Bill Pushed to Hospitalize Mentally Ill for Longer Periods

At 6 a.m., a woman dressed in filthy rags often wanders along Westwood Boulevard, talking to herself. Throughout the Los Angeles area, her counterparts are also beginning their days, sitting at bus stops, pushing shopping carts overloaded with belongings, sometimes yelling at passers-by.

Many of them are mentally ill, and Los Angeles County officials are pressing for state legislation that would permit authorities to keep these disturbed men and women in mental hospitals for longer periods than now allowed by law and to force them to continue treatment after their release.

“I think it is criminal to have a sick person sleeping on the corner exposed to the elements, a danger to himself and others, and not receiving proper treatment,” said County Supervisor Mike Antonovich, who is leading the move to change the state law.

In some ways, the effort resembles New York City Mayor Edward I. Koch’s controversial plan to remove seriously mentally disturbed people from streets. While the Los Angeles proposal is more limited than Koch’s plan, it may stir as much furor, with the American Civil Liberties Union and some mental health care advocacy groups preparing to fight it when the Legislature convenes in January.

“To say the problem is the law is to avoid the reality (that) there are no (mental hospital) beds available, no after-care available,” said Jim Price, an attorney with Mental Advocacy Services, an organization sponsored by the Los Angeles County and Beverly Hills Bar associations and the Mental Health Assn. The organization provides free legal services to the mentally ill and retarded.

The county proposal, contained in a bill by Assemblywoman Doris Allen (R-Cypress), makes major changes in the 20-year-old state Lanterman-Petris-Short Act, called “the Magna Carta of the mentally ill.” Aimed at stopping what sponsors said was the hurried and often illegal confinement in mental hospitals of thousands of people, the act tightened commitment standards and emphasized treatment of the mentally ill in community centers near their homes rather than in state hospitals.

But the Lanterman-Petris-Short Act, part of a 1960s nationwide move to shift treatment from hospitals to communities, has been increasingly criticized in recent years. The criticism has been sparked by growing numbers of homeless mentally ill on the streets and by families who find themselves unable to force disturbed children, spouses or parents to accept care.

The Allen bill would extend the time authorities can confine the mentally ill.

Currently, the disturbed can be held against their will for 72 hours for evaluation and treatment if relatives or authorities believe that they are dangerous to themselves or others, or are “gravely disabled,” unable to feed, clothe or shelter themselves.

If doctors believe that the disturbed need more treatment, they can be kept for an additional 14 days if a Superior Court hearing officer agrees. To hold the patients longer, authorities or relatives must persuade a Superior Court judge or jury in a trial that the disturbed are mentally ill and dangerous to others.

County officials have said that it is almost impossible to persuade judges or juries to do that. Of the 28,000 people held for 72 hours in 1986, 13,567 were confined for another 14 days, officials said. But county doctors sought court commitments for longer stays for only 10 people whom they believed could be proved to be a danger to others.

The Allen bill would permit doctors to obtain permission for a longer confinement without having to face a difficult Superior Court trial. Physicians could ask a hearing officer to grant another 30 days of confinement after patients have been held 14 days. In many cases, said Dr. Elsie Lu of the Los Angeles County Department of Mental Health, an architect of the bill, “it takes a minimum of 30 days to regulate the medication.”

As is the case today, doctors could discharge patients any time within the 14- or 30-day periods.

The Allen bill would also require released patients to accept out-patient care. Sponsors of the bill said they have not decided how to enforce that provision. Dr. Lu said one possibility would be to send the recalcitrant patients back to mental hospitals.

The Allen bill does not go as far as New York City’s approach. There, city authorities decided to re-interpret the State Mental Hygiene Law. The law permitted forced hospitalization of those considered likely to harm themselves. Under the Koch plan, psychiatrists approved commitment if they believed that the disturbed could harm themselves in the “foreseeable future.” The Allen bill makes no such change.

Yet it touched off strong opposition from the same forces that are opposing the Koch plan.

The coalition of civil libertarians and advocates for the mentally ill have said that increasing hospitalization will not solve the problem of growing numbers of mentally ill on the streets. Instead, they recommend less expensive, and in their opinion, more effective local community-care facilities.

Follow-up Care

“The problem with the system is that once people are stabilized, nothing is done in terms of after care, to make sure they will avoid the crises that put them in the hospital in the first place,” said Price of the Mental Health Advocacy Services.

“We favor the least restrictive approach, and this is the most restrictive approach,” said Marjorie Scwartz, legislative advocate for the American Civil Liberties Union.

Protesting that hospitalization is more costly than treatment at community clinics, she said, “All they are doing is tacking on 30 days of the most expensive care.”

State officials have also expressed doubts about the Allen bill, saying authorities, under current law, have enough power to confine the dangerous mentally ill.

By lengthening confinement, the Allen bill would require more beds in state mental hospitals, boosting state expenditures for the budget-conscious Administration of Gov. George Deukmejian.

The county is asking for additional state funds of up to $45 million to finance up to 600 more hospital beds, some in state hospitals and some in county hospitals.

Antonovich pressed for the money at a meeting with Dr. D. Michael O’Connor, state director of mental health, last month. But O’Connor was noncommittal.

“We had a good discussion of the issues, and we’re going to be working with the board (of supervisors). That’s all I can say,” he said.

Opponents of the Allen bill want expansion of the community-care approach they say has already been effective in Los Angeles County, despite a shortage of money.

An example of such programs is found on Los Angeles’ Skid Row, where a county mental health clinic in the Weingart Center treats homeless, mentally ill men and women, giving them medication to control their disorders, counseling and helping them to find places to live.

County mental health workers and private shelters, such as the Women’s Center and the Los Angeles Men’s Place, seek out the mentally ill on the street and slowly persuade them to accept treatment.

‘Basic Needs’

“We get people who have mental illness off the street in a tolerating environment that provides for their basic needs,” said Mollie Lowery, director of the Men’s Place. “We start re-integrating them into being a social person, building a relationship with staff and peers. . . . They feel comfortable about walking in. We don’t hassle them about a lot of stuff.

“They . . . start stabilizing, taking care of themselves, getting their entitlements (disability payments or pensions), using this place for mail. They start taking care of themselves hygienically.”

Eventually, the ill are persuaded to go to the nearby county clinic for treatment.

While supporting such efforts, Los Angeles County officials have said that they are not enough. Often, they said, it is hard to find sites for community clinics and halfway houses for the mentally ill because of neighborhood objections.

The Men’s Place, for example, has been trying to open a Skid Row residential facility, but has encountered stiff opposition from neighboring businesses. The businesses, defeated before a city zoning board, have taken their opposition to the City Council.

Antonovich conceded that the Allen bill would increase the number of patients in state and county hospitals.

“It would require a bigger state appropriation,” he said, “but this is appropriate. It would protect public safety.”