CVIndependent

Tue07072020

Last updateMon, 20 Apr 2020 1pm

This has been one hell of a news day—one of the busiest news days since this whole mess started, I’d say—so let’s get right to it:

• Big news item No. 1: The state’s reopening process is slated to begin on Friday, with, for starters, retail stores allowed to open for pickup. Here are the details on Gov. Newsom’s announcement today, from our partners at CalMatters.

• Big news item No. 2: According to The New York Times, a Trump administration projection anticipates deaths from COVID-19 will skyrocket over the next month. Meanwhile, states—many of which are currently seeing a rise in cases—are continuing the reopening process. Meanwhile, nothing makes sense anymore, and I need a cocktail.

• Big news item No. 3: Arizona, aka our neighbors to the east, are pushing the accelerator on the reopening process, with salons able to open on Friday, and restaurants able to open for dine-in service a week from today.

• Big news item No. 4: The continuing debate over Riverside County supervisors’ possible move tomorrow to cancel the orders of its own health officer, in favor of aligning with the weaker state orders. Earlier today, local supervisor V. Manuel Perez released a Facebook video in which he explained his thinking. I listened to all 37-plus minutes of it, and as far as I can tell, he is leaning toward rescinding some of Dr. Cameron Kaiser’s orders (on school closures, for example), and keeping at least parts of others (on face coverings and short-term rentals). He also announced the county would be opening two new testing sites in our valley—in Mecca and Desert Hot Springs—and touched on plans for the county to mobilize 200 contact-tracers. After listening to the whole thing, I now need another cocktail.

• This just in: The Coachella Valley Economic Partnership just released a report on the economic damage being wrought locally by the pandemic. I haven’t had a chance to read the whole thing yet, but, well, the news is pretty terrible. Read the report yourself here.

• From the Independent: Kevin Fitzgerald recently spoke to Allen Monroe, the CEO of The Living Desert, about where the Palm Desert zoo stands, and what the future holds. Interesting takeaway: The Living Desert had made emergency plans regarding earthquakes and fires—and that helped the zoo handle the pandemic, in some ways.

• There was a world summit today focusing on the effort to come up with a coronavirus vaccine. The U.S. didn’t take part.

• Testing on the rise: The Desert AIDS Project is now offering COVID-19 testing to anyone who wants it, even people who are asymptomatic. However, you need an appointment. Get the details here.

• OK, after all of that stuff, here, look! John Krasinski’s Some Good News is back with a new, graduation-themed episode.

• Feeling better? Good! Unfortunately, we now have to tell you that, according to this Washington Post headline: “The coronavirus pandemic is pushing America into a mental health crisis.”

• The Wheels Are Coming Off, Chapter 58: A security guard was shot and killed after telling a Family Dollar customer in Flint, Mich., to put on a face mask.

• The Wheels Are Coming Off, Chapter 59: Another restaurant—this one in Orange County—was packed after opening its doors this weekend.

• In other Orange County-related news, the governor decided to stop picking on them, and is allowing the beaches there to reopen.

• If you miss live music, and you’re not worried about the virus, Missouri is the place for you: Concerts can be held there now, as long as attendees are socially distanced.

Our friends at the Create Center for the Arts were burglarized recently. Sigh. However, they’re keeping up their efforts to make personal protective equipment for local medical professionals by using 3-D printers

• Do you find yourself at times needing to take a break from all the pandemic news? You’re most certainly not alone.

• According to The Conversation, if the world gets an effective vaccine, and vaccine-deniers refuse to take it, that could be very, very bad for all of us.

Donald Trump had an uncle who was legitimately a brilliant scientist. A friend of the late John G. Trump said he’d be horrified by his nephew’s antics.

More promising news on the drug front, this time regarding a flu drug called favipiravir, made by Japanese company Fujifilm.

• If you’re starting to look like a mountain man, or perhaps a Muppet (or, in my case, a Muppet mountain man), consider these self-care tips from Esquire.

That’s more than enough. Wash your hands. Wear a mask. Be kind. Buy your coloring book. Please consider becoming a Supporter of the Independent if you can afford to do so, so we can continue doing quality local journalism. We’ll be back tomorrow.

Published in Daily Digest

Everyone around him saw this coming.

No one managed to stop it.

For years, family members of James Mark Rippee—a blind, homeless Vacaville man with a traumatic brain injury and paranoid schizophrenia—have fought to get him into treatment. He resisted. And official after official cited California’s involuntary-treatment laws in explaining to his family why there was nothing they could do.

On the evening of Feb. 12, Rippee stepped off the center divide of a dimly lit Vacaville street into the path of an oncoming vehicle, police say. Now he’s facing multiple surgeries, said his sister Linda Privatte—for a fractured skull, a brain bleed, a shattered elbow, a dislocated shoulder and a crushed leg.

Like many other families, Rippee’s sisters place much of the blame on the mental health implications of a 1967 state law, Lanterman-Petris-Short. It imposed specific timeframes for involuntary confinement and limited involuntary holds to those deemed a danger to themselves or others, or those gravely disabled.

But families like Rippee’s are ratcheting up the pressure to change the controversial law—and policymakers seem to be listening. Gov. Gavin Newsom, in his State of the State address, said: “Clearly it’s time to respond to the concerns of experts who argue that thresholds for conservatorships are too high and need to be revisited.” 

After watching the speech, Rippee’s sisters aren’t yet convinced. They’ve been circulating a petition begging the governor to pay attention to Rippee’s situation and act to help him.

“It’s easy to stand up and say what needs to happen,” Privatte said. “What is he really going to do about it? What’s the plan? I watched it twice, and I didn’t hear one.”

An audit of Lanterman-Petris-Short is due out later this spring, and could suggest a possible path forward for the state. The governor’s office did not respond to requests for comment or provide any details about what exactly he would do to respond to change the rules surrounding involuntary treatment of people with mental illness. While the governor has not yet outlined a specific plan for the state, he did sign a bill to pilot expanded conservatorships in San Francisco.

