Public Education & Policy :: Position Papers

Snapshot of CNMHC Public Policy Activities

Prepared November 2003
(The following Snapshot provides a summary of how the CNMHC has implemented its public policy priorities.)

How Public Policy Priorities Were Chosen

All the current Public Policy Priorities have been voted for by both the membership and Board. In 1998, the CNMHC used three different surveys plus a large forum at the Client Forum of that year to brainstorm and prioritize the CNMHC's Public Policy Priorities. At the Forum, issues identified by the Surveys and the attendees were placed on flip charts and each person put dots on his/her highest 4 priorities. The issues with the most dots were later approved by the Board and became CNMHC Public Policy Priorities. Since that time, the Board and Membership has voted on seven (7) additional Priorities.

What We Have Done to Implement the Priorities

No expansion of forced treatment or involuntary outpatient commitment

AB 1421 (Thomason, Davis), a bill which allows counties to opt into an involuntary outpatient commitment program, became law in 2003. Although the CNMHC and allies were able to stall initiatives to expand forced treatment for 4 years, ultimately we could not stop this well funded, highly promoted, and media supported effort. However, there is no state mandated patient commitment program and the LPS laws have not been changed. The battle went to the local - county - level.

There are many obstacles in the bill that make it very difficult for counties to implement. CARES developed descriptive and policy papers about the new law, as well as its potential costs. The CNMHC and its allies have been there to fight this regressive idea from becoming a reality in counties.

AB 1421 has been implemented in only one County, on a very limited scale. The CNMHC plans to be the plaintiff in a suit against this County for its implementation of AB 1421,

Client-run crisis teams/develop client-run alternatives to involuntary treatment
More funding for mental health programs, i.e., vocational rehabilitation and, on a 24 hour seven day a week availability, patients' rights advocates
Peer Support and Self-Advocacy Programs

The CNMHC has consistently supported voluntary community services and emphasized peer support, insisting that gaps in holistic client driven services are the cause of great mental suffering and other dire consequences, including incarceration and homelessness. The CNMHC has rallied to build a system based on consent and concern not force and fear.

Supported and worked for the following bills:

AB 34, 2034, 334, (Steinberg, D-Sacramento). All of these bills are intended to provide certain populations with client friendly, non threatening outreach and humanistic services. As a member of the CARES Coalition, sponsored SB 1858 (Escutia, D-Whittier), which promoted appropriate discharge planning and community services, and the use of advance directives. Supported SB 1770 (Chesbro, D-Arcata) that established self-help and family empowerment programs for mental health clients and family members.

Supported SB 1534 (Perata, D-Oakland) which increased the scope of county patient rights advocates and provided other measures that would make patients' rights advocacy more effective. Co-sponsored, as part of the CARES Coalition, SB 891 (Escutia, D-Whittier) which supported peer liaisons to bridge the gap from the hospital to the community.

Supported SB 931 (Burton, D-San Francisco) that supports local strategies for persons who are being discharged from or at risk of commitment. These expenditure plans must be value based on client empowerment, recovery, voluntary engagement, non institutional settings and approaches and independent and integrated living.

Worked in collaboration with the mental health community on the Mental Health Services Act. This Initiative would expand services and develop innovative approaches so as to bring AB 34/2034 type programs to most people with mental disabilities. The services, as described in the Act, must be consistent with the recovery vision and promote consumer run programs as a means toward recovery. If enough signatures are gathered, it will be on the November ballot.

Of the bills, only Steinberg's AB 34/2034 series have become law. These programs have demonstrated the success of a voluntary and client friendly, non threatening approach. This is an effort California must build on. The budget crisis stopped other efforts and even cut model programs such as the Adult System of Care - as exemplified by the Village. However, the Mental Health Services Act provides a unique opportunity to bring voluntary services to most people with mental disabilities. It answers the need for social and rehabilitative community mental health services that address the real life needs of person with psychiatric disabilities. It speaks to services that are value based in recovery, hope, and self determination.

Work incentive issues regarding Social Security, including maintaining health benefits.

The Far North Region conducted trainings for two years on social security and incentives to go back to work. In 2001-2002, the Central Valley conducted trainings on the new federal back to work legislation and ADA requirements for employers of people with disabilities. The CNMHC also supported AB 925 (Aroner, D-Berkeley) that addressed this issue.

