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Canada Can Learn From California's Mishandling of Mental Health Policies

08/04/2015 12:26 EDT | Updated 08/04/2016 05:59 EDT
Hank Grebe via Getty Images

We often hear that the inadequate level of funding for mental health care in Canada is the biggest factor in so many grim outcomes for people with mental illnesses. It's easy to think that if we just put more money into some kind of mental health services we could solve the problem. This belief prevents us from understanding the other complicated forces at work that keep some people trapped in severe mental illnesses.

California's mishandled mental health policies can teach us a lot. Eager to improve the situation of people with severe mental illnesses, in 2004 voters approved Proposition 63. Called the "Millionaire's Tax" because of the source of the huge influx of money, the bill created enormous revenue to ensure that people with the most severe mental illnesses receive the treatment it had become apparent they needed.

California had earlier passed Laura's Law in 2003 and the new tax should have provided ample funds to ensure that very psychotic people received help from an intensive Assisted Outpatient Treatment program. Laura's Law was passed after the murder of college student Laura Wilcox and two others by a man who chose not to treat his mental illness. A major glitch was that counties in California had to individually decide to implement the law and for many years only small Nevada County, where Wilcox had lived, had the political will necessary to enact the program.

Meanwhile, the "Millionaire's Tax" began to be used to fund numerous "wellness" programs and other pet projects including groups actively opposed to any involuntary treatment. Sadly, a powerful adversary has been Disability Rights California that argues that until every possible voluntary treatment has been funded, Laura's Law shouldn't be implemented. Since this criterion is impossible to meet, the law until recently remained unfunded for most of California.

Essential to understanding the core conflict is knowledge about anosognosia, the brain based inability of most people experiencing psychosis to understand that they are ill. Readers who have been convinced that people given this "label" are just having unusual thoughts should watch this four-minute video clip. After the brief interview with a bereaved mom who couldn't get treatment for her son before he killed himself, you can watch footage of Russell Weston who killed two United States Capitol police officers to prevent the U.S. from being annihilated by cannibals.

As the number of people with psychotic disorders filled the streets, jails, and prisons in California, families began waging prolonged battles to get Laura's Law implemented and they have finally begun to be successful. In a recent gathering of Laura's Law advocates that I attended in San Francisco, they celebrated the opportunities for treatment ill people now have in Los Angeles, Orange, San Diego, San Francisco and other counties. This includes Contra Costa county where longtime advocate Teresa Pasquini and others have finally persuaded their local Board of Supervisors to implement Laura's Law. Like the children of many others in the room, Teresa's son never had the sustained treatment that would have prevented him from ending up imprisoned.

Candy Dewitt was also at this gathering. Because Alameda County where she lives is the new centre of power for the "psychiatric survivor" movement and hasn't implemented Laura's Law, her son still wouldn't receive the help he needs. Tragically, he has only been able to receive help because he is now incarcerated at Napa State Hospital, following the murder of an elderly stranger that he committed while profoundly psychotic and delusional.

The successes of these relentless advocates should have been the centre of the annual convention of the National Alliance on Mental Illness (NAMI) that was taking place nearby. Started by parents of people suffering from schizophrenia, this enormous organization has strayed from its original mission. In its efforts to be inclusive, especially of people who identify with the psychiatric survivor movement, it is unclear what it actually stands for anymore.

A featured presentation at NAMI this year was from The Village, a program that has recently been promoted in Vancouver. This well-funded initiative in Los Angeles offers services to many people who have previously been homeless and suffering from some kind of addiction and mental illness. The presentation included superbly produced footage of people who are doing well. However, until there was a question from the audience, the presenters chose not to mention that its programs are only for people who are able to volunteer for its services; in fact, the presentation openly opposed involuntary treatment.

In various question and answer sessions during the NAMI convention, parents kept trying to get others to understand the desperate situations of their untreated sons and daughters. However, after Candy Dewitt described not being able to get treatment for her son before he committed murder, we heard from someone supporting alternative approaches to "emotional distress." Like too many with his beliefs, this man works for a program providing mental health services.

How can we expect people who don't believe in the existence of mental illnesses to provide adequate help for people suffering from catastrophic psychotic disorders?

The struggles of families in California have been replicated across the U.S. This is why so many are actively supporting the recently reintroduced Helping Families in Mental Health Crisis Act. Initially examining rampage killings by people with untreated mental illnesses, a Congressional Subcommittee began focusing on the de-medicalized approach to mental illnesses promulgated by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) The Subcommitte's investigation revealed the devastating impact of this federal agency which has made it harder for people with severe mental illnesses to get the help they need.

Canada has a chance to learn from the tragic U.S. mistakes. Let's acknowledge the reality of psychotic brain disorders like schizophrenia and bipolar disorder and ensure that people with the most severe illnesses get the help they need.

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