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News:  Forced Treatment Bill AB 2357 Update! | Sally Zinman Announces New Role | CNMHC to Expand Programs | New CNMHC Staff Positions Available | CNMHC Regional Meetings Held Throughout State | Senators' Votes on Prior Bills Spell Trouble | AB 2357: Background | More News from the Cal Net Gazette

Views:  AB 2357: Why Oppose It | CNMHC Open Letter to Appropriations Chair Murray

Events:  CNMHC Bay Area Region Special Meeting Update! | Public Hearing on Police and 5150 Protocol in Berkeley New!

Presentations:  International Conference on Violence, Abuse and Trauma Alternatives

MHSA Events:  CNMHC Scholarships Available to Attend State-Level MHSA Meetings New! | DMH General Stakeholder Meetings and Conference Call New! | Oversight Commission to Vote on Principles, Guidelines for Prevention, Early Intervention New! | Mental Health Services Oversight and Accountability Commission (MHSOAC) Updates | California Department of Mental Health (DMH) MHSA Updates

Involuntary outpatient commitment bill AB 2357 goes before Governor Schwarzenegger

Clients, advocates mobilize campaign for veto

By Delphine Brody Updated August 28

Passed by wide majority votes in both the State Senate and Assembly last week, involuntary outpatient commitment extension bill AB 2357 (Karnette and Yee) has been enrolled and now goes to Governor Arnold Schwarzenegger's desk, either to be signed into law or to be vetoed.   

The bill would add five years to the Jan. 1, 2008 sunset date of AB 1421 ("Laura's Law"), an extension that a coalition of statewide groups representing clients, advocates and social rehabilitation service providers says would provide viability to an outdated, coercive and divisive practice that flies in the face of the client-driven transformation in California that was promised with the passage and implementation of the Mental Health Services Act (MHSA).

Super-majority 'aye' votes in the State Senate and Assembly.

After a nearly two-month-long series of delays, the Senate passed the California Senate August 21 with a vote of 30-4. The following day, the Assembly voted 65-11 to concur with a Senate amendment to the bill, passing the bill out of the State Legislature and ordering it enrolled

Opponents of the bill, including the California Network of Mental Health Clients (CNMHC) and Protection & Advocacy, Inc. (PAI), have expressed  great disappointment and concern at the overwhelming majority with which the bill was passed in the final votes of both the State Senate and Assembly.  The wide margins by which the bill was passed may be viewed by the Governor and his aides as a legislative mandate, adding pressure for him to sign it into law,  advocates say.  The August 21 Senate Floor vote represented the last opportunity for opponents to stop the bill in the Legislature.   Now the bill -- and the future of outpatient commitment in California -- are in Governor Schwarzenegger's hands.

Next target: Governor Schwarzenegger.

The CNMHC, together with the Coalition Advocating for Recovery, Empowerment and Services (CARES), a group that includes PAI and the California Association of Social Rehabilitation Agencies (CASRA), is mobilizing a second letter-writing campaign urging the Governor to veto the bill.

Clients, survivors and advocates across the state have vocally opposed this bill, noting that the statewide legislative battle has fueled a series of inflammatory editorials in some daily newspapers, rekindling tensions between mental health stakeholders and undermining the tentative trust that characterized relations between clients/survivors and county mental health officials during the first-year honeymoon of the MHSA.

If Governor Schwarzenegger signs the bill into law, California counties may opt to fund AB 2357 programs, greatly expanding their capacity to court-order adults and older adults to receive psychiatric treatment against their will. 

Amid a sea of 'ayes', six new 'noes' in the Assembly.

Among the eleven "no" votes in the Assembly last Tuesday were four who had voted "aye" in the May 18 Assembly Floor vote following the third reading of this bill, John Benoit (R-Riverside), Bob Huff (R-Anaheim), Jay LaSuer (R-San Diego) and Bill Maze (R-Visalia), as well as two who had abstained in the May 18 vote, Loni Hancock (D-Berkeley) and George Plescia (R-San Diego).  

Among the 65 "ayes", only one new affirming vote was cast by Rebecca Cohn (D-San Jose), who had previously abstained.  All but two Assembly Democrats voted "aye" Tuesday – 47 in all – including Majority Leader Dario Frommer (D-Glendale), Speaker Fabian Núñez (D-Los Angeles) and Health Committee Chair Wilma Chan (D-Oakland).

Republican Assembly vote split on outpatient commitment.

Together with previous "no"-voting Assemblymembers Chuck Devore (R-Irvine), Ray Haynes (R-Riverside), Doug LaMalfa (R-Redding), Tim Leslie (R-Roseville) and Dennis Mountjoy (R-Claremont), each of whom again voted "no", ten of the eleven final Assembly  "noes" were cast by Republicans.  However, almost twice as many GOP Assemblymembers (18) voted "aye" as those who voted "no" in Tuesday's final Assembly vote.  Two of the three Members who were either absent, abstained or didn't vote were also Republicans, including Dave Cogdill (R-Modesto), who voted "aye" in May.  

But the GOP Assembly leadership was divided on the bill, with Minority Leader Plescia, Chief Minority Whip LaMalfa, and Minority Whips Benoit and Huff voting "no", while GOP Caucus Chair Greg Azharian, Assistant Minority Leader Rick Keene, and seven other GOP leaders voting "aye".

Clients, advocates and allies say they hope the Governor will side with the ten Republicans who led the opposition on the Assembly Floor, but they don't expect him to be persuaded to veto the bill without a groundswell of letters urging him to do so. 

Four Senate Democrats defy party line, vote 'no'.

In stark conrast to the GOP-led opposition in the Assembly, all four stand-out "noes" in the final Senate Floor vote were cast by Democrats.   Three of the four, Deborah Ortiz (D-Citrus Heights), Liz Figueroa (D-Fremont) and Wesley Chesbro (D-Arcata), had voted against AB 2357 in the Health Committee.  The fourth "no" was cast by Alan Lowenthal (D-Long Beach), who as an assemblyman voted "aye" on AB 1421 but "no" on AB 1800. 

Among the "aye" votes were prior AB 1421 supporters, including AB 1421 co-author President pro Tem Don Perata (D-East Bay), Minority Leader Dick Ackerman (R-Orange), Assistant President pro Tem Jackie Speier (D-San Francisco/San Mateo).  

Unexpected "ayes" included Rules Committee member James Battin (R-Riverside), Richard Alarcón (D-San Fernando Valley) and Michael Machado (D-Linden), all of whom voted "no" on AB 1421.  

Also disappointing the bill's opponents were three hopeful swing "no" voters who voted "aye": Majority Whip Carole Migden (D-San Francisco), and Elaine Alquist (D-San Jose), who as assemblymembers voted "aye" on AB 1421 but "no" on AB 1800, and Chuck Poochigian (R-Fresno) who once voted "no" on 1421 in the Senate Appropriations Committee.

Misleading analysis may have beguiled Assemblymembers.

A fair amount of evidence indicates that several statements in the final Assembly Floor analysis were inaccurate and misleadingly slanted in favor of the bill.  If one accepts that the analysis was inaccurate and misleading, whether by accident or deliberately on the part of Assembly Health Committee Chair Chan's office, a case could be made that many of the Assemblymembers who voted "aye" for AB 2357 may not have done so if they had been properly briefed. 

Analysis suggests Prop 63 funding may be possible.

In November 2004, California voters passed Proposition 63, the Mental Health Services Act, which imposes one percent state income surtax on incomes exceeding $1 million to finance an expansion of community mental health programs. "Recent regulations adopted by the [State Department of Mental Health] require programs and/or services provided with MHSA funds to offer mental health services and supports to individuals with severe mental illness and/or severe mental disorders to be 'voluntary in nature' and [to] 'comply with the non-supplantation requirements,'" notes the analysis, prepared by Chan Legislative Assistant Rosielyn Pulmano.  

Yet without explanation, the analysis concludes, "It is unclear if Proposition 63 funds could be used for AB 1421 programs."

Discredited claim of  'AB 1421' program in Los Angeles revived.

