Modernizing
Our Behavioral
Health
Continuum
April 4, 2022
Introduction
Many individuals and families dealing with mental
illness are not well served by our current system.
Even with record investment in recent years, it will
take time to see results in our communities.
This is a package of bills intended to improve the
behavioral health system across the continuum,
from prevention and early intervention, community
supports and services, intersystem collaboration,
improving access to assisted outpatient treatment,
providing increased accountability through
outcome tracking, preventing avoidable
conservatorships, and improving the effectiveness
of our conservatorship process for those that need
them.
More information available
as senate.ca.gov/Eggman
Legislation
This bill is intended to address a data shortfall that exists on what services are provided to those under various Lanterman-Petris- Short (LPS) Act holds and their outcomes. Due to our fragmented mental health system, many different entities are involved in the identification, investigation, treatment, follow-up, and more when it comes to those experiencing serious mental illness, grave disability, or dangerousness to self or others, and current data requirements are inadequate.
SB 929
Under current law, a petition for conservatorship can be filed when a person is “gravely disabled.” This means that the person is, as a result of a mental health disorder, unable to provide for their basic needs of food, clothing, or shelter. When a petition is made, a temporary conservatorship can be established and a
conservatorship investigation commences. This bill would ensure that the court is considering the contents of the report filed at the conclusion of the investigation and that, during conservatorship proceedings, relevant testimony is able to be considered, provided it falls under a hearsay exemption.
SB 965
HHS will establish a suite of measurable outcomes from which each county will identify its goals, in consultation with local stakeholders and a new working group.
Counties will track and report on their performance, followed by a self-improvement plan and regular progress updates. A statewide online dashboard will make the information easily accessible and allow policymakers and the public to compare counties’ progress.
The state will fund technical assistance to support counties in reaching their goals, including creating collaborative spaces for counties to learn from each other.
Once the improvement framework is in place, HHS will 1) eliminate the current requirement for counties to spend 80% of their MHSA funds on Community Services and Supports, 20% on Prevention and Early Intervention, and 5% on Innovation, and 2) extend the three-year planning to a five-year cycle, a more realistic timeframe for achieving meaningful progress.
Applies to MHSA the transformational Continuous Quality Improvement model developed and refined by other state
programs. The bill has four main components:
SB 970
Current law allows court ordered treatment plans to include coordination and access to medication but it does not explicitly permit courts to order medication as part of a treatment plan.
This discrepancy was highlighted in the State Auditors report on the LPS Act. Medication adherence is an essential tool that allows an individual to stay safely in their community. SB 1035 would make explicit that medications can be included in an order for Assisted Outpatient Treatment when they are included in the treatment plan.
SB 1035
Mental illness, like many other health conditions, when treated early and with appropriate supports and services, will be less disabling and result in fewer adverse outcomes. Although 16% of California adults live with a mental illness, more than 60% of those individuals do not receive treatment. While we have seen a small increase in psychiatric beds since 2012, we are still falling well below nationally established standards of 40-60 beds per 100,000 population state and have 30% fewer beds than we had in 1995.
SB 1154 would establish a real-time, internet-based dashboard to collect, aggregate, and display information about beds in inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities, and licensed residential alcoholism or drug abuse recovery or treatment facilities. Access to an up-to-date database of available beds helps providers quickly find and secure treatment for clients in appropriate settings, reducing delays or extended stays in emergency rooms.
SB 1154
Under current law, counties can establish an option, through their boards of supervisors, to follow a 14-day period of intensive treatment with an additional period of 30 days for those with a mental health disorder that causes them to be a danger to self or others, or gravely disabled. This period is intended to reduce the need for conservatorships if it is expected that the patient will stabilize within 30 days. In situations where the person does not stabilize as expected, this bill would provide for one additional 30 day period as an alternative to conservatorship proceedings.
SB 1227
SB 1238 takes a regional approach to evaluation and planning to address the behavioral services and infrastructure shortage. This bill models the existing Regional Housing Needs Assessment to ensure a broader view of the behavioral health needs across the state, including requiring DHCS, in consultation with the COGs, to determine the existing and projected need for behavioral health services for each region.
SB 1238
This bill would modernize the definition of “gravely disabled” within the Lanterman-Petris-Short Act to more accurately provide for the needs faced by individuals experiencing severe mental illness. SB 1416 would include under the definition of “gravely disabled” a condition in which a person, as a result of a mental health disorder, is unable to provide for the basic needs of personal or medical care or self-protection and safety.
