Senate Health Committee narrowly passes forced treatment extension bill AB 2357

In a contentious hearing Wednesday, involuntary outpatient commitment extension bill AB 2357 (Karnette and Yee), which would extend the sunset date of AB 1421 ("Laura's Law"), was passed by the State Senate Health Committee with a vote of 5-3. The bill will be heard next in the Senate Appropriations Committee.

During the emotionally charged hearing, Health Chair Deborah Ortiz (D-Citrus Heights) asked the bill's proponents and opponents for clarification on the matter of whether any county had in fact implemented AB 1421.

In his statement in support of AB 2357, California Psychiatric Association lobbyist Randall Hagar claimed that Los Angeles County had implemented Laura's Law in a small pilot program, that case managers in the county had reported great success with the program, and that other counties, including Sacramento, San Francisco, and Nevada Counties, were intent on implementing the law. Hagar made the same claims repeatedly in prior hearings on the bill in the Assembly.

However, as California Network of Mental Health Clients (CNMHC) Executive Director Sally Zinman pointed out in her opposing comments, neither Los Angeles nor any other county has ever implemented the law. The L.A. County pilot program in question is a jail diversion program for mental health clients charged with misdemeanors, and both the program director and the county have publicly stated that this program does not implement AB 1421, following a settlement of a lawsuit against the county in which the CNMHC was lead plaintiff. And none of the other counties mentioned has either approved or reviewed an RFP for any AB 1421 program.

Visibly piqued by Hagar's apparent misrepresentation of the facts to the Senate Committee, Ortiz rebuked Hagar, imploring him to be truthful in his statements to the committee.

Senator Wesley Chesbro (D-Arcata) argued forcefully against the bill, noting that in his years of consulting with consumers, survivors and advocates on mental health legislation, clients and survivors have consistently voiced opposition to a series of forced treatment bills, including AB 2357 and its predecessor, AB 1421, on the basis that people who have been subjected to involuntary treatment report having been traumatized by that experience and losing trust in the mental health system, often subsequently avoiding all services, and that clients/survivors view the expansion of involuntary treatment as a violation of their civil rights. Chesbro stated that with many new voluntary Mental Health Services Act (MHSA) services just now receiving funding, he saw any extension of involuntary treatment legislation beyond the sunset date as being at best premature; clients should first be given an opportunity to access new, voluntary services.

Ortiz echoed Chesbro's opposition to the bill, stating that she could not see why the involuntary outpatient commitment demonstration project for which the law provides should be extended to 2013, and that she too was was concerned that the bill would pre-empt the introduction of new voluntary services under the MHSA. She asked the AB 2357 co-authors present, Assemblymembers Betty Karnette (D-Long Beach), Leland Yee (D-San Francisco) and Senator Samuel Aanestad (R-Nevada City), whether they would consider amending the bill to shorten the extension to three years instead � to 2011.

Instead, the co-authors defended the legislation in its current form; Yee spoke of his twelve years as a psychologist in a San Francisco day treatment center for youth, recalling that he "had to" repeatedly invoke Welfare and Institutions Code Section 5150 to initiate an involuntary 72-hour psychiatric hold (under the Lanterman-Petris-Short (LPS) Act) in order to treat a number of young people diagnosed with mental illnesses whom he described as "non-compliant" and "unwilling to show up for day treatment". Yee claimed that court-ordered outpatient commitment legislation was needed as an additional tool to enforce compliance among treatment-resistant clients.

Ortiz raised the question of whether monies from the MHSA could be used to fund an AB 1421 program; Chesbro argued that the intent of the MHSA was to fund voluntary services, and that this intent was reflected in the State Department of Mental Health (DMH) position in its MHSA Community Services and Supports Requirements that all services funded under the Act be "voluntary in nature".

Ortiz then asked the AB 2357 co-authors present whether they would accept an amendment to the bill to prohibit MHSA funding of such programs.

Rather than respond, proponents stood by as Aanestad made the rounds and counted likely "aye" votes among Committee members present.

Client advocate Dave Hosseini of the California Association of Social Rehabilitation Agencies (CASRA), who spoke in opposition at the hearing, later commented that the co-authors' silence in response to this proposed amendment offered evidence that they intend to seek MHSA funds for AB 1421/2357 programs.

Protection & Advocacy, Inc. (PAI) attorney Daniel Brzovic agrees, but points out that such funding is already prohibited under the MHSA. Brzovic, who also spoke briefly in opposition, has issued a public memorandum and co-authored an open letter to the DMH arguing that MHSA funds cannot be used to fund involuntary programs under AB 1421.

Advocate and PAI Board Director Sylvia Caras said that although she agrees that the MHSA cannot be used to directly fund AB 1421 programs, no one should be surprised if after counties receive funding for voluntary services under the MHSA, many then use other state funding once earmarked for voluntary services to fund involuntary outpatient commitment. For this reason, Caras did not support the MHSA prior to its passage.

This hearing departed from previous hearings on AB 2357 in the Assembly in a number of key ways. Whereas Democratic Assembly committee chairs Wilma Chan (D-Oakland), Dave Jones (D-Sacramento) and Judy Chu (D-Monterey Park) and Floor Leader Dario Frommer (D-Glendale) led the vast majority of Dems on their committees and on the Assembly Floor to join them in support of AB 2357, Ortiz and longtime mental health advocate Chesbro's vocal opposition emboldened fellow Dem Liz Figueroa (D-Fremont) on the Senate Health Committee to vote against the bill. Meanwhile, the Assembly trend of Republican-led opposition to the bill was also reversed, as recently added co-author Aanestad led the other three GOP senators on the Health Committee to vote "aye".

Senator Sheila Kuehl (D-Los Angeles), who signed on as co-author of AB 2357 on June 7 along with Senators Aanestad, Scott (D-Pasadena) and Torlakson (D-Antioch), left the hearing just prior to this agenda item, and was not present for the discussion; she returned at the end for the vote, providing the crucial fifth "aye" vote to pass the bill out of the committee. Kuehl's conspicuous absence during the discussion was widely speculated to reflect her backing of a bill viewed by the majority of the committee's Democratic members as an affront to progressive mental health reform, despite Kuehl's reputation as a solid progressive on most issues.

Consistent with past hearings, however, was proponents' apparent ignorance of California's existing forced treatment laws. During discussion, co-author Aanestad stated that the LPS Act has been mainly used as a means of getting law enforcement on the scene in emergencies, and that extending Laura's Law was needed to reduce hospitalization, incarceration, and homelessness.

However, Brzovic points out that the LPS Act already provides for court-ordered temporary conservatorship for a person who is found by a psychiatrist to be "gravely disabled", i.e. unable to provide for themselves food, clothing and shelter. In response to an extreme and unusual act of violence by a mental health client, AB 1421 and the bill that would extend its sunset date merely duplicate existing law, and in the ensuing public battle, add fuel to the fire of stigma and discrimination against mental health clients.