California proposition 1E will divert funds from much-needed mental health services

From the C.W. Nevius column in the San Francisco Chronicle:

Rozelle Trizuto always takes her glasses off when she sees her daughter. She's resigned to the fact that Angela may punch her at any moment and doesn't want to keep replacing broken glasses.

Angela Trizuto is a diagnosed schizophrenic. She hears voices, thinks terrorists are spying on her and lashes out violently. She spent Thursday, her 25th birthday, in a San Francisco jail cell on suspicion of assaulting a person this week on Van Ness Avenue. On Friday, she was transferred to Marin to face an outstanding arrest warrant for separate assault and battery charges.

"Please help my daughter," her mother said Friday. "She is dangerous to herself and to others, obviously. At what point do people see that she's gravely disabled and needs to be in a locked unit?"

The problem is that California law makes that incredibly difficult. Laura's Law, under which patients can be required to take their medications, is so expensive and cumbersome that it is rarely used. And a conservatorship, in which a judge orders someone to be kept in a locked setting against their will, can be a legal nightmare.

Now, mental health advocates worry that a proposition included in May's special statewide election will further hinder efforts to help people like Angela Trizuto. Proposition 1E would redirect $460 million from mental health services to help balance the state budget. San Francisco has also cut its mental health services in light of the looming deficit here.

As local health services decline, the state must step up and deal with the tragedy of uncontrollable mental illness.

"It's a mess," said Paul Linde, who has been a psychiatrist at San Francisco General Hospital's Psych Emergency Services unit since 1992. "We all want to protect civil liberties, but because of the way the laws are structured, we have to say someone is a danger to others 'at this time.' They almost literally have to have a knife to someone's neck to be able to say they are dangerous."

Rozelle Trizuto never thought she'd be trying to get her daughter locked up. Angela was a college-bound student at Lowell High School and gifted artist. But in her junior year she began to show irrational behavior. When she punched her mother, knocking her down, the police were called.

That's when Trizuto first learned about the mental health merry-go-round. Angela has been confined and released, confined and released, over and over. Last week, after Angela was arrested, Rozelle cleaned out her daughter's Eddy Street hotel room. It was smeared with feces. How can someone like Angela qualify as able to care for herself?

But mental health providers say there is little they can do.

"What it comes down to," said Linde, whose book on his experiences at S.F. General, "Danger to Self," will be out in January, "is trying to convince the (patient) that there is a problem."

Good luck with that.

"She's mentally ill, not stupid," Trizuto said. "She's learned to sit calmly for the five minutes while the doctor is examining her. She says, 'I'm not sick. There's nothing wrong with me.' "

As long as the patient says that, there's not much anyone can do. After years of hearing about mental health "snake pits," where helpless mentally ill people were confined and brutally treated against their will, voter-approved laws to protect patient rights have made confined treatment nearly impossible.

"In a sense we are paying for the sins of our past," Linde said. "The irony is that the treatments available now are much easier on the person's system than the old days of lobotomies, Thorazine and electroshock treatment."

The only bright spot in San Francisco is that Department of Public Health Director Mitch Katz says there seems to be some movement toward easing the restriction on court-ordered conservatorships.

"One change I see is an increased openness of judges to accept evidence of repeated episodes ... as evidence of the need for conservatorship," Katz said.

Still, Linde counters that you have to consider the scope of the problem.

"I would say we get a case like this (Trizuto's) nearly once a day," Linde said. "Certainly four or five times a week."

And in most cases, Linde said, the scenario is the same: The patient is mentally ill, and an administrator asks if that person is a threat at that exact moment. Linde admits that he or she is not - not right that moment - and a potentially dangerous patient is discharged.

Think about that the next time you walk past someone on the street who is talking to imaginary people.