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Introduction

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  1. OUR BROTHER’S KEEPER: A POLICY ANALYSIS OF THE LANTERMAN-PETRIS-SHORT ACT OF 1967Presented to the School of Social WorkCalifornia State University, Long BeachIn Partial Fulfillment of the Requirements for the DegreeMaster of Social WorkCommittee Members:Rebecca Lopez, Ph.D. (Chair)Jeffrey Koob, Ph.d.Marilyn Potts, Ph.D.College Designee:Christian Molidor, Ph.D.By Kendra Rae BaileyB.A., 2010, California State University, San BernardinoMay 2012

  2. Inspired by the legislative intent to cease the inhumane practice of indeterminate and inappropriate commitment periods for people with mental illness, California’s Lanterman-Petris-Short Act (LPS) was passed in 1967 (Capps, 2010; C. Jacobs et al., 1999). • In maintaining the parens patriae obligation of the state, the crux of LPS attempts to maintain public safety and a safeguarding of patients’ rights through a set of strict standards for detaining the mentally ill (Capps, 2010; C. Jacobs et al., 1999; Kanel, 2012; Los Angeles Superior Court, n.d). • California’s Lanterman-Petris-Short Act (LPS) specifies the criteria necessary to place an individual on a 72-hour inpatient psychiatric treatment hold and/or conservatorship (C. Jacobs et al., 1999; Los Angeles Superior Court, n.d.). • In addition, LPS legislation ensures hospitalized individuals have the right to have their case reviewed periodically, a right to the least restrictive environment available, the right to a minimum standard of care, the right to give informed consent before receiving treatment, and, in certain circumstances, the right to refuse treatment. The Project • Involuntary civil commitment has regularly been justified by the basic assumption that the need for treatment outweighs the socio-philosophical concerns regarding the deprivation of liberty and autonomy (Fradella, 2008; Henwood, 2008). • The dominant concern beleaguering the policy of involuntary commitment, therefore, remains the violation of one’s rights (Fradella, 2008). • The purpose of this project is to analyze the Lanterman-Petris-Short Act of 1967 by addressing issues surrounding the process for, and effectiveness of involuntary commitment; its application amongst various vulnerable and oppressed groups; and its ramifications from a systems perspective. Introduction

  3. Involuntary commitment legislation breeds a myriad of ethical dilemmas for social work practitioners in the mental health field. • Many social workers perform the initial evaluation to assess whether or not an individual meets criteria for involuntary hospitalization and treatment (Bradley & Ward, 2009). • During this process, social workers are confronted each day with challenges to many of the principles of the National Association of Social Work’s (NASW; 2008) stated ethical responsibilities to clients. • As lower socioeconomic groups and minorities are over-represented in the mental health system, there is great risk for disenfranchisement (Institute of Medicine of the National Academies, 2002). • Our role as advocates compels us to lobby and bring attention to the struggles of socioeconomically challenged and impoverished individuals who are seeking care, often in a system whose service provision leaves ample opportunity to fall through the cracks. • In order to fulfill our responsibilities as culturally competent professionals, we must continuously acknowledge cultural differences in instances where we will potentially be depriving rights based on acceptable, and unacceptable, behavioral displays. • It is imperative that social workers take the time to truly assess the individual objectively, but with a critical eye toward cultural distinctions in expression. • In collaboration with the client, local community, and legislators, social workers can also endeavor to actualize the ideal of the recovery model by encouraging the repeal or revision of policies which continue to cultivate the shame and stigma associated with mental illness. Social Work Resonance of the Policy

