Audit: Don’t make it easier to force mentally ill Californians into treatment — just improve treatment

by Jocelyn Wiener

A homeless person in a wheelchair on Sunset Boulevard in Los Angeles. The has struggled with how to provide care for people with mental illness, but a new state audit says the solution isn't lowering the criteria for compelling mentally ill Californians to get treatment. Photo by Damian Dovarganes, AP Photo

California’s half-century-old involuntary mental health treatment law isn’t broken, but much of the system meant to serve those with serious mental illness is, state auditors concluded in a much-anticipated report released today.

Some critics have called for rewriting state law to make it easier to force people into involuntary treatment, particularly by expanding the state’s definition of “grave disability” — something many recent bills have attempted – and failed— to do.

But instead, state auditors pointed the finger at treatment systems.

The thrust of their findings, based on an audit of Los Angeles, San Francisco and Shasta counties’ mental health systems, is encapsulated in the report’s title: “California Has Not Ensured That Individuals With Serious Mental Illnesses Receive Adequate Ongoing Care.”

Among State Auditor Elaine Howle’s major findings:

• Individuals who are under conservatorship — in which a court-appointed conservator manages another person’s living situation, medical decisions and mental health treatment — have limited treatment options. Many wait an average of a year to get into state hospitals. 

• People coming off of involuntary holds do not consistently receive ongoing care — in two counties, no more than 9% of these individuals were connected to such care.

• Two-thirds of the state’s counties have not yet implemented an assisted outpatient treatment program, also known as Laura’s Law.

• A lack of transparency and communication — both about how money is spent and who is in the mental health system — gets in the way of providing needed services to individuals with serious mental illness, and keeps the public from knowing whether mental health funds are being well-spent.

Not everyone agreed with all of the audit’s major findings and recommendations. Los Angeles County’s top mental health official was especially concerned by the auditor’s unwillingness to consider changing the law to make it easier to conserve people with serious mental illness who resist treatment. He also criticized the audit for failing to show how counties like his might receive more support from the state, feeling that it instead places further restrictions on how counties can use certain mental health funds.

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Audit: Don’t make it easier to force mentally ill Californians into treatment — just improve treatment