SAN FRANCISCO — A homeless man plagued by schizophrenia is beaten to death by police in Fullerton. A man from Fort Bragg fixates on aliens for years while denying he is ill, then kills two men before dying in a gunfight with law enforcement. A Nevada County mental health client who had refused additional care storms into a clinic and kills three workers.
Those headline grabbers, according to a task force pressing to change the California law that governs involuntary civil commitment to psychiatric hospitals, were merely the most visible signs of a broken system.
Tens of thousands of mentally ill people wind up each year in California jails and prisons, cycle in and out of overburdened hospital emergency rooms or die on the streets.
California's pioneering Lanterman-Petris-Short Act, passed in 1967, gave legal rights to those who previously could have been locked up indefinitely and treated against their will. But the task force — made up of family members, mental health professionals, judges and public defenders — contends that the law has failed those unable or unwilling to seek help.
They are calling for sweeping changes that would allow the involuntary commitment of those deemed incapable of making treatment decisions, expand the use of conservatorships, lengthen involuntary hospital stays and standardize the checkerboard way the law has been applied from county to county.
"Nobody wants to round people up and tie them down and give them shots," said task force member Mark Gale, a mental health activist whose son has a diagnosed schizoaffective disorder. "What we want is for people who should be evaluated to get that evaluation, and for people who need crisis care to get crisis care."
The self-appointed group recently released its report after 30 months of study. And some of its recommendations are likely to receive broad consensus. Among them: consistent application of the law statewide, interagency coordination to ensure that patients are promptly placed in appropriate hospitals, availability of crisis stabilization services in every county, and standardized training for police and others who respond to those in need.
But proposals that would broaden the terms of involuntary commitment and conservatorship touch the third rail of mental health policy — and are likely to provoke a familiar contentious debate.
One camp, which includes client organizations and advocates, asserts that only voluntary care can truly be effective. The other, dominated by medical professionals and family members, says illnesses such as schizophrenia and bipolar disorder often make sufferers incapable of the insight needed to engage in care voluntarily.
Furthermore, they note, jails, prisons and repeated brief hospital confinements end up delivering involuntary care regardless — at great cost.
"I'd go so far as to say that involuntary treatment has increased since implementation" of the act, said Randall Hagar, a task force member and director of government affairs for the California Psychiatric Assn.
Nearly 200,000 people in California get their outpatient services every year in a jail setting," he said. "Something is really wrong with this picture."
The report already has provoked outrage, most notably for its push to redefine "gravely disabled" to include an individual's "capacity to make informed consent to treatment and assess their ability to care for their health and safety."
"If I could send a message to the LPS Reform Task Force … I would like to tell them to please keep their mental health laws off my body," said Charmaine Asher of Yorba Linda, 25, who has been diagnosed as suffering from major depression and treated against her will.
The client voice is nonexistent in the report, she said, adding that "there is no healing when force is involved."
Dan Brzovic, an Oakland-based attorney with Disability Rights California, said "there is room for reform of the mental health system, and some of these proposals should be seriously considered." But, he said, any effort to extend stays or broaden the definitions that allow for involuntary commitment should be strongly opposed.
"You place someone in a facility if they're dangerous to society or themselves or unable to take care of themselves," Brzovic said. "As we get away from that standard, while you may help some people, you have the potential of roping people in who don't belong."
Assemblyman Michael Allen (D-Santa Rosa) said he hoped to take on a broad examination of the issues in the fall.
"Everyone agrees that voluntary care is preferable to anything done on an involuntary basis," he said. "But at what point ... do we change things so people don't have to go back to court multiple times to get a treatment plan for a loved one who doesn't believe they are mentally ill?"