BILL ANALYSIS                                                                                                                                                                                                    Ó






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                                   THIRD READING 


          Bill No:  AB 1194
          Author:   Eggman (D)
          Amended:  7/6/15 in Senate
          Vote:     21  

           SENATE HEALTH COMMITTEE:  7-0, 7/1/15
           AYES:  Hernandez, Nguyen, Hall, Mitchell, Monning, Pan, Roth
           NO VOTE RECORDED:  Nielsen, Wolk

           SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

           ASSEMBLY FLOOR:  79-0, 6/1/15 - See last page for vote

           SUBJECT:   Mental health: involuntary commitment


          SOURCE:    California Psychiatric Association

          DIGEST:   This bill requires an authorized person, when  
          determining if a person is a danger to him- or herself or others  
          because of a mental health disorder, to consider available  
          information related to the person's historical course of his or  
          her mental health disorder, as specified. This bill requires,  
          when a person is determined to need detainment, an admitting  
          facility to require a written application that records whether  
          information about the person's historical course, as specified,  
          was considered.

          ANALYSIS: 
          
          Existing law:

          1)Establishes the Lanterman-Petris-Short Act (LPS Act), which  








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            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 health 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 health  
            disorder, is unable to provide for his or her basic personal  
            needs for food, clothing, or shelter. 

          2)Requires, when determining if probable cause exists to take,  
            or cause a person to be taken, into custody, relevant  
            information about the historical course of the person's mental  
            health disorder be considered, if an authorized person  
            determines that the information has a reasonable bearing on  
            the determination of a person's mental condition.

          3)Specifies that "information about the historical course of the  
            person's mental disorder" includes evidence presented by: 

             a)   the person who has provided or is providing mental  
               health or related support services to a person subject to a  
               determination; 
             b)   one or more members of the family of a person subject to  
               a determination; or,
             c)   a person subject to a determination or anyone designated  
               by that person. 

          4)Requires, when a person cannot be properly served without  
            being detained, an admitting facility to require an  
            application in writing stating the circumstances under which a  
            person's mental condition was called to the attention of an  
            authorized person and that there was probable cause to believe  
            that a person was a danger to him- or herself or others, or  
            was gravely disabled, due to a mental health disorder.

          5)Specifies that an "authorized person" includes a:

             a)   Peace officer;
             b)   Professional person in charge of a facility designated  
               by the county for evaluation and treatment;
             c)   Member of the attending staff of a facility designated  
               by the county for evaluation and treatment;
             d)   Designated members of a mobile crisis team; or,
             e)   Professional person designated by the county.







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          This bill:

          1)Requires an authorized person, in determining if a person is a  
            danger to him- or herself or others as a result of a mental  
            health disorder, to consider available relevant "information  
            about the historical course," as specified in 3) above, of a  
            person's mental health disorder if the authorized person  
            concludes that the information has a reasonable bearing on the  
            determination of a person's mental condition. Specifies that  
            "danger" is not limited to danger of imminent harm.

          2)Requires the application, required in 4) above, to also record  
            whether the historical course of a person's mental health  
            disorder was considered when making a determination of  
            probable cause.

          Comments
          
          Author's statement. 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 him- or  
          herself or others, and requires law enforcement or other  
          qualified individuals to respond as according to provisions in  
          the Welfare and Institutions Code Section 5150 ("5150"). This  
          lack of clarity results in an uneven application during a 5150  
          incident in the event where a person in question is not  
          presenting an immediate or imminent safety risk when a peace  
          officer or other qualified person responds. AB 1194 simply  
          clarifies that when a person with a mental health disorder is a  
          danger to him- or herself or others, the term "danger" is not  
          limited to imminent or immediate risk of harm to him- or herself  
          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 during a 5150 incident.

          Background. According to National Alliance on Mental Illness  
          (NAMI) California's Web site, the LPS Act ended the  
          inappropriate, indefinite, and involuntary commitment of  
          mentally disordered persons to institutions and encouraged the  
          full use of existing agencies, personnel, and funds to provide  
          treatment, supervision, and placement of gravely disabled  







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          persons. The authors of the LPS Act envisioned an expanded  
          system of community based mental health centers providing  
          appropriate and timely support to those in need at a reduced  
          cost to the state.