Advanced Directives as a strategy under the priority to fight the expansion of forced treatment/outpatient commitment ad as a safeguard against forced treatments.

Three Regions have chosen advance directives as projects. The Bay Area has developed a Possessions Advance Directive as a way of protecting your housing, dependents, possessions, pets and finances, in the case of involuntary commitment or incarceration. The Region created a Training protocol and conducted Possessions Advance Directive Trainings. In 2000-01, the Central Valley Region, in collaboration with Protection and Advocacy, Inc, conducted a year of Advance Directive trainings. The Far North Region conducted Advance Directive trainings as its project for 2001-2002. And in 2002/2003, the Far North region used the Training protocol developed by the Bay Area and conducted Possessions Advance Directive trainings.

The CNMHC promoted language in SB 130 (Chesbro), a bill to reduce the use of seclusion and restraints, to include a person's advance directive regarding de-escalation (if one exists) when doing initial patient assessments.

Improved regulations of and rights protections in board and care homes.

The South Region has conducted surveys of Board and Care homes and advocacy outreach for the last two years. The CNMHC collaborated with Protection and Advocacy, Inc. in developing a grant application to further advocacy and self-help and peer support in board and care homes. This year

Restoration of "mental patient" Cemeteries and Histories - an anti-discrimination campaign.

In collaboration with the Peer and Self-Advocacy Unit of Protection and Advocacy, Inc. and People First groups, the CNMHC has developed the California Memorial Project. Its goals are threefold: Restoration of state hospital cemeteries and other places where state hospital patients remains have been placed; Telling Our Stories about life inside the hospital; Documenting the Ex-Patient/Survivor Movement in California.

Members of the California Memorial Project participated in the Senate Select Committee on Developmental Disabilities and Mental Health hearing on the status of state hospital and developmental center's cemeteries. The CMP co-sponsored and actively supported SB 1448 (Chesbro, Arcata), which supports cemetery restoration through conducting inventories, developing restoration plans for gravesites and cemeteries, and creating protocols for the future interment of patients. This bill became law.

The CNMHC gained funding for a .5 FTE CMP Coordinator to help implement the Project.

CNMHC members have been involved in regional groups working toward the restoration of cemeteries/gravesites. They have also been participants in the California Memorial Project Task Force, created by SB 1448. On Memorial Day, 2003, CMP members and friends paid respect at six (6) different cemeteries where mentally and developmentally disabled people are interred and unrecognized.

The CNMHC has concentrated on telling the story in display, picture, and video clips of the CNMHC, as part of the ex-patient/survivor movement in California.

Affordable Housing, Maximizing Independent Living, with Assistance When Desired.

The CNMHC supported SB 1227 which enacted the Housing and Shelter Trust Fund and placed 2.1 billion in general obligation bonds on the November 5, 2002 statewide general election ballot. This bond was approved by the voters.

The Elimination of the Use of Involuntary Seclusion and Restraints

The CNMHC was very active in all of the steps that culminated in SB 130 (Chesbro), a bill that aims to control and eventually reduce the use of seclusion and behavioral restraints in California. SB 130 is now law.

It started with a Report from the Senate Office of Research entitled Seclusion and Restraint; A Failure Not a Treatment in the Spring of 2002. Then came a Hearing in February 2003 on the use of Seclusion and Restraints. SB 130 followed. CNMHC contributed in the many subsequent stakeholder meetings on SB 130, hammering out the specifics of the bill and looking for agreement among the stakeholders.

CNMHC in partnership with the Services Employees International Union (SEIU) held focus groups in different parts of California to promote a dialogue between workers in facilities that use seclusion and restraints and the clients on whom these methods are used. The two groups developed a consensus statement urging the reduction of the use of seclusion and restraints.

The South Region for two years conducted dialogues on seclusion and restraint in facilities where these methods are used.

The mental health system, as a health system dedicated to helping individuals, must first and foremost do not harm and respect the rights and dignity of people with psychiatric disabilities. This means reducing and ultimately eliminating the use of seclusion and restraints. SB 130 begins this process.

Forensic Issues, Including the Criminalization of People with Mental Disabilities and Rights Protections when Incarcerated.

For two years, the Far South conducted sensitivity trainings for law enforcement personnel. This effort won two of the Project's leaders awards from the mental health community.