LETTER TO CA ASSEMBLY ABOUT LPS REFORM by Dede Ranahan

December 14, 2021

My written comment to the California Assembly Health and Judiciary Committee about LPS (involuntary commitment) reform:

As the mother of a son who fought hard to live with his schizo-affective disorder, I have over 25 years experience with the California mental health system. I don't agree with your conclusions that LPS gives counties adequate tools to meet the needs of SMI or that changes to the act would endanger civil liberties.

I do agree that LPS needs to ensure adequate follow up care. I.e. My son was involuntarily committed to Kaiser hospital in July 2014. Due to the lack of beds in Sacramento County, he was transferred to Dignity Health in Yolo County without our family knowledge even though he had designated me as his representative on his advanced care directive. His records were not transferred from Kaiser to Dignity Health. I was not able to speak with my son's doctor, they asked for my discharge plan even though I wasn't advised of his health status, and they called subsequently to announce that he'd died. The nightmare continued as I fought to get an independent autopsy and toxicology report.

Obviously there's not space here to divulge 25 years of terrible LPS history in my family. I've written two award winning books about this: Sooner Than Tomorrow (memoir) and Tomorrow Was Yesterday (65 stories from California mothers and mothers from 28 other states). Please read their stories if you really want to know what living under LPS law is like.

Tomorrow Was Yesterday includes a 15-point plan to address serious mental illness developed by activists from across the country. Our top 5 recommendations are: 1) Reclassify SMI from a behavioral to a physical medical condition — looking at SMI through a medical rather than behavioral lens would change the way insurance would have to operate, the way we incarcerate SMI, the way we view SMI homeless; 2) Reform HIPAA; 3) Repeal the IMD Exclusion; 4) Provide a full continuum of care; 5) Decriminalize SMI.

Involuntary treatment is not to impinge on civil liberties. It's to make sure that people receive their right to timely, quality treatment. It's to raise the bar for services rather than meeting only minimum standards. Let's stop fighting over "Are you a danger to yourself or others?" We don't do this for dementia/Parkinson's patients. Let's get people into treatment sooner.

Let's get out of the ideological weeds, stop the bureaucratic quibbling, and look at the big picture of what is needed. Bottom line: I'd demolish LPS as it is written and use available funding (reallocated MHSA funds, Medicaid, and reassigned funding given to unaccountable and unreliable nonprofits)to create a new system that has responsibility, accountability, and independent financial oversight (not MHSA oversight).

Thank you. Dede Ranahan

Just made my year-end donation to No One Cares About Crazy People. Please consider doing likewise to help bring this film to fruition. No One Cares documents the horrifying, inhumane state of our "mental illness system." It exposes human rights violations and asks for change. To donate, click on the link to the film homepage below.

No One Cares Film

Image from No One Cares film.

LET'S TALK ABOUT HOPEFUL VOLUNTARY ADMISSIONS by Mary Irwin Butler

Let's talk about hopeful voluntary admissions. We have had four very long ER visits (5-14 hours each) in the last couple of months trying to admit my fear-filled, very psychotic son voluntarily. When my son gets to the point that he's asking to go to the hospital, he's beyond ill and fearful. He battles monstrous auditory hallucinations while he's in crowded waiting rooms with the elderly, sick babies, and patients with infectious diseases. It's horrid for him and potentially horrid for them.

No beds were available in the Philadelphia metro/suburban area within a 50+ mile radius. These four useless ER visits led to exacerbated illness resulting in an involuntary admission which is always more heartbreaking and exhausting. Unfortunately, in our locale, we cannot call or look for available beds on our own. It must be done in a local ER as follows: 

      *Long waiting room wait

      *Triage evaluation (psych patients are rarely prioritized) 

      *Back to the waiting room and possibly another long wait 

      *Med clearance including blood/urine tests, etc. 

      *Psych evaluation by social worker when available 

      *Insurance approval — usually a lengthy process

      *Bed search (typically hours/sometimes days) 

      *Clinical review/approval by the admitting facility if a bed is available 

      *Wait for available transport to the admitting facility

      *Lengthy wait/intake at the admitting facility whatever hour fatigued patient arrives

At times, very ill patients have been known to lay in ER beds from overnight to an entire week+ until a bed becomes available. How terrible that someone seeking mental illness treatment is left waiting so long. Imagine if this happened to someone with appendicitis or broken bones. Understandably, patients with serious mental illness become uncomfortable, frustrated, anxious, and further disturbed. They receive very little attention from ER staff unless they're acting out. Many, including my son, give up and walk out of either the waiting room or the examination room. The process is pretty much the same here for involuntary admissions. They involve the police, lengthy paperwork at the County Crisis Center, and legal approval. So tack on several more hours.  

I've mentioned to several ER docs and nurses, to no avail, that these critically ill patients should have a separate waiting area, be triaged expeditiously to an ER bed, and not be left alone for long periods of time. It's a cumbersome and careless system. The entire process needs to be streamlined and more efficient. It needs to provide timely access to safe and attentive emergency care and in-patient beds.

The mainstream media paint the picture that if only these mentally ill individuals would seek/get the necessary help, then we wouldn't see these ongoing mass shootings. That may apply to a few but truly no one, especially the media, has a clue as to the availability of mental health care, let alone timely/quality care, unless they've walked in our weary shoes. 

Bottom line: We're serving our seriously mentally ill in a very questionable and trepidatious manner, if at all. The availability of in-patient beds is in crisis. It's no wonder. Several of the better hospital psych units in this premier healthcare area have closed (not profitable) in lieu of expanding profitable cardiac units, etc. A crying and growing shame leaving personal and community tragedies in the making...

Mary

Mary