SB 1184: Mental health: involuntary treatment: antipsychotic medication.

Existing law, the Lanterman-Petris-Short Act, provides for the involuntary commitment of persons who are a danger to themselves or others, or who are gravely disabled, due to a mental disorder or chronic alcoholism or drug abuse for 72 hours for evaluation and treatment, as specified. If certain conditions are met after the 72-hour detention, the act authorizes the certification of the person for a 14-day maximum period of intensive treatment and then another 14-day or 30-day maximum period of intensive treatment after the initial 14-day period of intensive treatment. Existing law, during the 30-day period of intensive treatment, as specified, also authorizes up to an additional 30 days of intensive treatment if certain conditions are met. Existing law authorizes the administration of antipsychotic medication to a person who is detained for evaluation and treatment for any of those detention periods, except for the second 30-day period.

Existing law establishes a process for hearings to determine a persons capacity to refuse the treatment. Existing law requires a determination of a persons incapacity to refuse treatment with antipsychotic medication to remain in effect only for the duration of the 72-hour period or initial 14-day intensive treatment period, or both, until capacity is restored, or by court determination. Existing law generally requires the capacity hearings described above to be held within 24 hours of the filing of a petition to determine a persons capacity to refuse treatment. Existing law authorizes the hearing to be postponed in certain circumstances, but prohibits the hearing from being held beyond 72 hours of the filing of the petition.

This bill would authorize, except as specified, a persons treating physician to request a hearing for a new determination of a persons capacity to refuse treatment with antipsychotic medication at any time in the 48 hours prior to the end of the duration of the current detention period when it reasonably appears to the treating physician that it is necessary for the person to be detained for a subsequent detention period and their capacity has not been restored.

The bill would require, under exigent circumstances, the hearing to determine a persons capacity to refuse treatment to be held as soon as reasonably practicable and within 24 hours. The bill would require, under exigent circumstances, an order for treatment with antipsychotic medication to remain in effect at the beginning of the 14-day period, or the additional 30-day period after the 14-day intensive treatment period, or the second 30-day period, provided that a petition for a new determination on the question of capacity has been filed, and would require the order to remain in effect until a hearing on that petition for that detention period is held and a decision issued. The bill would specify the factors required to be present in order for there to be exigent circumstances necessitating an expedited hearing, including, among others, that there has been a delay in a hearing to determine a persons capacity to refuse treatment with antipsychotic medication, creating a risk that the existing capacity determination may expire before a new capacity determination is made, and the persons treating physician executes a specified written attestation of exigent circumstances that is maintained in the persons medical record. The bill would require that, each time one of those attestations is made and an order for treatment with antipsychotic medication remains in effect, the treating facility report specified information to the county behavioral health director in the county in which they operate. The bill would require the county behavioral health directors to provide that information to the department, and would require the department to include that information in an annual report it is required to publish. The bill would make these provisions inoperative on January 1, 2030. By increasing the duties on county behavioral health directors, this bill would impose a state-mandated local program.

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.