HomeMy WebLinkAboutMINUTES - 06132000 - D3 3
Contra J9
TO: -BOARD OF SUPERVISORS ,'r` Costa
's
FROM: Supervisor Joe Canciamilla County
DATE: June 13, 2000 rA y
SUBJECT: CONSIDER ADOPTION OF A RESOLUTION OF SUPPORT FOR ASSEMBLY
BILL 1800, AN UPDATE OF THE LANTERMAN PETRIS SHORT ACT
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)AND JUSTIFICATION
RECOMMENDED ACTION:
1. Consider adoption of the attached resolution of support for Assembly Bill 1800, which provides for
an update of the Lanterman Petris Short Act related to services for the mentally ill.
2. If the Board of Supervisors acts to adopt the attached resolution, authorize the Chair of the Board
to prepare a transmittal letter to be sent to our State legislative delegation.
BACKGROUND INFORMATION:
The Lanterman Petris Short Act (5150 of the Welfare and Constitutions Code) was enacted to
integrate severely mentally ill persons with services in the community where care would be provided
in a more cost-effective, humane setting, But current provisions of the act require that a person be
found to be an immediate danger to self or to others, or be gravely disabled, before being
involuntarily held. As a consequence, state hospitals were emptied virtually overnight by placing
mentally ill persons back on the street even though sufficient services and funding were not in place
to provide the treatment and housing options necessary for them to function in our communities.
Access to quality public mental health services has improved, and will hopefully continue to improve
as policy makers give increasing attention to the needs of the mentally ill.
Changes are necessary, however, in the current legislation in order to allow for more effective
involuntary intervention for those who are so severely mentally ill that they refuse medical treatment
and deteriorate further without it.
Assemblywoman Helen MacLeod Thomson has introduced a bill, AB 1800, which will
implement the changes needed in this Act. A summary of the changes intended with the passage of
AB 1800, along with additional information, is attached for your review.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMNgDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S)
ACTION OF BOARD ON June 13. 2000 APPROVED AS RECOMMENDED: OTHER: XX
See the realtive Resolution No. 2000/309
VOTE OF SUPERVISORS: See the attached Addendum for Board action and vote .
UNANIMOUS(ABSENT )
AYE NOES-
I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY
OF AN ACTION TAKEN AND ENTERED ON THE MINUTES OF THE
T: AS BOARD OF SUPERVISORS ON THE DATE SHOWN.
ATTESTED
June 13, 2000
cc: County Administrator's Office PHIL BATCHELOR, LK OF THE BOARD OF
Dr.William Walker,Director-Health Services UPERVISORS ANCCD N ADMINISTRATOR
BY N W.r ir!
PUTY L)
ADDENDUM TO ITEM D. 3
June 13, 2000 Agenda
On this date,the Board of Supervisors considered the Adoption of a Resolution of Support for
Assembly Bill 1800, an update of the Lanterman Petris Short Act.
The Chair called for public comment, and the following people appeared to speak:
Herb Putnam, Chair, Contra Costa Mental Health Commission,presented the text of the
Commission's letter dated May 26, 2001. (see attached);
Lawrence Gault, 2201 San Jose Drive, #S— 105, Antioch;
Lynn Gurko, 4640 Deermeadow Way, Antioch;
Valerie Meredith,National Association of the Mentally Ill, 3517 Eagle Point Road,
Lafayette;
Lauren Jackson, (the Chair read her comments into the record); and
Barbara Anspaugh, 243 Village Place, Martinez.
Those desiring to speak having been heard, the Board discussed the matter.
The Board requested Donna Wigand, Mental Health Services Director, respond to their inquiries
about the proposed bill.
Following Board discussion, Supervisor Canciamilla moved that the Board support AB 1800
with the amendments specified in the Mental Commission's letter of May 26, 2001; and include
stating that the Board's support is contingent upon the legislation being fully funded by the State
of California to at least the level of$350 million dollars.
Supervisor DeSaulnier seconded the motion.
Supervisor Gioia noted he would not support the legislation because he would like the Mental
Health Commission to come back with a unified position,particularly the commitment standard
issue.
