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Issue Papers - Mental Hygiene [re: closing State Mental Hospitals] (3 of 3)
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Issue Papers - Mental Hygiene [re: closing State Mental Hospitals] (3 of 3)
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Ronald Reagan Presidential Library
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This is a PDF of a folder from our textual collections.
Collection: Reagan, Ronald: Gubernatorial Papers,
1966-74: Press Unit
Folder Title: Issue Papers - Mental Hygiene
[re: closing State Mental Hospitals] (3 of 3)
Box: P31
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To see all Ronald Reagan Presidential Library inventories visit:
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Contact a reference archivist at: [email protected]
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Mental
HUMAN RELATIONS AGENCY
FOR RELEASE 1:30 P.M.
Sacramento, California
Contact: Spencer Williams
JULY 2, 1969
Spencer Williams, secretary of the State Human Relations Agency, today
directed the formulation of a master plan to encourage the maximum development of
the mental 1y retarded.
Williams announced the action at a meeting of a Senate committee consider-
ing a report concerning the hospitalization of the mentally retarded which was made
at his request.
The Secretary urged the committee to back administration efforts to
"provide an integrated, modern, effective system of care for California's retarded."
Development of the master plan was the Number I recommendation on an
action program submitted by the Human Relations Agency Task Force on Mental
Retardation services.
"While this plan is being formulated we shall proceed to implement the
other three major points submitted to me for action by the task force so far as
the Legislature will permit," Williams said.
He said the state would expand its regional diagnostic and counceling
center network to provide residential and other services as close to home as
possible, consistent with quality care. "We will encourage innovation in provision
of residential care, but always with the best interest of the individual uppermost,"
Williams said. He said the centers would also provide a single point of entry into
the system of mentally retarded care to help each parent learn what his child needs
and to secure the necessary resources.
Some major recommendations directed to the department of mental hygiene
will be implemented at once, but others will require further study and legislative
approval.
-1-
Williams pointed out that substantial progress in the care of the
mentally retarded has already been made. He cited new legislation that went into
effect yesterday as providing some increases in service. He noted that other
legislation, particularly AB 225 supported by the administration, to bring all
mental retardation services together is pending.
Williams said the number of regional centers authorized was increased from
two to six last year and that the administration is supporting an additional increase
this year.
He said that the number of filled treatment positions in state hospitals
for the mentally retarded was increased by 500 persons in the past two years even
though there was a slight reduction in the hospital population. He said 200 more
positions are requested in the budget for this year.
Williams also called attention to increased efforts by the Department of
Rehabilitation, the expansion of development centers for handicapped minors and the
upsurge in community placement of the retarded from the state hospitals by the
Department of Social Welfare.
The 72-page report and its 26 recommendations were made by a three-man
task force headed by the associate dean of the University of California's College
of Medicine at Irvine, Dr. Thomas Nelson. Nine top consultants from throughout
the nation and scores of experts participated in the study which extended from
July 1968 to June this year.
Williams expressed his appreciation to the task force, the consultants and
others that assisted them for the report and assured them that all of their recom-
mendations will be given full consideration by the administration.
"The task force recommendations will probably raise controversy, objections
by some, and a few will distort and exploit the report, inflaming rather than
illuminating this emotional subject," Williams said. "Opinions as to what, when
and how much should be done do vary among different groups, parents, employee,
professional and citizen organizations."
-3-
The task force, consultants, and experts had something to say about the
types of facilities needed, the types of employees who should provide the services,
the research programs, the types of programs such as medical, rehabilitation,
education, and others, and the types of treatment that should be provided certain
categories of patients.
There was no hesitation by the Department of Mental Hygiene to recommend
basic acdeptance of the report. The Department's Director, James V. Lowry, M.D., has
always worked for elimination of the "control and custody" principle which the task
force states is a predominant policy of the state hospital programs, although the
team said there were "noteworthy exceptions to this policy".
The Department has been establishing the groundwork to provide hospitaliza-
tion only for those mentally retarded requiring it. The last fiscal year, ending
Monday, saw the first drop in seven years in the number of mentally retarded patients.
The Department of Social Welfare in cooperation of the Department of Mental Hygiene
willcontinue to seek placements for patients not requiring hospitalization.
The recommendations seek to attain the task force's objective: "To
assess present systems of services and recommend needed organizational and program
adjustments as well as guidelines for further program development."
The members of the task force are Thomas L. Nelson, M.D., Associate Dean,
California College of Medicine, University of California, Irvine, Chairman; Richard
Koch, M.D., Director, Child Development Division, University of Southern California
School of Medicine, Los Angeles; Irving Philips, M.D., Associate Clinical Professor
of Psychiatry, University of California Medical Center, San Francisco.
The recommendations follow.
For Action by Secretary, Human Relations Agency
1. The Secretary of the Human Relations Agency should develop a master plan
for achieving the goals set forth in the document referred to earlier in
this report, "The Undeveloped Resource, A Plan for the Mentally Retarded
in California." This document expressed a philosophical approach which
dictates that the general goals of programs for the mentally retarded are
to allow for maximum growth, development, and fulfillment for each indi-
vidual who is mentally handicapped. The master plan should be updated
annually in keeping with changing needs and newer trends of care.
2. A single point of entry should be established in each community, whether
it be a Regional Center contract agency, a local public health department,
or a Short-Doyle program, to help parents define the specific needs of
their child and reach the appropriate service resource.
3. An effort should be made immediately to implement regionalization of care
so as to provide residential services for mentaliy retarded individuals
at all levels from community to state care and as close as possible to
the individual's home consistent with quality care.
4.
Experimental and innovative models of community residential care should
be encouraged through expansion of present programs for placements from
state hospitals into family homes, hostels, cooperative living projects,
nurseries, and schools.
a
For Action by the Director of Mental Hygiene
5. The Departments of Mental Hygiene and Social Welfare should jointly (a)
determine the nature and extent of the placement, funding, and staff resources
required to effect movement of residents out of the state hospitals who no
longer require state operated residential services, (b) mobilize such resources,
and (c) expedite placement of the residents.
6. For those persons who require state residential care, services should be
organized consistent with broad program goals and sufficient budgetary support
to achieve the maximum developmental potential of each resident.
7. DMH residential services for the mentally retarded at any one facility
should include no more than 500 residents in a Medical Program for the
Multiply Handicapped (Type 1), no more than 150 in a Developmental Program
(Type II), and no more than 150 in a Rehabilitation Program (Type III).
8. A type and level of staffing should be developed for mental retardation
programs that would permit individual and small group programming in
keeping with recommendation No. 7, above.
9. The director of each MR service in a state institution should develop a
program for individual residents or groups of residents so that all care
and treatment personnel may know at any moment in a resident's institutional
stay (a) what stage of development he is in, (b) where he is going, and (c)
what is to be anticipated in his eventual development. The program should
always be in a state of flux with no ceiling placed on individual potential.
10. There should be greater exchange of resources between state hospital and
community; the hospitals should purchase high quality community services
where available and state hospitals should develop easily accomplished
procedures for short term admissions from the community.
b
11. Hospital projects that have proven their worth experimentally, whether
supported by federal funds or state research funds, should be continued
as part of the ongoing hospital operations budget. Efforts should be made
to translate the results of such projects into programs throughout the
hospital system wherever appropriate and with sufficient funding.
12. Educational services in DMH facilities should be provided in accordance with
standards of the California Department of Education for Special Education
programs in public schools.
For Action by Secretary, Human Relations Agency
13. Active support should be given toward obtaining substantial increases in
salaries.
For Action by the Director of Mental Hygiene
14. DMH Headquarters should be reorganized, placing the Director and the two
Chief Deputy Directors within the Office of Director.
15. The functions of the Division of Hospitals and Division of Local Programs
should be consolidated and redistributed between a Division of Mental
Retardation Services and a Division of Mental Health Services.
16. Services to the mentally retarded in state institutions should be headed
by a Program Director responsible to the Deputy Director, Mental Retardation
Services. There should be three broad program classifications: (a) Medical,
(b) Developmental, and (c) Rehabilitation, each headed by a Program Chief
responsible to the Program Director.
C
17. Development of MR programs in facilities on the grounds of MI hospitals is
supported as a temporary expediency and only under certain conditions and
guidelines: (a) written plan approved by Deputy Director, MR Services,
(b) implementation of plan before admission of residents, (c) transfers by
small increments, starting with Rehabilitation Programs, and (d) linkage of
MR/MI facility to a parent MR facility.
18. DeWitt State Hospital should be phased out as a facility for the mentally
retarded.
19. Parental consent for placement out of state institutions into community
facilities should be retained as a normal requirement, with an appeal pro-
cedure developed to sources outside of the facility for adjudication of
differences between staff and the responsible relative. A consumer repre-
sentative (not a relative) should participate in the adjudication process.
Personnel Utilization and Development (page 51)
20. Basic care personnel in Medical Programs for the Multiply Handicapped
(Type 1) should be licensed vocational nurses (LVN) and registered nurses
(RN).
21. Basic care personnel in Developmental Programs (Type 11) should be child
development aides and child development specialists.
22. Basic care personnel in Rehabilitation Programs (Type III) should be
psychiatric technicians.
di
23. Promotion, retention, and merit salary increases for physicians in MR
programs should be based primarily on a critical annual review of performance
as demonstrated in a clinical setting for the mentally retarded, irrespective
of specialty background of the physicians.
24. Basic res dency programs for physicians should be continued for psychiatric
programs and extended to pediatrics, emphasizing mental retardation and
related hundicapping conditions.
25. More opportunity should be given all basic care personnel for upward mobility
into various management and professional classes in order to fill manpower
needs.
26. Basic training for the various basic care personnel should occur in junior
colleges with DMH providing stipends and field practice settings.
e
news from the
CALIFORNIA STATE EMPLOYEES' ASSOCIATION
1108 o Street, Sacramento
Phone: 444-8134
For further information
FOR RELEASE TO AM's OF
contact: Jim Bald, 444-8134
January 19, 1972
The California State Employees' Association today charged that
thousands of mental patients have been released from state hospitals without
adequate protection or treatment.
In a special study titled, "Where Have All the Patients Gone?" CSEA.
urged the legislature to halt plans to close Mendocino, Metropolitan, Patton
and Stockton State Hospitals.
CSEA also asked a complete legislative review of community mental
health programs financed by state funds under the Lanterman-Petris-Short Act
of 1969.
"CSEA finds evidence that the tragic consequences of this act have
been to take thousands of mentally ill patients out of state hospitals and
scatter them among counties unequipped to provide adequate care, said
Walter W. Taylor, CSEA's general manager.
"LPS also has made it difficult to treat mentally disturbed persons--even
in a state hospital--for a significant period of time, " Taylor said.
"In far too many cases, these patients end up in transient hotels,
small board and care homes or in prison. Their illnesses are not being treated.
"County and private facilities just are not equipped to handle the flood
of patients being released by the state," said Taylor.
Taylor also said that "costs under LPS have skyrocketed. =
Between fiscal 1965-66 and 1970-71; expenditures at 1971 dollar
more
2-2-2-2
value for services to the mentally ill have increased by more than $28 million,
the CSEA study reports.
There will be a net increase of $9.7 million in the cost of state-
financed mental health care during fiscal 1972-73 under the governor's
proposed budget, despite plans to close 2 hospitals this year and 2 more
within 36 months, states the CSEA study.
"We charge," said Taylor, "that the state has distorted the
humanitarian aims of Lanterman-Petris-Short and used that law as an excuse
to act without adequate planning, without education of either the community
or the patient, and without provisions for alternative care."
"Complicating the problem is the crazy quilt pattern of state and
county licensing laws which permit an estimated 32,000 former mental
patients to live in unlicensed board and care homes alongside the geriatric
patient, Taylor said.
"Obviously, CSEA has more than a passing interest in what happens
to our mental hospitals. Thousands of our members are employed there.
Their jobs are in danger, along with the health of their patients," said Taylor.
"But it should be understood that the very members and non-members
of CSEA who urged the Association to undertake this study are also professional
treatment personnel who share a deep concern for the welfare of the men and
women they treat.
"Our report only scratches the surface of problems relating to community
mental health programs.
"We hope that by calling this situation to the public's attention we
will open a dialogue leading to a more objective and orderly approach to
treatment of California's mentally ill," said Taylor.
######
where have
all the
patients gone?
a csea report
on the crisis
in mental health
care in california
january 1972
introduction
In 1969 there were 9 state hospitals caring for
The California State Employees' Association
approximately 15,700 mentally ill citizens of
represents approximately 16,000 employees of the
California.
state Department of Mental Hygiene, including
Today, in 1972, only 6 state hospitals are treating
doctors, nurses, technicians and therapists.
mentally ill patients, and their number has shrunk to
They are concerned over the state of publicly
7,200.
financed mental health care in California. They are
Tomorrow-by the end of 1973-it appears 2 more
afraid they know what has happened to most of
hospitals will close and approximately 2,000 more
those 8,500 patients.
patients will be released to community-level care.
