As a practicing psychiatrist for over 50 years in San Diego, I have witnessed tremendous advancements in our understanding and treatment of mental illness, and the simultaneous failure of our public institutions to address affected communities. We are now at a pivotal moment in California. We can continue doing what doesn’t work when it comes to mental health or we can commit to investing in what does.
I think we’re ready for change.
In November 2014, voters approved Proposition 47, which reduced lengthy jail terms for petty offenses and required that resulting savings be reinvested into community-based services, including mental health care. Legislation sponsored by Assembly Speaker Toni Atkins, D-San Diego, clarified that Prop 47 savings can be invested in supportive housing — a critical need for the homeless mentally ill in our city.
Prop 47 savings haven’t been allocated yet this year. The Board of State and Community Corrections (BSCC), which will distribute the majority of Prop 47 savings, is still formulating its process for determining exactly how and where savings will go.
To its credit, the BSCC is touring the state to gather public input on spending priorities. This includes a stop at the San Diego Hall of Justice, 330 West Broadway, from 6 to 8 p.m. on Jan. 28. The BSCC usually meets in Sacramento, so this is a rare opportunity for San Diego residents to speak directly to the agency about our local needs. For me, this means emphasizing that Prop 47 savings should be invested in community-based services that support people living with mental illness.
For too long, we have looked the other way as jails and prisons became institutions for the mentally ill, especially the poor. Since California began closing the state’s mental institutions in the 1970s, rates of homelessness, suicide and incarceration among the mentally ill have all increased dramatically.
Deinstitutionalization did reduce the number of people being committed against their will to troubled state institutions, but California failed to complete the transition to mental health services in the community. This lack of commitment to the mental health needs of our families, loved ones and community members has driven many into a cycle of homelessness and incarceration, often for petty offenses like trespassing, sleeping on the sidewalk or drug possession.
Nationally, upward of 40 percent of people in jails and prisons suffer from mental health issues. About half the people with a diagnosis of severe mental illness also have a diagnosis of substance use disorder. People may self-medicate because symptoms of the illness are not under control or as a way to cope with their social isolation.
Even where incarcerated individuals receive treatment for their illness, they are often further traumatized by the experience of incarceration and come out in worse shape than when they went in — typically with little or no community support after their release.
Since Californians overwhelmingly passed Prop 47, we have a fork-in-the-road kind of decision to make. We can address mental health issues directly, in a scientifically sound and fiscally prudent way — or we can keep doing what hasn’t worked for more than five decades.
Here in San Diego County, we already have programs in place we could expand right now using Local Community Corrections dollars, which the county receives every year specifically to address and prevent low-level crime, including through mental health services and drug treatment. For example, San Diego’s Homeless Outreach Team, which connects 700 homeless people a year with services, could reach many more if expanded.
For those already in the system, the San Diego City Attorney Office’s year-old Community Court allows people charged with petty offenses to be held accountable through community service while also giving them the opportunity to connect directly to services.
San Diego is often an incubator for innovative health care and criminal justice solutions. With Prop 47, we have a marriage of the two.
Today’s BSCC meeting is a much-needed opportunity to highlight the need for better transition and diversion services for those who desperately need connections to programs that provide residential and behavior health services.
We can lead the state and the nation away from our over-reliance on prisons and toward more common-sense solutions that make our communities safer and healthier.
Strauss, M.D., specializes in psychiatry and lives in La Jolla.