S.O.S. for California's Integrated Services for Homeless Adults
With Serious Mental Illness (AB 2034)!!!!
...A Proven-Effective Program Slated for Elimination by Governor Schwarzenegger
Despite Patently Ample Funding According to the online version of the
Los Angeles Times, sometime around the middle of this month (meaning July, 2007)
Governor Arnold Schwarzenegger of California of California announced that he would eliminate-- for a professed budgetary shortfall-- the state's social service program known as Integrated Services for Homeless Adults with Serious Mental Illness (AB 2034), a program which has been successfully operating since its legislative inception by the California Assembly in 1999/2000 (under the gubernatorial watch of Gray Davis.)
At another site, I have published a document entitled
"A Social Program That Really Works: California's AB 2034 (Integrated Services for Homeless Adults with Serious Mental Illness" -- inferentially quantifying the astonishingly positive effect of this program--which showed dramatic
decreases for the homeless mentally ill in the number of days "off the street," days-in jail, and psychiatric-hospitalzation-days, in addition to an
increase days of full-time/part-time employment by this group. My analysis was based strictly upon the "hard facts" of
published California reports on this program to the government dated 2002 and
2003-- and therein I derive that as the program stood in 2002, there was
one chance in 12350-with-5483-zeroes totally random trials that the profound skew of reported positive impact was "happenstance." For the comparable 2003 figures, the result-- which included positive employment data to which I allude here-- was that such a result would occur by happenstance
once in 12-with-71120-zeroes totally-random trials. The rationale that California "lacks the money" for this program hardly seems credible, for the following reasons: 1.
In November, 2004, the people of California voted in Proposition 63-- which taxed millionaires (which California has in a certain abundance) 1% of their income, the funds for which were ear-marked exclusively for (community) mental health; 2. Schwarzenegger's own proposed 2007-2008 budget for mental health is-- accordingly from Prop 63-- rather awash in money-- showing an increase projected from $1.6 billion in 2006-2007 to $1.8 billion this fiscal-year (2007-2008)-- see
"Welcome to California's Governor's Budget 2007-2008-- Program Enhancements and Other Adjustments-- Department of Mental Health" ; 3. the cost of AB 2034 -- currently at $54.9 million per annum-- represents about 1.1% of the current mental health budget, .14% of the state's Health and Human Services budget, and .05% of the total budget of California-- see
"Welcome to California's Governor's Budget 2007-2008: Proposed Budget Summary." I do NOT know whether AB 2034 gets federal subsidy: if so, as is usual for such programmatics-- then the argument for state-penury is further diluted.
Even if the Integrated Services... program lacks federal fiscal support, it certainly gets encouragement and endorsement from "the feds." At the top-most level, President Bush himself has considered AB 2034 to be an exemplar for his New Freedom Commission (as it is by the private advocacy group NAMI-- see
"Model Program: Integrated Services for Homeless Adults with Serious Mental Illness" at this link.) The program is also held up as a national model by the federal
"United States Interagency Council on Homelessness" as well as by
the SAMHSA-sponsored agency GAINS -- for its substantial positive, evidence-based practice in housing for the homeless-mentally-ill. In this vein it is worth noting that the
and State of Georgia and other venues have planned to model their community-based mental health programs around AB 2034.
Given all these factors-- and the Governor-of-California's reticence to be overly specific about his motives for this proposed elimination, it is to be expected that mental health advocates hither and yon-- but perchance not so much California's Prop 63 millionaires-- are agitating to prevent this planned travesty. "Housing California" just put out a flyer decrying this move by Governor Schwarzenegger, with the statements
"4,900 previously homeless, mentally ill individuals will be turned out on the street overnight. California already has more than 360,000 homeless people on any given night, with 90,000 of those in Los Angeles. The governor should be expanding this program, not proposing to cut it." The Mental Health Association of Greater Los Angeles-- perhaps less stridently but emphatically-- speaks out against the proposed cut-- in view of the program's effectiveness in "...measuring reductions in homelessness, psychiatric hospitalization and jail time in independent living and employment."