Following further Board consideration, the Chair called the question, the vote was as follows:
AYES: SUPERVISORS UILKEMA,CANCIAMILLA,DeSAULNIER and GERBER
NOES: NONE
ABSENT: NONE
ABSTAIN: SUPERVISOR GIOIA
—DY e �
The Boarb of Supervisors
of Contra Costa CountN
In t�a Matter of Resof ution No. 2 0 0 0/3 0 9
Su art, ie Passage
O f Assemble Bill 1800
WHER,AS,one of everq five Americans experiences a mental bisorber in aq given dear,anb
haf f of all Americans have such bisorbers at some time in their lives;anb
WHLRRAS, nearb two-thirbs of those suffering from mental illness never seek treatment of
anN kinb;anb
WH ASS the positive mental heafth of all our citizens contributes to a more healttT anb
successful community;anb
W"HERE.A.S�current Caw boes not provibe anN legal authoritN to intervene earlier to prevent
mental illnesses from becoming more severe or to give the inbivibuaC a better opportunity for more
effective treatment,nor is there ani legal requirement or provision for the necessary structureb anb
superviseb follow-up mental health care necessary in the community upon release from involuntaq
betention;anb
W ASE Assembf�Bill 1800 will upbate anb reorganize the 30 v ear olb involunta-q
commitment anb treatment laws o�the Lanterman Petris Short Act to provibe more timer intervention
for the mentallN ill in a more time anb less restrictive setting;anb
WHBREAS7 Assembfv Bill 1800 woulb create a six-month assisteb outpatient program option
for those who are stable anb wou[b benefit from superviseb,comprehensive treatment on an out-patient
basis;anb
WHBREAS,this upbate will also provibe an appropriation of$350 million to provibe the
community services necessaq to implement such a program;anb
WHEREAS, the passage of Assemb(N Bill 1800 will prevent the loss of billions of bollars per
year paib out in excessive sick leave anb Low-probuctivity through untreateb bepression in the work place,
woulb eliminate the loss of funbs paib 6 the State for multiple involuntarN holbs for people who bo not
seek out mental health services anb wilt assist our criminal justice sNstem bN provibing a sa f etN net for
the bisproportionate number of untreateb mentaffy ill persons who are incarcerateb.
NOW,THERE'( U,BE IT R OLV ED that the Boarb of Supervisors of the CountN of
Contra Costa,California,boes hereby approve a resolution of support for the passage of Assemb(N Bill
1800.
PASSED bN unanimous vote of the Boarb members present on this 13th bard of june,2oo0.
I herecert6 ti at the foregoing is a true anb correct copN of a resolution enterez on tie minutes of the oarb of
Supervisors on to bate a f oresaib.
witness rm�hanb anb the Seal of the Boarb of Supervisors
of f ixeb on this 13�of June,2.000.
PHIL$A'TCHELOP,Cleat of the Boarb of Supervisors
anb CountlN' Abministrator
B,I� A'JI'd , . 46
D ut
Introb b bv�:
ervis joe Canciamilta
istrict v
1 3n 12 SIU 11 : 31a mhce 925 P• 2CONSIOM ,s
NTH 1 2 goo
EARD OFs
MENTAL HEALTH CONSUMER CONCERM,
�. PATIENTS'RIGHTS ADVOCACY AND TRAINING;PEER SUPPORT SERVICES
1420 Willow Pass Road,Suite 120
Concord.CA 9457-0
June 11, 2000 'lel;(925)6446-5788
Fax:(925)646-5787
Supervisor Donna Gerber
851 Pine Street
Martinez, CA 94553
Pe: Statement in opposition to AB 1800
Clear Supervisor Gerber:
Mental Health Consumer Concerns was founded in 1878 by former psychiatric clients,
and now runs a number of advocacy and self-help programs. We are contracted to
operate the state-mandated patients' rights program in Contra Costa County. Our
duties include representing psychiatric patients at literally thousands of commitment
hearings every year under the current law. Thus, we are very familiar with how the
this low is actually implemented.
This week, the Board of Supervisors will be asked to take a position in support of AB
1800, a bill which will drastically change the laws protecting psychiatric patients'
rights in California. The recommendation comes to you from the county Mental Health
Commission, which originally voted overwhelmingly to o ' the bill. The
Commission does not have among its membership the five mental health clients that
the state law requires. Thus, the viewpoint of those who will most be affected by AB
1800 was not properly represented on the Commission.
We are opposed to AB 1800 for a number of reasons.
The most dangerous (and probably unconstitutional) provision in AB 1800 is the
proposed new definition of "grave: disability". Proponents of the bill claim it is
necessary to loosen the standard for commitment In this way because the current law
makes it Impossible to force people into psychiatric treatment who allegedly need help.
The fact is that under the current law, 127,000 Californians were held under the
provisions of Section 5150 of the Welfare and Institutions Code during fiscal year
1998-1899, the most recent year for which these statistics were available from the
State Department of Mental Health. Furthermore,these numbers have been increasing
every year.
Under the current low, if someone is clearly not able to tape care of himself or herself,
that person Is invariably held. The stereotype that is tieing promoted in the media by
AB 1800's proponents is that a person who is Incoherent and dressed in filthy smelly
Jun 12 Off! 11 : 31a mhee 925 646-5787 p. 3
s e--x_?-erd
rags, who sleeps in doorways and finds his or her food in dumpste+rs, will be found to
be taking care of his or her need for food, clothing and shelter and will not be hold.
Our experience with the actual workings of the current law belies this claim. i myself
have done hundreds of hearings representing the kind of person described. I have
never seen one single person in that condition be released at the hearing.
The reason people who need treatment can't get it is not that the current law prevents
them from being committed. It is that the services are not available. When a person
Is brought into a public hospital, they are often released after triage, not because the
law doesn't work, but because there are not enough resources to treat that person.
