Wellness and Recovery or the Same Old Sickness?

California must choose either a humane or reactionary direction in mental health policy

by Michael Diehl

Since the passage of Proposition 63, the Mental Health Services Act, last November by California voters, an intensive public hearing process has begun, involving mental health clients, family members, members of the professional mental health community, social services providers, the criminal justice system and other community stakeholders.

Hearings have been held on the state, county and city level. The initiative itself has called for a commitment to expand the AB 2034 program from its use in model city programs, such as in Berkeley, to a statewide implementation of "wrap around services" for those living on the streets and suffering from severe mental affliction.

This program is aimed at getting people who have been homeless, often for many years, into housing first, with supportive services and more extensive street outreach (often under the name of Assertive Community Treatment). Alameda County's planning group on Housing and Homelessness has proposed a program to specifically target the so-called hard-core homeless, particularly in North County. The County plan will enroll 100 such individuals with serious mental health issues and often "co-occurring disorders" that also involve self-medication with illegal hard drugs and alcohol.

Alameda County has received 35 more Shelter Plus Care vouchers towards the goal of housing homeless people with mental afflictions. Enrollees will be recruited from John George Psychiatric Pavilion, Santa Rita county jail, and the planned county detox center and sobering facility, where those publicly intoxicated on the streets will be taken by police, rather than to Santa Rita. Other homeless people will be contacted by local outreach teams -- Health Care for the Homeless, Operation Dignity and Berkeley Mental Health's Mobile Crisis Outreach team.

These are the sorts of concrete outcomes I went to Sacramento to fight to achieve; but my concern now is that this be done in a humane and voluntary fashion, as much as possible. I am concerned that these guidelines will be turned into involuntary coercive programs to clear the streets of "undesirable" homeless people. Clearly, many merchants and housed members of neighborhood associations would like this coercive approach of forced treatment. The question now is whether they would accept housing such people in their neighborhood.

For all its vaunted liberal compassion, Berkeley often has been resistant to accepting programs for homeless and disabled persons; but even East Oakland communities, such as the one represented by Oakland City Councilmember Desley Brooks, have resisted the location of programs in their areas. Brooks does have a legitimate concern shared by many clients that programs also should be sited in more well-to-do neighborhoods.

This year I have become a voice for the concerns of mental health clients who want to see changes in the mental health system. In March 2005, I went to several state meetings on the Mental Health Services Act sponsored by the California Department of Mental Health at the invitation of Sally Zinman, director of the California Network of Mental Health Clients. We voiced the concerns of mental health clients such as myself who have experienced homelessness.

On May 18, 2005, state officials released a series of guidelines on the implementation of Prop. 63 that quite pleased advocates with the California Network of Mental Health Clients. On April 20, Carol Hood of the California Department of Mental Health had raised our ire by saying that money from Prop. 63 would be spent on maintaining and even expanding involuntary mental health services, such as the ACT involuntary outpatient program sponsored by State Sen. Helen Thompson that had not been implemented by any county due to lack of funding. This raised a great outcry and lobbying effort from the California Network of Mental Health Clients.

Hood's statements seemed a betrayal after all the warm and fuzzy public process that had heralded a transformation of the mental health system in California. More radical critics like MindFreedom, a national group of psychiatic survivors, and Robert Norse, who is active on homeless issues in Santa Cruz, had been predicting this sell-out all along.

Thus, the guidelines released on May 18 felt like a great victory. Darrell Sternberg, a legislative father of the Prop. 63 state initiative that passed last November, came out and publicly supported our contention that the proposition was not about funding more involuntary services.

The new state guidelines address the concrete outcomes I had particularly articulated, such as lessening the number of mental health clients in the criminal justice system, lowering the number of mental health clients who are living without a home, and reducing the number of involuntary commitments to mental health hospitals of these homeless clients (who are then often released back onto the streets). I was able to report these results to those I am representing on the streets who keep asking if I am getting any concrete results from going to all these meetings. I spoke of the need to rescue people from being forced to sleep on the concrete.

While those concrete outcomes remain to be implemented next year, the state guidelines to the counties now specifically include the goals of expanding the AB 2034 program and serving homeless people who are underserved or unserved. I was a strong voice in Sacramento demanding that these concerns be specifically addressed in the guidelines.

Many clients were concerned about my talk about the need to reach out to mental health clients stuck in the criminal justice system as reinforcing those who wanted to spend the money on involuntary services. I told them, as someone who speaks to the concerns of mental health clients who are people of color and homeless, I needed to articulate the need to get mental clients out of the involuntary criminal justice system that has locked away more clients than the mental health system.

In June, we in Berkeley got heavily involved in holding a number of public hearings on the Mental Health Services Act (MHSA); and I got active in the consumers workgroup fighting successfully in May to get stipends for other mental health consumers to do this work. On June 22, the consumers workgroup held a consumer forum at the Multi-Agency Services Center in Berkeley at which we got input from over 20 actively engaged mental health consumers. The consumers raised issues around race/cultural competence and the cozy relationship between Berkeley Mental Health and the Police Department and the need for the police to get more sensitivity training around the issues of homeless people suffering with mental health issues.

