When Randle Patrick McMurphy was locked up in an asylum in Ken Kensey’s One Flew Over the Cuckoo’s Nest, the 1962 novel directly exposed readers to the institutional horrors that had been going on for a long time in the United States. Led by Nurse Ratched, patients at the so-called hospital were neglected, abused and lobotomized with no concern or care for recovery or recuperation.
From deplorable living conditions to human right violations, the history of involuntary commitment and mass inpatient psychiatric hospitalization has been littered with ineffective care and abject despair for the people served for two hundred years. These systematic and pervasive issues led California to begin a process in the 1950s of deinstitutionalization, acknowledging the well-documented failure of this clinical approach.
Elected officials also took note and the bi-partisan Lanterman-Petris-Short (LPS) Act of 1967 served as the nail in the coffin. Primarily framed around the civil rights of individuals, the LPS Act sought to “end the inappropriate, indefinite, and involuntary commitment of persons with mental health disorders.” By setting out clear due process protections for all people suffering from mental health issues, the new law favored a treatment plan that didn’t deprive people of their constitutional rights, while also providing the right help needed to keep both the individual and the community safe and on the path to an improved quality of life.
Unfortunately, we never really followed through with the whole plan. Shutting down hospitals was supposed to be accompanied by increased outpatient care, supported independent living environments and a new mental health care system that focused on patient outcomes first. The massive federal funding cuts of the 1980s ensured that this dream could not be realized, and now people were without any kind of meaningful support. The people left behind in the wreckage of this policy failure have struggled and suffered on our streets for decades.
In recent years, we’ve seen locally that successful interventions like supportive housing with the right level of services can offer incredible benefit for the vast majority of these folks, with over 90% of the people served getting and staying housed for the long-term. But we need far more units to serve the needs of our community, and even then there will be some people outside who need even more help.
And because of this lack of supportive housing immediately available for people in need, we’re heading back into some potentially dangerous territory where we have tried and failed horribly so many times before. What we need is to figure out how to get the absolutely sickest people the help they need without depriving them of their rights or setting up massive systems that have already proven themselves to be fatally flawed.
Right now, Gov. Gavin Newsom’s newly-proposed Community Assistance, Recovery and Empowerment (CARE) Court is trying to thread that needle. On its face, the approach has some merit. Its aim is to “empower Californians in crisis to access housing, treatment, and care.” Trying to meet people where they are and get them the help they need makes sense and aligns with the work we’re already doing in Santa Clara County. If this new program means more funding to assist folks in accessing housing and treatment, it could help quite a bit and signal a new level of support — that’s been missing for some time– from the state. And a $14 billion multi-year investment to provide 55,000 new housing units and treatment slots and nearly $10 billion annually in community behavioral health services is something that everyone can agree that we need desperately.
But when you hear the word “court,” it’s awfully hard not to think of criminalization. And history has been pretty clear that we can’t arrest our way out of this issue. So as more details emerge on this new proposal, we’ll do well to pay close attention to make sure the focus remains the housing and support needed for the individual. Because if we go back to the other place of mass incarceration and institutionalization we can be sure that Nurse Ratched will be waiting quietly just around the corner.
San José Spotlight columnist Ray Bramson is the Chief Operating Officer at Destination: Home, a nonprofit that works to end homelessness in Silicon Valley. His columns appear every second Monday of the month. Contact Ray at [email protected] or follow @rbramson on Twitter.