One of unfortunate the side effects of the lockdowns from the coronavirus is an increase in the manifestations of mental illness. An August 14 CDC report found 40 percent of adults suffered mental health problems related to coping with “physical distancing and stay-at-home orders.”
Most of those afflicted will return to normal mental health. But some of these people will join what, in California, is already a serious crisis of mental health.
That’s why a long-awaited report from the California State Auditor couldn’t be more timely. The title is a good summary: “Lanterman-Petris-Short Act: California Has Not Ensured That Individuals With Serious Mental Illnesses Receive Adequate Ongoing Care.”
Called the LPS Act for short, it was hastily enacted in 1967 by the California Legislature in the final moments of Session, and signed into law by Gov. Ronald Reagan. Numerous modifications have been made since then, which are explained in my office’s report from January, “A History of the Lanterman-Petris-Short Act.”
The LPS Act is in desperate need of reform. The number of homeless individuals on our streets with severe mental illness should be enough evidence that something is out of kilter.
In his February State of the State address, even Gov. Gavin Newsom called for reforms to the LPS Act, which I commended. He was responding to a homelessness crisis largely caused by mental illness – a crisis that is only going to get worse if some form of involuntary holds are not pursued.
The new state audit affirmed that more must be done with the LPS Act to assist those who need long-term assisted outpatient treatment, something I have been advocating for a long time. Also lacking was the counter-balance the LPS Act required, the closing of California’s mental institutions. Sacramento was to replace them with community facilities.
The state has failed in this regard and has not provided the needed facilities promised a half-century ago.
Inadequate Long-Term Care
Specifically, the audit found, “Individuals exiting involuntary holds have not been enrolled consistently in subsequent care to help them live safely in their communities – in two counties, no more than 9 percent of these individuals were connected to ongoing care.”
In 2013, with the assistance of then-Senate President pro Tem Darrell Steinberg, D-Sacramento (now that city’s mayor), I was able to obtain funding from the Mental Health Services Act (Proposition 63 from 2004). SB 585, by Steinberg, funded what is known as assisted outpatient treatment. This is an appropriate medical regimen to assist someone dealing with severe mental illness, like schizophrenia. Orange County was the second county to implement what is known as Laura’s Law in 2014. Another 17 counties have since done the same.
According to the Audit, that means only 19 of the state’s 58 counties “have adopted assisted outpatient treatment, even though it is an effective community‑based approach to mental health treatment to help prevent future involuntary holds and conservatorships.”
It recommended, “Mental health reporting requirements should be overhauled to capture comprehensive spending information as well as outcomes for programs.”
A special problem was patients cycling in and out of the system with multiple short-term holds, as shown in this graph:
Five Reform Bills
There are legislative solutions and we have a governor who is sympathetic to this plight. Accordingly, earlier this year I introduced five bills to address and improve the LPS Act. But two things prevented me from advancing them. First, the coronavirus dramatically truncated or eliminated non-coronavirus-related bills in the Legislature. Consequently, all five bills were dropped by myself or at the request of a Committee Chair.
The second is a debate over civil rights, with forces demanding that severely mentally ill individuals on our streets be left there because an involuntary hold is inhumane. I would argue that leaving them on the streets, unmedicated and untreated, is inhumane.
Dynamics change from session to session, even in years without a pandemic. But, some form of forward movement must occur. Here are the five bills I had to relinquish for now:
- SB 1250 would make it the intent of the Legislature to repeal and replace the LPS Act with something better that reflects the needs of today.
- SB 1251 would authorize any county or city to adopt conservatorship provisions for the severely mentally ill within their jurisdictions.
- SB 1252 would revise the statutory advance health care directive form to clarify that a person may include instructions relating to mental health treatment.
- SB 1253 concerns the legal restraint order on any person to prevent acts of domestic violence, abuse and sexual abuse. The bill would authorize a court to issue an order requiring the restrained party to participate in a mental health recovery program.
- SB 1254 would authorize certain persons to petition the court for the appointment of a guardian ad litem.
With the California Auditor’s report in hand, let’s see what can be accomplished next year in the mental health space. With a clearly identified problem, Sacramento must provide solutions. It cannot wait another half century.
John M. W. Moorlach, R-Costa Mesa, represents the 37th District in the California Legislature
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