What has happened to the 8,500 patients released
As for new patients, what is happening to them is
since 1969?
known first-hand by CSEA's members who work in
Are they cured, and back with their families living
the 6 remaining state mental hospitals. And they are
happy, healthy lives?
upset.
If not, are they under professional care, and what
A radical change in the state's system of caring for
is the level of that care?
the mentally ill occurred in 1969 when the
And what of new patients, people who experience
Lanterman-Petris-Short Act of 1967 went into effect.
a mental breakdown which requires
institutionalization and treatment? How and where
Only now is the full impact of that change
are they being cared for?
begining to be felt.
These are some of the questions which this paper
It will be felt even more keenly in the months and
attempts to answer.
years ahead unless someone applies the brakes.
-1-
CSEA researcher Richard
Funderburg examines trash cans
and sink on landing of hotel
used by mental patients
discharged from state hospitals.
At left, hotel exterior. Hospital
security officer estimated 50
percent of those staying at the
hotel the day these photos were
taken were former patients.
-2-
E
(C)
to
the lanterman-petris-short act
What has become known as the Lanterman-
In far too many cases these patients end up in
Petris-Short Act was passed in the fading hours of
transient hotels or small board and care homes in
the legislature's 1967 session.
run-down neighborhoods where they receive no
It combines with the Short-Doyle Act of 1957 to
treatment for their illness;
form the California Mental Health Act.
decrease the number of days a state hospital may
As conceived by its architects, this revolutionary
hold a mentally ill individual.
new system for handling the mentally ill was designed
skyrocket the cost of mental health care.
mainly to:
Before LPS, patients were admitted to state
protect the patient from institutionalization
mental hospitals on a voluntary basis and kept as long
without his consent.
as either the patient or his physician felt was needed.
remove the stigma of mental illness by holding
Patients also were committed involuntarily,
all records confidential to the hospital.
through the courts, at the request of family or law
promote community-level care of the mentally
enforcement agencies, the length of their stay
disordered, aided by 90-10 state financing-with
determined by doctors' judgment.
county government paying 10 percent of the cost.
Under LPS, state hospital authorities can hold
CSEA finds evidence that the tragic consequences
patients for only 72 hours, unless they want to stay
of this act have been to:
longer or unless 2 attending physicians sign a paper
take thousands of mentally ill patients out of
certifying the person is a danger to others or to
state hospitals and scatter them among 58 different
himself, whereupon he is committed for 14 days for
counties, there to be absorbed by as many different
intensive treatment.
community mental health programs.
After that 14 days, whether or not the patient has
-3-
improved, he must be released unless he has
held counties responsible for providing community
physically assualted another person, in which case he
treatment facilities, (2) minamized court procedures,
may be kept for 90 days.
and (3) gave the mentally ill person the right to refuse
The Short-Doyle Act of 1957 designated the
involuntary treatment unless he was a grave danger to
county as the local unit of government to provide
himself or others.
mental health services and mandated that each county
The act protected the civil rights of patients,
with a population of 100,000 or more had to provide
mandating the right to a hearing before the Superior
mental health services. The act also provided that the
Court on a writ of habeas corpus, the right to
state would fund 75 percent (now 90 percent) of the
personal property, the right to see visitors, the right
community program and the county would provide
to use the telephones, to wear one's own clothing, and
the remaining funds.
the right to refuse shock treatments or labotomy.
The Lanterman-Petris-Short Act was aimed at the
In affect, the LPS Act provided a bill of rights for
mentally disordered, chronic alcoholic, and user of
the mentally ill.
narcotics and dangerous drugs. Incorporating findings
It also made it increasingly difficult to treat
expressed in the 1961 report of the Federal Joint
mentally disturbed persons for a significant period of
Commission on Mental Illness and Health, LPS: (1)
time.
-4-
a case in point: santa clara county
Santa Clara County is a progressive, sprawling
"The primary distortion is the present state
populous community south of San Franciso Bay.
administration's use of LPS philosophy as a rationale
Its residents have an active mental health
for acting without plan, without prior notice and
association, community programs aimed at improving
without concern, to remove from the state hospital
mental health care, and a small but modern
context, and to preclude from entrance to such
psychiatric facility-Valley Medical Center.
facilities, hundreds of ill persons without provisions
There are approximately 1,000 board and care
for alternative care. (Emphasis theirs)
homes in the San Jose area (San Jose is the county
Before Sept. 15, 1971 the usual patient caseload a
seat of Santa Clara County) housing geriatric patients
month at Valley Medical Center was 60. Since, the
and ex-mental patients.
C-CAP report states, the caseload has risen to 176
When the Department of Mental Hygiene began
average a month.
early release of hundreds of mental patients from
"The physical plant cannot absorb any more
Agnews State Hospital in San Jose, the community
patients," the report states.
awoke to find their local mental health facilities
"In addition, there is little privacy for patients.
seriously and dangerously overcrowded.
Because of lack of sufficient space, intake,
San 'Jose's Council for Community Action
counseling, examination, treatment-all take place in
Planning (C-CAP) studied the situation and adopted a
the midst of hectic, public environment.
report on the crisis on Nov. 27, 1971.
"The staff and program of Valley Medical Center
That report was highly critical of the
was reputed as one of the best in the state before the
administration of the Lanterman-Petris-Short Act.
increase in caseload produced a factory-like
Quoting:
atmosphere where the press of patients, the
"What the outcome of Short-Doyle and
uncontrollable noise level and the lack of space
Lanterman-Petris-Short might have been is now
destroyed the capability of an innovative service to
difficult to say, for its provisions have been distorted
deliver meaningful patient care," the report states.
in practice and misrepresented in policy
What of the impact on board and care homes in
determinations.
Santa Clara County?
-5-
C-CAP's report found that a large caseload in
"would be the destruction of the board and care
greater need of assistance, such as will be caused by
homes which now provide housing and sheltered care
closure of Agnews State Hospital's facilities for the
for 1,000 persons."
mentally ill, "would defeat recent movements aimed
at improved availability of services for the already
Another community organization to study the
discharged."
effects of closing Agnews was Chapter 23 of the
Investigators for C-CAP reported many ex-mental
California State Employees' Association, most of
patients found the board and care home experience
whose members work at the hospital.
"refreshingly positive."
They commissioned a $3,500 study of "The
"These facilities," said the report, "provide a
Impact of California's Mental Health Act on Mental
sheltered environment, a minimal degree of
Health Care in Santa Clara County."
supervision and assistance with transportation,
A San Jose research firm undertook the study and
medication, hygiene, etc., to their residents.
reached many of the same conclusions as did the
Having found that many board and care homes
Council on Community Action Planning.
were pleasant, well-run environments, C-CAP
investigators were forced to report also that "many
Dr. John Rieger III, M.D., a consultant employed
are negative places, at best, in which to reside."
by the San Jose research firm, reported:
The report states that the "freedom from restraint
"Of_12 facilities (board and care homes) visited,
which has fostered uniqueness and responsiveness to
one-third rated superior, one-third rated flatly
the residents has another face-a picture of
inadequate and the remaining third doing a passable
unregulated license which provides little protection to
job of warehousing mentally ill human beings.
residents and leaves to the discretion of the
board-and-care operator all conditions and often all
"Location of board and care homes, in San Jose as
decisions regarding the interests of the resident."
in other large metropolitan centers, are mainly in
deteriorating neighborhoods.
(1) the patients who live in them are too poor to
afford residence in more expensive areas of the city,
"Persons too sick
and
to be placed in board and care homes
(2) deteriorating neighborhoods frequently possess
are already in evidence."
large, once-elegant houses appropriate for the
purpose."
C-CAP researchers reported: "there is no licensing
and no means to enforce standards.
"board and care clients do not have adequate
What will happen
counseling, therapy and rehabilitative services at the
to psychiatric care facilities
present time."
in Norwalk?
"because of a lack of staffing standards,
residences are often ill-staffed for the provision of the
appropriate level of supervision
"some persons too sick to be placed in board
and care facilities are already in, evidence. The
dumping of clients in need of specialized and closely
The research firm found the average age of such
supervised environments, in homes geared to the
dwellings in San Jose to be 51 years.
client in need of merely a sheltered
Santa Clara County is fairly typical of
home-away-from-home has already created havoc in
metropolitan-suburban California.
a few homes and neighborhoods.
Problems which come to Santa Clara County will,
"for the misplaced patient, the denial of needed
in all likelihood, visit other similar communities in the
specialized service is unjustifiable and retards or
state.
negates attempts at rehabilitation."
What will happen to psychiatric care facilities in
C-CAP researchers concluded that for the
Norwalk (Los Angeles County) if Metropolitan State
Department of Mental Hygiene to release acute
Hospital closes its doors and dumps its mentally ill
mental patients from Agnews State Hospital and
patients on the doorsteps of hospitals and boarding
attempt to locate them in board and care homes
homes in southern California?
-6-
what has happened to the patients?
Few persons would dispute the desirability and
Most counties in California have a "community
value of community-based mental health services.
mental health program," as called for under the LPS
But CSEA does challenge the wisdom of
Act, in name only.
dismantling the existing state hospital system.
An administrator in a county office oversees
We charge:
transfers of mental health patients and deals them out
Facilities, personnel and programs are
to psychiatric wings at county hospitals and to
inadequate in most counties.
private psychiatric care facilities, which charge the
The Department of Mental Hygiene has failed to
county (and the state) for this service.
plan adequately for the future use of state hospital
Others are found to be eligible for "Aid to the
facilities. State hospital programs and community
Totally Disabled" (ATD) with 50 percent federal
facilities are not mutually exclusive.
funding, and can be placed in board and care homes.
Modesto State Hospital was closed in 1970 and
As of September 1, 1971, more than 8,100
turned over to Stanislaus County to be used for
mentally ill patients have been placed on ATD by the
educational purposes.
community services division of the Department of
DeWitt State Hospital at Auburn will close its
Social Welfare.
doors finally late in May of this year, and Agnews
State Hospital hear San Jose will close its books on
the mentally ill before the end of 1972.
"
Stockton State Hospital already has closed one
they are worried
wing devoted to care of the mentally ill.
about the cost of keeping them
CSEA has learned that DMH plans to close
in the hospital."
Metropolitan State Hospital and Mendocino State
Hospital sometime between June 30, 1972, and June
30, 1973.
This information is contained in a memo signed by
This method of handling mental patients has
Dr. O. L. Gericke, medical director at Patton State
become so popular with the state administration that
Hospital, of which CSEA has obtained a copy.
next year the community services division will be
He concludes this memo, dated 11/16/71:
moved lock, stock and typewriters to the Department
"Other hospitals for the mentally ill, such as
of Mental Hygiene, adding $21 million a year to the
Patton and Stockton, have uncertain futures with the
DMH budget for 1972-73.
closing date being possible from 24 to 36 months
A Napa State Hospital surgeon blames excessive
from now."
reliance on ATD, in lieu of proper psychiatric-medical
Few new county facilities have been built for the
care, for the low percentage of success with patients
care of mentally ill since LPS went into effect.
under the present program.
-7-
"Less than 10 percent of all patients admitted to
to 6 patients and is located in a poor, deteriorated
state hospitals are returned to the cominunity as
section of town.
productive citizens," he stated.
Board and care homes are not psychiatric facilities.
"County mental health administrators order
Mental patients are commingled with senile patients.
patients released long before they are ready because
they are worried about the cost of keeping them in
Undoubtedly many such homes are operated by
the hospital. It is cheaper to put them on ATD and
kind and considerate owners who carefully see to the
place them in a home at the expense of welfare. The
needs of their tenants.
procedure is dictated by economics, not
But supervision of patients is minimal and the
psychiatric-medical judgment."
owner need have no training in the care of such
Most counties have out-patient psychiatric
persons.
facilities, but because of the voluntary nature of
mental health care under LPS, many released patients
The only license needed to operate a 6-bed board
never show up.
and care home in any county in California is a $10
State and county welfare workers share the
business license.
responsibility for placing patients released from state
Some counties don't even insist on that, and state
hospitals, but cannot force them to use their ADT
law makes no provision for licensing board and care
checks for any particular purpose.
homes of 6 beds or less.
In Los Angeles County, the mental health
subcommittee of the county's Comprehensive Health
Planning Association reported in November of 1970
Many of his former patients
in a paper on consumer protection:
end up in transient hotels
"Superficial examination of the present system
paying $12 to $15 a week
reveals conditions in our residential care facilities
for a single room.
which (1) undermine attempts to rehabilitate (mental
patients) allows far too many proprietors of
residential care facilities to exploit those in their care
in favor of profit making, and (3) allow most of these
Confused, disoriented and often sedated upon
facilities to operate without licensing and surveillance
their release, many of these patients go off on their
by proper authorities.
own and end up in transient hotels paying $12 to
$15 a week for a single room.
