After decades of slashing voluntary mental health treatment, the state passed bill (AB 1421) that would allow the government to lock up people with mental health issues for not complying with their treatment plans. Counties now have an option to implement this law if they choose. As health professionals and people living with mental illnesses we oppose this law in SF.
Summary of Bill
Mental disorders, collectively, make mental illness the most prevalent health issue in America today—more common than cancer, lung and heart disease combined. Mental illness is real, common and treatable. (CA State Dept of Mental Health)
- In one, sweeping stroke of the pen the criteria for involuntary outpatient treatment is a long list that includes a clinical determination of being unable to survive safely in the community without supervision, history of hospitalization, failure to engage in treatment opportunities, and substantial deterioration.
- Any person with a family or professional relationship to a person with a mental illness may request a petition to be filed for an involuntary treatment hearing.
- The court may then order outpatient treatment not to exceed six months. If the person refuses to participate, they may then be detained for 72 hours. This is a new, earlier level to the current 72 hour hold under the 5150 law.
- Forced treatment can be extended to 180 days with court permission.
There are serious problems relating to expanding a program of forced treatment. There are not enough resources to provide services for existing clients who want it, let alone those who do not. (Sen. John Burton 2000, condensed from statement he made regarding AB 1800.)
- If an individual is a danger to themselves or others, or gravely disabled, they are hospitalized against their will.
Violates Civil and Human Rights
Use of coercion can also result in pushing the patient away from services. (1997 empirical study by Kaltiala-Heion R Impact of Coercion on Treatment Outcomes)
- Mental illness is a healthcare issue much like diabetes. Unfortunately, the media has focused on this as public safety issue. Sadly, AB 1421 mislead the public by capitalizing on the stigmas surrounding mental health issues, namely that people with mental illnesses are dangerous. Studies such as the MacCarthur Violence Risk Assessment study show people with mental illnesses are not any more violent then other people, and that mental illness by itself does not impair decision making capacities.
Unjust and Dangerous Direction
People of color have a history of being over-medicated by the mental health system (Leroy Moore, Disability Advocates for Minority Organization, 2002)
- AB 1421 criteria cast a wide net in vague language including individuals who are not dangerous or gravely disabled. This will disproportionately impact people of color.
- This bill expands the inappropriate use of police as social workers. Currently, police respond to most calls for people in psychiatric crisis. This is traumatizing. Mental illness is a medical condition—not a criminal justice issue.
Undermines Effective Programs that Work
The fear of being institutionalized and forced to take medication will crumble the already weak foundation of communication between mental health professionals and consumers. (2002 Mental Health consumer/advocate in San Francisco)
- State programs implemented three years ago serve the same population in a voluntary manner, and have 84% success rates, higher then involuntary program success. This bill would merge the voluntary and involuntary programs, undermining trust with clients and jeopardizing success.
A More Caring Solution: Expand Community Based Treatment
The U.S. mental health system is in crisis, unable to provide even the most basic services and support to people with psychiatric disabilities. (Federal Report released 9.16.02)
Mental health system is focused on crisis and on those ‘most in need,’ requiring that people with psychiatric disabilities ‘hit bottom’ before getting the services and supports they need. (National Council on Disability 9.16.02)
- AB 1421 is the wrong policy response to this issue. Instead of working to massively expand programs that work – it forces people into a system that has no room to serve them.
- San Francisco already has the highest rate of locking people with mental illnesses into hospitals for assessments (5150s) in the state.
- The lack of voluntary community based treatment has led to higher rates of expensive hospitalizations. AB 1421 would only make this bad situation worse. Voluntary community based treatment costs less then half of hospital care.
Effectiveness Remains Unproven
There is no evidence that simply amending the commitment statue to add outpatient commitment programs will make benefits accrue to people with mental illnesses. (The effectiveness of Involuntary Outpatient Treatment: Empirical Evidence and The Experience of Eight States. Santa Monica, CA Rand, MR-1340-CSCR-2001)
- AB 1421 is contrary to the current philosophy of the San Francisco Department of Health (DPH). DPH wants to expand community based options to reduce high end costs. It has embraced harm reduction and client centered treatment. The mirror opposite to AB 1421, DPH works to engage people in the system, and ensure they have a strong voice in the treatment plan.
Counties have an option of not implementing this arcane law! Help Us Fight It!