And it is unrealistic, to say the least, for the sponsors of AB 1800 to say that the
$350 million of now mental health funding called for in the bill will make it possible
for the needed services to he provided. I do not think there is a single member of the
state legislature who believes that $350 million will be appropriated, or that the
governor would sign for such an increase in mental health funding if it came to his
desk. Under the pretext of providing treatment, what this bill really does is create a
commitment standard that is so vague and loose that anyone could be committed.
Furthermore, the increase in commitments that this bill is sure to cause means that
Lantra Costa County will have to find a way to R1i1.Y for the increase in patients at the
county hospital. I point out that no funds at all have been appropriated for the bill by
the state legislature. Where will the county find the money for this?
Psychiatrists would be empowered to hold people based on a prediction that they
would come to physical or "psychiatric harm" If they were not treated. But in several
court cases over the lost twenty or twenty-five years, including Tara&, ff v, Regents
of the University of California, the American Psychiatric Association hes filed amicus
briefs in which they insisted that psychiatrists are not able to predict future behavior.
A number of studies done at about the time that the original LPS Act was passed
carne to the same conclusion. When psychiatrists are to be hold responsible for their
predictions,they complain that they are not really.able to make them accurately. They
should not be given the power now to be sable to detain people for over a month based
on a prediction that their own professional organization insists they are not able to
make.
By allowing commitment to be based on an opinion predicting the future, rather than
a behavioral standard, AB 1800 would set up a situation where, as a practical matter,
psychiatric patients would no longer be afforded meaningful hearings. This is true
because the only effective way one could counter the psychiatric testimony would be
to introduce psychiatric testimony of one's own. In the context of the commitment
hearing, which generally takes about fives or ten minutes and where the patient is
typically indigent, this would be impossible. All that the facility would have to do to
hold env patient would be to say that they were gravelly disabled.
And it has been our experiences even under the present law that patients are often
certified on all threw grounds, even though there may be no evidence whatsoever that
Jun 12 00 11 .32a mhcc 925 646-5767 ,)p. 4 1
they fit the criteria for more than one. This happens particularly in private, for-profit
hospitals, which have a financial motivation to hold the patient as long as possible,
or at least until the patient's insurance runs out. Presently, it is usually fairly easy for
the advocate to show that the patient doesn't fit the standard. Under AB 18 's
provisions, an accusation of grave disability could not be effectively countered.
The proposed new definition of grave disability is really a "need for treatment"
standard. This is exactly what was In the Welfare and Institutions Code before the
LIPS Act was adopted. tinder that standard, thousands of people rotted in state
hospitals because they had no legal recourse, since a more opinion that they needed
help was enough to keep them there.
Furthermore, the "need for treatment" standard that was then the criterion for
commitment in Florida law was struck down in 1975 by a unanimous United States
Supreme Court in Donaldson v. O'Connor. The Donaldson court held that the
government cannot constitutionally detain someone in a psychiatric facility if they are
"a danger to no one and able to survive safely In freedom". I urge you to note that
the standards the Supreme Court established in this case are precisely the standards
of the present LPS Act.
Since the entire thrust of AB 1800 is to make it easier to force people Into the mental
health system, and for a longer time, we are concerned about its other provisions as
well.
The bili would set up a system of forced outpatient commitment, euphemistically
called "community assisted treatment". While the bill's author claims such treatment
would be "voluntary", one must question how "voluntary" it can be when the
alternative is to stay locked up in a psychiatric facility for almost a month.
And again, where will the county find the money for such mandated outpatient
treatment, treatment that is unwanted by the person it is supposed to "help"?
As currently amended, AB 1600 says that patients who do not comply with the
outpatient commitment plan are to be returned to serve the remainder of the
underlying inpatient commitment by "court order". However, the bill falls to spall out
procedures that would be followed by the court. We are concerned that the due
process rights of patients be respected in any procedure that is devised. As the bili
stands now, It would leave to the courts, without any guidance from the legislature,
the task of devising a workable procedure.
AB 1800 puts much emphasis on "medication compliance", and seems to assume as
true the myth that psychiatric medications are wonder drugs that are completely safe
and have no harmful effects. In fact, there are now over two million people in the
United Staten suffering from tardive dyskinesia, a form of irreversible brain damage
caused by long-terra administration of psychiatric drugs. Among the most common
Mpy—,04— 14:16 P.02/02
CMA i+tdMi1E GNB ��
!t!�r►t +� A04n'ri#i+f
YJfiAvR 4E*;�llbiM �� + E'' `t r E: { w .• ,+.7t. Il �i
1/�MIYtr 11 P ia� req, tOMS
. Si.0Yr�4
Cwr 1' I
rriatiMtous�
N 1i�iijltJ' Jilt, Cl l7i�T1RKy't matt�
�P►ssnuxT S�Vic►Tr oxo 00"i
w .� WMAN&"04
ABMW
OWN"� 00
SUMMARY OF PROPOSED,AMENDMENTS TO AR 180K
=00 AW� "�M
• Adds details of the Community Assisted Outpatient Treatment Program (AOT)which
Include a M,ultidisel0naly team of physicians, psychologists, social workers. nurses,
peer counselors and other mental health providers to provide a specified stray of
intensive services designed to meet the individualized treatment, housing, and social
needs of the consumer.
