Southern California PSYCHIATRIST September 2025

President’s Column – Welcome to the Conversation

by Patrick Kelly, MD

As summer draws to a close and we transition into fall, I hope we all feel re-energized and ready for the year ahead. September traditionally serves as a pivotal month—children return to school, organizations prepare for their final quarterly push, and we all trade shorts for sweaters (though admittedly, less so in Southern California!). This seasonal shift is no less significant in the world of psychiatry, particularly around advocacy.

Late summer brought considerable activity in mental health policy, presenting both encouraging developments and concerning uncertainties that demand our attention:

• On August 5, the CDC launched “Free Mind,” a major national campaign targeting mental health and substance use among adolescents ages 12-17.
• On August 6, the Health Resources and Services Administration (HRSA) announced supplemental funding for the Pediatric Mental Health Care Access Program, providing additional resources through September 2026.

• On September 3, the American Psychiatric Association joined other prominent physician organizations in a joint statement addressing CDC leadership reorganization and its potential threats to public health stability, including vaccine recommendation inconsistency during the approaching cold and flu season

• One of the most critical developments has yet to occur. On September 30th, there is a scheduled expiration of key telehealth flexibilities, referred to as the “telehealth cliff.” Mark your calendars: our Private Practice Committee is hosting an educational seminar on September 13th to discuss these critical issues, including participation from legal experts, to help our members anticipate and navigate these potential changes

As leaders in the mental health field, we as members of SCPS bear the responsibility to stay informed about these developments while providing stability for our patients and our communities. It can be tempting to retreat into one of two equally problematic extremes: on the one hand, we can react by burying ourselves in clinical work while hoping “someone else” will address these challenges. While this represents stability in the extreme, it veers quickly into paralysis and disconnection. On the other hand, we can find ourselves tempted to react hastily and without thoughtful consideration – we have seen this in our pharmacies, where many have limited controlled substance prescribing to idiosyncratic and capricious geographic restrictions based on the patient’s address, the prescriber’s address, or both, without any clear evidence that this is helpful and with total disregard to the needs of their established patient population.

Our duty lies in finding the middle path—engaging in cautious, deliberate discussion and response that neither ignores these developments nor rushes into imprudent action without considering consequences. We owe our patients and ourselves a balanced response: neither paralyzed by change nor propelled into hasty action without reflection.

Finding this balance is rarely easy. But that’s why SCPS exists—so that none of us has to navigate these uncertainties alone. SCPS strives to take the best of us and enable open, frank, productive discussions, taking multiple viewpoints into consideration, to arrive at carefully considered next steps to help support and advocate for our patients and our field as a whole. I hope you will continue to join me, and each other, in these open, productive conversations—working together to understand, discuss, and shape responses to new developments. This is what my former Chair called the conversation. Through it, we harness the wisdom and perspective of our diverse membership to advance our highest ideals.

Your participation strengthens both our organization and our message. Whether through committee involvement, advocacy efforts, or simply staying informed and engaged, your unique perspective and experience contribute to our collective impact.

Thank you for being part of the conversation.

Civil Commitment in California: Then and Now

by Kayla Fisher, MD

The history of commitment in California stretches back over a century, marking a shift in how we conceptualize mental illness and the delicate balance between protecting individual rights and addressing broader societal concerns around treatment and public safety. The advent of state hospitals in the mid-19th century heralded the beginning of civil commitment. During this era, family members or physicians could petition for commitment with minimal court oversight.  Once committed, patients could remain hospitalized indefinitely as treatment emphasized custodial care rather than rehabilitation. This limitation was, at least in part, due to fewer therapeutic options available at that time. By the 1950s, critics raised concerns of overcrowding and neglect.

The 1960s, marked by the civil rights movement, also saw a growing awareness of potential abuses in mental institutions, leading to a call for reform. In California, this culminated in the Lanterman-Petris-Short (LPS) Act, passed in 1967 and implemented in 1969. This landmark legislation aimed to overhaul the state’s civil commitment laws by introducing due process protections and limiting the use of involuntary confinement. Under the LPS Act, a person could only be involuntarily committed if, due to mental illness, they posed a danger to themselves or others, or were gravely disabled.