Last Tuesday's analysis also states,"Los Angeles County has approved the implementation of AB 1421 for up to 30 mentally ill individuals involved in the criminal justice system for minor offenses per year."

The claim, made repeatedly by AB 2357 proponent Randall Hagar of the California Psychiatric Association, was discredited, however, during the emotionally charged Senate Health Committee hearing of June 14, in which Chair Deborah Ortiz asked the bill's proponents and opponents for clarification on the matter of whether any county had in fact implemented AB 1421.  

In his statement in support of AB 2357, Hagar claimed that Los Angeles County had implemented Laura's Law in a small pilot program, that case managers in the county had reported great success with the program, and that other counties, including Sacramento, San Francisco, and Nevada Counties, were intent on implementing the law.  Hagar made the same claims repeatedly in prior hearings on the bill in the Assembly.  

However, as CNMHC Executive Director Sally Zinman pointed out in her opposing comments, neither Los Angeles nor any other county has ever implemented the law.  The L.A. County pilot program in question is a jail diversion program for mental health clients charged with misdemeanors, and both the program director and the county have publicly stated that this program does not implement AB 1421, following a settlement of a lawsuit against the County in which the CNMHC was lead plaintiff.   And none of the other counties mentioned has either approved or reviewed an RFP for any AB 1421 program.  

Visibly piqued by Hagar's apparent misrepresentation of the facts to the Senate Committee, Ortiz rebuked Hagar, imploring him to be truthful in his statements to the committee. 

But the final Assembly analysis ignores that day's comments altogether.   "Specifically, [Los Angeles AB 1421 candidates] come from two sources: misdemeanor incompetent to stand trial defendants who have been restored to competency at the Los Angeles County Mental Health Court; or, misdemeanor defendants from the courts covered by the Mental Health Court Program who are at risk for becoming incompetent to stand trial.  

"According to the Los Angeles County Department of Mental Health, defendants in these instances voluntarily  [sic] agree to participate in AOT [assisted outpatient treatment], instead of being ordered by the court to undergo the treatment," notes the analysis.  The diversionary nature of the program, opponents point out, was in fact the rationale behind the CNMHC  lawsuit against the County, and was cited in the agreed terms of the out-of-court settlement as the reason why the county had not implemented an AB 1421 program, and would not call the program in question anything of the sort.

"In addition, the sponsors point out that Nevada County is also planning to implement an AB 1421 program," the Assembly analysis continues.  This too is a stretch, opponents argue.  Nevada County officials are, in fact,  seeking to implement AB 1421 as the settlement terms for another lawsuit, by the parents of slain college student Laura Wilcox, for whom "Laura's Law" was named.  But the County has yet to allocate sufficient resources to make AB 1421 implementation possible.

Missing: opponents' arguments.

Missing from the Assembly analysis were most of the arguments the CNMHC made in numerous letters to Assemblymember Chan's office in the weeks leading up to the Health Committee's April 4 vote.  Considerably more of the arguments of the bill's opponents were included in the final Senate Floor analysis of June 28, despite the fact that both legislative houses received numerous letters and visits in which members of the CNMHC made the same points.

Expedited vote.

The Assembly concurrence vote was expedited after Majority Leader Frommer was granted unanimous consent to suspend Assembly Rule 77 to permit consideration of Senate amendments to the bill, which would have been delayed until today or later.  

The Senate amendment to which the Assembly voted to concur added the names of two more Assemblymembers, Paul Koretz (D-West Hollywood) and Sally Lieber (D-San Jose), and four Senators, Samuel Aanestad (R-Nevada City), Sheila Kuehl (D-Los Angeles) Jack Scott (D-Pasadena) and Democratic Caucus Chair Tom Torlakson (D-Antioch), to the bill's list of co-authors.

Delays fired up the opposition.

When the vote was deferred earlier this month, the delay provided opponents of the extension of outpatient commitment -- mental health clients, survivors, advocates and allies -- one final opportunity to mobilize constituents.  The bill's opponents used the additional day and a weekend to wrap up a letter-writing campaign urging Senators to vote "no" on the bill

Last Monday's Senate vote followed a lengthy postponement in which the vote was delayed  seven times, while clients, survivors and advocates struggled to mobilize a letter-writing campaign among constituents.  The bill's final Senate vote was most likely postponed due to its position in the order of the Senate Third Reading File.  The vote was initially expected June 29 or 30; they were then postponed until August 7 due to legislative recess.   During the August  7 Floor session, the CNMHC  distributed a Floor Alert with talking points in opposition.  But the vote was held over to the next Senate Floor Session on August 10,  and then delayed again in a series of Senate Floor sessions continuing until August 21.

AB 2357: recent history.  

On June 26, in a surprise move that sent advocates scrambling to mobilize constituents on short notice, the State Senate Appropriations Committee canceled its scheduled hearing on AB 2357, reporting it out of the committee as a "non-money bill" pursuant to Senate Rule 28.8, requiring that they not hear and promptly report any bill that does not appropriate money to the Senate Floor , according to attorney Dan Brzovic of PAI, who attended the June 26 public meeting of the committee.  The move came as a shock to Brzovic and to client advocate Dave Hosseini of CASRA, both of whom attended what they expected to be the bill's hearing to speak in opposition.  

Expecting a final vote that week, a coalition of advocacy groups including the CNMHC redoubled efforts to to stop the bill in the legislature.  The CNMHC distributed a Floor Alert with a summary of talking points in opposition to the bill on the Senate Floor June 29 and again last week.  

Although no public comment is permitted during second and third readings, Legislative Advocate Evelyn Abouhassan of PAI joined the CNMHC and other statewide advocacy groups in encouraging individuals to write to legislators and register their opposition.

Appropriations Chair Kevin Murray's (D-Los Angeles) invocation of the rule to bump the bill to the Senate Floor "subverts any legitimate process", Hosseini charges.  The fairly obscure rule has been used to deter the public from commenting on pending legislation, Hosseini argues.   AB 2357 threatens to take away the civil rights of thousands of Californians, advocates say.  And sending such a bill directly to the Senate Floor after only one committee hearing, Hosseini contends, signals "the corruption of the process."

Although proponents assert that the bill would not appropriate money from the State, CNMHC Executive Director Sally Zinman pointed out in an open letter to Murray and other members of the committee that the bill would in fact be extremely expensive for counties to implement, because of the administrative infrastructure, court and legal costs it would incur.  Zinman notes that the infrastructure, court, and legal expenses of implementing New York State’s Kendra’s Law, on which Laura's Law was based, have cost New York almost twice what it spent on programs and services under the law.

Since the bill's introduction in February, the CNMHC and representatives of other agencies in the Coalition Advocating for Rights, Empowerment and Services (CARES) have been actively educating legislators about the bill's dangers and speaking in opposition.  

As amended April 4 in Assembly Health, the bill would extend the sunset date of AB 1421 by five years (to 2013) and require the California Department of Mental Health (DMH) to submit a report and evaluation to the Governor and the Legislature by 2011 of each AB 1421/2357 program implemented in whole or in part.  As AB 2357 made its way through first the Assembly and then the Senate, the bill's authors, Assemblymembers Karnette (D-Long Beach) and Yee (D-San Francisco) have picked up nine nominal co-authors over the past two months in both chambers, including one Republican co-author in the Assembly and another, Samuel Aanestad (R-Nevada City), in the Senate.

In AB 2357's first and only State Senate committee hearing on June 14, the bill was passed by the Health Committee by a narrow margin of 5-3 following a heated and contentious discussion.

Chesbro ups the ante. 

Senator Chesbro argued forcefully against the bill at the Health hearing, noting that in his years of consulting with consumers, survivors and advocates on mental health legislation, clients and survivors have consistently voiced opposition to a series of forced treatment bills, including AB 2357 and its predecessor, AB 1421, on the basis that people who have been subjected to involuntary treatment report having been traumatized by that experience and losing trust in the mental health system, often subsequently avoiding all services, and that clients/survivors view the expansion of involuntary treatment as a violation of their civil rights.  Chesbro stated that with many new voluntary MHSA services just now receiving funding, he saw any extension of involuntary treatment legislation beyond the sunset date as being at best premature; clients should first be given an opportunity to access new, voluntary services.  

