The Board of Supervisors voted this week to review its options for helping mentally ill homeless individuals who refuse treatment, including the potential for legislative changes.
Supervisor Kathryn Barger said it was time to consider changes, as the county prepares to spend hundreds of millions of dollars to counter homelessness. She estimated that about 30 percent of individuals living on the street suffer from some kind of mental illness.
“There needs to be a higher standard of mental healthcare,” Barger said in her motion. “With a short 10-year window to address homelessness using Measure H funds, the county must review and revisit the application of California’s Lanterman-Petris-Short Act to ensure that we have requisite authority to provide care for those who are suffering from mental illness and are unwilling and/or incapable of accepting care.”
The 1972 Lanterman-Petris-Short Act was designed to safeguard rights of the mentally ill and end the indefinite, involuntary commitment of those suffering from mental illness.
Barger said that while many among the chronically homeless refuse treatment, their inability to grasp the seriousness of their condition should not prevent them from receiving proper psychiatric treatment. A mandatory psychiatric hold can be “triggered,” she explained, when medical personnel or public safety authorities assess the person as a “danger to themselves or others.”
“This ‘trigger’ of mandatory psychiatric treatment also applies to those who are determined to be gravely disabled,” she said. “It is the definition of gravely disabled which has confounded attempts to help this vast homeless population. I strongly believe that if someone’s mental disorder prevents them from providing for his or her basic personal needs for food, clothing or shelter, they are in fact, gravely disabled, and in need of intervention and care.”
Barger said the law limits options to help the homeless, both because the standards to commit someone to treatment are difficult to meet and because the typical time limit for mandated treatment is 72 hours. As a result, some mentally ill homeless end up “hospitalized in our jails,” she said.
Department of Mental Health Director Dr. Jonathan Sherin agreed that too many of the resources for the mentally ill exist in jails and other “punitive environments … not designed for people to flourish.”
However, Supervisor Sheila Kuehl raised civil rights concerns and skepticism about efforts to “help” those who don’t want it.
“Let us be honest about how we draw the line,” Kuehl told her colleagues.
She warned that the county could end up taking on the responsibility for defining who is severely impaired, a decision typically left to the courts.
When Kuehl asked Sherin how he would approach the review, he told her, “We need to exhaust all options that are available to us currently,” but added that he was interested in “new care models.”
Sherin said the reassessment would include a fresh look at Laura’s Law, a state law that allows courts to mandate outpatient treatment for severely mentally ill individuals.
Carolyn Kelly, chair of the county’s mental health commission, echoed Kuehl’s interest in allowing mentally ill individuals to maintain their autonomy.
“Nothing about us without us … is something we want to very much honor,” Kelly said.
Kelly asked that the District Attorney’s Office be looped into the conversation as soon as possible, telling the board that enforcement and application of regulations is more important than the language of any law.
Just how many people would be affected by changes in the law or its application was another subject of debate.
The nonprofit organization Step Up on Second houses hundreds of people with serious and persistent mental illness who have been without a home of their own for decades, said Step Up CEO Tod Lipka. He told the board that “just 2-3 percent” need a new approach, while Barger said a “significant segment” of the chronically homeless population would benefit.
A report back is expected in 45 days.