Sacramento, Ca—The Lanterman, Petris, Short (LPS) Act falls grossly short in protecting California’s most vulnerable citizens: people who suffer from the severest forms of mental illness, schizophrenia and manic-depressive illness. The LPS Act is antiquated, expensive and Byzantine in its procedures. It cries for immediate reform if Californians expect to reduce the tragedy of criminalization, violence, homelessness, victimization, and suicide that far too often accompanies untreated mental illness.

The current legislative scheme for providing involuntary treatment to people with mental illness is discriminatory. The legal criteria for assisted treatment should be based on the severity of an individual’s symptoms, not behavioral by-products such as dangerousness, as is currently the standard. We abandon no other people suffering from medical illnesses. No one would leave a person delirious with a high fever to lash out in danger before providing him or her involuntary medical care. That person would be taken to the hospital and given medication until their symptoms abated sufficiently for them to make a rationale decision regarding continuing treatment.

Yet for people suffering some of the most devastating brain diseases known to mankind, we do not offer this level of assistance. Instead, we leave 49,500 of them on California’s streets or put them in our jails or prisons when behavioral outgrowths of their untreated illness lead to criminalization. Waiting for danger is too late as shown in the cases of Evan Dickinson, Kathryn Schoonover, Victoria Maderia and Tom Neville.

Even when a person qualifies under the current stringent standards for involuntary hospitalization, the person may still not receive needed medical care. Current law allows an involuntarily hospitalized psychiatric patient to refuse medication. The person languishes without treatment in an expensive acute care hospital bed as lawyers and physicians jockey through a multi-layered judicial labyrinth that seems to protect the person’s esoteric civil liberties more than their right to life. Only too frequently, under the triage of managed care, does this lead to premature discharge with the person no better after receiving hospitalization than before because they did not receive imperative medication. As one former patient with mental illness put it, "It is cruel and inhumane to abandon the untreated mentally ill to the streets based on a misconstrued argument for personal freedom."

A woeful failure to provide ongoing follow-up care for patients discharged from hospitals has sent many Californians with the severest forms of brain disease spinning through an endless revolving door of short-term hospital admissions, jailings and homelessness. Due to the way the LPS Act is written many psychiatric hospital emergency rooms are like battleground triage stations. Doctors desperately work to bandage psychic wounds, with their patients spending no more time in the hospital than necessary to receive a shower and some meals before the law requires they be discharged. Once discharged, there is no procedure which allows mandated medication supervision, daily living structure and rehabilitative support for those people who require it to maintain their recovery once back in the community.

The lack of treatment options and community supports have hardest hit the state’s jails and prison systems. There are an estimated 20,000 to 30,000 mentally ill inmates in California’s jails and prisons today. The LA County jail is called the nation’s largest psychiatric hospital. The expense is enormous. According to the Pacific Research Institute for Public Policy, the total cost to catch, adjudicate and incarcerate people with severe mental illness is between $1.2 to $1.8 billion annually. Mental illness can never be ‘punished’ out of its victim. It does respond to medical treatment.

Why are people living on the streets and in jail when tremendous scientific advances have been made in both understanding these illnesses and in developing new, effective treatments that help people lead productive lives? This defies common sense.

The problem is that some people with mental illness cannot accept community services voluntarily because brain dysfunction precludes about half of those who suffer schizophrenia or manic-depressive illness to have awareness of their disease. They do not recognize that the symptoms of their illness – hallucinations, delusions, paranoia and withdrawal – are, in fact, symptoms. To them, the symptoms are reality. Some of these individuals consistently refuse to take needed medication because they do not believe they are sick. For these individuals the only manner by which they can maintain their treatment regimes is through some form of continuing assisted treatment once they have been discharged to the community. And our current laws do not provide it. Conditional hospital discharge and conservatorships must be utilized to ensure these discharged patients with a continuity of treatment and medication.

For the last three years, a dedicated group of people intimately involved with involuntary treatment of people with mental illness – psychiatrists, family members, patients, psychologists, mental health workers, lawyers and law enforcement officers – have studied the glaring gaps within the LPS Act. We have come up with a legislative proposal that protects and enhances the individual’s civil rights and allows needed intervention, therapeutically and continually, when the individual is too ill to access that treatment for him or herself.

Specifically, we believe that the following provisions of reform must be enacted to adequately protect individuals with severe mental illness and their communities:

1. The treatment criteria must be expanded to allow treatment when the person has substantially deteriorated in functioning due to mental illness and the individual does not have the capacity to initiate or continue treatment on their own.
2. Administratively, the procedures within the LPS Act must be streamlined to be both cost effective and therapeutic. Capacity to refuse medication as well as detention issues must be considered in an immediate, automatic due process hearing shortly following hospitalization.
3. "Community Assisted Treatment" must be legislatively mandated to require the mental health system to provide the person who revolves through repeated hospitalizations, homelessness or jailings a continuously implemented and monitored treatment plan that is court-ordered once the person is released from acute care hospitalization.
4. The conservatorship laws must be available to any person who requires supervision and guardianship for long-term well being irrespective of the initial criteria under which the person was hospitalized.
5. Emergency crisis intervention teams and law enforcement personnel must be uniformly trained in compassionate response to de-escalate potentially violent situations and respectfully protect the individual and their families from the ravages of untreated disease.

Strengthening the LPS Act will end the days of Californians complacently accepting increasing rates of violence, incarceration, victimization, homelessness and suicide for its citizens with brain disorders. We can no longer be immune to the pain and suffering of people with untreated mental illness. They are not societal flotsam to live under our bridges and on our streets. People with mental illness are part of our community and they deserve the protection of society when they are too ill to provide it for themselves.

We look forward to working with our state legislators and Governor Gray Davis to make LPS reform a reality so that the welfare and potential of all Californians are protected.

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