Every Saturday morning, Phil Cenedella sets up at the corner of Newport Avenue and Abbott Street, just steps from the sand at Ocean Beach, with a small group of volunteers to serve food and connect people living on the street to services.
Cenedella, who chairs the OB Task Force on Homelessness, is trying to bring in providers so that people struggling with mental illness or addiction can get help there, instead of having to navigate the system on their own. But there are a handful of people who seem unreachable.
He and the other residents know them by name — or at least the names they use: Butterfly, Sharae, Kristen. Cenedella is the one who gets the call when they act up.
Recently, Kristen chased a terrified family with children up a nearby flight of stairs. Butterflies, Cenedella said, often yelled at people on the street, stampeding on the sidewalk.
It was Sharae he was most concerned about. He has repeatedly called the police and recently threatened to kill an elderly woman who called Cenedella, crying.
In October, Cenedella reached out to Dr. Aaron Meyer, a UC San Diego psychiatrist and the city of San Diego’s Behavioral Health Officer. Mayer, spoke freely not for the university, suggested he call the county and ask about 5200, a provision in California’s Welfare and Institutions Code that allows “any individual” to request a comprehensive mental health evaluation of a person who is believed to be a danger to himself or others, or gravely disabled.
Cenedella said that was not an option.
“I called his number 37 minutes later, I was told five times, no, no, no. I asked nicely, and it was, like, no,” he said.
He said he asked the county’s Mobile Crisis Response Team to come to Ocean Beach “to get a firsthand read on the untenable situation here.”
He was told that this was not an option, and the team “was only sent after a screening process.”
“We are not vigilantes,” Cenedella said. “But the status quo is unacceptable.”
For Cenedella, the lack of options has reached a breaking point — one state lawmaker has tried to solve without violating California’s strong protections for people with mental illness, which makes the intervention unnecessary.
The new bill, Senate Bill 1016, introduced last week by state Senator Catherine Blakespear, proposes modifying existing laws, including 5200, to make it easier for members of the public to request a mental health evaluation-ordered by the court if they believe that someone is a threat to themselves or others or seriously disabled.
It’s an effort, Blakespear, an Encinitas Democrat, said in an interview this week, to address growing public frustration in cases where people with obvious mental illness don’t seem to be receiving treatment, often while away from home.
Commuting weekly between San Diego and Sacramento for the past four years, Blakespear said he is constantly reminded of the issue.
“I see people who are seriously, seriously mentally ill; people talking to themselves, people who are completely unfit to dress, people who are very clean,” he said. “You know they’re suffering and they’re literally dying in front of us, and you ask yourself, ‘What are we going to do about this person?'”
Recently, this frustration has come together in the 5200 Welfare and Institutions code.
A report by the advocacy group Sacramento Quarter Turn Strategies, published in January, found that the district, including San Diego, does not receive evaluation requests under this law, instead directing inquiries to first responders, whether law enforcement officers or mental health response teams.
Despite being in law since 1967, 5200 is “largely unavailable in practice,” the report said, and most counties lack “publicly accessible policies, procedures, or processes” for handling petitions.
This gap has real consequences, the author answered. The mental health system is largely crisis driven, with interventions occurring in response to emergency needs.
There is disagreement about how this emergency system works.
In a statement this week, a spokeswoman for the county’s behavioral health department said existing resources are sufficient to treat those with serious mental health needs.
“In modern practice, the district’s mobile crisis clinic has conducted assessments at this location,” the statement said. “This team receives extensive training to determine whether someone should be taken to an LPS-designated facility for further evaluation and treatment.”
LPS is short for Lanterman Petris Short Act, legislation passed in 1967 that regulates involuntary treatment statewide.
But a growing number of people, like Cenedella, say people who seem to need help often don’t get the comprehensive mental health evaluations that can lead to appropriate treatment.
Instead of requiring the county’s behavioral health department to be involved directly, the bill proposes that such requests be added to the existing CARE Court process.
CARE Court allows a variety of people in the community, from family members to first responders, to file a petition if they believe someone diagnosed with schizophrenia or some type of bipolar disorder needs more comprehensive treatment.
