Newsom Signs 'Overhaul' of Mental Health System 

Gov. Gavin Newsom on Oct. 10 announced he signed the first of a series of bills aimed to transform California's mental health system. Depending on who you ask, this transformation represents a long overdue humanitarian response — or a worrisome step backward on civil liberties. 

The governor's Oct. 10 signature loosens long-standing rules about who is eligible for involuntary treatment under the half century-old Lanterman-Petris-Short Act, the landmark mental health law that regulates involuntary civil commitment in the state. Advocates and county leaders expect the new legislation will lead to more people being placed in treatment facilities against their will.

"California is undertaking a major overhaul of our mental health system," Newsom said in a written statement. "The mental health crisis affects us all, and people who need the most help have been too often overlooked. We are working to ensure no one falls through the cracks, and that people get the help they need and the respect they deserve."

Newsom also is expected to sign legislation sending two key ballot measures to voters next March: a $6.4 billion bond to pay for 10,000 new treatment beds and supportive housing, and an overhaul of California's 20-year-old law that funds mental health services with a tax on millionaires. A majority of voters would need to approve those measures.

All of this comes just as CARE Court, Newsom's signature mental health legislation from last year, begins rolling out in an initial cohort of seven counties. Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus and Tuolumne counties opened their Community Assistance, Recovery, and Empowerment (CARE) Courts on Oct. 2; Los Angeles County will open its court Dec. 1. The rest of the state will follow next year.

Addressing serious mental illness among the state's growing unhoused population is a major focus of all of these initiatives. That population has burgeoned to more than 170,000 people, less than a quarter of whom have severe mental illness, according to the U.S. Department of Housing and Urban Development. 

A recent survey of people experiencing homelessness by the University of California at San Francisco Benioff Homelessness and Housing Initiative, found that the majority had experienced serious mental health conditions at some point in their lives but the main reasons most became homeless were high housing costs and low incomes.

CARE Court allows family, close friends, first responders and behavioral health workers to petition a court to compel a person with untreated schizophrenia spectrum or other psychotic disorders into a court-ordered treatment plan. The ballot initiative that would redesign the Mental Health Services Act would require that 30 percent of tax dollars brought in under the plan go toward housing programs, half of it to serve people who are chronically homeless or living in encampments.

Taken along with the Oct. 10 signature of the involuntary confinement law, Senate Bill 43, the moment marks a significant departure from the decades in which the civil liberty protections for Californians with mental illness seemed virtually untouchable because of the Lanterman-Petris-Short Act. 

The authors of that law — Assemblymember Frank Lanterman and Democratic Sens. Nicholas Petris and Alan Short — sought to end the inappropriate and often indefinite institutionalization of people with mental illnesses and developmental disabilities. At the time, it had been relatively easy for family members to force people into mental health treatment, often locking them away for long stretches in state hospitals where conditions were abhorrent. 

New Standard for Involuntary Treatment

The law, which then-Gov. Ronald Reagan signed in 1967, established strict criteria to determine who was eligible for involuntary treatment, as well as specific timeframes that limited involuntary holds. This included the 72-hour hold known as a 5150. But concomitant promises to build up community-based support programs did not materialize.

Susan Talamantes Eggman, a social worker turned Democratic state senator from Stockton who has become one of the Legislature's main authors of mental health policies, is among those who feel California went too far back then.

"For fear of doing something wrong we did something even worse," she said.

Eggman authored the law signed Oct. 10, carried the legislation to redesign the Mental Health Services Act and also co-authored last year's CARE Act.

She told CalMatters she has tried five times in recent years to introduce legislation amending the Lanterman-Petris-Short Act. Stiff resistance from disability rights groups and some legislators impeded those changes, she said. 

This year's attempt sailed through the Legislature without opposition. It expands the legal definition by which someone can be deemed "gravely disabled" and treated against their will. The new, expanded definition allows for consideration of whether a person fails to provide for their own medical care or personal safety. It includes not just mental illness, but also severe substance use disorder and chronic alcoholism.

She called the current constellation of policy changes "the most significant thing we've done in the mental health, behavioral health workspace easily within the last 50 years."

Why Some Families Want Involuntary Treatment

Many families of seriously mentally ill individuals say they are thrilled with Eggman's bill and with the other policy shifts, having long felt sidelined in their efforts to press for treatment when loved ones refused it.

"I think, personally, that the tide is finally turning, that we are on our way to really doing something to help these very sick people get the treatment that they need," said Linda Mimms, vice chair of the national Schizophrenia and Psychosis Action Alliance. 

She lauded Newsom's interview with 60 Minutes last month, in which he called out critics of the changes, saying: "Change has its enemies. I get it. But one thing you cannot argue for — with all due respect to all the critics out there — is the status quo. You can't. And in the absence of alternatives, what the hell are we going to do to address this crisis?"

But those critics say they aren't defending the status quo at all. Rather, they point to other parts of the system — including affordable housing and an array of voluntary treatment services — that have suffered after decades of underinvestment. 

"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. "It is a conversation around poverty. We're still saying, 'Let's blame it on mental health and the mental health system.'" 

Many who live with mental illness have had traumatic experiences with involuntary treatment, Ubozoh said, and are "really scared" by the current direction the state is headed. 

"For no one to oppose this huge erosion of civil rights is just a really concerning change in the state Legislature," said Samuel Jain, senior attorney with Disability Rights California. He believes state leaders feel pressure to address the homelessness crisis, and as a result are conflating homelessness and mental illness. 

"We don't feel that this is going to change anything on the streets," he said. "This strategy seems to be to take people with mental health disabilities and put them into institutions."

In the meantime, he said, the organization's clients often find themselves stuck in emergency departments and locked psychiatric settings because there are no community-based beds for them. 

Worry About California's Mental Health Tax

Some mental health advocates also are wary of Newsom's ballot initiative to reallocate money from the millionaire's tax, which raises several billion dollars every year for programs. They say the redesign of the Mental Health Services Act will inevitably redistribute some funds away from current programs.

That worries Tiffany McCarter, executive director of the African-American Family and Cultural Center in Oroville, which provides children with food, after-school care and other services, such as anger management.

"I was pushing and pulling within my own self," she said. "I want to help the homeless on a mass level for sure." But she worries: "When it came to this measure, if they do this, what about our kids?"

That's because her organization depends almost entirely on money from the Mental Health Services Act. She's trying to rush to apply for grants but worries she doesn't have enough time. She says other organizations that serve people of color in her community — and around the state — are in the same position.

"It's a lose, lose, lose all the way around," she said.

Counties, which are charged with implementing many of the mental health policy programs coming down from the state, including CARE Court, caution that change will take time.

"It is a very positive thing that there are higher expectations around behavioral health in our communities," said Graham Knaus, CEO of the California State Association of Counties. 

But after decades of underfunding, he says, resources are still finite. The state continues to face significant shortages of appropriate housing placements, public guardians and mental health workers.

This article was originally published by CalMatters.