SB 1416
While the state continues its work to improve and expand behavioral health infrastructure, bring real accountability and outcomes to behavioral health dollars, increase access to community care and higher levels of treatment like AOT, there are still too many falling through the cracks and onto the streets.
Estimates by the Treatment Advocacy Center are that as many as one-third of California’s population experiencing homelessness are also living with a serious mental illness. That could mean, even conservatively, tens of thousands of those living houseless in the community are also experiencing a – likely untreated, or undertreated – mental illness. Recent reporting by CalMatters uses state data indicating up to one-third of incarcerated Californians live with documented mental illness (pre pandemic).
Fact sheets for all of these bills are included on the following pages
March 16, 2022
Honorable Dr. Richard Pan
Chair, Senate Health Committee
1021 O Street, Room 3310
Sacramento, CA 95814
Re: Sponsorship of Senate Bills 929, 965, 970, 1035, 1154, 1227, 1238, and 1416 Chair Pan,
On behalf of the Big City Mayors coalition, representing the 13 largest cities and roughly 11 million residents in California, we are proud to cosponsor the Senate Bills contained in this letter, authored by Senator Eggman.
We have seen firsthand how our communities have struggled to provide appropriate and timely care to those experiencing severe mental illness. Our coalition does not typically sponsor bills, but we feel that the level of crisis we are facing is a top priority that we must all commit to solving.
This package of legislation will take a holistic view of our behavioral health continuum and provide increased opportunities and incentives for early intervention and prevention to reduce the negative outcomes we have come to see on our s treets. It will also modernize portions of our treatment system to ensure that those who have fallen through the cracks are able to receive the care that they need to provide for their own needs, safety, and dignity.
Over the last several years, progress on behavioral health service delivery has been slow. This is a problem that predates the COVID -19 pandemic, which has only exacerbated ou r existing crisis.
Inaction across the state has contributed to even greater numbers of untreated or undertrea ted Californians suffering along freeways and sidewalks. The status quo is unacceptable, and that’s why we are advocating for substantial change.
Our constituents are the same as yours, and they are telling us loudly and clearly that we must do more to protect vulnerable Californians from suffering without the treatment and care that they desperately need and deserve.
So please, join us in supporting this package of bills, and let’s show California that the wellbeing of our communities will always come first.
SB 929
SB 929 will help us better understand the current state of our LPS system and how it cares for thousands of vulnerable Californians. This bill will provide information that will help evaluate the services and strategies currently utilized , and allow the state to improve outcomes for those who are served.
SB 965
We continue to see the struggles of our community members that cycle in and out of hospitalizations, shelters, and jails without getting the concrete connections to needed medication and treatment. We are encouraging support of SB 965 to ensure that relevant history can be considered by the court in a uniform manner across the state. Tools focused on acute symptoms are not suited for chronic and severe conditions that we see on our streets. This bill will ensure that a complete and accurate picture is presented in court when considering the very serious step of conservatorship.
SB 970
The Mental Health Services Act has been a crucial, dedicated funding mechanism for community behavioral health services for the last 15-plus years, and we are excited to support the continuous improvement of the Act through SB 970. Though the Act has served as an incredible tool to build up community-based services, we feel that a more direct focus on service outcomes, increased transparency and accountability, and frequent progress reports will help improve service delivery that our communities rely on.
SB 1035
Assisted Outpatient Treatment has long been an effective, if underutilized, tool for providing appropriate and intensive outpatient treatment to Californians that have been repeatedly hospitalized or have come into contact with law enforcement due to thei r serious mental illness.
While SB 1035 can be characterized as a clarification, we feel it is important to ensure that there is no ambiguity on the ability to include self-administered medication in a court-ordered treatment plan. Medication may not be a cure-all for the conditions faced by many in our community, but it is a key component of long-term recovery.
SB 1154
A sometimes-incapacitating challenge in our fragmented behavioral health continuum is a lack of care coordination between various provider types and a lack of information about which resources are accessible and available in the community. SB 1154 will address both issues by establishing a database of behavioral health and substance use placements with the ability to collect important data to help assess the capacity of our system.
SB 1227
Current law allows for a gravely disabled person receiving 14 days of intensive treatment to be certified for an additional 30 days. Continuing the goal of most of the bills in this package to reduce the need for additional conservatorships, SB 1227 would allow for a single 30 -day extension of the existing option for 30-day intensive treatment. Our hope is that an additional 30 days to recover and reconstitute can reduce the need for conservatorship.