Privatte and her twin sister, Catherine Hanson, recognize that making it easier to conserve people isn’t a simple fix, either. Disability-rights advocates are concerned that involuntary treatment is ineffective and jeopardizes people’s civil rights. County public guardians say they are overwhelmed with an influx of new clients, while the number of facilities available to treat them shrinks.

Even if Rippee were to be conserved, very few facilities in the state accept patients with traumatic brain injuries, Gerald Huber, the county’s director of Health and Social Services, said in an interview late last year.

Rippee himself, when I found him huddled at the edge of a Vallejo strip mall last year, told me he wants to live in a home with a shower and someone to care for him. But not a locked facility, he emphasized.

“To leave a blind man outside, you know, I just figured the county could do better than that,” he said.

This was not the first time Rippee has wandered into traffic. People who know his family regularly reach out to tell them they have pulled him out of danger, or have themselves almost hit him. In September, he was struck by a car and ended up hospitalized with a brain abscess. But after a couple weeks, his sisters said, the hospital discharged him to a board-and-care. Soon after that, he returned to the streets.

Lt. Mark Donaldson, of the Vacaville Police Department, said his officers regularly respond to calls about Rippee stepping into traffic.

“You have to go out and deal with these same people over and over again, and you know what the end result is going to be, because there’s no place to take them,” he said. 

“I got into this job to help people above all else, and we like to be problem-solvers, and when you simply don’t have the tools to solve these problems, it’s devastating,” he said. “It’s so frustrating. Your heart hurts for him and his family. There simply is no place; there’s nothing we can do.”

Privatte says she doesn’t blame the driver who struck her brother earlier this month.

“I just blame the whole situation of him still being out there,” Privatte said. “Sometimes I’m just amazed at how he does survive.”

She and Hanson say their brother has refused necessary medical treatments while in the hospital, including blood transfusions.

Rippee’s sisters have been fighting to get him into involuntary treatment for years. They testified on behalf of state legislation that sought to redefine “gravely disabled” to include those who don’t seek needed medical treatment. It failed. They attended Solano County Board of Supervisors meetings. They asked the police for welfare checks. They sent thousands of emails, and administer a Facebook group about their brother’s situation, which currently has more than 2,500 members.

“What we’re doing is unacceptable,” Solano County Supervisor Skip Thomson told Privatte as she wept during a board of supervisors meeting in 2018. Thomson declined to comment on Rippee’s most recent accident.

“I’ve struggled with this for the five years I’ve been here,” Huber, the county’s director of Health and Social Services, said last year. “The street is not an appropriate place for him to live.”

CalMatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.

Published in Local Issues

The sightings of James Mark Rippee are all over his sisters’ Facebook account.

Someone spotted him sleeping by a furniture store in Vallejo. Someone walked him to a gas station for coffee. Someone prayed for him at Nation’s Giant Hamburgers.

Rippee, 56, developed schizophrenia after a horrific motorcycle accident more than three decades ago caused a traumatic brain injury and the loss of his eyesight. His delusions range from being an alien, to getting chased by the KKK, to being prevented from collecting his lottery winnings, his sisters say.

In September, he stepped into traffic and was hit by a car, his sisters say; he then developed a brain abscess. After weeks in the hospital and a board-and-care, he walked out. His 62-year-old twin sisters—Catherine Hanson and Linda Privatte—weren’t alerted.

Now they couldn’t find him.

Complicating things further: Hanson is bedridden with blood cancer; Privatte is legally blind and cannot drive. They’ve come to depend on a Facebook community, “Mark of Vacaville,” to be their “eyes and ears” on their brother’s situation.

The existence of the 2,000-plus member group is at once a moving testament to a community’s compassion, and an indictment of a system that often leaves the most vulnerable to fend for themselves.

Why do people as sick as James Mark Rippee sleep on our streets? Some blame laws that prioritize civil rights over forced treatment; others point to an under-resourced and uneven mental-health system that has failed to provide people like Rippee with long-promised care.

Everyone struggles with the same underlying question: What should be done?

“When we allow people to deteriorate on the streets, or interface with law enforcement that leads to incarceration, what are we doing?” asks Dr. Jonathan Sherin, director of the Los Angeles Department of Mental Health. “We’ve lost our compass.”

State lawmakers are watching a controversial new pilot program to expand forced treatment in San Francisco.

In the meantime, families watch in desperation as loved ones cycle between homelessness, emergency rooms and jail cells. Short courses of medication may lead to the quieting of voices, which, in turn, leads to a release to the streets. Often, as in James Mark Rippee’s case, the family is simultaneously shut out of the conversation and blamed for abandonment.

Some of these families are aware of the downsides of involuntary treatment, the miserable side effects of psychiatric medications, and the critical shortage of inpatient facilities. They recognize that conservatorship—in which a court-appointed conservator manages another person’s living situation, medical decisions and mental health treatment—is no panacea, and should be a last resort.

James Mark Rippee himself puts it this way: “I don’t need to be in a locked-up facility. It was like I was a hostage.”

In recent years, Rippee’s twin sisters—Hanson, the red-headed warrior, Privatte, the blonde diplomat—have redoubled their decades-long effort to get him help. They worry their own health problems might someday leave no one to fight for him.

“He is the worst-case scenario of anybody being so vulnerable on the streets,” Hanson said. “Every winter we wonder: Is this going to be the year that he dies?”


In 1967, a law passed that transformed the treatment of people with mental illness in California.

Until then, it had been fairly easy for a family member to call police to force someone into mental health treatment. Conditions in the state hospitals were frequently abhorrent: Patients wore gunny sacks, sometimes bathed just once a week, and were subjected to lobotomies and electric-shock treatments. Too often, people were locked away for life.

