BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 364
AUTHOR: Steinberg
AMENDED: April 15, 2013
HEARING DATE: April 24, 2013
CONSULTANT: Bain
SUBJECT : Mental Health.
SUMMARY : Broadens the types of facilities that can be used for
purposes of a 72-hour treatment and evaluation under Section
5150 of the Lanterman-Petris-Short Act (LPS Act) for individuals
with a mental health disorder to include facilities licensed or
certified as mental health treatment facilities by the
Department of Health Care Services (DHCS) or the Department of
Public Health (DPH). Permits county mental health directors to
develop procedures for the designation and training of
professionals who will be designated to perform functions under
Section 5150.
Existing law:
1.Provides, under the LPS Act, for the involuntary commitment
and treatment of individuals with specified mental disorders
and for the protection of committed individuals.
2.States legislative intent regarding the LPS Act, which
includes ending inappropriate, indefinite, and involuntary
commitment of mentally disordered persons, developmentally
disabled persons, and persons impaired by chronic alcoholism,
and eliminating legal disabilities and protecting mentally
disordered persons and developmentally disabled persons.
3.Authorizes, under Section 5150 of the LPS Act, a peace
officer, member of the attending staff of an evaluation
facility designated by the county, or other professional
person designated by the county, upon probable cause, to take
a person with a mental disorder who is a danger to himself or
herself, a danger to others, or who is gravely disabled, into
custody and place him or her in a facility designated by the
county and approved as a facility for 72-hour treatment and
evaluation.
4.Requires a person who is taking into custody for a 72-hour
treatment and evaluation to be provided specified information
Continued---
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orally, and requires a person who is admitted for a 72-hour
evaluation and treatment to be provided specified information.
This bill:
1.Broadens existing legislative intent language in the LPS Act
to provide prompt evaluation and treatment of persons with
mental health disorders, instead of "serious" mental health
disorders in existing law.
2.Adds to existing legislative intent regarding the LPS Act (a)
to provide consistent standards for protection of the personal
rights of persons receiving services under the LPS Act and
under the Children's Civil Commitment and Mental Health
Treatment Act of 1988 and (b) to provide services in the least
restrictive setting appropriate to the needs of each person
receiving services under those two bodies of law.
3.Updates definitions within the LPS Act by clarifying that
"telehealth" is included within the definition of
"evaluation," by including within the definition of "crisis
intervention" to clarify that the interview or interviews
conducted as part of crisis intervention may include family
members, significant support persons, providers, or other
entities or individuals, as appropriate and as authorized by
law.
4.States legislative intent that referrals between facilities,
providers, and other organizations be facilitated by the
sharing of information and records in accordance with
applicable federal and state laws and an existing law
provision requiring confidentiality of information and
records.
5.Encourages each county mental health department's Internet Web
site to include a current list of ambulatory services and
other resources for persons with mental health disorders and
substance abuse in the county that may be accessed by
providers and consumers of mental health services. Encourages
the list of services on the Internet Web site to be updated at
least annually by the county.
6.Permits the county mental health director to develop
procedures for the county's designation and training of
professionals who will be designated to perform functions
under Section 5150. Permits these procedures to include, but
are not limited to, the following:
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a. The license types, practice disciplines, and
clinical experience of professionals eligible to be
designated by the county;
b. The initial and ongoing training and testing
requirements for professionals eligible to be
designated by the county;
c. The application and approval processes for
professionals seeking to be designated by the county,
including the timeframe for initial designation and
procedures for renewal of the designation; and
d. The county's process for monitoring and
reviewing professionals designated by the county to
ensure appropriate compliance with state law,
regulations, and county procedures.
7.Clarifies that a "professional person in charge of an
evaluation facility designated by the county" may take or
cause to taken a person with a mental disorder for a 72-hour
treatment and evaluation.
8.Permits a person with a mental health disorder to be taken
into custody for assessment evaluation and treatment or placed
in a facility, instead of being placed in a facility under
existing law.
9.Requires the facility, for purposes of a 72-hour treatment and
evaluation, to be licensed or certified as mental health
treatment facility by the Department of Health Care Services
or the Department of Public Health (instead of "approved" by
the Department of Social Services as a facility for 72-hour
treatment and evaluation under existing law).
10. Permits assessment, evaluation and crisis intervention to
be provided by a professional person in charge of an
evaluation facility designated by the county, or by a
professional person designated by the county.
11. Requires "a professional person designated by the county"
to provide evaluation, crisis intervention or other inpatient
or outpatient services on a voluntary basis, if the person can
be properly served without being detained (current law limits
who can perform evaluation, crisis intervention and other
inpatient and outpatient services to "professional persons in
charge of the facility designated by the county").
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12. Requires, if probable cause for detaining a person is based
on a statement of a person other than a peace officer, member
of the attending staff, or professional person, the identify
of the person and portions of the person's statement relevant
to the determination of probable cause to be documented in the
application, and requires a copy of the application to be
provided to the person being detained.
13. Expands the definition of "responsible relative" for
purposes of documenting who can take possession of the
property of a person with a mental illness who has been taken
into custody to include a domestic partner, grandparent or
grandchild.
14. Requires the oral advisements currently required to be
given to a person when he or she is first taken into custody
be provided in a language or modality accessible to the
person. Requires, if the person cannot understand an oral
advisement, the information to be provided in writing.
Requires the person be told to inform the person taking him or
her into custody if the individual needs assistance turning
off any appliance or water. Requires, when a person is
admitted to a designated facility, accommodations for other
disabilities that may impact communication to be made.
15. Requires, when a person is admitted to a designated
facility, the information he or she is provided include that
the individual can request to be treated at a facility of
their choice, and that the person will be given a choice of
providers. Requires the person be told he or she can contact
the county's Patients' Rights Advocates if they have questions
about their legal rights.