In the minds of many Californians, this proposal by Governor Schwarzenegger but be
reminiscent of Ronald Reagan-- when he was governor of this state-- to move to rid the state mental hospitals of patients, out of some perverse notion of "patient's rights not to be incarcerated, life, liberty and the pursuit of happiness" (pursuant to the Lanterman Petris Short Act of 1967)--
thus dumping the bulk of the "helpless" mentally ill from the back-wards on to the alley-ways and gutters of the inner-cities (in Los Angeles particularly.) Accordingly, many others-- perhaps the majority of the California community-- may be in a state of consternation because of this -- not LIBERAL NOT CONSERVATIVE BUT JUST UNWISE instance of misplanning.
I share these sentiments, and I root for the California advocates who wish to preserve this program, but for Kentucky civic reasons: for here at the Buckle-of-the-Bible-Belt, better known for "Real:Real:Christians" who wish to save your soul for afterlife, the-hell-with-this-existence-anyway, the rule of a certain social callousness and a following-the-leader prevails. We here do not inaugurate a social program until the great crowd of exemplars has gone before. We look to states like California and Massachusetts and New York for such inspiration, and I KNOW PERFECTLY WELL that conservative Democrats here as well as the Republicans of this Commonwealth will simply "jump" on the discontinuation of AB 2034 as "proof that this-- another social program-- does not work," when in fact nothing could be further from the truth. THIS PROGRAM IS WELL-PLANNED, WELL-EXECUTED, AND BY EVERY PRE-CONCEIVED EMPIRICAL EXPECTATION (BUT THE HAPPINESS FACTOR OF PROP 63 MILLIONAIRES) HAS BEEN VALIDATED. HOW UTTERLY RAW IT WOULD BE TO ELIMINATE SUCH A WORKING PROGRAM COSTING SO LITTLE OF THE CALIFORNIA MENTAL HEALTH BUDGET!!! HOW RAW INDEED!
I have been homeless, I would argue not for fair reasons, certainly not for reasons that acknowledged the mitigating factor that I was vulnerable due to my bipolar condition. The services I got when I was homeless were utterly thread-bare-- on the order of "counsel and close" by the Coalition for the Homeless here in Louisville. But other Kentucky counties/cities lack even a homeless agency that can "counsel and close" in matters like this. MY Kentucky lacks anything approximating the social safety net of California (or the other, "progressive" states.) I am "up in arms" about this plan afoot in California because without any doubt at all it will portend
horribly more drastic insults against the mentally ill of regressed regions-- like "My Ole Kaintucky Home." So come on, Arnie, can't ya do better than this? The eyes of the nation and world-- and certainly the mental health community-- are upon you now!
---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # 350
F31.2
Telephone: 1 (502)561-5419
E-Mail: freethink@bellsouth.net
What About the Mental Illness
Caused by Mentally Ill Criminals?--
A Statistical Estimate of Prevalence for This Cohort
And Some Humane Recommendations Those who have been following this Web-log know that I have been a strong advocate for mitigating the circumstances of the mentally-ill who (so easily) get caught up in the criminal justice system in these United States-- "by use of the least restrictive alternative for the patient consistent with her/his behavior/clinical-condition." I follow a fair number of Web-sites pursuant to this goal, and have of late come upon a blog which in part had content that was a real "mind-bender." By this disconcertion I refer to a June 30, 2007 entry in
"Grits for Breakfast: Welcome to Texas Justice: You Might Beat the Rap, but You Won't Beat the Ride," a site which deals with jailing and other criminal justice issues in the state of Texas.
In this entry, the author describes having gone to a workshop/seminar on "restorative justice" in Kerrville, Texas (? right state I presume, otherwise unmentioned.) There the reporter heard and passes on statistics compiled by a local Community Mental Health Center system about the "warehousing" (it seems to be an apt term in context) of chronically mentally ill prisoners in Harris County, Texas. The portion/prevalence of mental illness in this lock-up were "shocking data," yet while I found them deplorable too, they hardly seemed different than those for the rest of the "real Christian" Bible Belt-- including for Kentucky: we read that the mentally ill in this county were about 6.5 X as likely to be charged with a crime-- and 12 times more likely to be jailed-- than "normals." This figure included about 24% of those in the Harris County Jail.