          The LPS Act requires authorized people making a determination if  
          a person is a danger to him- or herself or others, or gravely  
          disabled, to assess whether or not the person can be properly  
          served without being detained. If a person can be properly  
          served without being detained, he or she is entitled to receive  
          an evaluation, crisis intervention, or other inpatient or  
          outpatient services on a voluntary basis. 

          Some anecdotal data provided by the author shows that 5150  
          situations are not always handled uniformly. Some law  
          enforcement departments and mental health agencies interpret the  
          term "danger to him- or herself or others" to apply only in  
          situations where a person poses an immediate danger. The word  
          "danger" is not defined in current law, which has created a  
          challenge in applying Section 5150 in certain cases.

          Related/Prior Legislation
          
          AB 193 (Maienschein - 2015) 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 health  
          disorder or impairment by chronic alcoholism. AB 193 is  
          currently pending in the Senate Appropriations Committee.

          AB 110 (Blumenfield, Chapter 20, Statutes of 2013), enacted the  
          2013-14 Budget Act, which included, among its other provisions,  
          $206 million ($142 million General Fund one-time) for a major  
          investment in mental health services, including additional  
          residential treatment capacity, crisis treatment teams, and  
          triage personnel.

          AB 1424 (Thomson, Chapter 506, Statutes of 2001), made 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.







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          SB 665 (Petris, Chapter 681, Statutes of 1991), established the  
          right, under the LPS Act, to refuse antipsychotic medication and  
          established hearing procedures to determine a person's capacity  
          to refuse treatment with antipsychotic medication.

          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   Yes


          SUPPORT:   (Verified8/19/15)


          California Psychiatric Association (source)
          American Federation of State, County and Municipal Employees
          California Association of Marriage and Family Therapists
          California Chapter of the American College of Emergency  
          Physicians
          California Hospital Association 
          California Medical Association
          California Police Chiefs Association 
          California Probation, Parole and Correctional Association
          California State Sheriffs' Association
          California Treatment Advocacy Coalition
          Contra Costa Mental Health Community Coalition
          Latino Coalition for a Healthy California 
          NAMI California
          NAMI Contra Costa
          NAMI Orange County
          St. Joseph's Behavioral Health Center
          Treatment Advocacy Center


          OPPOSITION:   (Verified8/19/15)


          Disability Rights California



          ARGUMENTS IN SUPPORT:     Supporters of this bill, comprising  
          medical professionals, law enforcement, and mental health  
          advocates, argue that this bill will provide more timely access  
          to treatment for people in psychiatric crises who, without  







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          treatment, may harm themselves or others. They state that this  
          bill could prevent certain situations from escalating into overt  
          acts of violence. Supporters further state that current law is  
          unclear whether the term "danger" is limited to danger of  
          imminent harm, and this bill will allow a more consistent  
          interpretation and determination of an individual's level of  
          dangerousness.


          ARGUMENTS IN OPPOSITION:     Disability Rights California (DRC)  
          states that a present risk of harm, as defined in this bill, is  
          too broad and most anything could be considered dangerous,  
          resulting in involuntary detention for anyone with a history of  
          mental health disability. DRC states that the proposed  
          definition has the potential to cause more problems than it  
          solved, and if people are not likely to harm themselves or  
          others at the present time, they should not be subject to  
          involuntary detention.

          ASSEMBLY FLOOR:  79-0, 6/1/15
          AYES:  Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,  
            Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,  
            Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,  
            Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina  
            Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,  
            Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,  
            Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder,  
            Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina,  
            Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen,  
            Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez,  
            Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,  
            Waldron, Weber, Wilk, Williams, Wood, Atkins
          NO VOTE RECORDED:  Wagner

          Prepared by:Reyes Diaz / HEALTH / 
          8/19/15 20:56:02


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