News
Government
Feb. 15, 2002
Mental Health Reform Leader Leaves Legacy
LOS ANGELES - When state Assemblywoman Helen Thomson, D-Davis, was elected in 1996, the Legislature had no plan for mental health reform. Six years later, her term is coming to an end, and the state Assembly and Senate are considering 36 separate mental health bills.
Six years later, her term is coming to an end, and the state Assembly and Senate are considering 36 separate mental health bills.
Thomson, a former psychiatric nurse and the chair of the Assembly Committee on Health, is the author of six of them and has been hailed as the shining star of a movement that tries to reform how society and the law handle mentally ill individuals.
Although mental health advocates regard her as a leader in elevating public awareness and reducing the stigma of mental illness, some have leveled sharp criticism at her.
They say Thomson has angered them by pushing for AB1421, a bill to provide courts the authority to order 180-day outpatient commitment for severely mentally ill people.
If enacted, the bill would put California in line with more than 40 states that have similar laws, to the dismay of civil libertarians and advocates who oppose the expansion of involuntary treatment in the mental health system.
Yet what really bothers her critics is her approach to lawmaking.
Those who oppose Thomson on AB1421 have tagged her as stubborn and insular. They charge that she pays lip service to the mental health coalition on key issues and caters to the families of mentally ill adults rather than the actual consumers of mental health services.
Her opponents believe that her doggedness has compromised her effectiveness as a legislator, cleaved the mental health caucus and alienated leaders in the Senate. What's worse, they say, she has violated time-honored rules of conduct by snubbing detractors and making political end runs.
Such refusal to compromise may have cost her a chance to run for state Senate after her Assembly term is up in August, observers say, pointing to a redistricting scheme that left an incumbent Democrat in office in her district until 2004.
With her time in the Legislature running short, Thomson is striving to pass AB1421 while defending her reputation as a lawmaker. She responded passionately to her critics last Thursday from her office in the state Capitol.
Visitors to Thomson's office do not need reminding that she is a nurse. In her waiting area, a vintage black-and-white photograph of her in her uniform hangs next to one of a group of nurses standing at attention with a caption that reads, "Sentimental Women Need Not Apply: A History of the American Nurse."
Inside her office, the walls are covered with plaques and commendations from medical associations, institutes and universities.
She produces a fax she recently received from the mother of a 31-year-old woman who is stricken with schizophrenia. The mother had just heard Thomson speak at a symposium on mental health at the University of California, Berkeley, and was moved by her speech.
"I receive boxes of letters like this," Thomson said. "We're the office of last resort for some people."
Her work is complex and contentious, she said.
"I did not come here to do simple stuff," Thomson said. "These are grinding issues, which should not diminish their importance.
"It's the work of the people, the voiceless and the sick."
"Before Helen Thomson, nobody knew or cared about mental illness," Paul Gerowitz, director of legislation and public affairs for Protection & Advocacy Inc., a nonprofit law firm, said last week. "For a long time, the standard response to a mental health proposal or idea was, 'What does Helen think?'"
Yet Thomson's image hardened along with her attempts to pass tough laws, Gerowitz said. Even when she succeeded, she angered supporters.
In 1999, when she introduced AB88, a bill to provide private insurance coverage to people with mental illness, members of the mental health coalition cried foul and charged that she reneged on a promise to broaden the coverage to include "any diagnosable mental illness."
Gov. Gray Davis signed the bill into law in 2000. It requires private insurance plans and HMOs to cover nine specific mental illnesses as they do physical illnesses.
Thomson sold out her supporters for a parity bill that limits coverage to disabling illnesses such as schizophrenia, bipolar disorder and major depression, which most often occur in mentally ill adults who do not have private insurance, some critics said.
"AB88 does not cover the majority of severely mentally ill people who are homeless, who lack jobs and family and who subsist on Medi-Cal, disability income and supplemental Social Security," said Richard Van Horn, president of the Mental Health Association of Los Angeles.
"The coalition had come together and worked with [Thomson] for three years to obtain the parity bill," Sally Zinman, director of the California Network of Mental Health Clients, said. "Even though advocates were angry, they forgave her. She was still their champion."
Thomson saw the glass as half full.
Davis had indicated a willingness to sign the parity law, she said, but told Thomson he would not extend coverage to "any diagnosable mental illness." Gov. Pete Wilson had vetoed a similar measure in 1998.
"When you get insurance in the private sector, you relieve pressure on the public sector," she said. "Critics of [AB88] said, 'If we don't get everything, then let's take nothing.'
"Well, it was my bill, I drafted it, and I didn't want to settle for nothing."
As a result of AB88, Thomson said, "People in the work force with schizophrenia can get insurance coverage for mental health treatment, and there is an autism center at the University of California, Davis.
"I am shocked, astonished, frustrated and ashamed for [Van Horn] that, as the director of the largest mental health association in the state, he would oppose this bill publicly."
While Thomson's opponents accuse her of tailoring her efforts to the interests of the families of mentally ill people, she insists that she is fighting for the rights of all people with psychiatric problems.
She is battling for housing for mentally disabled people, she said, and hopes to extend mental health plan contracts with the Department of Mental Health from one to three years, to enhance continuity of treatment.
She is trying to develop job training programs in mental health, obtain Medi-Cal reimbursement for social workers and marriage-and-family therapists and establish mental health treatment as an entitlement for all citizens in California, she said.
Her style is to broaden the field of advocates who care about mental health, she said, and to encourage her colleagues to take part in reform.
Her style has left her estranged from advocates who share many of her goals, however - particularly because of her efforts to create an involuntary outpatient treatment program for severely mentally ill people.