SB 1238
As we have seen with our struggles with housing and homelessness, people frequently cross city and county lines seeking shelter, community, and treatment. Despite the state’s view of these issues as regional in nature, behavioral health needs are not viewe d in the same way. SB 1238 would establish a regional planning process to evaluate whether behavioral health services and infrastructure are meeting the needs we have today and identify the needs that we should be planning for in the future.
SB 1416
Despite all efforts to reduce the need for conservatorship, the reality is that they can sometimes be the last resort to provide critical treatment to those who are gravely disabled. These individuals are the hardest to reach and often suffer from anosognosia , a condition which prevents them from being cognitively aware of the severity of their illness. The current definition and interpretation of “gravely disabled” does not accurately reflect the realities we are seeing in our communities and on the streets. SB 1416 would include in this definition a person’s ability to provide for their own personal or medical care, or self-protection and safety, to ensure that those who are truly vulnerable receive the help they need.
As was noted above, we do not typically sponsor legislation as a coalition. We feel that we have truly reached a crisis point of seriously mentally ill Californians languishing in our communities.
This package of bills will make improvements across the continuum of care and better position us to support our county partners with service delivery and provide the care that our constituents are desperately seeking.
Thank you for your consideration.
Sincerely,
Mayor Libby Schaaf
Oakland CA
Chair of Big City Mayors
Office of Senator Susan Talamantes Eggman • Senate Bill 929 Fact Sheet SB 929 – Lanterman-Petris-Short Act: Improved Data
SUMMARY_____________________________________________
This bill is intended to address a data shortfall that
exists on what services are provided to those under
various Lanterman -Petris-Short (LPS) Act holds
and their outcomes. Due to our fragmented mental
health system, many different entities are involved
in the identification, investigation, treatment,
follow-up, and more when it comes to those
experiencing serious mental illness, gra ve
disability, or dangerousness to self or others , and
current data requirements are inadequate.
BACKGROUND________________________________________
The Lanterman -Petris-Short Act of 1967 was the
state’s attempt to deinstitutionalize those
experiencing ser ious mental health disorders and
shift to community -based services. Unfortunately,
following the closure of many of these facilities,
those services did not follow.
Changes at both the state and federal level
followed, further slashing federal funding for
community mental health and shifting mental
health program responsibility to the counties.
Voters then passed the Mental Health Services Act
in 2004 to provide dedicated funding for
community supports and services and prevention
and early intervention. Sh ifting responsibility to
the counties can provide for more nuanced
decision-making around local needs, but it has also
hindered our ability to fully understand how
programs have worked across the state .
Throughout all of these changes, we have lacked
crucial data about how the LPS Act has worked and
some additional ways that services provided under
involuntary treatment orders can be improved to
ensure the best outcomes.
Further, the state has also experienced a dramatic
decline in inpatient psychiatric be d availability,
which contributes to the struggles to locate
appropriate services and provide for timely access
to care. The Department of Health Care Services is
currently required to collect and publish data on
the numbers of holds under the LPS Act, but there
are numerous challenges when it comes to forming
a complete picture of what is provided and how it
impacts outcomes.
The most recent report, published in July of 2021,
demonstrates the need for more specificity in this
requirement. The tables include totals reported by
each county for each of the LPS classifications,
including a table of the rates of detention per
10,000 people. This data is collected from three
primary sources: reports on services provided in
county jails, reports on conservat orships from the
Superior Court of the county, and the quarterly
report on involuntary detentions.
THIS BILL______________________________________________ This bill would require the state Department of
Health Care Services to collect additional data on
the implementation of the LPS Act annually,
including: outcomes for individuals placed in each
type of hold, the services provided to individuals in
each category, the waiting periods for individuals
prior to receiving care, current and future needs for
treatment beds and services, and more.
SUPPORT______________________________________________
Big City Mayors Coalition (Cosponsor)
Psychiatric Physicians Alliance of CA (Cosponsor)
CA State Association of Psychiatrists (Cosponsor)
FOR MORE INFORMATION__________________________
Office of Senator Eggman
Logan Hess
[email protected]
916.651.4005
Office of Senator Susan Talamantes Eggman • Senate Bill 965 Fact Sheet SB 965 – Conservatorships: Relevant History
SUMMARY_____________________________________________
Under current law, a petition for conservatorship
can be filed when a person is “gravely disabled.”
This means that the person is, as a result of a
mental health disorder, unable to provide for their
basic needs of food, clothing, or shelter. When a
petition is made, a temporary conservatorship can
be established and a conservatorship investigation
commences. This bill would ensure that the court is
considering the contents of the report filed at the
conclusion of the investigation and that, during
conservatorship proceedings, relevant testimony
is able to be considered, provided it falls under a
hearsay exemption.
