The insanity of how we deal with mental health in Los Angeles County

The Twin Towers Penitentiary is located in Los Angeles on Wednesday, April 1, 2020. (AP Photo/Damian Dovarganes)

On May 16, the Los Angeles County Board of Supervisors voted to create a unit at the Twin Towers Penitentiary to treat inmates with serious mental illnesses. The new prison inpatient unit, also called the acute intervention module, will have beds for inmates who pose a danger to themselves or others.

According to the board-approved motion, introduced by supervisors Kathryn Barger and Janice Hahn, the number of inmates needing urgent and emergency mental health services is on the rise. On average, 40 or more inmates with acute mental illness are booked each day.

Forty or more. Daily. Remember that number.

These are the inmates whose mental illness is too severe to be treated in an outpatient setting, the supervisors explained in their motion. Other mentally ill inmates live in a prison housing unit and receive regular mental health care, but do not require around-the-clock care.

How many? According to the supervisors’ motion, approximately 6,800 inmates housed in county correctional facilities participate in prison mental health programs with varying levels of care and treatment.

This makes Twin Towers Correctional Facility in Los Angeles the largest de facto mental health institution in the United States.

This is scary.

California could build and staff large hospitals and residential mental health care facilities. Instead, it clings to the old-fashioned belief that institutions are always bad and that somehow it’s best to let seriously ill people fend for themselves in the community and fund services for those who wish to benefit.

We still have the institutions. Once a mentally ill individual harms someone else, that lost soul can be thrown into the criminal justice system and locked up in a cell.

Is it preferable to treat the mentally ill in a prison rather than in a large psychiatric hospital?

Some people think so. Apparently Governor Gavin Newsom is one of them, and politics may be the reason.

The closure of large psychiatric hospitals decades ago was a consequence of the 1965 Medicare and Medicaid Act signed by President Lyndon Johnson. The law denied federal reimbursement for care in mental institutions that had more than 16 beds. As a result, indigent adults up to age 64 who were on Medicaid could not be treated in large residential facilities, because if they were, the counties would not receive federal money for their care.

At the time, it was fashionable to believe that new prescription drugs for mental illness were so promising that no one would need to be institutionalized, and community clinics were the modern way.

It was clear for a long time that this model didn’t work for everyone. Where are the people today who would have received treatment in a large hospital in that earlier era? Many are in jails and jails, or on the street, or cycle grimly among themselves.

In November 2019, the Kaiser Family Foundation released a report titled State Options for Medicaid Coverage of Inpatient Behavioral Health Services. In the very first sentence, the report states: Since Medicaid’s inception, federal law has generally prohibited states from using Medicaid funds for services provided to non-aging adults in mental institutions (IMDs). He then goes on to explain that in recent years the federal government has provided new mechanisms for states to fund IMD services for non-elderly adults through Medicaid in certain situations.