The need for more cultural competence in the delivery of mental health services was raised clearly at this consumer forum, at the Berkeley Drop-In Center, at the Drop-In cafe at Berkeley Mental Health with the leadership of commission member Artensia Berry, at a special forum reaching out to the Hispanic community and in my discussions with African American and Hispanic homeless clients.

At the state meeting on June 1, the forces of the status quo in the mental health system regrouped and came back strongly. New guidelines were coming out of the state with a focus on Assertive Community Outreach and AB 1421 that obviously had been worked out in detail in meetings where none of the mental health clients we know of were present. This raised concerns about the forces of reaction that were supporting reinstitutionalization and were using the impatience of many community members with the problematic street behavior of the mentally ill homeless to support a more repressive and more aggressive policing approach to clear the streets.

That reactionary approach fits too cozily within the fear-based agenda of national security at the expense of civil rights. I and other advocates like Delphine Brody aired our great concerns that we, in supporting the MHSA, were being used to fulfill the more reactionary police-psychiatric statist agenda that MindFreedom had been warning us we were falling for.

Also fitting in with this repressive approach are the efforts of Berkeley Mayor Tom Bates and the new police chief to appease the more conservative members of the Downtown Business Association and the Telegraph Area Association, in their call for more police enforcement and mobile crisis intervention. The word is that other cities are seeing similar sweeps.

Reportedly, Carol Hood is showing some backbone in supporting the May 18th guidelines and in standing up against the pressures coming from the California Psychiatric Association -- now backed by the California Alliance of the Mentally Ill.

I had wanted to write on these issues earlier for the Street Spirit; but, unfortunately, my own difficult struggle with asthma -- fueled, I'm sure, by the state of my own mental stress and exhaustion from fighting all these struggles -- didn't give me the strength to do this.

Also, I have been involved in opposing the efforts of the FCC to shut down Berkeley Liberation Radio 104.1 FM and our eviction from our site at the end of June; we pulled off a successful local media blitz calling attention to our plight. This means the loss of my weekly radio soapbox where I can speak out on these issues in my "Street Reports." This radio work has been good for my own mental health by giving me a creative outlet to sound off on my ideas, rant and use music (like the blues) to more emotionally address the issues around homelessness.

It is clear that for all my compassionate concern about the social injustice that is homelessness, I need to put more focus on my own wellness and recovery -- physically, emotionally and mentally. The shift in mental health services delivery is to look more closely at the holistic link between mental, emotional and physical health, with a growing concern about diet, exercise, and the need to address physical ills facing the poor such as obesity, diabetes, high blood pressure and asthma, often linked to issues of environmental racism.

It is hard on a personal level because the MHSA is bringing a lot of my own issues more to the front. However, for all my inadequacies and failings, I still feel a lot of pride in the work I have indeed been able to accomplish so far this year. My general experience is that I am a more effective organizer when I am true to myself, rather than seeking to conform to mainstream expectations of what mental health is and what a proper role model is. For me, that has always been a recipe for failure; I will always be differently abled. Like it or not, that probably won't change -- or won't change quickly.

However, it increasingly seems imperative to me that, despite the great difficulties of personal transformation, I must strive mightily to move towards a place where my actions to bring about social transformation to a mental health system clearly very resistant to change are motivated from a personal place of growing wellness and recovery, rather than the inner place of rage and frustration that has often motivated my activism.

The path of liberation must be both inner and outer to really succeed in the long run. We need to think of seven generations rather than the latest profit report to the stockholders. As a Hopi grandmother told us once, we are the ones we have been waiting for. I worry that the warmaking and earth-destroying madness of our leaders could have dire outcomes in the long run, unless there is a major, systems-wide transformation of everything we do as a human race here on mother earth.

Our country is exporting our consumerist alienation. We are no longer grounded in physical reality. Whether we run out of oil or end up setting off a nuclear holocaust, it is scary to contemplate what will happen if we don't transform the error of our collective madness. To stop that collective madness, we must all try to change our own personal madness. It is a pretty daunting task.

It means going beyond the individualism so prized in our Western frontier creed of capitalism to embrace a greater concern for community. We must begin helping everyone -- most particularly, those who are most in need. It also means getting beyond thinking in terms of "us" versus "them," since we, as the people of one earth, are all in this together. No hoarding supplies in underground bunkers or expectations of the holier-than-thou being raptured out of this world of sorrow is a sane or just answer.

E-mail Michael Diehl at adversary359@yahoo.com. Contact: BOSS Community Organizing Team, 2065 Kittredge Street, Suite E Berkeley, CA 94704. Phone: (510) 649-1930.

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