Bill Text

PDF |Add To My Favorites |Track Bill | print page

AB-1572 Mental health services: gravely disabled.(2019-2020)

SHARE THIS:share this bill in Facebookshare this bill in Twitter
Date Published: 02/22/2019 09:00 PM
AB1572:v99#DOCUMENT


CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill No. 1572


Introduced by Assembly Member Chen
(Coauthor: Senator Moorlach)

February 22, 2019


An act to amend Section 1799.111 of the Health and Safety Code, and to amend Section 5008 of, and to add and repeal Chapter 6 (commencing with Section 5470) of Part 1 of Division 5 of, the Welfare and Institutions Code, relating to mental health, and making an appropriation therefor.


LEGISLATIVE COUNSEL'S DIGEST


AB 1572, as introduced, Chen. Mental health services: gravely disabled.
Existing law, the Lanterman-Petris-Short Act, provides for the involuntary commitment and treatment of a person who is a danger to themself or others or who is gravely disabled. Existing law also provides for a conservator of the person or estate to be appointed for a person who is gravely disabled. Existing law, for the purposes of involuntary commitment and conservatorship, defines “gravely disabled,” among other things, as a condition in which a person, as a result of a mental health disorder, is unable to provide for the basic personal needs of food, clothing, or shelter.
This bill would change the definition of “gravely disabled” for these purposes to read, in part, 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 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 essential needs that could result in bodily harm. By increasing the level of service required of county mental health departments, this bill would impose a state-mandated local program.
This bill, until January 1, 2025, would appropriate $20,000,000 to the State Department of Health Care Services to establish a 4-year grant program to assist local jurisdictions to maintain appropriate caseloads for individuals who manage conservatorship cases. The bill would require the department, in consultation with the Mental Health Services Oversight and Accountability Commission, the California State Association of Public Administrators, Public Guardians, and Public Conservators, and the California Behavioral Health Directors Association, to establish guidelines for appropriate caseloads for case managers in public guardian and public conservator offices. The bill would specify requirements for applying for grants, including establishing a 4-year plan to meet and maintain the appropriate caseload goals. The bill would require the department to submit a report, as specified, on or before September 30, 2021, and each following year, to the Governor and the Legislature, as specified.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
Vote: 2/3   Appropriation: YES   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 The Legislature finds and declares all of the following:
(a) The State of California has failed people with severe mental illness, which includes only about 4 percent of the number of people suffering from any type of mental illness.
(b) When it comes to people with severe mental illness, the definition of “gravely disabled” is interpreted differently by each county.
(c) As a result, the definition has resulted in extreme disparities between counties regarding how they treat people with severe mental illness and whether they pursue conservatorship pursuant to Chapter 3 (commencing with Section 5350) of Part 1 of Division 5 of the Welfare and Institutions Code, also known as LPS Conservatorship.
(d) Manipulation of the vague definition of “gravely disabled” has had many negative consequences for people with severe mental illness who find themselves in a fail-first system.
(e) As a result, people with severe mental illness are overrepresented in jail and prison populations and in homeless communities, when compared to the general population.
(f) Emergency departments, jails, prisons, and homelessness have become the de facto repository for the people in our communities with the most severe mental illness.
(g) In many severe cases, an LPS Conservatorship and a surrogate decisionmaker is the best option to provide treatment to a person with a mental illness and to ensure that the person may live a secure and satisfying life in the community.
(h) Changing the definition of “gravely disabled” could increase the number of people with severe mental illness who are referred to, and placed on, an involuntary LPS Conservatorship. This would place additional burdens on public guardian and public conservator offices, which provide surrogate decisionmaking for these individuals.
(i) It is the intent of the Legislature in enacting this act to do all of the following:
(1) Provide a clear definition of “gravely disabled,” modeled after statutes in the State of Colorado, that requires involuntary holds and LPS Conservatorships to rely on the ability of an individual to make informed decisions about the provision of basic needs, including food, clothing, and shelter.
(2) Establish guidelines for counties to use when staffing public guardian and public conservatorship offices to ensure that people with severe mental illness who are under the care of those offices get the attention, treatment, and services they deserve.
(3) Partner with counties to provide additional resources for public guardian and public conservator offices to manage existing, and potentially increasing, LPS Conservatorship workloads that could result from the implementation of this measure.

