Our Mental Health Care System is Unconstitutional

The Oaklandside published a new story on the recently released report by the U.S. Department of Justice's Civil Rights Division on the mental health resources (or lack thereof) provided by Alameda County.

You can read the story here and the DOJ report here.

Of particular interest to my fellow neighbors would be the conditions and practices at John George Psychiatric Pavilion in San Leandro:

"An average of 1,111 people experiencing a mental health emergency enter John George Psychiatric Pavilion each month and remain there for up to 72 hours. The San Leandro hospital, which is operated by the county, provides care for people suffering nearly all of the acute psychiatric emergencies in the county. Nearly 240 people a month are admitted to inpatient services at the 80-bed public hospital, where they stay an average of 9 days. Some stay for months while they’re treated. Hundreds lasted for more than 30 days in a two-year period in 2017-2019. The hospital’s inpatient unit is used far more than other state and county psychiatric hospitals, according to the Department of Justice investigation. This intense utilization of the county’s emergency psychiatric hospital is due partly to the inadequacy of community-based mental health services that could treat people before they experience a crisis.

Investigators found that many people still occupying inpatient beds had been cleared for discharge but had nowhere to go. One year, 123 people stayed two weeks or more after they were cleared for discharge. There have long been reports of overcrowded conditions at John George, with patients cycling through as they are released without the means to live outside of the controlled setting. Many end up injuring themselves or others shortly after being released.

One unnamed woman mentioned in the DOJ investigation said she was taken to John George by police when she called to report domestic abuse. She spent two weeks there and said it was “the closest thing to Hell I’ve encountered.” When she was released, she had no treatment plan and received no medications, only a bus pass. 

People are released from John George and come back again and again, the investigation found. During a two-year period from 2017 to 2019, almost 1,600 people were admitted to John George four or more times, and 11% of people discharged from the inpatient unit were readmitted within two weeks. And the rate of readmission appears to be increasing. 

Hospital staff told federal investigators that people are often discharged directly into a state of homelessness and that this often leads them to lose connection with community providers and transition staff. A mental health services expert working for the DOJ team reviewed a sample of discharge treatment plans and found none of them were adequate. 

The Justice Department concluded that with appropriate community-based services, many patients could have avoided returning to the hospital. 

A class action lawsuit brought by Disability Rights California last year makes similar allegations against the county for the conditions at John George. According to the lawsuit, the county holds people longer than clinically appropriate, fails to develop individual treatment and discharge plans, and fails to coordinate with other county services, so people are released without the means to receive continued treatment of support and end up right back in the hospital."

This is bigger than just bad cops or bad wardens or bad doctors. As I keep saying, it's an entire system of interlocking rusted parts built over a rotten foundation. 

Mark my words, the Feds and the State are going to come down hard on some of the county's middle-management and maybe impose limited oversight, but all that will change are the players. The game of passing the buck along like a round of finger-pointing hot potato meets musical chairs will go on until we tackle this problem holistically.

I think if the county can't or won't take up this work, then San Leandro should step up to do it ourselves, rather than continuing to front the costs in dollars and lives for this gross incompetence to the point of criminal negligence.

Take note and take care.