Measure on Detaining Mentally Ill Planned

Vowing to reopen debate over California’s landmark mental health care law, two legislators Wednesday proposed the first bill in a decade to make it easier for authorities to treat severely mentally ill people against their will.

The legislation would overhaul the 1967 Lanterman-Petris-Short Act that helped speed the emptying of state hospitals for the mentally ill, and greatly expanded the rights of severely mentally ill people to refuse treatment.

The bill by Assemblywoman Helen Thomson (D-Davis) and Sen. Don Perata (D-Alameda) would permit psychiatrists to treat individuals for up to 28 days after they have been detained on initial 72-hour holds. In extreme cases, judges could deem “gravely disabled” individuals to be a danger to others and order them held in hospitals for up to a year.

“I’m trying to walk a narrow line and not overreach,” Thomson said. “I’m not talking about going back to the state hospital system. That’s not where we are in the evolution of mental health care.”

The bill, a newly amended version of AB 1028, would permit mentally ill people to be released from hospitals earlier if they agree to follow treatment plans, including taking prescribed medication and getting counseling. If patients failed to live up to what essentially would be contracts, they could be returned to hospitals involuntarily.

California is one of 12 states that has no provision for involuntary treatment of severely mentally people living outside institutions.

The legislation, perhaps the most ambitious measure of what probably will be several bills dealing with mental health, will be the focus of intense debate shortly after lawmakers return in January.

Under the Legislature’s rules, the measure will die unless it passes the Assembly by Jan. 31. The bill then would head to the Senate, where some key lawmakers are skeptical that current law needs a major overhaul.

The legislation already is the focus of intense discussion on the Internet. Patients’ rights groups are wary of attempts to require treatment, while family members decry their inability to get help for loved ones.

“Within the mental health community, this is incredibly controversial,” said attorney Jim Preis, of Mental Health Advocacy Services in Los Angeles, a legal aid group. “There is no middle ground when the issue is expanding involuntary treatment.”

The legislation comes as several other lawmakers have called for improvements to the state’s system of caring for California’s about 630,000 severely mentally ill people. Three decades after the state began emptying its hospitals, mental health experts believe about half the people suffering schizophrenia, manic depression and other severe mental illness receive treatment.

On Wednesday, Republicans in the state Senate called for spending an additional $10 million to treat homeless mentally ill people. That would double the amount being spent on such people this year.

In their proposal, Thomson and Perata are calling for an annual expenditure of $350 million more for treatment. Aides to Gov. Gray Davis say they doubt Davis would boost mental health care spending that much in a single year.

The legislation is similar to a bill recently signed into law in New York. The New York measure was dubbed “Kendra’s law,” for Kendra Webdale, a 32-year-old woman who died in January after being shoved in front a train, allegedly by a man with a long history of mental illness and hospital commitments. New York increased spending by more than $400 million.

The Thomson-Perata proposal would broaden the criteria for determining whether a person is “gravely disabled” and thus in need of mental health care. Current law says people are gravely disabled if they cannot provide “basic personal needs for food, clothing or shelter.”

The legislation would add to that language by allowing authorities to look at whether an individual has a “prior history of mental illness and again presents clear evidence of a recurrence that poses a serious risk” that would result in “serious harm to the person in the absence of treatment.”

In California, about 100,000 people a year are detained on 72-hour mental health holds; in Los Angeles County in 1998 that number was 43,000. That process would not change under the proposed legislation. Police and other authorities still could use the law to hold people at hospitals for observation for 72 hours.

But Thomson and Perata propose that after that three-day period ends, there would be several changes:

* If individuals are determined to be dangerous to themselves or others, they could be held for an additional 28 days, rather than the current 14 days.

* At the end of that 28-day period, there would be a hearing. A judge could conclude that the individual is a danger to himself or herself. After such a finding, the person would receive treatment for up to six months, either in an institution or on the outside.

* If the person is deemed to be a danger to others, he or she could be held for up to a year, rather than the current six months.

The legislation also would make it easier for prison authorities to require treatment of inmates who are severely mentally ill. About 24,000 of the state’s 162,000 state prison inmates--or 15%--are severely mentally ill.

Additionally, the legislation would loosen the standard that judges use when placing individuals on yearlong conservatorships, in which county public guardians or others help care for them.

As a result of a 1979 California Supreme Court ruling, courts now must conclude “beyond a reasonable doubt” that individuals cannot care for their own needs before they appoint conservators.

That standard is the hardest of all to meet, and is the same one used by judges and juries to determine guilt in a criminal case. Thomson and Perata propose lowering the standard to that of “clear and convincing evidence,” itself a difficult legal standard to meet.

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Times staff writer Julie Marquis in Los Angeles contributed to this story.