"I think [Thomson] underestimated her opposition on involuntary treatment," Gerowitz said. "She had the opportunity to meet with mental health stakeholders from all points of view, and she left them with the perception she was paying lip service to their concerns."
The mental health coalition began holding task force meetings in 1999 to discuss reform of commitment laws under the Lanterman-Petris-Short Act, Gerowitz said. From the start, stakeholders opposed expanding involuntary treatment to an outpatient setting.
Although a Thomson staff member attended the meetings, Thomson did not take her seat at the table until the final meeting, choosing to pursue a dialogue with advocates around the state who supported involuntary outpatient treatment.
In December 1999, against the wishes of the mental health coalition, she introduced AB1028, which would have provided $350 million for early intervention for people with a history of mental illness.
"The advocates were upset that they were not included in a dialogue before Helen introduced her own bill - Helen - a legislator - who wanted to introduce her own bill, based on hearings she had been to and hearings she had held," Stephanie Yoder, press secretary for Thomson, said.
Thomson said she saw no need for consensus among mental health stakeholders. She described her general approach to lawmaking.
"My philosophy is that, if I agree to do a bill, then it's my bill," Thomson said. "I'll work with sponsors to get it passed, but I'm in charge of my bill, and you can't speak for me and what I may or may not do with it.
"I want to know what the research says and what the issues are so I can control my bill. A lot of legislators get led around by the nose when they don't take control of their bills."
AB1028 died quickly but evolved into AB1800, which would have provided involuntary intervention and treatment for those who are too severely mentally ill to understand the need for treatment.
After AB1800 sailed through the Assembly but died in the Senate Rules Committee in 2000, Thomson recast her proposal as AB1421, titled Laura's Law, in memory of 19-year-old Laura Wilcox. Wilcox was killed in January 2001, when a mentally ill man opened fire in the Nevada County mental health clinic where she was working.
Thomson's persistence on involuntary treatment led to further adversity and perhaps will affect her immediate political future, observers said.
Many point to her departure from a Joint Committee on Mental Health Reform, convened by Senate President Pro Tem John Burton, D-San Francisco, as a critical mistake.
Thomson co-chaired the committee, which held public hearings in Sacramento, Los Angeles, Santa Rosa and Oakland in March and April 2000. When the committee would not agree to recommend expanding involuntary commitment on an outpatient basis, Thomson broke from the process.
Two separate reports emerged, both published in June 2000. One was submitted to the Legislature by Thomson's co-chair, Sen. Wesley Chesbro, D-Napa, on Senate Select Committee letterhead, explaining that the joint committee could not reach a consensus and therefore could not approve the report. Thomson published the other as a joint committee report on the letterhead of her constituents, the National Association for the Mentally Ill.
The reports were identical except Thomson's report contained a recommendation that the official joint committee had rejected: The Legislature should "support funding to establish assisted outpatient treatment programs for involuntary patients."
Legislators seeking to lobby for improved funding for voluntary outpatient services thought that the mental health caucus was weakened in the budget process as a result of this fracture.
"People felt that Thomson sabotaged the report because she wasn't getting her way," Zinman said. "Her own colleagues were livid.
"She's still paying for the way she has played the game."
Observers in the Capitol share the belief that Thomson became "collateral damage" when the Senate Election and Reapportionment Committee - led by Burton - redrew Senate boundaries in 2001 and left Thomson in a district which has no upcoming election.
She plans to run instead for county supervisor in Yolo County.
Nevertheless, Thomson's conviction about the need for outpatient commitment laws has not wavered.
She went to her file cabinet and pulled out a stack of reports and a photograph of the truck that rammed into the Capitol last year. The driver, Mike Bowers, who had been committed at Patton State Hospital, was killed in the crash.
"This man lost his life," Thomson said. "His doctors wanted him to stay in [treatment], and he wanted out.
"People cared about this man, including me."
Thomson brought her hand down on the stack of documents.
"That's him," she said. "All that was left of him was in the front seat of that truck.
"The people who oppose [involuntary outpatient treatment] have no answer to problems like this, and they don't like mine."
In 2001, when AB1421 passed in the Assembly 65-1 but was rejected by the Senate Budget Conference Committee, Thomson eschewed further debate and issued a press release. The proposal was going to cost $35 million. She stated that she planned to work with Davis' office to include funding for the program in the governor's budget and that, with his support, she expected to win approval in the Senate in 2002.
Again, critics saw her persistence as clouding her judgment.
"After a certain point, it isn't her position but her methods that backfire," Zinman said. "The issue of whether people should be committed more than they already are is decades old, and it's not going away.
"The problem is she's never opened the door to people who disagree with her."
In her Capitol office, Thomson described the hours of testimony and research she has studied in forming her position. Both she and her opponents point to the same study by RAND, however.
Thomson relies on a Duke University study incorporated into the RAND report, which concludes that outpatient commitment - under a six-month court order and with ongoing therapy - reduced inpatient hospital costs in North Carolina by 57 percent. Her opponents contend that the RAND study concludes there is no evidence that a court order is required to obtain good patient outcomes.
"Without consensus, I'm supposed to fold my tent and go home," she said. "But as a legislator, I won't do that."
"I've been pilloried for AB88," she continued, "and that law accomplished more than 20 other health care bills combined."
Thomson said that she has a big agenda to tackle in the current session and that she is not focused entirely on involuntary outpatient treatment.
"But it has to be dealt with, and if it isn't dealt with by me, then it will be dealt with by local officials who come into the Legislature," she said, "City Council members, school superintendents, county supervisors. They understand problems from the local perspective."
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Jeffrey Anderson
Daily Journal Staff Writer
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