The Board of Supervisors this week voted to sponsor state legislation that would allow social workers and law enforcement officers to detain severely mentally ill people who refuse life-
saving medical treatment.
Under existing law, only mentally ill people who pose a danger to themselves or others or are “gravely disabled” can be held for involuntary evaluation and treatment in a psychiatric setting. The definition of gravely disabled focuses on an individual’s ability to care for his or her own physical needs, to find shelter and food to survive.
Supervisor Kathryn Barger has urged her colleagues since October to consider expanding that definition to include an inability to seek care due to a mental disorder, telling colleagues about a woman she had seen on Skid Row who was bound to die soon without being forced to accept help.
“It is quite clear that the status quo mental health care system is inefficient and in need of thoughtful change,” Barger wrote in a motion co-authored by Supervisor Mark Ridley-Thomas. “While this recommended amendment to state law will not address all of the problems local jurisdictions face, it is a critical component which will allow for the humane treatment of those who are suffering from a mental illness and at risk of substantial physical harm or death.”
The board approved the motion on a 4-1 vote, with Supervisor Sheila Kuehl dissenting. Kuehl has expressed concern that expanding the definition could violate the civil rights of homeless people. She also warned that a county-sponsored bill to change state law would be unlikely to pass, citing her past experience as chair of the state Senate’s Health and Human Services
According to a Jan. 10 report to the board from Department of Mental Health Director Dr. Jonathan Sherin, a “significant number” of the 831 deaths of homeless people in Los Angeles County in 2017 were due to preventable or treatable medical conditions, listing cardiovascular disease, pneumonia, diabetes, cancer, cirrhosis and severe bacterial infections as some of the causes.
A survey of mental health leaders showed widespread support for amending the definition of grave disability, according to that report.
Sherin included data on homeless deaths, which have been rising at a faster pace than homelessness itself, jumping by more than 80 percent in the last four years, from 458 in 2013 to 831 in 2017. During that same period, the number of homeless individuals countywide has increased by roughly 46 percent, based on a point-in-time count in January of each year.
The data did not indicate how many of those who died were suffering from a mental illness that may have impaired their ability to seek treatment.
However, the percentage of homeless individuals suffering from mental illness has been increasing and an estimated 30 percent of the county’s homeless population suffers from serious mental illness, according to data from the Los Angeles Homeless Services Authority.
“In order to meet our ethical obligations to this population and our communities, it is our stance that the county should pursue legislation that would adjust the definition of gravely disabled to include individuals with serious physical health needs,” Sherin said.
The motion suggests amending existing language that defines gravely disabled as “a condition in which a person, as a result of a mental health disorder, is unable to provide for his or her basic personal needs for food, clothing, shelter” to add “or medical treatment where the lack or failure of such treatment results in substantial physical harm or death.”
The definition is similar to that followed by 37 states, according to the motion.
Proponents argue that the change would be “constitutionally precise” and require a finding of physical harm so the criteria could not be misapplied. Grave disability would still have to be proven beyond a reasonable doubt in order to enforce treatment.
“Allowing the most vulnerable to languish and even die on the streets without a lifeline to medical care is inhumane,” Barger said. “With (Tuesday’s) action, we can move forward to employ an effective approach to help deliver lifesaving treatment and care for those desperately in need and add California to 37 other states who consider medical treatment a basic human need for those suffering from a mental illness.”