The implementation of the California LPS Act coincided with the broader national movement towards deinstitutionalization. During the 1970s and continuing through the 1990s, thousands of individuals were discharged from state hospitals with the expectation that they would receive services in community-based programs. Critics raised concerns that many individuals with severe mental illness lacked access to adequate ongoing treatment and support, either due to their inability to participate in outpatient treatment or due to limited outpatient resources. The figure below contrasts the principal arguments for and against deinstitutionalization as described by Lamb & Bachrach (2001), Torrey (1997), Grob (1994), Appelbaum (1994), Mechanic & Rochefort (1990), and Scull (1989).

The 1980s and 1990s saw a significant increase in the homeless population and a disproportionate representation of people with mental illness in carceral settings. These findings were often attributed, at least in part, to the deinstitutionalization movement. In California, critics of the LPS Act argued that the legislation made it too challenging to intervene prior to a crisis occurring. Advocates of the LPS Act countered by emphasizing the need to protect civil rights. This debate raised the crucial question of what California could do to address the two concerns— protecting civil rights and providing treatment prior to a crisis.

The 2000s saw several significant reforms in California aimed at addressing the problems of repeated hospitalization, homelessness, and incarceration among those with mental illness. One such reform was the enactment of Laura’s Law in 2002. This law allowed counties to implement court-ordered Assisted Outpatient Treatment (AOT) for individuals with repeated hospitalizations, arrests, acts of self-harm, or violent acts stemming from severe and persistent mental illness. To qualify for AOT, individuals had to be unable to access voluntary treatment, be unlikely to survive in the community without supervision, and be experiencing substantial deterioration. The evidence for this court-ordered treatment had to meet the legal standard of proof level of clear and convincing. However, since the implementation of Laura’s Law was optional, not all counties chose to provide this treatment option.

California Senate Bill 43 (SB 43), signed into law on October 10, 2023, updated the Lanterman Petris-Short (LPS) Act, expanding the definition of “gravely disabled” to include individuals unable to care for their health and safety due to severe substance use disorder. Previously, “gravely disabled” applied only when a person could not meet basic needs due to a mental health disorder. SB 43 now includes severe substance use disorder (SUD), chronic alcoholism, and co- occurring mental health and severe SUD. SB 43 also adds the inability to maintain personal safety or obtain necessary medical care as a qualifying criterion.

In addition to expanding the definition of “gravely disabled”, SB 43 provides for a hearsay exception in conservatorship hearings. Expert testimony in conservatorship proceedings can now include information provided in medical records without requiring the person who observed the behavior or made the medical record entry to appear as a witness.

Although SB 43 took effect on January 1, 2024, counties may delay implementation until January 1, 2026, with many counties opting for this later implementation date. Advocates of SB 43 view it as providing another tool to help individuals access treatment, particularly when individuals lack insight into their impairment. Critics caution it could erode civil liberties without ensuring sufficient treatment resources.

The history of civil commitment in California illustrates the persistent tension between protecting individual freedoms and providing for the needs of those with severe mental illness. From the asylum era of the 19th century to the rights-focused reforms of the LPS Act and the current expansion under SB 43, the state has repeatedly redefined who can be committed, under what conditions, and for how long.

What remains consistent is the challenge of aligning law, policy, and resources in the field of mental health law. Without sufficient and robust community-based services, legal reforms may fail to achieve their intended goals. California continues to grapple with the same fundamental question first posed more than half a century ago: how to balance civil liberties with the need for humane and effective care for some of its most vulnerable residents. This ongoing struggle highlights the importance of ongoing engagement from the psychiatric community to enhance awareness in the field of mental health law.

References:

Appelbaum, P. S. (1994). Almost a revolution: Mental health law and the limits of change. Oxford University Press.

Bailey, J. – Mental Illness Among the Homeless and Incarcerated of Los Angeles – USC Schwarzenegger Institute | USC Schwarzenegger Institute, April 28, 2016.
https://schwarzenegger.usc.edu/prize_winners/jennifer-bailey-mental-illness-among-the-homeless-and-incarcerated-of-los-angeles/

Bowen, P. (2014). Is this a revolution? The impact of the Human Rights Act on Mental Health Law. https://doi.org/10.19164/ijmhcl.v1i10.143

California Department of Mental Health. (1997). California’s state hospital system: Historical overview. Sacramento, CA.