This information comes to CSEA from a
physician-surgeon at one of the state's hospitals, who
asked that his name not be used. He told CSEA
"those who benefit
investigators that many of his former patients have
are not the interested recipients
ended up in transient hotels where their money
but the proprietors
disappears.
of the residential care facilities."
They have no one to turn to and become police
problems, he said.
The sheriff of a northern California county told
CSEA investigators that since LPS, 2 of the transient
hotels in his town have become homes for many
"It should also be pointed out that while much of
ex-state hospital patients.
the financial support for residential care comes from
One day early in January 1972 a state hospital
the state, those who benefit are not the intended
security officer estimated to CSEA investigators that
recipients (the client) but the proprietors of the
50 percent of the occupants of one of the hotels were
residential care facilities."
former state mental patients living on ATD.
A Department of Social Welfare official estimated
Since 1966, more than 11,000 state mental
for CSEA that there are 32,000 mentally ill patients
patients age 65 and over have been admitted to
housed in unlicensed board and care facilities in
nursing homes.
California.
More than 16,000 younger patients have been
As of November 30, 1971, there were 108 licensed
placed in the several types of boarding homes whose
long-term facilities for treatment of the chronic
owners make a living by housing such patients.
mental patient scattered across the state. Their beds
A typical board and care home accommodates up
total 9,416.
-8-
What other private or public (non-state) facilities
made for her because she could not dress herself. A
are available to the mental patient discharged from a
good supply of these dresses was sent to her after her
state hospital?
release. The technicians found her in old clothing not
psychiatric hospitals for the acutely ill, licensed
belonging to her.
by DMH. As of July 1, 1971, there were 32 with
Another patient in another facility came up to the
2,594 beds.
technicians and cried, pleading to be taken back to
general hospitals, either private or public, with
Mendocino. "They never even talk to us here," she
wards for the acute mentally ill, licensed by the
said.
Department of Public Health. The latest available
At still another facility the technicians found a
figures date to December 30, 1970, which showed
former Mendocino patient who they recalled as a
there were 47, with 1,204 beds.
constant walker, up early each morning on her own.
county hospitals with wards for the mentally ill.
"She would take another patient by the hand and
As of January 1972, there were 31, with 1,239 beds.
walk her," one of the technicians recalled.
In 1972-73 the Department of Mental Hygiene is
But at the local care facility, they discovered her
expected to close state hospitals with 3,267 beds and
still in bed at 10:30 a.m. "She appeared to be sedated
discharge an estimated 1,900 doctors, nurses,
heavily. Her gown and bedding were soiled with-food,
technicians and therapists trained in the care of
possibly from breakfast. When we inquired as to why
psychiatric patients.
she was in bed, one of the staff implied that the aide
Two CSEA members, both psychiatric technicians
probably hadn't got around to getting her up yet.'
at Mendocino State Hospital, recently visited several
A fourth patient, who the technicians remembered
convalescent facilities to see how former patients
as ambulatory, was found tied in a chair with a black
were being cared for in the community setting.
eye and a discolored, swollen elbow, allegedly from a
They found one patient, a woman, tied in a chair
fall.
with a webb strap which was pulled tight and cutting
"She begged to come back with us," one of the
into her bust. The patient was blind, and while at
technicians reported. The patient died a short time
Mendocino had been provided with special clothing
after the visit, they told CSEA investigators.
deaths
Where have all the patients gone?
report is scheduled for release at the end of this
Some of them died, of course.
coming June.
Among transferred patients, the death rate appears
It shows an 18.2 percent mortality rate among
to be from 5-10 percent higher than among patients
patients transferred when Modesto State Hospital
who remained where they were.
closed 2 years ago. The death rate among Modesto
A study of the effect of transfers on the
patients averaged 10.5 percent in the 4 years
mortality rate of mental patients is being conducted
preceding closure of the hospital.
at the Langley-Porter Neuropsychiatric Institute in
Among a control group of 100 patients at
San Francisco.
Stockton State Hospital, the death rate was 5
Called the "Modesto Relocation Project," the
percent.
-9-
HOTEI
AFTER STOP
Avaura
RIGHT TURN
PERMITTED
ON RED
NO
Street scene near
one hotel assertedly
occupied by former
patients discharged
from state mental
hospital under the
Lanterman-Petris-
Short Act.
-10-
cost
State officials have claimed the closing of state
This means a net increase of $9.7 million in the
hospitals and shifting care to the local level is saving
cost of state-financed mental health care during fiscal
tax dollars.
1972-73.
In isolated areas of treatment this may be true.
Even these figures do not show the real growth in
However, in terms of total state expenditures,
the total program cost of maintaining mentally ill
savings of tax dollars has not materialized.
patients at the community level. Other significant
costs which are not easily identifiable and therefore
Between fiscal 1965-66 and 1970-71, expenditures
cannot be priced with a degree of accuracy include:
at 1971 dollar value for services to the mentally ill in
counties' share of local programs.
all programs increased by more than $28 million.
cost of services shifted from the Department of
Total expenditures for services to the mentally ill
Mental Hygiene to other departments (Social Welfare,
reached a high of $292,513,477 in the 1970-71 fiscal
Rehabilitation, and Public Health).
year.
Medicare and Medi-Cal contributions.
In the current fiscal year, the Department of
dentistry, physical therapy, and other
Mental Hygiene has budgeted $104.1 million to pay
professional services provided locally by charitable
its 90 percent share of the cost of community mental
organizations.
health programs.
Most county budgets for mental health have
Next year it proposes to spend $123.3 million for
increased under LPS. For example, in 1968-69, Los
community mental health care, an increase of $19.2
Angeles County's budget for treatment for the
million.
mentally ill was $16,245,786. In the 1969-70 fiscal
In the same time period, the department's budget
year, estimates were $22,925,790 and during the
for care of the mentally ill in state hospitals will
current fiscal year, county mental health officials
shrink from $107.1 million to $97.6 million, a drop
requested $36,864,304 and received $35,409,953 to
of $9.5 million.
finance their community mental health programs.
-11-
In Santa Clara County, the budget in fiscal
cases which find their way to county boards of
1969-70 for Health and Sanitation was $10,345,483
supervisors and other local authorities often contain
and during this fiscal year the budget increased to
evidence that local costs are excessive.
$13,065,646. Napa County's entire mental health
According to current figures in Sacramento
budget in 1965 was $80,000. Today the county has a
County, it costs $120 a day. for an average 8 to 10
budget of $1,100,000.
days to hospitalize a mentally ill patient-an increase
The above figures in themselves do not show the
of 70 percent over the February 1970 figures
staggering costs related to the community concepts of
released by the Department of Mental Hygiene.
treating the mentally ill. Various hidden factors are
Outpatient care in Sacramento County costs an
seldom identified as costs for treating the mentally ill.
average $36 an hour.
For example, the increased costs to local law
Although the county has no current waiting list,
enforcement, to our court system and especially the
they could still use more money. The county, because
increased cost of welfare as thousands of mentally ill
of lack of funds, is not able to do as much
patients are made eligible for Aid to the Totally
consultation as they would like to do.
Disabled with 50 percent federal funding.
The problem of multiplicity of services within
counties is a serious one. The County of Los Angeles
for instance operates 37 different facilities for the
diagnosis and treatment of mental illness, alcoholism,
"I cannot afford it
drug addiction, and emotional disturbances of
and I doubt that
childhood.
our taxpayers can."
In some treatment areas, costs are possible to
measure as evidenced by recent cost accounting
figures released by the Department of Mental
Hygiene.
However, in the important area of continuing
One citizen whose wife has been chronically ill for
psychiatric care, the comparison shows that it costs
over 12 years and has been hospitalized 6 times
more to contract out the psychiatric care of patients
writes:
than it does to treat them in state hospitals.
"Sacramento County facilities under the
In 1970 the average basic cost for continuing
Short-Doyle-Petris system do not provide the
psychiatric care in state mental hospitals was $34.35
clinical approach and are the most expensive I
a day. Varying widely, costs for similar care in county
have experienced. I cannot afford it, and I
facilities range from $39 a day at Monterey County
doubt that our taxpayers can, either. I had to
Hospital to $125.57 a day at Los Angeles
fight to get my wife released from Sacramento
County-USC Medical Center.
County facilities after she was there 10 days at
In between these 2 extremes are:
a cost of $1,448. My wife is now at Stockton
$70 a day at Sacramento County Medical Center
State Hospital."
$76 a day at San Francisco General Hospital
A new cost-reporting data collection system has
$47 a day at Kern County General Hospital
recently been approved and is expected to permit
$68 a day at Santa Barbara General Hospital
analysis and comparison of costs in local facilities
$62 a day at Orange County Medical Center
within a common frame of reference. Until such time
$68 a day at Stanford University Hospital
as reports become available, relative cost/effectiveness
While the total cost picture is admittedly sketchy,
analysis of programs will continue to be imcomplete.
-12-
mental illness and crime
CSEA charges that the number of mentally ill
department too stopped keeping data on mentally ill
persons wandering the streets of California has
suspects.
increased alarmingly.
Prior to 1969, Napa police handled an average of
Since Lanterman-Petris-Short went into effect,
10 suicide attempts a year by mental patients. In
some law enforcement agencies have experienced a
1970 the number soared to 51.
marked and abrupt increase in the number of
The Napa Police Department was in the habit of
incidents involving former mental patients.
keeping track of pedestrians "not in control of
themselves." Before 1969 the highest number of such
This flood of incidents has been so great that
incidents reported in any one year was 15, in 1966.
several police agencies have stopped keeping track of
In the last 6 months of 1969-right after LPS
the number of persons they pick up who are
went into effect, 27 such incidents were reported in
wandering around acting in a peculiar manner. These
include Los Angeles, Santa Clara, Napa and
the City of Napa. In 1970 the figure leaped to 74.
Mendocino counties.
In November of 1969, alarmed at the increase in
crime by the mentally ill, the Hon. Goscoe W. Farley,
The problem in Los Angeles County has become
president of the California Conference of Judges.
so acute that a special division of the sheriff's office
appointed an 11-member committee of judges to
has been formed to handle cases of mental illness.
study the effect of the Lanterman-Petris-Short Act.
Napa County Sheriff Earl Randol told CSEA
They reported back 2 months later. Among their
investigators that economic crime, such as
many findings:
shop-lifting, is his biggest problem with former
Commitments of the criminally insane to jail or
mental patients.
prison terms increased dramatically during the first
six months of the act. Compared to the same period a
Napa State Hospital, next to the City of Napa, has
year earlier (1968), the increases were 298 percent in
housed the mentally ill since 1875.
Los Angeles County, 66 percent in Alameda County.
60 percent in San Francisco County, and 50 percent
The Napa Police Department told CSEA
in San Diego County.
investigators they handled 12 cases involving mentally
"Under LPS since July 1, 1969 the mentally
ill patients in 1958, a typical year before LPS.
disordered defendant remains in jail without medical
In 1970 the number jumped to 328. Last year that
treatment and is criminally prosecuted.
-13-
"Because LPS does not involuntarily treat a
provide for involuntary treatment of mentally
mentally disordered person unless he is a danger to
disordered persons who do not fit into the
himself or others, or is gravely disabled, the individual
classification "dangerous to self or others, or gravely
often decompensates and finds himself in a criminal
disabled."
court.
prohibit release back to the community of
"Because he is not receiving medical treatment,
patients who are a "menance to the health and safety
he often further deteriorates to where he is unable to
of others."
stand trial."
So far, both the legislature and the Department of
"Many cases involve a mental disorder that is
Mental Hygiene have ignored the judges'
chronic, where the person is unable to provide food,
recommendations.
clothing or shelter. After a short-term hospitalization
and heavy medication, they go into a period of
remission (abatement of symptoms) as soon as the
person is out of the treatment facility and off
medication he goes into a period of exacerbation
"Defective and dangerous
where he cannot provide his food, clothing and
to the persons most directly
shelter."
involved."
"The urgency of the problem is clearly
demonstrated by the cases where the criminal
defendants are found to be legally sane and
competent to stand trial although they are found to
In 1968 Judge Albert H. Mundt of the Sacramento
be mentally disordered. The result is they are
Superior Court published a critical analysis of the
returned to the criminal court to remain in jail,
Lanterman-Petris-Short Act.
without treatment, for criminal prosecution."