But I do not wish to concentrate on this alarming set of statistics. The incarceration of the mentally ill into criminal justice facilities has always been common in the American South-- an area where Dorothy Dix' crusades-- as I understand her campaigns to rid jails and prisons of the mentally ill and put these into "asylums'-- never did "take" as well down here amidst the Believers (in Bible, slavery, and other complexities-made-pat.) What instead "made me tingle," not so much in pique but in curiosity, was the blog-writer's statement in this entry in "Grits for Breakfast" that restorative justice-- the topic of this seminar/workshop/symposium attended-- implies not just treatment for the prisoner but for the victims of crime. The writer says-- intriguingly--
"Once I learned more about the definition of restorative justice, I realized that these presentation, however interesting, really don't fit under that rubric. Neither man [speaking about jailing the mentally ill in Texas] spoke of the victims of the mentally ill's crimes, and the only 'restoration' contemplated by either was of the offenders' mental state...they're government bureaucrats trying to manage the system we have, which often doesn't work very well. That's not a beef, just an observation." This provoked a certain amount of research, and some computation, the results of which I shall summarize now. What this author is proposing is that the crimes of the mentally ill cause damage-- psychological perhaps and otherwise. I can hardly fathom
all the societal costs of the crimes of the mentally ill-- this would be complicated and subjective to a great extent-- and beyond the scale-of-modest-economy that my endeavors will permit. However, I think it possible to estimate the matter of intrigue for me-- revolving around the essentially-empirical question,
What is the prevalence of PSYCHOLOGICAL disturbance expectable by the crimes of the mentally ill? To assess the independent probability of mental illness caused by the mentally ill criminal, one needs to get prevalence figures for the rate of (especially violent) criminality in the mentally ill, and also such a figure for the rate of psychlogical/psychiatric sequelae for victims of violent crime. The intersect (one probability times the other probability) will be the
independent probability for such a contingency-- an important figure because it would have to do for a
baseline for all subsequent investigations of this nature. [The figures for psychiatric sequelae for the non-violent crimes do not obtain; there is some reason to think they may be -- using "thought experiment"-- lower than for violent crime-- but this is as yet unknown, as unstudied.]
Now reports have been surfacing in the media about the violence-potential of the mentally ill for a long time now-- these make "great copy" for the media, in part because the stories associated with such crime often tends to be sensational, and the context is usually still considered somewhat salacious.
Hard empirical studies that would pass the muster of science are more-rare in coming. One study I found about this topic does "meet muster," a study by a Louise Arseneault, and all, entitled
"Mental Disorders and Violence in a Total Birth Cohort," Archives of General Psychiatry 57:979-986, October, 2000. This study took 971 individuals, a cohort of total births in New Zealand from April 1, 1972 to March 31, 1973 and did an analysis based on self-reports +
D.S.M. III-R-based diagnostic interviews to assess involvement in violent crime in the mentally ill versus controls-- 961 individuals in all. The studying considered a unique definition of mental illness, including such things as marijuana dependence-- whose psychopathological designation is perhaps somewhat controversial. Nevertheless, individuals in the schizophrenia-spectrum were found to be 2.5 times more likely to engage in violent crime than normals, bipolar-disorder patients 4.8 times more likely to be violent, and alcoholics 2.5 times more prone to violence; remarkably, the marijuana population was 8.1 times more predisposed to violent behavior. Given the
number of categories involved in this study, the sample size might optimally have been bigger; otherwise these are troubling statistics for a mental health consumer and mental health advocate-- whose first concern in either case should be for reality/factuality.
An even better study--
"Major Mental Disorders and Criminal Violence in a Danish Birth Cohort," by Patricia A. Brennan, and all, Archives of General Psychiatry 57:494-500, May, 2000 -- using the a large cohort of 358,180 individuals born between January 1, 1944 and December 31, 1947 from birth and crime registries in Denmark-- obviously not a country with "Anglo" culture or values precisely, but a Western-European country with many of the characteristics of a diverse, essentially Caucasian, industrialized society. In this group, as we might expect, some individuals (the cohort included males and females), some became mentally ill and some did not, some engaged in violent crime in both sub-cohorts, and others did not. For to me somewhat mystifying reasons-- as I shall soon clarify-- this study reports that
"Approximately 2.2% of the men in the cohort were hospitalized for a major mental disorder and committed 10% of the violent crimes committed by all the men in the cohort; 2.6% of the women had been hospitalized for a major mental disorder and committed 16% of the violent crimes committed by the women in the cohort." ...But every way I compute the data tabulated in this study-- I get a
higher prevalence figure for the violent propensities-- in both genders-- of the mentally ill. To wit: the total population in the cohort, the number of mentally ill men and women was
43,465 individuals. Similarly, we compute that the number of violent incidences in both the mentally ill men and mentally ill women stands at
7,962. Now the fraction
7,962/43,465 = .1832-- (in other words) 18.32%. So let us use this figure-- which seems accurate-- for the prevalence figure of violence in the cohort of the mentally ill.
