Policy

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Diverting Mentally Ill to Treatment, Not Jail

Officers Ned Bandoske (left) and Ernest Stevens are part of San Antonio's mental health squad — a six-person unit that answers the frequent emergency calls where mental illness may play a role. (Jenny Gold/KHN)

Officers Ned Bandoske (left) and Ernest Stevens are part of San Antonio’s mental health squad — a six-person unit that answers the frequent emergency calls where mental illness may play a role. (Jenny Gold/KHN)

This week, Julie Small has reported on this blog about court-ordered overhauls in caring for mentally ill inmates in California prisons. About one-fourth of California’s inmates — 37,000 people — have mild to severe mental illness.

As Small reported, U.S. District Judge Lawrence Karlton ordered the California Department of Corrections and Rehabilitation (CDCR) in April to draft new policies for use of force and has signed off on CDCR’s plans. Now the department is working on plans to comply with Karlton’s orders to change how it handles segregation for inmates with mental illness.

So, I was riveted by a report this morning from NPR and Kaiser Health News about a different approach — a coordinated, comprehensive approach — to a county-run mental health system. The story was set in Texas’ Bexar County, (pronouced “bear”) home to San Antonio and the Alamo, and the program is now a model for the nation. Continue reading

Judge Orders Overhaul in Segregation for California’s Mentally Ill Inmates

All Inmates are shackled whenever they leave their cells. (Julie Small/KQED)

All Inmates are shackled whenever they leave their cells. (Julie Small/KQED)

By Julie Small

Segregating prison inmates who repeatedly break the rules or turn violent against other inmates or guards is not new in California. For years the state has placed these inmates in special housing sections with multiple barriers between them and others.

Evidence that segregation ‘can and does cause serious psychological harm’ in inmates with serious mental illness.

But the practice of isolating inmates whose bad behavior may be part of a mental illness is under fire amid a rash of suicides and attempted suicides. The focus on this type of treatment comes against a backdrop of lawsuits brought by inmates against the state over the last two decades. Those lawsuits have exposed a correctional system poorly equipped to handle their extraordinary needs.

Now a federal judge says that kind of punishment poses too great a risk for inmates with serious mental illness who, he says, can and do worsen in segregation.  Continue reading

Fresno Considers Ending Health Services for the Undocumented

Fresno residents demonstrate their support for a county health program that covers care for undocumented immigrants (Courtesy: Fresno Building Healthy Communities)

Fresno residents demonstrate their support for a county health program that covers care for undocumented immigrants (Courtesy: Fresno Building Healthy Communities)

Update: Fresno County’s Board of Supervisors voted 4-1 to end the contract providing care to the poor and to undocumented immigrants. 

Original Post:

Brandon Hauk’s job is about to get a lot harder. The health of about 7,000 patients he helps at Clinica Sierra Vista in Fresno is in the hands of the county board of supervisors – they are set to vote Tuesday whether or not to shut down a program that covers specialty care for the undocumented.

Hauk doesn’t want to think about how he’s going to explain that to people when their primary care doctor says they need to see a cardiologist, pulmonologist, or endocrinologist.

“What do you say to somebody that has chronic illness and we can’t refer them out? Sorry?” says Hauk. “I mean, how can you tell someone that has abdominal bleeds, I’m sorry, but we can’t help you.”

Fresno’s Medically Indigent Services Program was set up decades ago to provide health coverage for the poor, and later, the undocumented. But now that the Affordable Care Act has gone into effect, the county says it doesn’t need the program anymore. Now tens of thousands of uninsured Fresnans have health coverage through Obamacare. More than that, the county says it can’t afford to keep the program going. Continue reading

The Assisted Living Reform Bills That Died

By Polly Stryker

Taking some fresh air in the courtyard at Westchester Villa, an assisted facility in Inglewood. (Rachael Myrow/KQED)

Taking some fresh air in the courtyard at Westchester Villa, an assisted facility in Inglewood. (Rachael Myrow/KQED)

Last Thursday, August 14, was the day that bills still in the state Senate Appropriations Committee sank or swam. The Senate Appropriations Committee is where bills costing $150,000 or more go for consideration. If bills make it out of this committee, then bills are still in play and could make it to the governor’s desk, albeit with potential amendments along the way. If not, they die.

Going into the home stretch of this legislative session, 16 bills were on the table that, altogether, constituted the first major overhaul of the assisted living industry in nearly 30 years.

Two have already made it to the governor’s desk. AB1523 mandates liability insurance for all assisted living facilities. Advocates say liability insurance is one of the best ways to improve conditions in the industry. Operators whose violations make buying insurance too expensive will be simply forced out of business. The industry group California Assisted Living Association supported AB1523. AB1572 mandates facility operators allow and support resident and family councils at assisted living facilities. CALA supported that one as well.