16. Requires, for each patient admitted for a 72-hour
evaluation and treatment, the facility to keep in the
patient's record the language or modality used to communicate
the advisement.
17. Updates language in the LPS Act (such as changing "mentally
disordered persons" to "persons with mental health disorders")
and rearranges provisions of the LPS Act to have the statute
align with the sequence of events and to move provisions
dealing with voluntary treatment earlier in the statute.
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FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee
COMMENTS :
1.Author's statement. Unfortunately, Section 5150 of Welfare and
Institutions Code has become part of a modern day vernacular
that implies an individual is being locked-up, and put away.
SB 364 is intended to change this construct by making focused
changes to this section of the landmark LPS Act which was, and
remains to this day, a civil rights act for persons with
mental health disorders to ensure their personal rights. SB
364 makes several fundamental changes. First, it broadens the
types of facilities a county can designate for 5150 purposes
to include licensed facilities, such as psychiatric hospital
facilities, free-standing acute psychiatric hospitals and
psychiatric units in general hospitals, as well as certified
facilities such as crisis stabilization units. This will
provide counties with more options for assisting clients with
significant and grave needs, can assist in alleviating
emergency room wait times for this client population, and most
importantly, can offer a less restrictive environment for a
client to receive necessary assistance.
Second, this bill authorizes county mental health directors to
develop procedures for the county designation of LPS
facilities and the training of professionals who perform the
functions of Section 5150. This change will improve
consistency across counties for the application of 5150
protocols as well as serve as a quality improvement tool for
professionals to be specifically trained in the 5150 process.
Further, SB 364 restructures and recasts several provisions of
the 5150 process to more clearly articulate the sequencing of
events, as well as the need for mental health treatment. It
clarifies upfront that if a person can be treated without
being detained, they can be transitioned for evaluation,
crisis intervention or other inpatient or outpatient services
on a voluntary basis.
2.5150 of the LPS Act. Section 5150 law allows peace officers,
member of the attending staff of an evaluation facility
designated by the county, or other professional person
designated by the county to take an individual into custody if
they believe that, due to a mental disorder, an individual is:
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a. A danger to himself or herself;
b. A danger to others; or
c. Gravely disabled (gravely disabled is defined as a
condition in which a person, as a result of a mental disorder,
is unable to provide for his or her basic personal needs for
food, clothing or shelter).
Under existing law, the person taking an individual into
custody must take reasonable pre-cautions to safeguard their
property, advise the individual that this is not a criminal
arrest, allow the individual to gather some personal things to
bring with them, and allow the individual to make a phone
call. The professional staff of the county designated facility
may detain the individual for up to 72 hours if the staff
finds that the individual meets the 5150 criteria. The
individual must be given written notice of why he or she is
being held, and he or she must be evaluated. The evaluation
consists of a multidisciplinary analysis of the individual's
medical, psychological, educational, social, financial and
legal situation.
3.Double referral. This bill is double referred. Should it pass
out of this committee, it will be referred to the Senate
Committee on Rules.
4.Support if amended. The California Mental Health Directors
Association (CMHDA) writes that it appreciates that the bill
has been amended as suggested by CMHDA to provide a number of
helpful clarifications to the LPS Act, while upholding the
original intent of these landmark civil rights statute,
including:
a. Clarifying that telehealth evaluations are
permitted, which are helpful for ensuring the
availability of prompt evaluations, particularly in rural
counties and in hospital emergency departments that are
designated by counties;
b. Authorizing each county to develop written
procedures for the designation and training of
professionals it designates to carry out LPS Act
functions;
c. Clarifying and providing consistency that four
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groups of individuals are authorized to take or cause to
be taken, a person into custody for assessment,
evaluation and crisis intervention or to place them in a
designated facility: peace officers, professional persons
in charge of a designated facility, members of the
attending staff of a designated facility, or professional
persons designated by the county;
d. Empowering assessment, evaluation, and crisis
intervention to occur in the field, rather than require
these activities to occur only within the confines of
designated facilities;
e. Removing the unnecessary and burdensome
administrative process of requiring the facilities that
counties have designated under the LPS Act to also be
"approved" by the state;
f. Broadening the types of facilities that may be
designated by counties to include, for example, crisis
stabilization units; and
g. Moving a number of existing provisions of law to
earlier locations in order to better reflect the sequence
of events that may occur under the LPS Act.
CMHDA states that it has concerns about one particular
provision of the bill, and requests a clarifying amendment
on page 11, lines 7-8 (Section 5150 subdivision (h), which
includes the following new statement being included in the
advisement that is provided to each person admitted to a
designated facility:
You may request to be treated at a facility of your choice.
You will be given a choice of treatment providers.
CMHDA writes that the statement would give individuals the
false impression that they would be guaranteed to be
treated by any facility or provider of their choice during
the LPS Act process. CMHDA states that it agrees that
individuals should be given the opportunity to request a
preference for treatment providers, and that counties try
to make accommodations, when possible. However, CMHDA
states it is not possible to accommodate these requests in
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every instance due to the lack of available local treatment
facilities and providers, limited local resources, the
narrow and urgent timeframes occurring during psychiatric
crises, and that only designated facilities and designated
professionals are permitted under law to evaluate and treat
an individual. CMHDA indicates it is concerned that
counties would incur significant financial costs to comply
with this provision of the bill, and requests the bill be
amended to re-word the advisement as follows:
You may request to be treated by a facility or provider of
your choice. However, while we make an effort to honor such
requests, we cannot guarantee that you will be treated by a
specific facility or provider.
The author's office indicates he is willing to accept this
amendment.
SUPPORT AND OPPOSITION :
Support: None received
Oppose: None received
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