Lanterman Petris Short Act. The California State Assembly LPS Hearings will be held December 15. In preparation PPAC ad-hoc LPS task force convened a couple of nights ago. PPAC’s board recently re-adopted the Lanterman Petris Short Act Task Force II report and recommendations (2012) as policy. Also, recommended reading, the first LPS TF report and recommendations (1998). Finally, The Dilemma Report – issued (1967) by the legislature, shows the thinking in 1966-7 that shaped the LPS.
The dilemma. Opening statement in the LPS Dilemma Report contains this:
“ . . the basic objectives of California’s mental health system, [are] individual health and public safety. And therein lies a basic dilemma. While these goals need not always conflict, differences in emphasis have engaged the medical and legal professionals in a continuous debate over which is more important, ‘civil liberties’ or ‘treatment’ considerations” . . . this has tended to place state legislatures in the uncomfortable position of having to choose between the medical objectives of treating sick people without legal delays and the equally valid legal aim of insuring that persons are not deprived of their liberties without due process of law.”
Further. “Both positions are right and wrong, and actions that further ‘medicalize’ or ‘legalize’ the present system are, at best, a poor compromise.” Remember, this statement was made in 1967.
Timeout for my comment. An operative policymaking tension exists today. Case in point. PPACs Laura’s Law bill (AB 507) in 2021 was subject to amendments proposed by both health and judiciary committees. In health we wanted to make sure that those who recidivate in and out of conservatorships can access Assisted Outpatient Treatment programs – called highly effective by the state auditor who recommended this very provision.
Judiciary Committee staff, on the other hand, were alarmed by language that made conservatees eligible for AOT orders without satisfying any of the criteria in current law that non-conservatees would have to satisfy. We worked that out, preserving the intent of the bill without the requirement to accept well-meaning roadblocks to treatment. Several weeks of work by committee staff, author, sponsors and the committee chairs contributed to and shaped the current law. Conservatees get the benefit of AOT; serial 5150s can be addressed, too. This is an example of good policymaking. The tension spoken of in the Dilemma Report was overcome.
On the other hand, Senator Wiener’s SB 1045 proposed in 2018 an innovative conservatorship for street-drug using, mentally ill individuals which also provided housing. This law shows what happens when the dominant force shaping it is almost exclusively legal. SB 1045 was extensively amended by judiciary committees in both houses with the rationale that extensive civil rights protections were needed. When implemented, it was so restrictive that only one individual was enrolled in the first year of operation; five more in a second. In my opinion, the pendulum swung too far to the legal extreme, resulting in a policy that prevented what could have been effective treatment. A policymaking fail.
Dilemma report system proposal. The LPS as envisioned in 1967 would be enacted in community settings with Emergency Services Units as the centerpiece of treatment. ESUs would replace commitment courts of bygone eras, providing “a wide variety of voluntary services quickly without stigma or legal disabilities.” ESUs would provide “medical, psychological, social and legal evaluations as required.” ESUs would also be able to involuntarily detain individuals gravely disabled or “overtly destructive” for “72 hours and cause them to be transported to an approved, licensed hospital” with a variety of services available to meet the need of the current crisis.
ESUs. Then as now, it was left to local authorities to establish ESUs. Few apparently did. Today most people don’t remember the concept of ESUs. And fewer still remember an ESU established in their county. LPS was dependent on ESU’s. Any wonder why we have difficulties with the therapeutic deliverables in the LPS? That’s simplistic, of course, but still. We’ll be examing all these critical issues in the upcoming LPS hearing. Stay Tuned!