Republican Assemblyman Frank Lanterman and Democratic Sens. Nicholas Petris and Alan Short proposed a radical overhaul, which Gov. Ronald Reagan signed into law. When the Lanterman-Petris-Short law took effect a few years later, it established strict criteria for involuntary treatment. It imposed specific timeframes for involuntary confinement and limited involuntary holds to those deemed a danger to themselves or others, or gravely disabled. This included the 72-hour hold that police term a 5150.

But within a few decades, Sen. Petris noticed growing numbers of people with serious mental illnesses appearing on the streets and in jails.

In a 1989 oral history, Petris lamented that while the law had promised funding to treat people with mental illness in the community, Gov. Reagan diverted tens of millions allocated back to the state general fund.

“That took the guts right out of this state money for local treatment,” Petris said. “It emptied out the hospitals, but there was no follow-up treatment. … In this overemphasis to get away from this tyrannical and oppressive system … of incarcerating people so easily, we went overboard the other way.”

Even when funding was available, “Not In My Back Yard” resistance also made it challenging to locate residential and community treatment facilities. In the half-century since, much of the debate about helping people like Rippee has centered on the Lanterman-Petris-Short law. The state auditor is currently examining it; a report is anticipated this spring.

In recent years, several bills in the Legislature have been proposed to modify the law, focusing on redefining the term “gravely disabled.” Rippee’s sisters petitioned and testified last year on behalf of a bill that sought to define “gravely disabled” to include not just those who can’t provide for their own food, clothing and shelter, but also those who don’t seek needed medical treatment. It failed, in part because opponents considered it ineffective and dangerously expansive.

More than 5,000 people in the state were on permanent conservatorships, and close to 2,000 were on temporary conservatorships, as of 2016-2017, according to data collected by the Department of Health Care Services. The data is incomplete; Scarlet Hughes, executive director of the California State Association of Public Administrators, Public Guardians and Public Conservators, calls it “extremely inaccurate.” 

Last year lawmakers agreed to create a narrow 5-year pilot program that makes it easier for three counties (San Francisco, Los Angeles and San Diego) to conserve homeless individuals with serious mental illnesses or substance-abuse disorders. The program allows courts to conserve individuals who have been placed under a 72-hour psychiatric hold at least eight times in a year. A second law, passed this year, expanded the rules to allow 50 to 100 more people in San Francisco to be placed under conservatorship.

Civil-rights advocates have raised serious concerns: In 2018, Susan Mizner, the disability rights program director for the ACLU, described conservatorship as “the biggest deprivation of civil rights aside from the death penalty” and said the law would incentivize police to repeatedly detain homeless individuals.

So far, only San Francisco has adopted it. That reflects another reality: Different counties have different rules. Even without the pilot program, depending on where you live, public defenders, judges, public guardians and others have different interpretations of the law.

“It varies from county to county, it varies within counties,” said Randall Hagar, government relations director for the California Psychiatric Association. “What is ‘gravely disabled’ here may not be considered ‘gravely disabled’ there.”

Because counties must use local funds to pay high placement costs—and because not all counties have the same types of services available—variations are a significant concern.

Disability rights advocates insist that maintaining the standards outlined by Lanterman-Petris-Short is essential to protect people’s civil rights. Most people with serious mental illnesses aren’t refusing help, they say; appropriate help just isn’t available.

Lynn Rivas, associate director of Oakland-based Peers Envisioning and Engaging in Recovery Services, understands that families feel desperate. She knew a woman with paranoid schizophrenia who lived on the streets of Richmond. Mental-health workers tried repeatedly, but couldn’t get her to come inside.

Even though “it breaks my heart,” Rivas said, she’s willing to live with that consequence. “I think involuntary imprisonment is worse,” she said.

Heather, a program coordinator at the organization, has herself experienced involuntary treatment. In the hospital, she said, everything was taken from her, and her entire schedule revolved around medication.

“I think it’s just really cold the way they treat you,” she said. “It’s like you have a disease. … They treat you like you’re not a human being.”

Once she stabilized, she said, the hospital discharged her back to the streets, without addressing her underlying issues. The experience not only didn’t help her, she said; it made her afraid to seek help.

Some worry that public dismay about the current homelessness crisis will encourage lawmakers to strip people of their rights.

“It’s still political failures that are trying to be masked with solutions that may decrease the visibility of individuals on the street,” said Curtis Child, director of legislation at Disability Rights California. He also compares the situation of people with mental illness to that of people with developmental disabilities. For the latter group, deinstitutionalization was accompanied by the creation of regional centers, he said, “in which everyone gets a plan, everyone gets a worker.

“With mental illness, we did nothing.”

For Child, and many other advocates, the solution is not more conservatorship; it’s creating affordable housing and more robust mental health services.

“The volume of individuals who are entering homelessness on a given day is overwhelming all of our systems,” said Michelle Cabrera, executive director of the County Behavioral Health Directors Association of California. “We’ve got a serious problem on our hands.”

Dr. Amy Barnhorst, vice chair of community and hospital services for the UC Davis Department of Psychiatry, agrees that the focus should be on building out the mental-health system, not changing the law.

“It’s like cutting more doors into an empty building,” she said. “There’s not the services there. We don’t have the workforce. We don’t have the treatments. We don’t have the infrastructure.”

Even if a change in law permitted more people to be conserved, a shortage of placements and “a gross lack of funding” for county programs means there would be nowhere to send many of them, said Hughes, of the California State Association of Public Administrators, Public Guardians and Public Conservators. Earlier this year, a state budget proposal to increase the amount of funding for public guardians by 35 percent—or $68 million—failed.

County conservators receive no direct state funding, and in the past five years have received a huge influx in clients diverted from the criminal-justice system, Hughes said. Some counties went from five referrals a month to 30 or 40, she said.

“They are drowning,” she said.