BACKGROUND________________________________________
Under existing law, the Lanterman-Petris-Short Act
of 1967 (LPS) establishes the rights, pro tections,
and process for the provision of involuntary
behavioral health treatment for someone who is
“gravely disabled” or a danger to themselves or
others. LPS consists of various evaluation and
treatment periods, ranging from 72 -hours up to
renewable pe riods of one year under a
conservatorship.
When a conservatorship petition is made to
provide treatment to an individual believed to be
“gravely disabled,” the person may be placed under
a temporary conservatorship to allow for
additional investigation. A conservatorship
investigation is conducted by a public guardian
employed by the county, and a report is filed with
the court, which includes information on the
subject of the petition’s medical, psychological,
financial, family, vocational , and social con dition.
WIC 5008.2 also makes clear that relevant
historical information about the course of one’s
mental disorder shall be considered when it has a
direct bearing on the determination of whether the
person is gravely disabled.
In 2016, the California Sup reme Court held in
People v. Sanchez , that when any expert witness
relates to the jury case -specific out -of-court
statements (such as the conservatorship
investigation report), and treats those statements
as true and accurate to support the expert witness’
opinion, those statements may constitute hearsay
unless they fall under an existing hearsay
exemption. .
There are concerns , instances of which have
already come to fruition, that important medical
record information may be considered hearsay
within co nservatorship proceedings due to
Sanchez. In response to the LPS Audit in 2020, LA
County wrote that the Legislature should: “ Add
state law that would allow medical experts to share
details with a court about a proposed conservatee
that are observed by other medical personnel and
staff as recorded in a medical record and not just
those directly observed as limited by People v.
Sanchez, 63 Cal 4th 665.”
That is what this bill intends to accomplish.
THIS BILL______________________________________________ SB 965 would require the court to consider
relevant history and the comprehensive report
submitted by the public guardian after
investigation. It would also create a hearsay
exemption for information contained in a medical
record in or der to ensure all relevant information
can be presented to, and considered by, the court.
SUPPORT______________________________________________
Big City Mayors Coalition (Cosponsor)
Psychiatric Physicians Alliance of CA (Cosponsor)
CA State Association of Psychiatrists (Cosponsor)
FOR MORE INFORMATION__________________________
Office of Senator Eggman
Lilliana Udang
[email protected]
916.651.4005
SB 970 – MHSA Outcomes and Accountability Act
Office of Senator Susan Talamantes Eggman • Senate Bill 970 Fact Sheet SUMMARY_____________________________________________
Requires counties to set ambitious goals for their
Mental Health Services Act (MHSA) programs and
the state to monitor and publicly report their
progress. It also shifts the focus of spending
priorities to focus on achievable outcomes rather
than specific buckets.
BACKGROUND________________________________________
Since its passage by vo ters in 2004, the MHSA has
provided more than $18 billion to strengthen the
state’s behavioral health infrastructure and
support services focused on wellness and recovery.
Its successes include broad expansion of the
proven Full Service Partnership model, creation of
wellness and recovery centers throughout the
state, and a shift in public attitudes toward people
with behavioral health problems.
But California still faces major challenges closely
linked to behavioral health disorders:
Deaths from opioid an d methamphetamine use
have skyrocketed.
More than 50,000 people experiencing
homelessness live with a serious mental health
condition.
Rates of major depression among adolescents
increased by more than 50% over 12 years. This
contributed to a doubling i n the number of ER
visits by suicidal children and teenagers.
Each of these heartbreaking facts compels us to ask
whether MHSA funds are focused on meeting our
communities’ greatest needs. The Act allows
counties great spending flexibility, leading some to
embrace innovation. What’s missing is
accountability for setting goals, tracking outcomes,
and continually improving approaches to address
state and local challenges.
THIS BILL_____________________________________________
Applies to MHSA the transforma tional Continuous
Quality Improvement model developed and refined
by other state programs. The bill has four main
components:
1. Establishing measurable outcomes that
address top public priorities . Health and
Human Services Agency (HHS) will convene a
stakeholder working group that includes data
and metric experts. Based on their
recommendations and the outcomes specified
in the bill, HHS will establish a suite of
measurable outcomes from which each county
will identify its goals, in consultation with local
stakeholders.
2. Publicly tracking progress and
continuously improving. Counties will track
and report on their performance, followed by a
self-improvement p lan and regular p rogress
updates. A statewide online dashboard will
make the information easily accessible and
allow policymakers and the public to compare
counties’ progress.
