California mental health care: State prisons, police fall short

Though Gov. Gavin Newsom signed a handful of laws earlier this month to address the state’s mental health crisis — including a measure to loosen rules about who is eligible for involuntary treatment and another that gives voters the opportunity to decide on a multi-billion dollar bond measure to add thousands of treatment beds statewide — it’ll take several months, or even years, to truly know the effect of these initiatives. 

Until then, inadequacies of California’s mental and behavioral health systems continue to manifest — at times resulting in violent outcomes for bystanders but mostly for those who seek or need treatment themselves. 

For example, California will face more than $50 million in fines for providing inadequate mental health care in its state prisons and failing a court-ordered mandate to fill mental health staffing vacancies, reports The Sacramento Bee.

The fines are part of a federal lawsuit stretching back from 1995 involving prisoners with serious mental disorders, their high suicide rates and the state’s lack of proper treatment — a violation of the U.S. constitition’s ban on cruel and unusual punishments.

Though the California Department of Corrections and Rehabilitation submitted plans in 2009 to improve its mental health care system, plaintiffs argue that it has been unsuccessful at implementing appropriate suicide prevention measures, including maintaining a job vacancy rate for psychiatrists and other health care staff at 10% or below. More than one-third of state prisoners have serious mental health disorders, according to court documents.

The department does not comment on ongoing litigation, but a department spokesperson, Terri Hardy, pointed out in an email statement that state prisons have made some improvements, despite the fact that they are located in rural communities, which are “historically difficult to staff.” In August, the union representing state prison doctors — which are some of the best-paid public employees — threatened to strike over staffing shortages before reaching a new labor agreement a month later.

• Hardy: “We have taken many steps to improve mental health care and improve the recruitment and retention of mental health staff…. These include expanding the use of telepsychiatry, beginning implementation of telepsychology and telesocial work, and expanding the use of registry staff to alleviate staffing vacancies.”

Outside prison walls, deficiencies in the state’s mental health services were also raised by local leaders in defense of San Jose police officers’ use of force against mentally impaired people. In response to a Bay Area News Group investigation that found that the majority of people involved in use-of-force cases with San Jose officers were mentally impaired, the city’s mayor argued that “police officers should not be forced to play the role of trained clinicians.”

• Mayor Matt Mahan, to Bay Area News Group: “While we strive to continuously improve our training programs, especially related to an issue as complex as mental illness, I want to make clear that the failure of California’s mental health system has put our officers in an untenable position.”

San Jose Police Chief Anthony Mata also penned an op-ed, contending that the department has made “progress” in its de-escalation tactics, despite “bold promises for alternative response models involving mental health workers” never materializing, which leaves officers to become “social workers of last resort.”

In a handful of ways, California and Hong Kong’s goals to address climate change are similar to one another: California has ambitions to reach carbon neutrality by 2045 and earlier this month, Gov. Newsom signed first-in-the-nation legislation to require large companies to disclose their greenhouse gases. 

Likewise, Hong Kong wants to achieve carbon neutrality by 2050 and in April released preliminary plans to mandate companies in its stock exchange to disclose their carbon emissions.

These parallels surfaced during the governor’s visit to Hong Kong Monday, as he kicked off his week-long trip to China focused on climate change (after making a brief stop in Israel). 

The governor spoke with Gong Peng, the University of Hong Kong’s vice president and pro vice chancellor, touching on the role academic institutions play in helping to solve pressing climate issues. Newsom also told audience members — which included faculty members, students and business leaders — that they “can rely on California,” when it comes to being allies in climate change, reports AP News.

• Newsom, in a statement: “This is a global crisis and it requires a global response. The long-standing partnership — and competition — between California and China has led to measurable progress…. This visit is an opportunity to share our successes, learn from one another and continue driving an ambitious climate agenda.”

The governor also met with the U.S. Consul General Gregory and Li Yongsheng, the deputy commissioner of the Chinese foreign ministry in Hong Kong.

This year severe flooding, a tropical storm and wildfires have all hit California. In addition to raising Newsom’s international profile, the trip has the potential to cement “his evolution into a full-blown climate champion,” writes Politico, though advocacy groups, including UC Davis’ Hong Kong Political Affairs & Social Services Society and Bay Area Friends of Tibet, have decried Newsom on this trip for not prioritizing human rights issues in China.

Next stop: The governor is expected to visit Guangdong province and learn about its transition to electric vehicles and electric public transit fleets. He’s also anticipated to sign a memorandum of understanding to establish a climate partnership between California and the region.

From CalMatters’ reporter Jeanne Kuang:

Unhoused residents of San Francisco are 16 times more likely to die in what doctors call “sudden deaths” than their housed counterparts, a newly published medical study says.

The findings by UC San Francisco medical researchers add to an already grim collection of statistics on the mortality rates of California’s homeless population. 

Homeless people have a mortality rate nine times that of the general population according to the paper, published Monday in the Journal of the American Medical Association. 

The paper focused on the autopsies in 868 out-of-hospital deaths that occurred over eight years in San Francisco that were categorized as “sudden deaths,” with cardiac arrest suspected. Of those, 17% who died were unhoused. 

The homeless residents who died were on average younger and more likely to be male than the housed residents. They were also more likely to have actually died of non-cardiac causes like drug overdoses or infection. But even among those whose hearts stopped suddenly, researchers found the unhoused deaths were seven times more likely to have been preventable with a defibrillator, and suggested increasing availability of the devices. 

Deaths among homeless people have increasingly alarmed public health officials and state lawmakers. Unsheltered homelessness rose this year in a number of large counties, including Los Angeles. 

A new law going into effect Jan. 1 will allow counties to form homeless death review committees to more closely study causes and trends. 

Some counties already have such review teams. The Orange County Sheriff’s Department’s homeless deaths review committee published its first report this year, finding that deaths among the county’s unhoused population increased nearly fourfold in less than a decade, from 103 in 2012 to 395 in 2021.

From CalMatters economic reporter Levi Sumagaysay:

California’s latest jobs numbers have Great Recession vibes. 

Businesses added only 9,000 jobs in the state in September, and the state’s unemployment rate inched up from 4.6% the previous month to 4.7%, compared with the U.S. rate of 3.8%. In addition, the number of jobs added in the state in August was revised down by 20,000 to just 3,000 jobs. 

The state’s Legislative Analyst’s Office said that means California has had “sluggish” monthly job gains — of less than 10,000 jobs — four months in a row. The last time that happened was June to September 2010, “when the state was still in the midst of the Great Recession,” said Chas Alamo, principal fiscal and policy analyst for the office. He also said the state saw the same pattern in August to November 2007 right before the Great Recession took hold. 

​​The number of unemployed workers in the state has climbed by nearly 200,000 since last summer, and Alamo said it’s possible — but “not very likely” — that recently reported job gains could also be revised downward and result in a net loss of jobs for the year.