Simultaneously, the number of facilities that can take them is shrinking, said Chris Koper, a legislative analyst for the organization. At one point, she said, she and some friends started listing the facilities in that county that had shut down. They stopped when they got to 35, she said: “It was too depressing.”

That leaves many conservatees in a “placement pending” status, stuck in jails or hospitals. In some cases, conservators have resorted to having staff members care for people with mental illness in hotel rooms rather than leave an individual on the streets, she said.

Most state hospital beds are now reserved for people in the criminal-justice system. Inmates with mental illness can wait in limbo for months or even years in county jails before a bed opens up. Five years ago, an average of 343 inmates with mental illness were awaiting placement. Last year, the average was 819.

“The easiest legislative fix is to expand conservatorship,” Koper said. “It then will appear that the Legislature is trying to do something. But as is often the case with social problems, the wound is so much deeper than that. And the wound will require a lot of money.”

As San Francisco has assumed new authority to place people under conservatorships, the San Francisco Chronicle found a backlog. In a locked ward at San Francisco General Hospital, individuals who were conserved were waiting four months for placement in Napa State Hospital, and even longer for a residential facility.

A woman who answered the phone at the public guardian’s office in Solano County, where Rippee lives, said she didn’t have time or permission to talk, repeating several times, “We’re extremely short-staffed.”

Gerald Huber, the county’s director of Health and Social Services, noted that even if Rippee were to be conserved, there are very few facilities in the state that accept people with traumatic brain injuries—and they are always full with waitlists.

Rippee’s sisters are aware.

“If they tell him, ‘Mark, you’re conserved’—” Privatte began.

“—where are they going to put him?” Hanson concluded. “There’s no place.”


The events of June 21, 1987, are seared in the minds of Rippee’s twin sisters:

Rippee had purchased a Harley-Davidson just 10 days earlier, but he was already talking about selling it. With his slight frame, the big bike felt unwieldy.

The family had gathered for a Father’s Day barbecue in Vacaville. Rippee, 24, was optimistic about a budding career in construction. He was popular with girls and never went anywhere without his guitar.

That evening, he took off down a country road toward Hanson’s house. A car swerved into his lane. Trying to avoid it, Rippee steered off the road into a dark field.

A neighbor heard the crash. Officers searched for an hour, following the moans, before discovering a gruesome scene: Rippee had smashed into an antique grain harvester. The impact had ripped his eyes from their sockets, knocked out his teeth, split his head open and strewn brain matter on the ground. Paramedics told the family they were so sure he was dead that they initially didn’t turn on the siren.

His sisters rushed to the hospital, where a team of surgeons was attempting to piece their brother’s brain and body back together. Their father was overwhelmed, Hanson said, and asked her to take over medical decision-making.

After Rippee stabilized, a neurosurgeon warned the family it would take a few years for him to recover from the brain injury. Then, at some point, his mental health would decline. The doctor recommended Rippee be transported to a state rehabilitation facility where he might need to spend his entire life, his sisters said.

Instead, Hanson said, their father grabbed the papers giving her legal decision-making over her brother’s care and shredded them. His only son, he insisted, was coming home.

“This is how we lost complete control,” she said.

Under his mother’s care, Rippee did heal somewhat, his sisters said. He was completely blind, had severe damage to his frontal lobe and was suicidal. But, for a time, he was able to take computer classes.

Then the delusions crept in, his sisters say. He heard voices in the air conditioner. He tried to jump out of a car on a freeway overpass, nearly pulling Privatte with him. 

Still, for years, Rippee lived with his family. For a while, Privatte housed her brother in a 60-foot trailer adjacent to her house. Neighbor Chris Plowman, at the time a volunteer firefighter, remembers seeing smoke coming from the trailer one morning and hearing Privatte scream, “Save my brother! Save my brother!”

Plowman kicked in the door and ran through the trailer, looking for Rippee. He wasn’t inside. The trailer burned to the ground.

Then Rippee threatened to kill his mother with an ax, according to his sisters, who say the family felt it was no longer safe to have him live with them. But, gradually, he ran out of other options. Local motels refused to rent to him, his sister said.

Karen Newton, an office assistant with Solano County, first met Rippee in front of the county building where she worked; he was sleeping on a strip of cardboard. She bought him taquitos, chocolate milk and clean clothes. Newton, whose own son has schizophrenia and is currently in Napa State Hospital, was disturbed by the frequent assaults she saw against Rippee, including a bad beating that left him swollen.

“The things I’ve seen in the last year have been horrifying,” she said.

In the past 15 years, Vacaville police say they have arrested Rippee 25 times, charging him with unlawful camping and public intoxication.

Sgt. Aaron Dahl, who supervises the community response unit for Vacaville Police, says he wants people like Rippee to stay inside, take medications and get help, but “that’s not the reality of how things work.”

“I wish I had a magic wand that could go help everybody,” he said. “And it’s very hard, because there’s not an easy answer for everybody. There’s just not.”

In early 2018, Privatte said her daughter saw members of a Solano County community Facebook site criticizing their family for abandoning Rippee.

The twins intensified their efforts to help their brother.

“The law has stopped Mark from getting treatment,” Privatte said. “The law. Not us.”

On April 24, 2018, Privatte told the Solano County Board of Supervisors that her brother had attempted suicide more than 20 times, and that other people beat and robbed him regularly.

“It’s not because I want to lock my brother up and be done with him,” she said, crying. “It’s because I want him to be safe.”

“What can we do to help?” asked Supervisor Skip Thomson. “Because what we’re doing is unacceptable.”

Privatte showed up repeatedly to beg the board for help. Last spring, she received an email from Thomson’s office on behalf of the county, explaining that her brother could not be conserved, in part because each time he was placed on an involuntary hold, he stabilized to the point that he legally had to be released.

“This is not a situation that we have ignored nor that we condone,” the letter said. “Simply the law requires stringent standards to impose conservatorships—standards that so far we cannot meet.”

