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Forced Psychiatric Treatment: Coming Soon to A County Near You?

AB 1421 was signed by the Governor last year. It weakens the "danger to self, others, or gravely disabled" criteria that allowed court-ordered forcible treatment--including forced medication outside of a psychiatric hospital.
Forced Treatment under AB 1421: Coming Soon to a County Near You?

by Robert Norse for Street Spirit newspaper August 2003

For years survivors of California’s “mental health? system fought a drive by state assemblywoman Helen Thomson (D-Davis) expanding state powers to forcibly incarcerate & drug those labeled “mentally ill.? Advocates were able to stop AB 1028 and AB 1800, earlier versions of the bill. But on September 28, 2002, Governor Davis signed AB 1421, which allows counties to opt into an involuntary outpatient commitment [IOC] program. IOC significantly increases the pressure to take psychiatric “medication.?
For counties who choose the program, AB 1421 significantly weakens the protections of the Lanterman-Petris-Short (LPS) Act. The LPS Act mandates that a person cannot be forcibly held in a psychiatric hospital (“5150?-ed) unless a threat to herself, others, or “gravely disabled? (i.e. unable to provide the necessaries of life).
AB 1421 allows the forcible restraint and
“medication? of a person “suffering from a serious mental illness? “if the person’s relapse or deterioration...would be likely to result in grave disability or a danger to the person or others?--a much weaker restraint than the LPS conditions.
Additionally, the person must (1) be deteriorating to the point at which they might be dangerous to themselves or others or gravely disabled--again a weaker protection; (2) have been offered voluntary services and refused them; and (3) be offered the “least restrictive alternative.?
Finally one of the two following conditions must also apply: (1) A person must have had “a history of lack of compliance that has caused them to be in a hospital or incarcerated [i.e. a jail] in the last 36 months,? or (2) she has made any “acts, attempts, or threats of serious violent behavior toward self or others within the last 48 months.?
Though the list of conditions in AB 1421 is longer than the wording of the L-P-S. law, the AB 1421’s wording makes it significantly easier for authorities to ensnare and coerce an unwilling "patient" and force them to take "medication" under an IOC mandate.
Robert Whitaker, former Boston Globe reporter, has documented the toxicity of psychotropic drugs (such as Thorazine and Haldol) and “atypical? antipsychotic drugs (such as Zyprexa, Clozaril, and Risperdal) in his Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill (see Street Spirit interview June 2003).
Jane Kysor is an independent PIRC [Psychiatric Inmates Rights Collective] advocate from Santa Cruz, who has been monitoring psychiatric abuses for many years. She commented, “The hazards and toxicity of psychiatric drugs are well-known. The
mental health system already uses untruths and exaggerations to hold people. This bill makes it potentially much worse.
The only free services the system provides are drugs, restraint, and electroshock. Instead of forcing more drugs on people, we need to start detoxification programs for those who want to get off the psych drugs.?
Virginia Knowlton, head legislative public relations worker at Protection and Advocacy, tried to get Davis to veto AB 1421. “We took a pummeling from the L.A. Times. There’s so much stigma and misunderstanding of people with psychiatric disabilities. The media falsely claims that people lack insight into their own treatment, so they have to be coerced.?
“In New York City,? Knowlton notes, Kendra’s law--a similar bill--was used “as a sort of street-cleaning measure. The numbers were overwhelming black male. It was skewed in a racially economically discriminatory fashion.?
Sally Zinman, an activist since 1977 in the consumer/survivor movement? is Executive Director of the California Network of Mental Health Clients (CNMHC). She cites a CNMCH report that notes that 83% of the two thousand court-ordered involuntary druggings state-wide were in New York City.
In New York state, 51% of the clients are white, making up 29% of the commitments. Though 24% of NYC is black, blacks make up 42% of the commitments there. The criteria used is not the “serious violent behavior? one used to sell Kendra’s Law to the public. Rather, in 95% of the cases “repeat appearance in hospitals? is the
standard used to force people to take drugs in IOC.
“IOC as it’s used in NY," Zinman concludes, “has been used to sweep homeless people up off the streets of New York City. It’s a chamber of commerce tool, not a mental health tool. It has been racially targeted. It cost the state $140,000,000, half of it for administrative, judicial, investigative infrastructure.? Where are the services? Zinman asks.
“All the research proved is what the people need are the services. The Bellevue Study and Rand Report [on IOC] pointed out it was the existence of the services [and not the element of coercion] that made the difference.?
Indeed, it is the requirement for services in California’s AB 1421 that may make it completely unworkable on a county level. Kendra’s law, Zinman explained, didn’t require services be available. But critics were able to add to AB 1421 the requirement that counties must not reduce any voluntary programs if they institute the easier forced drugging system.
Additionally housing and community support services are required locally before AB 1421 can be opted for, as well as access to substance abuse services, psychological counseling, vocational rehabilitation, and veteran’s services. Since such services aren’t likely to be available anytime soon--particularly in the current budget crisis, County Boards of Supervisors are not likely will “opt in? to the coercive AB 1421 system.
Counties can’t take any money for this program from any voluntary services, nor can they
decrease any current services that are voluntary. In effect, they would have to vastly expand voluntary services for all clients to use
AB 1421 for some.
CARES (Coalition Advocating for Rights, Empowerment and Services) was formed four years ago “to guard against the expansion of forced...treatment & to work for increased access to & development of effective voluntary community mental health services. Their on-line analysis at details further obstacles to instituting AB 1421.
These include open discussion, citizen planning, and citizen review provisions with public hearings to assure voluntary services would not be adversely affected. If the housing and services become available, the County must show that these services are also available voluntarily.
