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Being There: Making A Commitment to Mental Health
By Richard R. Terzian

California must make a commitment to serve people with mental illness. We should fulfill a promise made years ago to provide community-based care to people who need mental health services. The Little Hoover Commission, after more than a year of study, concluded that ensuring that people receive the mental health care they need to remain productive and active community members makes sound fiscal and moral sense.

One in five Californians experiences a mental illness each year. For many, their illness will mean time away from work, a setback in school or a permanent disability. The U.S. Surgeon General reports that mental illness costs the U.S. economy $79 billion a year, primarily from lost productivity. That figure translates to $10 billion for California's economy based on the size of our population.

California cannot afford to ignore the fiscal costs of mental illness and it should not ignore the social and moral costs of failed mental health policies. For 1.3 million Californians, the symptoms of mental illness will be so debilitating they may lose their jobs or homes. But many will not receive treatment because we ration care to only those with the most severe symptoms. Thousands of people are denied access to less expensive prevention and intervention services, only to be hospitalized when their symptoms progress. Others will be unable to find housing, substance abuse treatment or other services essential to their recovery. As a result, they end up homeless, in hospitals or behind bars.

All Californians should be concerned that thousands of people end up in jail simply because treatment is unavailable. In many communities, when a client is in crisis at 3 a.m., the only help available is a cop and the only facility open is the jail. For others, untreated illness can result in paranoia, fear or other symptoms that can lead to criminal activity. We should decriminalize mental illness. That is, no one should end up in jail solely because they could not receive mental health services. Treatment is more humane and more cost-effective.

The fundamental problem is that most Californians are only beginning to understand mental illness. As a community we have not committed to help people with mental health needs, as we have committed to help other people who cannot care for themselves. This commitment will raise expectations. No longer will it be acceptable to ignore people whose illness leads to homelessness. We won't accept the lost productivity. We will support early intervention efforts.

The Little Hoover Commission believes that policy-makers should convene a limited-term Mental Health Advocacy Commission. Community and business leaders should be recruited and charged with raising the awareness of mental illness, documenting the costs of failed policies and advocating for reform. Just as we have with cancer, mental illness needs to be transformed from a private struggle to a public challenge.

Richard R. Terzian is chairman of the Little Hoover Commission. The commission's report, "Being There: Making a Commitment to Mental Health," is available on its website: www.lhc.ca.gov or a copy can be requested by contacting the commission at 916-445-2125.

Importantly, we know what to do. We know tailored services can preserve and restore functionality. For some, medication is enough. Others need help with housing, substance abuse and medical treatment. In each case, the system fails if individuals do not receive what they need. Look no farther than The Village - an integrated treatment program in Long Beach that has become a model for the world, but not for California.

And importantly, some policy-makers are willing to lead. The Legislature has recently funded programs to divert some clients from jail into treatment. Job training, substance abuse treatment and case management can move clients off the streets and into employment. Early outreach can encourage voluntary participation in treatment and reduce the need for expensive hospitalization. Effective mental health programs can lower criminal justice costs, support healthy business districts and renew hope for thousands of our neighbors.

This is an obligation for all Californians, not just government. The state should fully fund a safety net, but the costs and the responsibility for providing care must be shared among employers and community organizations. And as individuals we cannot continue to avert our eyes. We cannot expect people to find housing or to benefit from services if we refuse them as our neighbors.

Providing adequate care will be expensive. The first step is to make the commitment to providing care and to understand the challenge. The public sector must work with the private sector to fully assess the costs of providing mental health services to all who need care. Progress will be incremental and must recognize that providing mental health services is an investment that can offer a return. Improved access to services must translate into increased productivity and higher quality of life for our neighbors, for our neighborhoods, our communities and all of California. Investing in mental health is an investment in our future.

In its report, the commission provided policymakers a roadmap for increasing public understanding of the impact of mental illness on California, developing appropriate leadership, reforming funding and building accountability. All Californians have a role in addressing mental illness. Our role includes holding the public sector accountable for leadership and outcomes.