Public Education & Policy :: Position Papers

Policy Arguments Against Implementation of AB 1421

AB 1421 permits counties to expand involuntary outpatient commitment. Counties would have to demonstrate sufficient capacity to comply with statutory requirements, including providing housing and extensive services, to implement the law. (See CARES document entitled "Inadequate Mental Health System Capacity Precludes AB 1421 Implementation") Below are policy arguments against implementation of AB 1421 at the local level.

AB 1421 moves California in the wrong - and unproven - mental health policy direction toward coercion & away from voluntary service.

"Almost all agree that coercion should not be a substitute for effective care that is sought voluntarily", says the Surgeon General of the U.S. (Mental Health: A Report of the Surgeon General)

• 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.
• 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 and attempts to cover up this real problem.
• Coercive treatment is not an answer to "treatment noncompliance." Refusing treatment is often the result of having experienced forced treatment. Fear of involuntary treatment drives people away from the treatment system.
• Expansion of forced treatment will require administrative costs (e.g., petition investigation, police detention, court costs) that could be better spent on increasing the availability of voluntary housing and supports.

AB 1421 moves California in an unjust and dangerous direction.

• AB 1421 criteria cast a wide net in vague language and include individuals who are not and never will be dangerous or gravely disabled.
• AB 1421 would deny persons the right to equal protection under the law by subjecting persons to different involuntary commitment criteria from one county to another. For instance, a person's liberty could be curtailed in one county while it could not be in another.

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. Also, those involved in the implementation of current law lack training.

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

• AB 34/2034 established Integrated Services for the Homeless Mentally Ill programs, which are available on a very limited basis in some 30 counties. These programs have helped to reduce incarceration, hospitalization and homelessness. Implementation of AB 1421 threatens to undermine the integrity of AB 34/2034 programs. It would associate coerced treatment with voluntary, non-threatening outreach and support under AB 34/2034 programs. This would change the nature of AB 34/2034 services and cause clients to lose trust in them. This will jeopardize the success of AB 34/2034 programs.

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 drive to increase forced treatment. This myth is debunked by a MacArthur Foundation study of coercive treatment, which 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 which do not have symptoms of substance abuse." (MacArthur Violence Risk Assessment Study, Executive Summary, April 1999).
  
  
• The false stereotype that people with psychiatric disabilities have no notion of their condition also fosters the need to increase forced treatment. This myth is debunked by another MacArthur Foundation study, which found that "the majority of patients hospitalized with schizophrenia performed adequately on any particular measure of decision-making ability, and about half did well on all the measures combined." (MacArthur Treatment Competence Study, Executive Summary, April 1999). The study also found that "Taken by itself, mental illness does not invariably impair decision making capacities."
  
  

What the Little Hoover Commission said on changing the commitment laws to make it easier to forcibly treat people with mental disabilities.

The Little Hoover Commission, an independent state oversight agency, in Being There: Making a Commitment to Mental Health, November 2000, on the reform of the Lanterman, Petris, Short (LPS) law (California's involuntary treatment law):

The Commission believes that adequate information has not been developed to fully assess the need for LPS Reform. Involuntary treatment laws may need to be reformed. But involuntary treatment should be understood as the last and final resort in a continuum of care that prioritizes voluntary treatment. The Commission believes the debate over LPS reform should be guided by the following analysis:

• An assessment of how the current LPS law is administered across counties. Are due process requirements adequate and involuntary treatment decisions consistent across the state?
• An assessment of how improved access to voluntary treatment could diminish the need for involuntary treatment. The State should ensure that involuntary treatment is only an option when no other form of treatment is effective. Inadequate access to voluntary care does not warrant the use of involuntary care.
• The dimensions of the problem that LPS reform would address. Preliminary data suggest the rate of involuntary commitment is increasing; it is unclear why. How has the use of involuntary commitment changed over time? How does the law affect different ethnic groups? How would a reformed law change outcomes?
• The capacity of state and local authorities to better serve existing clients through other "involuntary" models, such as CONREP, mental health courts, or probation.
• The ability of the State to improve the quality of involuntary care and decrease the level of fear clients associate with forced treatment.

"California's involuntary commitment law - the LPS act - is one of the most controversial mental health issues of the day. But the Commission found the most important and immediate concern to be the 1.5 million Californians who need help, but do not receive it." Being There: Making a Commitment to Mental Health, Executive Summary.

What the RAND Report said on the Effectiveness of Involuntary Outpatient Treatment

RAND was commissioned by the California Senate Committee on Rules to develop a report on involuntary outpatient commitment, The Effectiveness of Involuntary Outpatient Treatment, Empirical Evidence and the Experience of Eight States, 2001, which found:

• The data is inconclusive on whether involuntary outpatient commitment works.
• "There is no evidence that a court order is necessary to achieve compliance and good outcomes..."
• The literature provides clear evidence that "alternative community based mental health treatments can produce good outcomes for people with severe mental illness."
• "The data suggest that a significant percentage of people with mental illness who need services aren't getting them, and those who do get very few."