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Tara Caffrey. MSW Patient’s Rights Advocate, San Francisco, CA

We are still Mad about the Mad in San Francisco

In November 2004, California voters passed Proposition 63, the law that would become the Mental Health Services Act. The Act was passed with a broad coalition of consumers, providers, and family members. Initially the passage was greeted with hope because the tax on millionaires that would fund programs promised a much needed infusion of cash into a system that many believe is broken and unable to serve the needs of California’s diverse population. Hope seems to be vanishing as California, through its counties, implements the Act. The Act promises to provide new, innovative and comprehensive programs to address the many needs of the “mentally ill,” with a focus on the voluntary treatment. Specifically, the funds were not to be used for involuntary treatment. Since the passage, some counties have asked for funds to provide involuntary hospitalization for up to 30 days.

The Act has been codified into the California Welfare and Institutions Code and the California Code of Regulations. The statute states that, “The state Department of Mental Health shall establish a program designed to prevent mental illness from becoming severe and disabling.” (WIC §5840 (a)) The statute goes on to say that, “The program shall include the following components: Reduction in stigma associated with either being diagnosed with a mental illness or seeking mental health services and a Reduction in discrimination against people with mental illness.” (WIC §5840 (b) (3) (4) ) The new law seems to be trying to get individuals to seek help and treatment before they become so sick that they become a financial burden to themselves, their families and the counties they live in. But can a law change the stigmatizing impact of having a diagnosis? Can a law change the attitudes that services providers and the public have about people with a diagnosis? Can a law make ineffective treatment, effective?

The law and those who supported its passage and those who are working on its implementation all have the best of intentions. However, the reduction in stigma and discrimination is impossible when the public, providers included, believe in the efficacy and necessity of involuntary treatment for those with so called mental illness. The Act has not changed how treatment is conceived—the Act wants people to have access to treatment that is “medically necessary.” This paper is a textual analysis of San Francisco Chronicle columnist CW Nevius and how his work has helped perpetuate stigma and discrimination in San Francisco. Mental illness and homelessness is a political issue because of the unsightly nature of both. Public attitudes supporting involuntary treatment are reinforced by Nevius. The public is able to respond to his columns on the Chronicle’s website, sfgate.com. This paper will look at the columns and the comments to demonstrate that since the passage of the Mental Health Services Act, stigma and discrimination are alive and well in San Francisco. The stigma and discrimination move beyond those who have been diagnosed or the waiting/needing to be diagnosed to those who support and advocate for their right to treatment or their right to refuse treatment.

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