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Proposed bills could lead to more people being forced into mental health treatment

San Diego Union-Tribune - 3/1/2023

San Diego Mayor Todd Gloria joined other California mayors in Sacramento on Wednesday to urge support for a bill that could increase the number of people ordered into conservatorship or treatment because of serious mental health issues.

Senate Bill 43, proposed by state Sen. Susan Eggman (D-Stockton), would broaden the term "gravely disabled," which in California is the condition a person must be in before involuntary treatment for mental health can be ordered. The rule dates back to California's 1967 Lanterman-Petris-Short Act, which defines "gravely disabled" as the inability to clothe, feed or shelter oneself.

Advocates who support broadening the term have argued for years that the narrow definition sets the bar for involuntary treatment too high, resulting in many people with brain disorders living in homelessness and even dying on the street. Opponents have argued it could result in unnecessarily committing people to involuntary treatment, while other steps should be taken to improve the mental health system.

Gloria said the bill would redefine the term to apply to someone who is not able to care for his or her medical needs and is at substantial risk of death, organ failure or other serious conditions.

"Our current rules absolutely do not make any sense," Gloria said. "When I'm often asked, 'Mayor, why aren't you doing something about this person who is screaming at the top of their lungs on the street corner?' And when I say, 'They're not a threat to themselves or others,' that rings hollow. And when I deliver that message, it doesn't feel good to me, either, because I know that person is sick. I know that person needs help."

At the Sacramento press conference, Eggman said the bill will include people who have substance use disorders that can result in the risk of serious harm.

The bill is similar to last year's Senate Bill 1416, which was proposed by Eggman but did not get a hearing in the Judiciary Committee. Gloria said he is optimistic that the new bill will be heard this year in the committee, which now is chaired by Assemblymember Brian Maienschein, who served on the San Diego City Council from 2000-2008.

The bill also is similar to Senate Bill 232 proposed by state Sen. Roger Niello (R-Sacramento), which would redefine "gravely disabled" to mean a condition in which a person is incapable of making informed decisions about basic needs or medical care without significant supervision and assistance, placing them at risk of substantial bodily harm.

The proposals are just the latest legislative acts to mandate mental health treatment for more people. The creation of Laura's Law in 2002 allowed for court-ordered assisted outpatient treatment for people with serious mental illness and a recent history of psychiatric hospitalizations, incarcerations or violent behavior. Gov. Gavin Newsom has called the results disappointing and last year noted that only 218 people in the state were subjected to it in 2021.

The state also is launching the Community Assistance, Recovery and Empowerment (CARE) Court, which could lead to mandated treatment for many more people with mental health and substance use disorders.

Others attending Wednesday's press conference in Sacramento included San Francisco Mayor London Breed, San Jose Mayor Matt Mahan, Anaheim Mayor Ashleigh Aitken, state Sen. Scott Wiener (D-San Francisco), National Alliance on Mental Illness CEO Jessica Cruz and NAMI member Teresa Pasquini, Psychiatric Physicians Alliance of California member Dr. Collin Shumate and California State Association of Psychiatrists member Dr. Emily Wood.

Several speakers acknowledged past opposition from civil rights organizations such as Disability Rights California, the American Civil Liberties Union and the Western Center on Law and Poverty, which argued that there was not sufficient evidence to justify expanding the definition, which could infringe on civil rights.

"This is not about mass institutionalization like some people would say in a very alarmist way," Wiener said, adding that the change would affect a small and focused group of people.

"We will no longer settle for the status quo that has forced too many of our loved ones to die with their rights on," Pasquini said. "It's time for a right to treatment before tragedy. It's time that we all care together."

Asked to comment on Eggman's bill, Deb Roth, a senior legislative advocate with Disability Rights California, said her organization opposes it.

"The bill expands the definition of 'gravely disabled' in a way that is highly speculative and will lead to locking more people up against their will and depriving them of fundamental rights, including privacy and liberty," she said. "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. The response should not be to make it easier to lock people up and strip them of their rights."

Linda Mimms, a Poway resident and vice chair of the national Schizophrenia & Psychosis Action Alliance. has called for a change in the definition of "gravely disabled" for years and said she supports Eggman's bill.

"I know the new definition is going to be much more inclusive and based on medical necessity," she said. "The current definition is not based on medical necessity. The LPS (Lanterman-Petris-Short) definition of 'gravely disabled' has been responsible for untold suffering and untold death across our state for over 55 years."

Mimms said she sees the action as a medical policy issue, not a civil rights issue.

Eggman also has introduced Senate Bill 363, which would create a database to identify in real time the availability of beds in chemical dependency recovery hospitals, acute psychiatric hospitals, mental health rehabilitation centers and other facilities.

"It makes no sense for mental health professionals to be on the phone, with a notebook, calling places to see if there's a bed for somebody in desperate need," Eggman said.

This story originally appeared in San Diego Union-Tribune.

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