Huber, the director of Health and Social Services, said that “many, many, many different agencies” have interacted with Rippee over the years, and the county has made—and continues to make—efforts to provide treatment. 

“I’ve struggled with this for the five years I’ve been here,” he said. “The street is not an appropriate place for him to live.”

The county this year implemented Laura’s Law, a 2002 state law which allows for court-ordered outpatient treatment. A few weeks ago, Rippee’s mother applied for it on her son’s behalf. But the program doesn’t serve someone with a traumatic brain injury, Huber said.


On Sept. 27, someone posted a picture of Rippee on the Facebook group. His head looked swollen; his sisters recognized symptoms of a brain abscess.

Privatte convinced her brother to go with her to the hospital, where he had surgery the next morning. After two weeks, the hospital transferred him to a Suisun City board-and-care. In late October, he returned to the streets.

That same week, dozens of mental-health leaders from around the state gathered in Sacramento to talk about the future of Lanterman-Petris-Short. They discussed how counties lack the resources to build out a continuum of care.

Sacramento Mayor Darrell Steinberg asked his colleagues if the debate around involuntary treatment might be reframed to insist that people have both a right—and an obligation—to come indoors. That would mean that, before the state could compel people to come indoors, they would have to have safe, appropriate placements to offer them.

“Our North Star needs to be to end this horrific situation,” he said.

A few weeks later, I found Rippee at a Vallejo strip mall, asleep on a patch of concrete littered with dirty socks and desiccated orange peels. His head rested on a blue IKEA bag, which held a pale green fleece blanket studded with burrs.

After Rippee woke up, he requested a coffee the way he likes it—a lot of sugar, a little coffee. He was friendly and talkative, his facts smoothly interwoven with delusions. He talked about the beauty of classical music. He recalled delivering pies for his parents’ business. Then he toggled to concerns about the KKK chasing him: “I’m trying to stay ahead of those guys,” he said.

Ultimately, Rippee said, he wants home with a shower and someone to care for him. He doesn’t want to be in a locked facility, but he does wish he could live inside.

“At night, it gets cold,” he said. “I just sit there and shake.

“To leave a blind man outside, you know, I just figured the county could do better than that,” he continued. “They’re not supposed to leave me outside. The United States of America is nice enough. They’re not supposed to let this happen.”

CalMatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.

Published in Local Issues

State Sen. Jim Beall is angry.

Four times now, he has introduced legislation to better enforce state and federal “parity” laws, which require equal treatment of mental and physical health problems. Four times, that legislation has failed.

As he enters his final year in the Legislature, the San Jose Democrat plans what he calls a “full-frontal assault.”

“I’m going to put even more effort into next year,” Beall said, “because I’m madder than hell about it.”

California’s parity mandate was signed into law in 1999, and a federal parity law followed in 2008. But the state has struggled to ensure those laws work‚ which helps explain why parity feels like an empty promise to so many Californians. More than half of Californians believe that most people with mental health conditions can’t get the services they need, according to a poll conducted last year by the Kaiser Family Foundation and the California Health Care Foundation.

Those who do get services often have to search hard and pay extra for them: California patients were more than five times likelier to have office visits for mental health or addiction problems from providers outside of their insurance plan’s network than patients seeking medical or surgical care, according to a new analysis by healthcare consultants Milliman Inc. Insurers here paid primary-care providers 15 percent more than they paid behavioral-health providers.

“We need stricter enforcement of mental health parity laws,” Gov. Gavin Newsom declared during his campaign. That didn’t happen again this year, although Dr. Tom Insel, Newsom’s top mental-health adviser, recently told CalMatters the administration intends to take “a fresh look at parity enforcement.”

“Instead of doing this topic by topic, let’s step back and find an overall plan, a blueprint, that tells us: What’s the system we want?” Insel said. “I don’t think the state’s done that for a long, long time.”

What state officials have been doing is rebuffing many attempts to tighten parity enforcement. The most recent failure: Beall’s 2019 bill to ramp up requirements for health plans to report parity-compliance data to state agencies each year instead of every three years, as it does now. The bill would have required the agencies to report results to the Legislature, and to post them on their websites to make them easily accessible to the public. Beall says that would help make the state less reliant on patient complaints to trigger enforcement. The bill also would have prohibited insurers from requiring prior authorization and “step therapy”—or making patients first try lower-cost medications before receiving other prescriptions to treat substance abuse.

With a public desperate for better mental health services, what is keeping the state from ensuring that health insurers and plans comply with state and federal parity laws?

Some note the lack of the kind of broad, emotionally affecting campaign that has moved the needle in other states. There’s also disagreement among mental-health advocates about whether Beall’s proposals would best address the problem.

The senator, for his part, has another explanation.

 “The insurance companies have too much power in Sacramento on the subject of mental health,” he said. “Whatever support I’ve gained has been countered by them effectively. … They’re the best lobbyists in Sacramento that money can buy.”


Industry representatives maintain that a crackdown is unnecessary, saying the real challenges relate not to compliance, but to a well-documented statewide shortage of mental-health providers.

“Health plans in California have made mental health a top priority, going above and beyond what the mental-health laws are requiring,” said Mary Ellen Grant, spokeswoman for the California Association of Health Plans. Many plans are putting behavioral health providers in primary care offices and using more telemedicine, she said. “We’re not aware of any legislation that would improve whatever it is that Sen. Beall thinks is the issue.”

Leanne Gassaway, a senior vice president for America’s Health Insurance Plans, warned “there will be 50 different flavors of auditing and reporting” if each state creates its own parity reporting tool. Instead, she recommended the federal government create a single one.

“We don’t have a problem with reporting,” she said.

States aren’t asking the right questions or getting granular enough data, said Dr. Henry Harbin, former CEO of the managed behavioral health care company Magellan Health. The result: California’s approach “has not produced the change you would expect it to have.”

Once a problem is identified, is the state doing enough to enforce it? 

