SB 640 would amend state law that already permits the involuntarily treatment of individuals who are "gravely disabled" to also include [legislative counsel's digest] "a condition in which a person, as a result of a mental health disorder, is incapable of making informed decisions about, or providing for, the person's own basic personal needs for food, clothing, shelter, or medical care or shelter without significant supervision and assistance from another person and, as a result of being incapable of making these informed decisions, the person is at risk of substantial bodily harm, dangerous worsening of a concomitant serious physical illness, significant psychiatric deterioration, or mismanagement of the person’s essential needs that could result in bodily harm."

That approach could be a game-changer for seriously ill individuals now basically left on the street who need and deserve help, as well as residents and businesses who feel for them but also want and deserve relief.

SB 640 gained early support from the CA District Attorneys Association, the CA Police Chiefs Association, the City of Santa Monica, and NAMI Sacramento but drew opposition from the American Civil Liberties Union, CA Hospital Association (unless amended), Disability Rights California, Mental Health America of Northern CA, SEIU California and the Western Center on Law and Poverty.

At an April 8, 2019 hearing in the state Senate Health Committee, Sen. Moorlach explained his basis for reforming current state law; he brought witnesses offering compelling testimony in support of SB 640; Committee Dems politely thanked Sen. Moorlach and his witnesses for raising the issue but raised various objections to it in its initially offered form. Several indicated they'd vote "no" on it (blocking it), leading Sen. Moorlach to offer to make SB 640 a "two year bill" that he could try to amend to address objections they raised. To see/hear in detail what was said and what took place, see VIDEO below:

The Committee withheld a vote on SB 640. It remains in the state Senate Health Committee but with an uncertain future. If/when it returns with offered amendments, one of the state Senate Health Committee members who may hear it and vote on it is former LB Councilwoman/now state Senator Lena Gonzalez (D, LB/SE L.A. County).

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Dr. Pinsky summarized his stance on SB 640 in an April Sacramento Bee op-ed he titled "Housing Alone Won't Solve Homelessness; Let's Rethink How We Treat Mentally Ill" at this link.

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A state Senate Health Committee Legislative Analysis provided details of SB 640 here:

...According to the author, California is failing its seriously mentally ill. Current law states that a person is gravely disabled if, as a result of a mental health disorder, he or she cannot provide for their basic needs for food, clothing, and shelter. This law was intended to serve as a protection to individual liberties but has created a system that, instead of helping the most seriously mentally ill, relegates them to the streets, jails, and emergency rooms. Better metrics are needed to help seriously mentally ill individuals that are simply powerless to provide for their own personal well-being. This is especially important when the absence of significant supervision and assistance leaves the individual at risk of substantial bodily harm. Clarifying the definition of "gravely disabled" will be a step towards repairing a system that is failing to serve those who need it most.

...The LPS [Lanterman-Petris-Short] Act provides for involuntary commitment for varying lengths of time for the purpose of treatment and evaluation, provided certain requirements are met. Additionally, the LPS Act provides for LPS conservatorships, resulting in involuntary commitment for the purposes of treatment if an individual is found to meet the grave disability criteria. Typically one first interacts with the LPS Act through a 5150 hold, which allows a designated facility to involuntarily commit a person for 72 hours for evaluation and treatment if they are determined to be, as a result of a mental health disorder, a threat to self or others, or gravely disabled. The peace officer or other authorized person who detains the individual must determine and document that the individual meets this standard. When making the determination or determining that a person should be placed on a 5150 hold, the peace officer or other authorized person may consider information about an individual’s historical course of a mental disorder, which includes evidence presented by a person who has provided or is providing mental health or related support services to the person on the 5150 hold; evidence presented by one or more members of the family of the person on the 5150 hold; and, evidence presented by the person on the 5150 hold, or anyone designated by that person, if the historical course of the person’s mental disorder has a reasonable bearing on making a determination that the person requires a 5150 hold.