Effective legal counsel must be made available at every stage of the forced treatment process, according to the law, with additional expenses for evaluations, contempt of court orders, court monitoring of 60-day affidavits of need for the program, etc. Training and education for additional personnel would add an extra expense.
A December 2002 Newsalert on the CNMHC website titled “AB 1421 Fight Goes to the Counties? notes: “Although the CNMHC and allies were able to stall initiatives to expand forced treatment for four years, ultimately we could not stop this well funded, highly promoted, and media supported effort.
However, there is no state-mandated patient commitment program and the LPS laws have not been changed. The battle now goes to the local--county--level. And the CNMHC and its allies will be there to fight this regressive idea from becoming a reality in any county.?
In addition AB 1421 sunsets in 5 years. But the CNMHC claim that the “LPS law? with its stronger protection against capricious or arbitrary incarceration is still too weak for many who oppose forced incarceration and drugging entirely. While the LPS law is unchanged at the state level., counties which opt into the program, though it is costly, can now use a far weaker standard for snatching those with a history of mental illness and hospital incarcerations if they refuse to take state-approved medications.
Los Angeles County is the only county so far to implement AB 1421, Zinman reports. However, the L.A. system targets individuals who have been already adjudicated legally incompetent to stand trial in misdemeanor cases and hence would go to a State Hospital anyway.
No more resources are being used, claims L.A. county bureaucrats, since hospital beds already being used are being “freed up?. The point of intake would be L.A. County’s Mental Health Court.
The guinea pigs in this AB 1421 “experiment? have criminal charges hanging over them already and so are already forcibly confined (those with mental disabilities are picked up more often for poverty crimes like trespass and petty theft). Still how can those already locked up be said to have been offered the “voluntary? services that AB 1421 is required to provide along with its toxic tranquilizer “treatments??
Zinman’s group may be suing the County to stop the charade. Assemblywoman Helen Thomson,
author of AB 1421, who is now on the Yolo County Board of Supervisors, is likely to press for Yolo County to “opt in? to AB 1421 as well. Santa Barbara and Ventura Counties have already considered and rejected involvement.
What about the spectacle of “Needles on Wheels?--court-mandated psych techs and police coming to your house to force you to “take your meds?? Consumers for the tardive dyskinesia and diabetes-producing “medications? millions are hooked on, thanks to the Mental Health megalith, do keep the wheels of the large pharmaceutical industry turning.
“Take your pill or take a ride to the psych ward? is actually a reality today in California where the court has ordered such a procedure, even where AB 1421 has not been approved. Zinman suspects such humiliating and coercive intrusions are going on more widely under IOC in North Carolina and Wisconsin, two of the forty other states that have passed the IOC law.
Some claim financial benefits for court-ordered involuntary outpatient treatment because it replaces costly in-hospital stay time with cheaper court-mandated drugging at home. The American Association of Community Psychiatrists (“Position Paper, June 2001?) also admits very real problems such as “distorting effects on patient-clinician relationships?, the vulnerability of people in poverty to misues of IOC, unclear findings on whether violent behavior is reduced and “treatment? is adhered to, and danger of its being used an inappropriate substitute for real services.
Voluntary services, Zinman says, are what makes the difference. Studies of a trial IOC program at Bellevue Hospital in New York City in 1995 and a broader Rand Corporation study some years later showed that the availability of the services themselves, not the coercive apparatus, drew clients to the program. A pilot program expanding voluntary services, AB 34, an earlier California law, provided housing, counseling, support, and--even medication--voluntarily. It showed dramatic results, so much so that AB 1421 advocates added it to their bill as a sweetener.
Zinman points out that a May 2002 report to the state legislature found that the stay time in a psychiatric hospital dropped 65.5% for those enrolled in the voluntary program. There was a drop of 81.5% for jailtime served. Homelessness
dropped 71.9%. 83% of those served voluntarily stayed in the program.
4720 individuals used the $45 million program over three years. There was a savings to the public of $23 million in reduced hospitalization, homelessness, and jail costs.
Zinman summed up: “Given the budget crisis, the idea that any county would divert funds from current programs that are working for an approach that is unproven and could be damaging would be criminal and illegal. AB 1421 isn’t meant to force people to take housing, counseling, services or jobs, it’s there to force drugs on people.?

Those interested in learning more about AB 1421 are invited to check out, the website of the California Network of Mental Health Clients.

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Re: Forced Psychiatric Treatment: Coming Soon to A County Near You?

I think the movie "Frances" shows us how this law will be abused in silencing the nonconformist or any who dares to question authority. I have experienced our co. officials use certain emotional situations to thier advantage by exagerating and omitting information when they want a certain outcome or are hiding wrongdoings. It is very sad that we value money more than people. In my opinion the only way to reduce the amount of people who spend there lifes in institutions will be to build self-esteem and positive re-inforcement through educational, and vocational programs in which a person can provide themselves with the basic roof over their heads, heat, food, and clothing that the rest of us take for granted. The "Spectra" program is a fine example of this and we need to support and keep it alive as well as more such as this one. It is so wonderful at building the confidence to take on other challenges as it is impossible not to produce a work of art one will be proud of. I am sure there are many who won't be able to be reached and for them hospitals and prison will be the only place safe for them and others, and who is to decide which is which? I would think a jury but only if there is a real threat to the safety of the community and real evidence of this not just someone declaring it as true.


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