Tuesday, December 18, 2018

Sonoma Medicine

The magazine of the Sonoma County Medical Association

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Where Do We Go From Here?

Mark Sloan, MD

On Sept. 5, 1902, a Cloverdale painter identified only as “Blackman” appeared before Sonoma County’s Lunacy Commission. Six weeks of heavy drinking and increasingly bizarre behavior, including two suicide attempts, had led to his arrest and eventual transport to Santa Rosa. 

Blackman had first tried to kill himself with a hand drill, an attempt that failed when, as the Press Democrat reporter assigned to the hearing dutifully informed his readers, “the instrument did not go in deep enough.” Next, Blackman beat his head against a stone wall “in the hope that a crevice would be crushed in his skull so that the gray matter therein could escape.” It was this second attempt that attracted the attention of the sheriff, the reporter and the Lunacy Commission.

Blackman explained himself “quite intelligently” to the commissioners that morning. Spirits from another world spoke to him constantly via wireless telegraphy, he told his interrogators, and murderous vigilantes followed him everywhere he went. Given these torments, he saw suicide as his only escape. The commissioners listened, conferred and then disagreed with Blackman’s conclusion. They ordered him detained “somewhere” pending a complete insanity evaluation. 

That “somewhere” was likely a police lockup, or perhaps the “crazy cell,” a small, heavily-timbered building used to confine “maniacs” at the old county hospital (since demolished), located on what is now called Chanate Road. Blackman would have been held no more than 20 days, in accordance with California’s Lunacy Commission Act of 1897—just long enough for two reputable physicians to decide whether his condition was due to “too much beverage” (the reporter’s verdict) or true insanity. If Blackman came to his senses when he sobered up, he would have been returned to his undoubtedly nervous family. If not, he’d have ended up at the Mendocino State Asylum for the Insane in Ukiah. 

That’s how Sonoma County’s public mental health system worked until the middle of the 20th century: law enforcement as first responders; a temporary hold for evaluation; then back to family or the streets, with an out-of-county destination reserved only for those with severe mental illness. Outpatient care for such patients was nearly nonexistent.

In 1967, Gov. Reagan signed the Lanterman-Petris-Short Act, which eventually led to the 1972 closure of the Mendocino asylum, whose name had changed to Mendocino State Hospital. Oakcrest—an inpatient psychiatric facility that Community Hospital opened in 1969—cushioned the blow in Sonoma County, but the 1970s and 80s were still difficult times, with mental health financing subject to ever-shifting political winds in Sacramento. 

All that changed in 1991, when the Bronzan-McCorquodale Act transformed California’s mental health care system, shifting program and funding responsibilities from state to county governments. “Realignment” was funded by increases in sales tax and vehicle license fees—and for about a decade it worked, more or less. But as California’s population boomed and its economy faltered, revenues failed to keep pace with costs. Sonoma County’s Mental Health Services Division found itself in ever-tighter financial straits. Well-intentioned measures like Proposition 63 (the “millionaire tax” of 2004) provide funding for new services, but forbid the use of that money for existing programs. As a result, older “core” services have steadily deteriorated. 

The last couple of years have been especially grim, with deep funding cuts and complete elimination of state programs for homeless people with mental illness. These troubling financial times have been reflected locally in the closure of both the Norton Center (the former Oakcrest) and Memorial Hospital’s inpatient psychiatric unit. Though treatment is increasingly outpatient-based, the statistic is still sobering: Sonoma County now has as many acute inpatient psychiatric beds as it did in 1902—none.

What can be done? In this issue of Sonoma Medicine, several local physicians describe the daunting challenge of meeting the mental health needs of the county’s citizens in an era of dwindling resources. These doctors report on the outlook for inpatient and outpatient treatment, care of the homeless, and the integration of mental health into primary care.

The fate of Blackman, the Cloverdale painter, is lost to history. Perhaps he made a full recovery, or maybe he spent the rest of his days locked up in Ukiah, far from his family. However life turned out for him, we owe the Blackmans of today and tomorrow—and the many other local residents with less severe mental health issues—an assurance that the care they need will be available right here, in Sonoma County.

 Dr. Sloan, a pediatrician at Kaiser Santa Rosa, serves on the SCMA Editorial Board. E-mail: mark.sloan@kp.org.

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