BILL ANALYSIS Ó
AB 1194
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Date of Hearing: April 14, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 1194
(Eggman) - As Introduced February 27, 2015
SUBJECT: Mental health: involuntary commitment.
SUMMARY: Requires that, for purposes of determining whether a
person is a danger to themselves or others, danger be defined as
constituting a present risk of harm that requires consideration
of the historical course of a person's mental health disorder.
Specifically, this bill:
1)Requires that when an individual is being taken into custody
pursuant to Welfare and Institutions Code (WIC) Section 5150,
consideration of the historical course of a person's mental
health disorder be made, and consideration of the risk shall
not be limited to imminent or immediate risk of harm to others
or to themselves.
2)Requires an application determining whether an individual was
a danger to others or themselves or gravely disabled to also
record whether the historical course of the person's mental
disorder was taken into consideration.
EXISTING LAW:
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1)Establishes the Lanterman-Petris Short Act (LPS Act), which
authorizes a person to be involuntarily detained for a period
of up to 72 hours for assessment, evaluation, and crisis
intervention, when, as a result of a mental disorder, the
person is a danger to him or herself or to others, or is
"gravely disabled." Defines "gravely disabled" to mean 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.
2)Allows, under the LPS Act, a person who is gravely disabled to
be involuntarily detained for further inpatient mental health
treatment for an additional 14 days, as provided, which can be
extended for 14 days if the person presents an imminent threat
of taking his or her own life or 30 days if the county has
authorized the program and the person remains gravely
disabled.
3)Allows, under the LPS Act, a court to order an imminently
dangerous person to be confined for further inpatient
intensive health treatment for an additional 180 days, as
provided.
4)Requires, when determining if probable cause exists to take a
person into custody, or cause a person to be taken into
custody, pursuant to WIC Section 5150, any person who is
authorized to take that person into to consider available
relevant information about the historical course of the
person's mental disorder if the authorized person determines
that the information has a reasonable bearing on the
determination as to whether the person is a danger to others,
or to himself or herself, or is gravely disabled as a result
of the mental disorder.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
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COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, current law
does not make clear what constitutes danger when a person, as
a result of a mental health disorder, is a danger to
themselves or others and requires law enforcement or other
qualified individuals to respond due to WIC Section 5150.
This lack of clarity results in an uneven application of WIC
Section 5150 in the event where the person in question is not
presenting an immediate or imminent safety risk when a peace
officer or other qualified person responds.
The author argues that this bill simply clarifies that when a
person with a mental health disorder is a danger to themselves
or others, the term danger is not limited to imminent or
immediate risk of harm to themselves or others. Rather,
danger constitutes a present risk or harm that requires
consideration of the historical course of a person's mental
health disorder. The purpose of this bill is to ensure that
those who are a danger to themselves or others receive the
appropriate care under WIC Section 5150.
2)BACKGROUND. Section 5150 of the LPS Act allows peace
officers, staff-members of county-designated evaluation
facilities, or other county-designated professional persons,
to take an individual into custody and place him in a facility
for 72-hour treatment and evaluation if they believe that, due
to a mental disorder, the individual is a danger to himself,
herself, or others, or is gravely disabled-i.e., unable to
provide for basic personal needs for food, clothing, or
shelter due to a mental disability. The LPS Act, enacted in
the 1960s, was intended to balance the goals of maintaining
the constitutional right to personal liberty and choice in
mental health treatment, with the goal of safety. At the time
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of its enactment, the LPS Act was considered progressive
because it afforded the mentally disordered more legal rights
than most other states. Since its passage in 1967, the law in
the field of mental health has continued to evolve toward
greater legal rights for mentally disordered persons.
3)SUPPORT. The sponsors of the bill, the California Psychiatric
Association, states in support that this bill will provide
more timely access to treatment for people in psychiatric
crisis who, without that treatment, may harm themselves or
others. In particular, this bill could prevent a current risk
of harm from escalating into overt acts of violence.
Clarifying what danger does and does not constitute can assure
uniform application of the law where now there is wide
variability in interpretation of danger throughout California.
The sponsors write that seen from the ill person's and
family's point of view, people with schizophrenia can keeps
signs of aberrant behavior in check for the 20 minutes it
might take police to interview them, and present no good
reason for an officer to take any action. Once the officer
leaves, the person may openly evince psychosis with agitation,
incoherent yelling, and threats that caused the call by family
members to the police in the first place.
