Homeless problem spurs need to change mental health rules
LOS ANGELES — When Gov. Ronald Reagan signed the Mental Health Act of 1967, the legislation signaled a new era in the treatment of mentally ill Californians.
Also known as the Lanterman-Petris-Short Act, the law recognized that not everyone with a mental illness needed to be confined to a state-run psychiatric hospital. Section 5150 established guidelines for the detention of “mentally disordered persons” up to 72 hours for assessment and treatment.
The 1967 law has become a valuable tool for law enforcement agencies and mental health professionals dealing with people living on the street.
But with homelessness surging throughout California, some argue that the 5150 provision needs to expanded, giving authorities wider latitude in deciding when someone should be removed from the streets.
Legislators in Sacramento will consider this question in the coming months as they debate Assembly Bill 1971. The measure, introduced by Assembly members Miguel Santiago, D-Los Angeles, and Laura Friedman, D-Glendale, would include those who are unable to seek treatment for serious medical conditions.
In 2017, more than 800 homeless people died in L.A. County from medical conditions that are considered to be preventable, records show. There is no estimating who among these were mentally ill, but it is acknowledged that mentally ill people are least likely to perceive how dangerous and unhealthy their living environments are.
“Individuals are falling through the cracks,” said Eric Matos, a deputy for Los Angeles County Supervisor Kathryn Barger, who co-sponsored a county motion supporting the bill.
Under the current law, people can be detained if they are deemed to be a danger to themselves or others, or are “gravely disabled,” which is defined primarily as being unable to provide food, clothing or shelter for themselves, or to understand the nature and severity of their illness. Such holds can be extended up to a month and eventually include conservatorship for more than a year.
But Matos describes a scenario in which people with a life-threatening medical condition could not be helped under the law because they are not considered gravely disabled. They scrounge for food in a trash bin, sleep under an overpass and rummage for clothes at a thrift store.
“What we’re trying to do is change what initiates a conservatorship to include getting medical treatment,” Matos said.
Proponents see the measure as an extra tool for law enforcement agencies, mental health professionals and outreach workers when they find someone who’s sick or injured.
“I actually don’t see this as an expansion of grave disability but a clarification,” Dr. Jonathan Sherin, L.A. County’s mental health director, told the Board of Supervisors in January. At their request, Sherin helped develop the language that would become the basis for AB 1971.
“It’s a red flag for us to recognize,” Sherin said. “It’s an objective measure that judges will be able to use and properly apply by considering the data when they’re making a determination about whether someone is gravely disabled.”
The Los Angeles County Council of the National Alliance on Mental Illness supports the additional language.
Critics, however, argue that without proper resources and support such as housing and case management, medical treatment will be ineffective.
“To sponsor legislation to amend Lanterman-Petris-Short so that being gravely disabled includes not seeking medical treatment imagines that there is somewhere to go and somewhere to stay,” said Supervisor Shelia Kuehl, who cast the board’s lone vote opposing the county motion.
Without housing and longterm assistance, she argued, the new law will not be enough to keep people safe.
Kuehl also raised a concern over “forced treatment.”
“The medical establishment has made decisions for people, taking away their rights to make decisions for themselves in the past in some very egregious ways,” she said, making a case for further measures that would protect the autonomy and civil rights of people who might qualify for this hold.
For some homeless advocates, it’s a delicate balance.
“Our position has been in the middle,” said Megan Hustings, with the National Coalition of the Homeless. “We understand there are some people who are a danger to themselves and others and the community needs to respond, but the idea of involuntary or forced action is difficult when we’re in a massive affordable-housing crisis.”
When the Lanterman-PetrisShort Act went into effect in 1972, it was one of the first attempts in the country to wrestle mental-health care away from the often cruel and antiquated practice of incarcerating the mentally ill, indefinitely and involuntarily.
The goal of establishing county facilities throughout the state for treating the mentally ill was never realized. Meager funding from the state and local government limited treatment options, and mentally ill people often ended up on the street.