Ortiz moves to shorten the sunset date extension.

Ortiz echoed Chesbro's opposition to the bill, stating that she could not see why the involuntary outpatient commitment demonstration project for which the law provides should be extended to 2013, and that she too was was concerned that the bill would pre-empt the introduction of new voluntary services under the MHSA.  She asked the AB 2357 co-authors present, Assemblymembers Betty Karnette (D-Long Beach), Leland Yee (D-San Francisco) and Senator Aanestad, whether they would consider amending the bill to shorten the extension to three years instead – to 2011.  

Instead, the co-authors defended the legislation in its current form; Yee spoke of his twelve years as a psychologist in a San Francisco day treatment center for youth, recalling that he "had to" repeatedly invoke Welfare and Institutions Code Section 5150 to initiate an involuntary 72-hour psychiatric hold (under the Lanterman-Petris-Short (LPS) Act) in order to treat a number of young people diagnosed with mental illnesses whom he described as "non-compliant" and "unwilling to show up for day treatment".  Yee claimed that court-ordered outpatient commitment legislation was needed as an additional tool to enforce compliance among treatment-resistant clients.

The million-dollar question: Prop 63 funding.

During the Health hearing discussion, Ortiz raised the question of whether monies from the MHSA could be used to fund an AB 1421 program; Chesbro argued that the intent of the MHSA was to fund voluntary services, and that this intent was reflected in the DMH position in its MHSA Community Services and Supports Requirements that all services funded under the Act be "voluntary in nature".

Ortiz then asked the AB 2357 co-authors present whether they would accept an amendment to the bill to prohibit MHSA funding of such programs.   

Rather than respond, proponents stood by as Aanestad made the rounds and counted likely "aye" votes among Committee members present.  

Hosseini, who spoke in opposition at the hearing, later commented that the co-authors' silence in response to this proposed amendment offered evidence that they intend to seek MHSA funds for AB 1421/2357 programs.  

Brzovic agrees, but points out that such funding is already prohibited under the MHSA.  Brzovic, who also spoke briefly in opposition, has issued a public memorandum and co-authored an open letter to the DMH arguing that MHSA funds cannot be used to fund involuntary programs under AB 1421.  

Advocate and PAI Board Director Sylvia Caras said that although she agrees that the MHSA cannot be used to directly fund AB 1421 programs, no one should be surprised if after counties receive funding for voluntary services under the MHSA, many then use other state funding once earmarked for voluntary services to fund involuntary outpatient commitment.  For this reason, Caras did not support the MHSA prior to its passage.

New chamber, new trends.

The June 14 Health Committee hearing departed from previous hearings on AB 2357 in the Assembly in a number of key ways.  Whereas Democratic Assembly committee chairs Wilma Chan (D-Oakland), Dave Jones (D-Sacramento) and Judy Chu (D-Monterey Park) and Floor Leader Dario Frommer (D-Glendale) led the vast majority of Dems on their committees and on the Assembly Floor to join them in support of AB 2357, Ortiz and longtime mental health advocate Chesbro's vocal opposition emboldened fellow Dem Liz Figueroa (D-Fremont) on the Senate Health Committee to vote against the bill.  Meanwhile, the Assembly trend of Republican-led opposition to the bill was also reversed, as recently added co-author Aanestad led the other three GOP senators on the Health Committee to vote "aye".  

Playing it Kuehl.

Senator Sheila Kuehl (D-Los Angeles), who signed on as co-author of AB 2357 on June 7 along with Senators Aanestad, Scott (D-Pasadena) and Torlakson (D-Antioch), left the Health hearing just prior to this agenda item, and was not present for the discussion; she returned at the end for the vote, providing the crucial fifth "aye" vote to pass the bill out of the committee.  Kuehl's conspicuous absence during the discussion was widely speculated to reflect her backing of a bill viewed by the majority of the committee's Democratic members as an affront to progressive mental health reform, despite Kuehl's reputation as a solid progressive on most issues.

What hasn't changed.

Consistent with past hearings, however, was the proponents' apparent ignorance of California's existing forced treatment laws.  During discussion at the Health hearing, co-author Aanestad stated that the LPS Act has been mainly used as a means of getting law enforcement on the scene in emergencies, and that extending Laura's Law was needed to reduce hospitalization, incarceration, and homelessness. 

However, Brzovic points out that the LPS Act already provides for court-ordered temporary conservatorship for a person who is found by a psychiatrist to be "gravely disabled", i.e. unable to provide for themselves food, clothing and shelter.   In response to an extreme and unusual act of violence by a mental health client, AB 1421 and the bill that would extend its sunset date merely duplicate existing law.  And in the ensuing public battles, Brzovic notes, this redundant legislation has only added fuel to the fire of stigma and discrimination against mental health clients.

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Action Alert: Urge Governor Schwarzenegger to Veto AB 2357! 

Updated August 28

Involuntary outpatient commitment extension bill AB 2357 (Karnette and Yee), which would add five years to the Jan. 1, 2008 sunset date of AB 1421 ("Laura's Law"), has passed by a wide majority in both the State Senate and the Assembly.  The bill now goes to the Governor's desk, either to be signed into law or to be vetoed.

The California Network of Mental Health Clients (CNMHC), along with Protection & Advocacy, Inc., the California Association of Social Rehabilitation Agencies, the Berkeley Mental Health Commission, and other advocates across the State have voiced strong opposition to this bill.   Extending the sunset deadline of AB 1421 will provide viability to outpatient commitment, which is antithetical to the  transformation that has been taking place in California since the passage of the Mental Health Services Act.

The CNMHC encourages clients, survivors, ex-patients, advocates and allies to write Governor Arnold Schwarzenegger and urge him to veto this outdated, coercive and divisive bill.  Let's send a powerful message to the Governor that clients, survivors, advocates and allies oppose this bill.

Write to the Governor today!

Send your letters, emails or faxes to:

Honorable Arnold Schwarzenegger
Governor of California
State Capitol Building
Sacramento, CA 95814

Fax: (916) 445-4633

E-mail: To ensure a much faster response, the Governor's office recommends using their online form at http://www.govmail.ca.gov/.

Please copy your letter or e-mail to the California Network of Mental Health Clients.

Talking points: 

The CNMHC's talking points - "AB 2357 - Why Oppose It" can be read online here. Click here to download a copy.  Feel free to use any of these arguments in your e-mailed or faxed letter.  

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Scholarships now available for California clients and survivors to attend State-level MHSA meetings

New 'scholarship pool' option allows applicants to to be automatically in the running for future assistance

By Delphine Brody 

Updated September 5 

What types of meetings will the scholarships assist people to attend?

The California Network of Mental Health Clients (CNMHC) has received support from the State Department of Mental Health (DMH) to provide financial assistance for clients/survivors to attend DMH General Stakeholder and Work Group Meetings regarding the Mental Health Services Act (MHSA). 

In addition, the CNMHC has received support from the Mental Health Services Oversight and Accountability Commission (OAC) to provide financial assistance for clients/survivors to attend monthly OAC Meetings regarding the MHSA. 

The purpose of these Meetings will be for the respective State agencies to provide clients/survivors and other stakeholders, including family members, service providers and representatives of county and local agencies, updates on the planning and implementation of various components of the Act, including Community Services and Supports (CSS), Prevention and Early Intervention (PEI), Capital Facilities and Information Technology (IT), Workforce Development, Education and Training, Innovations, and Performance Measures and Outcomes

What types of scholarships are currently available?

A limited number of DMH scholarships will include support for travel, lodging, food, and any other expense that is necessary for clients/survivors to attend each DMH Meeting. 

Other, smaller CNMHC scholarships to attend DMH Meetings are available to clients/survivors who live within commuting distance (about 90 miles) of each DMH Meeting and can attend with food, gas, train or bus fare only.  

A small number of OAC scholarships are also available to clients/survivors who live within commuting distance (about 90 miles) of each OAC Meeting and can attend with financial assistance for food, gas, train or bus fare only. 

What is a 'scholarship pool'?