4)OPPOSITION. Disability Rights California (DRC) states in
opposition that a present risk of harm as defined in this bill
is overly broad, arguing most anything could be considered
dangerous and thus involuntary detention could occur for
anyone with a history of a mental health disability.
Determination of the risk of danger requires consideration of
the type of risk and type of potential harm in order to
justify confining a person in a mental health treatment
facility against their will. DRC states that the
determination of present danger should be based on all of the
circumstances including historical course. The proposed
definition suggests that consideration of historical course
alone can lead to a finding of present danger. Singling out
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historical course puts too much emphasis on it. It opens the
door to the possibility that someone will be involuntarily
confined for mental health disability who poses no danger to
themselves or others.
5)RELATED LEGISLATION.
AB 193 (Maienschein) permits a judge presiding over a probate
conservatorship to recommend to the county investigating
officer the establishment of an LPS conservatorship when there
is evidence of grave disability as a result of a mental
disorder or impairment by chronic alcoholism. AB 193 is
pending a hearing in the Assembly Judiciary Committee.
a) AB 59 (Waldron) changes requirements for county
participation in the AOT Demonstration Project and
increases the maximum period of imposed outpatient
treatment under the AOT Demonstration Project from six
months to one year. AB 59 will be heard in the Assembly
Health Committee on April 14, 2015.
b) AB 1193 (Eggman) mandates county implementation of the
AOT Demonstration Project, known as Laura's Law, and
authorizes a superior court judge to request a petition to
obtain assisted outpatient treatment for a person who
appears before the judge. AB 1193 will be heard in the
Assembly Health Committee on April 14, 2015.
6)PREVIOUS LEGISLATION.
a) AB 110 (Blumenfield), Chapter 20, Statutes of 2013,
enacts the 2013-14 Budget Act, which includes, among its
other provisions, $206 million ($142 million General Fund
one-time) for a major investment in mental health services,
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including additional residential treatment capacity, crisis
treatment teams, and triage personnel.
b) SB 585 (Steinberg), Chapter 288, Statutes of 2013,
clarifies that Mental Health Services Act funds and various
County Realignment accounts may be used to provide mental
health services under the AOT Demonstration Project Act of
2002, or Laura's Law, and allows counties to opt to
implement Laura's Law through the county budget process.
c) AB 1424 (Thomson), Chapter 506, Statutes of 2001, makes
various changes to the LPS Act to: increase the
involvement of family members in commitment hearings for
the mentally ill; require more use of a patient's medical
and psychiatric records in these hearings; and, prohibit
health plans and insurers from using the commitment status
of a mentally ill person to determine eligibility for claim
reimbursement.
d) SB 665 (Petris), Chapter 681, Statutes of 1991,
establishes the right, under the LPS Act, to refuse
antipsychotic medication and establishes hearing procedures
to determine a person's capacity to refuse treatment with
antipsychotic medication.
7)POLICY COMMENTS. It is unclear how this bill's requirement
that an individual's mental health history is taken into
account provides any more protection or clarification than
what is in current law. Existing law provides that, when
determining if probable cause exists to take a person into
custody pursuant to Section 5150, any person who is authorized
to take that person into custody shall consider available
relevant information about the historical course of the
person's mental disorder [WIC Code Section 5150.05 (a)].
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This bill's proposal that the determination should not be
limited to an immediate risk of harm is intended to ensure
that an individual that at one point in time may not appear
dangerous but who has a mental health history who makes them
unstable can still be taken into custody. This expansion of
"risk of harm" to not only include an immediate or imminent
risk is designed to grant authorities more latitude in what
factors to consider regarding to whether or not an individual
qualifies to be taken into custody. Such consideration of the
course of the person's mental health disorder be subject to
abuse by other individuals at the scene who could provide
authorities inaccurate or misleading information to further
their own desire to prompt authorities to act.
REGISTERED SUPPORT / OPPOSITION:
Support
California Psychiatric Association (sponsor)
California Chapter of the American College of Emergency
Physicians
California Hospital Association
California Medical Association
California State Sheriffs' Association
California Treatment Advocacy Coalition
Dignity Heath
Opposition
Disability Rights California
AB 1194
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Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097