SEC. 2.

 Section 1799.111 of the Health and Safety Code is amended to read:

1799.111.
 (a) Subject to subdivision (b), a licensed general acute care hospital, as defined in subdivision (a) of Section 1250, that is not a county-designated facility pursuant to Section 5150 of the Welfare and Institutions Code, a licensed acute psychiatric hospital, as defined in subdivision (b) of Section 1250, that is not a county-designated facility pursuant to Section 5150 of the Welfare and Institutions Code, licensed professional staff of those hospitals, or any a physician and surgeon, providing emergency medical services in any department of those hospitals to a person at the hospital shall not be civilly or criminally liable for detaining a person if all of the following conditions exist during the detention:
(1) The person cannot be safely released from the hospital because, in the opinion of the treating physician and surgeon, or a clinical psychologist with the medical staff privileges, clinical privileges, or professional responsibilities provided in Section 1316.5, the person, as a result of a mental disorder, presents a danger to himself or herself, themself or others, or is gravely disabled. For purposes of this paragraph, “gravely disabled” means an inability to provide for his or her basic personal needs for food, clothing, or shelter. has the same definition as in paragraph (1) of subdivision (h) of Section 5008 of the Welfare and Institutions Code.
(2) The hospital staff, treating physician and surgeon, or appropriate licensed mental health professional, have made, and documented, repeated unsuccessful efforts to find appropriate mental health treatment for the person.
(A) Telephone calls or other contacts required pursuant to this paragraph shall commence at the earliest possible time when the treating physician and surgeon has determined the time at which the person will be medically stable for transfer.
(B) In no case shall the The contacts required pursuant to this paragraph shall not begin after the time when the person becomes medically stable for transfer.
(3) The person is not detained beyond 24 hours.
(4) There is probable cause for the detention.
(b) If the person is detained pursuant to subdivision (a) beyond eight hours, but less than 24 hours, both of the following additional conditions shall be met:
(1) A discharge or transfer for appropriate evaluation or treatment for the person has been delayed because of the need for continuous and ongoing care, observation, or treatment that the hospital is providing.
(2) In the opinion of the treating physician and surgeon, or a clinical psychologist with the medical staff privileges or professional responsibilities provided for in Section 1316.5, the person, as a result of a mental disorder, is still a danger to himself or herself, themself or others, or is gravely disabled, as defined in paragraph (1) of subdivision (a).
(c) In addition to the immunities set forth in subdivision (a), a licensed general acute care hospital, as defined in subdivision (a) of Section 1250 that is not a county-designated facility pursuant to Section 5150 of the Welfare and Institutions Code, a licensed acute psychiatric hospital as defined by subdivision (b) of Section 1250 that is not a county-designated facility pursuant to Section 5150 of the Welfare and Institutions Code, licensed professional staff of those hospitals, or any a physician and surgeon, providing emergency medical services in any department of those hospitals to a person at the hospital shall not be civilly or criminally liable for the actions of a person detained up to 24 hours in those hospitals who is subject to detention pursuant to subdivision (a) after that person’s release from the detention at the hospital, if all of the following conditions exist during the detention:
(1) The person has not been admitted to a licensed general acute care hospital or a licensed acute psychiatric hospital for evaluation and treatment pursuant to Section 5150 of the Welfare and Institutions Code.
(2) The release from the licensed general acute care hospital or the licensed acute psychiatric hospital is authorized by a physician and surgeon or a clinical psychologist with the medical staff privileges or professional responsibilities provided for in Section 1316.5, who determines, based on a face-to-face examination of the person detained, that the person does not present a danger to himself or herself themself or others and is not gravely disabled, as defined in paragraph (1) of subdivision (a). In order for this paragraph to apply to a clinical psychologist, the clinical psychologist shall have a collaborative treatment relationship with the physician and surgeon. The clinical psychologist may authorize the release of the person from the detention, but only after he or she the clinical psychologist has consulted with the physician and surgeon. In the event of a clinical or professional disagreement regarding the release of a person subject to the detention, the detention shall be maintained unless the hospital’s medical director overrules the decision of the physician and surgeon opposing the release. Both the physician and surgeon and the clinical psychologist shall enter their findings, concerns, or objections in the person’s medical record.
(d) Nothing in this section shall This section does not affect the responsibility of a general acute care hospital or an acute psychiatric hospital to comply with all state laws and regulations pertaining to the use of seclusion and restraint and psychiatric medications for psychiatric patients. Persons detained under this section shall retain their legal rights regarding consent for medical treatment.
(e) A person detained under this section shall be credited for the time detained, up to 24 hours, in the event he or she the person is placed on a subsequent 72-hour hold pursuant to Section 5150 of the Welfare and Institutions Code.
(f) The amendments to this section made by the act adding this subdivision shall not be construed to limit any existing duties for psychotherapists contained in Section 43.92 of the Civil Code.
(g) Nothing in this section is This section is not intended to expand the scope of licensure of clinical psychologists.

