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The Long Beach Press-Telegram

December 17, 1999

Reprinted with permission.  Copyright 1999 The Long Beach Press-Telegram.  All rights reserved.

Reform Mental Treatment Bill: Deciding Who Needs Help--Against Their Will

The key changes are only a few hundred words, and if they get enacted into law they will save thousands of families desperately seeking help for loved ones who have slipped into the midnight fog of mental illness.

In a news conference Thursday, Assemblywoman Helen Thompson unveiled the heart of Assembly Bill 1028, a landmark revision to the 1967 Lanterman-Petris-Short Act. The 1967 LPS law was a bold attempt to cure the abuses of the state's mental hospital system, but it has gone badly awry.

We expect there will be an intense discussion of these few hundred words.  Deciding when people must receive mental treatment against their will - starting with a 72-hour hold - is an awesome responsibility.

For example, what does "gravely disabled" mean? Right now, it's anyone who can't provide clothing, food or shelter. But under that vague standard, a weeping depressive woman attracting sympathetic handouts in Belmont Shore is considered capable of supporting herself and can't receive any meaningful treatment.

A hallucinating schizophrenic who can wrap himself in a blanket, fish a Big Mac out of a trash can, and sleep under a freeway also can meet that criterion.

No wonder we have a revolving door where emergency room psychiatrists repeatedly release psychotic individuals back onto the street, sometimes only hours after they have been brought in.

AB 1028 would allow authorities to account for a prior history of mental illness, coupled with clear evidence of a recurrence that risks serious deterioration and serious harm. That would deal with the nightmare faced by those who see a productive family member relapse into psychosis.

Under current law, someone who meets the standards of being a danger to himself or others can be held 14 days longer, which doesn't allow much time for intensive treatment. AB 1028 would extend that period to 28 days.

The bill would also eliminate a tragically cumbersome form of due process, where one hearing is held for involuntary commitment, while another is required before patients can be given medication against their will.

It's not surprising that schizophrenics would refuse medication, since a key symptom is the inability to recognize that one is mentally ill. A patient admitted just before the weekend begins might spend nearly a week before getting medicated.

That's particularly unfortunate, since most serious disorders are biologically-based and respond to chemical treatment.

The key to the bill is a six-month voluntary, community-assisted outpatient program. Patients could opt for the program as an alternative to a 28-day hold, or at the end of a 28-day treatment program.

Ideally, this scenario would work something like an advance directive.  A person who had been stabilized through medication would understand the benefits of staying on a program of therapy and treatment.

Signing up would be voluntary, but after that, the six-month hitch would be mandatory. So if people stopped taking their medication in the mistaken belief that they were cured, they could be put back into inpatient treatment.

The proviso is that a community-assisted treatment program is available to help the person. If the $350 million in funding is dropped from the bill, AB 1028 will fall prey to the same disasters that followed the 1960s deinstitutionalization of the mentally ill.

There may be attempts to change this bill. Sometimes, the result is a grand, finely-honed compromise. Other times, the result is mush. 

There's a lot of pain behind the years-long crusade to reform the Lanterman-Petris-Short Act. No matter what happens, the essence of this bill must be preserved. Anything else would be a cruel fraud.

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