Beginning September 2006, clients/survivors now have the option of placing scholarship applications in scholarship pools.  This will allow clients to be considered for future scholarships for State-level meetings that have yet to be announced, without having to re-submit an application. 

How do I apply?

If you are interested in receiving financial support to attend DMH General Stakeholder or Work Group Meetings, OAC Meetings, or both, please download the CNMHC Scholarship Application (see below), fill it out, and e-mail, fax or mail it to the CNMHC main office:

California Network of Mental Health Clients
1722 ‘J’ Street, Suite 324, Sacramento, CA 95814
1-800-626-7447   Fax: 916-443-4089   E-mail: main@californiaclients.org

Download your Scholarship Application here:

CNMHC Scholarship Application [Microsoft Word format]

CNMHC Scholarship Application [PDF format; Adobe Reader required for Windows, Linux or Mac OS Classic users]

CNMHC Scholarship Application [Text-Only MS-DOS format]

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DMH Meetings, Conference Call on MHSA Workforce Education, Stakeholder Process 'Phase 2'

Updated September 5

What:  The State Dept. of Mental Health (DMH) will be hosting a Mental Health Services Act (MHSA) Conference Call Sept. 18 and two MHSA General Stakeholder Meetings in the North September 25th and the South September 26 in Sacramento.  The topics of discussion will be  Education and Training and the Stakeholder Process, Phase 2.

When: 

  • The MHSA Statewide Conference Call will be September 18, from 3:00-4:00 PM
  • The MHSA General Stakeholder Meeting "North" will be September 25, from 9 AM-12:30 PM; 
  • The MHSA General Stakeholder Meeting "South" will be September 26, from 9 AM-12:30 PM
  • View Save the Dates

Online Registration: 

  • Please note that online registration cutoff for General Stakeholder Meetings occurs at 11:00 AM the day prior to each meeting.  To register online please go to MHSA Meeting/Workgroup Registration.

Where:  

Conference Call Details:

  • September 18, 2006 Statewide Conference Call
    • Time: 3:00 - 4:00 pm
    • Toll-free call-in number: 1-866-296-6505 (updated 8/29/06)
    • Verbal passcode: MHSA
    • The TTY# is 1-800-735-2929
    • Agenda and Discussion Material PDF File (in development)
    • Discussion Document PDF File (in development)
    • Conference Call Procedures PDF File (updated 8/30/06)

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Oversight and Accountability Commission to Hold Public Meeting to Discuss, Vote on Principles, Guidelines for Prevention, Early Intervention

What:  Public Meeting of the Mental Health Services Oversight and Accountability Commission (MHSOAC)

Where:  The Crowne Plaza Anaheim Resort Anaheim-Garden Grove
12021 Harbor Blvd.
Garden Grove, CA 92840

Hotel Reservations: 1-800-972-2576
Hotel Front Desk: (714) 867-5555 

When: Thursday, September 28 (2-5 PM) and Friday, September 29 (9 AM-3 PM), 2006

Agenda:  Draft Prevention and Early Intervention (PEI) Proposed Principles and Implementation Recommendations for the MHSOAC and the timeline for PEI Guidelines will be deliberated and voted upon by the MHSOAC Commissioners.  Full Agenda TBA.

Click here to download a copy of the California Network of Mental Health Clients (CNMHC) First Draft PEI Proposed Principles and Implementation Recommendations.

Click here to download a copy of the California Mental Health Directors Association (CMHDA) PEI Proposed Principles and Implementation Recommendations.

Conference Call Availability:  

MHSOAC meetings are accessible by telephone for those unable to attend.

This is a listen-in-only call. You will not be able to speak to the Commissioners through this number.  It is a free call.

The number to call is 1-800-416-4956.  The passcode is 82719173# Please listen to the operator’s instructions, including the request that you mute your phone so that other listeners won't be disturbed by any sounds you make.

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Clients to speak out at public hearing on routine use of police in mental health crisis interventions in Berkeley

By Delphine Brody

Updated September 1 

On September 7th, clients, survivors and ex-patients will be among the speakers sharing their experiences and opinions on police-assisted mental health crisis intervention services in Berkeley.  

The event, a long-awaited public hearing of the Berkeley Mental Health Commission in collaboration with the Berkeley Police Review Commission, came  about in response to long-standing criticism by Berkeley Mental Health Commissioners and consumers alike of the Berkeley policy that police must be the first to respond to all mental health-related crisis calls, often resulting in involuntary inpatient commitment under Welfare & Institutions Code 5150.  

This past winter, homeless advocates reported a sharp rise in the frequency of 5150s among homeless people in Berkeley's Southside, as part of a wave of police sweeps and harassment that advocates say reflects Mayor Tom Bates' recent about-face in homeless policy.  Recently a number of homeless Berkeley residents have  reported that they received orders from police to "either go to John George [Psychiatric Pavillion, a locked facility] or leave town", according to Berkeley Mental Health Commissioner Michael Diehl.

More information on the background of events leading up to this historic hearing will be posted here shortly.  Please bookmark this web page for important updates as they unfold.

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Sally Zinman announces transition, new role 

CNMHC Executive Director to leave position in June 2007; will continue as advisor, advocate

By Michele Curran

Sally Zinman, the Executive Director of the California Network of Mental Health Clients (CNMHC) for the past nine years, has announced that she is ready to change her role within the client advocacy movement.  Sally was one of the founders of the Network and was also part of the re-organization that took place in 1997.  She is an international leader and renowned expert in the field of client self-determination and self-help services/programs.  Sally is widely respected as a civil and human rights spokesperson.  Her knowledge of the history of the client movement serves as the foundation for the hope and challenges of the future.

Sally announced her decision to leave the position of CNMHC Executive Director as of June 30, 2007 to the CNMHC Board of Directors during the June 2006 meeting.  She emphasized the importance of the next year of evolution and the need to develop a one-year transition plan.  The Board accepted her announcement with regret and expressed deep appreciation for her outstanding service to CA clients and the client movement as a whole.  Sally was asked to continue her work with CNMHC after June 2007 as a consultant and advisor and she agreed to do so.  She also stated that she wished to continue in her roles as public policy participant and contributor in human rights.

The Board of Directors will be forming a search committee to employ a new Executive Director.  A job description and application will be developed and published widely by January 2007 with the selection process to begin in the spring of 2007.  It is planned that the selected Executive Director will be in place beginning the fiscal year (July 1, 2007).

This article originally appeared in the Cal Net Gazette June 2006 E-Zine Edition.  Click here to download a copy.

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CNMHC to expand programs in 2006/07

By Sally Zinman, Delphine Brody and Michele Curran

Updated September 1 

The California Network of Mental Health Clients (CNMHC) is expanding its programs so as to provide education, training, and support to maximize client involvement and leadership in each county and region as well as statewide in all stages of MHSA planning, implementation, oversight and evaluation. 

 The goal of our newly created MHSA Client Involvement Program is to provide a strong client voice throughout the state.  Included in the program expansion are staff positions addressing the Mental Health Services Act.  Bay Area Regional Coordinator  Delphine Brody has just been hired to fill the 32-hour-per-week Statewide Coordinator for MHSA Policy and Implementation; her new job begins today.  Delphine will also continue on as Bay Area Regional Project Coordinator.  Five half-time Regional MHSA Coordinators will also soon be hired to advocate for client inclusion in each Region throughout the State.

In addition to State Department of Mental Health (DMH) support for this increased capacity, the Mental Health Services Oversight and Accountability Commission (OAC) will be supporting representatives from the CNMHC, as well as two other statewide stakeholder advocacy groups, NAMI California and United Advocates for Children of California (UACC), to travel to each OAC meeting throughout the State and to present the views of their constituency.  The CNMHC Board of Directors voted to add this responsibility to the job description of the new statewide Mental Health Services Act Coordinator, as this staff person would be the most knowledgeable about the MHSA and, as coordinator of the regional MHSA staff, would have access to local contacts in each of the counties.  The CNMHC will also be able to assist local clients in attending OAC meetings as the Commission travels around the State.

This expansion also includes long overdue salary increases for administrative personnel, bringing salaries closer in comparison with other non-profit agencies to enable competitive hiring, as well as adding much needed office space.

