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 Health Election Platform

1. Reimagine Mental Healthcare and Crisis Response to be Low-Barrier and Community-Based

To create a healthier community, Law Foundation supports low-threshold, non-coercive, patient-centered, peer-driven, community-based mental health care rooted in principles of prevention, harm reduction, trauma-informed care, freedom of choice, and dignity of risk. To promote wellness and safety law enforcement should not have a role in health care.

a. RECOMMENDATION: Increase funding for Mobile Crisis Response Teams (MCRT)/Trusted Response Urgent Support Teams (TRUST) and expand alternatives to police responses.
Santa Clara County has already made important strides toward prioritizing the critical needs of people experiencing mental health crises by implementing mobile crisis response teams. However, the number of people experiencing mental health crises who need trauma-informed de-escalation responses outside of traditional law enforcement remains high, as indicated by the hundreds of calls made to MCRT in 2019-2000.

Because our community’s mobile crisis response programs are limited, police remain the default responders to most mental health crises in the County. Roughly half of people killed by police have a disability because they tend to escalate emotional situations and misread a person with a disability’s responses. To prevent these killings, mental health consumers need crisis response services independent of law enforcement. Those experiencing mental health crises need care and compassion, not criminalization and coercion.  

Increased funding for MCRT/TRUST is essential to increase the availability of mobile crisis teams throughout the County, provide data collection and analysis for performance measurements, expand culturally-inclusive community outreach efforts (including multilingual services), provide staff training, and connecting community members benefitting from these mental health services with long-term supports.

b. RECOMMENDATION: Remove law enforcement completely from mobile crisis responses.
Currently, in Santa Clara County, mobile crisis teams sometimes work alongside and in cooperation with law enforcement. However, policing is inherently at odds with mobile crisis’s goals of de-escalation, service, and nonviolent intervention. Given the brutality with which law enforcement has long terrorized communities of color, mobile crisis teams’ cooperation with police may deter people from contacting the program for crisis and care services. To promote trust and community safety, Law Foundation calls for complete divestment from police in mental health crisis responses.

c. RECOMMENDATION: Do Not Build a New County Jail or Locked Psychiatric Facility.
Throughout American history, the criminal legal system has been used to control and confine those excluded by their race, class, gender, and disabilities. Jails and prisons fail to deter crime or rehabilitate people. Instead, incarceration exacerbates racial disparities by causing people to lose their jobs, housing, and connection to families and communities. Incarceration also increases people’s experience of trauma and leads to adverse health impacts.

Instead of confining people in jails, the County should expand community-based diversion programs where people can receive access to restorative programs and mental health services of their choice. Over a recent, two-year period, the County jail had 9,055 unique patients who were diagnosed with mental health conditions or taking psychotropic medications. During this period, there were roughly 2,000 to 3,000 people in the jails at any point in time. This data suggests that many of the mental health consumers in the jail cycle are in and out relatively quickly on petty charges. If our community reinvested the enormous sums needed to build a new facility into diversion programs in our community, the number of people being arrested, recidivating, and requiring jail beds would decline. Instead of investing in a new jail, that money should be redirected toward investment in proven diversion programs such as supportive housing and community-based mental health and drug treatment services.

Similarly, Santa Clara County should not invest in a new locked psychiatric facility in place of the jail. Investments in correctional mental health services perpetuate false perceptions of substance use and mental health issues as criminal matters. It also can cause fewer funds to be allocated to fund community-based solutions – programs that treat mental illness without denying consumers’ civil liberties. Jails are set up to confine, to punish, and to cage, and those purposes run contrary to the goals of mental health and holistic wellness which are to heal, to help, and to treat. These contrary goals can contribute to the adverse health outcomes mental health consumers face in carceral settings.

