was testament to the political reach of Spetzler’s collaborations and connections with other clinic directors, associations, and local, state, and federal lawmakers.

“He was a larger-than-life character,” said Bobbie Wunsch, a health care management consultant and longtime friend. “He was the kind of person that when you walked into a room, he lit up, he wanted to greet you personally, and he always asked about you. . . . He was a real conceptual thinker, always thinking about the next challenge.”

Spetzler was deeply committed to the health care safety net for low-income residents and co-founded or led multiple local, state, and national associations focused on rural health and primary care services. California State University in 2014 presented him with an honorary doctorate “in recognition of his enduring and extraordinary impact on North Coast rural health care.” He added that to a bachelor’s degree in geography from California State University, Los Angeles, and a master’s in education from Humboldt State University.

Dr. Bill Hunter had been practicing medicine on the North Coast for 20 years when Spetzler recruited him to become Open Door’s medical director in 1998. The two were kindred souls committed to providing quality health care to those who had none.

Primary Care for All

“Herrmann was such a strong leader, a great boss, great instincts about people and how they worked together, a really strong intuitive sense, and a tireless advocate for the particular needs of rural primary care,” Hunter said. As technology advanced, he said, Spetzler was “a really strong proponent of telemedicine, which is very important in rural areas.”

Archetectural rendering of clinic
The Fortuna Community Health Center now under construction. Rendering and design by Julian Berg of Arcata.

Spetzler pioneered a telehealth center, partnering with UC Davis Medical Center and specialists in big cities to link remote areas with specialty services that weren’t available in the region. Open Door deployed mobile vans for dental and medical care to remote sites in Humboldt and Del Norte Counties.

“Although it’s breathtakingly beautiful, there is also devastating poverty,” Hunter said.  According to 2015 US Census data, 21% of Humboldt and Del Norte residents live in poverty. “We started out taking care of so many marginalized people, and now we have become a big part of the primary care network in Northern California.”

Whenever the subject of retirement came up, Spetzler would avoid commitments, Germano said. Spetzler said he planned to retire after “one more project,” or that he had to “close the loop on this . . .”

After Spetzler’s death, Cheyenne Spetzler was named interim director of Open Door. “I’ve put my life into this organization,” she said. “I want to be sure we have a soft landing.” She is focused on completing current projects, including a 32,000-square-foot “state-of-the-art” clinic under construction in Fortuna, about 30 miles south of Arcata, and the accreditation of a residency program in rural health care for family practice physicians. Open Door already has residency programs for nurse practitioners and dentists.

“Herrmann’s vision is in good hands,” said US Representative Jared Huffman, D-San Rafael.

A Family of Immigrants From Germany

Herrmann was born in Nuremberg, Germany, in 1948, emigrating to the US when he was seven years old with his mother and four siblings to join their father, an engineer and watchmaker credited with inventing the self-winding wristwatch. His father had come to the US a year earlier. “It was a big deal,” Cheyenne said. “How do you take six kids away from their grandparents? And they don’t speak the language.”

But the family thrived in America, with all the Spetzler siblings earning advanced degrees (including two PhDs and two MDs). His four brothers and a sister live all over the US, and the extended family is close, with large reunions every two years. “Each sibling sets aside 1.5% of their gross annual income to pay for all the children, grandchildren, and their families to come to the reunions,” said Cheyenne. “That was Herrmann’s idea.”

The Spetzlers settled in Illinois. After he graduated from high school, Herrmann Spetzler moved to Southern California for college. Cheyenne was the divorced single mom of a toddler son working as a waitress at an Italian restaurant in Pasadena when she met her future husband. Herrmann, a Cal State LA student, was working in the seismology lab at the California Institute of Technology. “One of my jobs [at the restaurant] was to check the IDs of students,” she says. “I ‘carded’ him, and he was insulted. He made such a big fuss about it.”

After they married in 1973, they lived in Orange County in an apartment with Cheyenne’s 4-year-old son Gary from her previous marriage (who was adopted by Herrmann), and she was pregnant with their daughter Maria, now a physician assistant at Open Door.

Herrmann was hired by Orange County as assistant director of county mental health services and briefly served as interim director before he became executive director of the Sierra Council on Alcoholism and Alcohol Abuse in South Lake Tahoe.

The Green Hills of Arcata

The couple chose to move to Arcata partly because “it looked like southern Germany,” Herrmann’s birthplace, Cheyenne said. “When we first came [to Arcata], the hills were green, with patches of woods. . . . It was nostalgic, rural, and had a university.” Their third child, Gabriel, was born in Arcata.