  4. Inspired by the legislative intent to cease the inhumane practice of indeterminate and inappropriate commitment periods for people with mental illness, California’s Lanterman-Petris-Short Act (LPS) was passed in 1967 (Capps, 2010; C. Jacobs et al., 1999). • LPS legislation’s long-term goal was to facilitate the reintegration of institutionalized mentally ill individuals back into the community to live dignified lives, thereby subsequently decreasing hospital admission rates and lengths of stay. • California’s LPS legislations utilizes both the parens patriae responsibility of the state to intervene on behalf of the mentally ill individual, as well as exercise its police power in order to maintain the welfare of society (Slobogin, 2006, p. 7). Commitment extending from the state’s police power is based on a prediction of dangerous behavior rather than actual conviction or occurrence of a crime or hazardous incident (Fradella, 2008). • The medicalization of mental health contributed significantly to the provisions of the policy and the deinstitutionalization movement (Aho, 2008). “An increasingly biological interpretation of mental illness where social etiology is downplayed and illness is largely reduced to genetic predispositions and chemical imbalances in the brain” helped substantiate the advents in psychotropic medication in the early 1960s (Aho, 2008, p. 244). • Additionally, the medical model views mental health problems as a “potential obstacle to health care, requiring admittance to a hospital for treatment,” thus justifying involuntary admission’s goal of providing treatment (Fischer, 2006, p. 2). • The policy also sought to balance the increasing evidence supporting the medical model with the civil rights model’s quest for autonomy and equality (Fischer, 2006). The civil rights model’s proponents hold that an individual should not be forced into treatment based upon dangerousness, but rather, that one should be evaluated for their “capacity to make hospitalization and treatment decisions, how likely the person is to suffer deterioration, and how treatable [one] is” (Fischer, 2006, p. 2). • The LPS act nobly attempted to balance the responsibilities and privileges of both models in order to ensure the protection of both the mentally ill and the public at-large. Literature

  5. In order to review the Lanterman-Petris-Short Act systematically, this policy analysis employed a modified version of Gil’s (1992) policy analysis framework in order to focus on relevant topics. • The proposed framework consisted of a standard set of foci utilized in the study of given policies. • “The set of foci is standardized in order to facilitate systematic coverage of aspects deemed relevant to the understanding of social policies and their consequences for a society” (Gil, 1992, p. 32). • This is, in fact, what this policy analysis attempted to accomplish with the use of the above policy analysis framework. • Gil's policy analysis framework is composed of three objectives, of which, two were used for the purposes of this policy analysis. • The first objective was to discuss the issues that constituted the focus of the policy being analyzed. • The second objective was “to discern the chain of substantive effects resulting, or expected to result, from the implementation of a given social policy, including intended and unintended, short and long range effects (Gil, p. 31). • Data sources included the Lanterman-Petris-Short Act itself, professional journal articles, books, public agency documents, private-non-profit advocacy group documents, and government agency documents. Methods

  6. This study utilized a secondary review of the existing literature in order to explore the issues surrounding involuntary commitmentwith an analysis of the Lanterman-Petris-Short Act of 1967. • Data sources included the Lanterman-Petris-Short Act itself, professional journal articles, books, public agency documents, private-non-profit advocacy group documents, and government agency documents. • The analysis was limited in that secondary documents, which may have been biased or incomplete, formed the basis for analysis. • This analysis may have overlooked numerous studies due to time constraints and limitations regarding research resources, including online databases and library materials. • Further research regarding the specific impact LPS has had on older adults; the rights of conservators and conservatees; and racial, ethnic, and sexual minority populations would contribute to a more in-depth analysis of the ramifications of LPS legislation. • Additionally, research which explores the experiences of involuntarily committed individuals and their perceptions of need for, and benefits of, treatment would greatly benefit continued understanding of this topic. Methods

  7. Issues Dealt with by the Policy • Nature, Scope, and Distribution of Issues • Causal Theory(ies) or Hypothesis(ies) Concerning the Issues  • Objectives, Value Premises, Theoretical Positions, Target Segment(s), and Substantive Effects of the Policy • Policy Objectives: Overt Objectives and Covert Objectives • Value Premises and Ideological Orientations Underlying he Policy • Theory(ies) or Hypothesis(ies) Underlying the Strategy and the Substantive Provisions of the Policy • Target Segments of Society—Those at Whom the Policy is Aimed • Non-Target Segments of Society Impacted by the Policy • Short and Long-Range Effects of the Policy on Target and Non-Target Segment(s) in Ecological, Demographic, Biological, Psychological, Social Economic, Political and Cultural Spheres • Intended Effects • Unintended Effects • Insufficient service provision • Quality of life challenges • Overall Costs and Benefits • Implications of the Policy for the Operating and Outcome Variables of Social Policies • Changes in the Distribution of Material Resources • Changes in the Distribution of Services and Rights • Interactions of the Policy with Forces Affecting Social Evolution • History of the Policy’s Development and Implementation, Including Legislative, Administrative, and Judicial Aspects • Implications of the Policy for the Operating and Outcome Variables of Social Policies • Social Policies Relevant to the Focal Issues of the Policy Policy Analysis

