Mental Health: Involuntary Commitment
Introduction of AB 1300 Mental Health: Involuntary Commitment
AB 1300 the Mental Health: Involuntary Commitment bill was introduced to the California State Legislature on February 27, 2015 by Assembly Member Ridley-Thomas. The bill was developed in conjunction with the California Hospital Association (CHA) and the California Chapter of the American College of Emergency Physicians (California ACEP) to modernize the 48-year old Lanterman-Petris-Short (LPS) Act which governs involuntary civil commitment for psychiatric treatment in California. Aimee Moulin, MD an Emergency Department Physician at U.C. Davis Medical Center stated in a radio interview “AB 1300 is critical for developing a more comprehensive solution by easing congestion in hospital …show more content…
emergency departments and helping to better ensure that patients get the care they need” (Robinson-Taylor, 2015). The bill was assigned to the Assembly Health Committee, Assembly Judiciary Committee, and Assembly Appropriations Committee on March 26, 2015. The bill has progressed 25% through the process. It was placed in the suspension file on May 28, 2015 and will now be a two year bill. The way mental health services are delivered has been transformed over the last 48-years due to social, economic, and ethical factors. AB 1300 aligns the laws that govern the care being provided to these individuals with current practice. If passed by the California Assemble MHIC will amend sections 5150, 5151, and 5152 of the LPS to ensure consistent statewide application of involuntary commitment and ensure that patients receive the most appropriate care in the least restrictive environment appropriate to their needs (California Hospital Association, n.d.).
Background/ Significance and Scope of AB 1300 One in twenty adults in California suffers from a serious mental health illness (Holt, 2013, p. 3). Cutbacks in mental health funding have led to a declining availability of specialized mental health resources (Baraff, Janowicz, & Asarnow, 2006). This leaves individuals experiencing an acute mental health crisis nowhere to turn except local emergency departments. Mental health presentations account for 6% to 9% of all emergency department visits (Zeller, Calma, & Stone, 2013, p. 1). Patients with a mental health diagnosis needing inpatient evaluation and treatment wait an average of 6.8 hours to 32 hours for inpatient placement (Zeller, et al., 2013, p. 1). Instead of receiving the medication and psychiatric interventions these patients need, they are often restrained and medicated to provide for their safety. Zun (2012, p. 830) indicates in Pitfalls in the Care of the Psychiatric Patient in the Emergency Department that “many Emergency Physicians are not comfortable managing boarded psychiatric patients in the ED”. California law allows individuals to be temporarily detained against their will for evaluation and treatment if designated professionals believe the individual is a danger to himself or herself, a danger to others, or gravely disabled. This 72-hour involuntary mental health hold is meant to protect the individual and the public from harm. The law has not been updated to reflect changes in how mental health treatment is delivered for nearly half a century.
To address this concern the California Hospital Association and the California Chapter of the American College of Emergency Physicians have partnered with Assembly Member Ridley-Thomas on MHIC to ensure mental health patients in crisis receive the right care, at the right time in the right place. AB-1300 is listed as an active bill in the California Legislature (Legalinfo, n.d.). The Judiciary Committee has passed the bill, hearings in the Health Committee, and Appropriations Committee are still pending.
Social Impact
The Lanterman-Petris-Short (LPS) Act has helped the mental health delivery system in California evolve from providers of large state hospitals to a focus on community care. This has provided increased autonomy and quality of life to individuals with serious mental health disorders. Individuals with a mental health disorder no longer have to be afraid of seeking treatment , then being locked up for long periods of time. The advances in mental health treatment allow individuals with a mental health disorder to participate in society and lead a fairly normal life.
As funding for mental health resources declines, society as a whole feels the impact. Individuals with a mental health disorder are increasingly unable to obtain care until they reach a state of crisis. This is frustrating not only to the individual who has now lost control, but also to the other members of society who often suffer collateral damage. Often there is no other place for these patients to find treatment than a hospital emergency department. Hefflefinger (2014, p. 365) claims in the Journal of Emergency Nursing that, “the situation has risen to a point of crisis”. She argues that the increased portion of ED visits consumed by mental health patients in crisis is not only impacting the quality of care these individuals receive, but also the quality of care all patients receive (Hefflefinger , 2014, p. 365).
