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Monday, Jan 07 2013 11:00 PM

JIM WATERMAN: Intensive outpatient care is far superior to involuntary care

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    Jim Waterman

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In the aftermath of the horrific events in Connecticut, there has been much discussion about the role of mental health treatment in preventing these murders. It is an important dialogue to have. Serious mental illness doesn't just strike down people at the margins of society. Schizophrenia, bipolar disorder and severe depression are highly genetic in etiology and are made worse by trauma and severe circumstances. They can strike bright, energetic students, workers, soldiers and family members.

The Californian suggests that implementing "Laura's Law is a good place to start" (Our View, Dec. 30). I applaud the implied question. Where do we start?

There is a good reason that this law, which authorizes involuntary outpatient treatment, has been implemented in no county other than Nevada County. Involuntary outpatient treatment was so extremely controversial when considered by the California Legislature that lawmakers compromised and passed Laura's Law, but placed key provisions in the law that made it almost impossible to implement. For example, there is no provision for involuntary medications or current funding to implement it. So what can be done?

First, let's recognize that very troubled kids need to be helped as early as possible. One of the best approaches is called Student Assistance Programs. Teachers identify kids who need help. Referrals are made to a trained team on the campus. Schools work with parents to get the kids help either on campus or through treatment programs that the family can access. Kern County Mental Health has put almost $7 million of Mental Health Services Act funds (Prop. 63's 1 percent tax on millionaires) into such programs in the last three years. However this widely researched program is only in 11 schools and our foster care system. More is needed.

Intensive outpatient treatment programs are needed for children and adults. These teams go into schools, homes and the community, building relationships with individuals and families. They teach skills that help people get a life and find hope. We see reductions in jail days of 92 percent the first year of treatment, 83 percent reduction in homeless days and 85 percent reduction in hospital days. The key to these reductions is the availability of intensive services. So, one good place to start is to expand, as much as possible, intensive outpatient programs with aggressive outreach programs. The county system has these services, but few insurance plans cover them.

You will notice that most of the shooters in these incidents are not poor people on Medicaid. Medi-Cal programs, like county mental health departments, offer fairly comprehensive mental health treatment. Not so, historically, for many insurance plans. Thankfully that is changing. Parity is now the law of the land, which means that if an insurer is willing to treat a broken foot, they have to be willing to treat a broken brain. Insurers may not like it. They are not immune from stigma against mental health. But since the Wellstone-Domenici Parity Act of 2008 and the Affordable Care Act of 2010, it is now the law of the land that mental health treatment is an essential service that must be treated and has parity with other conditions. We have a long way to go to achieve this.

The system is not perfect, but if I had a seriously ill relative, I would absolutely want them treated in the county Medi-Cal system rather than through most private insurance plans. Treatment is not only better clinically, but less costly. It costs more than $225,000 per year to place someone in the state hospital. For those who are most ill, we can do comprehensive outpatient treatment for under $20,000 per year.

Just before Christmas, I was at a luncheon and sat eating with several people who are recovering from serious mental illnesses. One was going to college and is becoming active in the community. The other was talking about his positive relationship with a person he loves. Normal, everyday kinds of talk over lunch, until you realize that these individuals had spent years in state hospitals and until the last 20 years, would have spent their whole lives in institutions.

Comprehensive mental health treatment works. People with serious mental illnesses do recover. Our community is safer and it costs less to do the right thing.

James A. Waterman, Ph.D., is the director of the Kern County Mental Health Department and a licensed clinical psychologist. Community Voices is an expanded commentary of 650 to 700 words.

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