In this document he said the statute is, in his
"Many individuals certified for 14-day intensive
opinion, "defective and dangerous not only to the
treatment (in state hospitals) do not fit the definition
persons most directly involved, the mentally ill and
of gravely disabled, nor do they fit the strict
the alcoholic, but to all of the people of the State of
requirements (for) 90-day.treatment.
California."
"Many individuals have to be discharged into the
He was particularly critical of a provision which
community while still in need of psychiatric
prevents detention of a suspected mentally ill person
treatment
until that person violates a court order.
As a consequence the judges' committee
"It (the new law) provides for a court-ordered
recommended extending the period of involuntary
evaluation of a person who is, as a result of mental
treatment to 30 days, instead of 14.
disorder, a danger to others, or to himself, or gravely
disabled, who has refused or failed to accept
evaluation voluntarily.
So far
"The order obtained after the filing of a petition is
the Department of Mental Hygiene
served on the person by a peace officer, a counselor
has ignored the
in mental health, or a court appointed official.
"The person, after the service of the notice, is
judges' recommendations.
permitted to remain in his home, or any other place
of his choosing, prior to the time of evaluation,
without the exercise of any control whatever.
Judge Harry Petris of the Los Angeles Superior
"It is only when he fails to appear for evaluation
Court was chairman of the judges' committee.
after having been so notified, that he may be taken
Interviewed in Los Angeles recently, he told
into custody and placed in the facility. for treatment
CSEA:
and evaluation for a period not to exceed 72 hours."
"Developments in the first 6 months under
The old law allowed the court to order detention
Lanterman-Petris-Short have become even more
pending evaluation, after finding the person
pronounced today."
dangerous to himself and others.
Two years ago that committee recommended that
Mundt (who is retired now) wrote:
the legislature:
"The mentally ill person is not always responsible
authorize municipal, superior and federal court
for.his conduct and may be very dangerous. The fact
judges to suspend criminal proceedings and obtain
that it is necessary to get an order for evaluation is in
involuntary medical treatment for mentally
and of itself indicative of stress and an emotional
disordered individuals.
condition, because of which he does not cooperate
-14-
"He often is aware that an evaluation might result
"Heavy sedation has been and still is being utilized
in his detention for a substantial period of time. A
to control their conduct.
notice to appear for such evaluation is very likely to
"It seems to me that those who have pressed so
throw that person into a state of panic, or anger, or
hard for this (law) somehow conceive that if you
other frenzied conduct that might result in serious
ignore these realities and say there is no mentally ill,
harm to him or to others.
that such sick people will disappear or the illness will
"It is ironic," Mundt notes, "that under (LPS) a
go away, when such, of course, is not the fact."
peace officer may arrest and detain an alleged
And sure enough, Judge Mundt was right.
mentally ill person while a Superior Court Judge is
"Such sick people" have not disappeared nor gone
required to wait until a person fails to appear for
away.
evaluation before he is permitted to order the
They have been released from state hospitals.
exercise of that power..
They are living in 6-bed board and care facilities,
Judge Mundt wrote it is "difficult to conceive why
in county hospitals, in long-term treatment homes
the legislature seized upon 14 days as the period
and in transient hotels.
during which all mentally ill people requiring care
They are in jail. The judges' report tells us that,
have recovered to the point where they no longer
and so do police department records.
need that care.
But how many are in state prisons CSEA has been
"Certainly we are...aware that the chronic
unable to learn because the LPS Act keeps secret all
mentally ill who require treatment over long periods,
state mental health records.
frequently lack the judgment, because of their illness,
The facts, however, suggest that there may be a
to understand and appreciate the fact that they do
correlation between the effect of LPS on mental
need treatment.
health care in California and the recent violence in
"We find these people resisting treatment. Many
California prisons.
of them are ill to the point where they need to be
At least it would be well for the state legislature to
closely confined, under constant surveillance.
investigate this possibility.
alan post said it in 1970
Legislative Analyst A. Alan Post, in his 1970
problems because the community lacks any effective
analysis' of the state spending program, stung
machinery to deal with them.
operation of the Lanterman-Petris-Short Act with a
"In Los Angeles and San Francisco chronically ill
series of criticisms:
persons are often without friends or relatives. These
persons often live in hotels where they frequently
"Another result of the fragmented mental health
'act-out.' Many hotel owners, in order to relieve
themselves of a problem, will ask the person acting
system is the lack of control and supervision of
out to move on rather than calling the police or
mentally ill individuals living in the community."
medical authorities.
0 "As a result these mentally ill individuals end up
"A number of chronically ill patients,
moving from hotel to hotel until they are eventually
particularly in metropolitan areas, are creating
jailed or hospitalized again."
-15-
"A series of visits undertaken by staff of this
"Eventually, many of these patients do not again
office to state hospitals, Short-Doyle clinics, local
become visible to mental health professionals until
welfare agencies, community services division offices
they deteriorate to the extent that their abnormal
and other concerned agencies throughout the state,
behavior is brought to the attention of such 'crisis'
indicate that the high rate of re-admissions to state
agencies as the police."
hospitals is the result of insufficient supervision and
"There are numerous unlicensed board and care
support of patients discharged from the hospitals."
homes located throughout California. Many of the
"It is clear that to return hospital patients to the
persons in these unlicensed homes are ex-mental
community without assuring the adequate provision
hospital patients or persons with severe emotional
of follow-up services constitutes a disservice to the
problems.
patient, a disservice to the residents of the
community into which the patient is placed and a
"In the past (the Community Services Division of
drain on the fiscal resources of both local and state
DMH) and county welfare staff could and did remove
agencies.
patients from homes with inadequate standards."
"Many of the patients released from the state
"Since July 1, 1969, mentally ill persons leaving
hospitals are not able to make contact with the
state hospitals are released without supervision
community agencies responsible for assuring the
because of the lack of authority, neither CSD nor
successful readjustment of former mental patients to
county social workers are able to remove patients as
community living
they did in the past."
-16-
csea recommends
CSEA investigators and researchers spent 4 months
coordination of fiscal, psychiatric, social,
and 700 man-hours compiling this report on the crisis
educational and recreational needs of the mentally
that faces publicly-financed care of the mentally ill in
ill.
California.
-development of a uniform treatment program
We have attempted to answer the question asked
to include establishment of minimum criteria for
at the beginning: "Where have all the patients gone?"
community-level mental health care programs,
In all too many cases they have ended up in
avoiding 58 fragmented programs administered by
prison, in transient hotels and in unlicensed board
58 counties, but taking into consideration the
and care homes.
need for flexibility and adaptability.
More will make the same hopeless trip unless the
-clarification of the functions and
administration and legislature act to stop the closure
responsibilities of the various agencies dealing with
of state mental hospitals and take another look at
the mentally ill to avoid leaving mentally ill
how we are caring for our mentally ill.
individuals living in the community without
Therefore, CSEA makes the following
supervision and control.
recommendations:
The Department of Mental Hygiene should hold
The legislature should order an evaluation of the
its plans to close Mendocino, Metropolitan, Patton
effectiveness of state-financed mental health care at
and Stockton State hospitals in abeyance until the
the community level to include an analysis of:
legislature completes its study and makes
-quality, availability, cost and social impact of
recommendations.
local programs as they have evolved under the
The legislature should pass emergency legislation
Short-Doyle and Lanterman-Petris-Short laws.
repealing AB 2648 of 1971, which orders counties to
-merit and feasibility of developing
use all existing county and private facilities before
cooperative programs between state mental
admitting patients to state hospitals.
hospitals and community facilities.
The state should assume full responsibility for
-development of a master plan for providing
the quality of publicly financed mental health care in
mental health services to insure overall
California.
-17-
Light slants through
stairway door in
transient hotel
frequented by mental
patients discharged
from state hospitals.
-18-
State of California
Department of Mental Hygiene
Memorandum
To
:
James M. Hall
Date
:
March 16, 1972
Secretary
File No.:
Human Relations Agency
From :
Office of the Director
Subject:
Plan for State Hospital Closures During Fiscal Year 1972-73
The Legislature has requested a timetable for the closing of state hospitals
during the 1972-73 budget year. The budget indicates that closure of two
hospitals may be required during the coming year. The latest report on
use of state facilities affirms this proposed estimate insofar as one hospital
is concerned. It is not possible to report a decision now on a second
hospital: geographical considerations, fluctuations in patient referrals, and
further inquiries to local program directors require more time before such
a decision is made.
Accordingly, the Department of Mental Hygiene plans to close Mendocino
State Hospital by September 1, 1972. Attachments indicate the rapidly
decreasing use of this hospital by community programs.
The number of patients in the state-operated hospitals for the mentally
disordered continues to decline. Shorter hospital stays and provision of
alternate methods of treatment in the community eliminate the need for many
referrals to state hospitals. County governments have indicated they can
provide service to their citizens. All of these factors contribute to the decline
in state hospital bed requirements.
Admissions to Mendocino State Hospital will not be necessary after May 1.
Patients at this hospital who can be more suitably treated or cared for in
community programs or facilities will be placed in the community. Local
program directors and relatives or guardians will be consulted.
Patients at Mendocino, who in the judgment of community mental health
directors continue to require state hospital treatment and care, will be placed
in a state hospitalhaving a program suitable to their needs.
James M. Hall
-2-
March 16, 1972
In general, programs at Mendocino State Hospital will be transferred intact
together with the current staff to support them to the degree such staff will
move to the hospitals that are listed in the attachments to this report and at
the times specified.
Treatment personnel and support persons not moving with programs will
exercise the normal civil service rights to transfer, demotion and/or layoff.
The Department's plan for transfers and training is an attachment.
The equipment in Mendocino will be redistributed in accordance with state
laws and current rules and regulations.
Property will be turned over to the Department of General Services for
disposition in accordance with law.
WD.
J. M. Stubblebine, M.D.
Director of Mental Hygiene
Attachments:
1. County Referrals to State Hospitals
2. Patient Movement Plan
3. Personnel Plan
4. Episode Costs - State Hospital and Community Programs
5. Fiscal Impact Statement
MENDOCINO STATE HOSPITAL USE BY COUNTY
1966-67
July 1971 - February 1972
Admissions
inpatient Days
Admissions inpatient Days
Colusa
19
2,477
0
244
Mendocino
363
57,313
480
26,172
Del Norte
19
3,212
4
1,196
Shasta
97
20,196
2
2,119
Humboldt
168
31,660
54
9,695
Siskiyou
22
5,184
21
3,138
San Francisco
1,306
173,291
103
29,020
Marin
277
15,280
24
7,700
Sonoma
515
60,007
51
11,317
Alameda
177
35,121
5
7,072
Lake
80
8,104
117
5,831
Tehama
30
3,625
10
808
Trinity
8
2,326
1
272
Glenn
18
3,306
0
0
Other Counties
336
157,788
388
64,806
Totals
3,435
578,890
1,260
169,370
NUMBER OF PATIENTS
MENDOCINO STATE HOSPITAL
Fiscal Year
Fiscal Year
Ending
Ending
June 30
June 30
1950
2,716
1961
2,261
1951
2,711
1962
2,302
1952
2,607
1963
2,264
1953
2,635
1964
2,061
1954
2,490
1965
1,815
1955
2,378
1966
1,715
1956
2,305
1967
1,590
1957
2,237
1968
1,538
1958
2,456
1969
1,308
1959
2,421
1970
1,115
1960
2,330
1971
821
March 1, 1972
560
June 30, 1972 (Est.)
150
Attachment 2: Patient Movement Plan (Mendocino)
Admissions from all counties will be closed by May 1, 1972.
Transfers
Probable
Number
Present
for
Date
Program
Population
Transfer
Transfer to
May 1
(Penal Code)
74
74
Napa
May 1
(Southern Counties)
55
55
Camarillo
May 15
Medical-Surgical
31
5-10
Napa
May 15
Special Projects
45
45
Stockton
(MR)
June 1
General Psychiatric
133
100-110
Stockton
June 15
Geropsychiatric
60
30-40
Stockton
June 15
Alcohol
40
5-10
Napa
July 1
Adolescent
83
20-40
Stockton
July 1
Drug
24
5-10
Napa
July 15
Acute Psychiatric
12
0
I
The hospital will be closed on September 1, 1972.
Rated Bed Capacity & Present Number of Patients
Napa
Rated Bed Capacity
2,105
Patients
1,738
Difference
367
Stockton
Rated Bed Capacity
1,055
Patients
782
Difference
273
Total No. of Patients to be Transferred to Stockton: 195 - 235
Total No. of Patients to be Transferred to Napa:
89 - 104
Attachment 3: Personnel Plan
The Department is able to offer positions to all ward level nursing
services personnel. If the employee is willing to transfer, he has 30 days
in which to move and all moving expenses will be paid; as well, a per diem
allowance for up to 30 days is permitted during relocation. In the case of
working couples, every effort is made to transfer spouses in class to the
same location and the dates of transfer are coordinated.