The MHIC bill implements a plan to provide consistent treatment for mental health patients across California. It ensures counties have sufficient capacity to provide care for individuals with a mental health disorder. Providing the right care, at the right time, in the right place assure quality for all patients.
Economical Impact The mental health challenges being seen in society today is largely due to economics.
Decreases in funding for mental health services have led to a decline in available inpatient beds, outpatient services, and mental health professionals. Hospitals can no longer afford to support inpatient beds dedicated to mental health patients, counties can no longer afford numerous outpatient treatment programs and professionals can afford to specialize in mental health care. The expenditures for mental health care grew by only 6.4% from 2002 to 2005 while overall health care expenditures grew by 7.3% (Holt, 2013). MHIC requires counties to provide a liaison to facilitate communication between the county mental health system and healthcare facilities, and requires them to have sufficient capacity for the provision of care for individuals with a mental health disorder. Opponents to MHIC indicate that it is an unfunded mandate, since the bill does not provide any additional funds to counties to provide these services. The Assembly Committee on Appropriations has not determined the fiscal impact of AB-1300 other than indicating it will be over $200,000 (Assembly Committee on Appropriations, 2015).
Political …show more content…
Impact President Barack Obama indicated in a message to the National Alliance on Mental illness “All of us—Michelle and myself included—know a family member, a neighbor, or a friend who struggles with mental health issues at some point in their lives” (NAMI, n.d.). When politicians speak up about mental illness and the impact it has had on their personal life, it helps remove the stigma attached to mental illness in our society. Public policy provides some of the tools required to treat mental illness. Mental health professionals sometimes need to place mental health patients in crisis on a temporary involuntary hold to complete their evaluation and treatment. This authority can only come from the State or Federal Government. Mental health services are largely funded by States since individuals with mental health conditions often have no other way of paying for services. Organizations like the California Hospital Association and National Alliance on Mental illness often advocate for public policy that they feel is most beneficial to the groups they represent.
Ethical Considerations
As healthcare providers we have an obligation to prevent harm to our patients, weigh and balance potential risks of our actions and look out for our patient’s interest, especially when they cannot do so for themselves (Pantilat, 2008).
MHIC demonstrates this principle of beneficence in several ways. The bill preserves the protections currently provided by LPS to individuals being placed in a 72-hour involuntary hold, and protects them further by clearly defining when the 72-involuntary hold period begins and ends. AB 1300 also demonstrates the principle of justice by ensuring that individuals presenting with similar conditions are treated the same regardless of where they present for
assistance.
Biblical Implications
Despite the fact that nearly 60 million Americans suffer with mental illness, it remains a taboo in our culture. Individuals with a mental healthiness are often feared, misunderstood and avoided. As Christians we know that man was made in the image of God and that he said it was good. Rick Warren (2015) argues in his video blog that “the best way to show our love as Christians is to take, care of the least, the lost, the last, those that are inflected with physical or mental illness”. As Christian’s nurses we are called to “Speak up for those who cannot speak for themselves” (Proverbs 31:8, NIV). Advocating for change through public policy permits nurses to speak for those who cannot speak for themselves, ensuring they receive the treatment they need.
Proponent and Opponent Arguments
Hospitals and physicians find themselves at odds with counties over AB 1300. MHIC supported by The California Hospital Association, California Chapter of the American College of Emergency Physicians and California Psychiatric Association (CPA). It is opposed by the County Behavioral Health Directors Association of California (CBHDA) and National Alliance on Mental Illness (NAMI).
Proponent Arguments
The Mental Health: Involuntary Commitment Bill is supported by hospitals and physicians who care for patients in Emergency Departments. These groups feel the current law, LPS needs to be modernized to reflect the current model of mental health services in California. The California Hospital Association (n.d) claims that on any given day an estimated 800 individuals are on 72-hour hold in California. It was published in the Journal of Emergency Medicine that 88% of patient experiencing a long length of stay in the emergency department had a mental health diagnosis (Stephens, White, Cudnik, & Patterson, 2014, p. 416). This is concerning because longer length of stay results in increased potential for adverse events, increased violence and decreased patient and staff satisfaction (Hefflefinger, 2014, p. 365).
