The Los Angeles County Board of Supervisors voted Tuesday to work on legislation that would allow social workers and law enforcement officers to detain severely mentally ill individuals who refuse treatment that could save their lives.
By law, those with mental illness who pose a danger to themselves or others or are “gravely disabled” may 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 urged her colleagues to consider expanding that definition to include an inability to seek care due to a mental disorder.
Barger talked about meeting a woman named Deborah who has lived on the streets for 20 years and mistakenly believes her parents live across the street.
“There are predators out on Skid Row and this is a woman who, if not getting access to care and housing and shelter, is going to die on our streets,” Barger said, later telling the board, “She’s not going to make it through the winter, she’s just not.”
Barger and mental health advocates said the resources are available to help Deborah and others in desperate need, but that health care workers’ hands are tied.
“There are individuals in such dire need that their lives are in jeopardy,” said Brittney Weissman, executive director of the National Alliance on Mental Illness, Los Angeles County Council. “The limits of the law insist (health care workers) turn away from providing life-saving help.” Supervisor Sheila Kuehl voted no.
“I’m very grateful for the impulse behind this motion … but I could
not disagree more,” Kuehl said.
Kuehl asked the head of the county’s Department of Mental Health what happens when someone is brought in on a “5150 hold,” a reference to the relevant state government code that allows involuntary treatment.
Dr. Jonathan Sherin explained that a mental health team would engage the person, who would be taken to a hospital emergency room and then evaluated over a 72-hour period. Depending on the severity of their mental illness, the individual would then be released with a plan for care or kept for a longer period of time.
“So the 72-hour hold is whether they agree or not. They could protest, but under the law, it’s a `for your own good’ kind of thing?’ Kuehl asked.
Sherin replied that longer holds would require court approval.
Kuehl has expressed concern that changing the law could violate civil liberties and that people could be targeted for not meeting transitory definitions of what is “normal.” At an earlier board meeting, she recalled a time when gay and lesbian individuals were judged to be mentally ill.
Dr. Emily Defraites, a psychiatrist who works at the Veterans Health Administration, told the board that efforts to expand the definition of “grave disability” were aimed at a small segment of those with mental illness.
“I’ve realized that I really need this motion to try to take good care of people,” Defraites said. “This will only apply to a very small minority of our sickest psychiatrically and medically ill people.”
Kuehl 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 Committee.
“Personally, it think it will have a fairly rough time in Sacramento and I would prefer that the county not be a sponsor of the bill,” Kuehl said. Barger originally brought this motion two weeks ago, as part of broader set of recommendations for helping mentally ill and homeless individuals. The board had postponed a vote in favor of further discussion.
Barger said Tuesday she would welcome working with Kuehl to make sure any recommended legislation dealt with her concerns, but that the time to act was now.
“The county is a safety net provider for a reason and has a moral obligation to ensure that those on our streets who are suffering from grave mental illness, who are living in deplorable conditions and unable to provide for themselves, (for their) basic human needs, receive life-saving treatment and care,” Barger said.
An estimated 30 percent of the county’s homeless population and roughly 27 percent of county jail inmates suffer from serious mental illness, according to the Los Angeles Homeless Services Authority and the sheriff’s department.
The board directed Department of Mental Health staffers to work with county lawyers, mental health advocacy groups and civil rights organizations to develop a set of recommendations in 60 days.