Where a position in his own class is not available, an employee under
certain circumstances may demote in lieu of layoff. Employees with over
ten years of satisfactory State service who are displaced in this fashion may
be granted a "red circle rate"; that is, they may retain their former salary
rates for specified periods depending upon number of years of service.
Where employees cannot be placed in an area of their choice and must
terminate their State service, they are placed on priority reemployment lists
which are good for five years.
Through DMH and State Personnel Board programs, employees are
placed in other departments, such as the Department of Corrections, where
their skills can best be used.
Various training programs for employees are sponsored by DMH in
anticipation of shrinking job opportunities in DMH: Training course to
prepare for community employment; training of Psychiatric Technicians to
become Registered Nurses; one and two year curriculums in work with the
mentally retarded and with mentally ill children; demonstration projects
where they can show transferability of skills to other settings.
State employees separated by layoff or inability to transfer to another
location upon hospital closure are now eligible for unemployment insurance.
Attachment 4: Episode Costs - State Hospital and Community Programs
MENDOCINO SERVICE AREA COUNTIES
INPATIENTS COST PER EPISODE *
1971
Total State
State Hospital
Total
Community
Hospital
Cost Per
Community
Cost Per
Episodes
Episode
Episodes
Episode
17
$3,989.29
38
Del Norte
$387.05
Humboldt
174
$ 176.39
590
$118.11
Siskiyou
93
$2,180.81
303
$361.96
Mendocino
943
$1,654.46
NO
LOCAL
INPATIENTS
Marin
851
$1,663.26
759
$252.33
Tehama
45
$2,500.36
174
$611.09
Sonoma
929
$2,328.66
1,718
$182.67
Alameda
5,695
$1,526.50
2,213
$934.31
Lake
193
$1,421.23
NO
LOCAL INPATIENTS
Trinity
12
$2,565.50
2
$310.50
*These are costs at which each hospital patient from each county is referred to
and not necessarily Mendocino. However, the comparisons are about the same
no matter which hospital is used.
ATTACHMENT 5: FISCAL IMPACT STATEMENT
Closure of Mendocino State Hospital by September 1, 1972 will result in
a savings of 275.3 positions and $1,860,000 in annual expenditures.
MENTAL
H46
HUMAN RELATIONS AGENCY
HRA #72-4
Sacramento, California
Contact: Alex Cunningham
IMMEDIATE RELEASE
(916) 445-0198
March 23, 1972
Dr. J. M. Stubblebine, Director of the state Department of
Mental Hygiene, today announced that Mendocino State Hospital will
be closed by September 1, 1972. He said the closure is the result
of the successful implementation of the Lanterman-Petris-Short Act.
"Never in the history of California have such successful med-
ical and social programs been available to Californians who are
mentally ill," Stubblebine said. "Because of the increased effect-
iveness of the treatment being provided by community mental health
programs, fewer Californians need to be cared for in state hospitals.
"Community mental health directors are referring fewer patients
to state hospitals. The operation of numerous state hospitals for
the mentally disordered is fast becoming unnecessary."
There are now 9,100 patients in the state hospitals for the
mentally ill (see attached chart). There were 10,876 at the start
of the fiscal year. In 1966, there were 26,567 patients. The
average length of stay in state hospitals has declined steadily
days
from 223/in 1960 to 75 today. The average stay for first admis-
sions is 14.7 days.
Mendocino State Hospital now has only 541 patients, down from
821 on July 1, 1971, the start of the fiscal year. The hospital
has the capacity to care for 900 patients and has handled in excess
of 2,700 prior to 1967 when Governor Reagan adopted new space
standards recommended by the American Psychiatric Association.
-2-
New admissions to the hospital will be halted May 1. Between
now and the final closure date, approximately 215 patients will be
transferred to Stockton state Hospital and about 100 to the Napa
state facility. Other patients will be able to return to their
homes or communities by the time Mendocino is closed.
Stubblebine said community mental health programs have been
especially successful since the Lanterman-Petris-Short Act was
approved in 1969. The legislation, introduced by Assembly Frank
Lanterman (R-La Canada) and Senators Nicholas Petris (D-Oakland)
and Alan short (D-stockton), requires that community mental health
programs be established, that counties be reimbursed by the state
for 90 percent of the costs of their community programs, and pro-
hibits commitment of a Californian unless he is a present danger to
himself or others.
Community programs will have more than $25 million in additional
money available from state, federal, and local funds, and fees and
insurance revenues during the 1972-73 fiscal year. Over $250 million
will be spent during the same period for the care and treatment of
patients who are mentally ill, compared with $151 million in 1966-67.
More than $170 million will go to community programs in the coming
fiscal year compared to $35 million in 1966-67. The remainder will
provide treatment for patients referred by the communities to state
hospitals.
Governor Reagan said he was extremely pleased with the success
the Department of Mental Hygiene has had in implementing the
Lanterman-Petris-Short Act.
-3-
"Dr. Stubblebine and his staff are to be congratulated for
the work they have done on behalf of the mentally ill," the Governor
said. "There is no question that California is the nation's leader
in providing care and treatment for its citizens stricken with
mental illness. The department's implementation of the LPS Act
is mainly responsible for this success."
James M. Hall, secretary of California's Human Relations
Agency, whose eight departments include the Department of Mental
Hygiene, said: "California's mental health record is outstanding.
The measurement is not in numbers or dollars, but rather in the
quality of care and treatment of patients. Our citizens have bene-
fitted by having mental health programs available that allow them
to remain close to home and lead near-normal lives.
"Dr. Stubblebine and the entire Department of Mental Hygiene
understand the needs of mentally disordered patients. They have
held the patients' interests paramount and have provided excellent
and positive care and treatment. My appreciation is shared with
the families and friends of patients who have their loved ones
home again."
With the closing of Mendocino, three hospitals for the men-
tally ill will have been closed this year--Dewitt, Agnews, and
Mendocino.
There are currently 607 employees at Mendocino. All ward
nursing personnel will be offered positions at other hospitals. (310)
Some non-ward treatment employees will have to transfer to other
state agencies. Openings exist in several state departments,
including the Department of Corrections.
310 Nursing (includes fanitors!) Dept. of F.
100 Non-nursing (but treatment) prob. pr
Support (Cooks, Gardiners) other Dept:
-4-
Mendocino was opened in 1893. For many years it was the
state's "security" hospital, where patients were referred from the
courts after trial on criminal charges or because they were too
mentally disordered to stand trial. The "security" unit was moved
to Atascadero in 1954. Mendocino has served North Coast and Bay
Area counties since that time as an open hospital.
All of the counties affected by the closing have in-patient
mental health programs, except Mendocino and Lake Counties. Funds
will be made available to the two counties to establish programs.
These counties also have the option to contract with other commun-
ity programs or refer patients to Napa State Hospital.
####
Attached is a chart showing the long term trends in State hospital
utilization.
LONG-TERM TRENDS IN STATE HOSPITAL UTILIZATION
Average Daily Population of Mentally Disordered
Population
1950-1972
40,000
Tranquilizing Drugs
,
ATD Funds for
35,000
Leave Placements
Short-Doyle Act
30,000
(50% state funding
of county programs)
Short-Doyle Act
(state reimbursement
25,000
increased to 75%)
20,000
15,000
Lanterman-Petris-Short Act
(90% state funding of
county programs)
10,000
5,000
0
1950
1955
1960
1965
1970
Fiscal Year Ending June 30
April 10, 1972
Department of Mental Hygiene
Office of Information
744 P Street, Room 724
Sacramento, California 95814
#34
Telephone: (916) 445-6921
MEMORANDUM FOR THE PRESS
,
In late February the Department of Mental Hygiene was apprised that
medical records of patients at Atascadero State Hospital may have been altered for
purposes at that time unknown.
An investigative committee was appointed immediately to determine if the
allegations were true. The committee has found many of the allegations to be true.
It is an unacceptable situation and will be remedied. A copy of the committee's
findings are attached. But with no recommendation as yet.
The Department is currently developing new programs, procedures and
considering personnel changes. These will be made public as quickly as possible,
but not before next Friday. At that time the investigating committee will be in
Sacramento to consider the program and procedure suggestions and to make
recommendations based on their findings. Because the meeting consistently will
be involved with personnel matters, it will be a closed meeting. However, the
recommendations will be made public as quickly as approved by the committee and
adopted by the Department.
The investigation into the problems at Atascadero were initiated by
Dr. J. M. Stubblebine, Director of the Department of Mental Hygiene, as promptly
as they were called to his attention.
The Attorney General is being informed this morning of the findings.
Atascadero patients (all males) are:
1. Persons referred by the courts who are too sick to stand trial.
These persons are referred back to the court upon certification of
competency.
MEMORANDUM FOR THE PRESS
-2-
April 10, 1972
2. Persons found not guilty of a crime because of insanity and sent to
Atascadero for treatment and observation. When treatment is completed,
these persons are referred back to the court for its disposition.
3. Persons convicted of a crime who are mentally disordered sex offenders
and who are hospitalized for treatment. When treatment is completed,
these persons are referred back to the court for its disposition.
4. A small group of patients who are too mentally disordered and
dangerous to patients and personnel at other open state hospital grounds.
There are about 2,400 mentally disordered offenders in hospitals for the
mentally ill, of which 1,300 are at Atascadero. About half of the 2,400 were
involved in sex offenses. The remainder are not dangerous and have been assigned
to other hospitals. The Department has found that the records of these patients have
not been tampered with.
The following statement is that of Dr. J. M. Stubblebine:
I have been concerned about the treatment for and opportunities offered
to the mentally disordered offender for a very long period of time. I am
concerned about those in prison, on the streets, or in hospitals. They are men,
women and youngsters.
Since I became Director of the Department last July, a considerable amount
of time and thought has gone into developing suggestions toward not only solving a
critical public problem but at the same time, aiding the offender to recover his
health and return to society as a productive citizen.
did not know of these tragic occurrences at Atascadero until recently.
I am not yet sure how grave and depriving they have been to any particular person.
The degree and consistency of the activity, as found by the special committee, is
abhorrent.
MEMORANDUM FOR THE PRESS
-3-
April 10, 1972
The Department has requested funds from the California Council on Criminal
Justice to establish an elite "blue ribbon" committee to investigate, take testimony,
weigh facts and make recommendations to overhaul the entire structure of the law
as it relates to the mentally disordered offender. I am hopeful of approval.
In the meantime, this Department will act quickly and effectively to make
sure that Atascadero procedures and programs are changed and monitored. These will
be in effect by May 1, or sooner. The altering of medical records has, of course,
ceased. Personnel changes as are necessary will be made, and I wish to make the
first announcement today.
I have offered the position of Clinical Director at Atascadero State
Hospital to Dr. Michael Serber who was with me today. He is going to consider
it and will let us know as quickly as possible.
Members of the committee are: John L. Moody, M.D., Northern California
Psychiatric Society; Norman Graff, M.D., California Medical Association; Dr. Abe
Linn, Napa State Hospital; Dr. Jerry Kayne, Patton State Hospital; Dr. Harold W.
Nolen, Agnews State Hospital.
####
April 7. 1972
Project #11
Review of Professional Practices at Atascadero State Hospital
1. Charge:
A. To determine the validity of a number of charges alleging that treatment
and administrative practices at Atascadero State Hospital failed to meet
professional, legal and ethical standards.
B. To recommend remedial action in any instance where the charges were found
to be valid. Specifically, the charges to be investigated alleged that
court decisions were given preference to medical standards in determining
treatment program, medical records were being altered, and medical care
was not being provided to all those patients whose physical conditions
warranted additional attention.
11. Recommendations: (to be developed)
111. Findings:
In looking into the charges, the task force findings fell into five major
areas including: Organization, Court Influence on Treatment Programs,
Medical Records, Medical Care and Additional Observations. Although the
examination of such items as medical records, statements of policy and
operating procedures, administrative directives, as well as interviews with
staff resulted in a number of specific findings pertaining to specific
cases, only the general conclusions are presented in this report.
A. Organization: Atascadero State Hospital has not implemented the program
organization used in the other state hospitals. The treatment program
is divided into five Sections which serve specific geographic catchment
areas. In addition to these five programs there is a Med/Surg. Section
which serves the entire hospital population and a Service Section which
-2-
which houses the coordinators of such services as Professional Education,
Research, Nursing, Psychology, etc. All of these Sections report
directly to the Associate Medical Director. With this organization
the formal chain of command from the top level down is designed as
follows:
1. Hospital Medical Director;
2. Associate Medical Director;
3. Section Chief (Staffing Psychiatrist);
4. Ward Physician or Program Coordinator.
The major problems that seem to exist at Atascadero in conjunction
with this organization are as follows:
1. Although the formal organization would indicate that all unit
personnel are responsible to report to the Ward Physician or
Program Coordinator, in reality, this organization is frequently
bypassed and staff report to the Section Chiefs or Service
Coordinators.
