Californians Concerned About Mental Illness Problems

Californians Concerned About Mental Illness Problems

You might want to read this one. Apparently, SB1606 is under consideration, and would provide assisted outpatient treatment (which is a type of outpatient commitment) for every county in the state. A few counties have been operating such programs, but most apparently do not--including, from what I have read, San Francisco, which needs it more than most.

The bill itself is a bit more complex than that. One provision would extend the 14 day intensive treatment period that is currently provided for those hospitalized under Cal. Welfare & Institutions Code sec. 5150 to include those who have been ordered into assisted outpatient treatment by a court.

Another provision removes one of the notice requirements related to these hearings. I'm not quite sure why, and this probably won't survive a court challenge under substantative due process requirements.

Other provisions that seem understandable and aren't obviously unconstitutional delete the requirement that those certified for assisted outpatient treatment get recertified every 60 days for the program. This makes perfect sense to me; most people with severe mental illness problems don't recover in 60 days. Many never recover at all. Recertification every 60 days seems like a lot of paperwork for no good purpose.

Another provision changes the extension period for assisted outpatient treatment from 180 days to 360 days. This makes sense to me for the same reason as the recertification change.

Most importantly: this bill would make assisted outpatient treatment programs available in every county in the state. That's a big win.

It turns out that New York State has used a similar program for some years now. Here is a report from 2005 on the consequences. Over the roughly five four years the program was in effect, 10,078 persons were referred to the program; 4,041 were apparently determined to be ill enough that a petition was filed seeking to put them under this supervision. Of these, 3,766 persons were placed under supervision (meaning that 93% of the petitions were granted).

The diagnosis of those placed under this outpatient supervision was 71% schizophrenic, 13% bipolar disorder. Unsurprisingly, a bit more than half had a combination of mental illness and a substance abuse problem.

The rest of the report gives details on the improved situation of those who were placed on this program. I guess that most of you won't be surprised that the net effect was to substantially improve the condition of those who were now under court-ordered outpatient supervision.

We probably aren't ever going to go back to the mental hospital system that we had in the 1960s. This may be an alternative for many of the mentally ill whose conditions just deteriorates until they die (the usual case), or until they become an ugly newspaper headline (a relatively rare situation).