Beall doesn’t think so, and neither does Meiram Bendat, a Los Angeles attorney and psychotherapist who won a much-touted case this spring. In that case, a Northern California federal court found that United Behavioral Health had wrongly restricted treatment for patients with mental-health and substance-abuse disorders in order to cut costs.

Bendat said that, over the years, many patients had asked the state Department of Managed Health Care for help with mental-health claims denied by United Behavioral Health. But he said the department, which oversees health plans that receive monthly fees to provide health care for their members, has failed to inform the public of any systemic, corrective action against the insurer.

He uses the terms “toothless and ineffective” to describe the department’s parity enforcement.

California allows plans to decide, for themselves, what makes a treatment “medically necessary” based on clinical standards. Critics, such as Bendat, contend plans often apply the wrong standard of care. Some other states require the use of medical necessity criteria determined by nonprofit, clinical specialty organizations.

“California is behind the curve in this regard,” Bendat said. “The abuses that we see by managed care are widespread and ruinous, and they need to be stopped,” he said.

Bendat and others do praise the work of the Department of Insurance, which covers a small fraction of the state’s health plans.

The Department of Managed Health Care said in an email that it “works diligently to ensure that health plans comply with state and federal requirements regarding mental health services.”

This includes surveying all licensed plans every three years, interviewing plan staff, reviewing enrollee files, and tracking complaints. In recent years, the department added two staff members and conducted focused comprehensive reviews of 25 health plans’ methodologies for providing mental health services. It then required those plans to eliminate impermissible day and visit limits, revise prior authorization requirements, and reimburse enrollees a total of more than $517,000. In the last decade, it has cited health plans dozens of times for mental health-related violations, resulting in more than $4 million dollars in fines—most levied against Kaiser in 2013.

The department says if patients feel they have been denied medically necessary treatment by their health plans, they can appeal to the state for an independent medical review. But critics say the vast majority of patients never appeal.


Sen. Beall is outraged by the swelling numbers of untreated individuals residing under doorways and overpasses.

“It sounds horrible, doesn’t it?” he said. “That’s because that’s what it is. It’s a horror.”

Beall was an undergrad studying urban planning and political science at San Jose State in the early 1970s when Gov. Ronald Reagan began shuttering the state’s mental hospitals at the same time traumatized veterans returned from Vietnam.

Years later, as a Santa Clara County Supervisor and liaison to the county mental-health commission, Beall learned how mental health and substance abuse impacted all corners of society: housing, criminal justice, health, education and foster care.

“We kept seeing people ending up in our system because private insurance wouldn’t cover them adequately,” he said.

After Beall was elected to the Legislature in 2006, he began trying to pass laws to strengthen mental health parity. One made it through the Assembly and died in the Senate. Another made it through the Senate and died in the Assembly. A third, which would have allowed additional penalties of $2,500 per patient per day for each parity violation, was vetoed by Gov. Jerry Brown, who said the state insurance commissioner already had “broad authority” on enforcement. The most recent bill never left the Senate.

 “I’m in a lot of pain right now. It hurts,” Beall said at a Sacramento forum on mental health organized by CalMatters a few days after the latest bill died. He has spoken publicly in the past about having a family member with schizoaffective disorder. “I tried four times, and it’s actually getting harder to get it passed. … My own colleagues killed it.”

The industry has opposed parity laws for a long time. Health insurers “fought tooth and nail” against California’s state parity law, stopping it twice in the 1990s before it ultimately became law, said the law’s sponsor, former state Assemblywoman Helen Thomson of Davis. A psychiatric nurse-turned-legislator, she said the law was eventually pared back to cover just nine serious mental illnesses because of this pushback.

In the case of Beall’s most recent bill, he says he had to remove the parity provisions, because staff and members of the Senate Health Committee didn’t agree with them. But he also insists that some of his colleagues are too connected to health insurers, allowing former staff members and legislators who work for the industry to use these relationships to stop his bills.

In the years that Beall has been trying to pass parity legislation, health insurers have contributed almost $10 million directly to winning candidates and industry lobbyists have spent more than $85 million.

Other states did pass parity-related bills last year, among them Colorado, Connecticut, Delaware, Illinois, New Jersey and Tennessee. A massive publicity effort featuring compelling personal stories, combined with negotiations, may be part of the equation—and part of what’s been missing in California. Health insurers have often dropped their opposition after intensive negotiations and media and education campaigns, said Tim Clement, director of legislative development at the American Psychiatric Association.

Clement, who was at the negotiating table in many of those states, but not California, called it “pretty close to impossible to get a bill passed if insurance industry-opposed.” He blamed California’s inaction partly on the lack of “a cohesive, boots-on-the-ground movement” for parity.

In Colorado—which just passed an expansive parity bill that will close loopholes, improve transparency and enforcement, and strengthen mental health prevention and screening—“we just were relentless,” said Lauren Snyder, state policy director with the advocacy organization Mental Health Colorado. That included working with media outlets to share personal stories of individuals harmed by lack of mental health care, and ads urging people to contact their legislators.

Such a movement was part of what eventually worked in California in the 1990s, said former Assemblywoman Thomson. She said she had a full-time public-relations person working on the effort to pass a parity law; that major newspapers in the state editorialized in its favor; and that many legislators gave personal testimonies about how a lack of mental health care had impacted their loved ones.

That law now has strong provisions for the coverage of medically necessary treatments for serious mental illnesses like schizophrenia and bipolar disorder, but does not cover a wide range of other mental-health conditions or substance-abuse disorders. Some parity advocates say California needs to ensure medically necessary treatment for more individuals, including those with substance-abuse disorders. 

Dr. Richard Pan, a Sacramento pediatrician who chairs the Senate Health Committee, wants to give plans more incentives to serve people with serious mental illnesses.

“No one wants to be known as the health plan with the best mental-health coverage or diabetes or asthma,” he said. His idea: a shared risk pool to reward plans that provide quality care for people with chronic conditions.


