Overhaul of Psychiatric Commitment Studied

SACRAMENTO —  A legislative committee Tuesday took the first steps toward changing a 30-year-old state law that makes it all but impossible to force mentally ill people into treatment unless they commit crimes.

The effort led by Assemblywoman Helen Thomson (D-Davis) stirred the passions of opponents of forced treatment, as dozens crammed a hearing room and held a rally outside the Capitol saying that civil liberties are being threatened.

But Thomson, a former psychiatric nurse, said she will pursue the inquiry--and may carry legislation--because she is concerned that thousands of mentally ill people end up in prison, and that many more are living on the streets.

“Our system is working backward,” Thomson said. “People must go to jail before they get mental health services. . . . I’m looking for a way to take the burden off the jails and prisons.”

Witnesses representing law enforcement, state prisons, and state and local mental health experts described a crisis in which 49,000 mentally ill people are living on the streets in California, too ill to know they need help. An additional 20,000 to 30,000 are in state prisons.

Sgt. Barry Perrou of the Los Angeles County Sheriff’s Department said Los Angeles law enforcement delivers 12,000 people a year into the county’s psychiatric care system, a seventh of all patients seen by the county Department of Mental Health.

The Sheriff’s Department and the Los Angeles Police Department combined receive more than 100,000 emergency calls a year to deal with people having psychotic episodes. Perrou told of one woman who was committed 56 times in a 20-month period.

“We need changes to the law that would prevent the [mentally ill person] from reaching a deadly crisis before reasonable action can be taken,” Perrou said. “Where the law is now, they have to go up on the bridge or put the gun in their mouth.”

Another witness, Dr. E. Fuller Torrey, said the current system of helping severely mentally people only when they seek it “is outdated, and the consequences have been and continue to be tragic for California.”

Torrey, president of the Treatment Advocacy Center in Arlington, Va., estimated that 1,000 homicides are committed nationwide each year by severely mentally ill people, including 120 in California.

Advocates of a more aggressive approach to mental health treatment say that the crisis had its beginnings in the late 1960s, when California began emptying state hospitals but provided little or no care for the patients in communities where they live.

In 1969, the Legislature approved the Lanterman-Petris-Short Act, which limits authorities’ ability to detain people unless they are thought to be a danger to themselves or others. Even then, they can be held against their will for no more than 72 hours.

Although the state hospitals once housed more than 30,000 patients, the remaining state hospitals house 911 people who have not committed crimes. An additional 3,300 are confined to state hospitals because they have committed crimes.

One of the driving forces behind Tuesday’s hearing is the Los Angeles County affiliate of the National Alliance for the Mentally Ill and the Southern California Psychiatric Society, which issued a report Tuesday calling for revision of the Lanterman-Petris-Short Act.

“No one advocates a return to unnecessary long-term placement,” the report said. “Our dilemma is how to provide treatment to people who do not have the medical capacity to accept or access it themselves.”

The California Research Bureau, part of the state library, also issued a report timed for Tuesday’s hearing. The report estimated that 10% to 15% of the inmates in local jails and state prisons are mentally ill. Women offenders are more likely to be mentally ill, with 19% in one study being diagnosed as having serious mental illness.

The annual law enforcement and prison costs of handling the mentally ill in California’s criminal justice system is as much as $1.8 billion, according to a report by the Pacific Research Institute, a conservative think tank in San Francisco.

Assemblywoman Thomson’s hearing brought a strong reaction from the California Assn. of Mental Health Patients’ Rights Advocates. Members of the group jammed the hearing room, and testified that there is no need to change the laws.

Although Torrey and others advocate the use of antipsychotic medication to control diseases such as schizophrenia and manic depression, critics warned that the drugs also cause problems.

“The medications cause the brain disease,” Dr. Loren Moshner said.

Thomson, who was skeptical about the claim, asked for any scientific information to buttress the statement, and noted that if mentally ill people stop taking medication, they risk breakdowns that land them in prison.