From my presentation to Covered California today, August 23, 2017.

SAMHSA: One in five in the US suffers from mental illness. One in 25 suffers from serious mental illness (SMI) such as schizophrenia (1.15%) and severe bipolar disorder (2.2%).  Of the 4% with SMI (11 million), 40-50% have anosognosia or lack of insight into their illness.

In no particular order:

  • Reclassify SMI as brain diseases or neurological illnesses so the affected can receive integrated psychiatric/primary care and coverage in the physical health system. Just like Parkinson's, Alzheimer's, and dementia.
  • Use Assisted Out Patient (AOT) treatment programs delivered with care and compassion. 
  • Cut county mental health programs that don’t directly serve the needs of the SMI. I.e. wasteful and ineffective stigma campaigns. Make bussing out of county illegal.
  • Rename the system “Mental Illness System.” Mental health and SMI are not the same thing.
  • Reconcile the Medical Model (meds and beds) and the Recovery Model (peer support and social services). Make evidence-based programs compulsory for each model.
  • End the Institutes of Mental Disease (IMD) Exclusion which limits beds.
  • Change Medicare’s 190 day lifetime cap on psychiatric hospitalization.
  • Amend outdated and confusing HIPAA laws that prevent families and caregivers from helping their loved ones. Allow caregiver evidence of “best interest.” Pass a Caregiver Rights Bill.
  • Require law enforcement to receive and investigate reports from family and community members. Require Crisis Intervention Training (CIT) as routine training.
  • Increase FACT (Forensic Assertive Community Treatment) teams to help ill persons remain in treatment during parole and probation.
  • Provide beds in facilities that offer long-term psychiatric care. California Hospital Association: 50 mental health beds are needed per 100,000 people.
  • Enforce the Mental Health Parity and Addiction Equity Act of 2008, including parity for the 4% on Medicaid. (The 4% don’t receive “essential benefits” under the CA WI Codes.)
  • Stop dumping the SMI into jails and ERs. Treatment and Advocacy Center 2014 study: Mentally ill inmates are ten times the number of patients in psychiatric hospitals. 
  • Eliminate the inhumane standard — “Must be a danger to self or others” before intervening.
  • Encourage family advocacy groups and consumer advocacy groups to work together.
  • Create supported housing, employment, and education.


 Photo credit: Michael Toy

Photo credit: Michael Toy