For a long time, Sen. Beall has “carried the mantle on (mental health parity), kind of alone,” said Sacramento Mayor Darrell Steinberg, a former state Senate leader who founded the Steinberg Institute to advocate for mental health policies.

Beall calls his inability to pass parity legislation thus far “my biggest failure as a legislator.”

Earlier this year, the Assembly passed a resolution calling on all relevant state agencies and the Attorney General to ensure that all health insurers are complying with federal and state parity laws. But a resolution, while it may raise awareness, is akin to a suggestion.

Beall says he’d like to introduce one more parity bill before he terms out—though he’s still working out the details.

“My style is to keep fighting and fighting and fighting,” he said with a laugh. “I don’t give up.”

Jocelyn Wiener is a CalMatters contributing writer. Her reporting is made possible by a grant from the California Health Care Foundation. CalMatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.

Published in Local Issues

Elizabeth Brown’s bedroom holds a trove of evidence of her fight to save herself.

Preserved among Twilight novels, posters of Korean pop singers and cameras she used for her budding journalism career are clues about the Santa Rosa teenager’s agonizing struggle with the mental illness that claimed her life last year.

Next to her bed sits the lavender candle she lit to soothe herself. On her desk are the bunny slippers she wore when she was too depressed and anxious to leave the house. Taped to the wall are two plastic hospital bracelets from separate psychiatric admissions in 2017.

Underneath them hang four sticky notes, on which she had printed:

“channel all the anger, sadness, hurt into this one thing”

“you can have control”

“you can be beautiful”

“this pain is good.”

The cutting, the suffocating despair, the suicidal thoughts—those details live in the journal she hid behind a password on her laptop.

“She really tried hard,” says her mother, Seong Brown. “She believed in the medical system to help her.

“But they failed at every turn.”


Around California, people with mental illness—and their family members—talk about pleading with insurance providers for treatment.

Their stories share an underlying premise: Despite policy advances in the last two decades intended to compel insurers to provide equivalent levels of care for physical and mental illnesses, the reality on the ground still looks very different.

A poll released in January by the California Health Care Foundation and the Kaiser Family Foundation found that more than half of those surveyed thought their communities lacked adequate mental-health-care providers, and that most people with mental health conditions are unable to get needed services.

The state Department of Managed Health Care has cited health plans dozens of times in the past decade—penalizing them millions of dollars—for mental-health-related violations.

And earlier this month, a federal judge in Northern California ruled that United Behavioral Healthcare had wrongly restricted treatment for patients with mental-health and substance-abuse disorders in order to cut costs, in violation of federal law.

Not all problems with access to mental health care are illegal, but some almost certainly are, said David Lloyd, policy adviser at The Kennedy Forum, a nonprofit mental health advocacy organization founded by former congressman Patrick Kennedy.

“There’s a lot of evidence that discrimination by plans is happening,” he said.

Experts say mental health has been underfunded historically, in part because of prejudice against people with mental illness and substance abuse disorders.


California enacted a law requiring health plans to provide coverage for the diagnosis and treatment of severe mental illnesses in 1999.

A decade later, in a major victory for mental-health advocates, the state passed a law requiring health plans that offered mental health coverage to provide the same level of care they gave on the medical/surgical side. The law was strengthened again in 2010 when the Affordable Care Act listed mental health as an essential benefit that insurers were required to provide.

Insurers say they’re doing their best to comply with these laws but face a shortage of mental-health providers. Plans are working closely with state regulators and using a variety of methods, including virtual appointments, to meet these “serious challenges,” said Mary Ellen Grant, spokeswoman for the California Association of Health Plans, a trade group that represents insurers.

Most plans no longer limit the number of visits to a mental-health provider, nor do they charge higher co-pays or deductibles. But that hasn’t made access to mental and physical health care equivalent, said Lloyd of The Kennedy Forum.

The primary challenges for patients now exist in areas harder to track and quantify, including pre-authorization requirements and determinations of what is “medically necessary,” he said.

Parity laws are often so complex that it can be hard for people to know whether the barriers they face are actually illegal or just feel unfair, said Jennifer Mathis, policy director at the Bazelon Center for Mental Health Law in Washington, D.C.

“Most people aren’t able to figure this out,” Mathis said.

All many people know is that their loved one desperately needs help—and isn’t getting it.


In early January 2019, on the first anniversary of the day that Elizabeth Brown took the action that eventually ended her life, her parents, Seong and David, sat at the kitchen table in the immaculate Santa Rosa home that Seong, an architect, designed.

Seong retrieved an email from her husband’s colleague detailing cancer treatment his wife received from Kaiser Permanente. While Elizabeth descended into mental illness, their friend’s wife was treated by a team of oncologists, nurses, counselors, social workers and outside specialists.

“This is what she got,” Seong said. “And she’s still here.”

Citing federal privacy laws, Kaiser declined to comment on Elizabeth’s care. In a written statement, the company said, “This is a heartbreaking story, and our condolences go out to the Brown Family and her loved ones. While we can’t speak to any individual case out of respect for the privacy of those involved, the loss of any person greatly saddens every physician, therapist and nurse involved in that patient’s care. We review each case extensively and when opportunities to improve are discovered, we share that knowledge with our care teams.”

Elizabeth was a top student, her parents said. She earned a black belt in karate, played piano and was a violinist in the San Francisco Symphony Youth Orchestra.

After sophomore year, she applied to Bard College at Simon’s Rock in Massachusetts and started there before her 16th birthday. She made the dean’s list.

She also started having panic attacks. In May 2016, after her second year at Bard, she asked to see a therapist.

“Something’s not right, Mom,” Seong said she told her.

A few days later, Elizabeth first met with a Kaiser psychologist in Santa Rosa, beginning a treatment odyssey chronicled in 3,000 pages of medical records provided by her parents. The psychologist described “depression, self-criticism and self-destructive behaviors,” suggesting a self-forgiveness audio program and discussing cognitive behavioral therapy strategies.

