California Gov. Gavin Newsom proposed on Feb. 17 to make involuntary commitments easier as a means to address the mental health and homelessness crises. Gov. Newsom takes the proper approach, namely extending housing for the mentally ill, without hospitalizing them or abridging their rights. This manages to correct errors in the implementation of previous health reform, while not compromising the spirit of those bills.
The Lanterman-Petris-Short Act was one of many bills passed in the 1960s regarding mental health reform.
The purpose of these reforms was to end the inhumane system of overcrowded asylums prior to the 1960s. The health care reform of the 1960s restricted involuntary hospitalization to only the most dysfunctional cases. Furthermore, it established explicit rights for mental health patients and mandated due process for treatment. Under the LPS Act, only grave disability or being a clear and present danger to self or others are ground for involuntary commitment. Furthermore, the effective treatment with the fewest restrictions to the patient’s civil liberty must be chosen.
In 1999, a commission found several flaws in the LPS Act, which Newsom’s proposal aims to address. Firstly, the LPS Act’s restrictions requires severe tragedy to occur or be threatened before treatment commences. Mentally ill individuals who were either functional enough to be inadmissible under the LPS Act or who were homeless were neglected. Gov. Newsom’s plan provides a means of treatment for the homeless with mental illnesses whose illness fails to meet current standards for involuntary commitment. This prevents the tantrums, breakdowns and homicidal threats required to commit patients involuntary under current law. Furthermore, Newsom’s plan plans to reintegrate the homeless with mental illnesses into society. California State Senators Frank Lanterman, Nicolas Petris and Alan Short had planned for community outpatient programs, but sadly that support structure never materialized. Hopefully, if the current housing conservatorship program succeeds, funding for community outpatient care will materialize.
Excessive forced hospitalization is unacceptable for several reasons. Firstly, if the admittance violated the patient’s due process, parents or relatives who oppose the commitment can threaten legal action, such as suing the hospital or transferring their relative. Involuntary holds under the LPS Act only last 72 hours. Extensions of the initial hold require court hearings and psychiatrist certifications. Since hospitals wish to avoid the adversarial and lengthy trials, they release many patients to avoid these hearings as often as necessary. Terminating holds prematurely increases re-admission rates and the frequency and severity of future episodes. The LPS act also lacks provisions to prevent charismatic patients from charming their way into being released, which can have tragic consequences. This revolving door of detention and release is unsustainable and fails to adequately treat those affected by mental illness. A health care system should not produce worse results than alternatives. Hospitalization should be harder for both admittance and release and thus reserved only for when good faith deliberation yields no alternatives.
In contrast to involuntary hospitalization, outpatient treatment has been found to be more effective in preventing recidivism and reducing the severity and frequency of future episodes. However, despite being more effective and being more in accordance with the spirit of LPS, outpatient care is rarely pursued.Private hospital greed, ignorance or lack of funding could produce this preference for hospitalization. After all, outpatient care is more involved and produces less profit than hospitalization. Defaulting to hospitalization leads to overcrowded hospitals, which LPS was meant to prevent. Effective treatment of patients, not profit and convenience for the hospital system should be the aim of a healthcare system.
Newsom’s proposal provides outpatient care and treatment for those Lanterman-Petris-Short does not cover while preserving as many civil rights as possible for the patient, but it does not correct abuses arising from misapplication of the LPS act. One key reform would be stripping the ability to commit patients under the LPS Act from private hospitals and requiring physicians to personally commit all patients, without delegating admissions to their employer’s administration. This would minimize unnecessary hospitalization, ending the practice of turning away those who need hospitalization while hospitalizing others for financial gain, through fees to their insurance and subsidies for filling beds. Another step to reduce unnecessary hospitalization would be requiring police forces to hire enough physicians to evaluate whether a squad should commit someone when notified about the behavior of their behavior. These would prevent false imprisonment and enable hospitals to increase their ability to intake patients that lack alternatives to hospitalization. These steps would reform our system to a more humane system with better outcomes, as the original mental health revolution of the 1960s desired. The best way to achieve mental health reform is to restore the spirit of the reformers of the 1960s.
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Jacob Ningen is a contributor for The Daily Campus. He can be reached via email at firstname.lastname@example.org.