AB 1300 the Mental Health: Involuntary Commitment bill was introduced to the California State Legislature on February 27, 2015 by Assembly Member Ridley-Thomas. The bill was developed in conjunction with the California Hospital Association (CHA) and the California Chapter of the American College of Emergency Physicians (California ACEP) to modernize the 48-year old Lanterman-Petris-Short (LPS) Act which governs involuntary civil commitment for psychiatric treatment in California. Aimee Moulin, MD an Emergency Department Physician at U.C. Davis Medical Center stated in a radio interview “AB 1300 is critical for developing a more comprehensive solution by easing congestion in hospital …show more content…
emergency departments and helping to better ensure that patients get the care they need” (Robinson-Taylor, 2015). The bill was assigned to the Assembly Health Committee, Assembly Judiciary Committee, and Assembly Appropriations Committee on March 26, 2015. The bill has progressed 25% through the process. It was placed in the suspension file on May 28, 2015 and will now be a two year bill. The way mental health services are delivered has been transformed over the last 48-years due to social, economic, and ethical factors. AB 1300 aligns the laws that govern the care being provided to these individuals with current practice. If passed by the California Assemble MHIC will amend sections 5150, 5151, and 5152 of the LPS to ensure consistent statewide application of involuntary commitment and ensure that patients receive the most appropriate care in the least restrictive environment appropriate to their needs (California Hospital Association, n.d.).
Background/ Significance and Scope of AB 1300 One in twenty adults in California suffers from a serious mental health illness (Holt, 2013, p. 3). Cutbacks in mental health funding have led to a declining availability of specialized mental health resources (Baraff, Janowicz, & Asarnow, 2006). This leaves individuals experiencing an acute mental health crisis nowhere to turn except local emergency departments. Mental health presentations account for 6% to 9% of all emergency department visits (Zeller, Calma, & Stone, 2013, p. 1). Patients with a mental health diagnosis needing inpatient evaluation and treatment wait an average of 6.8 hours to 32 hours for inpatient placement (Zeller, et al., 2013, p. 1). Instead of receiving the medication and psychiatric interventions these patients need, they are often restrained and medicated to provide for their safety. Zun (2012, p. 830) indicates in Pitfalls in the Care of the Psychiatric Patient in the Emergency Department that “many Emergency Physicians are not comfortable managing boarded psychiatric patients in the ED”. California law allows individuals to be temporarily detained against their will for evaluation and treatment if designated professionals believe the individual is a danger to himself or herself, a danger to others, or gravely disabled. This 72-hour involuntary mental health hold is meant to protect the individual and the public from harm. The law has not been updated to reflect changes in how mental health treatment is delivered for nearly half a century.
To address this concern the California Hospital Association and the California Chapter of the American College of Emergency Physicians have partnered with Assembly Member Ridley-Thomas on MHIC to ensure mental health patients in crisis receive the right care, at the right time in the right place. AB-1300 is listed as an active bill in the California Legislature (Legalinfo, n.d.). The Judiciary Committee has passed the bill, hearings in the Health Committee, and Appropriations Committee are still pending.
Social Impact
The Lanterman-Petris-Short (LPS) Act has helped the mental health delivery system in California evolve from providers of large state hospitals to a focus on community care. This has provided increased autonomy and quality of life to individuals with serious mental health disorders. Individuals with a mental health disorder no longer have to be afraid of seeking treatment , then being locked up for long periods of time. The advances in mental health treatment allow individuals with a mental health disorder to participate in society and lead a fairly normal life.
As funding for mental health resources declines, society as a whole feels the impact. Individuals with a mental health disorder are increasingly unable to obtain care until they reach a state of crisis. This is frustrating not only to the individual who has now lost control, but also to the other members of society who often suffer collateral damage. Often there is no other place for these patients to find treatment than a hospital emergency department. Hefflefinger (2014, p. 365) claims in the Journal of Emergency Nursing that, “the situation has risen to a point of crisis”. She argues that the increased portion of ED visits consumed by mental health patients in crisis is not only impacting the quality of care these individuals receive, but also the quality of care all patients receive (Hefflefinger , 2014, p. 365).