3. Supporting counties and sharing best
practices. The state will fund technical
assistance to support counties in reaching
their goals, including creating collaborative
spaces for counties to learn from each other.
4. Allowing county goals to drive spending.
Once the improvement framework is in place,
HHS will 1) eliminate the current requirement
for counties to spend 80% of their MHSA funds
on Community Services and Supports, 20% on
Prevention and Early Intervention, and 5% on
Innovation, and 2) extend the three -year
planning to a five -year cycle, a more realistic
timeframe for achieving meaningful progress.
This powerful next step in the MSHA’s evolution
will bring the act closer to fulfilling its promise to
tackle major statewide challenges. A relentless
insistence on accountability and improvement will
focus energy where it belongs: facilitating the
recovery and thriving of Californians who live with
severe mental illness and substance use disorders.
SB 970 – MHSA Outcomes and Accountability Act
Office of Senator Susan Talamantes Eggman • Senate Bill 970 Fact Sheet SUPPORT______________________________________________
Steinberg Institute (sponsor)
Big City Mayor Coalition (Cosponsor)
FOR MORE INFORMATION__________________________
Office of Senator Eggman
Anna Billy
[email protected]
916.651.4005
Office of Senator Susan Talamantes Eggman • Senate Bill 1035 Fact Sheet SB 1035– AOT: Medication Requirements
SUMMARY_____________________________________________
This bill will give courts the express authority to
include self-administered medication
requirements in assisted outpatient t reatment
plans.
BACKGROUND________________________________________
In 2020, AB 1976 required the implementation of
Assisted Outpatient Treatment (AOT) statewide
unless a county chose to opt out. At this time, over
30 counties have adopted a program, ensuring that
this effective and community-based approach to
mental health treatment will continue to serve
individuals in need. Last year, SB 507 updated the
eligibility requirements by allowing individuals
exiting 5150 holds or those who have recently left
conservatorships to benefit from the con tinuum of
treatment and services that AOT offers . It also
added a small step towards medica tion adherence
by addressing an individual ’s capacity to give
informed consent regarding psychotropic
medication. As we continue to build a strong
infrastructure improving access and availability of
both voluntary and court -ordered treatment ,
medication compliance is vital to ensuring long
term stabilization and the ability to thrive in the
community.
Current law allows court ordered treatment plans
to include coordination and access to medication
but it does not explicitly permit courts to order
medication as part of a treatment plan . This
discrepancy was highlighted in the State Auditors
report on the LPS Act. Medication adherence is an
essential tool that allows an individual to stay
safely in their community. Adopting this
recommendation would give counties a
mechanism to ensure that individuals that are at a
high risk of medication noncompliance remain on
their medication and maintain their stability. This
allows recovery to take place in the least restrictive
environment possible which is the intent of our
State’s mental health system.
According to the State Auditor’s findings, the
prevailing factor that determ ines why individuals
cycle back into restrictive settings is medication
non-compliance. The report further determined
that 12 other states include court ordered
medication in their outpatient treatment plans,
specifying medication plan detail s and
administering practices. Explicitly allowing court -
ordered medications to be incorporated into
assisted outpatient treatment plans with the clear
intent that an individual will self -administer the
medication is key to preserving their stability and
decreasing thei r high risk of repeated
hospitalization, or arrest and incarceration.
THIS BILL______________________________________________ SB 1035 would make explicit that medications can
be included in an order for Assisted Outpatient
Treatment when they are included in the treatment
plan.
SUPPORT______________________________________________
Big City Mayors Coalition (Cosponsor)
Psychiatric Physicians Alliance of California
(Cosponsor)
CA State Association of Psychiatrists (Cosponsor)
Steinberg Institute
California State Sheriff’s Association
FOR MORE INFORMATION__________________________
Office of Senator Eggman
Anna Billy
[email protected]
916.651.4005
Office of Senator Susan Talamantes Eggman • Senate Bill 1154 Fact Sheet SB 1154 – Behavioral Health Bed Database
SUMMARY_____________________________________________
SB 1154 would establish a real -time, internet -
based dashboard to collect, aggregate, and display
information about beds in inpatient psychiatric
facilities, crisis stabilization units, residential
community mental health facilities, and licensed
residential alcoholism or drug abuse recovery or
treatment facilities. Access to an up -to-date
database of available beds helps providers quic kly
find and secure treatment for clients in appropriate
settings, reducing delays or extended stays in
emergency rooms.