As the months passed, Seong and David Brown grew increasingly concerned. Their daughter would head off to college, only to land in a hospital or threaten to kill herself and return home to California.

The family was dissatisfied with the frequency of sessions available through Kaiser. They were referred to an outside contractor, records show, but grew frustrated waiting to hear back. They eventually began paying $160 a session so she could see an outside therapist once or twice a week.

On Jan. 18, 2017, records show, Elizabeth tore up her parents’ house, searching for pills to swallow to kill herself. She found herself holding a kitchen knife and, frightened, called police. They took her to the hospital. Two days later, she was screened for an intensive outpatient treatment program offered through Kaiser.

“Patient’s mother is very worried that Patient will kill herself and requested a higher level of care,” the provider Elizabeth met with wrote in her notes.

Elizabeth agreed to try the Kaiser program—group therapy a few hours a day, several times a week, for two weeks. She was taking several medications, but they didn’t seem to be working, her parents said.

A letter she wrote herself during that time offers a window into her mindset.

“The depression drops you into a deep pit, leaving you to claw at the edges in an attempt to pull yourself out,” she wrote. “But there are people, resources, pieces of hope that will drop you a ladder—I promise. Even though you scream, and it seems like no one hears you, you will learn to help yourself. … You can rely on yourself; you are your own saving grace. Because in the end, you won’t be saved by IOP or medications or therapy—you will be saved by you.”

Around that time, records show, her Kaiser psychiatrist diagnosed her with bipolar disorder. Over the next few months, he changed her medications regularly and offered words of encouragement via email.

But a few weeks later, she was struggling again.


In 2013, the state Department of Managed Health Care levied a $4 million fine—one of the largest in its history—against Kaiser for deficiencies in providing timely access to mental health care and for violations of state parity law related to mental health education materials.

In an interview, Department Director Shelley Rouillard said Kaiser “actually is doing very well” at meeting the settlement agreement’s benchmarks.

In December, Democratic state Sen. Jim Beall of San Jose introduced legislation to require plans to report to the state annually on parity compliance—and for the state to make those reports accessible to the public.

That same month, Kaiser mental-health workers went on strike for five days to protest long patient wait times. Striking providers described not using the restroom all day and working through lunch, afraid that any call they don’t answer will leave a patient to suffer.

“The HMO is not going to go to oncology and say, ‘Our next available opening is in six weeks, so that’s what’s available,” said Kenneth Rogers, a psychologist with Kaiser in Elk Grove who serves as a shop steward for the union.

People on both sides of the debate agree that mental health workforce shortages are a big piece of the problem.

Kaiser has hired 30 percent more therapists since 2015, and pays the state’s highest rates, said Dr. Linda Kim, chair of regional mental health and addiction medicine and recovery services for Kaiser Northern California.

“I truly believe no other organization is doing more than what we are doing, in terms of aggressively hiring and in terms of truly innovating and finding new models of care that are evidence-based,” she said.

Professional associations representing psychiatrists and social workers say they often don’t want to work with insurers at all, citing low reimbursements and onerous administrative burdens.

One study found that only 55 percent of psychiatrists accept insurance, compared to an average for all health care professionals of 89 percent.

Sheree Lowe, vice president of behavioral health for the California Hospital Association, said health plans often require reauthorization every five days for hospitalized patients receiving mental-health or substance-abuse treatment—even for evidence-based care that routinely takes much longer. In some cases, clinicians have to wait up to two hours on hold in order to get that authorization, she said.

“That doesn’t happen if you go in with a fractured hip or with pneumonia,” she said.


Elizabeth returned to college in Massachusetts in the fall of 2017. She was quickly hospitalized twice. Doctors there diagnosed her with borderline personality disorder, her parents said, which was subsequently added to her Kaiser medical record.

That October, as the deadly Tubbs Fire moved closer to the hills around the home Elizabeth’s mother had designed, she hosed down her roof and bargained with God: “Take my house. Bring my child back.”

The house was spared. Elizabeth got sicker. Desperate, her parents made plans to send her to a residential treatment program in January 2018. It would cost $45,000 out-of-pocket.

On Dec. 4, 2017, Elizabeth emailed her Kaiser psychiatrist. “There is a lot to cover since we last met,” she said.

“It’s a 30 min visit to remind you and my part at this time is to refill your meds in the transition to your more intensive treatment,” he responded, according to Elizabeth’s medical record.

That afternoon, Seong sent the psychiatrist an email: “This is very critical and important for Elizabeth’s well-being because of her acute symptoms. She will be home more than a month and she needs an intensive outpatient therapy that is more than once a week.”

He responded that he understood, and that Elizabeth could return to the Intensive Outpatient Program or try to see a new therapist through an outside contractor. “That is the options I have available,” he wrote.

Seong developed a protocol when she was away from Elizabeth. She’d check in via text. If no response came within 15 minutes, she would call twice. If there was no answer, she’d race home.

On Jan. 10, 2018, Seong felt hopeful. Elizabeth texted that she was drinking coffee and reading a book. They made plans to buy new glasses frames after Seong came home from work.

In between texts to her mother, her parents said, Elizabeth also sent one to a friend. Its message, in essence: Send the police to collect my body. I don’t want my parents to find me.

This is an abridged version of the full story, which is available here at CALmatters.org—a nonprofit, nonpartisan media venture explaining California’s policies and politics. The coverage is funded by a grant from the California Health Care Foundation. Consumers experiencing access issues, or other issues with their health plans, can reach the state’s Department of Managed Health Care Help Center at 1-888-466-2219 or www.HealthHelp.ca.gov. If you or someone you know is having thoughts of suicide, there is help available. Call the National Suicide Prevention Lifeline 1-800-273-8255 (TALK) for resources and support.

Published in Features