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January 2, 2000

Reprinted with permission.  Copyright 2000 Ventura County Star.  All rights reserved.

If you are in an automobile accident and lose consciousness, should paramedics be able to whisk you immediately to a hospital for repairs to your damaged body? Or should they be forced to stand around until you regain consciousness and give them permission to act, or until a judge can be persuaded to rule that confining you without your consent in the emergency room is necessary to save your life?

We take it for granted that when we are injured in accidents or struck down by serious illness we will be provided medical care, even if the nature of the injury or illness makes it impossible for us to ask for help. Yet under California law, that same consideration generally is denied to people who suffer from one category of illness: severe mental disorders.

Laws intended to safeguard the civil rights of people suffering from such maladies as schizophrenia, clinical depression, bipolar disorder and dementia make it almost impossible to compel medical treatment or confinement. There is noble intent at the root of such laws; history is replete with tales of people locked up "for their own good" by relatives or strangers whose motives were less than admirable. In a nation that values personal liberty above all else, preventing involuntary confinement is a fundamental public interest.

In California, the law making it very difficult to treat or hold the mentally ill without their permission, the Lanterman-Petris-Short act, dates from 1967. Although it was motivated by true concern for individual rights, the law operates from presumptions about the nature of mental illness that subsequent scientific advances have shown to be deeply flawed. It is in need of revision, of the sort promised by new legislation awaiting lawmakers this month when they return from the holidays.

In effect, the LPS act prohibits anyone -- family member, police officer, doctor -- from pulling a mentally ill individual off the street, unless that person is deemed to pose a threat to himself or others. Even when that determination is made, the law provides for only a 72-hour hold for observation, which can be extended a maximum of 14 days if the threat persists. Involuntary commitment beyond that requires a lengthy, heavily bureaucratized process of hearings and paperwork, with the scales tipped decidedly against confinement.

In practice, this law -- which emptied the state's mental hospitals -- condemns the seriously disturbed and their families to life on a terrifying treadmill. Because severe mental disorders impair the very faculties required to make rational decisions about treatment, it is nearly impossible to obtain consent from someone in a delusional state. Families must stand helplessly by while a loved one stops taking stabilizing medication, deteriorates and arrives at a crisis. At that point, the police may intervene, sometimes with tragic results.

The bill amending the LPS Act, AB 1028, would streamline the hearing process, allow slightly longer periods of involuntary confinement for those deemed dangerous, and expand the criteria used to determine whether a patient is gravely disabled and therefore eligible for mandatory treatment. It would also appropriate $350 million to provide the necessary community services.

That last may be a major sticking point, given the governor's reluctance to authorize major new spending. Nevertheless, the changes wrought by AB 1028 are necessary and respectful of the delicate balance between civil liberty and societal self-protection. It deserves quick approval.

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