BACKGROUND________________________________________
In 2019, the federal Substance Abuse and Mental
Health Services Administration (SAMH SA), along
with the National Association of State Mental
Health Program Directors (NASMHPD) , began
work with 23 states “to improve their coordination
of crisis services by making web -based bed
registries accessible to front line crisis counselors
in local behavioral health agencies, mobile crisis
teams, crisis call centers, and hospital emergency
departments.” Hospital emergency departments
continue to be frontline responders to those in
behavioral health crisis, and finding the most
appropriate treatment, as timely as possible, is
critical to improve outcomes.
Mental illness, like many other health conditions,
when treated early and with appropriate supports
and services, will be less disabling and result in
fewer adverse outcomes . Although 16% of
California adults live with a mental illness, more
than 60% of those individuals do not receive
treatment. While we have seen a small increase in
psychiatric beds since 2012, we are still falling well
below nationally established standards of 40 -60
beds per 100,000 population state and have 30%
fewer beds than we had in 1995.
Many individuals receive initial assessment and
stabilization for a psychiatric crisis in the
emergency department, which is a crucial piece of
the safety net for individuals with diffic ulty
accessing mental health services including those
who lack awareness of their own mental health
condition. However, due to a combination of a
difficult to navigate crisis response system which
lacks adequate capac ity - an environment not
conducive to the stabilization of psychiatric crisis -
and a lack of mental health programs, facilities and
professionals, individuals in crisis often languish
untreated in emergency departments for long
periods of time as ED staff struggle to find open
beds.
In additio n to streamlining access to care, these
databases can be useful data tools. Nine of the state
projects use bed registry data to measure bed
capacity and ut ilization to monitor resources,
promote their appropr iate use, and inform budget
and policy decisions . Five states use b ed registry
data to measure the effectiveness of diversion
policies and strategies to treat crises in the least -
restrictive environment
THIS BILL______________________________________________ This bill requires the California Department of
Public Health, in consultation with the State
Department of Health Care Services and the State
Department of Social Services to establish a
database for psychiatric, substance use disorder,
and community mental health bed openings, to be
updated and mai ntained as changes in availability
occur in order to streamline communication and
reduce patient waiting time for placement in
appropriate beds.
It would require the database to include a
minimum of specific information, including the
contact information f or a facility’s designated
employee, and have the capacity to, among other
things, enable searches to identify beds that are
appropriate for the treatment of individuals in a
mental health or substance use disorder crisis.
SUPPORT______________________________________________
Big City Mayors Coalition (Cosponsor)
Psychiatric Physicians Alliance of California
(Cosponsor)
CA State Association of Psychiatrists (Cosponsor)
Office of Senator Susan Talamantes Eggman • Senate Bill 1154 Fact Sheet SB 1154 – Behavioral Health Bed Database
Steinberg Institute
California State Sheriffs’Association
Alcohol Justice
FOR MORE INFORMATION__________________________
Office of Senator Eggman
Anna Billy
[email protected]
916.651.4005
Office of Senator Susan Talamantes Eggman • Senate Bill 1227 Fact Sheet SB 1227 – Additional 30 Days of Intensive Treatment
SUMMARY_____________________________________________
Under current law, counties can establish an
option, through their boards of supervisors, to
follow a 14-day period of intensive treatment with
an additional period of 30 days for those with a
mental health disorder that causes them to be a
danger to self or others, or gravely disabled. This
period is intended to reduce the need for
conservatorships if it is expected that the patient
will stabilize within 30 days. In situations where
the person does not stabilize as expected, this bill
would provide for one additional 30 day period as
an alternative to conservatorship proceedings.
BACKGROUND________________________________________
Under existing law, the Lanterman-Petris-Short Act
of 1967 (LPS) establishes the rights, protections,
and process for the provis ion of involuntary
behavioral health treatment for someone who is
“gravely disabled” or a danger to themselves or
others. LPS consists of various evaluation and
treatment periods, ranging from 72 -hours up to
renewable periods of one year under a
conservatorship.
If a person is detained for 72 hours and has been
evaluated, they may be certified for up to 14 days
of further intensive mental health treatment (or
treatment related to impairment by chronic
alcoholism) if the professional staff of the agency or
facility providing care has found the person is
gravely disabled or a danger to self or others; a
state designated facility agrees to provide the
intensive treatment; the person will not accept
necessary treatment voluntarily; they don’t have
others that can help them meet their needs of food,
clothing, and shelter. The certification must then be
delivered to the person certified and their attorney
or advocate. The person has a right to a
certification review hearing, to be held within 4
days of their certi fication, and the review hearing
shall be conducted by either a court -appointed
commissioner or a referee, or a certification review
hearing officer. If the hearing determines there is
not probable cause to believe the person is a
danger or gravely disabled then the person may no
longer be detained.
