Dan Morain

Dan Morain: Mentally ill deserve more of our attention

The U.S. Commission on Civil Rights issued a little-noticed report last week that, based on the history of such tomes, won’t be long-remembered.

That’s too bad. It details a story that needs to be retold.

The report was inspired by The Sacramento Bee’s reports last year about the dumping of 1,500 mentally ill patients from Rawson-Neal Psychiatric Hospital in Las Vegas.

Nevada state authorities paid for Greyhound bus tickets and sent them to each of the other 47 continental United States, with little if any regard for what awaited them at the end of the ride.

Self-styled patient advocates say people who suffer from severe mental illness have the right to refuse care, even if that care is for their own good. But by definition, the civil rights commission cares about civil rights, and this latest report decries how cavalierly we treat such people.

We dump and ignore them. When they don’t react well, we jail and imprison them, unless, that is, they take matters into their own hands and kill themselves, as happens 40,000 times a year.

The report cited several instances in which hospitals in recent years have mistreated psychiatric patients. They included Duke University Hospital and hospitals in Houston, North Carolina, Wisconsin and Florida.

Commissioner David Kladney, a retired attorney in Reno who specialized in helping disabled people, had urged that the report be done. Kladney and other commissioners found issues large and small.

Federal law requires that emergency rooms post notices detailing how patients who feel as if they’ve been mistreated can complain. The notice should include a phone number.

“How many mentally ill are going to call?” Kladney said when we spoke by phone the other day.

The Emergency Medical Treatment and Labor Act, signed into law in 1986 by President Ronald Reagan, requires that hospital emergency rooms provide care for people who have emergencies until they are “stable.” It’s easy to stabilize someone who has a broken bone. The definition of stability for someone who is severely mentally ill is far more complicated.

In Kladney’s view, Congress should empower emergency staff to choose the most effective intervention for such patients. It would be far better to transport them to clinics where the staff is trained to deal with them.

“We need to engage social workers to not just let these people walk out the door. They need to make sure they have a place to go that is safe,” Kladney said.

In California, attitudes about rights of the most severely mentally ill people are beginning to change.

Gov. Jerry Brown signed legislation authorizing family members to seek restraining orders forcing mentally ill relatives to give up their guns.

Because of recent legislation freeing up state funds, counties are adopting a more aggressive approach known as assisted outpatient treatment to deal with severely mentally ill people who revolve in and out of jails and emergency rooms, and are chronically homeless.

Initially, only Nevada County authorities adopted the program. They had felt a special obligation. Laura Wilcox, the college student after whom the law was named, was shot and killed in 2001 as she worked at the behavioral health department by a mentally ill man who had been in Nevada County’s care.

About 80 severely mentally ill have gone through the program, living in their homes, meeting regularly with therapists and taking anti-psychotic medication. Nevada County finds that as they are in the program, they don’t land back in hospitals or jail.

Yolo County adopted a Laura’s Law program in 2013; about five people are in it at any time. This year, Orange, San Francisco and Placer counties have adopted Laura’s Law programs. Contra Costa County supervisors will consider a proposal this week.

The Los Angeles County Board of Supervisors voted to implement Laura’s Law in July. Robin Kay, chief deputy director of the county’s mental health department, said her department will be providing “outreach on steroids” to roughly 500 people.

Los Angeles County has established an advisory group to work out details. That could take months. The group’s membership includes Disability Rights California, a state and federally funded legal-aid group that sued Los Angeles County when it tried to implement Laura’s Law a decade ago, and has threatened to sue other counties since.

Disability Rights attorney Pamela Cohen would not talk with me. But she was quoted in a publication last month as saying assisted outpatient treatment doesn’t work and that Disability Rights was contemplating suing Los Angeles County to block the implementation of Laura’s Law. Such a suit could have consequences, both for the expansion of assisted outpatient treatment programs and for Disability Rights.

In the mid-1970s, Congress funded legal-aid groups such as Disability Rights California to defend the civil rights of mentally ill people who were held in inhumane conditions in asylums.

“Their initial mission of stopping maltreatment has morphed into stopping treatment, and that is wrong,” said Rep. Tim Murphy, R-Pa.

Murphy is carrying HR 3717 to alter antiquated laws and authorize more federal money for aid the care of people who are the sickest. It also would pare back the $35 million that the federal government spends on legal-aid groups such as Disability Rights.

Eleven members of the California delegation have signed onto the bill, including Rep. Jeff Denham, R-Turlock, and Rep. Doug LaMalfa, R-Richvale. Rep. Ami Bera, D-Elk Grove, is one of six California Democrats who are co-sponsors. There is a partisan divide, unfortunately. Democrats Doris Matsui of Sacramento, John Garamendi of Walnut Grove and Mike Thompson of St. Helena embrace a competing bill.

Some people on the left and right say assisted outpatient treatment strips people of their rights. To the contrary, they have the right to treatment. Others say it is the last resort. Far from it. The last resort occurred in 2011 when a young man was sentenced to 15 years in prison for a $65 million arson fire at the Roseville Galleria, after he had refused mental health services at a Placer County shelter.

It occurred last September when a young mother drowned her 5-year-old daughter, after her sister failed to convince Davis police that the mother needed help. And it happens 40,000 times a year when someone commits suicide.

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