Following an initial 5150 hold, a person may be certified for intensive treatment, which initially permits a person to be held for an additional up to 14-days, without court review, if they are found to still be a danger to self or others, or gravely disabled. When determining whether the person is eligible for a 14-day detention, the professional staff of the agency or facility providing evaluation services must find that the person has been advised of the need for, but has not been willing or able to accept, treatment on a voluntary basis. A notice of certification is required for all persons certified for intensive treatment, and a copy of the notice for certification is required to be personally delivered to the person certified, the person’s attorney, or the attorney or advocate, as specified. If after the initial 14 days a person is still found to remain gravely disabled and unwilling or unable to accept voluntary treatment, the person may be certified for an additional period of not more than 30 days of intensive treatment. A person cannot be found at this point to be gravely disabled if he or she can survive safely without involuntary detention with the help of responsible family, friends, or others who indicate they are both willing and able to help.

The LPS Act provides for a conservator of the person, of the estate, or of both the person and the estate for a person who is gravely disabled as a result of a mental health disorder or impairment by chronic alcoholism or use of controlled substances. The person for whom such a conservatorship is sought has the right to demand a court or jury trial on the issue of whether they meet the gravely disabled requirement. The purpose of an LPS conservatorship is to provide individualized treatment, supervision, and placement for the gravely disabled person. Current law also deems a person as not being gravely disabled for purposes of a conservatorship if he or she can survive safely without involuntary detention with the help of responsible family, friends, or others who indicate they are both willing and able to help.

SB 1045 (Wiener and Stern, Chapter 845, Statutes of 2018) established, under a five-year pilot project in San Francisco, Los Angeles, and San Diego Counties, a conservatorship process for individuals who are incapable of caring for their own health and well-being due to a serious mental illness and substance use disorder as evidenced by "frequent detention" for evaluation and treatment under 72-hour involuntary holds. Frequent detention is defined as having eight or more 5150 holds in the preceding 12 months.

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The Committee legislative analysis summarized positions on the bill pro and con as follows:

Support. The City of Santa Monica states that although the current definition of gravely disabled was intended to protect individuals from inappropriate, indefinite, and unnecessary involuntary commitments, it has created a system that often relegates those who are gravely disabled to the streets, jails, and emergency rooms, and has failed to deliver care that is desperately needed. The City of Santa Monica argues that this bill would clarify gravely disabled to more closely align with the original intent of the LPS Act and to provide care that the current system has failed to deliver.

...Support if amended. Tenet Healthcare recommends that this bill be amended to pilot modernization of conservatorship programs in counties that have also adopted specific, voluntary community mental health and sheltering programs. Tenet states that ultimately the state must have resources to expand the continuum of care for behavioral, medically fragile and homeless patients. Tenet notes, for example, that Orange County has availed itself of two very appropriate tools: Laura’s Law/Assisted Outpatient Treatment and whole person care pilot programs. Tenet argues that without county support, wrap-around services, and vested community partnerships, simply transporting the gravely disabled population to a hospital emergency department (ED) will likely only exacerbate present bottlenecks in that ED caused in part by patients that we are unable to discharge by the hospital.

Opposition. Disability Rights California, the American Civil Liberties Union, and the Western Center on Law and Poverty write as a coalition to argue that this bill needlessly expands LPS to permit an undefined standard by which to impose involuntary care for individuals in a restrictive and confined environment; proposes a solution that does not meet the stated goals of addressing homelessness; and, does nothing to ensure that those proposed to be conserved under the expansion will be provided with adequate food, clothing, shelter, or medical and behavioral health care. The coalition states that many terms in the expanded definition are undefined and expansively broad and that the bill does nothing to promote uniformity between the counties and, to the contrary, substitutes a vastly more confusing standard for every stakeholder in the LPS system to attempt to learn and attempt to consistently apply. The coalition further states that involuntary treatment means the county has the duty to treat and house conservatees, which includes making physical and mental health services actually available, and this bill puts the cart before the horse since the counties are already unable to provide services and supportive housing for this population. The coalition states that they do not believe this bill has specified a clear or factual underpinning to support moving away from the current gravely disabled standard that has served for decades to balance the needs of individuals with behavioral illnesses and the protection of their own and others safety. Mental Health America of Northern California (MHA NorCal) shares similar concerns as the coalition. MHA NorCal also argues that efforts to institutionalize people with mental health conditions is not only counterproductive to the recovery model embraced by California but may also be a violation of civil rights. MHA NorCal also notes that Laura’s Law has been implemented in various counties, which consists of court-ordered coercive treatment with appropriate conditional elements that promote opportunities to remain in community services. SEIU California shares similar concerns as the coalition and argues that this bill would not assist the state with a more uniform application of conservatorships. Instead, it would create a more confusing set of criteria which will be newly reinterpreted and tested throughout California’s various jurisdictions in myriad ways. SEIU California states that by opening the definition up to include individuals who need help with providing for their basic needs, it fears it would be even harder to provide help on a voluntary basis to our most in-need populations.