Spetzler Family in 1977
Herrmann and Cheyenne Spetzler with their children Gary and Maria in Arcata in 1977. Photo courtesy of Cheyenne Spetzler

Spetzler was severely dyslexic, and his wife helped him with his college papers. “I think it is why he was so good at verbally communicating,” she said. “As technology improved, he could listen to everything. He listened to hundreds of audio books a year. He listened to the news in German so he could communicate with family in Germany.”

Spetzler extolled the natural beauty of the region to recruit highly qualified professionals to work at Open Door while also offering clinical support and training. He helped create and sustain the Clinic Leadership Institute, which provides training and mentoring for emerging health care professionals.

“He believed very deeply in fostering leaders in community health,” said Carlina Hansen, who for 17 years was executive director of the San Francisco Women’s Community Clinic. Hansen recently joined the California Health Care Foundation as a senior program officer working to improve access to care for the state’s low-income residents. “I first met him because I was an early participant in the Clinic Leadership Institute,” Hansen said. “He was a standout presence — a man of strong opinions, game-changing ideas, and a big, big heart. He’s done so much to develop leaders in community clinics.”

Herrmann created a unique and enduring template for rural health clinics, Hansen said. “The community clinic movement has always been extremely important in California, and rural clinics have their own unique challenges,” she said. “There can be a scarcity of providers and great distances to cover. Open Door is a real lifeline, often the only source of care, and very well-respected for the high-quality, comprehensive care that they deliver.”

Spetzler’s unexpected death leaves a huge void in the leadership of California clinics, especially in rural areas. But the structure he left in place will endure, said many clinic administrators, clinicians, and government officials. “My perception is that they are fully prepared to [carry] on,” said Chesbro.

“Herrmann directly or indirectly impacted the lives of tens of thousands of people,” he said. “One could only hope to have so much impact in one lifetime.”Related Tags: CHCF Goal: Improving Access to Coverage and CareCommunity Health CentersCommunity-Based CareFederally Qualified Health CentersProvidersTelehealthThe CHCF BlogSigrid Bathen

Sigrid Bathen is a Sacramento-based journalist whose award-winning health care coverage has appeared in many publications. She was a Sacramento Bee reporter for 13 years; a senior editor at the California Journal, a magazine about state government and politics; and communications director for three state agencies. She has been an adjunct professor of journalism and communications at California State University, Sacramento, since 1988. She can be reached at sigridbathen@gmail.com.

Clay Jackson, Sacramento Lobbyist

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.

Mario Gutierrez: Improving Access for All, “Giving Voice to the Voiceless”

The CHCF Blog

Mario Gutierrez: Improving Access for All, “Giving Voice to the Voiceless”

September 07, 2017

by Sigrid Bathen

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.

“I was invited to go to a community meeting, and there were several different tribes represented. The clinic was in trouble,” she said. “Mario was the only person I knew, and he signaled me to sit next to him. The meeting was getting more rancorous, more heated. People were calling people out. I sincerely thought it was going to come to blows in the parking lot. He turned to me and said, ‘I think I’ve had enough.’ And he went to the podium and said the tribes were going to have to come together and see this as a common good, and that the government was trying to keep them apart so they would remain as an underclass. After 30 minutes, he had them setting up a new board of directors and making a mission statement. I was just astounded. He could talk to a room full of people and make everyone feel important — and steer the ship in the direction it was meant to go. I thought, ‘This is a man I really need to get to know.'”

Mario Gutierrez

Gutierrez, a trailblazer who devoted his career to improving the health of people marginalized by disparities in California’s health care system, died on August 16 in Sacramento after complications from surgery. He was 68. Renowned in California as a pioneer in bringing health care to the rural poor, he gained national recognition for supporting telehealth programs to reach that goal.

For the past six years, Gutierrez was executive director of the Center for Connected Health Policy (CCHP), a program of the Public Health Institute, and a leader in the developing field of telemedicine. He was instrumental in the passage of California’s Telehealth Advancement Act of 2011. The following year, Gutierrez helped CCHP win a contract from the US Health Resources and Services Administration to serve as the federally designated National Telehealth Policy Resource Center. He also worked on a groundbreaking two-year pilot project for CCHP that linked 43 safety-net clinics across California with medical specialists at the five University of California medical schools. Before joining CCHP in 2010, Gutierrez served as director of strategic programs and director of rural health strategies at The California Endowment, a longtime supporter of telehealth.

 

Gutierrez saw telemedicine as “a way to enfranchise rural Americans and those with chronic conditions for whom access to care was difficult and costly. . . . He saw telemedicine as the great equalizer.”

Throughout his career, Gutierrez was heralded for bringing disparate communities together for a common purpose. “He was always really interested in helping those people who didn’t have a voice,” Johnson said. “Native Americans. AIDS patients when they were ostracized. Agricultural workers. He worked with communities of poverty that were rich in culture and banded together to improve public health through education and public development.”

