Gavin Newsom Signs Law In ‘overhaul Of Mental Health System. It Changes Decades Of Practice
summary
Gov. Gavin Newsom's mental health regulations will allow more Californians with serious mental illnesses to receive mandatory treatment. Some fear that the new law will restrict civil liberties against people's will.
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Governor Gavin Newsom announced today that he has signed the first of a series of bills aimed at transforming California's mental health system. Depending on who you ask, this transformation is either a long-awaited humanitarian response or a frightening erosion of civil liberties.
Today's signing relaxes long-standing rules about who is eligible for involuntary treatment under the fifty-year-old Lanterman-Petris-Short Act. Advocates and local leaders hope the new law will force more people into treatment facilities against their will.
"California is undergoing an overhaul of our mental health system," Newsom said. “The mental health crisis affects us all and the people who need help the most are often overlooked. We are committed to ensuring that no one falls victim to this problem and that people get the help they need and the respect they deserve."
Newsom is also expected to sign the mail-in ballot bill to voters, which includes two key provisions: a $6.4 billion bond to pay for 10,000. new treatment beds and an overhaul of a 20-year-old California law that funds supportive housing and mental health services with millionaires' taxes. A majority of voters in the March primary must approve the measure for it to become law.
All of this comes as Newsom's mental health law from last year's CARE trial is being implemented in seven states in its initial phase. Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus and Tuolumne counties opened Community Assistance, Recovery and Empowerment (CARE) courts on October 2; Los Angeles County will open its courthouses on December 1. Other federal states will follow next year.
The primary goal of all these initiatives is to combat serious mental illness among the state's growing homeless population. According to the US Department of Housing and Urban Development, this population has grown to more than 170,000 people, less than a quarter of whom suffer from a serious mental illness.
A recent survey of homeless people by the UCSF Benioff Initiative on Homelessness and Housing found that most homeless people have experienced serious mental illness at some point in their lives, but the main reasons for homelessness are high housing costs and low income.
CARE Courts allow family members, close friends, first responders and behavioral health professionals to assist the court in getting someone with schizophrenia spectrum or other psychotic disorders to follow a court-ordered treatment plan. A ballot initiative that would rewrite the mental health services law would require that 30 percent of tax dollars collected under the plan go to housing programs and half to people who are chronically homeless or living in encampments.
Today's signing of the voluntary detention bill, Senate Bill 43, marks a significant departure from the decades when civil liberties protections for Californians with mental illness were sacrosanct under the Lanterman-Petris-Short Act.
Legislators - Rep. Frank Lanterman and Democratic Senators Nicholas Petris and Alan Short - want to end the inappropriate and often unsafe institutionalization of people with mental illness and developmental disabilities. Back then, it was relatively easy for family members to force people into mental health treatment by keeping them in public hospitals for long periods of time, often in horrific conditions.
New standards for voluntary treatment
Law, then governor. Signed into law by Ronald Reagan in 1967, this law established strict criteria for determining eligibility for involuntary treatment and specific time limits for involuntary incarceration. This includes a 72-hour waiting period known as 5150. But promises to create a community-based support program did not materialize.
Susan Talamantes Eggman, a social worker-turned-Democratic senator from Stockton and one of the state's top mental health policymakers, is among those who believe California has come too far.
"We do something worse out of fear of doing something wrong," he said.
Learn more about the lawmakers mentioned in this story
State Senate, District 5 (Stockton)
State Senate, District 5 (Stockton)
Time in the office
2020-present
background
Education Officer/Member of City Council
Eggman authored the legislation signed into law today, the bill overhauling the Mental Health Services Act, as well as last year's CARES Act.
He told CalMatters that he has tried to introduce legislation to amend the Lanterman-Petris-Short Act five times in the past year. Fierce opposition from disability rights groups and some state legislatures blocked the change, he said.
This year's attempt passed without opposition in the parliament. It expands the legal definition of when someone is "severely disabled" and can be treated against their will. This new and expanded definition allows consideration of whether a person is depriving himself of medical care or personal safety. These include not only mental illness, but also serious substance disorders and chronic alcoholism.
He calls the current policy changes "the most important thing we've done in mental and behavioral health in the last 50 years."
Why some families want forced treatment
Many families of terminally ill patients say they are excited by Eggman's bill and other policy changes because they feel they have long been left out in their efforts to seek treatment because their loved ones have denied it.
"I personally think the tide is finally turning and we're really doing something to help these critically ill patients get the care they need," he said.
Linda Mimms, vice president of the National Schizophrenia and Psychosis Action Alliance.
Last month, Newsom praised the 60 Minutes interview, calling out critics of the changes, saying, “Change has its enemies. I understand that. But there's one thing you can't argue with—with all due respect." Critic. There—it's the status quo. That's what it is. It's not working. If there's no other alternative, what are we going to do about this crisis?"
But these critics say they are in no way defending the status quo. Instead, they point to other parts of the system that have suffered from decades of underinvestment, including affordable housing and various voluntary treatment services.
"We're never having the right conversation," said Kelechi Ubozoh, a mental health advocate and author of We've Been Too Patient: Voices from Radical Mental Health. "This is a conversation about poverty. We still say, "Blame mental health and the mental health system."
Ubozoh said many people with mental illness have had traumatic experiences with forced treatment and are "very afraid" of the state's mandate.
"For anyone concerned about this massive erosion of civil rights, this is just a disturbing change in state law," said Samuel Jain, California's chief disability rights attorney. He believes state leaders feel pressured to address the homelessness crisis and therefore equate homelessness with mental illness.
"We don't feel like it's going to change anything on the roads," he said. "This strategy seems to institutionalize people with intellectual disabilities."
Meanwhile, she said, the organization's clients are often stuck in emergency rooms and committed to psychiatric hospitals because there are no community beds for them.
Concerned about California's mental health tax
Some mental health advocates are also wary of Newsom's ballot initiative to reallocate money from the billionaire tax, which generates billions of dollars a year for the program. Revision of the Mental Health Services Act will undoubtedly result in reallocation of some funding from current programs.
That worries Tiffany McCarter, executive director of the African American Family and Cultural Center in Oroville, which provides meals, after-school care and other services for children, such as anger management.
"I pushed and pulled," he said. "I definitely want to help the homeless in a big way." But he is worried: "If something like this happens, what will happen to our children?"
This is because the organization relies almost exclusively on the Mental Health Services Act. She's trying to speed up the grant application process, but she's worried she won't have time. He said other organizations serving people of color in his community and state are in a similar position.
"Loss, loss, loss," he said.
States charged with implementing many state mental health programs, including the CARE courts, warn that change will take time.
"It is very positive that there are higher expectations for behavioral health in our communities," said Graham Knaus, CEO of the California Association of State Counties.
But after decades of underfunding, resources are still limited, he said. The state continues to suffer from a shortage of adequate housing, public safety officers and mental health professionals.
Please note: This story was updated at 11 a.m. Tuesday, Oct. 10, to clarify that Governor Newsom is expected to send a mental health ballot to voters for the March 2024 election.
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