  8. LPS “allow[s] the state to deprive individuals of liberty”; however it significantly lacks explicit guidelines as to what behavior constitutes confinement (Fisher & Grisso, 2010, p. 365). • The debate over how to define mental illness, dangerousness, and other ambiguous concepts subject to cultural and personal interpretation continues to plague the issue of involuntary commitment. • The LPS Act of 1967 attempted to redress much of the vulnerability of the severely and persistently mentally ill by ensuring their rights are clearly outlined and enforced within the very institutions in which they often sought refuge. Impact on Social Work Clients • An alarming effect of the LPS Act, has been the difficulty with which individuals with mental illness are admitted to the hospital. • Budget constraints and the lack of appropriate outpatient care have hindered the efforts of advocates and activists in facilitating the community reintegration of institutionalized mentally ill individuals. • Discharged patients were simply shifted from state psychiatric hospitals to prisons, nursing homes, and into the community with little-to-no resources (Grabowski, Aschbrenner, Feng, & Mor, 2009). • In fact, more than 500,000 people with mental illness, including those living with schizophrenia, bipolar, depression and anxiety, currently reside in U.S. nursing homes (Grabowski et al., 2009). • The rapid discharge of the mentally ill from state hospitals also placed significant pressures on their families and communities due to the strain on the sparse available social services allotted for their care (Etter, Birzer, & Fields, 2008, p. 80). • The requirement of dangerousness made hospitalization criteria more stringent, and served to hinder the admission of those mentally ill individuals in need of services who lacked symptoms that were severe enough in presentation (Slovenko, 2011). Strengths and Challenges of LPS

  9. Aho, K. (2008). Medicalizing mental health: A phenomenological alternative. Journal of Medicine and Humanities, 29, 243-259. Bradley, C., & Ward, K. (2009). Mental health and addictions: Legal and ethical issues for practice. InT. Maschi, C. Bradley, & K. Ward, (Eds.), Forensic social work: Psychosocial and legal issues in diverse practice settings (pp.183-19). New York, NY: Springer. Capps, D. (2010). Understanding psychosis: Issues and challenges for sufferers, families, and friends. Lanham, MD: Rowman & Littlefield. Etter, G., Birzer, M., & Fields, J. (2008). The jail as dumping ground: The incidental incarceration of mentally ill individuals. Criminal Justice Studies, 21, 79-89. Fischer, J. (2006). A comparative look at the right to refuse treatment for involuntarily hospitalized persons with a mental illness. Hastings International & Comprehensive Law Review,153, 1-31. Fisher, W., & Grisso, T. (2010). Commentary: Civil commitment statutes—40 years of circumvention. Journal of American Academic Psychiatry and Law,38, 365-368. Fradella, H. (2008). Forensic psychology: The use of behavioral science in civil and criminal justice. Mason, OH: Cengage Learning Gil, D. (1992). Unraveling social policy, (pp. 71-74). Boston, MA: Schenkman. Grabowski, D., Aschbrenner, K., Feng, Z, & Mor, V. (2009). Mental illness in nursing homes:variations across states. Health Affairs, 28(93), 689-700. Henwood, B. (2008). Involuntary inpatient commitment in the context of mental health recovery. American Journal of Psychiatric Rehabilitation,11, 253-266. doi:10.1080/15487760802186337 Institute of Medicine of the National Academies. (2002). Unequal treatment: confronting racial and ethnic disparities in healthcare. Washington, DC: National Academy Press. Jacobs, C., Galton, E., Howard, B., Abdalian, G., Black, H., Hagar, R. . . . Stavis, P. (1999). Reform of the Lanterman, Petris, Short Act. Retrieved from http://www.treatmentadvocacycenter.org/storage/ documents/report%20by%20the%20lps%20reform%20tast%20force%20%20rdc%20pdf.pdf Kanel, K. (2012). A guide to crisis intervention (4th ed.). Belmont, CA: Brooks/Cole, Cengage Learning. Los Angeles Superior Court. (n.d.). Mental Health: LPS administrative facility based hearings. Retrieved from http://www.lasuperiorcourt.org/mentalhealth/FacilityBased Hearings.htm National Association of Social Workers. (2008). Code of ethics of the National Association of Social Workers. Retrieved from http://www.socialworkers.org/pubs/code/ code.asp Slovenko, R. (2011). Psychiatry in law (2nd ed.). New York, NY: Taylor & Francis Group. References

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