• Provides for a mental health client to coordinate the delivery of AOT services to the
consumer.
• Specifies that the $350 million appropriation goes to the Department of Mental Health
for local assistance to those counties that implement an ACT for the purpose of this bill.
Specifies that up to 25% may be used for impatient services at the discretion of the
county department of mental health.
•► Revises new criteria for"gravely disabled" to "an acutesisX of Dhysm I ora ych ssttric
11 rn to the a—Mon it the absel3ce,of nt,'
• Clarifies upon si bearing %Icer,`ffi finQlna. the certified patient meets the qualifications for
the AOT program.
Clarifies that any consumer who breaks hl&rner AOT contract and poses a risk of acute
harm would be returned to the Initial hold by courtr-_r_der.
Restores language relating to the right to refuse treatment and clarifies the proposed
combined probable ceruse and capacity hearing process.
• Providers an option for appeal to superior court on the Initial capacity derAsion.
Requires that families who bring consumers home to avoid certification arra willing and
able to assist the consumer in meeting hl&%er medical end 28vchi®tr c needs.
• Clarifiers that the only provision of AB #BDO that applies in prfsons is the new"gravelly
disabled" criteria.
• Leaves unchanged: 'dear and convincing evidence", 2S-day hold, and postcertification
provisions.
"gab rcrrai. P.102
TOTAL P.02
' 9TATE CAPITOL
PO BOX 9426+9 CHAIR
SACRAMENTO.CA 94249.0006QQ SELECTCOMMMIEE ON
(916;319.2006 MEN'TAL HEALTH
-FAX(916131 11,2109
iOLANOCOUNTY I .tyIl 1 � � LEG!$(JRlVEET1iICSCOA4.ttTTEE
' i55 MASON$'BEET.SJ17E 275 `' iiLL
VACAV:.A.CA 95656 STAND04 COMMMUS
17^71 t6S•!^25 AGRICULTURE
FAX;7C7Itdd•0t90 APPIFICPRATIONS
HEALTH
YOLCCOUNrV HELEN MAcL.EOD vTHOMSON LOCALGOVERNWENT
r2MAIN.8A E7 wxnER,f�K$.AND WILDLIFE
WOG 301 Us,CA 91696 ASSEMBLYWOMAN,EIGHTH DISTRICT
(1301 U2-7667
FAX(53^,436-0770 amcr COMMMMS
AssisTAN-T SPEAKER PRo TEMPORE CALIFORNIA PORTS
"ail CALIFORNIA WINE
MNe1.W4"tW*sase+mtXxa.9w ROM GAMING
NATIVE AMERICAN REPATRIATION
website RURAL ECONO+fiC DEVELOPMENT
MI91n,rw.essenbq+CA pWblt NIV
iCMCOI FACILITIES FINANCE
JOINT COMIKI'TEE
FAIRS ALLOCATION AND CtAS$IFIOATION
SUMMARY OF AB 1800
Assisted outpatient treatment for the severely mentally ill
• Creates a voluntary contractual 6-month Assisted Outpatient Treatment Program for
those who have been certified for involuntary commitment and qualify for treatment on
an outpatient basis.
• Appropriates $350 million to provide the community services necessary to implement
the program.
• Allows greater access to community mental health services by expanding the existing
criteria for "gravely disabled" when the patient's prior history of mental illness again
presents clear evidence of a recurrence which poses a serious risk of substantial
deterioration that is likely to result in serious harm to the person in the absence of
treatment.
• Streamlines the hearing process by combining in one probable cause hearing the
certification that the person meets the commitment criteria and a determination whether
he/she has the capacity to consent to or refuse psychotropic medication.
• Eliminates the separate "Riese" hearing which requires the determination of capacity
only in the event the patient refuses medication.
• Provides that the burden of proof at trial for determining grave disability or a danger to
others be by clear and convincing evidence.
• Extends the 14 day hold to 28 days and eliminates the second 14 days.
• Extends the postcertification period to one year for those demonstrated to be dangerous
to others to provide more consistent and effective treatment as is provided those in
conservatorships for grave disability.
• Requires treatment criteria in prison to conform to the new community standards.