Gutierrez saw telemedicine as a “way to enfranchise rural Americans and those with chronic conditions for whom access to care was difficult and costly,” she said. “He really thought that was the wave of the future for the poor. He saw telemedicine as the great equalizer.”

He was the first Latino to receive the prestigious Terrance Keenan National Leadership Award in Health Philanthropy in 2007, and he served on multiple health care boards and advisory panels.

Clinics Endure and Thrive

Longtime friend Jim Crouch, who succeeded Gutierrez as executive director of the California Rural Indian Health Board in 1987, said Gutierrez’s efforts were always based in “community organizing, facilitating, very much a community-focused public health approach to wellness — making things happen by making state law and policy.” He said Gutierrez’s lasting contribution was the “permanence of the structure” of the Indian Health Board, including clinics “from Bishop to Crescent City,” first created in the 1970s. “He created the structure, providing technical assistance, policy development, and advocacy,” Crouch said, enabling the clinics to endure and thrive.

Richard Figueroa, director of prevention for The California Endowment, said Gutierrez “lived the work.” He had a “real knack for connecting people who ordinarily wouldn’t connect — communities, funding sources — to collaboratively work on issues facing agricultural and rural communities,” Figueroa said. “He would always make the connections. It’s such a loss.”

When Gutierrez worked at the Sierra Health Foundation with Chet Hewitt, now its CEO, Gutierrez “was the ultimate bridge-builder, bringing together people with different perspectives and backgrounds without compromising populations that are too often marginalized,” Hewitt said. “He had a very rich history and extraordinary accomplishments in rural health, and was one of the first to focus on health in the Central and San Joaquin Valleys.”

Dr. Tom Nesbitt, associate vice-chancellor for Strategic Technologies and Alliances at UC Davis Health, shared Gutierrez’s interest in health disparities and telemedicine’s potential to ease them. “It was really never about the technology for Mario,” he said. “It was about the ability of technology to address health disparities — trying to remove barriers, reduce injustice and disparities, bring people together to create policy. He made everyone feel valuable — people in government, rural health, Native Americans, farmworker organizations. Everybody knew and trusted him as someone who was working for their benefit rather than his own.”

Moving Expertise Where It’s Needed

Nesbitt worked with Gutierrez in securing Sierra Health Foundation funding for telemedicine programs in the early 1990s. “It was slow going, difficult to get traction,” he recalls. “Now, as people talk about problems with access and geographic health care disparities, telemedicine is seen as a tool to move expertise where it’s needed.”

Gutierrez was a key participant in regular meetings of the 14 national and regional telehealth resource centers in the National Consortium of Telehealth Resource Centers. Deborah Peters, co-program director of the Pacific Basin Telehealth Resource Center, based at the University of Hawaii-Manoa, said Gutierrez was adept at “smoothing out the edges, without acrimony” to form an umbrella organization for the centers, which are in various stages of telehealth development. “Our situation is very different from California, or the Northwest,” she said, “with different infrastructure, varying levels of adoption [of telemedicine]. He had a vision for us. I can’t imagine what it will be like without him at our next meeting in October.”

The son of Cuban immigrants, Gutierrez grew up in Miami. He earned his bachelor’s degree at the University of Miami and a master’s in public health at UC Berkeley. His Cuban roots were strong, and he made frequent trips to Cuba with his wife, a plastic surgeon, as she performed reconstructive surgeries for international medical missions in developing countries. They developed programs to teach Cuban physicians new techniques. During his training, he took classmates to Cuba, gravitating to the health needs of residents, becoming close friends with the director of a pediatric hospital. Johnson said he was “perfectly bilingual” and enjoyed sharing his culture with family, friends, and colleagues.

“I was a great fan of his paella,” said Hewitt. “He was truly a Renaissance man, loved art, loved service, and had a deep devotion to the poor and disadvantaged. He lived a full life, cut too short, but his passion, his work left benefits for so many communities.”

In addition to his wife, Debra Johnson, Gutierrez is survived by their two children, Gabi and Pablo, and his brother, John Gutierrez. http://www.chcf.org/articles/2017/09/remembering-mario-gutierrez

Related: The CHCF Blog, Medi-Cal & Public Coverage, Telemedicine & Technology

About Sigrid

Sigrid Bathen is a Sacramento-based journalist whose award-winning health care coverage has appeared in many publications. She was a Sacramento Bee reporter for 13 years; a senior editor at the California Journal, a magazine about state government and politics; and communications director for three state agencies. She has been an adjunct professor of journalism and communications at California State University, Sacramento, since 1988. For more information, see www.sigridbathen.com.

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