If there is probable cause, the person will continue
to receive involuntary treatment for up to 14 days.
They will then be released at the end of 14 days,
unless: they agree to voluntary treatment, they are
certified for an additional 14 days of treatment
(additional treatment for suicidal persons), they
are certified for 30 days of additional intensive
treatment, or they are the subject of a
conservatorship petition.
The 30-day intensive treatment (WIC 5270.1 0-
5270.65) is only an option in counties that have
adopted a resolution authorizing it. If the
professional staff believe a person completing a 14-
day hold would benefit from an additional 30 days
of treatment, they repeat the certification process
above. A 30-day intensive hold is not required prior
to a conservatorship. WIC 5270.55 (a) states
specifically that if conservatorship appears likely, a
referral should be made during the initial 14-day
intensive treatment period. According to WIC
5270.55 (b): If it appears that with up to 30 days
additional treatment a person is likely to
reconstitute sufficiently to obviate the need for
appointment of a conservator, then the person may
be certified for the additional 30 days.
THIS BILL______________________________________________ SB 1227 would allow this certification process to
be repeated for one additional period of 30 days of
intensive treatment, i f it appears likely they will
recover in that time and a conservatorship can be
avoided.
SUPPORT______________________________________________
Big City Mayors Coalition (Cosponsor)
Psychiatric Physicians Alliance of CA (Cosponsor)
CA State Association of Psychiatrists (Cosponsor)
FOR MORE INFORMATION__________________________
Office of Senator Eggman
Anna Billy
[email protected]
916.651.4005
Office of Senator Susan Talamantes Eggman • Senate Bill 1238 Fact Sheet SB 1238 – Behavioral health services: existing and projected needs.
SUMMARY_____________________________________________
This bill requires the Department of Health Care
Services (DHCS) to work with each council of
governments (COG) to identify each regions’
projected need for behavioral health services. This
bill follows the model established by the Regional
Housing Needs Assessment to take a broad and
holistic view of regional behavioral health needs to
ensure the collaboration nee ded to provide the
most appropriate and timely care.
BACKGROUND________________________________________
Currently across the state there is a shortage of
adequate placements for people suffering from
behavioral health issues. There is a growing need
for behavioral health service s across the
continuum, from inpatient psychiatric beds and
Assisted Outpatient Treatment to community -
based prevention and early psychosis
interventions.
DHCS recently completed an assessment of our
behavioral health service cont inuum in California
and included a number of findings indicating that
there is a lack of appropriate services. Specifically,
the assessment reported:
“…the rate of serious mental illness in
California as reported in survey data has
increased by more than 50 percent from 2008
– 2019”
“One in 13 children in California has a [serious
emotional disturbance] , with rates higher for
low-income children and those who are Black
or Latino, relative to other racial and ethnic
groups”
“…marginalized groups in Californ ia often are
at higher risk for behavioral health issues, but
also are less likely to be able to access
services.”
“…close to one in three adults in prison (30
percent) received mental health services in
2017, more than doubling the rate since 2000.
Jails typically have even higher rates of
individuals living with mental health and
substance use disorders, largely because
people may have been arrested and
incarcerated for nuisance crimes associated
with their conditions”
“Among Californians seeking mental h ealth
services, more than four in ten (43 percent)
reported that it was somewhat or very difficult
to secure an appointment with a provider who
accepts their insurance.”
Lack of appropriate treatment options funnels
patients to emergency rooms, county jai ls, and
homelessness instead of a proper treatment
option. The Rand Corporation recently partnered
with CalMHSA to study projected psychiatric bed
need regionally in California. This report
recommended that the state:
“Prioritize ps ychiatric bed infrastructure in the
areas with the greatest need. In terms of an
absolute s hortfall of beds, the shortfall was
greatest in terms of subacute beds, driven partly by
four regions (Los Angeles County, San Francisco
Bay Area, Inland Empire, Sup erior region) that
represented a shortfall of more than 2,000 beds—
more than a quarter of all additi onal beds needed
throughout the state. If polic ymakers examine the
psychiatric bed shortfall as a proportion of regional
adult population, this might lend greater weight to
regions with sma ller or more rural populations:
For exa mple, the shortfall of subacute beds is 5.2
beds per 100,000 adults in Los Angeles County
compared with 17.2 per 100,000 adu lts in the
Southern San Joaquin Valley. (p.4)”
THIS BILL______________________________________________ SB 1238 takes a regional approach to evaluation
and planning to address the behavioral services
and infrastructure shortage. This bill models the
existing Regional Housing Needs Assessment to
ensure a broader view of the behavioral health
needs across the state, including requiring DHCS, in
consultation with the COGs, to determine the
existing and projected need for behavioral health
services for each region.
