Imagine, if you will, three people. Any three people. Picture their hair, their clothes, the color of their eyes. You can even make up names for them. Take a moment to let them come to life in your mind. I wonder, what mental health challenges did you come up with for these individuals? Even if you didn’t think of this attribute yet, I’d suspect you are now. Chances are, you’re afflicting each of them with something different. Depression, PTSD, schizophrenia, it’s up to you. We’re still playing make-believe here. Naturally, the mind wanders to afflict our imaginary friends with any number of hardships – cancer, diabetes, heart disease.

Let’s say each of these individuals had a crisis with their medical condition and had to go to the hospital. It should be obvious that we wouldn’t provide the same treatment to each patient. Therefore, it would make logical sense to treat each patient experiencing a psychiatric crisis based on their particular condition(s) as well. Unfortunately, this is one of the most critical problems for mental-health patients under the current system.¹

Mental Health America, a leading non-profit mental-health advocacy group, states their official position on involuntary mental health treatment is that it should occur only as a last resort and should take into account the decisions of the patient regarding their care. They further go on to state, “effective protection of human rights and the best hope for recovery from mental illness comes from access to voluntary mental health treatment and services that are comprehensive, community-based, recovery-oriented and culturally and linguistically competent” (“Position Statement 22”). It’s clear that these mental-health experts agree that care should be patient-oriented. The fact they need to say this at all leads one to believe the current system is something other than the caring, positive environment they hope for.

Sadly, the California Welfare and Institutions Code 5150, the law under which individuals are able to be “detained” against their will under vague and subjective pretense by an under-qualified individual, is anything but comprehensive and recovery-oriented. This statute sets standards for a minimum quality of care that can be considered primitive-at-best. The law is written not for the benefit of the individual being imprisoned, but for the protection of law enforcement, medical personnel and government institutions. Because such a low standard of care is required, many facilities, especially those under government contract, provide only the minimum quality of care. This can potentially cause further trauma or deterioration of the patient’s condition.

Dr. Dinah Miller explores this idea in detail, noting both the quality of care provided to patients as well as the stigma attached to emergency psychiatric care. She notes that most emergency departments do not have trained personnel on-site at all times, if at all. At best, she says, “the most crucial and controversial decision in psychiatry often falls on the shoulders of an emergency physician” (Miller). To be clear, these individuals are trained in the broadest range of medicine, with most not having a specialization and having not gone through psychiatric training since med school, which could have been decades ago, back when homosexuality was in the DSM.

When discussing those emergency personnel – and this can extend to police and EMS employees as well – Dr. Miller pays special attention to the stigma attached to patients in need of emergency psychiatric care. She compares the typical mindset of emergency departments, which mirrors society as a whole, in thinking that forced care is a good thing, often taking a “better safe than sorry” approach. She compares this with a viewpoint that echoes the position of Mental Health America, stating, “If doctors start off with the assumption that forced care is potentially traumatizing in a way that leaves some patients with years of distress, then the threshold for committing patients to involuntary treatments is significantly altered” (Miller).

In California, statistics emphasize the use of the ‘shoot-first’ approach to mental health care. The per-capita instances of involuntary hospitalization are higher than any other state, ten times that of the national average. Since statistics don’t show a higher rate of mental health diagnoses in California, one could infer from this data that the state is applying involuntary ‘treatment’ at a significantly higher rate than other states (Lee and Cohen).

It’s not just the rate of hospitalization or standard of care that is a concern, although being denied access to food, exercise, sunlight and self-care products can potentially be traumatizing as well. What Dr. Miller and countless others are concerned with is the presumption that mental health patients are unable to make rational decisions regarding their care and are potentially violent. Medical and psychiatric care providers having this mindset while considering their own legal and malpractice liability often leads to decisions being made that are not in the best interest of the patient.

Roy Richard Grinker, a mental health anthropologist and fourth-generation psychiatric specialist, goes into extensive detail about the economic and cultural factors at play in his study on mental health stigma throughout history. He notes that throughout the medical field, human bodies are the medium that the industry capitalizes on. Because of this, he continues, bodies and their diagnosis must be broken down into mechanical and utilitarian terms. He states, “When bodies become sick in capitalism, they become vulnerable to technologies like pharmaceuticals and reimbursable diagnosis” (215). This creates and encourages a profits-over-people attitude throughout the entirety of medicine and psychiatry.