California State Senate Committee Reports. (1967). Legislative history of the Lanterman-Petris Short Act. Sacramento, CA.

California Senate Bill 43, 2023 Reg. Sess.

Grob, G. N. (1994). The mad among us: A history of the care of America’s mentally ill. Free Press.

Lamb, H. R., & Bachrach, L. L. (2001). Some perspectives on deinstitutionalization. Psychiatric Services, 52(8), 1039–1045. https://doi.org/10.1176/appi.ps.52.8.1039

Mechanic, D., & Rochefort, D. A. (1990). Deinstitutionalization: An appraisal of reform. Annual Review of Sociology, 16, 301–327. https://doi.org/10.1146/annurev.so.16.080190.001505

Nevada County v. Superior Court, 118 Cal.App.4th 821 (Cal. Ct. App. 2003).

Scull, A. (1989). Social order/mental disorder: Anglo-American psychiatry in historical perspective. University of California Press.

Torrey, E. F. (1997). Out of the shadows: Confronting America’s mental illness crisis. Wiley.

Welfare and Institutions Code §§ 5000–5550 (Lanterman-Petris-Short Act).

Welfare and Institutions Code §§ 5345–5349.5 (Laura’s Law).

SCPS Private Practice Psychiatry Committee Updates: and One Big Announcement

from the SCPS Private Practice Committee Chair, Matthew Goldenberg, DO

This March I wrote about the importance of APA developing a Private Practice Component. While many APA components currently touch on private practice issues, none focuses on the practice of medicine, the legal, scope and other issues that directly impact psychiatrists in private practice.

This April I wrote about the important aspect of the new APA Council on Private Practice will be to identify those members who are in private practice to coordinate their efforts and experiences to shape APA positions and advocacy efforts. The new component will become a valuable member benefit for APA members, and future members, who work in Private practice.

In the coming months, SCPS will continue our outreach to the APA and to the APA assembly expressing the importance of a Council on Private Practice Psychiatry.

The big announcement is that the SCPS Private Practice Committee has an exciting upcoming event, which is open to all SCPS members!

What: The SCPS Private Practice Committee is hosting a presentation: “Telepsychiatry and Controlled Substance Prescribing”.

Where: ONLINE via Zoom

When: Saturday, September 13^th, 2025, from 9:00am to 10:30am PST

Who: Risk management expert (David Cash from PRMS) AND local administrative attorney (Kevin Cauley), who defends physicians against civil and administrative allegations.

Why: An informative talk and Q + A for any psychiatrist who prescribes controlled substances (i.e. Stimulants, Benzos, Z-drugs etc) and/or uses telepsychiatry in their practice.

How: If you are interested in attending, please email Mindi at socalpsychiatric@gmail.com to RSVP!

But wait, there is more… If you are planning to attend and have questions for our presenters, please email Mindi (socalpsychiatric@gmail.com) to submit your question(s)!

In addition to this big announcement, the SCPS and CSAP will continue to advocate for the private practice psychiatry at the local and statewide levels over the coming year. At SCPS, our private practice committee has provided a regular and deliberate effort, through CSAP, to flag policies and legislation that have a specific impact upon private practice. This is direct advocacy on behalf of SCPS members.

If there are issues, barriers, concerns or struggles that are impacting your private practice, please let us know. SCPS needs to know what is happening in your neck of the woods, so please email Mindi if you have suggestions for SCPS advocacy efforts that would improve and/or support your private practice and/or your care of patients.

If you do not have a lot of time to advocate yourself, this is an opportunity to have SCPS and CSAP take the lead.

If you are interested in getting involved with our SCPS private practice committee, please let us know and get on the mailing list for future committee meetings.

Hope to see you on September 13^th!

Welcome New SCPS Members!

We are proud to spotlight some of our newest members:

Young Susan Chung, MD – General Member – Semi Retired

My you tube channel, “수잔정 마음 건강 열린 상담실” was produced for the main goal of lowering suicide rate among Korean-Americans, Koreans inside Korea and all other Korean diasphora outside of the country.