SEC. 3.

 Section 5008 of the Welfare and Institutions Code is amended to read:

5008.
 Unless the context otherwise requires, the following definitions shall govern the construction of this part:
(a) “Evaluation” consists of multidisciplinary professional analyses of a person’s medical, psychological, educational, social, financial, and legal conditions as may that appear to constitute a problem. Persons providing evaluation services shall be properly qualified professionals and may be full-time employees of an agency providing face-to-face, which includes including telehealth, evaluation services or may be services, part-time employees employees, or may be employed on a contractual basis.
(b) “Court-ordered evaluation” means an evaluation ordered by a superior court pursuant to Article 2 (commencing with Section 5200) or by a superior court pursuant to Article 3 (commencing with Section 5225) of Chapter 2.
(c) “Intensive treatment” consists of such hospital and other services as may be indicated. Intensive treatment shall be provided by properly qualified professionals and carried out in facilities qualifying for reimbursement under the California Medical Assistance Program (Medi-Cal) set forth in Chapter 7 (commencing with Section 14000) of Part 3 of Division 9, or under Title XVIII of the federal Social Security Act and regulations thereunder. Intensive treatment may be provided in hospitals of the United States government by properly qualified professionals. This part does not prohibit an intensive treatment facility from also providing 72-hour evaluation and treatment.
(d) (1) “Referral” is means referral of persons by each agency or facility providing assessment, evaluation, crisis intervention, or treatment services to other agencies or individuals. The purpose of referral shall be is to provide for continuity of care, and may include, but need not be limited to, informing the person of available services, making appointments on the person’s behalf, discussing the person’s problem with the agency or individual to which the person has been referred, appraising the outcome of referrals, and arranging for personal escort and transportation when necessary. Referral shall be considered complete when the agency or individual to whom the person has been referred accepts responsibility for providing the necessary services. All persons shall be advised of available precare services that prevent initial recourse to hospital treatment or aftercare services that support adjustment to community living following hospital treatment. These services may be provided through county or city mental health departments, state hospitals under the jurisdiction of the State Department of State Hospitals, regional centers under contract with the State Department of Developmental Services, or other public or private entities.

