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Pat Nolan: "Will Democrats Finally Address the Mental Health Crisis?"

Other blue state Dems should take Newsom's small steps in the right direction.

The following is a recent article published in The American Spectator by Director Emeritus of the CPAC Foundation Nolan Center for Justice, Pat Nolan:

Our major cities struggle with increased crime, sprawling homeless encampments, overcrowded jails, sky high taxes, and exploding budget deficits. Yet most government officials ignore the one factor that contributes significantly to each of these problems: the lack of acute psychiatric beds to treat mental illness.

The federal government already spends $150 billion on mental health every year, and states kick in billions more. How is it possible that despite the huge sums we spend on mental health there are too few psychiatric beds? The answer is simple: we are spending those billions helping the wrong people. 

Most of the mental health dollars are spent on those dealing with minor life crises such as losing a job, breaking up with a girlfriend, being evicted, or the loss of a loved one. While stress and anxiety are common problems, they are not mental illness. They are normal reactions to temporary crises. However, the mental health industry cleverly rebrands it “psychological trauma” and “sub-clinical depression” to give it a gravitas that it doesn’t deserve. The Manhattan Institute described this as a “shift in mental-health funding that deprioritized treatment for the mentally ill in favor of preventing mental illness among the masses.”

An example of how the money is spent on the “walking wounded” rather than on those with serious mental illness (SMI), California uses the $2 billion per year raised from a 1 percent tax on millionaires — which had been pledged to help people with “serious mental illness” — to fund activities such as yoga, line dancing, drumming, and “soulful movement,” deeming those individuals as suffering from “subclinical depression.”

When the state mental hospitals were emptied, legislators promised to fund community treatment. Sadly, the legislators reneged on those promises. Instead of building acute care beds in the community they built clinics with no beds in the suburbs (far from where the homeless mentally ill congregate). The clinics are only open five days a week, M-F, 8am to 5pm. And the patients often wait over two weeks to schedule appointments.

Unfortunately, those suffering from SMI don’t act out during the clinics’ business hours. The clinics are of little help to a person about to jump off a building or whose voices in their head tells them to stab a stranger walking past.

The unspoken truth is that mental health providers avoid dealing with the severely mentally ill. It is easier to work with people experiencing a transitory difficulty in their lives; they recover much faster and can articulate their gratitude. On the other hand, those with mental illness are frequently not very likeable. They are ill-kempt, lack personal hygiene, and they are always difficult to deal with. So, the system chooses to deal with the easy cases while the seriously mentally ill are allowed to decompensate on the streets until they are ready for jail.

Our prisons and jails have become the default mental health system. It is not law enforcement’s fault. The police would much rather take the non-dangerous mentally ill to facilities with acute psychiatric beds — but those beds are simply not available. The Los Angeles County Jail is the largest mental health institution in the United States. Cook County Jail and Rikers Island in New York City hold the largest mentally ill populations in their states.

The video “Prisons and the Mentally Ill” provides an inside view of difficulties prisons and jails must deal with when people with SMI are incarcerated. Though the video was produced 10 years ago, the problems discussed in it remain unchanged.

The government has prioritized help for those dealing with minor life crises over helping those who suffer from serious mental illness. Sadness and grief are receiving treatment while those with schizophrenia and bipolar disorder are ignored and left to the streets and jails. In New York nearly 40 percent of the most seriously mentally ill receive zero treatment. Mental health dollars should be focused on programs that treat people with serious mental illnesses and “not just making people happier.”

Because there are no psychiatric beds available, the most severely ill are turned over to police and law enforcement in record numbers. When they are released from jail they are on their own, without families and social networks to help them obtain the services they need. It is laughable to expect patients with serious mental illness to navigate the mental health bureaucracy to find housing and the professional services they so desperately need. They end up back on the streets, where they languish untreated until they spiral into disorder and violent behavior, get arrested again and continue to serve life sentences on the installment plan. 

There is a much better way to handle people with serious mental illness. Those billions spent on “mental health” should be used to fund additional acute psychiatric beds in hospitals — rather than in jails.

There is a second important step we should take to reduce the number of mentally ill on our streets — enact a process that can require mentally ill people to stay in treatment after they are released. Most of those with SMI can lead peaceful and productive lives — as long as they stay on their anti-psychotic drugs. However, these patients can deteriorate quickly when they stop taking their medicines. They are too sick to realize that they need their medications to remain stable. People with SMI often stop taking their medications due to some unpleasant side effects. They decide that their lives are going well and conclude they don’t need to take the drugs any longer. That decision puts the patients and the community at risk.

Several states have established Assisted Outpatient Treatment (AOT), in which a judge can order someone with a serious mental illness to follow a treatment plan, including taking their medications. Data from the New York State Office of Mental Health found that following six months of AOT:

  • 55 percent fewer recipients engaged in suicide attempts or harm to self,

  • 47 percent fewer recipients physically harmed others,

  • 46 percent fewer recipients damaged or destroyed property, and

  • 43 percent fewer recipients threatened physical harm to others.

These data indicate that AOT programs reduce arrests and incarceration in excess of 80 percent for those in it. Another study found that individuals in AOT are four times less likely to commit violence than the untreated seriously mentally ill.

There is some good news from California. Governor Newsom and the legislature are finally getting serious about its crisis of untreated mental illness. California is home to 12 percent of the country’s population, but the state accounts for half of the people living on the streets nationwide.

In the last few months, the state established a court intervention program for people with severe mental illness and passed a law making it easier for relatives and first responders to send people to mandatory treatment. And Governor Newsom announced a $6.4 billion bond proposal to build nearly 25,000 psychiatric and addiction beds statewide.

Some are concerned that involuntary treatment can be misused. And that is a reasonable apprehension given the record of governments around the world that have declared political opponents insane. However, the safeguards built into the AOT laws, i.e., hearings must be held in open court with competent counsel for the patient, have proven successful at preventing abuse.

The alternative to involuntary treatment is to continue to allow those with SMI to live in homeless encampments, covered in feces, screaming at themselves, lying face down on bus shelter floors with their pants around their ankles, wandering into traffic or fighting with ghosts and with each other — and often dying on the streets.

As Los Angeles Mayor Karen Bass has noted, “It is profoundly inhumane to allow people to suffer mental illness and die on our streets.” AOT laws seek to find a path to protect the right of psychiatric patients to live where and how they want in the least restrictive setting, and those patients and their loved ones to avoid the often tragic effects of the patient’s illness. There are too many cases where the letter of the law was met, and the patient died. Or as one psychiatrist put it, they died “with their rights on.”

Hopefully other blue state governors and mayors follow Newsom’s lead and take steps to deal with the seriously mentally ill on their streets so that America’s cities become livable once more.

Pat Nolan is the Director Emeritus of the Nolan Center for Justice at the American Conservative Union. He served in the California Assembly from 1978-94, where he was a leading voice for reform of mental illness laws.


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