The MHIC bill implements a plan to provide consistent treatment for mental health patients across California. It ensures counties have sufficient capacity to provide care for individuals with a mental health disorder. Providing the right care, at the right time, in the right place assure quality for all patients.
Economical Impact The mental health challenges being seen in society today is largely due to economics.
Decreases in funding for mental health services have led to a decline in available inpatient beds, outpatient services, and mental health professionals. Hospitals can no longer afford to support inpatient beds dedicated to mental health patients, counties can no longer afford numerous outpatient treatment programs and professionals can afford to specialize in mental health care. The expenditures for mental health care grew by only 6.4% from 2002 to 2005 while overall health care expenditures grew by 7.3% (Holt, 2013). MHIC requires counties to provide a liaison to facilitate communication between the county mental health system and healthcare facilities, and requires them to have sufficient capacity for the provision of care for individuals with a mental health disorder. Opponents to MHIC indicate that it is an unfunded mandate, since the bill does not provide any additional funds to counties to provide these services. The Assembly Committee on Appropriations has not determined the fiscal impact of AB-1300 other than indicating it will be over $200,000 (Assembly Committee on Appropriations, 2015).
Political …show more content…
Impact President Barack Obama indicated in a message to the National Alliance on Mental illness “All of us—Michelle and myself included—know a family member, a neighbor, or a friend who struggles with mental health issues at some point in their lives” (NAMI, n.d.). When politicians speak up about mental illness and the impact it has had on their personal life, it helps remove the stigma attached to mental illness in our society. Public policy provides some of the tools required to treat mental illness. Mental health professionals sometimes need to place mental health patients in crisis on a temporary involuntary hold to complete their evaluation and treatment. This authority can only come from the State or Federal Government. Mental health services are largely funded by States since individuals with mental health conditions often have no other way of paying for services. Organizations like the California Hospital Association and National Alliance on Mental illness often advocate for public policy that they feel is most beneficial to the groups they represent.
Ethical Considerations
As healthcare providers we have an obligation to prevent harm to our patients, weigh and balance potential risks of our actions and look out for our patient’s interest, especially when they cannot do so for themselves (Pantilat, 2008).
MHIC demonstrates this principle of beneficence in several ways. The bill preserves the protections currently provided by LPS to individuals being placed in a 72-hour involuntary hold, and protects them further by clearly defining when the 72-involuntary hold period begins and ends. AB 1300 also demonstrates the principle of justice by ensuring that individuals presenting with similar conditions are treated the same regardless of where they present for
assistance.
Biblical Implications
Despite the fact that nearly 60 million Americans suffer with mental illness, it remains a taboo in our culture. Individuals with a mental healthiness are often feared, misunderstood and avoided. As Christians we know that man was made in the image of God and that he said it was good. Rick Warren (2015) argues in his video blog that “the best way to show our love as Christians is to take, care of the least, the lost, the last, those that are inflected with physical or mental illness”. As Christian’s nurses we are called to “Speak up for those who cannot speak for themselves” (Proverbs 31:8, NIV). Advocating for change through public policy permits nurses to speak for those who cannot speak for themselves, ensuring they receive the treatment they need.
Proponent and Opponent Arguments
Hospitals and physicians find themselves at odds with counties over AB 1300. MHIC supported by The California Hospital Association, California Chapter of the American College of Emergency Physicians and California Psychiatric Association (CPA). It is opposed by the County Behavioral Health Directors Association of California (CBHDA) and National Alliance on Mental Illness (NAMI).
Proponent Arguments
The Mental Health: Involuntary Commitment Bill is supported by hospitals and physicians who care for patients in Emergency Departments. These groups feel the current law, LPS needs to be modernized to reflect the current model of mental health services in California. The California Hospital Association (n.d) claims that on any given day an estimated 800 individuals are on 72-hour hold in California. It was published in the Journal of Emergency Medicine that 88% of patient experiencing a long length of stay in the emergency department had a mental health diagnosis (Stephens, White, Cudnik, & Patterson, 2014, p. 416). This is concerning because longer length of stay results in increased potential for adverse events, increased violence and decreased patient and staff satisfaction (Hefflefinger, 2014, p. 365).