California’s treatment of people with serious mental illness discriminates against those with the most severe mental illnesses, according to a special task force report entitled, “Separate and Not Equal: The Case for Updating California’s Mental Health Treatment Law,” issued March 18,2012 (A previous, 1999 Task Force Report is Here)
The report, written and researched by the LPS Reform Task Force II – a think tank of medical and legal experts with first-hand experience dealing with California’s mental health laws – includes 14 specific recommendations for reforming California’s 50 year old Lanterman-Petris-Short Act, which was originally designed to govern involuntary commitment to psychiatric hospitals.
“Repetitive psychiatric hospitalizations, jailings and the tragedies surrounding untreated mental illness are exceedingly costly to California taxpayers,” said Carla Jacobs, co-chair of the Task Force. “The cause of this stupendous waste of money and lives is an inadequate and scientifically antiquated set of mental health treatment laws in California known as the Lanterman-Petris-Short Act. The law as it now stands affords no consistency in treatment and thus kills rather than helps.” According to the Task Force report, unless the Lanterman-Petris-Short Act is reformed:
- Untreated mental illness will remain a main “feeder” to the state’s jail and prison system.
- Hospital emergency rooms will continue to be a dumping ground for mentally ill patients, and will be unable to provide the treatment resources necessary to assist individuals in crisis. Not only is this inappropriate, it can endanger staff, the general public and people with mental illness themselves.
- City streets will remain open air asylums where people with mental illness are brutally victimized or, in some cases, may victimize others.
- California’s promises of mental health treatment for all its citizens will remain unfilled.
“Serious mental illness is a medical condition. In our society, people suffering other medical conditions receive stabilizing treatment even if they are too ill to consent to that treatment,” said Dr. Cameron Quanbeck, forensic psychiatrist and member of the Task Force. “But California’s mental health legal system requires that a seriously disabled individual with mental illness deteriorate so far that they be in an imminently dangerous position prior to receiving society’s help. That’s discrimination plain and simple.” Ms. Jacobs added: “Prompt treatment and equal protection for individuals with severe mental illness requires that California make some tough decisions. Are we willing to continue with needless tragedies that are preventable or will we reform our laws to assure that the most severely disabled amongst us have a chance at recovery and wellness? The LPS Reform Task Force report issues the challenge and solution. It’s time for change. Frankly, it’s beyond time. We can no longer afford neglecting severely mentally ill people. Waiting for danger is too late.”
Following is a brief summary of recommendations contained in this report.
- Implement Assisted Outpatient Treatment (Laura’s Law) statewide.
- Define “Grave Disability” to address the individuals’ capacity to make informed consent to treatment and assess their ability to care for their health and safety.
- Adopt concurrent legal processes to determine probable cause for hospitalization and capacity to refuse medication in one hearing.
- Conform initial acute care hospital certification periods to 28 days, renewable for 28 days. Consider less restrictive alternatives to hospitalization at each hearing or upon renewal of holds.
- Establish criteria for an LPS conservatorship to be “grave disability” as defined under Recommendation # 1 of this report.
Establish conservatorships by clear and convincing evidence. Revise procedures to allow for efficient application and due process for conservatorships applied for from community settings.
- Authorize an additional 90 day certification to continue acute care hospitalization for individuals whom the demonstrated dangerousness standard in WIC 5300, with a right of appeal. Provide notice of application for impending post certification commitment under WIC 5300 to County District Attorneys and Public Defenders 30 days before expiration of the 90 day certification. Commitment should be for one year, renewable, with the relevant historical course of the individual’s illness considered during the trial, and demonstrated danger established by clear and convincing evidence.
- Adopt a statewide standardized form to record the historical course of a person’s illness.
- Develop local systems of interagency coordination to ensure timely transportation and placement in facilities appropriate to the person’s needed level of care.
- Ensure Medi-Cal definitions for voluntary and involuntary hospitalization are consistently defined, monitored and applied. Appeals should conducted by a neutral third party.
- Prioritize services to the most seriously disabled adults with a mental illness whether those services are needed on a voluntary or involuntary basis in the community or a hospital setting.
- Expand mental health courts in all jurisdictions and increase the capacity
and utilization of current mental health calendars statewide.
- Conform local emergency response capability in each county under a legislative framework that requires standardized training for all designated response entities.
- Set uniform state custodial standards for who can generate a 5150 hold and clarify who can enforce, release or continue that hold.
- Ensure statewide uniform application of the Lanterman Petris Short Act to achieve equity and equal protection for all consumers statewide.