The mental health system that Californians once prided themselves on has become a subject of intense controversy within the state.
Under Gov. Edmund G. Brown Jr., the critics are contending, the system has deteriorated to the point that thousands of patients are being pushed out of mental hospitals to find their way through the inhospitable worlds of skid rows, flophouses and county jails.
"It's a national scandal, an outrage," protests Dr. Paul O'Rourke, a longtime consultant on mental health for the state's bipartisan Little Hoover Commission. "People who need help have been put out to be beaten up, robbed, persecuted and exploited."
Condemnation of Brown's handling of the state mental health system comes from a broad spectrum of professional and political opinion, including top specialists like Dr. Matt Greenblatt, former commissioner of mental health in Massachusetts and currently professor of psychiatry at the University of California at Los Angeles, and legislative leaders ranging from liberal Democratic Assimblyman Tom Bates to conservative Republican state Sen. Bill Campbell.
These critics accuse Brown of failing to fund adequately the state hospitals or the community care facilities that, since the Reagan years, have been touted as the cornerstone of California's mental health system. They point to several Brown vetoes since 1975 of bills to upgrade hospital staffing standards and his repeated refusal to spend large amounts on community care facilities as proof of what they call his malignant neglect of the mentally ill.
There are numerous signs that the state's mental health program is cruising toward a breakdown. Among the leading indications of the growing crisis:
A host of lawsuits filed this year against the state for alleged inadequate care and staffing at state hospitals serving the mentally ill. Among those filing are such diverse groups as the activist Western Center on Law and Proverty and the conservative California Medical Association.
A recurrent pattern of unexplained deaths in the mental wards of the state hospitals. One internal study conducted by state investigators uncovered some 1,285 deaths between 1973 and 1976-the latter two of those years in the Brown Administration-including 120 directly traced to physician or nursing staff negligence and over-drugging.
A decline in the physical condition and staffing at these hospitals so severe that in 1976 five state hospitals lost their national accreditation. Since 1978, the U.S. Department of Health, Education and Welfare has decertified these hospitals due to numerous deficiencies, costing the state an estimated $6 million a year in federal aid.
A full-scale federal audit of alleged state "dumping" of up to 30,000 mental patients in inadequate nursing home facilities. HEW officials claim the state could lose an additional $10 million a year as a result of their investigation.
Crowding within the state's financially strapped system has grown to the point where some mental patients, unable to find a hospital bed, are being arrested and placed in county jails for their own safety. Some have spent as long as a month in prison waiting for a mental hospital bed.
Nowhere are these festering problems more evident than in sprawling Los Angeles County whose 7 million people constitute a third of the state's total population. County mental health and local law enforcement officials alike blame Brown's budget cut-backs for the deteriorating level of services for the mentally ill throughout the region.
"Things went fairly well under the Reagan administration," said Dr. Richard Elphers, the highly respected Los Angeles County mental health director. "It wasn't pie in the sky, but there was genuine concern for people. Now I don't see much concern for people at all."
Dr. Jerome Lackner, the governor's former director of health says, "When Jerry Brown talks about lowering expectations, he is really talking about lowering expectations for the poor, the mentally ill and the disabled."
One of the items vetoed by Brown was an appropriation to improve staffing standards at Metropolitan State Hospital in Norwalk, 20 miles south of Los Angeles. It was at Metropolitan in late 1977 that public attention became focused on Brown's handling of the mental health issue after several unexplained patient deaths at the hospital and a growing revolt of the medical staff were reported.
As a result, many legislators and mental health advocates hoped Brown would lose what they viewed as indifference on the issue. He flew down to the hospital in the midst of the crisis and pledged that the next year, 1978, would be "the year of mental health." He promised to spend an additional $82.6 million to bolster community care facilities as a humane alternative to the beleaguered state hospitals.
The "year of mental health," however, proved to be shortlived. Within 48 hours of the passage of Proposition 13, Brown, suddenly committed to strict budgetary austerity, removed virtually the entire $82.6 million promised appropriation from the state budget.
This year, once again, media stories about the state system's inability to provide adequate care for its estimated 450,000 patients has put heavy political pressure on Brown to restore some of the promised state funds to mental health.Earlier this year, the Brown administration unfurled a new proposal which would provide for approximately $25 million in new mental health funds.
