BILL ANALYSIS Ó
AB 1300
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Date of Hearing: May 27, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
1300 (Ridley-Thomas) - As Amended May 20, 2015
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill makes numerous changes and specifies numerous aspects
of the Lanterman-Petris-Short (LPS) involuntary detention
process (known as "5150" for the Welfare and Institutions Code
section in which the process is established.) Specifically,
this bill:
AB 1300
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1)Modifies provisions related to holds, detention, and transfer
of individuals.
2)Creates a construct called "local or regional liaison," and
spells out the duties of the liason, which include
facilitating communication between the county mental health
system and health facilities.
3)Contains sections encouraging counties to take various
actions, including establishing more robust community mental
health services and designating liaisons.
4)Allows correctional health facilities to be "designated
facilities" for purposes of 5150 holds.
5)Distinguishes psychiatric medical emergencies (which are
subject to federal law requiring a hospital to treat and
stabilize any individual requiring treatment) from evaluation
and treatment services pursuant to 5150.
6)Allow counties to designate ambulatory facilities, and
requires the Department of Health Care Services (DHCS) to
encourage counties to use appropriate ambulatory facilities
for evaluation and treatment.
7)Allows an emergency physician to release a 5150 hold if the
physicians finds there is no longer probable cause to
determine the detention for evaluation and treatment.
Prohibits probable cause determinations for detention, or to
continue detention, from considering the availability of beds
or services.
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8)Exempts facilities, physicians, and other professionals from
civil or criminal liability for injury resulting from their
decisions related to detention and release of a person, or the
terms and conditions of detention. Exempts the same from
liability relating to injury caused by, or to, an eloping
person who has been detained, and from liability relating to
their wrongful death.
9)Specifies a 72-hour hold begins upon detention. Specifies
conditions under which an individual must be released from
detention, including lack of specified paperwork accompanying
the individual
10)Defines new terms and reorganizes definitions.
11)Requires DHCS to create specified forms for use statewide.
FISCAL EFFECT:
1)Significant cost pressure, likely exceeding $200,000 GF, to
DHCS for a complex, high-interest regulatory effort to adapt
current regulations to the new statutory framework, and to
further clarify or specify the law, including developing
related forms. In addition, the department would likely incur
unknown, significant costs for legal analysis and to assist
counties in complying with the new protocols and processes
established in this bill. DHCS is charged with administration
of the LPS Act and is required under current law to adopt
rules, regulations, and standards as necessary.
2)To the extent this bill may result in fewer individuals being
detained in hospital emergency departments, or being detained
for a shorter length of time, potential cost pressure to the
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law enforcement agencies including the California Highway
Patrol to respond to additional incidents, as well cost
pressure for county mental health crisis teams and related
services, to the extent they are available. Likelihood and
magnitude of additional costs are unknown; local costs appear
non-reimbursable.
3)Counties and cities, particularly behavioral health agencies
and law enforcement, may incur significant, non-reimbursable
one-time costs to adjust current practices (including costs
for analyzing, training personnel, and ensuring compliance),
and ongoing costs to modify response patterns to behavioral
health incidents due to the changes in this bill.
COMMENTS:
1)Purpose. According to the author, in the 48 years since the
LPS Act's passage, there have been significant changes in the
mental health delivery system, adversely impacting a patient's
ability to obtain prompt evaluation and treatment as required
by current law. In addition, the fragmented and inconsistent
application of the LPS Act by California's 58 counties has led
to an increasing and often inappropriate dependence on
hospital Emergency Departments (ED's) to care for this
population, without the necessary resources. The author
states that this has resulted in individuals with mental
illness languishing for hours, days, and sometimes weeks,
awaiting psychiatric assessment and treatment.
2)5150 of the LPS Act. Welfare and Institutions Code (WIC)
Section 5150 of the LPS Act allows peace officers and other
specified persons to take an individual into custody and place
him or her in a facility for 72-hour evaluation and treatment
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
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food, clothing, or shelter due to a mental disability.
Counties designate facilities for the purposes of the initial
evaluation and treatment services. Many emergency departments
are designated facilities. Some individuals in crisis are not
able to be transported to a designated facility and are
instead taken to non-designated emergency departments, where
county staff must perform an evaluation. This bill makes
numerous changes to the 5150 process, many of which appear
designed to reduce the role of emergency departments in the
process, while putting pressure on counties to develop
adequate infrastructure to serve the need for mental health
treatment.
3)Support. The sponsor of this bill, the California Hospital
Association (CHA), writes in support of the bill that this
bill would modernize the 5150 process to more closely conform
to the evolving community health care delivery system, while
ensuring consistent civil liberty protections for individuals
subject to detention. Cosponsors of the bill, the California
Chapter of the American College of Emergency Physicians, and
the Association of California Healthcare Districts note that
this measure increases the emphasis on the prompt provision of
services in both LPS-designated and non-LPS designated
facilities. The California Medical Association adds in
support that the current system is failing psychiatric
patients by forcing them through a fragmented medical delivery
system that is inefficient and wastes valuable ED resources.
4)Opposition. Numerous core stakeholders in the 5150 arena have
significant concerns with this bill. The California State
Association of Counties and the Urban Counties Caucus state
this bill moves in the opposite direction of the progress made
in the last four years by imposing new silos, costs, and
liabilities surrounding the timely treatment for mentally ill
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individuals. National Alliance for Mental Illness (NAMI)
California cites significant concerns that the bill limits
access to emergency departments, which may be the only place
someone in crisis can turn. They cite several specific
provisions they believe put their mentally ill loved ones at
risk, including the provision starting the 72-hour clock upon
detention and provisions related to non-designated hospitals.
County Behavioral Health Directors Association cites numerous
serious concerns, including that it will be easier to release
individuals in crisis, resulting in increased incarceration
rates for individuals living with mental health conditions.
They add that the LPS Act was modernized two years ago through
SB 364 (Steinberg), Chapter 567, Statues of 2014, with broad
stakeholder support, and note this bill does nothing to
increase available services.
5)Prior Legislation.
a) SB 364 revised the law related to 5150 holds by adding
to the types of facilities that a county is allowed to
designate to provide services, allowing county mental
health directors to develop procedures for the designation
and training of professionals who can perform 5150
functions, and making other clarifying and substantive
changes.
b) AB 110 (Blumenfield), Chapter 20, Statutes of 2013, the
2013-14 Budget Act, 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.
6)Staff Comments. Challenges in this area appear to largely be
related to the sufficiency of community and inpatient
behavioral health services. Both public and private inpatient
psychiatric services are often insufficient compared to the
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need, largely due to the lack of reimbursement and
profitability for these services, respectively. It appears
even though an individual may be evaluated as needing
treatment, the unavailability of beds or other appropriate
services causes individuals to be detained longer than is
ideal in emergency departments. This inability to direct
individuals to the most appropriate level of care appears to
be a source of frustration for all stakeholders-hospitals,
county behavioral health, law enforcement, families of
mentally ill individuals, and the individuals themselves.
The LPS Act appears to be operationalized differently in
different counties depending on local resources and other
factors. It is unclear whether lack of standardized
application of 5150-related processes is a problem to be
solved, or a sensible adaptation to very different local
conditions. It may be a combination.
Analysis Prepared by:Lisa Murawski / APPR. / (916) 319-2081