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2. Preserve and Protect Mental Health Consumers’ Civil Rights

Competency, guardianship, and civil commitment proceedings strip people with mental health disabilities of their full civil rights. People can be detained and forcibly medicated for symptoms of a mental health disability. Conservatorships and guardianships make people with disabilities more vulnerable to abuse when they are stripped of rights to make decisions about their care and their daily lives. Law Foundation believes that those with mental health disabilities should retain their full autonomy and rights. Forcible treatment can be detrimental to the patients’ health.

a. RECOMMENDATION: Eliminate court-mandated medical treatment, including through “alternatives” to incarceration.
These “alternatives” include specialized courts which mandate drug treatment programs and mental health treatment. We also call for the elimination of the Assisted Outpatient Treatment (AOT) program. AOT is a barrier to providing non-coercive, culturally competent mental health care. The experience of being hospitalized and/or treated against one’s will can be traumatizing and lead to distrust of mental health professionals. Mandated treatment leads to worse long-term engagement in care and poorer health outcomes.  

b. RECOMMENDATION: Invest in voluntary, non-coercive outpatient services and resources.
The Law Foundation supports investment in low-barrier, robust outpatient services such as Assertive Community Treatment instead of the coercive use of a judge’s order to force treatment through Assisted Outpatient Treatment (AOT). The court, administrative, and data-keeping costs associated with AOT could be reinvested in additional voluntary treatment slots and/or housing options for hard-to-reach community members.

c. RECOMMENDATION: Provide legal representation at all stages of the Assisted Outpatient Treatment (AOT) process.
While the Law Foundation objects to the adoption of AOT, should the County continue its implementation, we hope that people who are referred to AOT are advised of their rights and options by an attorney early in the process, and at every stage thereafter. Providing each patient with legal assistance at every step can help to ensure that patients are advised of their legal rights and treatment options so they can meaningfully advocate for themselves. Many people - especially those who are experiencing acute mental health symptoms, have language barriers, or learning disabilities - do not understand what rights they should have or how to assert them without the assistance of legal counsel. Legal advocates can also spot systemic issues to ensure that patients’ rights are not being violated. Particularly when a person is being forced to engage in treatment under the threat of a court-order, extreme precaution should be taken to protect their civil rights.

d. RECOMMENDATION: Eliminate the use of seclusion and restraints
Under current law, there is no time limit on how long a psychiatric facility can place a patient in seclusion and restraints. The experience of being in seclusion and restraints can be painful, humiliating, dehumanizing, unreasonable, and scary. Seclusion and restraints can lead to neglect and abuse of patients. The good news is that mental health treatment for people in crisis can be done effectively and safely without use of such traumatizing measures, as proved by research performed by the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration.(1) Seclusion and restraints should be abolished to prevent inflicting harm on people experiencing mental health symptoms.

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3. Increase Access to Quality Mental Healthcare

Mental healthcare is most effective when provided in a comprehensive and preventative fashion rather than administered as an emergency response to a crisis.  Many mental health conditions are chronic.  Patients need long-term access to services and care that is flexible, specialized, and ongoing, rather than spending several days in intensive locked care only to be released back into the same situation they faced prior to hospitalization without any long-term support. Law Foundation promotes investment in free, long-term supportive systems of care to replace forced inpatient hospitalization.

a. RECOMMENDATION: Increase funding for community outreach and neighborhood-based, peer-led trauma-informed mental healthcare.
Individuals who require mental healthcare should have low-barrier access to care in community settings. Removing patients from their networks of support and comfort to provide care in a hospital can be destabilizing. Forced hospitalizations can result in additional problems for people in crisis. Someone who is unable to show up to work or pay their rent due to their forced hospitalization may face unemployment or an eviction upon their release. Care should be provided in a way that allows patients to engage as much as possible with their regular lives and obligations. Such care will not only prevent negative ramifications for patients stemming from hospitalization itself but will also increase the likelihood that patients will voluntarily engage in long-term care, leading to better health outcomes. Adding peers to community-based mental healthcare teams can increase culturally responsive care. People also deserve to access high-quality trauma-informed care regardless of their housing or financial status without concern that they are choosing mental healthcare at the expense of feeding themselves or paying rent.

b. RECOMMENDATION: Increase funding for and prioritize training for healthcare providers centered around culturally competent care.
People seeking mental healthcare should be treated with respect and dignity, as should their beliefs and cultural/religious practices. Whenever possible, space should be made to incorporate an individual’s cultural practice or treatments into their care plan in accordance with their wishes. Providers should take extra care to consider the power dynamics from which they approach each patient and to respect and honor the frame of reference from which the patient may approach healing. Law Foundation supports increased funding to promote culturally competent training and care including hiring peer mental healthcare workers.