Oppose unless amended. CHA states that this bill will only make it more challenging for hospitals to meet the needs of an increasing volume of patients with behavioral health needs. Over a six-year period, data shows that ED utilization increased by a staggering 47% for people with behavioral health conditions, while overall ED use increased only 14%. CHA argues that this bill expands criteria for 5150s and causes an unintended ripple effect that will negatively impact patient care such that under the expanded definition many patients with mental health disorders could be involuntarily detained simply because they do not follow a doctor’s recommended treatment; patients on 5150s would linger in EDs; and hospitals could not forcibly treat patients but would need to keep them. CHA argues that broader policy changes and investment need to be made, such as: standardization of involuntary commitment laws; mandated assisted outpatient treatment in all counties; and adequately funding California’s overburdened court and public conservatorship system.

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In L.A. County's second largest city, Long Beach Mayor Garcia (who doesn't set city policy) has acknowledged homelessness is complex with multiple aspects but has tried to steer discussion mainly toward building more housing units (including below market/subsidized "affordable" housing.) In 2018, Mayor Garcia chose an "Everyone Home Task Force" that included a number of "affordable housing" developers and homeless service providers. It produced a Dec. 2018 report contending LB (parts of which are already densely populated) needs thousands of new housing units. On a separate track, Councilman Rex Richardson has been soliciting contributions (as of June 30 over $200,000) from affordable housing developers and homeless service providers for a future revenue-raising (read: tax imposing) LB ballot measure (LBREPORT.com coverage here.)

The Garcia-chosen Task Force acknowledged that a 2017 Long Beach homeless count found roughly a third (31%) reported a mental illness and 21% report a substance use disorder but its recommendations focused on housing, offering mainly conventional bureaucratic responses regarding mental illness issues. Under the heading "Increase access to Behavioral Health and Physical Health Services" the Garcia Task Force wrote:

Improving access to services is an important step to accessing housing and helping people maintain their housing once housed. In addition, our hospitals are impacted by those experiencing homelessness who have physical and behavioral health conditions. With state legislation in place that precludes discharging a person into homelessness, there is a tremendous need to increase collaboration among hospitals and community partners to access shelter and housing, as well as to increase the number of, and access to, recuperative care beds and sobering center opportunities in the City.

The Garcia Task Force recommended an agreement with LA County's Housing for Health program for "a coordinated referral program to serve the City's most vulnerable and most frequent users of City resources"; "partnering" with LA County and the State "to implement a substance use detox center, sobering center, and increased recuperative care beds and work to implement a safe needle exchange program; substance use treatment opportunities."

It also advised a "significantly increase [in] long-term mental healthcare capacity" and "to reform the conservatorship rules and processes to make it easier to get people the care they need and maintain it as long as the level is appropriate."

But that's already in the works. SB 1045, enacted in 2018 and co-authored by state Senator Scott Wiener, established a five-year pilot project in San Francisco, Los Angeles, and San Diego Counties for "a conservatorship process for individuals incapable of caring for their own health and well-being due to a serious mental illness and substance use disorder as evidenced by 'frequent detention' for evaluation and treatment under 72-hour involuntary holds."

SB 640 proposes to go where some in LB City Hall and Sacramento haven't gone...thus far. Developing.

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