I have tried to educate them that mental illness is not to be ashamed of but to be treated. I focused on 3 illnesses , alcoholism, bipolar disorder and untreated ADHD to get treatment to prevent suicides.

I emphasize bio-psycho-socio-spiritual aspects of treatment and I have about 5.600 subscribers since I started it three years ago.

Nicole Smith, MD – General Member

I am the owner of Mind Unfolded Psychiatry, Inc., a private practice in LA where I can see adult patients via telehealth or in-person. I specialize in working with LGBTQ+ people, young adults, and those navigating PTSD, OCD, depression, anxiety, bipolar disorder, and/or comorbid complex medical conditions, and am taking new patients.

All new SCPS members are invited to provide Membership Spotlight materials.  (Providing these materials is optional.)

George L. Mallory Diversity, Culture and Social Justice Award Guidelines

Please see the following guidelines to apply for the George L Mallory Diversity, Culture and Social Justice Award.
Please send materials to socalpsychiatric@gmail.com

Award Description: The Diversity and Culture committee is very excited to announce the George L. Mallory Diversity, Culture and Social Justice Award. This award recognizes a Southern California psychiatrist for their exceptional contribution to advocacy, teaching, research and/or leadership aimed at countering structural racism and advancing our understanding of culture and diversity in psychiatry.

This memorial award is named in honor of Dr. George L. Mallory, a prominent educator, psychiatrist and civil rights activist who dedicated his life to treating the underserved in Los Angeles County. Dr. Mallory was one of the first staff members of Martin Luther King Jr./Drew Medical Center, a president of the Black Psychiatrists of Southern California, and the recipient of numerous awards. The purpose of the George L. Mallory Award is to honor current psychiatrists who are continuing this important work in reshaping public mental health to be more inclusive and equitable to all. The Committee encourages SCPS members to send in nominations (self-nominations accepted) for consideration for this award. For more information including past awardees please visit: https://www.socalpsych.org/about/diversity-culture-committee/

Application opens: November 1, 2025
Application closes: January 15, 2026
Nomination Process: Self-nominations and 2nd party nominations welcomed
Application Requirements: Description of the nature of your commitment to justice, equity, diversity and inclusion (1-2 pages). A copy of your CV (1-5 pages).

Selection Criteria:

● Award recipient should demonstrate a historical contribution and ongoing commitment to advocacy, teaching, research and/or leadership aimed at countering structural racism and advancing our understanding of culture and diversity in psychiatry
● Award recipient must be a psychiatrist serving in the SCPS regions
● Award recipient must submit their application materials by the published deadline in order to be considered

Award Recipient selected by: February 25, 2026

Awards Ceremony: Spring 2026. The award recipient is strongly encouraged to attend the SCPS Installation and Awards Ceremony to be recognized in person.

Classified Ad

Harbor-UCLA Medical Center is seeking one full-time attending psychiatrist for the Psychiatric Emergency Room.  Harbor-UCLA Medical Center is a public teaching hospital, affiliated with the David Geffen School of Medicine at UCLA. These positions require supervision and teaching of residents from the Harbor-UCLA Psychiatry training program and other programs, as well as medical students.  The positions are a core part of the Harbor-UCLA Psychiatry residency training program and applicants should have strong interest in teaching and contributing to the training of Psychiatry residents. These positions have the opportunity for an academic appointment in the Department of Psychiatry and Biobehavioral Sciences at UCLA. This is a Los Angeles County Department of Health Services position, with benefits that include 457(b) matching plan and Los Angeles County Pension plan

The Psychiatric Emergency Room position is part of the emergency mental health team. The position requires rapid diagnosis, acute pharmacological management, risk assessment, and crisis management in a culturally diverse patient population, many of whom come from socioeconomically disadvantaged backgrounds. The treatment team consists of attending staff, nurses, social workers, and trainees. Applicants should be board-eligible or board-certified in Psychiatry, able to thrive in an acute Psychiatry setting that requires rapid assessment and decision-making.

We are equal opportunity employers, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, pregnancy and pregnancy-related conditions or any other characteristic protected by law. Women and candidates from underrepresented groups are encouraged to apply.

Contact:  Michael Makhinson, Chair, Department of Psychiatry

mmakhinson@dhs.lacounty.gov