1/7/00
STATE CAPITOL
PC,BOX 9426AP .rty� r CK41A
SupA�9iEtSELECT CZMM"M ON
219.2008IN'O CA +90006 jy �y, l KSNALHEALTH
iAX 19�bi 379.7706 rr tt'(�t/„i`. ji ` j�3,a��yy }� ;*�` M
SOLANO COUNTY �I1tIII�'xC12� ae is tfu ae UGI51AMVEETHICSCOMMM7EE
• 655+AASC�:S"'REE*.SU!TE 275 L+i4 4 Gi {4iy"�6
VACAV;L.E CA 95666 CT ETANW4 C6 7MS
OV;455.6025 AGRICULTURE
FAX;70.j 05.0490 APP"RtATIONS
HEALTH
YOLOCOUNTY HELEN MACLEOD `THOMSON LOCAL GOVERNMENT
i12 AS ti STREET96695
9
WOOODLAr;r CA 66WATFA,PARKS.AND WI=FE
t53cI W-11167 ASSEMBLYWOMAN,EIGHTH DISTRICT
FAX t53:i 4DE•C770 swer C6MMITTTEES
Assisu r SPEAxER Pxo Tmmpon CALIFORMA PORTS
e-mail CAUFORNtA WINE
aan.~°y.`8.00.
AS 1800 FACT SHEET RO#.%VvING
NATIVE AMtERiCAN REPATRIATION
avtbaitr 6!4JRAL E".,ONOMIC DEVE:.'JPMEh7
!w nw.asar^yy.ea 9�+eramaon SCHOOL FACIU MES FINANCE
dOINT MNIMTTTEE
FAIRS ALLOCATION AND CLASSIFICATION
CURRENT LIPS LAW
Provides for involuntary commitment and treatment when a person's mental illness has progressed to
the point that they are suicidal, an immediate danger to others or totally unable to function in society,
There is no legal authority to intervene earlier to prevent mental illnesses from becoming that severe and
to give the person a better chance at more effective treatment. There is no legal requirement or
provisions for necessary structured and supervised follow-up mental health care in the community upon
release from involuntary detention.
WHAT THE BILL DOES
Provides $350 million for earlier intervention for those who have a history of mental illness in order to
give them access to timely, more effective treatment, It also creates a 6-month assisted outpatient
program option for those who are stable and would benefit from well-structured, supervised,
comprehensive treatment on an outpatient basis, It also streamlines the hearing process to combine in
one hearing both determinations for the need for commitment and the capacity to consent or refuse
treatment.
PUBLIC INTEREST
One out of every five Americans experiences a mental disorder in any given year, and half of all
Americans have such disorders at some time in their lives, but nearly two-thirds of them never seek
treatment, according to the Surgeon General of the United States. Ten to fifteen percent of state prison
and county jails populations are suffering from severe mental illnesses and ninety percent of those who
were arrested were not receiving any treatment at the time of the arrest. AS 1600 would update and
reorganize 30 year old involuntary commitment and treatment laws to make them a more effective tool
for delivering timely services to the severely mentally ill in the least restrictive setting.
PAYING FOR TIMELY TREATMENT SAVES PUBLIC AND PRIVATE DOLLARS
Today's alternative is businesses paying billions of dollars every year for excessive sick leave and low-
productivity through untreated depression in the work place, The state pays for the revolving door of
multiple involuntary holds for people who do not seek out mental health services, and our criminal justice
system providing the safety net for the disproportionate number of the untreated mentally ill who are
incarcerated. We can either pay less in timely humane intervention up front or continue the more
expensive status quo of shameful neglect and abandonment of the mentally ill.
SUPPORT
AB 1800 is widely supported by mental health provider organizations, law enforcement, consumers in
support of LPS reform, and countless family members who advocate for the mentally ill.
OTHER STATES
Eight other states have enacted laws to provide structured, supervised assisted outpatient treatment
programs for the severely mentally ill, most recently New York's Kendra's Law . It's past time for
California to provide more effective and humane commitment and treatment laws for its residents,
STATE CAPITOL }+�+� CWUR
PO SCx .20019 $E1ECT LTH
SACRAMENTO CA 94249.0006 iECTC:COMMITTEE
($1E:319.2006
FAX C916i 319.2109 CO
SOLANO COUNTY A ���
� f
TTEE
555 MASON STREETSJ�TE 276
YA E.CA'956E STAMM COMMITTEES
(707)16•112s AGRICULTURE
APPAOPPArO4
fAX(5'J7)40-0490
TH
VOLOCOUNT'Y HELEN MAcLEOD THOMSON GOVERNMENT
712 MA,N STREET WR BARKS.AND WILOUFE
WOM-ANC.CA 95695 XSSEMB.YWOMAN,EIGHTH DISTRICT
(5
30)ae2.7ea� SaXCT TW
fAxt53o;1Ja•ono ASSISTANT SPEAKER PRO TEMPORE CALIFORNIA PORTS
*.mail CNJFORNIA WINE
foie. mO-Mom aaae+nay.u.9cv PDXN GAMING
NATIVE AMERICAN REPATRIATION
Wobsfla RJRM.ECONOMIC DEVELOPMENT
MteJArn..ataamf+y,eA.pw.'elansan
iCN00:.fAACiL,RtES FlNA.tiCE
iow CCrw wrml!
FURS AidDCATiCEN AND CLASSIFlCAT iCN
INVOLUNTARY TREATMENT STUDIES
• The majority of individuals who refuse medication and were informed
that a determination had been made that they must accept treatment
subsequently accepted medication orally. (American Academy of
Psychiatry, 1996)
• The majority of patients who initially refused medication retrospectively
agreed that the decision to coercively medicate them was correct.