2. There is a lack of open two-way communication between the Section
Chiefs and the Ward Physicians or Program Coordinators.
3. The organization of all clinical personnel including both
physicians and members of other disciplines is unclear in terms
of lines of communication, lines of authority and individual
responsibilities.
4. Appropriate committees, although identified in the formal
organization, are ineffectively utilized. This was particularly
true of the Credentials Committee which failed to carry out its
assigned functions of:
a. Delineation of privileges to be extended to the members of the
active medical staff beyond those assignments made by the Section
Chiefs, Associate Medical Director and Medical Director.
-3-
b. Investigation of any breach of ethics that may be reported
involving members of the active staff.
C. Investigation of the credentials of newly appointed staff
members.
5. The Medical Records Librarian's position of a consultant-advisor
with limited knowledge of the mechanics of the hospital's daily
routine recording procedures inhibited her effectiveness in
carrying out the full range of quality control procedures included
in her responsibility.
B. Court influence upon treatment program design.
Atascadero State Hospital's diagnostic and treatment procedures may be
traced by a series of "staffings" which serve as decision points during
the patient's course in the hospital. When a patient first arrives at
the hospital he is examined by the Ward Physician and an evaluation
of his physical and mental status is completed within 72 hours after the
examination. At this time a tentative diagnosis is entered in the
patient's record. Within five weeks after admission the Ward Team
members jointly evaluate the patient and submit their findings through
the use of a multidisciplinary staffing form to the Section Chief.
The Section Chief then reviews the findings and, after a brief discussion
with the Ward Team and brief interview with the patient, confirms or
revises the tentative diagnosis and treatment plan. Periodically, the
Ward Team reviews the patient's progress through his treatment program.
Finally, when the Ward Team feels that the patient has gained maximum
benefit from his hospitalization the staffing process is repeated to
determine final disposition of the case.
In reviewing this decision making process the task force concluded that
the treatment program is heavily influenced by the judicial system.
This influence is noticeable to the point that court decisions are
-4-
given preference to medical standards in treatment program determination.
The key points leading to his conclusion are as follows:
1. The major determinants for treatment programs for each individual
patient are:
a. The type of commitment.
b. The crime or alleged crime of the patient.
C. The probable sentence the patient would have received if
convicted and sent to Corrections for a definite period
of time.
d. The patient's ability to respond to treatment as manifested
by his confession of guilt.
2. Arbitrary amounts of time in residence are required of patients
according to their type of commitment or offense rather than their
progress in the treatment program. Review of the "staffing
checklist" as well as statements made during the interviews
revealed that:
a. Minimum time limits were required for specific types of
commitments and offenses.
b. Minimum periods of time in residence without ataractic
medication were categorically required of some patients as a
condition for their return to court in spite of an acknowledgement
by some staff that this was inappropriate for many patients.
3. The primary treatment modality used at Atascadero is group therapy
on the basis that it seems to be the best means of forcing the
patient to acknowledge his guilt. Through peer pressure the patient
"learns to be a patient" and submits to the power of the therapist.
Individual therapy is minimized as a low-yield, uneconomical
treatment modality.
-5-
4. The attitude of the Senior Medical Staff (Section Chiefs) established
a dictatorial atmosphere which:
a. Emphasized physical and legal constraints over psychiatric care.
b. Emphasized the necessity of caution in releasing patients so that
the hospital and its staff would not receive adverse publicity due
to patient "failures" upon return to the community.
C. Appeared preoccupied with acting in the function of "judge and
jury" rather than providing appropriate psychiatric evaluation
and consultation.
d. Regarded court decisions which disagreed with hospital
recommendations as "losses" on a win-lose basis.
5. In the interest of avoiding criticism from the courts, both written
statements as well as unwritten policies emphasized the need for
consistency of clinical opinions. Because of this, conflict which
arises from disagreements between staff is generally repressed
rather than dealt with openly and creatively. Examples of this
repression appeared in:
a. Statements made in interviews that it was unwritten policy that
opinions entered on the multidisciplinary staffing forms must be
in agreement with each other and consistent with other notes in
the records.
b. Statements in the staffing checklist which emphasized the need
for consistent notes particularly in cases being returned to
court with negative recommendations.
C. Statements made in interviews that all disagreements were worked
out in team meetings prior to the entry of clinical opinions in
the medical records.
d. Record review which revealed a remarkable degree of uniformity in
the majority of cases.
-6-
C. Medical Records.
The process of making an entry into a medical record at Atascadero State
Hospital begins with the professional staff member's initial note either
being dictated on tape or written in long hand on a "C-Note" form. The
original note is sent to the Section Clerk for transeription while the
carbon is maintained on the ward (a carbon of the dictated note is returned
to the ward after initial transcription). The Section Clerk then files
the initial note in a temporary file until enough entries have been made
to complete a type-written page. Once the entries have been typed into
the medical record the original notes are destroyed and a carbon copy
of the page is sent to the ward to replace the several entries in the
ward chart. When the notes are entered in the medical record they are
submitted to the authors for their signature. At the desire of the
Section Chief, at any point in this process he may review the entries
in the medical record and take one of the following actions:
1. Approve the note;
2. Request the author to change the note;
3. Request the author to delete the note;
4. Delete the note without the author's consent;
5. Enter a counter note in the chart.
Upon his own initiation, the author of a note may also make changes in
his note at any point during this process. One exception to this practice
is the entries in the continuous nursing notes in the ward charts. In
consultation with the Medical Record Librarian, nursing service has
followed the practice of lining out any notes which are in error rather
than deleting the notes. In conjunction with the accusations regarding
the practice of changing notes the major findings are:
-7-
1. The medical records are altered by removal, omission or replacement
of staff notes containing clinical opinions.
a. This practice was particularly prevalent in Section E during a
recent period of several weeks when all notes were reviewed by
the Section Chief resulting in the elimination of "conflicting
or contradictory" entries. According to information received
in the interviews this same practice was commonly used in the
other Sections at the discretion of the Section Chiefs.
b. Changes made in the notes either by the authors or by the Section
Chiefs have been both editorial and substantive.
C. Both the Medical Record Librarian and the Chief Clerk disclaimed
knowledge of these practices resulting in alteration of the
records but, agreed that such practices would be inconsistent
with acceptable standards of medical records practice.
2. Entries by professional staff into the medical records are restricted
in order to conform to other opinions, particularly those of the
Section Chiefs.
a. Evidence obtained through interviews and review of the medical
records verified that entries made by the professional staff in
cited cases were restricted when they failed to conform to ward
team recommendations or Section Chief evaluations. This was
found primarily in Section E and was not always a uniform practice
throughout the other Sections.
b. Although there was evidence where divergent opinions were entered
in the medical records, it was noted that most of the records
revealed a considerable degree of uniformity of opinions and
recommendations.
d. Staff interviewed cited the team meetings as useful in settling
disagreements. While such meetings may account for positive
-8-
agreement resulting in uniformity of opinion they may also be
a subtle means of exerting pressure to eliminate all divergence
of opinion prior to making any notations in the charts.
D. Medical care.
Although it had been alleged that the hospital administration had
arbitrarily restricted or limited medical investigation, care and follow-up
of clinical somatic problems, there was no evidence to validate this charge.
1. There was no evidence of any deliberate or wanton denial of diagnostic
and therapeutic care of patients.
2. There was evidence in a small minority of cases of questionable
judgment in terms of appropriate treatment procedure.
3. There was evidence of lack of communication between one ward physician
and the Med/Surg. Section Chief which may have resulted in a lack
of appropriate referrals for additional diagnostic laboratory
procedures.
E. Additional observations.
1. The medical staff, particularly the Section Chiefs, exhibited
inadequacies and deficiencies in accepting and practicing newer
concepts in psychiatric care and administration. Specifically
they appeared:
a. Unable to communicate effectively with and provide appropriate
guidance to their subordinate staff;
b. Lacking the technical competence necessary to function in their
positions;
C. Lacking confidence in their own professional ability particularly
in relationship to testifying in court;
d. Unable to make creative use of conflict or divergence of opinion.
2. In some records reviewed it appeared that the hospital is not following
departmental policy regarding the use of seclusion and restraints.
-9-
There were instances of patients remaining in seclusion for periods
as long as 14 days with no 24-hour reviews recorded in the notes.
IV. Methodology
A. A Task Force was formed to investigate the charges which included
representatives from Psychiatric practice both within the Department of
Mental Hygiene as well as from relevant professional organizations.
B. The Task Force was provided with background information regarding the
charges and also oriented to Atascadero State Hospital's unique function
of serving the mentally ill offender. Included in the background
material were relevant statements of policy and procedures abstracted
from both the Department and the Hospital manuals, records, etc., as
well as relevant material from the various legal codes pertaining to
Atascadero.
C. A site visit was conducted by the Task Force which included:
1. Orientation to the hospital and its administrative practices by the
Medical Director and Hospital Administrator.
2. Interviews with staff including both those directly involved in the
charges as well as others randomly selected from the Hospital staff
roster.
3. Record review of cases including:
a. Specific cases cited by both the individuals making the charges
as well as other staff defending the hospital's position;
b. A sample of cases of patients who had filed writs of habeas corpus;
C. A random sample of discharges over the last six months;
d. A random sample of the current resident population.
D. The findings of the Task Force were summarized and distributed in draft
form to the Task Force members for review and comment.
E. A follow-up meeting will be scheduled to review the findings and draft
the recommendations.
mere
Mental Hygienc
NEWS RELEASE
12
Department of Mental Hygiene
Office of Information
744 P Street, Room 724
Sacramento, CA 95814
#42
Telephone: (916) 445-6921
A special commission of judges, a district attorney, and a business
executive have concluded that it "is imperative that there be greater liaison
between the medical profession and those engaged in the administration of
justice in order to attempt to resolve misunderstandings" related to treat-
ment of the mentally disordered offender.
The commission recommended that the "Department of Mental Hygiene
and the Judicial Council sponsor a joint committee to review the laws relating
to the confinement of the mentally ill who are charged with or convicted of
criminal acts and the administration of these laws so that the law and the
practices thereunder may reflect both the current state of learning concerning
psychiatric problems and modern concepts of due process of law. If
The commission was named by Dr. J. M. Stubblebine, Director of
the Department of Mental Hygiene, to review a department document of last
May in which it was reported that medical procedures at Atascadero State
Hospital were expedient in some cases or preferred by medical and legal
entities rather than always in the best interests of patients.
The reviewing group found that some practices were true insofar as
some procedures involving medical decisions by staff at Atascadero, but the
commission said there was no basis in the records they reviewed which
indicated judges requested the changes, as had been implied in the original
document.
The commission also recommended:
"Because of questions raised by the material developed in the
earlier investigation, there should be further review to determine the
extent to which there were any alterations or deletions from any
patient's record, and if so, whether it had any appreciable effect on
his detention or release.
NEWS RELEASE - #42
Page 2
"The Director of the Department of Mental Hygiene should
provide to those staff members responsible for reporting to and
appearing in court, through a qualified attorney, seminars and other
educational materials concerning the state laws and court procedures
governing the custody and release of those committed to the institution. H
In it's finding the commission found:
"On the basis of the evidence reviewed, this committee found no
specific case where a patient was detained or released because of an
alteration or deletion of a record.
"There was no evidence to justify the conclusion that there were
illegal or unethical practices among the general staff. In one section
of the hospital, it was admittedly the practice of the section chief to
remove from the patient record, or omit, or replace, notes made by
members of the staff. The section chief characterized those notes as
inappropriate, untruthful, contradictory, and conflicting. However,
the evidence does not support a finding that this practice occurred in any
other sections of the hospital.
"There is no evidence that any judge or public prosecutor requested
or suggested that any patient of Atascadero State Hospital ready for
release or return to court should be kept in confinement in violation of
his constitutional rights. There is no evidence that any judge or public
prosecutor requested or authorized or was aware of the alteration of
any medical record. There is no evidence of court interference with
the treatment program design. 11
The commission members reviewed the task force report, the transcript
of the interviews of Atascadero State Hospital personnel conducted by the task
force, and had available for review all written material, including patient
records, considered by the task force.
