Gov. Gavin Newsom today announced he signed the first of a series of bills that aim to transform California鈥檚 mental health system. Depending on who you ask, this transformation represents a long overdue humanitarian response鈥� or a worrisome step backward on civil liberties.
Today鈥檚 signature loosens long-standing rules about who is eligible for involuntary treatment under the half century-old Lanterman-Petris-Short Act, the landmark mental health law that regulates involuntary civil commitment in the state. Advocates and county leaders expect the new legislation to lead to more people being placed in treatment facilities against their will.
鈥淐alifornia is undertaking a major overhaul of our mental health system,鈥� Newsom said in a written statement. 鈥淭he mental health crisis affects us all, and people who need the most help have been too often overlooked. We are working to ensure no one falls through the cracks, and that people get the help they need and the respect they deserve.鈥�
Newsom also is expected to sign legislation sending two key ballot measures to voters next March: a $6.4 billion bond to pay for 10,000 new treatment beds and supportive housing, and an overhaul of California鈥檚 20-year-old law that funds . A majority of voters would need to approve those measures.
All of this comes just as CARE Court, Newsom鈥檚 signature mental health legislation from last year, begins rolling out in an initial cohort of seven counties. Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus, and Tuolumne counties opened their on Oct. 2; Los Angeles County will open its court on Dec. 1. The rest of the state will follow next year.
Addressing serious mental illness among the state鈥檚 growing unhoused population is a major focus of all of these initiatives. That population has burgeoned to more than 170,000 people, less than a quarter of whom have , according to the U.S. Department of Housing and Urban Development.
A recent survey of people experiencing homelessness by the , found that the majority had experienced at some point in their lives but the main reasons most became homeless were high housing costs and low incomes.
CARE Court allows family, close friends, first responders and behavioral health workers to petition a court to compel a person with untreated schizophrenia spectrum or other psychotic disorders into a court-ordered treatment plan. The ballot initiative that would redesign the Mental Health Services Act would require that 30% of tax dollars brought in under the plan go toward housing programs, half of it to serve people who are chronically homeless or living in encampments.
Taken along with today鈥檚 signature of the involuntary confinement law, , the moment marks a significant departure from the decades in which the civil liberty protections for Californians with mental illness seemed virtually untouchable because of the Lanterman-Petris-Short Act.
The authors of that law 鈥� Assemblyman Frank Lanterman and Democratic Sens. Nicholas Petris and Alan Short 鈥� sought to end the inappropriate and often indefinite institutionalization of people with mental illnesses and developmental disabilities. At the time, it had been relatively easy for family members to force people into mental health treatment, often locking them away for long stretches in state hospitals where conditions were abhorrent.
New standard for involuntary treatment
The law, which then-Gov. Ronald Reagan signed in 1967, established strict criteria to determine who was eligible for involuntary treatment as well as specific timeframes that limited involuntary holds. This included the 72-hour hold known as a 5150. But concomitant promises to build up community-based support programs did not materialize.
Susan Talamantes Eggman, a social worker turned Democratic state senator from Stockton who has become one of the legislature鈥檚 main authors of mental health policies, is among those who feel California went too far back then.
鈥淔or fear of doing something wrong we did something even worse,鈥� she said.
Eggman authored the law signed today, carried the legislation to redesign the Mental Health Services Act and also co-authored last year鈥檚 CARE Act.
She told CalMatters she has tried five times in recent years to introduce legislation amending the Lanterman-Petris-Short Act. Stiff resistance from disability rights groups and some legislators impeded those changes, she said.
This year鈥檚 attempt sailed through the Legislature without opposition. It expands the legal definition by which someone can be deemed 鈥済ravely disabled鈥� and treated against their will. The new, expanded definition allows for consideration of whether a person fails to provide for their own medical care or personal safety. It includes not just mental illness, but also severe substance use disorder and chronic alcoholism.
She called the current constellation of policy changes 鈥渢he most significant thing we鈥檝e done in the mental health, behavioral health workspace easily within the last 50 years.鈥�
Why some families want involuntary treatment
Many families of seriously mentally ill individuals say they are thrilled with Eggman鈥檚 bill and with the other policy shifts, having long felt sidelined in their efforts to press for treatment when loved ones refused it.
鈥淚 think personally that the tide is finally turning, that we are on our way to really doing something to help these very sick people get the treatment that they need,鈥� said
Linda Mimms, vice chair of the national Schizophrenia & Psychosis Action Alliance.
She lauded last month, in which he called out critics of the changes, saying: 鈥淐hange has its enemies. I get it. But one thing you cannot argue for 鈥攚ith all due respect to all the critics out there 鈥� is the status quo. You can鈥檛. And in the absence of alternatives, what the hell are we going to do to address this crisis?鈥�
But those critics say they aren鈥檛 defending the status quo at all. Rather, they point to other parts of the system 鈥� including affordable housing and an array of voluntary treatment services 鈥� that have suffered after decades of underinvestment.
鈥淲e鈥檙e never having the right conversation,鈥� said Kelechi Ubozoh, a mental health advocate and author of We鈥檝e Been Too Patient: Voices from Radical Mental Health. 鈥淚t is a conversation around poverty. We鈥檙e still saying 鈥榣et鈥檚 blame it on mental health and the mental health system.鈥欌��
Many who live with mental illness have had traumatic experiences with involuntary treatment, Ubozoh said, and are 鈥渞eally scared鈥� by the current direction the state is headed.
鈥淔or no one to oppose this huge erosion of civil rights is just a really concerning change in the state legislature,鈥� said Samuel Jain, senior attorney with Disability Rights California. He believes state leaders feel pressure to address the homelessness crisis, and as a result are conflating homelessness and mental illness.
鈥淲e don鈥檛 feel that this is going to change anything on the streets,鈥� he said. 鈥淭his strategy seems to be to take people with mental health disabilities and put them into institutions.鈥�
In the meantime, he said, the organization鈥檚 clients often find themselves stuck in emergency departments and locked psychiatric settings because there are no community-based beds for them.
Worry about California鈥檚 mental health tax
Some mental health advocates also are wary of Newsom鈥檚 ballot initiative to reallocate money from the millionaire鈥檚 tax, which raises several billion dollars every year for programs.They say the redesign of the Mental Health Services Act will inevitably redistribute some funds away from current programs.
That worries Tiffany McCarter, executive director of the African-American Family & Cultural Center in Oroville, which provides children with food, after-school care, and other services, such as anger management.
鈥淚 was pushing and pulling within my own self,鈥� she said. 鈥淚 want to help the homeless on a mass level for sure.鈥� But she worries: 鈥淲hen it came to this measure, if they do this, what about our kids?鈥�
That鈥檚 because her organization depends almost entirely on money from the Mental Health Services Act. She鈥檚 trying to rush to apply for grants but worries that she doesn鈥檛 have enough time. She says other organizations that serve people of color in her community 鈥攁nd around the state 鈥� are in the same position.
鈥淚t鈥檚 a lose, lose, lose all the way around,鈥� she said.
Counties, which are charged with implementing many of the mental health policy programs coming down from the state, including CARE Court, caution that change will take time.
鈥淚t is a very positive thing that there are higher expectations around behavioral health in our communities,鈥� said Graham Knaus, CEO of the California State Association of Counties.
But after decades of underfunding, he says, resources are still finite. The state continues to face significant shortages of appropriate housing placements, public guardians and
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