(American Academy of Psychiatry, 1996)
• The majority of patients who were involuntarily treated retrospectively
agreed that they would be more likely to accept treatment voluntarily in
the future. (American Academy of Psychiatry 1996; American Public
Health Association 117th Annual Meeting, Chicago, 1989)
+ The majority of patients who were involuntarily hospitalized
retrospectively agreed that they needed to be hospitalized. (American
Journal of Psychiatry, 1999)
• The majority of patients who had to be court ordered to comply with
treatment in the community remained treatment compliant after the court
orders expired. (Hospital and community Psychiatry, 1988; Iowa
Consortium for Mental Health, Services, Training, and Research, may
1998)
/_7'60
STATE CAPITOL ,py} 0"PSOX gYtt I�
SACRAMENTO'CA N249.OWS SELECT COMMITTEE ON
19i D;3�9.2008 20CD MENTAL HEALTH
F(9AX(918)319 -210D
FAIR
SOL ANO COUNTY ~ • *t• LEGISLATIVE ETHICSCOMM"TEE
555 MAS S-REE7.Se°TE 275
VACAV+L:LF CA95656 � � f STANDING COMMTTES
AGRICULTURE
(iC7ya55DC25
FAX(707)455.0490 APPROPRXIONS
VOLOCOUNTY HELEN MACLEOD TiioMSON
HEALTH
LOCAL
iO MAIN$TP.EET WATER.WKS.AND WILDLIFE
WOODLAND_7 95695 ASSEMBLYWOMAN,EIGHTH DISTRICT
15301 , 7667 SWCTCOMMITTEES
FAX(s3�,ao6•o-7o AssisTAiN7 SPEAKER PRo TEMPORE CALJFORNIAPORTS
�msti CALIFORNIA WINE
hekn.rr+anra+ftue"Oy CA Vv INDLA.N GAMING
LACK. OF INSIGHT NATIVE AMERICAN REPATRIATION
wrb4ke r FVkAL ECONOMIC DE'VELOPMEN r
Mtn fAwrw�.endr .0�.�O^+soa' A Compton symptom of severe mental i l G n ess SCHWL FACLITU FINANCE
.IOINT COMMRTEC
rWRS ALLOCATION AND CLASSIFICATION
• Impaired insight is a very common symptom of schizophrenia and
bipolar disorder (manic depression). Both inpatients and outpatients with
schizophrenia and bipolar disorder have sho Am the same rate of
unawareness -- approximately 50%. (Husted,J.,Journal of the American
Acaderny of Psychiatry d.Law, Vo1.27,#1,1999) (Amador et al, Archives of General
Psychiatn•, 1994)
• Being unaware of being ill — lacking insight—is strongly correlated with
nonadherence to treatment. (AmadorAT;Strauss DH; Yale SA; Gorman JM&
Endicott J. The American Journal of Psychiatry' 150:873-879, 1993.)
• Patients with schizophrenia and schizoaffective disorder with poor
insight have very poor adherence to either psychosocial treatment or
medication even when they have expressed their desire to participate and
work at the program. (Lysaker PH;Bell MD;Milstein R;Bryson G &Beam Golet
J. Insight and Psychiatric, Vol. 37, November 1994)
• Lack of insight not only leads to noncompliance with community
treatment but leads to the revolving door of involuntary hospitalizations.
McEvov JP, .F'reter S. Everett G, Geller JL, Appelbaum PS, Apperson LJ&Roth L.
(1989).Journal of Nervous and Mental Disease, 177(1):48-51)
• Studies of affective disorders find that lower levels of insight are
correlated with a poorer course of illness, lack of adherence to treatment
and increased involuntary hospitalizations. (Ghaenti NS& Pope HG, Jr. Lack
of Insight in Psychotic and Affective Disorders:A Review of Empirical Studies.
Harvard Review of Psychiatry, May/June:22-33, 1994.) (Also see Amador et al,
"Unawareness of Illness in Schizophrenia, Schizophrenia,
Schizoaffective and Affective Disorders,Archives of General Psychiatry, 1994)
• The inability of the noninsightful patients to understand they have a brain
disorder or to accurately evaluate their living conditions and plan for
daily needs supports the necessity for some form of"community assisted
treatment." Without supervision or court order, the person may not seek
treatment, or if temporarily coerced into treatment when hospitalized, be
unable or unwilling after discharge to comply with the treatment regime.
(Rusted, J., Journal of the American Academy of Psychiatry&Law, Vol. 27, #1,
1999)
Compliments Of
Assmb�nzn Httoo Thomson
Friday. ?March 14. 2004
�J U
Mjlldr
THE YOKE OF THE WEST
1
EDITORIALS
Hop' e for the Mentally III
I A bly Legislation
dClE1`Y'S TREATNIE:v'T of its se- In an effort to tum the tide of a system that
verely mentally ill is a disgrace. has not worked for California's mentally ill.
