For Mentally Ill and Society Too

Every day thousands of mentally ill Californians suffer on city streets or in jail cells, bedeviled by their inner torments. Think of Margaret Laverne Mitchell, the tiny homeless woman shot to death last year by a Los Angeles policeman after brandishing a screwdriver at him. Her family had tried for years to get her to accept treatment for her severe mental illness, to no avail.

Such people are victims not only of their illnesses but of a well-intentioned 1968 law called the Lanterman-Petris-Short Act, which essentially prohibits doctors from treating or medicating seriously mentally ill people against their wishes unless it can be proven that they are in imminent danger of harming themselves or others.

Wednesday night, the Assembly passed a bill by Assemblywoman Helen Thomson (D-Davis) that would sensibly loosen the law to allow involuntary treatment of a person who “presents, as a result of mental disorder, an acute risk of physical or psychiatric harm . . . in the absence of treatment.”

The current law was intended to protect mentally ill people from overzealous attempts to restrain and medicate them in institutions like the one fictionalized in “One Flew Over the Cuckoo’s Nest.” But in effectively barring treatment of the seriously mentally ill it has condemned them to cycling in and out of jails and prisons, often as a result of petty crimes.

In the 1960s, antipsychotic medications like Thorazine and Haldol had such severe side effects--including sedation, blurred vision, impaired memory and muscle stiffness--that some patients preferred their hallucinations. Since then, those drugs have been replaced by highly effective medications that have few adverse side effects and greatly enhance the patient’s ability to make rational decisions. The law denies such medications to the people most in need of them: those who are too sick to recognize their need for care.

Thomson’s bill faces an uphill battle in the state Senate, whose president pro tem, John Burton (D-San Francisco), sees it as “coercive.” Burton argues that the seriously mentally ill are being harmed not by the current law but by inadequate funding of the community health programs that were supposed to provide care after the state began closing its mental institutions three decades ago.

Burton is correct that the state has underfunded care for the seriously mentally ill. He should acknowledge, however, that the law itself is also an impediment to care.

Thomson’s legislation would not only give mental health professionals a tool to reach people who need treatment, it would help correct the underfunding problem by broadening the criteria used to determine eligibility for state-paid care. Enacting this bill, in addition to being moral, would be fiscally sensible. That’s because the cost of treating the seriously mentally ill with outpatient counseling and medication is far lower than the cost of letting their conditions deteriorate until they are incarcerated or hospitalized. The cost of arresting and adjudicating the mentally ill and keeping them in county jails and state prisons alone is estimated at $1.8 billion a year.

As the late Assemblyman Frank Lanterman himself concluded after observing the unintended effects of the legislation he sponsored, the law had come to “prevent those who need care from receiving it. The law has to be changed.”