Study of Forced Mental Care Urged Health

Study of Forced Mental Care Urged
Health: Researchers suggest the Legislature order a pilot project of compulsory outpatient services. The issue splits activists.

By ERIC BAILEY, Times Staff Writer

     SACRAMENTO--Rekindling the fierce debate over care for the mentally ill, a state-sponsored study suggests that lawmakers consider intensive and compulsory outpatient treatment for severely troubled people who refuse help.
     The study by Rand Corp., a Santa Monica think tank, says a pilot project similar to an effort underway in New York could help answer a thorny question that has divided the Legislature for years: How far should government go in treating the seriously ill against their will?
     The 110-page research paper, commissioned by leaders in the state Senate and set for release during a Capitol news conference today, comes as the Legislature girds again to tussle over involuntary outpatient treatment.
     In the three decades since the state largely moved its mental patients out of institutions, a growing number of critics have called for involuntary treatment of troubled patients before they cross the threshold into violence. But advocates for the mentally ill, many of them former patients haunted by horrific treatment in the mental health system, raise civil liberty concerns.
     Last year, a measure by Assemblywoman Helen Thomson (D-Davis) that would have established a forced-treatment outpatient program got through the Assembly. But state Senate Leader John Burton (D-San Francisco) blocked the measure in the upper house, fearing it posed too broad an infringement on patients' rights. To break the logjam, Burton agreed to commission the Rand study.
     While skirting definitive conclusions on that fundamental issue, the Rand research team determined through a review of clinical studies that intensive treatment and follow-up of patients in the communities where they live produced the most successful results.
     The study could not, however, conclude whether involuntary outpatient treatment is more effective than voluntary alternatives.
     Burton applauded the study's call for more intensive treatment services for the mentally ill, a cause he has long championed. He said he would consider a pilot project to study involuntary treatment, but was not prepared to endorse the approach on a broad scale.
     "The real problem is that when Ronald Reagan shut down the state mental hospitals, the treatment money was supposed to follow the patient into the community and it never did," Burton said. "That's the reason we're discussing this problem now."
     Sally Zinman, executive director of the California Network of Mental Health Clients, which represents patients, said such people need a range of services, from help with transportation to getting jobs, that will draw them voluntarily into treatment programs.
     "Taking our rights away isn't the answer," Zinman said. "The answer is to put real effort and money into building the right kind of system."
     Others suggest that involuntary treatment is needed in the case of patients who don't believe that they need help. Left to fend for themselves, such patients can slide until they pose a danger to themselves or society.
     The better alternative, some advocates say, is a carefully monitored involuntary system that intercedes before a patient sinks too far.
     "I don't think anyone would argue that being treated in the community where they live is much less intrusive on persons' civil liberties than being in the hospital," said Mary Zdanowicz, executive director of the Treatment Advocacy Center, a nonprofit group that supports involuntary outpatient programs.
     A New York state program saw 512 people committed to involuntary treatment over the first 14 months, far fewer than many had expected, Zdanowicz said. An additional 837 agreed to voluntarily participate after being referred for treatment.
     Carla Jacobs, a board member with the National Alliance for the Mentally Ill, an advocacy group for the mentally ill and their families, said she would support a pilot project, but would prefer seeing lawmakers simply launch an aggressive and well-financed statewide effort that would provide involuntary outpatient treatment.
     "It's extremely frustrating to twiddle our thumbs and drag our heels when we know something works," she said.
     The Rand study comes on the heels of a November report by the Little Hoover Commission, a state watchdog organization, concluding that the state mental health system is chronically underfunded and fails to address the needs of patients, leading to lost productivity for businesses, increased costs for criminal justice and other unintended consequences.
     The effort to upgrade treatment of the mentally ill has also received an ominous push in recent weeks from several headline-grabbing cases involving mentally ill people.
     A man is accused of fatally shooting two people Jan. 10 at a Nevada City, Calif., mental health clinic where he had been getting treatment, then killing a third man at a restaurant that he allegedly believed had been poisoning him.
     A week later, a truck driver with a history of mental illness drove his big rig into the state Capitol, igniting a blaze that caused $8 million in damage and incinerated him.
     On Jan. 29, Joshua Daniel Lee, 22, fatally stabbed a 66-year-old woman outside a Redondo Beach shopping mall just weeks after his release from a psychiatric ward over the protests of his mother. Lee was found hanging in his jail cell Friday.
     Zinman said such cases are rare exceptions that prod the public and lawmakers toward "knee-jerk reactions that are very punitive and judgmental."
     Zdanowicz, however, said a more effective program of involuntary treatment in the community would "likely have prevented these tragedies." She said a recent study found that patients who refuse treatment are 63% more likely to turn violent.
     Jacobs agreed that a buttressed effort might have helped, but said the more broad-based effect would be on those who don't pose a headline-grabbing danger.
     "The bigger problem is not so much the headline makers but the quiet tragedies," she said. "These are the people who quietly suffer on the street or in their parents' back bedrooms."

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Times staff writer Jenifer Warren contributed to this story.