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--- SB 364 | Page 2 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: SB 364 | Page 3 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"). SB 364 | Page 4 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. SB 364 | Page 5 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: SB 364 | Page 6 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 SB 364 | Page 7 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 SB 364 | Page 8 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 -- END --