Administrative/Regulatory
Jun. 18, 2002
Budget Crisis Could Prevent Passage of Bill for Mentally Ill
LOS ANGELES - State lawmakers are moving toward passage of AB1421, a measure that would expand the state's ability to treat people with mental illness without their consent.
However, the bill's passage is far from certain given the statewide budget crisis and concerns for the civil liberties of the mentally ill.
The primary obstacle to the bill's passage, according to sources who attended the Senate hearings last week, is the $33 million statewide reduction in spending for mental health programs for 2002-03.
"In a year when existing mental health programs are being cut back, should we initiate a new expensive program?" one mental health expert asked. "Or do we cut back services such as therapy and medication for people who want treatment so we can provide treatment for people who are resisting?"
Mental health officials in Los Angeles estimated a cost to the county of $28 million but nonetheless supported the proposal - provided the state will pay. San Francisco County officials supported the measure but offered no cost estimate.
In addition, the California Judicial Council opposed AB1421 unless amended to reimburse courts for an estimated $5 million in increased costs for hearing additional commitment petitions that could result.
After two days of in-depth hearings last week, the Senate Health and Human Services Committee will vote Wednesday whether to approve AB1421.
"Serious concerns about significant issues were raised," said one mental health expert who attended the hearings. "Advocates for the bill want to expand the existing conservatorship laws, but doing that through a program with no funding without supplanting existing mental health services in a budget crisis is tough."
The bill would allow family members, roommates or law enforcers to petition the court for an order to involuntarily treat mentally disordered individuals on an outpatient basis for up to 180 days.
Opponents say the state cannot afford to treat the thousands of individuals with mental illness who would volunteer for such treatment.
However, the bill's supporters point to deaths of innocent bystanders at the hands of psychotic individuals and the struggles of family members to deal with mentally ill relatives as reasons why it should pass.
AB1421 has cleaved the mental health community for two years, at times pitting the Senate leader, Speaker Pro Tem John Burton, D-San Francisco, against the bill's strong-willed author, Assemblywoman Helen Thomson, D-Davis.
Thomson, a former nurse, has fought doggedly for the proposal, naming it "Laura's Law" for 19-year-old Laura Wilcox, who was shot to death in 2001 by a mentally ill client at the Nevada County clinic where she worked.
Thomson has alienated fellow legislators and advocates for the mentally ill with what some see as an unbending dedication to her core constituents on the issue - the law enforcers who regularly deal with individuals who are homeless and mentally ill, and family members of the mentally ill who live at home.
"If you take comments from legislators and make changes but don't remove your opposition, then you haven't gotten to the heart of their concerns," one legislative consultant said.
Thomson's critics further say she has manipulated the public and the press by emphasizing the Wilcox tragedy along with the death of Mike Bowers, a former mental patient at Patton State Hospital who rammed his truck into the Capitol last year and died.
Calls to Thomson's office seeking comment were not returned.
Sources said the chair of the Health and Human Services Committee, Sen. Deborah Ortiz, D-Sacramento, criticized Thomson during the hearings for naming her bill Laura's Law because the legislation does not address the situation presented by the man responsible for Wilcox's death, who was receiving treatment at the time.
"It's clear that [Thomson's] posture has been manipulation," said Jim Preis, executive director of Los Angeles' Mental Health Advocacy Services Inc. "But I'm not sure if that translates to votes."
Ortiz could not be reached for comment.
If AB1421 is approved Wednesday - it needs seven votes on a committee of 12 - it would move to the Senate Judiciary Committee for further debate and approval before going to a full Senate vote.
In 2000, the state Assembly voted 65-1 in favor of the measure. However, it was never approved by the Senate.
More than 40 states have similar laws, including New York, which has enacted "Kendra's Law," named for Kendra Webdale, who in 1999 was pushed to her death under a subway train by a schizophrenic man.
Civil libertarians in New York objected to the law, but according to Preis, that opposition was overshadowed by public safety concerns and the support of law enforcers.
In the past, Burton has blocked the bill in the Senate on the grounds that involuntary outpatient treatment violates individuals' civil liberties. However, he reportedly has offered Thomson his support - provided she addresses concerns expressed by other lawmakers in the Senate.
Under state law, people who present a grave danger to themselves or others may be committed in a hospital for 72 hours, with additional procedures for commitment of up to six months.
AB1421 would expand the law to allow courts to order treatment on an outpatient basis for 72 hours or up to 180 days.
Aside from its cost, law makers and advocates expressed concern last week that the bill does not protect the rights of individuals with mental disorders, and it expands the ability of people without mental health expertise to bring a petition for commitment before the court.
According to sources who attended the hearings, Ortiz expressed concern that the bill does not contain pre-screening guidelines to protect individuals' rights. In New York, sources said, the court throws out 50 percent of commitment petitions for lack of just cause.
"[Thomson's] opponents want a screening component that at least is similar to what we already have in our [inpatient] commitment laws," one observer said.
Sen. Martha Escutia, D-Montebello - who chairs the Senate Judiciary Committee, which could be the next to hear the bill - also was concerned that there are no provisions to lift a commitment order before 180 days are up if it seems warranted, sources said.
Existing laws allow psychiatrists to re-evaluate people who have been committed to see whether they can be safely released from the hospital.
Escutia could not be reached for comment.
Sources also reported that representatives of the Judicial Council said AB1421 could lead to litigation regarding individuals' civil liberties which could increase court costs with no means of reimbursement.
"Even if [Thomson] makes some of the changes people suggested, she will have to ask for more money in the bill, and she doesn't want to do that," one legislative aide said.
Preis presented a compromise proposal on behalf of Richard Van Horn, chief executive officer of the Mental Health Association of Los Angeles County, which would allow for a 180-day outpatient conservatorship for individuals unable to provide themselves with food, clothing or shelter, if it could be shown that involuntary treatment would prevent them from being dangerous to others.
Others suggested patience and further study of the bill to determine whether a court order and comprehensive mental health services are actually more effective in treating people with mental illness than a system of voluntary treatment that offers similar services.
Unless Thomson agrees to radically amend her bill, however, the Health and Human Services Committee will vote on some version of the current one on Wednesday.
Escutia reportedly has instructed the Senate Judiciary Committee to be ready to hear further debate on AB1421 should it pass.
Jeffrey Anderson
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