In addition, the CNMHC will continue to fund the Diversity Outreach and Inclusion Team, our California Outreach and Education Collaborative
(COEC) project.  This project will enable the CNMHC to outreach to unrepresented and unserved clients and survivors and to facilitate their involvement in the MHSA planning, implementation, oversight and evaluation process.  COEC has been a coalition of representatives from NAMI-CA, UACC, Mental Health Association in California (MHAC) and the CNMHC, with the joint goal of  outreach and inclusion to unrepresented and under-represented groups.  DMH Multicultural Services Chief Rachel Guerrero has recently become the project monitor and will be leading this collaborative in the future.

T
he expansion of CNMHC's programs this coming year, combined with next summer's change in leadership when Executive Director Sally Zinman steps down and a new Director is hired, promises to make 2006/07 a truly challenging, transitional year for the Network.

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New staff positions available at CNMHC

By Sally Zinman and Michele Curran   Updated July 13

The California Network of Mental Health Clients (CNMHC) announces the opening of multiple positions for staff headquartered in both the CNMHC Sacramento office and in the Regional areas.  Job descriptions and applications for six of these positions can now be downloaded from this webpage (see below), and all will also be listed on the CNMHC's soon-to-be-released, newly re-designed website.  The newly open positions include the following:

  • 5 MHSA Regional Coordinators  [Click here to download job announcement (in Word format)]
  • CA Outreach and Education Collaborative CNMHC Representative
  • 1-2 Regional Program Coordinators
  • Contractor for Coordination of Client Forum 2007  

Please contact the CNMHC if you have questions regarding any of these job opportunities and their accompanying deadlines.

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CNMHC Regional meetings held throughout state

New Directors elected, Regional Projects selected

By Sally Zinman, Michele Curran, and Delphine Brody   Updated July 13

During the past few weeks, California Network of Mental Health Clients (CNMHC) Regional meetings have taken place across the state.  Each Region elected at least one new Regional Board Director, some chose an Alternate, and all have selected the Regional Project for the coming fiscal year, with the exception of the Bay Area, who will meet again in August to select their Project.

Bay Area:  The Bay Area Region met Saturday, July 8 at the Office of Self-Help/Oasis Community Center in San Francisco, with a larger-than-usual turnout of 40 members.  

Members revised a proposal for Committees of Correspondence or Local Action Groups, a pilot process which would facilitate timely local, grassroots action in response to issues as they arise in the name of the CNMHC.  In September, the newly constituted CNMHC Board will discuss and then vote on Bay Area members' proposed amendment that labor in each Region be divided between a Regional Liaison (a proposed representative of the Region, as yet unidentified, whose responsibilities would be distinct from the duties of the Regional Coordinator), the Executive Director, and the Public Education and Policy Project (PEPP) Committee.  Under the proposed amendment, the Regional Liaison would prepare and submit a local action proposal, the Executive Director would review each proposed action within the course of one week, and the PEPP Committee would then separately review each proposed action and approve or reject it within one week.  

Regional Coordinator Delphine Brody showcased the new Bay Area Regional Project website, a series of recent local presentations and upcoming national/international presentations on the 2005/06 Regional Project, which involved disseminating the client/survivor message on stigma and discrimination, based on emerging themes from a focus group study the Region undertook in fiscal years 2003/04 and 2004/05.  

In a hotly contested race with seven candidates, Carol Patterson of Alameda County was elected to the Board of Directors, and Macchell Reeves of Contra Costa County was elected as an Alternate.  Carol serves as Consumer Liaison at Berkeley Mental Health, directed the National Empowerment Center's West Coast affiliate NEC-West, and was a plaintiff in the landmark 1987 civil rights lawsuit, Riese v. St. Mary's Hospital.  In September, she will take the seat held for the last four years by Alameda County Network of Mental Health Executive Director and current CNMHC Board President Nancy Thomas, who must step down due to term limits.  Macchell is Co-Director of the Contra Costa County Office for Consumer Empowerment's Service Provider Individualized Recovery Intensive Training (SPIRIT) Program.

Bay Area members also brainstormed seven different proposals for a 2006/07 Regional Project.  However, there was not enough time left at the meeting to discuss, clarify, and vote on the Project proposals.  For this reason, members agreed to have a special meeting for that sole purpose on August 26.

Central Valley:  The Central Valley met on June 24 in Stockton. The arrangements were made by an emerging consumer-run program with Cheryl Torres at the helm. Invited speakers shared the history of the client movement and the status of the MHSA statewide with the attending members. The new Director from this Region will be Andrea Hillerman from Sacramento. The 2006-07 Regional Project will be trainings in the tenets of “Telling Our Stories” based on the Listening Well Program developed by Paula Comunelli.

South:  The South met on June 24 in Los Angeles at the Project Return: The Next Step offices. The election for Director was between several quite excellent candidates, and the vote went to Bill Slocum from Los Angeles. The Regional Project for FY 2006-07 will be a continuation of last year's project, which is an outreach to unserved ethnic groups to learn their concerns about access and services.

Far North:  The Far North met on June 20 and 21 in Willows. This Region traditionally holds a two-day Regional event due to the geographic distance between counties.  An "Introduction to Peer Counseling" training was held at the Regional meeting.  Many members attended the meeting and several guests were there to speak to topics of interest, including Social Security benefits, empowerment and employment. The newly elected Board member is Karen Zimmer. The Far North 2006/07 Regional Project will be a Peer Counseling Training Video.

Far South:  The Far South met on June 19 in Riverside. The newly elected Board member is Georgia De Groat from Riverside, a past member of the Board. The new Regional Project for FY 2006-07 will be peer self-advocacy training.

The newly constituted Board of Directors will meet September 15-17, 2006 in Sacramento. New Board members will receive training on Board duties and responsibilities in combination with the Board meeting.  Prior to the Board meeting, three additional Board members will be appointed by the new Board with the focus on diversity representation.

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Clients continue the fight to stop 'assisted' outpatient treatment

AB 2357: Why oppose it

By Sally Zinman

This legislative session has brought another battle over the expansion of involuntary treatment.  AB 1421 ("Laura's Law"), a law allowing "assisted" outpatient treatment (AOT) under very strict criteria, was passed in 2002.  Since then, not one county has chosen to implement this regressive and arbitrary law.  No stakeholder group has pushed for this form of forced treatment in any county's three-year Community Services and Supports (CSS) Plan under the Mental Health Services Act (MHSA).  Only the Nevada County Mental Health Department, in response to a lawsuit settlement, has included the possibility of using AB 1421 in its CSS plan.  Since AOT is involuntary in nature, the California Network of Mental Health Clients (CNMHC) is hopeful that the State Department of Mental Health (DMH) will reject this proposal. 

AB 1421 is scheduled to sunset (end) in 2008. A new bill, AB 2357 (Karnette and Yee), was introduced during this session to repeal the sunset.  During the first legislative hearing, AB 2357 was amended to move the sunset on AB 1421 to Jan. 1, 2013 with the additional requirement of a report due in 2011.  The CNMHC has been present at every hearing so far, working with our partners in the Coalition Advocating for Rights, Empowerment and Services (CARES) to fight this extension and to allow AB 1421 to perish in 2008.

Seven more years is seven too many for an outdated, coercive, unproven and divisive law that would turn back the clock on transformation, even as funding for voluntary, wellness and recovery-based services is finally available through the MHSA.  

Please feel free to use any or all of the following talking points developed by the CNMHC in your e-mails and faxes to the State Senate leadership.

Click here to download a copy of these talking points in Word format.

AB 2357: Why Oppose It

AB 2357 extends the sunset deadline of AB 1421, the bill which codified outpatient commitment, from 2008 to 2013.  Extending the sunset deadline will provide a viability to outpatient commitment which is antithetical to the transformation that is taking place in California through the implementation of the Mental Health Services Act (MHSA.)

Give voluntary community services (through the Mental Health Services Act) a chance.

