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Sign On San Diego

December 10, 2010

A better way to build a mental health lifeline

Based on myth and misinformation, some Californians believe that expanding involuntary treatment will cure what ails the state's struggling mental health system. It would not.

In 2003, the Legislature passed Assembly Bill 1421, known as "Laura's Law," to permit counties to develop controversial programs of court-ordered assisted outpatient treatment. Only Nevada County currently has such a program.

Instead of spending scant resources on the AB 1421 approach, some counties are building up community-based voluntary services to prevent crises. This approach relies on highly effective peer support, full-service partnerships and supportive housing. This approach works.

Mental health consumers, family members, providers and advocates have worked hard together to overcome annual service cuts. We all agree that the state's policy of emptying mental hospitals was not coupled with adequate funding of community mental health programs. We have been on a slippery slope ever since.

The greatest success came with passage of the landmark Mental Health Services Act in 2004. The MHSA was modeled after successful voluntary service programs. Studies demonstrate that such programs are humane and highly cost-effective in reducing incarceration, psychiatric hospitalization and homelessness. The act imposes a 1 percent income tax on personal income in excess of $1 million, and was estimated to generate $683 million in 2005-06 and increasing amounts thereafter.

Some believe that MHSA funds are available for AB 1421 programs. Not true. Instead, counties would be required to use scarce local resources to fund involuntary outpatient commitment programs, a bad budget decision in these difficult economic times.

Proponents of AB 1421 implementation cite New York, which has put millions of dollars into enhanced, court-ordered services, whereas California requires counties to foot the bill for AB 1421 pilot programs. A three-year controlled study in New York City comparing the results of enhanced services with and without the use of involuntary outpatient commitment found no difference in rates of improved outcomes.

The better policy and budget decision is to fund voluntary, community-based MHSA programs that promote recovery and seek to build trust between service providers and consumers.

In California, we can show positive outcomes like those that AB 1421 proponents attribute to the New York law. But they have been achieved with voluntary MHSA programs. Peer support, crisis residential care, supportive housing and full-service partnerships keep people out of costly hospitals, homeless shelters and the prison system.

The full-service partnership programs provide consumers with a broad spectrum of services to aid in their movement toward recovery. This includes mental health services and supports, such as medication management, crisis intervention, case management and peer support. It also provides non-mental health services such as food, housing, respite care and treatment for co-occurring disorders, such as substance abuse. A key element of the full-service partnership programs that is different from the current usual care is that it provides a more intensive level of care and a broader range of services.

As of last Feb. 26, $3.7 billion has been approved/distributed based on county requests. In addition, approximately 25,000 clients have been served by these partnerships and over 400,000 clients have been served in all MHSA programs. The MHSA mandates that programs emphasize strategies that reduce seven negative outcomes: suicide, incarceration, prolonged suffering, school failure or dropout, unemployment, homelessness and removal of children from their homes.

Implementation of AB 1421 would erode the success of such voluntary programs by causing consumers to associate getting help with coercive treatment. Many of our clients confirm that avoiding treatment is often the direct result of prior negative experiences with involuntary treatment.

In other words, if forced treatment is the only door to services, many will find ways to avoid that door.

Investing in cost-effective voluntary services is the answer to the suffering that surrounds us, not compulsory treatment.

Our way forward is direct, cheaper than coerced treatment and has far better outcomes. We want to help San Diego provide a lifeline connecting people with mental health problems to providers of MHSA approved voluntary services, built around housing.