Courts consider the CARE Act process to be voluntary, and some people refuse to participate. Generally, this would disqualify them, but Blankspear’s bill would allow petitioners to ask the court for an evaluation if they believe the person’s unwillingness stems from “severe mental disorder or lack of insight into their mental disorder.”
The court will require anyone making such a request to provide “records, reports, or other evidence available to the applicant, setting forth facts sufficient to establish cause of action.”
When the legislation governing the CARE Court was written, many advocacy groups insisted that coercion was ineffective and that modern mental health care preferred to treat people in the most restrictive settings.
Blakespear said he believes it is possible to protect people’s rights while also taking action when a severe disability impairs someone’s ability to make rational decisions.
“We have to admit that there is a small part that should be done involuntarily in the same way that people with advanced Alzheimer’s (disease) are kept behind locked doors for their own safety,” he said. “The voluntary commitment conservatories, removing the rights of the people to make every decision for themselves, is in the best interest of them and the people, and I personally do not shy away from that.”
“We don’t need to go back to ‘One Flew Over the Cuckoo’s Nest’,” he said, referring to a 1975 film that depicted the horrors of forced mental health care. “We have made great advances in medical care and understanding of civil rights and behavioral health needs, and we can better protect human rights while also treating mental illness.”
said the county is reviewing the bill, but predicted it will likely have a narrow effect. Most residents with severe mental illness, the emailed statement said, already have access to evaluation and treatment.
“In rare, exceptional circumstances, a court-ordered evaluation can be useful, but generally only for people who are not known to the local mental health system and are physically isolated,” the district statement said.
The county said it was “aware of the recent public discussion about the historic process called the 5200 petition,” but that this process “has been largely eliminated by the expansion of modern mental health services and access points.”
The statement, which did not name specific individuals due to privacy concerns, pushed back on the notion that allowing the 5,200 petitions would help more people with severe mental illness into treatment.
“Contrary to recent claims, this section of the code does not create a new treatment path or authorize long-term detention,” said the county. “When read in their entirety, they permit courts — under narrow circumstances — to order only evaluations that may result in the standard 72-hour evaluation and withhold treatment.”
Meyer, who co-authored the Quarter Turn Strategies report, and other advocates say the normal course of detention and treatment doesn’t really apply to people with severe mental illness.
In a follow-up email on Friday, the district said it is committed to “ensuring that individuals who meet the criteria are connected to evaluation and treatment.” San Diego County’s financial commitment to mental health care has increased dramatically. Behavioral health spending hit $1.2 billion this year, an increase of almost 300% over the $440 million spent in the 2015-2016 budget year.
San Diego Mayor Todd Gloria said Blakespear’s bill is part of a broader effort to fix gaps in the county’s behavioral health system.
But even as lawmakers propose new tools, Gloria said, the bigger issue is whether existing tools are being used effectively.
At a meeting of mayors of major cities in California this week, Gloria said the county is failing to pull its weight in responding to homelessness, mental illness and addiction.
“There are dollars flowing to our local government partners in the county, and they have to step up to the game,” he said, adding that the city is left with “sanitation departments” and “police departments.”
“None of them are appropriate tools to respond to people dealing with addiction and mental illness,” he said.
“I can point to every shelter bed we’ve created, but it’s not a mental health institution,” he said in an interview with The San Diego Union-Tribune. “People fail to get out and come back to the street and cycle through shelters, cycle through prison. At some point, they need to be placed in a clinical setting that can help them deal with the underlying issues.
While he pointed to reforms like the CARE Act as steps forward, he said the impact has been limited to practice. In many cases, he said, “you end up with a program that started as mandatory and became voluntary.”
The result, he said, is a system that continues to miss those who most need, but refuse, treatment.
“Often, I’m in conversations where people think the existing process is fine when they clearly aren’t,” he said. “Anyone who walks around a major city, really, anywhere in the country, not just in California, knows that we have untreated mental illness.”
#state #bill #aims #expand #access #mental #health #evaluations