It is hardly humane to allow people Assemblywoman Helen Thomson. D.Davis.
not capable of making rational deci- has written legislation that would both
sions for themselves to lie in their own filth streamline the hearing process and extend
on the streets as members of the anonymous the time allowed for involuntary treatment.
homeless" population or to face prison The measure,AB 1800,was carefully wntten
terms rather than treatment to protect individual patient
options because they cannot rights, to ensure that the pa-
differentiate right fromWiQt Ct2lICI move tient had reliable ad.ocaey '
wrong, representation at hearings,to
Yet studies show that at the mentally Ill favor outpatient, over inpa- �
least one-third of homeless tient, care and to encourage
individuais and approximate- out p voluntary compliance. But it
} lv 16 percent of inmates in also recognizes that the
California tails and prisons homelessness choice for treatment cannot
are severely mentally ill — always be left up to the pa-
meaning they suffer from + � �" tients themselves. especially
schizophrenia,major depres- in the early stages of treat-
ission and other disabling con- treatment ment.
ditions, Each year, about 'T'homson's measure.
1.000 homicides are commit- which is scheduled for its
ted across the country by individuals with first legislative hearing in the Assembly
} severe mental illness. Health Committee on Tuesday. also would
E khat could change these deplorable cir- ,set aside 53 50 million for desperatelvneeded
{ cumstances is treatment. Even the most in- community services for the mentally ill.
sidious brain diseases can be successfully
treated, Current law, however, makes if very The bill is intended to provide people with
difficult to provide that treatment to people the care they need in the shortest time possi-
j who don't want it. The Catch-12 is that it ble and also Five doctors and the courts a E
takes treatment for many mentally ill people reasonable amount of time in which to suc- l
to understand that they would be better off ceed. Thomson's bill would help end the
%XAth rnSA;f-tet;^n my rnlirkcrlirta nr hnth tis nerlect and crminati7-stinn of the state's
7
114 Momcay.February 22.'999 -!a aaeramtn;c Bane
i
OPINION
.
107 — - `"' �gm: :alt ueG
M 11tal health uri& de'r- fue
Legislature tackles flawed reform of the past
he Lanterman•Petris-Short Act. either to jail or held briefly in local mental
California's landmark mental health health facilities.where they were stabilized
reform legislation of a generation ago. and released into the coma.,=' v until tie}
urgently needs reform of its own.Families of lapsed again.in an expensive.never-ending
.he mentally ill.mental health providers.law cycle.
enforcement officials and social secs-ice work-
ended
Ionizer conf;�.ed in hospitals.too n.an}•
ers have known this for some time. Legis:ators errden up either homeless or in jail or prison.
heard it last week when they received a report p'►%Ie only 4.000 patients still reside in state
from a state task force of doctors,police and hospital.an estimated 20,000 to 30.000 men-
social workers who have been looking for three tally ill are in our state prisons and local Jails.
years at the state's broken mental health sys• At least an equal number are homeless,
tem and the law upon which it is built. The task force has offered 12 recorr.znenda-
When first enacted 32 years ago. California's tions for change.The most controversial would
allow,under certain limited circumstances.
lacy facilitated the release of tens of thousand involuntary treaxrnenL of people=t�tiz ;?astir
-Si mentally al people from state hospitals. �
;There nra�av had been invoiuntarlr conilned. .f psychotic episodes. �,ritics of-ha= U11.1irn.
among.hem former mental patient.: .who :ear
in those days,it was easy to commit people -- a return of the forced ?.ospizaiiz3tie ws or'.:.ti
to,)easy,The task force estimates that some 70 past,have raises strong obiectiors.
percent of those who were located up in dreary,
sometimes ainumane state hospitals:asap Ott A-ss#,:pial:-womrin"Heler,7hurnrc r. zags
.here for no other reason than that tate were Bequel pressure is coming:4om fa.,:ii:es �.
alcoholics.senile,behaved oddly or.I ch idren. seriously aisturbed peupie such a: the motl.
di?r xotively. who wrote 'homson anout the plight r
ru
e:.antern.an-Petris-ShortAct secured for adult schi:.ophrenic daughter;viler:-r:*t::;..�= wc:
Che rentally `.Il.And hose falsely labeied as take her predication and dis tpperred `.'cr
such,long-overdue due-process safeguards.It :veeks.:`he desperate another found cr
provided that people cannot be involuntarily ter in a :u,—jless shelter in Oakia:.a W:::V is` er
ccnfnea;carless they pose a"danger to them- shed been raped :`�?peatr^.ly
selves and-sther s.'Enactment of the reform lea "kers wi_" i.ave to be careful that
to the release from state hospitals of thousands rerorm does not the nue-process rights
of perfectly,sane people.It also permitted the that proteex all cirazens Vair t arbit:arty cr)n-
release of ic=rizophrenics.manic depressives fnenxent and abuse. 3ut on farad :.zin�z 2], s:c�a
and others with serious meatal illnesses who in the mental health debate agree:�:c: -2f rm
were supposed to receive less restrictive carewill work if`the state fails to make :arra :Lr.:
in community-based programs. available.The money California nokr:ioerICS :c,
arrest,book,transport,adjudicate.hous;: am
hat's where the reform broke down. treat the mentally ill its prisons and jails coin'
Promised support for the truly mentally ill be more usefully and humanely spent to builri
*never materialized.Without it,many of them
the comprehensive commuaity.basea mental
stopped taking their predications or walked health system that www nrnmised by the earlier
3.00
� A !
rm amp
too
*;..
