Column by By Sharon Byrne, as featured in the Santa Barbara Sentinel
Elliot Rodger committed mass murder in May in Isla Vista. Nicolas Holzer murdered his parents and two young sons in August. Severely mentally ill individuals wander Santa Barbara streets, sometimes shouting loudly at passersby. One could start wondering if we’ve become the next Waco around here, and not be thought mad.
Prop 63, the Mental Health Services Act, passed in 2004, was supposed to deal with the most acutely mentally ill. The MHSA has come under fire from critics charging that it’s been a boondoggle for mental health insiders. Instead of funding critical care for the acutely mentally ill, critics contend it’s been used to fund conferences and glossy brochures. Counties get to propose the programs they will offer under MHSA, some critics say, and many don’t want to take on these difficult cases. So they don’t, leaving a huge gap in services for those most in need of mental health care.
The State Auditor’s office audited the MHSA in August of 2013, covering 2006-2011, when almost $7.4 billion was spent on mental health through Prop 63. The audit found that each county was using different approaches, and that the state’s entities “have provided little oversight of county implementation of MHSA programs and their effectiveness. We expected that Mental Health and the Accountability Commission would have used a process to monitor, guide, and evaluate county implementation that built on their broad and specific MHSA oversight responsibilities and also incorporated best practices in doing so, but that is not what we found.”
Law enforcement is often the first point of contact in these cases. Our sheriff, Bill Brown, perhaps more than anyone else in our county, has been on the frontlines on mental health issues recently.
Sheriff Brown also serves on the Mental Health Services Oversight & Accountability Commission. He says Prop 63 “is a great tool to try to bridge the gap from the deinstitutionalization movement in the 1970’s”, and feels some of the funds go to good programs. He listed the Mental Health Association of Long Beach as an example. They are a “one-stop shop: mentally ill individuals can do laundry, get medical services, bank, get vocational assistance – it’s very impressive, with a lot of partners working together to make it work, including the police department. Additionally, they have a strong peer-counseling element available, working with mental health professionals to address mental illness. This is particularly helpful with the homeless because the peer counselor might have navigated that system and can help more than a professional with a degree on the wall, but who might not be able to relate to that world as well.”
The oversight commission reviews and approves requests for funding, and ‘some of those are hard, particularly when services are really remote from the folks needing them’, Brown said, citing the concern of more rural counties. There has long been a movement in government funding to allow programs to be driven by the local needs. This is the case for mental health as well. But the problem arises when Kern County has a particularly robust set of programs, while another county’s might be lagging.
Brown is hard at work building the new jail, and mental health is very much on his mind. “Jails have become the de-facto mental institutions for communities because there’s often nowhere else. PHF (the county’s Psychiatric Health Facility) has 16 beds, far too few for a county our size, and we end up having to take people out of county. People in crisis don’t have resources, commit some kind of crime, and end up in jail. The new jail is being designed in such a way that there’s a health wing being custom designed as a better way for us to manage people who have severe mental illness.’ Brown was quick to note this wouldn’t be a mental health hospital. But jails now clearly need to have some ability to deal with the mentally ill that wind up in their facilities, bringing up the key question of why Prop 63 isn’t addressing more of those cases.
Psychology and psychiatry are relatively juvenile sciences, when compared to, say, physics and chemistry. Newton’s achievements in the 17th century led to us putting a man on the moon. In contrast, Freud and Jung achieved their breakthroughs a little more than a century ago. The dark days of female hysteria, forced institutionalization and lobotomies to create more compliant housewives are still fairly recent history. Pharma-psychology is all the rage now – there’s a pill for that, whatever ailment that is.
We’re just still pretty new at treating mental illness.
Brown also worries that recent high profile instances make mentally ill individuals seem dangerous, and violent, when this is the exception, rather than the norm. “It’s unfortunate we had two back-to-back like this, here, but most mentally ill people do not commit violent crime. These instances do drive home the point that we need to be collectively behind getting people treatment, to help them and the rest of the community.”