Making a commitment to help the mentally ill

By C.W. Nevius

 

Last January, Dale Milfay's 32-year-old son, Andre, told her he wanted to talk about his feelings.

She immediately called the police.

Milfay, who says Andre is "manic, psychotic, paranoid and (often) homicidal," knew what would follow when he wanted to discuss feelings - an uncontrollable outburst.

"He threw me down on the floor in front of the fireplace and broke my glasses," Milfay says. "When my husband rushed downstairs, he karate-kicked him. Then he got in his car and left before the police arrived."

Clearly, Andre Milfay needs help. He's a danger to himself, to others, and his mother is genuinely afraid that he will kill her.

And there's nothing she can do about it.

"It is an issue of civil liberty," says Dr. Mitch Katz, director of the San Francisco Department of Public Health. "We (in this country) have decided that the benefit of the doubt belongs with the individual. The rules are very strict about locking someone up against their will."

This comes up because next Wednesday there will be a hearing before the budget and finance committee of the Board of Supervisors to discuss the cutting of some 20 acute care beds at San Francisco General Hospital. Those beds are used for severely mentally ill patients who are picked up by police and determined to need involuntary confinement.

There are two points of view on this. Katz, although extremely sympathetic to the families of what he says is an estimated "37,000 persons with a severe mental illness," says the cuts won't make much difference. Another facility, the highly regarded Progress Foundation, will open its doors next year. The hope is that the center, which specializes in acclimating mentally ill to everyday life, will make up the difference for the beds eliminated at S.F. General.

But Milfay, vice president of the local National Alliance on Mental Illness (NAMI), disagrees. So does Officer Kevin Martin, vice president of the Police Officers Association.

"I think it is a big deal," Martin says, "because any time someone is being turned away, their only refuge is on the street."

To be fair, the Progressive Foundation will have beds. However, it is voluntary, meaning that if the patient doesn't want to stay, he or she can leave. That's entirely different from the confinement at S.F. General, where patients are supposed to spend at least 72 hours under psychiatric care.

"My son cannot be voluntary," says Milfay, who says Andre has been hospitalized over 35 times. "He won't take his medications, he gets homicidal. Where does someone like my kid go? To be honest, he got better treatment in jail."

While the issue of the beds at S.F. General is important, there is a much larger issue. Across the country, and particularly in California, we need to take an honest look at the consequences of letting mentally ill people decide whether they want to accept treatment. Remember, in these cases their own parents are begging to have them confined to a safe, secure facility where they will have to take their medication and hopefully begin to find themselves. Leaving the choice up to them, as a consequence of patient rights movement, is a recipe for failure.

"Think about it," says Katz. "This is the only illness where the illness causes you not to take the treatment. It is the nature of the illness to say, 'There is nothing wrong with me.' "

So, under the current system, Milfay and her good friend Pamela Fischer, who is president of San Francisco's NAMI chapter, must spend their lives dreading the next phone call as their children careen out of control. Fischer's son, once a top student at the rigorous Phillips Academy in Andover, Mass., has lived on the streets in the Tenderloin, is addicted to crack cocaine, and cannot function in everyday life.

"It's taken over our lives," says Fischer, who says NAMI's San Francisco chapter has over 100 members, almost all of whom have family members with several mental issues. "It's just ghastly."

The sad and upsetting part of this story is that everyone agrees that this is a terrible problem - one that not only puts families at risk, but the rest of us as well.

Officer Martin, who walks a beat in downtown San Francisco, estimates that "six to seven out of 10 of our contacts have mental health issues." The police have limited recourse, even in the most extreme cases. One thing they can do is file a 5150 under the California welfare and institution penal code, which is a "72-hour psychiatric hold." But Martin says even that confinement is often "a pipe dream."

"There's been times when I've 5150'd somebody," he says, "and they'd be walking out when I was getting back into my patrol car."

The only certainty is that no one seems able to agree on what should be done. Suggestions range from community centers like Progressive Foundation to "tough love" facilities where patients have to toe the line or lose their bed.

"They've taken the idea of tough love and hitting bottom and placed it on mental illness," Milfay says. "My son has no bottom. The bottom is death."

There is one proposal that seems to make sense, but good luck getting support for it. Katz says "Laura's Law allows forced outpatient treatment if someone has a repeated history of going off their meds."

The state law passed, but it was such a political hot button that counties were left on their own to come up with money to carry it out.

So far, only one, Los Angeles, has funded Laura's Law. Milfay and her fellow NAMI members are strong supporters of statewide funding legislation, even if they think it might take something dramatic to get the public's attention.

"If my son kills me," she says. "I hope that law is passed."

CW Nevius is a columnist for the San Francisco Chronicle.