NEWS RELEASE - #42
Page 3
The commission said:
"The complaints giving rise to the original investigation and
the evidence produced in that investigation focus the spotlight on the
inherent difficulty of combining judicially administered restraint with
medically administered treatment. The evidence produced indicates
that those charged with the treatment of the mentally ill offender may
misunderstand the requirements of the legal system and feel improper
pressures because of that misunderstanding. It is equally probable
that those engaged in the administration of justice are inappropriately
seeking and demanding a certainty in diagnosis and prognosis which
the medical profession cannot supply. 11
The commission consists of:
Mr. Ed Bell on the corporate staff of Beckman Instruments,
Inc. and a member of the Board of Directors of the California
Association for Mental Health
Superior Court Judge Arthur L. Alarcon of Los Angeles
Justice Richard M. Sims, Jr., First District Court of
Appeal, San Francisco
Superior Court Judge Jay R. Ballantyne of Tulare County
Mr. Robert Tait, District Attorney of San Luis Obispo County
September 26, 1972
REPORT OF RECOMMENDATIONS AND CONCLUSIONS OF THE
ATASCADERO STATE HOSPITAL REVIEW COMMITTEE
Committee Members:
Mr. Ed Bell, Chairman
Judge Arthur L. Alarcon, Vice-Chairman
Justice Richard M. Sims, Jr.
Judge Jay R. Ballantyne
Mr. Robert Tait
The committee was formed at the request of J. M. Stubble-
bine, M.D., Director of the State Department of Mental Hygiene,
to review the findings set forth in a task force report concerning
Atascadero State Hospital, dated May 2, 1972. The purpose of
the review is to ascertain if the findings in that report are
supported by the evidence considered by the task force which made
the report and to make recommendations thereon. The task force
report is entitled "Project 11. Review of Professional Practices
at Atascadero State Hospital."
The committee members reviewed the task force report, the
transcript of the interviews of Atascadero State Hospital
personnel conducted by the task force, and had available for
review all written material, including patient records, considered
by the task force.
The committee met on June 29 and 30, 1972, in San Francisco.
The recommendations and conclusions of the Atascadero State
Hospital Review Committee are as follows:
Page 2
A. RECOMMENDATIONS
1. The complaints giving rise to the original investigation and
the evidence produced in that investigation focus the spot-
light on the inherent difficulty of combining judicially
administered restraint with medically administered treatment.
The evidence produced indicates that those charged with the
treatment of the mentally ill offender may misunderstand the
requirements of the legal system and feel improper pressures
because of that misunderstanding. It is equally probable
that those engaged in the administration of justice are
inappropriately seeking and demanding a certainty in diagnosis
and prognosis which the medical profession cannot supply.
It is imperative that there be greater liaison between the
medical profession and those engaged in the administration
of justice in order to attempt to resolve those misunder-
standings.
To this end, it is recommended that the Department of Mental
Hygiene and the Judicial Council sponsor a joint committee
to review the laws relating to the confinement of the mentally
ill who are charged with or convicted of criminal acts and
the administration of these laws so that the law and the
practices thereunder may reflect both the current state of
learning concerning psychiatric problems and modern concepts
of due process of law.
Page 3
2. Because of questions raised by the material developed in the
earlier investigation, there should be further review to
determine the extent to which there were any alterations or
deletions from any patient's record, and if so, whether it
had any appreciable effect on his detention or release.
3. There is a continuing, ongoing need for research projects.
In the future, such projects must be carefully delineated
and personnel selected who are able to work compatibly with
other hospital personnel.
4. The Director of the Department of Mental Hygiene should
provide to those staff members responsible for reporting to
and appearing in court, through a qualified attorney,
seminars and other educational materials concerning the
state laws and court procedures governing the custody and
release of those committed to the institution.
5. With reference to the findings D and E of the May 2, 1972
report, it was this committee's observation that they involved
methods of medical treatment and individual competence which
we were not qualified to evaluate.
B. GENERAL CONCLUSIONS
1. On the basis of the evidence reviewed, this committee found
no specific case where a patient was detained or released
because of an alteration or deletion of a record.
Page 4
2. There is no evidence that any judge or public prosecutor
requested or suggested that any patient of Atascadero State
Hospital ready for release or return to court should be
kept in confinement. There is no evidence that any judge
or public prosecutor influenced or authorized the alteration
of any medical record. There is no evidence of court inter-
ference with the treatment program design.
3. There was no evidence to justify the conclusion that there
were illegal or unethical practices among the general staff.
In one section of the hospital, it was admittedly the practice
of the section chief to remove from the patient record, or
omit, or replace, notes made by members of the staff. The
section chief characterized those notes as inappropriate,
untruthful, contradictory, and conflicting. However, the
evidence does not support a finding that this practice
occurred in any other sections of the hospital.
4. The generalities contained in the findings of the task
force report as a whole were not warranted or supported by
the limited scope of the investigation undertaken by the
task force making that report. It would be unfortunate if
these generalities may have reflected upon the staff members
and employees of Atascadero State Hospital whose ability
and loyalty have never been questioned. The task force
Page 5
which prepared the May 2 report acted quickly because of
complaints which indicated a disruptive situation that
appeared to threaten the functioning of at least one section
of the hospital. It appears that most of the complaints
came from one person who had a sincere disagreement with the
person to whom he was administratively responsible with
respect to the practices reviewed by the earlier task force.
C. CONCLUSIONS ON EVIDENCIARY SUPPORT ON
SPECIFIC FINDINGS MADE IN MAY 2 REPORT
FINDING A; Page 4
The report states:
"Atascadero State Hospital has not implemented
the program organization used in the other
hospitals."
This committee has been informed that Atascadero State
Hospital was at one time exempt from the program concept concep-
tualized in PRU Project #57, "A Study of Patient Treatment
Program Organization for State Hospitals." We are also advised
that in September, 1971, this exemption was withdrawn and the
Superintendent of the hospital was instructed to implement
that program.
The timing and the full responsibility for implemen-
tation for that program is not clear from the record and no
opinion is expressed as to what steps should have been taken by
Page 6
the time of the original review. The findings are correct in
that the recommended program was not implemented and they
correctly set forth the practice of geographical distribution
in effect at the time.
FINDING A, 1 and 2; Page 5
The report states:
"1. Although the formal organization would
indicate that all unit personnel are
responsible to report to the Ward Physician
or Program Coordinator, in reality, this
organization is frequently bypassed and
staff report to the Section Chiefs or
Service Coordinators.
"2. There is a lack of open two-way communica-,
tion between the Section Chiefs and the
Ward Physicians or Program Coordinators."
The record review shows evidence of lack of communi-
cation apparently engendered by the lack of chain of command
between the research project and the normal functioning of the
hospital. The conclusion that the staff frequently bypassed
the Ward Physician or Program Coordinator and that there was a
general lack of open two-way communication between Section
Chiefs and the Ward Physician or Program Coordinator is not
sustained by the limited record before us.
Page 7
FINDING A, 3: Page 5
The report states:
"3. The organization of all clinical personnel
including both physicians and members of
other disciplines is unclear in terms of
lines of communication, lines of authority
and individual responsibilities."
We find no support in the record for this finding.
FINDING A, 4a and 4b; Page 5
The report states:
"4. Appropriate committees, although identified
in the formal organization, have been in-
effectively utilized in some instances.
This was particularly true of the Credentials
Committee which failed to carry out a number
of its assigned functions, e.g.:
a. Investigation of any breach of ethics
that may be reported involving members
of the active staff.
b. Investigation of the credentials of
newly appointed staff members."
No written records were available to establish
whether or not the Credentials Committee met and carried out any
of its assigned functions. In the absence of any evidence
that any breach of ethics was reported to the Committee, it
cannot be assumed that it was derelict in failing to conduct
an investigation.
Page 8
It should be noted, in reference to Finding 4b, that
the by-laws of the medical staff of Atascadero State Hospital
provide:
"The Credentials Committee shall not be concerned
with appointment of physicians to the medical staff
since that is the function of the Associate
Medical Director, Medical Director, and State
Personnel Board."
(By-laws, Page 5, Paragraph 3, Section 2)
FINDING A, 5: Page 5
The report states:
"5. The Medical Records Librarian's position of
a consultant advisor with limited knowledge
of the mechanics of the hospital's daily
routine recording procedures inhibited her
effectiveness in carrying out the full
range of quality control procedures included
in her responsibility."
There is evidence to support the conclusion that
there was inadequate centralized supervision of the procedures
for recording medical records.
FINDING B; Pages 6 and 7
The report states:
"B. Court influence upon treatment program design.
Atascadero State Hospital's diagnostic and
treatment procedures may be traced by a
series of 'staffings' which serve as decision
points during the patient's course in the
hospital. When a patient first arrives at
Page 9
the hospital he is examined by the Ward
Physician and an evaluation of his physical
and mental status is completed within
72 hours after the examination. At this
time a tentative diagnosis is entered in
the patient's record. Within five weeks
after admission the Ward Team members
jointly evaluate the patient and submit
their findings through the use of a multi-
disciplinary staffing form to the Section
Chief. The Section Chief then reviews the
findings and, after a brief discussion with
the Ward Team and brief interview with the
patient, confirms or revises the tentative
diagnosis and treatment plan. Periodically,
the Ward Team reviews the patient's progress
through his treatment program. Finally,
when the Ward Team feels that the patient
has gained maximum benefit from his hospitali-
zation, the staffing process is repeated to
determine final disposition of the case."
For reasons set forth below, this Committee considers
the title of this finding "Court influence upon treatment
program design" unfortunately inappropriate. The report
correctly states the general procedure as set forth in the
first paragraph under this heading quoted above.
Finding B of the report continues as follows:
"In reviewing this decision-making process, the
Task Force concluded that the treatment program
is heavily influenced by the judicial system.
This influence is noticeable to the point that
court decisions are given preference to medical
standards in treatment program determination.
The key points leading to this conclusion are
as follows:
Page 10
"1. The major determinants for treatment
programs for each individual patient
are:
a. The type of commitment.
b. The crime or alleged crime of the
patient.
C. The probable sentence the patient
would have received if convicted
and sent to Corrections for a
definite period of time.
d. The patient's ability to respond
to treatment as manifested by his
confession of guilt."
Analysis of key points under this paragraph reflects
the following discrepancies:
There is no evidence of court interference with the
treatment program design. There is some evidence that in a few
instances medical decisions were improperly influenced by the
following factors:
a. To avoid embarrassment in court proceedings
because of possible staff disagreement on diagnosis or prognosis.
b.
To keep a patient in confinement in certain
cases for the minimum time the person would serve if sent to
prison to avoid further incarceration.
C. To justify a failure to recommend release from
confinement.
Page 11
d. To avoid criticism because of use of medication
to tranquilize a patient returned to court.
e. To prevent criticism if a person were released
and subsequently committed a violent crime.
There is no evidence that any prosecutor or judge
requested or suggested that any patient ready for release or
return to court should be kept in confinement, nor that any
prosecutor or judge influenced or authorized the alteration
of any medical record.
The record does not support that the "major deter-
minants for the treatment programs" are those set forth in
Finding B, 1, a, b, C, and d. It does show that the treatment
program has been influenced with reference to a, b, c, and d
and that d applies only to Mentally Disordered Sex Offenders.
FINDING B, 2; Page 7
The report states:
"2. Arbitrary amounts of time in residence are
required of patients according to their
type of commitment or offense, rather than
their progress in the treatment program.
Review of the "staffing checklist" as well
as statements made during the interviews
revealed that:
a. Minimum time limits were generally
required for specific types of commit-
ments and offenses.
Page 12
b. Minimum periods of time in residence
without ataractic medication were
categorically required of some patients
as a condition for their return to court
in spite of an acknowledgement by some
staff that this was inappropriate for
many patients."
The Atascadero "Staffing Checklist" suggests that
minimum time limits for specific types of commitments and
offenses should be considered. There is evidence to support
the finding that minimum periods of time in residence without
medication are required before return to court.
FINDING B, 3; Page 7
The report states:
"3. The primary treatment modality used at
Atascadero is group therapy. A major
reason for employing this treatment,
according to the Section Chiefs, is its
usefulness in forcing the patient to
acknowledge his guilt. This confession
is viewed by the Section Chiefs as a pre-
requisite to the patient's ability to
benefit from further therapy."
The record, including the Atascadero State Hospital
Staffing Checklist, which suggests this procedure, supports
the finding insofar as verbal persuasion may have been used.
However, there is insufficient evidence to indicate that this
modality was universally applied to all cases.
Page 13
FINDING B, 4 and B, 5; Pages 8 and 9
The report states:
"4. The attitude of the Senior Medical Staff
(Section Chiefs) established a dictatorial
atmosphere which:
a. Emphasized physical and legal constraints
over psychiatric care.
b. Emphasized the necessity of caution in
releasing patients so that the hospital
and its staff would not receive adverse
publicity due to patient "failures" upon
return to the community.
C. Appeared occupied with acting in the
function of "judge and jury" at the
expense of providing appropriate
psychiatric evaluation and consultation.
d. Regarded court decisions which disagreed
with hospital recommendations as "losses"
on a win/lose basis.
e. Emphasized potential dangerousness of the
patients beyond realistic appraisal.