What is the nature of mental/psychiatric distress among victims of (violent) crime? A study on this type of epidemiology has of late been published --
"Mental Health Needs of Crime Victims: Epidemiology and Outcomes," by Dean G. Kilpatrick and Ron Acierno, Journal of Traumatic Stress 16(2):119-132, April, 2003. Here we read that quite frequently there
are psychological mishaps resulting from being the victim of violent crime:
post-traumatic stress disorder (PTSD) is the most-likely psychiatric impairment resulting from such victimization [same work just cited, page 119.] Now PTSD is a malady that must be considered over both the short-span of the immediate time-frame after the index incident and for the affected individual's lifespan: with regard to PTSD in victims of violent crime-- the prevalence is
9.7% (.097) CURRENT PTSD and 25.8% (.258) LIFETIME PTSD [page 126, work cited here.]
Now we are ready to compute the expectable portion of
one important psychiatric sequel to crime-by-the-mentally ill-- that is, here, for PTSD in the victims thereof. I am
being generous to the "critics" and so using the
"high figures" in part for this reason, in part because they seem to reflect a certain
demonstrable reality.
If PTSD's baseline from the victims of the crimes by the mentally ill-- we may anticipate it to be-- on the basis for computing "probability intersects" outlined procedurally above-- by multiplying .1832 X .258; the result-- and the reader may consult her/his calculator to validate what I impute here-- is .0473 (4.73%) of the total population of crime victims having PTSD as the result of violence perpetrated by a mentally ill individual. This/these figure(s) deserve comment. It will be seen that our friend from Texas-- concerned about the restoration of justice to the PTSD victims of crime by the mentally ill is in fact talking about a small minority of the total population of crime victims. Not a few of these PTSD victims will themselves have some precursor mental illness. Nevertheless, it is only fair and right that these victims be treated with the dignity and welfare they deserve. By further implication, it is only fair and right that the victims of crime by the mentally ill receive counseling/psychotherapy/psychopharmacology commensurate with their PTSD needs. AND treatment for the victim does not diminish the burden of forensic psychiatric facilities to accomodate mentally ill prisoners with psychiatric treatment-- either kind of deficiency in service is for an advanced culture unconscionable.
In fine detail-- and in the Southern U.S.A. in another "fine"-- we are dealing with the callous and systematic disregard of the needs of a predictable part of the population-- the mentally ill criminal on the one hand -- and the mental illness caused by the crimes of the mentally ill criminal on the other. What is needed is
more mental health in general and
more mental health planning in particular: not less. The demagogic "beating of the rubber chicken" against "bureaucrats" does not obviate the necessity that
rational bureaucracy-- to use the phraseology of social theorist Max Weber-- needs to be augmented and bolstered if
these true and burning needs will be met. Such planning would include "comprehensive care" for the forensic psychiatric patient and also for victims of PTSD (as well as any other psychological or social mishap) of victims of crime by the mentally ill.
I for one will aspire to keep an ethical "seamless garment" in these Web-logs I keep: I shall not knowingly perpetrate either falsehood or inequity. So I shall not conscion the serious crimes-- or any other crimes-- by the mentally ill, for they are irresponsible behavior (with the possible exception of "crimes" of civil disobedience.) From the "systems" end, I shall try to recommend fairness to all parties, as we see espoused in
A Theory of Justice by John Rawls, Harvard University Press, Cambridge, Massachusetts, 1999 (1971.) This predisposition to fairness would include accommodation for the victims-- in mental health services or otherwise-- for victims of the crimes of the mentally ill (as well as the victims of other types of crime, the vast vast majority.)
Fair is just fair. That is not only "restorative justice" but simple justice, for the mentally ill and for the unfortunates who occasionally are wronged by them.
---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # 350
F31.2
Telephone: 1 (502) 561-5419
E-Mail: freethink@bellsouth.net