Office of Senator Susan Talamantes Eggman • Senate Bill 1238 Fact Sheet SB 1238 – Behavioral health services: existing and projected needs.
SUPPORT______________________________________________
Big City Mayors Coalition (Co-Sponsor)
Psychiatric Physicians Alliance of California (Co-
Sponsor)
California Sta te Association of Psychiatrists (Co -
Sponsor)
FOR MORE INFORMATION__________________________
Office of Senator Eggman
Alison Kostusak
[email protected]
916.651.4005
Logan Hess
[email protected]
Office of Senator Susan Talamantes Eggman • Senate Bill 1416 Fact Sheet SB 1416 – Modernizing “Gravely Disabled” in the LPS Act SUMMARY_____________________________________________
This bill would modernize the definition of “gravely
disabled” within the Lanterman-Petris-Short Act to
more accurately provide for the needs faced by
individuals experiencing severe mental illness. SB
1416 would include under the definition of
“gravely disabled” a condition in which a person, as
a result of a mental health disorder, is unable to
provide for the basic needs of personal or medical
care or self-protection and safety.
BACKGROUND________________________________________
The Lanterman -Petris-Short Act of 1967 was the
state’s attempt to deinstitutionalize those
experiencing serious mental health disorders and
shift to community -based services. Unfortunately,
following the closure of many state institutions ,
those services did not follow.
Changes a t both the state and federal level
followed, further slashing federal funding for
community mental health and shifting mental
health program responsibility to the counties.
Voters then passed the Mental Health Services Act
in 2004 to provide dedicated fund ing for
community supports and services and prevention
and early intervention. While this funding has
shown so much promise and helped provide access
to critical care to many Californians, including
through full service partnerships, there are still
many b arriers to providing the appropriate and
timely care to many struggling at the margins,
disconnected from treatment.
While the state continues its work to improve and
expand behavioral health infrastructure, bring real
accountability and outcomes to behav ioral health
dollars, increase access to community care and
higher levels of treatment like AOT, there are still
too many falling through the cracks and onto the
streets. Estimates by the Treatment Advocacy
Center are that as many as one-third of California’s
population experiencing homelessness are also
living with a serious mental illness. That could
mean, even conservatively, tens of thousands of
those living houseless in the community are also
experiencing a – likely untreated, or undertreated
– mental illness. Recent reporting by CalMatters
uses state data indicating up to one -third of
incarcerated Californians live with documented
mental illness (pre pandemic).
The focus of the LPS Act on the ability to provide
for one’s food, clothing, and shelter is inadequate to
address the real needs in our communities. While
some may point to the State Auditor’s
recommendation that the criteria are adequate and
consistently applied, this is not a finding
corroborated by many in the behavioral health
community. The Legislature has taken, and will
continue to prioritize, steps to develop access to
community-based treatment, early intervention,
supported decision -making, assisted outpatient
treatment, and every other step along the
continuum to prevent the need for LPS Act holds
and conservatorships.
In its written response to the Audit, San Francisco
County noted: “ While a very small proportion of
individuals with serious mental illness have
episodes of violence, individuals with mental
illness are disproportionally v ictims of violence in
our communities. We encourage every effort to
protect these individuals and support patient
rights protections to ensure that involuntary care
is a last resort to support the recovery and wellness
of an individual; however, as experts in behavioral
health it is our professional opinion that these
resources are needed in serious cases.”
There are serious risks faced by those living with
serious mental illness that extend beyond their
ability to provide for food clothing and shelter. This
bill takes those additional risks into account when
it comes to providing behavioral health care.
THIS BILL______________________________________________ SB 1416 would amend the definition of “gravely
disabled” to add additional core criteria that a
person experiencing serious mental illness should
have the capacity to provide for their own personal
or medical care, and their own self -protection and
Office of Senator Susan Talamantes Eggman • Senate Bill 1416 Fact Sheet SB 1416 – Modernizing “Gravely Disabled” in the LPS Act safety when considering whether a
conservatorship or other involuntary intervention
is appropriate.
SUPPORT______________________________________________
Big City Mayors Coalition (Cosponsor)
Psychiatric Physicians Alliance of California
(Cosponsor)
CA State Association of Psychiatrists (Cosponsor)
FOR MORE INFORMATION__________________________
Office of Senator Eggman
Logan Hess
[email protected]
916.651.4005