9� � v
f L V 9 C M
rr
-1
a� f
ave i
La ;
c o i " Mme'►
=IL
vc i
_ �r
..
A °,
Is JI
•to-ink ,
they arrived,Julie demanded they Fearing a deadly accident, Gon-
leave. Later that evening, Garza• zalez more than once called police.
Sacramento Bee lei want to sea her daughter,who "I told them Julie has a problem.
December 24, 1999 said."I think you're putting some. She is driving carelessly. I told
thing in my food to make me an. them a tragedy is going to hap.
gay"and told her to leave. pen."Gonzalez said.
On Father's Day the next year,
Julie invited her parents over for Like many with mental disor-
dinner, but just before serving it, ders,June appeared normal when
she dumped the meal in the gar. confronted by authorities, who
bage, Gonzalez recalled. On other said they couldn't do anything for
occasions, Julie accused her hus. her,Gonzalez said.
hand of harboring strangers in the Julie's brother, Richard Gonza-
attic and suspected her neighbor fez. also talked to police officers.
was plotting against her. 'They felt she could make her own
It wasn't until late 1996 that decisions." he said. "I was mad.
Gonzalez convinced Julie to come Maybe they didn't know she had a
with her to the Sacramento Coun- problem.But we knew."
ty mental health treatment een. Matt Powers,deputy chief of op-
ter,a locked facility offering treat• eratiors for the Sacramento Police
mans to voluntary and involun-
Lary mental health patients. Department. said current law re-
quires they observe dangerous be-
A therapist interviewed both havior before holding someone.
mother and daughter. Gonzalez "If this was the mid-1960s, my
L said they discussed Julia's para• gut feeling is it would have been
+ noia,anger and violent temper. easier to get her committed," he
The therapist later asked Gon. said of Julie. 'The law used to be
zalez if Julie had ever threatened more permissive,and government
anyone.She said no,and he decid. could deprive you of your liberties
ed not to hospitalize her. with far greater ease. Tragically,
"I was disappointed," Gonzalez this is the price that we,as a soci-
•aid. `They give her the number ety,pay to protect those liberties."
of a counselor (Julie) never After Priscilla was bom,Gonza-
Called." lez approached Julie's obstetrician
Julie did not sweet the criteria about her daughter's behavior.He
suspected depression and sug-
for involuntary treatment, Tom gested Julie we him. She refused,
Sullivan,county mental health di- telling her mother she was fine.
rector. said recently. "Even if she The doctor, who could not be
had been admitted.a hearing offi- reached for comment, never fol.
cer would have released her be•
cause there was no way to prove lowed up.Gonzalez said.
Gonzalez also triad discussing
she was a danger to herself or oth. the problem with Julie's social
ers, he said. And she wasn't worker through Aid to Families
gravely disabled because»he had with Dependent Children, the
food,shelter and clothing. county's welfare program.The so-
A Sacramento psychiatrist,who cial worker said she could not dis.
spoke on condition of anonymity, cuss her client because of confi-
agreed with Sullivans assess- dentiality rules.
ment: 'The law is so narrow it In spring 1998, Gonzalez again
doesn't matter that I am talking brouea Julie to the county men-
to myself, I am swatting things tal facili n she was evalu-
out of the air.that I think the dev- ated and let go with a suggestion
it is after ate.* to seek counseling.
In early 1997, pregnant with Sullivan, who called Julie "a
her third child.Julie left her hus- borderline case,"said if the county
band in Walnut Grove. She and had adequate resources a case-
her children moved into her par- worker could have seen her the
ants'south Sawamento home. next day to try to get her into
Her behavior was becoming in- treatment.
creasingly bizarre.She moved fur. Julie moved back with her hus.
niture and fed her children during band. 'twice in the summer of
sleepless nights,then pounded on 1998,sheriffs deputies responded
her parents' bedroom door de. to calls involving Julies violent
manding to know why they behavior. Her husband made the
wouldn't let her sleep. When her first call in July,but Julie had lA
weir AM"'t WMAP .kA a„wn a+i krr
i ..• � % ' i ter.`. a
vi; tic
IL
or
w arc,"°.$',+„Cis-
�o
SO gGA r 0.%a It ..
rr,
re � res'2 ;• r t a !e %
S. :-r ''� rte:
10
RE
r
r Sv 101 1W r,��,'i � � �'� '�' � lam;✓ y"3 ."'
..., 1�r+'$ " s 'is .
'
., ,� ...• :• s :
" i
lot
air
rill
la ', r
t t ",