BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 1194| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 1194 Author: Eggman (D) Amended: 9/2/15 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 a person who determines that an individual should be taken into custody, because he or she is a danger to him- or herself or others, to consider available information related to the historical course of the individual's 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. Senate Floor Amendments of 9/2/15 specify that a determination AB 1194 Page 2 about whether an individual should be taken into custody should not be limited to the consideration of the danger of imminent harm. ANALYSIS: Existing law: 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 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 AB 1194 Page 3 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. 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 the relevant information about the historical course of an individual's mental health disorder. Prohibits the determination from being limited to the consideration of the 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 AB 1194 Page 4 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 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 on the Senate Floor. 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 AB 1194 Page 5 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; required more use of a patient's medical and psychiatric records in these hearings; and prohibited health plans and insurers from using the commitment status of a mentally ill person to determine eligibility for claim reimbursement. 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: (Verified9/2/15) 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: (Verified9/2/15) AB 1194 Page 6 Department of Health Care Services 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 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. The Department of Health Care Services argues that this bill lowers the standard for placing an individual on a 5150 hold, as the additional language adds a broad and vague standard that is not specific enough to ensure appropriate application of involuntary detainments for mental health treatment. 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, AB 1194 Page 7 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 / 9/3/15 15:32:01 **** END ****