Brandon Nelson’s descent into California’s fractured mental health treatment system illustrates the dysfunction that has put thousands of mentally ill people on the streets, experts say.
It began decades ago, after California closed psychiatric hospitals to usher in more informal — and less expensive — community-based care, according to reports by the California Hospital Association.
The result was “a devastating drop in psychiatric inpatient services.”
Since 1995, as California’s population increased by more than 20 percent, the number of facilities with inpatient psychiatric beds available to the general public has fallen more than 20 percent. And the number of beds available in the remaining facilities has declined more than 30 percent.
Together, the drop in beds and jump in population mean psychiatric beds per capita has plummeted more than 42 percent since 1995.
“California’s system for serving the mental health population is in crisis,” the CHA said.
This contributes to a host of ills, from homelessness to the profusion of more diffuse, and often less well-staffed, community-based centers that are more difficult for the state to regulate and for consumers to navigate.
Nelson, 26, of Santa Monica was diagnosed with bipolar affective disorder earlier this year. He was discharged from Mission Hospital Laguna Beach’s psychiatric unit on March 7 and went to an unlicensed Sovereign Health “sober living home mental health facility,” which its owners said was a “step-down” facility appropriate for Nelson’s needs.
There, Nelson failed to get his medications on time, had another breakdown and was left unattended, according to police and coroner’s reports. He hanged himself on March 8.
Nelson’s death was a failure of a system lacking sufficient standards, oversight and regulation — and one that desperately needs to change, his parents said.
Statewide system broken up
“We have a very fragmented and disjointed delivery system,” said Sheree Lowe, the California Hospital Association’s vice president of behavioral health.
It’s a system that was decades in the making.
“In 1991, the state decided that behavioral health would better be delivered at the local level,” Lowe said. “They broke up the statewide system and gave pieces to counties to operate. Commercial health plans followed suit.”
Physical health care, and mental health care, cleaved into separate systems, she said.
Records are not kept electronically, so doctors and caseworkers can’t easily share patient information. Federal privacy protections make communication even more difficult. Well-qualified workers are in short supply, partly due to the stigma attached to mental illness.
“I often say to folks, ‘You can’t ever point your finger at one reason why this isn’t working,’ ” Lowe said. “It’s decades in the making, and will take a lot of time to fix.”
To that end, the CHA and the National Alliance on Mental Illness have joined forces to push policymakers to do just that. Their new Behavioral Health Action coalition aims to fundamentally change the status quo, and make behavioral health a top priority at the federal, state and local levels.
“We need to revisit the construction of the delivery system,” Lowe said. “That’s really what it’s all about. Do we have the right resources in the right locations so patients can get the right care at the right time with the right provider?”