Voluntary enhanced services are the answer to the mental suffering that surrounds us, not the expansion of forced treatment. In 1999, when legislation to expand forced treatment was introduced in California, the perception of the need for increased involuntary services was an incorrect response to the lack of accessible mental health services.  Today, accessible voluntary community services are on the horizon with the passage of the Mental Health Services Act (MHSA.)  Before resorting to the extreme measure of denying the rights of a whole group of persons, give these voluntary community services a chance. 

Deinstitutionalization did not fail; it was never completed. People with mental disabilities were never offered the full array of voluntary community mental health services they were promised, including medications, housing, job and benefits assistance, outreach teams and other alternative support for people in crisis, client–run and self-help services, such as peer counseling. 
The Surgeon General’s Report,
Mental Health: A Report of the Surgeon General (1999), states, “One point is clear: the need  for  coercion should be reduced significantly when adequate services are readily accessible to individuals with severe mental disorders who pose a threat of danger to themselves or others.” The Little Hoover Commission agrees, and urges an “assessment of how improved access to voluntary treatment could diminish the need for involuntary treatment,” before implementing options that would increase forced treatment”. With the passage of Prop 63, the Mental Health Services Act, California is moving in the direction of making adequate services readily accessible to Californians with mental disabilities, of improving access to voluntary services. California is fulfilling a promise made 30 plus years ago when it closed so many of its institutions. Give this initiative a chance.

The Surgeon General’s Report further states, “Almost all agree that coercion should not be a substitute for effective care that is sought voluntarily”.  Making AB 1421 a viable program option by extending the sunset provision would substitute coercion for a mental health system based on effective care that is sought voluntarily envisioned in the MHSA.

Outpatient commitment is an old idea whose time has passed.

AB 1421 was an incorrect answer to an inadequate mental health system.  In California, that system is now changing.  The environment that created the perceived need for AB 1421 is changing.  In fact, other states are beginning to reject outpatient commitment. In 2005, outpatient commitment was proposed in New Mexico, and died on the floor of the legislature.   

Transformation, promoted in the President’s New Freedom Commission’s Achieving the Promise: Transforming Mental Health Care in America (July 2003), is now sweeping the country.  Federal transformation grants have been awarded to states’ mental health divisions.  In California, the MHSA promises a transformation of our mental health system, with services that transcend outdated and stigmatizing reactions to people with mental disabilities.    

Outpatient Commitment is an outdated and stigmatizing reaction to people with mental disabilities; it looks backwards, not forwards.  Whereas the traditional system has used coercion and force in its attempt to solve problems, a transformed system will create options that maximize client self-determination and autonomy, goals of the MHSA.  The implementation of the MHSA supports a new direction for mental health services, not the same old – unsuccessful – answers. Making AB 1421 secure by extending the sunset clause supports the same old answers and is antithetical to the immanent changes throughout the country.

Coercive treatment is ultimately ineffective.

The expansion of forced treatment will not stop “treatment noncompliance,” which is viewed as a problem that more forced treatment will solve.  In fact, researchers have found that forced treatment causes noncompliance.  The Well Being Project, a research project supported by the California Department of Mental Health, found that 55% of clients interviewed who had experienced forced treatment reported that fear of forced treatment caused them to avoid all treatment for psychological and emotional problems.  Moreover, coercion seriously undermines the therapeutic relationship between a client and his/her therapist.

Choice is essential for recovery. 

Choice is so important a concept to humankind and human dignity that medical interventions, with only the exception of psychiatric, are soundly based on choice, including extensive consent policies and procedures.  Informed choice about treatment and control over one’s own individualized path to health is necessary for recovery.  Treatment and civil rights are not antithetical to each other; in fact, good treatment can only occur in an atmosphere of choice and freedom.

Introducing the issue of forced treatment is divisive.

The introduction of AB 2357 threatens to destroy the consensus of the mental health stakeholders that has been forged in the development, promotion and implementation of the MHSA.  The MHSA has spurred a unique collaboration among mental health stakeholders.  By focusing on what we all can agree on – voluntary community services – the MHSA has brought together the whole mental health community.  In unity is our success in building a transformed mental health system; in divisiveness will lie our failure.  AB 2357 threatens to tear apart the whole.

The introduction of forced treatment is the one subject that will create dissension and animosity among stakeholders and county/state administrators. It is divisive at a time when we need to be working together and diversionary at a time when our energy needs to be focused on working toward the goal of transforming the mental health system.

MHSA funds cannot be used for AB 1421 programs.

A rationale for AB 2357 is that AB 1421 needs to become a secure option (through extending the sunset deadline) because of the funding opportunities that the MHSA provides it.  In fact, MHSA funds cannot be used for AB 1421 programs. The services that provided the model for the MHSA, AB 34 and 2034, are designed to be voluntary, and require providers to follow a client-directed, culturally competent and recovery-based standard of service.  The California Council of Community Mental Health Agencies, one of the lead advocates of the MHSA, writes that “the law (AB 34/2034 programs) describes a process of developing an individual personal services plan in which each client participates. These are voluntary community services programs. There is no authority for using Proposition 63 funds for any other type of program.  The imposition of involuntary treatment precludes such standards.” This is reiterated in the following passage from the State Department of Mental Health’s Requirements for Community Services and Supports Programs: “Individuals accessing services funded by the Mental Health Services Act may have voluntary or involuntary legal status which shall not affect their ability to access the expanded services under this Act.  Programs funded under the Mental Health Services Act must be voluntary in nature.” 

California is not New York State: Comparison to New York State’s “Kendra’s Law”

The author of AB 2537 cites positive outcomes for Kendra’s Law in New York City in her promotion of AB 1421.  In fact, there are no California outcomes, because there has been no full implementation of AB 1421 in California.  In addition, Kendra’s Law outcomes are based almost entirely on the opinions of case managers and fail to provide a comparison with a control group of those who received a voluntary package of similar enhanced services, according to a report by New York Lawyers for the Public Interest.

However, in California, positive outcomes like those that AB 2357 proponentts attribute to Kendra's Law have been achieved with voluntary community services alone, such as the AB 34/2034 programs upon which the MHSA is based.  The expectation is that with the implementation of the MHSA, these positive outcomes will be repeated.  For example, under the AB 34/2034 programs,  the number of days hospitalized has decreased by 55.8%, the number of days incarcerated has decreased by 72.1%, the number of days homeless has decreased by 67.3%, the number of days employed (full time) has increased by 65.4%, and the number of days employed (part time) has increased by 53.1%. 

In analyzing New York’s outcomes, it is important to know that New York State put millions of dollars into enhanced services for court ordered people. A 1998 study of outpatient commitment in New York City found that, when comparing a control group to persons court ordered to outpatient commitment, there was no difference in any qualitative or quantitative outcomes. The positive element with both the court ordered and non court ordered groups was the enhanced community services offered to both. It is not the court order, but rather the enhanced community services that lead to positive outcomes, an explanation inferred in a Rand Study that was commissioned by the California Senate Committee on Rules during the legislative course of AB 1421. Why deny a person’s civil and human rights to achieve outcomes that have been proven to be achievable without this deprivation?

It is also important to know that court-ordered treatment under Kendra’s Law in New York has disproportionately targeted people of color, specifically African Americans and Latinos.  A recent analysis of state data by the New York Lawyers for the Public Interest showed that African American clients were nearly five times as likely as whites, and Latinos twice as likely as whites, to be the subject of court ordered treatment under Kendra’s Law.  For California to implement a similar involuntary outpatient commitment law would invite a comparably discriminatory application of court-ordered treatment, violating the principle of cultural competence as well as civil rights. 

There is no justification to extend the sunset deadline of AB 1421.

No county has chosen to implement AB 1421.  The Assembly Health Committee analysis that AB 1421 was implemented in Los Angeles is incorrect. Los Angeles County implemented a diversionary program for incarcerated persons with mental disabilities under the “negotiated settlement” section of AB 1421; it ignored the rest of the law.  Los Angeles County describes its program as a voluntary wraparound program, not an AB 1421 program.  The RAND report commissioned by the Senate Rules Committee cites that one reason for the lack of implementation of outpatient commitment laws throughout the country is that mental health providers don’t like it; they don’t want to undermine their therapeutic relationship with coercion.  Only one county is considering implementing AB 1421: Nevada County promised to implement the law as a lawsuit settlement with the Wilcox family over their daughter’s death.  Because there has been no implementation of AB 1421, there are no program outcomes to justify its continuance.  There is no new money that can support AB 1421; the MHSA cannot support involuntary programs.  There is no rationale for continuing the sunset deadline beyond what is in the law.