Each

(2) Each agency or facility providing evaluation services shall maintain a current and comprehensive file of all community services, both public and private. These files shall contain current agreements with agencies or individuals accepting referrals, as well as appraisals of the results of past referrals.
(e) “Crisis intervention” consists of an interview or series of interviews within a brief period of time, conducted by qualified professionals, and designed to alleviate personal or family situations which that present a serious and imminent threat to the health or stability of the person or the family. The interview or interviews may be conducted in the home of the person or family, or on an inpatient or outpatient basis with such therapy, the therapy or other services, as may be appropriate. The interview or interviews may include family members, significant support persons, providers, or other entities or individuals, as appropriate and as authorized by law. Crisis intervention may, as appropriate, include suicide prevention, psychiatric, welfare, psychological, legal, or other social services.
(f) “Prepetition screening” is a screening of all petitions for court-ordered evaluation as provided in Article 2 (commencing with Section 5200) of Chapter 2, consisting of a professional review of all petitions; an interview with the petitioner and, whenever possible, the person alleged, as a result of a mental health disorder, to be a danger to others, or to himself or herself, themself or others or to be gravely disabled, to assess the problem and explain the petition; when indicated, efforts to persuade the person to receive, on a voluntary basis, comprehensive evaluation, crisis intervention, referral, and other services specified in this part.
(g) “Conservatorship investigation” means investigation by an agency appointed or designated by the governing body of cases in which conservatorship is recommended pursuant to Chapter 3 (commencing with Section 5350).
(h) (1) For purposes of Article 1 (commencing with Section 5150), Article 2 (commencing with Section 5200), and Article 4 (commencing with Section 5250) of Chapter 2, and for the purposes of Chapter 3 (commencing with Section 5350), “gravely disabled” means either of the following:
(A) A condition in which a person, as a result of a mental health disorder, is unable to provide for his or her incapable of making informed decisions about, or providing for, the person’s basic personal needs for food, clothing, or shelter. 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.
(B) A condition in which a person, has been found mentally incompetent under Section 1370 of the Penal Code and all of the following facts exist:
(i) The complaint, indictment, or information pending against the person at the time of commitment charges a felony involving death, great bodily harm, or a serious threat to the physical well-being of another person.
(ii) There has been a finding of probable cause on a complaint pursuant to paragraph (2) of subdivision (a) of Section 1368.1 of the Penal Code, a preliminary examination pursuant to Section 859b of the Penal Code, or a grand jury indictment, and the complaint, indictment, or information has not been dismissed.
(iii) As a result of a mental health disorder, the person is unable to understand the nature and purpose of the proceedings taken against him or her them and to assist counsel in the conduct of his or her the person’s defense in a rational manner.
(iv) The person represents a substantial danger of physical harm to others by reason of a mental disease, defect, or disorder.
(2) For purposes of Article 3 (commencing with Section 5225) and Article 4 (commencing with Section 5250), of Chapter 2, and for the purposes of Chapter 3 (commencing with Section 5350), “gravely disabled” means a condition in which a person, as a result of impairment by chronic alcoholism, is unable to provide for his or her their basic personal needs for food, clothing, or shelter.
(3) The term “gravely disabled” does not include persons with intellectual disabilities by reason of that disability alone.
(i) “Peace officer” means a duly sworn peace officer as that term is defined in Chapter 4.5 (commencing with Section 830) of Title 3 of Part 2 of the Penal Code who has completed the basic training course established by the Commission on Peace Officer Standards and Training, or any a parole officer or probation officer specified in Section 830.5 of the Penal Code when acting in relation to cases for which he or she the officer has a legally mandated responsibility.
(j) “Postcertification treatment” means an additional period of treatment pursuant to Article 6 (commencing with Section 5300) of Chapter 2.
(k) “Court,” unless otherwise specified, means a court of record.
(l) “Antipsychotic medication” means any medication customarily prescribed for the treatment of symptoms of psychoses and other severe mental and emotional disorders.
(m) “Emergency” means a situation in which action to impose treatment over the person’s objection is immediately necessary for the preservation of life or the prevention of serious bodily harm to the patient or others, and it is impracticable to first gain consent. It is not necessary for harm to take place or become unavoidable prior to treatment.
(n) “Designated facility” or “facility designated by the county for evaluation and treatment” means a facility that is licensed or certified as a mental health treatment facility or a hospital, as defined in subdivision (a) or (b) of Section 1250 of the Health and Safety Code, by the State Department of Public Health, and may include, but is not limited to, a licensed psychiatric hospital, a licensed psychiatric health facility, and a certified crisis stabilization unit.

SEC. 4.