Brown's proposal, however, has received a chilly reception from the likes of Peter DuBois, lobbyist for the state Mental Health Association, and Assemblyman Bates who have denounced it as being too little and too late. Indeed, Bates, chairman of the Assembly subcommittee on mental health, accused the Brown administration's proposals as being tantamount to "an almost total retraction of the public commitment" mady by the governor in 1978.
Los Angeles health director Elpers denounces the Brown administration for eliminating thousands of state hospital beds without adequately funding alternative services in the localities. In Los Angeles County alone, Elpers estimates, more than 100,000 patient days were lost between 1977 and 1978 due to administration-ordered cut-backs at Camarillo and Norwalk state hospitals.
"Where have those people gone? They are out there, they still need services and they don't get them." Elpers said. "Our local hospitals are bulging at the seams. People are not getting in. People are giving up on getting mental health care. You can't document everyone that has given up. The governor says we are just treating fewer people. But they are out there killing themselves and starving to death."
At the Los Angeles County jail there are sometimes as many as 50 mentally disabled persons locked up as long as a month waiting for a bed in the state hospital system. Officials acknowledge that prison is far from the proper place for treating the mentally ill.
Once the bars slam behind them, these individuals find themselves at the mercy of the same criminal elements who plague them on the street and can harass them virtually at will. Recently, for instance, one young man with a long history of psychiatric trouble entered the county jail on minor charges. Despite the effort of Dr. Donald Erin, chief psychiatrist at the jail, and sheriff's deputies, they were unable to find a place for the youth at Metropolitan State Hospital due to the recent state-ordered closing of some 175 beds there.
Stuck in prison even his captors wished him free from, the young man was beaten and sexually assaulted and had his possessions stolen by other inmates. These traumas, according to Erin, triggered a "psychotic reaction" - resulting in attempted suicide.
"I still can't get that guy into the state hospital," Erin said bitterly."The lowest common denominator in California today is that people are being arrested and sent here just for being mentally ill."
Another logjam exists at county hospitals in Los Angeles where some psychiatric wards are packed with patients forced to spend days sitting on wood benches waiting for a state hospital bed. Some are turned away after brief emergency treatment, says Dr. Rod Burgoyne, director of emergency services at the psychiatric hospital of the County-University of Southern California Medical Center in east Los Angeles. Those turnaways occur, he said, because their psychoses, while often desperate and acute, haven't reached the total crisis stage now required before staff can even attempt to get a state hospital bed.
Mal Towery, the director of Metropolitan State Hospital, denies refusing admission to patients in need for care. But he was contridicted in comments to reporters by members of his own staff and Dr. Elpers, as well as officials at the county hospital and the jail.
During Brown's tenure, conditions at Metropolitan - a large sprawling campus-like facility - have stood at the center of the mental health controversy. Complaints concerning Metropolitan, including inadequate staffing, medication errors, unsanitary conditions and the inappropriate placing and treatment of patients, have cropped up continually in numerous state reports, newspaper exposes and television documentaries.
To head off this criticism, The Brown Administration has systematically emptied the wards of the hospitals to the point where its capacity has dropped from a high of over 4,000 beds a decade ago to approximately 1,000 today, according to the hospital's medical director's office. But even now, for those still at Metropolitan, several medical staff members report, conditions continue to worsen.
"The patients here are over-medicated and regimented," said Dr. Michael Kannas, a staff psychologist at Metropolitan. "They're not getting the treatment they need. This place used to be run like a hospital but now it's run like a prison."
Dr. Dale Farabee, state director of mental health, admits medication error and other problems still plague the state hospital system. In charge of the department since July, Farabee has made some changes in his 800 member staff but says he's still frustrated by bureaucracy and the civil service system in trying to weed out incompetence.
Gray Davis, the governor's chief aide, says that Brown, after an admittedly slow start, is now tackling the crisis within the state mental health system. Davis cites as an example of Brown's commitment recent budget increases aimed at reducing the state hospital population and increasing community mental health treatment.
"It's difficult to show quick results dealing with the mentally ill," Davis said. "We'd be the first to say that we wish the efforts we've made would have produced more results." CAPTION: Picture, Now vacationing in Africa, Brown meets President Julius Nyerere of Tanzania. At home, he faces intense controversy over California's mental health system. UPI