AB 1421 should be allowed to die as we enter the 21st century and commit ourselves instead to transforming the mental health systemIn a state that avows to support client empowerment, a client driven system, and client inclusion in decision making, the fact that clients of the state overwhelming oppose increasing forced treatment is in itself a powerful reason to oppose making AB 1421 a permanent law.  The very people for whom this approach intends to help, who the state professes should drive the system, oppose it.

 
References 

◊    U.S. Department of Health and Human Services, Mental Health: A Report of the Surgeon General. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999.

◊    Little Hoover Commission, Being There: Making a Commitment to Mental Health, November, 2000.

◊    Final report. Research Study of the New York City Involuntary Outpatient Commitment Pilot Project. Policy Research Associates, Inc. December 4, 1998.

◊    The Effectiveness of Involuntary Outpatient Treatment: Empirical Evidence and the Experience of Eight States,  RAND Corporation, 2001.

◊    Achieving the Promise: Transforming Mental Health Care in America,  Final Report, The President’s New Freedom Commission on Mental Health, July 3002.

◊    The Well-Being Project: Mental Health Clients Speak for Themselves, Campbell, Jean; Schraiber, Ron.  California Network of Mental Heath Clients, California Department of Mental Health, 1989.

◊    Mental Health Services Act Community Services and Supports Three Year Program and Expenditure Plan Requirements, Fiscal Years 2005-06, 2006-07, 2007-08. California Department of Mental Health, August 1, 2005.

◊    Effectiveness of Integrated Services for Homeless Adults with Serious Mental Illness: A Report to the Legislature, Grantland Johnson, Secretary California Health and Human Services Agency and Stephen W. Mayberg, PhD., Director of California Department of Mental Health, May 2003.

◊    Racial Disporportion Seen in Applying 'Kendra’s Law', Michael Cooper, The New York Times, April 7, 2005;  Kendra’s Law Hearing Reopens Coercion Controversy, April 11, 2005 http://community.webtv.net/stigmanet/kendraslaw

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State Senators' votes on earlier forced treatment bills spell trouble for AB 2357 opponents as final vote nears

Swing votes, past noes may reverse bill's course

By Delphine Brody    

Updated July 3

When the the California Senate reconvenes August 7th, a final Senate Floor vote is expected for outpatient commitment extension bill AB 2357 (Karnette and Yee).  California mental health clients, survivors and advocates are mobilizing to stop the bill, which would extend the sunset date of soon-to-expire outpatient commitment law AB 1421 ("Laura's Law").  Many are writing letters to vacationing state senators to voice their opposition.  But the voting records of the majority of state senators on similar forced treatment bills do not bode well for AB 2357 opponents.

Much of the current Senate leadership voted "aye" for AB 1421 in 2002, including President pro Tem Don Perata (D-East Bay), the bill's principle co-author; Assistant President pro Tem Jackie Speier (D-San Francisco/San Mateo); Democratic Caucus Chair Tom Torlakson (D-Antioch); Minority Leader Dick Ackerman (R-Orange); Majority Whip Carole Migden (D-San Francisco); Republican Caucus Chair George Runner (R-Lancaster) and Minority Whip Dennis Hollingsworth (R-El Cajon).  The latter three were assemblymembers at that time, and cast their votes for the bill at its final hearing on the Assembly Floor.  

Also among the AB 1421 "aye" votes was Kevin Murray (D-Los Angeles) [pictured, left, with Senator Perata], the current Chair of the Senate Appropriations Committee who stunned advocates last week when he invoked the obscure Senate Rule 28.8 and reported AB 2357 out of that committee, to be placed on the Senate Floor second reading file.  The bill was read a second time and is now on the third reading file, where it awaits a final vote on the Senate Floor in August.  

Some advocates who attended the bill's scheduled June 26 Appropriations hearing cried foul as Murrray's move to bump the bill to the Floor pursuant to Senate Rule 28.8 preempted the last opportunity for the public to comment at a hearing.  The move came as a shock to attorney Dan Brzovic of Protection & Advocacy, Inc. (PAI) and to client advocate Dave Hosseini of the California Association of Social Rehabilitation Agencies (CASRA), both of whom attended what they expected to be the bill's hearing to speak in opposition.

In addition, a significant number who voted to pass AB 1421 also voted "aye" two years earlier for inpatient commitment expansion bill AB 1800 in the Assembly in 2000, including Senators Ackerman, Samuel Aanestad (R-Nevada City), Roy Ashburn (R-Bakersfield), Gilbert Cedillo (D-Los Angeles), Dave Cox (R-Roseville), Dean Florez (D-Shafter), Sheila Kuehl (D-Los Angeles), Abel Maldonado (R-San Jose), Bob Margett (R-Glendora), Tom McClintock (R-Thousand Oaks), George Runner (R-Lancaster), Jack Scott (D-Pasadena), and Edward Vincent (D-Los Angeles).

But the "ayes" of yesterday do not always translate into "ayes" of today.  Without a doubt, many of the senators who voted "aye" to AB 1421 are expected to again vote "aye" to AB 2357,  such as Aanestad, Kuehl, Scott and Torlakson, who signed on as co-authors of AB 2357 on June 7.  However, other senators who voted "aye" to 1421, such as Senate Health Chair Deborah Ortiz (D-Citrus Heights) and Liz Figueroa (D-Fremont) appear to have changed their minds, as evidenced by the fact-finding questions the two asked at the Health Committee hearing June 14, followed by two "no" votes.   Principled swing votes like these offer some hope to clients, survivors and allies who seek to stop the bill in the legislature.

And of course, there remain a significant number of senators who voted "no" on AB 1421, including current Majority Leader Gloria Romero (D-Los Angeles), Rules Committee member James Battin (R-Riverside) and stalwart client/survivor ally Wesley Chesbro (D-Arcata), who spoke  critically of involuntary treatment's ineffectiveness at the Health Committee hearing, noting that many who have been subjected to forced treatment report being traumatized as a result and consider it a civil rights violation.  Senators Richard Alarcón (D-San Fernando Valley) and Michael Machado (D-Linden) also voted "no" on AB 1421.  Romero and Battin are also examples of senators who have changed their minds about the need for involuntary treatment; Battin voted "aye" forAB 1800 two years before his "no" vote on 1421, and Romero voted in support of AB 1421 two months prior to her "no" vote on the Senate Floor.

Faced with AB 1421's passage into law four years ago, as well as the majority votes that have thus far propelled AB 2357 through the Assembly and now through the Senate, many opponents of the current bill see it as a foregone conclusion that it too will pass. Still, some advocates remain stubbornly optimistic that if the senators who have voted "no" remain opposed, become more vocal on the Senate Floor, and convert a critical number of others to switch votes, the opposition may pick up a majority of 21 votes, defeating AB 2357 and halting the expansion of forced treatment.

AB 1421 has yet to be implemented by any county.  As advocates in the Coalition Advocating for Rights, Empowerment and Services (CARES) noted in a position paper published soon after the law was passed in late 2002, inadequate public mental health system capacity has thus far precluded the implementation of the law.  This is because Counties must pay for this program themselves, and must first offer equivalent services on a voluntary basis.  Funding for such services has been sorely lacking, making AB 1421 implementation impossible even in the few counties in which some stakeholders or officials have pushed for an AB 1421 program.

Most likely swing voters. 

Based on their voting histories, perhaps the most likely senators to be persuaded to vote "no" on AB 2357 who have not always opposed forced treatment legislation in the past are the ones who voted "aye" for one of the previous forced treatment bills, but "no" on the other.  Top contenders include Senators Migden, Alan Lowenthal (D-Long Beach) and Elaine Alquist (D-San Jose), who as assemblymembers voted "aye" on AB 1421 but "no" on AB 1800.  It should be noted, however, that since AB 1800 only came to a vote in the Assembly, the only current senators who voted on that bill are the handful who were then in the Assembly.  

