Point Reyes Light - August 12, 1999
Mentally ill struggle in rich Marin County
When former Governor Ronald Reagan moved to de-institutionalize the treatment of mental illness in the early 1970's, counties like Marin were relieved of forking out millions of dollars to support state-run facilities like the Napa State Hospital.
The idea was to leave patients closer to home, near to county and community health services. The majority of the mentally ill would no longer be treated through bureaucratic systems designed in Sacramento, but would instead be cared for and socialized by the county in which they lived.
For Marin, the policy meant that tax dollars would support Community Mental Health and a long list of satellite providers, both private and public, rather than costly out-of-county institutions.
Three decades later, the vision of the Reagan administration has far from lived up to its promise, and a wealthy county like Marin has failed to support mental health services for those who need it most - the poor and the uninsured.
Ed Walker, Mental Health Director at county Health and Human Services, said the Reagan plan ran head-first into funding difficulties after 1978's Proposition 13, which limited the state's ability to tax property.
"We saw a great reduction of funds in the 80's," Walker told The Light. "Some federal funds were phased out at the same time as Proposition 13. Local and state funding dried up, there were program cut-backs, and then you throw in a recession and you can imagine what happened."
As The Light reported two weeks ago, many of Marin's mentally ill end up classified as 5150, a designation which defines an individual as "gravely disabled" and a danger to themselves or others. 5150's are taken by law enforcement to the Crisis Unit at Marin General and detained for 72 hours for evaluation and treatment.
While the most severe or "acute" cases of mental illness are often managed and provided with full-time care, the majority of cases, until they sporadically meet the "emergency" criteria of a 5150, are left with ever-decreasing options for treatment.
Ann Pring, an Inverness resident and head of Psychiatric Services at St. Mary's Hospital in San Francisco, told The Light that friends or family members usually have to see the mentally ill "bottom out" before they get proper care. "There are not a lot of avenues [for treatment]. A person may be having a difficult time, or not taking their meds, but until it's a 5150, they can't do anything," Pring said. "The county is doing the best they can, but the funds are limited."
Bolinas Fire Chief Kevin Hicks told The Light he sees that the poor and homeless are often the ones that suffer, as they lack the money for proper treatment and a place to go in times of crisis.
"Sometimes what they really need is just some rest and relief from the pressures," Hicks said. He said the mentally ill he often sees through his work are less threatened by firemen and paramedics than by the sheriff's department, but there is still a lack of facilities that firemen can offer them.
Even with limited funding, Marin County still provides a wide array of health and support services for the mentally ill. According to Mental Health Director Walker, public funds were available to the counties in the early years of the Reagan policy, and Marin successfully campaigned for money for mental health treatment. "Other counties didn't propose enough, but Marin did [a better job]," he said.
The county, Walker explained, provides care through Health and Human Services, as well as through contracts with private, mostly non-profit, agencies. He pointed to his department's West Marin Service Center as the primary option for mental-health care and support for the coastal region.
From the office in Point Reyes Station, treatment is administered on a sliding scale, and referrals are made to practitioners or one of the 21 Continuing Care Contract Providers for Community Mental Health.
One such agency is the Buckelew Program in San Rafael, which is primarily funded by the county. According to Buckelew Executive Director Jay Zlotnick, the program accepts and treats "adults with a major illness," such as acute schizophrenia or bi-polar disorder. Zlotnick told The Light that with limited funds coming in from the state, counties must target the more severe cases. "A Marin County resident will only get full services if they have an acute mental illness," Zlotnick said.
Buckelew, he explained, provides four categories of service:
Residential support services provides 68 beds with 24-hour care in seven locations throughout Marin.
Supported Housing provides housing assistance for an additional 36 clients in a home environment in which they carry their own key.
Independent living assistance for 63 clients who require less supervision. The program provides clinical training and assistance in finding and keeping housing in their community.
Non-housing programs, such as Tamalpais Day Services, which provide 110 clients with day treatment, socialization, and vocational training.
Buckelew, the largest county supported agency for long-term housing, assists on average about 500 people per year. All are referrals from Community Mental Health.
Zlotnick acknowledged that the county may indeed have a waiting list for services, and that some fees are required for the people assisted in their programs. "In general there is greater need than there are resources," he added.
Another valuable resource for Marin adults seeking care or support, according to Walker, is the National Alliance for the Mentally Ill. NAMI, as it is called, operates locally out of an office in San Rafael, and serves to link people with support groups and agencies that are working partners of the county.
NAMI prints a newsletter which lists support groups for the mentally ill and their families, and can be reached at (415) 456-9419.
Still, Walker said, many of the lower-class and moderately-ill slip through the county's system of care. "Anyone with medical insurance can get services through Community Mental Health," he told The Light. "Where the problems are felt by families is if someone is uninsured or uncovered - publicly or privately. And fewer and fewer plans cover mental health and substance abuse."
In California, he added, the public is not required to cover individuals who are being treated on an outpatient basis. "It's really a public policy question which California is avoiding. The state is just not willing to commit the funds," he said.
Inverness' Pring sees mental health as the unwanted "step-child" in the family of medical treatment. "There is often a waiting list for treatment," she said. "Patients are discharged too soon, and HMOs are putting limits on outpatient visits. It's very heartbreaking to see these situations."
With more West Marin residents being faced with caring for mentally ill friends or family members, Walker believes that it is paramount for the public to de-stigmatize mental illness so it is seen as a treatable condition instead of an indignity.
He advises that affected individuals take advantage of the resources that are in place, and "avoid isolation and inaction." He suggests that a telephone call to someone that is familiar and trustworthy, such as a general practitioner, priest, or rabbi, can help mobilize people into action.
"If someone is in a psychiatric emergency, we have 24-hour service available to the residents of Marin," Walker explained. "And urgent care is available five days a week." The number to call for emergencies is 499-6666.
Bolinas Fire Chief Hicks handles several dozen incidents involving the mentally ill per year, and believes that the best approach to defusing a crisis is to be calm and non-confrontational. "You have to listen to them, pay attention to them, and respect them," he said. "Give them a chance to be heard."
Hicks sees several troubled Bolinas residents on a regular basis, and laments that the state has shirked its responsibility for caring for the mentally ill. "Because there are no real facilities, no appropriate destination to take them, we as communities have to learn how to better deal with this," Hicks concluded.