State senator urges changes to mental health system

Last September, then-19-year-old Matthew Hoff walked into a Bank of America branch in Buena Park, Calif., and demanded a $1,000 from a teller through a threat-laden sticky note. His plan quickly unraveled. Apprehended by police soon after, Hoff is now looking at a prison term of at least 11 years, possibly more.

The incident marked but the latest bout of heartbreak for the Hoff family, who has watched Matthew struggle with severe mental illness his entire life. His mother, Jennifer Hoff, says her son has endured terrible fits of paranoia, hallucinations and crippling fears since he was a toddler. His treatment file is longer than most novels. Long before his troubles with the law came to a boil last year, Matthew had undergone intensive psychotherapy, attended special schools, and later, lived in locked institutions for years at a stretch in Texas and Montana. His parents did whatever they could while he was their charge. Once he was an adult, however, his parents found out they were no longer able to ensure their son got the care and meds he clearly needs.

“He’s my boy and he’s going to live in prison because he turned 18 in a nation that has no room for severe mental illness after the age of 18, or before it for that matter,” Hoff said, sharing her emotional story with the 2013 California Endowment Health Journalism Fellows this week.

Hoff’s harrowing story raises the question of whether the state of California and its counties are doing enough to provide mental health care for severely ill adults like Matthew. Despite the passage of Prop. 63 (the Mental Health Services Act), state Sen. Leland Yee (D-San Francisco) told fellows Wednesday that thanks to budget limitations, those suffering from mental health problems must be in full-blown crisis mode before they’re able to tap needed care.

“I think the problem right now in the state of California is that because of diminishing dollars … we have really gotten to a point where if you’re not going to act out rather bizarrely and in a violent way, it is extremely difficult for you to get a lot of help,” Yee said.

But by then it might be too late; the time for prevention passed. While some might say the responsibility for seeking out care should reside with the adult suffering the mental illness, those individuals aren’t always able or willing to seek help.

“There are individuals [who] have mental health issues but do not believe that they need treatment, [who believe] they can handle things on their own,” said Yee, who trained and worked as a child psychologist earlier in his career.

This raises a dilemma: Should society then be able to force mentally ill individuals to get treatment, or does that amount to a infringement on their civil liberties?

“On the one hand, we live in a free society,” Yee said. “No one ought to take away your freedom. No one ought to say you have to get treatment, even though you don’t think you need treatment.”

And yet in practice that has often meant that severely ill individuals such as Matthew are abandoned to a dangerous downward spiral of homelessness, drugs, jail and violence, while their parents or loved ones stand helplessly by.

“Clearly many of the parents of these individuals are saying, ‘We need to find a way to get them help’,” Yee said.

In California, Laura’s Law represents one path forward. The law, passed in 2002, allows the courts to legally order assisted outpatient treatment for those who have a history of serious mental illness as well as recent hospitalizations, arrests or other indications of violent behavior toward themselves or others. While then-Governor Gray Davis signed the bill into law over a decade ago, Nevada County is the only county in the state that has actually implemented it.

“I think one of the unwritten aspects of Laura’s Law is the politics of mental health,” Yee said. “There are ideological attitudes about what ought to be mental health treatment.”

In addition to fears over infringing on civil liberties, some county officials have cited concerns that implementing the law’s programs would siphon money away from already existing mental health programs.

Frustrated with California counties’ lack of action in implementing Laura’s Law, Yee announced last month he would introduce a bill in the state senate that attempts to streamline the implementation of the law while allowing counties to use existing mental health funds in doing so. As Laura’s Law is currently written, a county’s Board of Supervisors must vote in favor of launching the assisted outpatient program. Yee’s bill would allow such a program to launch without supervisor approval, which is currently a sticking point.

As Yee sees it, if political barriers are standing in the way of signed law being actually implemented, then he’ll seek new legislation aimed at removing those obstacles, with the hope that families like the Hoffs will be given the ability to intervene when their loved ones are spiraling dangerously out of control.

“You can’t have it both ways,” said Hoff. “You can’t be 100 percent against treatment for some people too sick to know it, and then blame me when my son blows your son away in a movie theater. I’m so sick and tired of families bearing everything.”