Most of the rest of the bills are still swimming. But what about the bills that died?

Continue reading

California Prisons Begin ‘Use-of-Force’ Reforms for Mentally Ill Inmates

A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)

A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)

By Julie Small

The number of inmates with mild to severe mental illness has grown to 37,000 in California, about a quarter of the prison population.

A series of lawsuits brought by inmates against the state over the last two decades has exposed a correctional system poorly equipped to handle their extraordinary needs.

Now California is trying to comply with a federal court order to change when and how correctional officers use pepper spray to force uncooperative inmates to leave their cells or follow orders.

Pepper spray may have contributed to three inmate deaths and an unknown number of injuries — unknown because the California Department of Corrections and Rehabilitations doesn’t consider the effects of pepper spray an injury. Continue reading

Report: California State Employees Get Relatively Generous Health Insurance

(Getty Images)

(Getty Images)

SACRAMENTO, Calif. (AP) — Health insurance plans offered to state employees in California and elsewhere are relatively generous, with government picking up a large share of deductibles and co-pays, according to a report released Tuesday.

The report by The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation was a first-of-its kind survey of state government health insurance plans nationwide. It found that state plans paid on average 92 percent of a typical enrollee’s health care costs, which is equivalent to the best offerings — “platinum” plans — that the public can purchase on one of the new health insurance exchanges.

In California, Pew found that figure was 95 percent and that 68 percent of plan members had no annual deductible.

Putting the report into a broader context that can make the data easily understood is difficult. Continue reading

State Reconsiders Letting Catholic Universities Limit Abortion Coverage

Santa Clara University's employee health insurance will stop covering 'elective' abortions next year unless state officials change their minds. (Michael Zimmer/Flickr)

Santa Clara University’s employee health insurance will stop covering ‘elective’ abortions next year unless state officials change their minds. (Michael Zimmer/Flickr)

By Grace Rubenstein and Mina Kim

State officials are reviewing whether they made the right call when they approved health plans that limit abortion coverage.

California law has strongly protected abortion rights for decades. But in recent years, the state’s Department of Managed Health Care — which oversees health insurance — has approved a handful of plans that exclude coverage for “elective” abortions. That is, abortions that aren’t necessary to protect the health of the mother.

Those insurance-plan approvals occurred quietly, with little public attention. Until last year, when officials at two Catholic universities, Santa Clara University and Loyola Marymount in Los Angeles, told faculty and staff that the schools would now only cover abortions that are “medically necessary” for the mother’s health. State officials had approved those insurance plans.

The decision surprised and angered hundreds of Santa Clara faculty members, who tried and failed earlier this year to get the school’s Board of Trustees to reverse the decision. And it also appeared to reverse decades of legal precedent in California. Now, officials from the Department of Managed Health Care say they’re going back and reviewing the policy.
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Are The Proposed Assisted Living Reforms in California Enough?

CAPTION COMING (Rachael Myrow/KQED)

A “crime book” maintained by the San Diego advocacy group Consumer Advocates for RCFE Reform. (RCFE is short for Residential Care Facility for the Elderly.) This book contains cases of what CARR calls “egregious neglect” at San Diego assisted living facilities. (Rachael Myrow/KQED)

Over the last 25 years, the number of assisted living facilities in California has nearly doubled. The homes are intended to care for relatively independent, healthy seniors, but that doesn’t describe a lot of the people living in them today.

“There’s been a seismic shift in the population they serve,” says Deborah Schoch of the California HealthCare Foundation Center for Health Reporting. Schoch says the system was set up to meet the needs of people who could use some extra help with the tasks of daily living –- and it does. But many of those people need a lot of help.

The system, she says, is caring for people “who are frail, who may have dementia, who may be wheelchair bound, who may not be able to turn on their own in bed.”

Continue reading

Crime in Assisted Living: What Happens After

Stacy Siriani's father suffered a serious injury while in an assisted living facility in San Diego. (Rachael Myrow/KQED)

Stacy Siriani’s father suffered a serious injury while in an assisted living facility in San Diego. (Rachael Myrow/KQED)

When families place a loved one in an assisted living facility, there’s an expectation that if something goes wrong, there will be consequences. Mistakes will be addressed. If crimes are committed, they will be prosecuted. Or at least investigated by law enforcement.

But that’s not always what happens.

Take the case of Stacey Siriani of San Diego County. Her experience with assisted living began four years ago when she got an awful phone call from Houston. Her father was involved in an auto accident that left him brain damaged.

“It was very tough,” she recalls. Siriani is an only child; her father is a widower. There was nowhere else to turn for support.

Continue reading