 Chapter 6 (commencing with Section 5470) is added to Part 1 of Division 5 of the Welfare and Institutions Code, to read:
CHAPTER  6. Conservatorship Grant Program

5470.
 (a) The State Department of Health Care Services shall establish a four-year grant program to assist local jurisdictions to maintain appropriate caseloads for individuals who manage conservatorship cases.
(b) The department, in consultation with the Mental Health Services Oversight and Accountability Commission, the California State Association of Public Administrators, Public Guardians, and Public Conservators, and the California Behavioral Health Directors Association, shall establish guidelines for appropriate caseloads for case managers in public guardian and public conservator offices. The guidelines shall consider the duties related to making decisions for individuals who have been determined to be severely mentally ill and incapable of making informed decisions about the provision of their basic needs.
(c) For purposes of this chapter, the following definitions shall apply:
(1) “Appropriate caseload” means the number of individuals under conservatorship pursuant to Chapter 3 (commencing with Section 5350) that can be managed by one case manager to ensure that each conservatee receives the care and attention consistent with their individualized, needs-based treatment plan.
(2) “Conservatorship” means a conservatorship established pursuant to Chapter 3 (commencing with Section 5350).

5471.
 (a) The grant program established pursuant to this chapter shall provide four-year grants to local jurisdictions to provide conservator case management services. Grants shall be awarded for a four-year term, to be distributed in annual increments as established in the grant application.
(b) The department shall create a grant application that requires all of the following information:
(1) Current number of conservatorships managed by the applying county.
(2) Current number of case managers assigned to manage the current conservatorship caseload.
(3) Average number of conservatorships managed by each case manager.
(4) An estimate of the difference between the current average caseload and the appropriate caseload to provide the most efficient, appropriate level of care for people under conservatorship.
(5) An estimate of the total additional resources necessary to hire additional case managers to achieve appropriate caseload levels.
(6) (A) A four-year plan to meet and maintain the appropriate caseload goals established by the department pursuant to subdivision (b) of Section 5470. The plan shall include the amount of grant funding requested each year and the amount of county funds committed each year.
(B) In the first two years of the grant, the county shall commit to providing at least one-half of the funding for the plan. In the third and fourth year, the county shall commit to providing at least 75 percent of the funding.
(C) County funds shall be in addition to current expenditures, and shall not supplant funds currently being spent on conservatorship case management.
(7) Commitment by the county board of supervisors to meet the funding requirements in paragraph (6).
(8) Commitment by the county board of supervisors to maintain the appropriate caseloads in the public guardian’s or public conservator’s office after the expiration of the grant funding.
(c) (1) A county that receives a grant pursuant to this chapter shall annually report to the department all of the following:
(A) The number of conservatorships managed by the county in the prior year.
(B) The current number of case managers assigned to manage the current conservatorship caseload.
(C) The average number of conservatorships managed by each case manager.
(D) A comparison of average caseloads from the prior year to the current year that demonstrates achieving, or significant progress toward achieving, the appropriate caseloads with the additional resources, as required pursuant to the plan submitted in the grant application.
(E) An estimate of the total resources needed to maintain or achieve appropriate caseloads in the next year.
(F) The total amount spent, in grant funds and matching county funds, to achieve or maintain appropriate caseloads.
(G) The amount of the prior year’s grant funding that remains unspent. The department may reduce the next year’s grant disbursal to account for unspent and unencumbered grant money from prior years.
(2) If the department determines that the county has not complied with the plan set forth in the application, the county shall not receive the grant money the following year unless the department determines that the county will use the grant money and required matching county funds to bring itself into compliance with the plan.

5472.
 (a) On or before September 30, 2021, and each year thereafter, the department shall provide a summary report that includes all of the following:
(1) A list of the counties that submitted applications for grant funding and the amounts requested.
(2) A list of the counties that received grant money and the amount provided.
(3) A list of counties that applied for, but did not receive, a grant.
(4) The amount that would be required to provide grants for all applying counties that meet the eligibility requirements.
(5) The average conservatorship caseload reported by each county that received a grant.
(6) Average conservatorship caseload reported by each county for each county that received a grant.
(b) The report required pursuant to this section shall be submitted to the Governor’s office and the Legislature pursuant to Section 9795 of the Government Code.

5473.
 This chapter shall remain in effect only until January 1, 2025, and as of that date is repealed.

SEC. 5.

 The sum of $20,000,000 is hereby appropriated from the General Fund for the 2019–20 fiscal year to the State Department of Health Care Services for the purpose of implementing the grant program established in Chapter 6 (commencing with Section 5470) of Part 1 of Division 5 of the Welfare and Institutions Code. The money shall be available for use or encumbrance for five years after appropriation.

SEC. 6.

 If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.