Public Education & Policy :: Archive

CNMHC News Alert, September 4, 2002

AB 1421 On Governor's Desk

Call to Action

After a four-year battle against the expansion of forced treatment laws in California, California clients denounce passage of AB 1421 (Thomson) out of the state legislature. "This represents a move backward for mental health clients' rights and recovery", says Sally Zinman, Executive Director of California Network of Mental Health Clients.

California Clients, along with other mental health and disability advocates, service providers and administrators will take their battle against AB 1421 to the Governor.

Join them and write to:
The Honorable Gray Davis
Governor of California
State Capitol Building
Sacramento, CA 95814
Fax: 916-445-4633

Join them at a RALLY at the State Capitol Building on Tuesday, September 17, 11 AM, to urge Governor Gray to veto AB 1421.

AB 1421, modeled after Kendra's Law in New York, creates a new involuntary outpatient commitment program for persons with psychiatric disabilities and expands present commitment criteria and time frames.

AB 1421 moves California in the wrong - and unproven - mental health policy direction

• In Mental Health: A Report of the Surgeon General, The Surgeon General of the US states, "Almost all agree that coercion should not be a substitute for effective care that is sought voluntarily". AB 1421 proposes coercion that casts a wide net and includes individuals who would never become dangerous or gravely disabled.
  
  
• Investing in voluntary enhanced services is the answer to the suffering that surrounds us, not more forced treatment. Voluntary community based services that support recovery have never been adequately funded. More forced treatment ignores this real problem.
  
  
• Coercive treatment is not an answer to "treatment noncompliance." Refusing treatment is often the result of forced treatment; therefore, more forced treatment is not a solution.
  
  
• Informed choice about and control over one's treatment is essential for recovery. AB 1421 removes choice and thus moves away from wellness and recovery.
  
  
• Current commitment law already has the power to force treatment on people who are dangerous to themselves or others or are gravely disabled. The problem is that current commitment law is not uniformly applied throughout the state. All those involved in the implementation of current law need training.
  
  

In a recent presentation to CNMHC members Board President Roy Crew stated, "AB 1421 will not address the really important issues facing our mental health community. There is already a shortage of voluntary mental health services and this legislation will make the situation worse. It has the potential to drain limited resources while compromising people's legal rights. It will upset the balance of civil liberties. Why take a forced approach when voluntary treatment has proven to be more effective?"

AB 34 Programs Are Doing the Job and Are At Risk Of Being Undermined

The AB 34 programs, model voluntary programs initiated 3 years ago and now in 30 counties, essentially serve the same population as AB 1421 proposes to serve. A witness supporting AB 1421 reported that involuntary outpatient commitment programs have a 70% engagement rate. AB 34 programs have engaged 84% of the difficult-to-serve people who have been contacted, reducing incarceration, hospitalization and homelessness significantly. Why duplicate or rob a successful program with a program that is less successful according to its own experts; more costly because of the staff ratio and investigation, court and enforcement costs; not proven based on the RAND report (commissioned by the California Senate) which calls involuntary outpatient commitment "experimental"; and harmful, according to the vast majority of clients who would suffer under it.

AB 1421 also may compromise the integrity of the AB 24 programs. AB 1421 programs, according to the author, "would attempt to bring this "resisting" group into the services provided through AB 2034." This merging of coercion and an involuntary population with the voluntary, non-threatening AB 34 programs will compromise the integrity of these programs, changing the nature of the services and causing clients to lose trust in them. This will jeopardize the success of the AB 34 programs.

"Kendra's Law" Applied Unequally

AB 1421 is a County option-in version of New York State's "Kendra's Law". Based on New York State's experience with outpatient commitment, the data raises concerns that outpatient commitment may target people of color. In New York State, 42% of the client population placed under outpatient commitment are Black while Black people represent only 24% of the total client population served. Conversely, 29% of the client population placed under outpatient commitment are White while that population represent 51% of the total client population served. 60% of those placed under outpatient commitment are male, and 83% have been located in New York City whose residents represent only one half of the State's client population. Involuntary outpatient commitment appears to be used for political not mental health reasons, and the basis for a court order seems to rely heavily on a combination of a person's ethnicity, gender, and location. Despite this racial imbalance in the implementation of Kendra's law, on which AB 1421 was based, AB 1421 does not include demographics in its reporting requirements.

The Foundation of AB 1421 is Discrimination Based on Centuries Old Stereotypes that have been Exploited to Pass a Law

• The false stereotype of the violent mental patient underpins the need to increase forced treatment. On the contrary, the MacCarthur Violence Risk Assessment Study found that "the prevalence of violence among people who have been discharged from a hospital and who do not have symptoms of substance abuse is about the same as the prevalence of violence among other people living in their communities who do not have symptoms of substance abuse."
  
  
• The false stereotype that people with psychiatric disabilities have no notion of their condition also fosters the need to increase forced treatment. On the contrary, the MacCarthur Treatment Competence Study found that, "Most patients hospitalized with serous mental illness have abilities similar to persons without mental illness for making treatment decisions. Taken by itself, mental illness does not invariably impair decision making capacities."
  