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4. Support Disability Liberation Through Increased Funding for Government Benefits and Eliminating Barriers to Access These Programs

People with disabilities deserve the same access to quality care, comfort, and participation in community as anyone else. However, in a world that is not built for different accessibility needs, it can be more expensive and difficult for people with disabilities to access education, jobs, resources, and services than the general population. Increasing public benefits and lowering barriers to enrollment can to enable people with disabilities to live more independent and fulfilling lives. 

a. RECOMMENDATION: Invest in “SSI Advocacy” to provide legal support to people applying for disability benefits
The process of applying for Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI) and other disability-linked cash benefits is work intensive and challenging. Most people are initially denied, despite having meritorious applications. The complexities of these programs are incredibility difficult for many people with disabilities to navigate on their own, particularly those experiencing homelessness. 

When appealing disability benefits denials, persons who are represented by an attorney are roughly twice as likely to get approved for benefits than those who are not. A pilot project in San Francisco County found that providing representation to help people receiving General Assistance get onto SSI resulted in a $5 to $1 return on investment.(2) Currently our County provides SSI Advocacy to people on General Assistance during the application and first stage of the appeal process. However, people who are denied must contact private attorneys on their own to seek representation in a hearing. For people experiencing homelessness, non-English speakers, or those with acute mental health symptoms, this may be an insurmountable barrier. We recommend funding free legal services to assist with SSI, SSDI, and Cash Assistance Program for Immigrants (CAPI) applications to increase the number of people accessing these benefits. 

b. RECOMMENDATION: Implement and Expand Guaranteed Basic Income Programs
We support the County’s continued investment in providing Guaranteed Basic Income (GBI) to former foster youth and hope that this program is sustained and expanded. This cash benefit provides people additional support to meet their basic needs and costs little to administer. The money enables recipients to spend less time worrying about their most basic needs, so they can better focus on eradicating barriers to economic and housing stability. We encourage the expansion of GBI to address the needs of other historically excluded groups, particularly those who have difficulty accessing the job market, such as people reentering our communities following periods of incarceration and people experiencing homelessness.

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5. Prioritize and Center Marginalized Voices in Government Decision-Making

a. RECOMMENDATION: Prioritize voting accessibility
The Law Foundation calls on all candidates for office to prioritize voting rights for those who may be unable to vote at a traditional in-person polling place during a short, set period. This includes people living with physical, intellectual, and mental health disabilities. Ways to increase access include day-of voter assistance hotlines, expanded vote by mail/online registration, implementation of accessible voting machines and materials, and providing poll-worker training on accessibility. We applaud our County’s efforts to make voting accessible and easy and hope these measures will be expanded to other communities.

b. RECOMMENDATION: Uplift voices of historically excluded communities
We also call on candidates to speak to the issues that people with disabilities face and to engage directly with these constituents. Too often, people with disabilities are written off as unable to engage in politics and current events when they are among those most affected by the outcomes of policy decisions. Law Foundation implores candidates to visit board and care homes, hospitals, nursing homes, and other care facilities to engage this sector of their constituency and listen to their concerns.

c. RECOMMENDATION: End felony disenfranchisement and restore voting rights for Californians who are currently incarcerated
At least half of those currently incarcerated in the United States are mental healthcare consumers. While Santa Clara County’s jails mostly detains people awaiting trial or sentencing, we know that Latinx residents are overrepresented in the County jail by nearly two-fold and Black residents are overrepresented by nearly four-fold compared to their percentage in the County overall. Due to disparities in enforcement, California’s prison population has similar racial disparities. By maintaining any kind of felony disenfranchisement, even while a sentence is served, we disproportionately strip away the voices of people with disabilities, particularly those who are Black, Indigenous, and Latinx. Disenfranchising this population excludes them from having a say in decisions that disproportionately impact their interests, fueling the prison-pipeline rather than investments in community well-being. We must restore voting rights.

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Endnotes

1. Charles G. Curie, “Special Section on Seclusion and Restraint: Commentary: SAMHSA’s Commitment to Eliminating the Use of Seclusion and Restraint,” Published Online: Sept. 2005 https://doi.org/10.1176/appi.ps.56.9.1139. 

2. Maria Martinez,Lucia Garcia “Return on Investment: How SSI Advocacy Became a Standard of Practice in San Francisco” (May 1, 2008). https://www.sfdph.org/dph/files/SSIdocs/ROI-SSIAdvocacySFrev05022008.pdf. 

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