Forcing mental health treatment could get easier with new bill
A state senator is attempting to make it easier to force people into treatment when they are incapable of caring for themselves, the latest in a series of reforms intended to move Californians with severe mental illnesses off the streets.
Two new bills introduced by Sen. Susan Talamantes Eggman, a Stockton Democrat, would overhaul how the state handles conservatorships — a last-resort program for those who are incapacitated due to mental illness or addiction. The current system, which has been in place for decades, makes it difficult to help those with severe mental illness who are unable to take care of themselves. As a result, advocates of reform say too many people are left to wander the streets of the Bay Area and beyond — even when they are partially clothed, meandering into traffic and screaming at cars.
“We know that they deserve care. They are somebody's sister. They are somebody's mother,” Eggman said during a news conference this week to announce the bills. “It's so hard to explain to our children why we can't do better. This is the year that we are going to do better.”
The bills would revamp a statewide program through which courts appoint a conservator to control a patient's medication and treatment. Patients in the program are generally confined to a residential psychiatric facility.
The legislation comes at a time when the state as a whole is responding to an increasingly loud callto-action from those who are tired of seeing their incapacitated neighbors and loved ones living on the streets or bouncing in and out of hospitals without receiving meaningful and appropriate care. While expanding involuntary treatment has been controversial, conjuring grim images of mass institutionalization, officials increasingly are embracing the idea as the homelessness crisis worsens. Gov. Gavin Newsom's new CARE Court, signed into law last year, allows judges to order treatment plans for people in crisis. Those who refuse to follow the plan could be referred to a more restrictive conservatorship. San Francisco must start the new program by October, while the rest of the Bay Area must implement the law by December 2024.
This isn't the first time Eggman has tackled the state's fraught mental health system. She introduced a set of bills last
year tackling the same issues, most of which stalled or were vetoed before they could become law. This year, she's optimistic the outcome will be different. Her new bills have bipartisan support and are backed by the Big City Mayors Coalition, including San Jose Mayor Matt Mahan and San Francisco Mayor London Breed.
They still face opposition from civil rights groups that argue the state should not be expanding programs
that strip people of their autonomy.
“The response should be to invest in greater voluntary, culturally responsive mental health services and supports to help people get on a path to recovery while maintaining their dignity and civil rights,” Deb Roth, senior legislative advocate with Disability Rights California, said in an emailed statement. “The response should not be to make it easier to lock people up and strip them of their rights.”
And Eggman's bills do nothing to address one of the state's chief problems when it comes to mental health care: a lack of treatment resources. And it's unclear how many more people might enter conservatorships under the proposal or how much it would cost.
Senate Bill 43 would expand who qualifies both for a long-term conservatorship and for a short-term, involuntary stay in a psychiatric hospital. To be eligible for that type of intervention, someone must be “gravely disabled” — defined since 1967 to mean the patient is unable to provide for their food, clothing and shelter. The new legislation would broaden that definition to include, among other qualifications, the inability to seek medical care and keep themselves safe. The bill also specifies that an incapacitating addiction can qualify someone for involuntary care, and it makes it easier to use a patient's medical history when determining if they can care for themselves.
Senate Bill 363 would create an online dashboard to show where beds are available in psychiatric and substance-abuse facilities. While the tool by itself won't increase the state's sparse supply of beds, advocates hope it will make it easier for clinicians to refer patients to treatment.
“We know that California is in desperate need of beds,” Jessica Cruz, executive director of mental health organization NAMI California, said during this week's news conference. “This will at least provide us with a little bit of insight into beds that are actually available, but a whole lot of insight into the lack that we have available within the state.”
The state's broken mental health system is on full display in the Bay Area. In San Francisco, the city's new crisis response team fielded more than 14,000 calls over a year and a half, Mayor Breed said during this week's news conference. Many of the patients were placed on 72-hour involuntary holds in psychiatric facilities. But after that, the city had no power to force them into treatment or even into housing — something Breed described as a “tragedy.”
In 2021, a homeless man who was unable to care for himself was beaten to death in Oakland after a group of concerned neighbors spent months trying to get him placed in a conservatorship.
Patricia Fontana, a steering committee member for
Alameda County-based Families Advocating for the Seriously Mentally Ill, described Eggman's new legislation as very encouraging. Fontana's adult son, who has a diagnosis of schizoaffective disorder, has bounced in and out of homelessness, conservatorships and other programs for years to little avail because it was so hard to get early intervention and long-term care, Fontana said. Crisis responders said her son didn't qualify as “gravely disabled” because he knew the location of a garbage can where he could find something to eat, she said.
For now, her son has housing in Berkeley amid progress she described as “fragile.” The proposed reforms could help others like her son before they deteriorate dramatically.
“This is really a matter of life and death,” she said. “It's so, so important.”