In order to break down the stigmas and provide care that is “comprehensive, community-based and recovery-oriented” it’s imperative that the system of involuntary hospitalization be reformed to be used as a last-resort, as many experts believe it should be. Rewriting the legislation and changing the entire process is a long road with many bumps along the way. To begin the journey, we need to explore an alternative form of in-patient treatment that is dynamic to the needs of each patient, creates a community-oriented support system and encourages enrichment and overall wellbeing.

Measure KCX proposes to invest two-million dollars initial investment and a 0.025% sales tax increase for five years into the development of this treatment formula in Kings County as a testing-ground for statewide deployment. Funds would create rural mental-health inpatient facilities managed by trained mental health professionals outside of the clinical/hospital environment. Local training would be provided to first responders to work in tandem with this facility and its personnel for save responses to mental health crises.

Opponents may argue that the current system “works”, but we can see through the statistics provided by Lee and Cohen the annual increase in mental health diagnoses and the pervasiveness of law-enforcement altercations in the media, that the contrary is, in fact, true. They may argue that a new system is too expensive or difficult to implement. As can be seen by the Prospectus and Budget, the cost would be minimal compared to any health facility – even when compared to the startup costs of a pizza restaurant! Not only that, but these facilities have a potential to generate income and provide valuable resources to the community and employment to otherwise marginalized individuals. The use of specialists trained for this type of program reduces the need for redundant staff or those who serve a singular function.^*

According to Kings County Behavioral Health, the average cost for MediCal patients at in-patient facilities is $1,341 per day with an average stay of 6.9 days. This would be approximately $9,252 per stay, per patient. The county reports 434 stays in the 2021 fiscal year, which comes to just over $4 million per year spent by the county for MediCal patients. This does not include acute stays at hospitals, like Adventist Health Center, which are exponentially more expensive. Only 25% of patients move from hospitals to inpatient care (eg. CBHC, Kaweah) which meants that 1,736 patients are admitted to the ER on 5150 holds in Kings County.^** This could mean untold millions saved in acute mental health care through hospitals with the addition of an acute mental health facility in the county. Not to mention the resources and healthcare workers that could be devoted to other patients. Law enforcement and EMS resources could also be used for otherwise more pressing emergencies because, in addition to trained facility personnel being able to respond, another overt purpose of this measure is reducing the fear and stigma attached to having a psychiatric emergency and creating a community where individuals and their families know how to get help and feel safe doing so. This would effectively cause the number of involuntary hospitalizations to plummet except in the cases of those who need acute medical care.

This grassroots effort is seeking signatures for inclusion on the 2024 county ballot. Donations can be made, but it we’d prefer if you told your friends and posted on social media. It’s not that expensive, so if it doesn’t pass, maybe we do it anyway. A vote of No means you like to have an extra $5 per year better than your cousin Rob who might finally go through with it if he has to deal with one more hospital stay. Why haven’t you called him lately, anyway?  While you’re at it, tell him to vote Yes on KCX.

Works Cited

Grinker, Roy Richard. Nobody’s Normal. Norton, 2021.

Lee, Gi and David Cohen. “Incidences of Involuntary Psychiatric Detentions in 25 U.S. States.” 3 Nov 2020, American Psychiatric Association, ps.psychiatryonline.org/doi/10.1176/appi.ps.201900477. Accessed 6 Mar 2022.

Miller, Dinah. “Is Involuntary Hold for Psychiatric Patients the Only Answer?”, 10 July 2017, American College of Emergency Physicians, www.acepnow.com/article/involuntary-hold-psychiatric-patients-answer. Accessed 6 Mar 2022.

“Position Statement 22: Involuntary Mental Health Treatment.” Mental Health America, https://www.mhanational.org/issues/position-statement-22-involuntary-mental-health-treatment. Accessed 4 Mar 2022.

State of California. Welfare and Institutions Code, Sections 5150-5155. leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=WIC&division=5.&title=&part=1.&chapter=2.&article=1

1. Note: most counties and hospitals in California refer to the system I will be addressing as “Behavioral Health” but I believe this comes with a stigma that implies psychiatric or neuro divergence is best suppressed with ‘appropriate’ social behavior, so I will be using the terms mental health or psychiatric health.