Small Local Teams of Professionals Can Better Aid the Mentally Ill

The public is spending more than $2 billion annually for the mentally ill in California, yet a study ranked California 42nd in the nation in the quality of care. California’s mental-health system has been in trouble for many years, and more money alone won’t fix it. Dedicated professionals are working hard, and community workers volunteer their time and best efforts. But the mentally ill and their families tell us that the system is failing them.

What’s wrong with our mental-health system?

A year ago the California Commission for Economic Development, which I chair, appointed a blue-ribbon panel to provide some answers. They examined fundamental organization, government and financing problems. Serious mental illness affects at least a quarter of a million Californians and their families, and thus has enormous longterm implications and deserves special attention.

The commission’s panel, a 25-member Task Force on the Seriously Mentally Ill, now has published a preliminary report that challenges the basic design of the way we care for persons suffering from severe mental illness. The mentally ill need a range of services from residential facilities to social and vocational rehabilitation. Yet the task force concluded that California’s mental-health system is neither structured nor funded to provide these comprehensive services in a logical and coherent way. Authority and money are diffused in too many different agencies. Nobody has the power to make certain that the mentally ill receive the array of services that they require. Severely ill people are bounced from one provider to another.

Compounding the problem, each county runs its own separate and unique version of a mental-health system. The state provides most of the money, but has little say over who will be served, and how. In short, there is no state mental-health system. What we have is a Humpty Dumpty that no one can put together.

Task force members studied and visited successful programs in other cities and talked with hundreds of California professionals, clients and family members. They found that the mentally ill can lead decent lives if resources are reorganized to help them gain independence to the greatest degree possible. The task force proposes the creation of an integrated service system. The state would contract with local not-for-profit agencies to provide or purchase services needed by clients and families.

Such a system would replace today’s fragmented and confusing bureaucratic patchwork with a team of local professionals who would oversee the care of a specific number of mentally ill individuals. The team would have the money now scattered about in dozens of agencies, and would be responsible and held accountable for its clients.

Under the current setup, the mentally ill must deal with a different agency, caseworker and set of rules and regulations for each need--housing, mental health, rehabilitation. Our alternative puts the authority and the money into one place. The state would assure fiscal and program accountability. The idea is actually very simple.

Variations have proved successful across this nation and in Sydney, Australia. Small teams of professionals are successfully helping mentally ill persons at a cost no greater than what we spend for our large, bureaucratic, fragmented system. Expensive hospitalization and redundant interagency transactions are minimized, while at the same time assistance to the mentally ill and their families is personalized and available 24 hours a day.

For the rest of the year these proposals will be discussed in legislative hearings and town hall meetings around the state. The conclusions and the proposed solutions of the task force will be tested in these public forums to make certain that changes produce the right results. By January, 1988, the task force hopes to have mobilized broad-based support for the enactment of legislation.

Changes in public policy seldom come easily, and some people will resist a new approach. Too often public policies are governed by bureaucratic momentum, failing both the public servants who try to make the system work and the citizens who are in need. We will do our job for California and for the mentally ill by creating a system that works for the people who use it.