Mayor's Disability Council
City and County of San Francisco

Resolution

Regarding Involuntary Mental Health Treatment

Resolution 2001-05

November, 2001

WHEREAS:

Many people with psychiatric disabilities are unable or unwilling to receive mental health services, with disastrous results for the individual, their family and the community;

WHEREAS:

The Lanterman-Petris-Short Act, a California law in place since 1967, already provides for involuntary in-patient treatment for those people whose mental disabilities make them "gravely disabled" or "a danger to self or others,"

WHEREAS:

The hearing, `Mandatory Mental Health Treatment: For Good or For Ill?' was held October 12, 2001 and public testimony was overwhelming against Involuntary Treatment and AB 1421,

WHEREAS:

In 1999 and 2000, over 300 homeless people who identified as having mental illness were surveyed and over 92% said that if mental health programs were available that met their needs, they would willingly enter them; and about one third said they had voluntarily attempted to get mental health services in the past but could not obtain ANY form of mental health treatment;

WHEREAS:

The Little Hoover Commission report "Being There: Making a Commitment to Mental Health," Executive Summary, November, 2000 found:

"California's involuntary commitment law - the LPS act - is one of the most controversial mental health issues of the day. But the Commission found the most important and immediate concern to be the 1.5 million Californians who need help, but do not receive it";

WHEREAS:

The Duke Study, in North Carolina, found that in order to effectively treat people with severe psychiatric disabilities a minimum of 36 treatment contacts a year were necessary;

AND that:

In California, people with severe psychiatric disabilities receive an average of 3 treatment encounters a year;

WHEREAS:
The MacArthur Treatment Competence Study found, "Most patients hospitalized with serious mental illness have abilities similar to persons without mental illness for making treatment decisions. Taken by itself, mental illness does not invariably impair decision making capacities";

WHEREAS:

The MacArthur Violence Risk Assessment Study found that "the prevalence of violence among people who have been discharged from a hospital and who do not have symptoms of substance abuse is about the same as the prevalence of violence among other people living in their communities who do not have symptoms of substance abuse";

WHEREAS:

The Well Being Project, a research project supported by the California Department of Mental Health, found that 55% of clients interviewed who had experienced forced treatment reported that fear of forced treatment caused them to avoid all treatment for psychological and emotional problems;

WHEREAS:

People with psychiatric disabilities testified that: Involuntary mental health treatment undermines the development of a trusting, therapeutic relationship between the client, the mental health practitioner and their family;

WHEREAS:

People with psychiatric disabilities also testified that: psychotropic medications, while they can be helpful in controlling symptoms, can have very serious side effects; and should only be administered after informed consent;

WHEREAS:

The RAND study, "The Effectiveness of Involuntary Outpatient Treatment: Empirical Evidence and the Experience of Eight States," found that "these findings cannot be generalized to suggest that involuntary outpatient treatment would be more effective than alternative, non-coercive interventions for all target populations";

WHEREAS:

AB 1421, a bill that will provide funding for Assisted Outpatient Treatment (aka Involuntary Outpatient Treatment), is intended to serve a small number of people with severe psychiatric disabilities but defines the eligibility criteria for this treatment so broadly that many people with psychiatric disabilities could be inappropriately involuntarily treated;

WHEREAS:

Of the stakeholders the RAND study interviewed who supported involuntary outpatient treatment, there was significant "skepticism and uncertainty about the practical application of these laws";

AND

The RAND study found that Involuntary Outpatient Treatment is used infrequently in states where there are laws that permit it;

WHEREAS:

The RAND Institute study on the "Effectiveness of Involuntary Outpatient Treatment" found "clear evidence that alternative, community-based mental health treatments can produce good outcomes for people with severe mental illness";

WHEREAS:

The landmark "Mental Health: A Report of the Surgeon General," January, 2000 states, "One point is clear: the need for coercion should be reduced significantly when adequate services are readily accessible to individuals with severe mental disorders who pose a threat of danger to themselves or others";

WHEREAS:

The voluntary, comprehensive community-based programs created by state bills AB 34, AB 2034 and AB 334 provide the necessary treatment encounters and have been found to be effective in engaging homeless and difficult-to-reach people with psychiatric disabilities in effective mental health programs;

WHEREAS:

San Francisco's AB 2034 program has shown itself effective in reducing the number of days its clients spend in jails and hospitals, reducing homelessness of its clients, and increasing employment of its clients;

WHEREAS:

The National Council on Disability, an independent federal agency mandated to make recommendations to the President and Congress, extensively interviewed people with psychiatric disabilities and has recommended that:

"Laws that allow the use of involuntary treatments such as forced drugging and inpatient and outpatient commitment should be viewed as inherently suspect, because they are incompatible with the principle of self-determination. Public policy needs to move in the direction of a totally voluntary community-based mental health system that safeguards human dignity and respects individual autonomy;" (Core Recommendation #1.)

AND

The National Mental Health Consumer Summit came to consensus on this recommendation at three consecutive gatherings;

WHEREAS:

The National Council on Disability also recommended that:

"Federal research and demonstration resources should place a higher priority on the development of culturally appropriate alternatives to the medical and biochemical approaches to treatment of people labeled with psychiatric disabilities, including self-help, peer support, and other consumer/survivor-driven alternatives to the traditional mental health system;" (Core Recommendation #4.)

NOW THEREFORE BE IT RESOLVED THAT:

The Mayor's Disability Council urges the Mayor and the Board of Supervisors to support increased Mental Health funding for voluntary, community-based services and to oppose the expansion of involuntary treatment of any kind;

AND BE IT FURTHER RESOLVED THAT:

The Mayor's Disability Council concurs with the National Council on Disability on Core Recommendations #1 and #4.