LOS ANGELES – The Los Angeles County Board of Supervisors voted Tuesday to expand treatment for individuals suffering from mental illness, but stopped short of backing laws that would expand the criteria for detaining those who refuse treatment.
Under the law, those with mental illness who pose a danger to themselves or others or are “gravely disabled” can be held for involuntary evaluation and treatment in a psychiatric setting.
Supervisor Kathryn Barger had pressed her colleagues to support legislation seeking to expand the definition of “gravely disabled.” State law as written focuses on an individual’s ability to care for his own physical needs. Assembly Bill 1539 is one proposal that would include those who are unable or unwilling to seek treatment because of a mental disorder.
“The county has a moral obligation to ensure that those on our streets that are suffering from grave mental illness — who are living in deplorable conditions and unable to provide for their own basic human needs — receive the treatment and care that would drastically improve their quality of life,” Barger said in a statement previewing the discussion.
In April, the board had asked Department of Mental Health Director Jonathan Sherin to look at existing state mental health laws and the county’s standard of care.
“We’ve had difficulty engaging folks we want to help,” Sherin told the board.
Barger said the Los Angeles Homeless Services Authority estimates nearly 30 percent of homeless individuals in Los Angeles County are battling mental health issues, including substance abuse.
“That’s 15,728 individuals on the street right now facing mental health challenges. That is a devastating number,” she said.
There are 2,300 acute psychiatric beds available in the county plus 550 beds in board-and-care facilities offering intensive treatment and another 1,054 beds in long-term locked psychiatric facilities.
A working group led by Sherin developed 13 recommendations, only one of which requires changes to existing law.
They include rebooting training for first responders and clinicians, increasing the inventory of psychiatric beds for acute patients and expanding assisted outpatient programs. The county will also set up a working group to look at expanding court-ordered outpatient care.
New training will be aimed at making sure workers consistently interpret the criteria for detention, typically called a 5150 hold because of its government code number.
But Supervisors Sheila Kuehl and Hilda Solis said expanding that criteria raised civil liberties concerns.
Kuehl recalled a time when “large numbers of our young people were institutionalized … if you were gay or lesbian, you clearly had a mental illness,” adding, “I want to make certain that we know where we’re drawing the line.”
Solis raised similar concerns about elderly residents who might be victimized by an expanded definition of grave disability, as well as those who don’t speak English or have trouble navigating legal systems.
Barger agreed with those concerns.
“My goal is not to open up the floodgates. We don’t want to go back to warehousing” individuals, Barger said, but rather provide treatment with the ultimate goal of independent or group home living.
Brittney Weissman, executive director of the National Alliance on Mental Illness, Los Angeles County Council, urged the board to push forward on all of the recommendations.
“Don’t piecemeal it,” Weissman said. “Our parents and kids and relatives are counting on you.”
The board ultimately agreed to discuss the legal issue around grave disability further and to move forward on the other 12 recommendations.