Dan Morain

Dan Morain: A cost of dismantling mental health care

Dan Morain
Dan Morain

Kathy Gaither, the person in charge of daily operations at the California Department of State Hospitals, went on an unexplained administrative leave earlier this month, a week after the state Senate confirmed her appointment.

Cliff Allenby, a veteran administrator who started working for the state in 1963, continues to oversee the department. He is 76, having come out retirement to serve as acting director when Gov. Jerry Brown took office in 2011.

Officials aren't discussing Gaither's leave, announced by an email from Allenby to the staff and first publicly reported by the Monterey Herald. Whatever the reason for Gaither's departure, the lack of permanent leadership raises questions of priorities.

The California Department of State Hospitals has a $1.6 billion budget and more than 10,000 employees, and is responsible for the care of 6,560 severely mentally ill people in seven state hospitals. The department has been without stable leadership since the previous director retired in December 2010.

One reason could be pay. Gaither's salary is $147,660. Hospital administrators in the private sector can earn many times that sum. And the job is hard. Most state hospital patients have committed crimes, some of them heinous.

There are deeper issues, too. The department has been a stepchild for decades, a reflection of society's inability to confront and treat severe mental illness.

Politicians get little reward for running mental health care systems. Not much good happens at state hospitals. Successes rarely become public because everything related to psychiatric patients is cloaked behind confidentiality requirements.

Shortly after taking office, Brown turned many mental health care functions over to counties, discontinued others and focused on the administration of the state hospitals.

The decision to blow up the department was long past due. Auditors regularly criticized the department. In 2008, for example, a state Department of Finance audit found "weak budgetary controls, lack of communication and coordination and weak fiscal oversight among units."

Years of bad management, tight budgets and reductions have created an issue of succession. Part of the old generation's job is to train the next generation. That hasn't happened in the mental health care system.

"I haven't even gotten to a salary discussion," Diana Dooley, Brown's health and human services secretary, told me. "I haven't found the candidate I want (to run the department).

"I've looked in lots of places. We're thin at that level of leaders who are at the deputy and chief deputy levels. We're all stealing from each other."

It's a story a retired state official named Don Stockman knows well, and one I came to know, too.

Stockman put himself through Sacramento State by working as a Department of Motor Vehicles clerk in the 1960s, and got a job in the mental health department. That's where he intersected with my family.

I was 14 when my 21-year-old brother, Frank, suffered a terrible brain injury in a car crash while coming home from work one night in 1969. Unable to care for him at home, my parents placed him at Napa State Hospital, then at the since-closed Camarillo State Hospital, and back at Napa.

Then as now, state hospitals could be brutal places. On many occasions, other patients beat up Frank. In that mess, sometime in the mid-70s, my parents found Stockman, who had held the title patient advocate.

I called Stockman the other day and got him to recount for me a little bit about that: "I sat down with your mother and asked her, 'What can I do for you?' Her response was 'I want him to be treated like a human being.' "

Stockman helped devise a patient's bill of rights. In essence, it guaranteed them such basic rights, the most important of which to my family was that Frank had a right to live in a safe setting. It was a small victory, though short-lived. The state moved my brother out of Napa in the early 1990s to a nursing home, and he died in 2000.

Stockman had become director of Patton State Hospital for five years in the 1980s. In another time, he could have been director of the entire department.

By the 1990s, however, the growth was not mental health care. Stockman went to work for the prison system, where he became associate warden at Wasco State Prison and at Corcoran State Prison. He retired in 2005.

In the 1960s, state hospitals housed more than 30,000 patients. Now they house a fraction of that number, which is appropriate. Over the decades, however, the state did more than cut population. It dismantled the part of the mental health care system for the sickest of the sick. A consequence is that there's no next generation of leaders.

Follow Dan Morain on Twitter @danielmorain. Back columns, www.sacbee.com/morain.