BILL ANALYSIS
AB 1800
Page 1
Date of Hearing: May 17, 2000
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Carole Migden, Chairwoman
AB 1800 (Thomson and Perata) - As Amended: May 10, 2000
Policy Committee: HealthVote:10-0
Judiciary 10-4
Urgency: No State Mandated Local Program:
Yes Reimbursable: Yes
SUMMARY
This bill expands the conditions and length of time for which a
person may be involuntarily detained and treated for mental
illness. Specifically, this bill:
1)Expands the definition of "gravely disabled" for purposes of
involuntary detention and conservatorship to include a
condition in which a person, as a result of a mental disorder,
presents an acute risk of physical or psychiatric harm to
himself/ herself in the absence of treatment. Current law
defines "gravely disabled" to mean a person is unable, as a
result of a mental disorder, to provide for his or her basic
personal needs for food, clothing, or shelter.
2)Defines "psychiatric harm" to mean an exacerbation or
escalation of symptoms or behaviors in the 30 days prior to
detention that make it likely the person will be unable to
provide for his or her basic needs or become dangerous to self
or others.
3)Broadens the conditions necessary to consider a person not
gravely disabled, by requiring that family, friends or others
must be willing and able to assist the person in meeting
his/her medical and psychiatric needs.
4)Requires the certification review hearing officer to determine
if the person lacks the capacity to make an informed refusal
(if a person certified for involuntary treatment refuses
treatment with psychotropic medication.) If so, psychotropic
medications may be administered without the person's consent
during the certification period. Provides for judicial review
AB 1800
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of the hearing officer's decision at the patient's request.
5)At the end of the 14-day intensive treatment period, permits
the person to be certified for an additional 180 days of
community assisted outpatient treatment if he/she agrees to
the treatment, is not a danger to self or others, is stable
enough to live in an unlocked setting, and has a community
treatment plan with specified services. However, if the
person does not follow the treatment plan, including
medication compliance, and poses an acute risk of physical and
psychiatric deterioration, a court may order him/her returned
to inpatient treatment for the balance of the involuntary
treatment period. Also permits persons with severe and
persistent mental illness to receive 180-day community
outpatient treatment.
6)At the end of the 14-day intensive treatment period, extends
the maximum period of further involuntary treatment to one
year (from 180 days) for certain dangerous persons. Requires
the person to be found dangerous beyond a reasonable doubt
(current law contains no standard of proof).
7)Requires the Department of Mental Health (DMH) to obtain
specified data from counties on persons in involuntary
treatment, length of detention and involuntary treatment time,
changes in mental health utilization patterns, and
effectiveness of community assisted outpatient treatment
programs. Requires DMH to submit a report to the Legislature
by April 1, 2002, on the effectiveness of this bill based on
county data and make specified recommendations.
FISCAL EFFECT
1)Appropriates $350 million GF to DMH in FY 2000-01 for counties
that implement a community assisted outpatient program. A
county may use up to 25% of its allocation for short-term
inpatient services if deemed appropriate by the county mental
health department to ensure the availability of appropriate
mental health treatment services.
2)Unknown one-time costs to DMH, likely $150,000 to $200,000 GF,
to compile data from counties and produce the report to
Legislature.
COMMENTS
AB 1800
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1)Purpose . This bill streamlines the hearing process for
determining a person's need for commitment and capacity to
refuse treatment, in order to provide mental health
interventions earlier to gravely disabled persons. Supporters
argue this bill will save time, suffering and expense in
getting appropriate treatment to mentally ill persons, who
could deteriorate if treatment is delayed or not provided.
The latest amendment defining "psychiatric harm" allows the
hearing officer to consider a person's deterioration in the
30 days prior to admission, thereby basing the detention
decision on a person's recent history. By revising the
current involuntary treatment system and funding earlier
interventions, the author intends to more effectively treat
persons who have a demonstrated history of mental illness.
2)Opposition . The California Mental Health Directors
Association (CMHDA) is opposed unless amended, based primarily
on the expanded definition of "gravely disabled." They fear a
return to earlier days when "predictions of future behavior
led to significant abuse of the involuntary treatment system."
CMHDA supports more involvement by family members in the
certification process and opposes requiring rehospitalization
of persons who do not comply with outpatient treatment plans.
The Coalition Advocating for Rights and Empowerment Services
feels AB 1800 presents numerous constitutional and legal
problems and undermines the well-being of mental health
consumers in California. They advocate more efforts at
voluntary, rather than involuntary, treatment.
3)Technical Amendment . On page 12, lines 2 and 3, amend to
read: "pursuant to Article 4.8 (commencing with Section
5280 )."
Analysis Prepared by : Joyce Iseri / APPR. / (319) 319-2081