A Law to Reclaim Lives

Many street corners and other public spaces in California have come to resemble open-air insane asylums. Sometimes muttering obscenities and lashing out at invisible demons, the state’s estimated 50,000 mentally ill homeless people often have just each other and the streets. Government pays attention only after they harm someone or otherwise break the law. Even then, the typical response--tossing them in jail, then releasing them without any required follow-up care--does nothing to redirect them into productive lives.

This week the Assembly Judiciary Committee will consider legislation by Assembly- woman Helen Thomson (D-Davis) that would solve a key part of the problem. AB 1421 would amend the Lanterman-Petris-Short Act, a well-intentioned but ultimately misguided law passed in the 1960s that bars doctors, judges and counselors from compelling seriously mentally ill people to be treated unless it can be proven they are at imminent risk of harming themselves or others.

The law was intended to protect what was seen as the civil right of mentally ill people to be free from the overzealous restraints that were common at the time--primarily medications like Thorazine and Haldol, with their harsh side effects like sedation, blurred vision, impaired memory and muscle stiffness. But today, highly effective medications with few adverse side effects greatly enhance patients’ decision-making ability. The law, as outmoded as Thorazine, denies helpful medications to people who are too sick to recognize their need for care.

At a series of town hall meetings organized to support Thomson’s bill in recent months, relatives of victims harmed by untreated mentally ill people have detailed how the act’s original intention went awry. At a rally at UCLA earlier this month, Cindy Soto said she found little comfort in knowing that a paranoid schizophrenic who refused treatment is now in prison after plowing his Cadillac into 30 children at a Costa Mesa playground in 1999, killing Soto’s daughter and another child. “Do you think [he] is better off in prison than he is in a treatment program?” Soto asked. “Am I better off without my daughter? There is nothing civil or right about that.”

Last year, Senate President Pro Tem John Burton (D-San Francisco) successfully opposed a similar version of the bill out of fear that it would abrogate the civil rights of the mentally ill. Burton has not come out against AB 1421, however, in large part because this year’s version includes due process rights and other safeguards to ensure that families and a range of mental health professionals are consulted before medication or other treatment is compelled. The state revenue drain caused by the power crisis makes it unlikely that the fiscal part of AB 1421 would be funded: a $50-million provision calling for “the delivery of community-based care by multidisciplinary teams of highly trained mental health professionals with staff-to-client ratios of not more than 1 to 10.” Even so, changing the Lanterman-Petris-Short Act would allow public health workers to better serve the mentally ill using existing--if woefully insufficient--resources.

Adequately funding community services for the seriously mentally ill, using successful models like Long Beach’s the Village and Wisconsin’s PACT program, makes sense. Well-conceived continuing care--including group housing, therapy, daily supervision and job assistance--has been shown to reduce costly hospitalizations and incarcerations by more than half.

Although the fiscal crisis may have foreclosed legislative consideration of such long-term care, at the very least lawmakers should pass the cost-neutral portions of AB 1421. It is high time for Sacramento to recognize that the only civil entitlement the current law protects is the right to a future dashed by debilitating illness.