  

Ms. Zinman recently wrote in an editorial piece, "AB 1421 panders to fear and stereotypes. It scapegoats mental patients for homelessness, violence and the general ills of our society, creating the misconception these civic concerns will be lessened. Legislators should commit the system to providing services to people with mental disabilities, not commit the people whom the system has failed."

The CNMHC is joined by many other organizations that are urging the Governor to veto AB 1421. These organizations include: Protection and Advocacy Inc., California Association of Mental Health Patients Rights Advocates, California Association of Social Rehabilitation Agencies, California Council of Local Mental Health Agencies, California Psychological Association, California Foundation of Independent Living Centers, and many more state and local mental and disability organizations.

Some Specific Concerns about AB 1421

AB 1421 will create a new kind of involuntary commitment system in those counties that opt for it. It expands the criteria for commitment, including for emergency commitments, the time period for commitments, and proposes an over broad list of people who can initiate a commitment process. Although there has been an attempt to build in some safeguards, it is within the framework of taking people's rights and freedom away by increasing forced treatment.

• AB 1421 proposes overbroad commitment criteria that will cast a wide net and include individuals who would never become dangerous or gravely disabled. The criteria does not apply to a small, targeted population as the author claims. Moreover, people's freedom will be taken away not for actions that they have done, or for actions that are imminent, but for actions that they may do in the future according to a less than scientific prediction.
  
  
• AB 1421 proposes a commitment time of 180 days, which can be repeated. The bill provides for a mandatory review at 60 day intervals of the need for commitment which the subject of the order can contest if he/she is in disagreement. Nevertheless, the commitment time frame expands current LPS periodic time frames with their protections of people's liberty and freedom of choice. The 60 day interval reviews do not mitigate the expansion of the commitment time frame.
  
  
• Allows an overly broad list of people who can initiate a petition for commitment. Permits family and many friends to file petitions for an order authorizing involuntary outpatient commitment: roommates, parents, spouse, siblings or children 18 years or older. The potential for abuse of the power to initiate a commitment, such as in a custody or divorce proceedings, or for fiduciary gain, is endless. Current commitment law was developed to eliminate this kind of abuse of power. The bill sets in place a screening mechanism which limits the power of these lay people to directly petition the court. Nevertheless, the list of persons who can initiate a petition is expansive and intimidating, encouraging friends and loved ones to become keepers.
  
  
• Adds a new emergency commitment criteria (5150) in the counties that opt for this system: noncompliance of the court order or the negotiated settlement as well as refusal to be examined can initiate a 72 hour hospitalization. In other words, if a person does not agree with and thus doesn't follow his/her treatment plan, he or she can be committed for up to 72 hours, not counting holidays or weekends.
  
  
• Raises constitutional issues of equal protection under the law as different counties will have different commitment laws, including time frames and emergency commitment criteria. If a person lives in a county that opts for this new involuntary commitment system, he/she will have less rights than a comparable person living in another county. A person's liberty can be curtailed in one county while it cannot be in another.
  
  
• Based on New York State's experience with outpatient commitment, raises concerns that outpatient commitment may target people of color. In New York State, 42% of the client population placed under outpatient commitment are Black while Black people represent only 24% of the total client population served. Conversely, 29% of the client population placed under outpatient commitment are White while White people represent 51% of the total client population served. 60% of those placed under outpatient commitment are male, and 83% have been located in New York City. Involuntary outpatient commitment appears to be used for political not mental health reasons, and the basis for a court order seems to rely heavily on both a person's ethnicity, gender, and location. Despite this racial imbalance in the implementation of Kendra's law, which AB 1421 is based on, AB 1421 does not include demographics in its reporting requirements.
  
  
• AB 1421 may compromise the integrity of the AB 34 programs. The author states that AB 1421 programs "would attempt to bring this "resisting" group into the service programs provided through AB 2034." This merging of coercion and an involuntary population with AB 34 programs will compromise the integrity of these programs, changing the nature of the services and causing the clients to lose trust in them.
  
  
• AB 1421 has no state oversight, monitoring or quality control. The infrastructure of county advocates has not been expanded to protect the rights of people involuntary committed in the community. This laisse faire approach to the activity of forced treatment is ripe for client abuse.
  
  
• AB 1421 is optional for counties to adopt and is not contingent on a grant. Those research studies on outpatient commitment that suggest favorable outcomes insist that the commitment must be combined with intensive mental health services. AB 1421 adds only expanded commitment without additional services. AB 1421 adds non supplanting language stating that a county must make a finding that funding can not come from a reduction of current voluntary programs. New monies should follow proven voluntary programs that are chronically underfunded and in desperate need of resources, especially given the 24 billion dollar deficit faced in California. In the last few years, California has begun to build a client-friendly outreach and service system through "AB 34" programs. These programs have engaged 84% of the difficult to serve people that have been contacted, reducing incarceration, hospitalization and homelessness significantly. Any new funds for the involuntary AB 1421 model would clearly cut into the availability of increased funding for and thus growth of voluntary services. Also, as the non supplanting language in AB 1421 is very weak (county supervisors make unsupported findings all the time), AB 1421 may rob from proven voluntary programs.
  
  

Prepared by:
California Network of Mental Health Clients
1722 "J" Street, Suite 324
Sacramento, CA 95814
916-443-3232