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Testimony on LHC Report

Testimony to The California Assembly Health Subcommittee on Mental Health and The California Senate Select Committee on Developmental Disabilities and Mental Health on the State's Little Hoover Commission, Being There: Making a Commitment to Mental Health
by Sally Zinman, 01/30/2001

Pointing to the Answers

Being There, Making a Commitment to Mental Health affirms a goal of the client community: a mental health system that provides voluntary and holistic community services on demand. Instead of blaming people with mental disabilities for their suffering, the report clearly targets a failed mental health system that has not provided community services and kept the promise made with deinstitutionalization. Instead of using judgmental language such as lack of insight, medication noncompliance, and broken brains about clients, it judges a system that denies care to an estimated 1.5 million Californians in need, turning away all but the most critical, and often even them. It lays the responsibility for the increase of people with mental disabilities in our jails and among our homeless on the failure of a system to provide assess to voluntary and holistic community services, not a failure of the people. The theme throughout the Report is that jail, homelessness, and forced emergency interventions are too often the result of the lack of the right kind of care, or even any kind of care, at the point at which it is requested. Although the Report measures the huge cost to society in terms of dollars, the cost should equally be measured in human terms of experiences of degradation and abuse, loss of trust, broken spirits and often, lost lives.

Call for Holistic Services

The recommendation that "mental health care means more than medication and emergency services" echoes the voices of clients. Clients repeatedly, over years, have voiced their need for an array of comprehensive services that meet the needs of the whole person. They have known that recovery is possible with supports including housing, employment, substance abuse treatment, independent living skills, physical health care, and peer support; the system, except for model programs that are not replicated as a norm, has not responded. In a recent survey of homeless individuals with mental health problems conducted by the San Francisco Coalition on Homelesssness, 92% of those surveyed said that if programs were designed that met their individual needs, they would enter them. (One third of those who tried to get services, were turned away.)

Call for Voluntary Services

The Commission prioritizes voluntary care as the first response. It explicitly states that forced treatment should not be used because of inadequate access to voluntary care. It also suggests that improved access to voluntary care could diminish the need for forced treatment. The report echoes the client value of self-determination and choice. It lends support for the view that the expansion of forced treatment is a way of covering up the gaps in services and an excuse for lack of services. It points in the direction that available and accessible voluntary services are the answer to the suffering that surrounds us.

The Report not only echoes the client voice. It also echoes the recent report, Mental Health; A Report of the Surgeon General. "Almost all agree that coercion should not be a substitute for effective care that is sought voluntarily." "One point is clear: the need for coercion should be reduced significantly when adequate services are readily accessible to individuals with severe mental disorders who pose a threat of danger to themselves or others."

How Do You Get There

Although clients were actively involved in the information gathering processes leading to the Report and it echoes many of the concerns voiced by the client community, the Report ignores clients as part of the solution, of "how you get there." In spite of the trend in the current mental health system of including clients in the provider workforce and on policy and monitoring bodies, we are not presented as active participants in our own and the system's recovery, but rather as the stereotype passive recipient of care. The Report describes doing things for us, but not with us. Clients are not presented as partners in their own individual treatment plan and in systemic planning. Client initiatives, such as self-help programs, which are proven to be effective, are excluded. The mental health system is not going to get from here to there without breaking down the barriers of them and us, and including clients as partners in the community.

The Little Hoover Commission Report calls on leadership from the Department of Mental Health and the formation of a California Mental Health Advocacy Commission to "get us there", where mental health services are available as an entitlement to all Californians who want and need them.

Department of Mental Health Leadership

Report proposes that the Sate Department of Mental Health be the State's mental health champion and implement a vision for community mental health care. It recommends a financial and organizational restructuring to enable the Department to provide this leadership. We envision other changes, of which the Department has already begun. Staffing must include clients on every level of service and leadership must promote this same staffing pattern in local mental health delivery systems. Thinking must continue to move from a maintenance model of mental health care to a recovery model for every person, from institutional/ medical model treatment to holistic, client directed services. Without this evolution the state's leadership will result in the same failures.

California Mental Health Advocacy Commission Leadership

The Little Hoover Commission Report proposes a Mental Health Advocacy Commission to inspire an on-going commitment to mental health by community leaders and the public. Membership on this panel must include traditional stakeholders, particularly clients, along with non-traditional stakeholders representing the public at large. The public at large is tainted by the daily stereotypical depictions of people with mental disabilities as violent and/or incompetent. A recent study found that "Rather than waning, research suggests that stereotypes of dangerousness are actually on the increase and that the stigma of mental illness remains a powerfully detrimental feature of the lives of people with such conditions".1 Non-traditional stakeholders by definition will bring the prejudices of the public about people with mental disabilities to the table and to the resultant policies. Clients must be present as equal and active members of and staff to the Commission to breakdown these biases in a personal way. Moreover, commissioners must be exposed to the first hand experience of having a mental disability and getting or tying to get help.

The Little Hoover Commission Report proposes to bring people with mental disabilities "back from the edges of society, out from under the bridges and the margins of our conscience," to include us in the mainstream of society; this inclusion must be modeled by the leadership groups who will inspire the change of consciousness.

1. Bruce Link, PhD, et al, Public Conceptions of Mental illness: Labels, Causes. Dangerousness, and Social Distance. American Journal of Public Health, September, 1999, Vol.89.No.9.