"5. In the interest of avoiding criticism from the
courts, both written statements as well as
unwritten policies emphasized the need for
consistency of clinical opinions. Because of
this, conflict which arises from disagreements
between staff is generally repressed rather
than dealt with openly and creatively.
Examples of this repression appeared in:
a. Satements made in interviews that it was
unwritten policy that opinions entered on
the multidisciplinary staffing forms must
be in agreement with each other and con-
sistent with other notes in the records.
Page 14
b. Statements in the staffing checklist which
emphasized the need for consistent notes
particularly in cases being returned to
court with negative recommendations.
C. Statements made in interviews that all
disagreements were worked out in team
meetings prior to the entry of clinical
opinions in the medical records. While
such meetings may account for positive
agreement resulting in uniformity of
opinion, they may also be a subtle means
of exerting pressure to eliminate all
divergence of opinion prior to making any
notations in the charts.
d. Record review which revealed a remarkable
degree of uniformity in the majority of
cases."
The comments set forth above with respect to Find-
ings B, 1, B, 2, and B, 3, apply to Findings B, 4 and B, 5.
FINDING C; Pages 9 through 11
The report states:
"C. Medical Records.
The process of making an entry into a medical
record at Atascadero State Hospital begins
with the professional staff member's initial
note either being dictated on tape or written
in longhand on a "C-Note" form. The original
note is sent to the Section clerk for trans-
cription while the carbon is maintained on the
ward (a carbon of the dictated note is returned
to the ward after initial transcription). The
Section Clerk then files the initial note in a
temporary file until enough entries have been
Page 15
made to complete a typewritten page. Once
the entries have been typed into the medical
record, the original notes are destroyed, and
a carbon copy of the page is sent to the ward
to replace the several entries in the ward
chart. When the notes are entered in the
medical record they are submitted to the
authors for their signature. At the desire
of the Section Chief, at any point in this
process, he may review the entries in the
medical record and take one of the following
actions:
1. Approve the note;
2. Request the author to change the note;
3. Request the author to delete the note;
4. Delete the note without the author's
consent;
5. Enter a counter note in the chart.
Upon his own initiation, the author of a note
may also make changes in his note at any point
during this process. One exception to this
practice is the entries in the continuous
nursing notes in the ward charts. In consul-
tation with the Medical Record Librarian,
nursing service has followed the practice of
lining out any notes which are in error, rather
than deleting the notes. In conjunction with
the accusations regarding the practice of
changing notes, the major findings are:
1. The medical records are altered by
removal, omission, or replacement of
staff notes containing clinical opinions.
a. This practice was particularly
prevalent in Section E during a recent
period of several weeks when all notes
Page 16
were reviewed by the Section Chief,
resulting in the elimination of
"conflicting or contradictory" entires.
According to information received in
the interviews, this same practice was
used in the other Sections at the dis-
cretion of the Section Chiefs.
b. Changes made in the notes either by
the authors or by the Section Chiefs
have been both grammatical and sub-
stantive.
C. Both the Medical Record Librarian
and the Chief Clerk disclaimed knowl-
edge of these practices resulting in
alteration of the records, but agreed
that such practices would be inconsis-
tent with acceptable standards of
medical records practice.
2. Entries by professional staff into the
medical records are restricted in order to
conform to other opinions, particularly
those of the Section Chiefs.
a. Evidence obtained through interviews
and review of the medical records
verified that entries made by the
professional staff in cited cases
were restricted when they failed to
conform to ward team recommendations
or Section Chief evaluations. This
was found primarily in Section E and
was not always a uniform practice
throughout the other Sections.
b. Although there was evidence where
divergent opinions were entered in the
medical records, it was noted that most
of the records revealed a considerable
degree of uniformity of opinions and
recommendations.
Page 17
C. Staff interviewed cited the team
meetings as useful in settling
disagreements."
It was admittedly the practice in Section E to
remove, omit, or replace from the medical records some notes
made by the staff. The Section Chief acknowledged that he had
removed notes which he characterized as inappropriate, untruthful,
contradictory, and conflicting. The interviews recorded also
reflected that some other Section Chiefs have also deleted
notes from the medical records. Nevertheless, the record fails
to support a finding that there was a general removal, omission,
or replacement of staff notes, or that there was a general
restriction of entries in order to conform to other opinions.
As to the finding that the Medical Record Librarian
and Chief Clerk "agreed that such practices would be inconsistent
with acceptable standards of medical record practice," we were
unable to find any factual support in the record before us for
that opinion.
With reference to the factual allegations contained
in No. 2 a, b, and C, the record shows that some of the staff
cited team meetings as useful, while others felt restricted in
the free expression of their professional opinion.
Page 18
FINDINGS D and E, Pages 11, 12 and 13
The report states:
"D. Medical Care:
Although it had been alleged that the hospital
administration had arbitrarily restricted or
limited medical investigation, care, and
follow-up of clinical somatic problems, there
was no evidence to validate this charge.
1. There was no evidence of any deliberate
or wanton denial of diagnostic and thera-
peutic care of patients.
2. There was evidence in a small minority of
cases of differing judgment in terms of
appropriate treatment procedure.
3. There was evidence of lack of communica-
tion between one ward physician and the
Med/Surg. Section Chief which may have
resulted in a lack of appropriate
referrals for additional diagnostic
laboratory procedures.
The evidence appears to support the finding in D.
"E. Additional Observations:
1. The medical staff, particularly the Section
Chiefs, exhibited inadequacies and defi-
ciencies in accepting and practicing newer
concepts in psychiatric care and admini-
stration.
Specifically, they appeared:
a. Unable to communicate effectively
with and provide appropriate guidance
to their subordinate staff;
Page 19
b. Lacking the technical competence.
necessary to function in their
positions;
C. Lacking confidence in their own pro-
fessional ability, particularly in
relationship to testifying in court;
d. Unable to make creative use of conflict
or divergence of opinion.
2. In some records reviewed it appeared that
the hospital is not following departmental
policy regarding the use of seclusion and
restraints. There were instances of
patients remaining in seclusion for periods
as long as 14 days with no 24-hour reviews
recorded in the notes.
3. The major positive impact upon the treat-
ment program seemed to be provided by the
nursing staff."
We felt this was medical in nature and outside the
scope of our review.
With reference to E, it was this committee's obser-
vation that it involved medical treatment and individual
competence which we were not qualified to review.
*
STATE OF CALIFORNIA-HEALTH AND WELFARE AGENCY
RONALD REAGAN, Governor
DEPARTMENT OF MENTAL HYGIENE
744 P STREET
CC: EM, JEJ DL, MKD, ACS, RW,
SACRAMENTO 95814
HE, NH, EWT, EJG, RG, CEW, JM,
WE, TC, TJ, vo, KFH.
February 18, 1973
Dear Parents and Friends of the Retarded
I want you to know that I share your concern for the good care of the
retarded in our State facilities. In the past few days there has been
some confusing publicity about the role of the State hospitals. Please
be assured that the Health and Welfare Agency and the Department of
Mental Hygiene have no plans for mass transfers or sudden closures.
Present programs will continue while new goals and services are
being planned.
At a press conference this past Thursday, the Department of Mental
Hygiene presented a "plan for a plan" emphasizing the orderly and
gradual improvement of community-based programs. That statement
committed us to local agency involvement in the planning of coordi-
nated services over the next five years. All of this has been spelled
out in a recent submission to the Legislature and will be printed in
the next issues of the departmental newspapers that you will receive
shortly.
Many community and special interest groups will participate in this
planning during the next five years. For the retarded persons in the
state programs now, only planned changes with family involvement
will occur. This administration will continue to meet its financial
and legal caretaking responsibilities.
All of us in health administration genuinely hope that these facts will
reassure you and encourage you to work with us in giving the very
best continuing care to every needy retarded person.
Sincerely,
William mayer,MD.
William Mayer, M.D.
Director of Mental Hygiene
GOVERNOR'S REPLY TO A QUESTION CONCERNING THE CLOSING OF
HOSPITALS FOR THE MENTALLY AND PHYSICALLY RETARDED--
Young People's Television Program, February 27, 1973
QUESTION: When the state hospitals are closed what's going to happen to
all the patients?
ANSWER: Well, here again these are good ones (questions) and I'm glad
you're asking because we have some demonstrators here (in Sacramento)
right now (February 22). Most of the demonstrators'. presence is based
on a total misunderstanding of the facts. They've been fed some propaganda
and there's been wild rumors running around that we're going to kick all the
patients out of the hospitals. Not truel
Several years ago before I became Governor, a piece of legislation was
passed called the Lanterman/Petris/Short bill. This was based on a progressive,
modern approach to the treatment of the mentally ill. For generations past,
in our whole country, and right here in California, you had these giant
so-called state hospitals. Once upon a time they called them asylums. Then
everybody got self-conscious so they said, "Let's call them hospitals. " But,
they were warehouses.
You put the people in there because they were mentally ill and basically they
never came out. There was no cure, they simply were stored away for the
rest of their lives. The other day a story broke in Illinois of a woman who
had been in an Illinois state hospital for 40 years. She never had any mental
problem at all. She was physically crippled and when her mother died the
rest of her family didn't want to take care of her, so they put her in this
institution, Everybody in the institution knew that she was mentally sound
and it wasn't until just a short time ago that a legal aid group found out about
her case and took it to court. She is now living on a pension in an apartment,
happy to be out, with no bitterness about it, but she knew all the time that
she was mentally sound.
The approach under this bill in California is for the state to subsidize county
mental health care clinics and hospitals that are closer to the patient's home,
where it is easier for the family to visit the patient, rather than having to go
half way across the state to one of the big state hospitals, But even more, to
treat the patients as hospital patients and, if possible, with our new modern
drugs, tranquilizers, and SO forth to cure them and make them able to live
a normal life, and to be a hospital in fact as well as in name.
It (the law) had been passed, as I said, before I came here. But, it hadn't
been really fully implemented, There was some mental health care clinics
that weren't getting as full a subsidy as they should. The law called for 75
percent and they were getting, in most cases, 50 percent. We are now
subsidizing the development of these clinics at 90 percent.
But, no one is being shoved out of a hospital until the county itself says it's
ready to take care of him and has the facilities for this care. On this basis,
the patients go out and the hospitals are shrinking in population because of
this. But, no one is just simply being turned out because we want to close a
hospital.
Now when you get down to two hospitals and one's got 700 patients and is
built for 3, 000, and another one has three or four hundred (patients) and it's
built for 3, 000--well, pretty soon you close one of those two and you bring
these patients over to the nearest hospital. We've been doing this with the
mentally ill.
-2-
Now we're evolving a plan for the mentally retarded, and this is even more
important: To build smaller, more intimate, personalized institutions, near
the centers of population and near where the patients come from, to make it
easier for their parents to visit them--and this is very important in the
mentally retarded cases because they need love and affection.
They're retarded, but this simply means that they're like a little child. No
matter how old they get physically, their minds remain at an age that can be
from a one year old baby. And these are the most pitiful cases, when they
get to be an adult physically, to see someone who is mentally one year's old
who is as big as we are and yet who has to have the same care that you give
a baby that has to be changed and all this.
But, the more tragic cases are those who reach a level of, say a small child,
and they have the same desire for affection and relationship that any small
child has. So the whole program is aimed for the patient's sake: getting
them into these personalized smaller institutions closer to home and then
simply closing out the big hospitals because they're not needed.
In many instances, in the areas near the cities, before the state institution is
closed, we offer to local government the institution itself if they can use the
facilities for perhaps their own mental health care clinics. And in some
cases they do--they start by leasing part of it or taking it over from the
state.
But with this plan (mental health) right now, with all the concern that had been
drummed up for the parents of patients, particularly in the mentally retarded
area, it is tragic that some politicians try to further their own purposes and
their own partisan goals by causing this distress to the family and parents of
a child who is in one of these retarded homes.
In the first place, no mentally retarded patient will be moved from one
hospital to another without the parents' consent. The plan for change to this
more localized treatment will be done with planning, and in coordination
with the parents and the local communities, It has actually, so far, made
California probably the foremost state in the nation, if not in the world, with
regard to the care for the mentally ill. We have people coming here from all
over the nation and from all over the world to look at our system and our
program.
And it makes you a little bitter sometimes, to find this misinformation, this
assailing of this program, that is aimed at the best interests of the patient--to
hear it assailed as an economy measure. The truth is mental health comes
only second to education with regard to state priority. The amount of money
we're spending has gone up from less than one hundred million dollars (in 1967)
to almost three hundred million dollars I believe. But I know that there has
been a tremendous increase in spending for this program to make this
transition to this more progressive method of care,
(The above was taken from a direct quote of a question and answer period
that the Governor had with high school students.)
gd