Next most likely, perhaps, to vote "no" on AB 2357, despite having cast an "aye" vote on 1421 on the Senate Floor, is Chuck Poochigian (R-Fresno) who voted "no" on 1421 in the Senate Appropriations Committee.

The burning question facing AB 2357 opponents is whether these four potential swing voters will follow the lead of Romero, Chesbro, Ortiz, Figueroa and three other almost assured "no" voters - and whether they will be able to persuade 10-14 others to oppose the bill.

Forced treatment bills from the recent past: a primer.

AB 1421, signed into law in September 2002 by then-Governor Gray Davis, allows counties that provide an array of voluntary services to elect to participate in an involuntary outpatient treatment program in which courts may order adults to obtain outpatient treatment if prescribed criteria are met. 

Its predecessor, AB 1800, which sought to broaden criteria for involuntary commitment under the Lanterman-Petris-Short (LPS) Act, passed the Assembly in June 2000, but was immediately referred from the Senate Rules Committee by then-Chair John Burton (D-San Francisco) to the Joint Committee on Mental Health Reform, where the bill was eventually reported out without further action.

Perata: past forays into forced treatment legislation.

Although Senator Perata has not co-authored or spoken publicly on AB 2357, many advocates predict that he will likely vote "aye" based on his past principle co-authorship of both prior bills.  When Perata signed on as co-author of AB 1421 in April 2001, the bill was still in the Assembly.  Under Perata's initial amendment to the bill, the State Dept.of Mental Health (DMH) would have been allocated $50 million to award grants for AB 1421 programs to counties that already  provided similar services on a voluntary basis; this provision was deleted two months later in a subsequent amendment that shifted the financial burden of program implementation onto counties, while retaining the requirement that they already offer the same voluntary services.  

Another key provision of Perata's initial amendment would have required AB 1421 programs to administer periodic blood tests or urinalyses to determine compliance with prescribed medications, along with alcohol or substance abuse treatment and counseling and periodic tests for the presence of alcohol or substance abuse. These provisions were also soon struck from the bill in another amendment

While the primary author of AB 1800 and 1421, former Assemblymember Helen Thomson, no longer serves on the state legislature, Sacramento sources say she has remained very active behind the scenes in the current effort to extend AB 1421.

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AB 2357: Background

Recent history of the bill

By Delphine Brody

On May 18th, in a move that disappointed the CNMHC and other advocates for freedom and choice in mental health services and threatened to further undermine the dwindling, tentative collaboration between mental health clients and the public mental health system in the early implementation the Mental Health Services Act, the California Assembly passed the bill with a vote of 65 to 5The bill, which would extend AB 1421 by five years and require the state to evaluate and report on any county efforts to implement it, was read later that day by the State Senate and referred to the Rules Committee, who referred it to the Health Committee on May 25th.  

Amended following its introduction in the Assembly Health Committee, the bill no longer deletes the sunset clause to make AB 1421, officially known as the Assisted Outpatient Treatment Demonstration Project Act of 2003, permanent, but instead extends the sunset date from January 1, 2008 to January 1, 2013.  Also, the amended bill would require the State Department of Mental Health (DMH) to submit a report and evaluation to the Governor and the Legislature by July 31, 2011 of any and all county-implemented AB 1421/2357 programs.

When the bill was first heard in the Assembly Health Committee April 4th, Committee Chair Wilma Chan introduced the amendment to extend rather than delete the law's sunset date, and Assemblymember and Mental Health Services Oversight and Accountability Commissioner Mark Ridley-Thomas moved to further amend the bill to require the state submit evaluations of pilot programs.  After the two amendments carried, the Committee passed AB 2357 with a 13-1 vote.  The amended bill was then referred to the Assembly Judiciary Committee, who voted 7-2 in favor of the bill April 18th, referring it to Appropriations, who in turn passed the bill onto the Assembly Floor on May 10th, with a vote of 17 to 1.

Existing law. 

The existing law, AB 1421 (known as "Laura's Law"), establishes a demonstration project in which each county may elect to participate in an "assisted" (involuntary) outpatient mental health treatment program, which the current bill's proponents seek to extend.  Under AB 1421, a court may order an adult to obtain outpatient treatment if prescribed criteria are met, including, but not limited to, that the person has been diagnosed with a mental illness, that there has been a clinical determination that the person is "unlikely to survive safely in the community without supervision", and that the person has a history of "not complying with treatment".  Existing law repeals these provisions on January 1, 2008.   

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CNMHC Bay Area Region Special Meeting: Selecting Our 2006/07 Regional Self-Help Project

All Bay Area clients, survivors and ex-patients welcome!

When?  Saturday, September 2, 2006, 11 AM to 3 PM
[Please note change of date] 

Where?  Berkeley Drop-In Center
3234 Adeline Ave., Berkeley, CA 94703 

(510) 653-380
[Please note updated phone number; the previous phone number on this webpage contained a typo]

Draft Agenda:

  • Guidelines, Notes, Brief Introductions 
  • Approval of Agenda, Minutes
  • Review: Project Proposals from the July 8 Annual Meeting
  • New Project Proposals 

* Light Lunch Provided * 

  • Discussion: Clarification and/or Amendments to Proposals
  • Action: Select Regional Project for 2006/2007
  • Announcements, Check-Outs 

    Click here to download the Draft Agenda (Word format).

    Click here to download the Flyer (Word format).

Directions: 

The Berkeley Drop-In Center is wheelchair accessible, and is located at the corner of Adeline and Harmon Sts. (between Fairview St. and Alcatraz Ave.) in Berkeley.  

Parking is available at the nearby Ashby BART station.  The station entrance is on Woolsey St. between Adeline St. and Tremont St.  

From Ashby BART, take elevator or stairs to Adeline St.  Then go two blocks south to Harmon St.; the building is on the right.

For more information:

Contact CNMHC Bay Area Regional Coordinator Delphine Brody at bayregion@californiaclients.org.

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Upcoming presentations on the CNMHC Bay Area Regional Self-Help Project

Client / survivor perspectives on discrimination, stigma, systems transformation and social change

International Conference on Violence, Abuse and Trauma

Presentation: "The Trauma of 'Treatment': Client/Survivor Perspectives on Stigma and Discrimination"

Where:   Town & Country Resort & Convention Center
500 Hotel Circle North, San Diego, California
(room TBA)

When:  Monday, September 18, 2006, 8:30-10:00 AM

Abstract:  We will examine emerging themes from a series of focus groups in which mental health clients and psychiatric survivors shared stories and opinions on stigma and discrimination.  In identifying primary sources and forms of stigma and discrimination, evaluating prevailing anti-stigma campaigns, and re-defining the terms, the focus group responses shed light on important issues that rarely surface in public discourse, and suggest strategies to combat discrimination in institutions and society.  

[Click here to download the more detailed summary submitted as part of the proposal for this workshop.]

Presenters: 

Delphine Brody, Bay Area Regional Coordinator, California Network of Mental Health Clients [pictured right; photo by Kathi Stringer]

Andrew Phelps, grassroots organizer and activist in "mental patient liberation" since the 1960's; Professor of Computer Information Technology, San Jose City College

More information:  http://www.ivatcenters.org/conference.htm

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Alternatives 2006 Conference

Presentation:  "From Stigma and Discrimination to Self-Determination: A Prescription for Systems Change" 

Where:  Portland Marriott Downtown Waterfront Hotel
Portland, Oregon
(room TBA)

When:  Conference: Wednesday-Sunday, October 25-29, 2006
Workshop: Friday, October 27, 2006, 3:45 PM

Abstract:  Bay Area clients conducted a series of focus groups in which consumers and survivors gave first-hand accounts of stigma and discrimination, shared opinions on mainstream anti-stigma messages and defined key terms.  Based on this study, we will examine recommended strategies to resist oppression and transform our institutions and culture.

[Click here to download the outline submitted with the proposal for this workshop.]

Presenters: 

Delphine Brody, Bay Area Regional Coordinator, California Network of Mental Health Clients

Artensia Barry, lifelong social justice activist; former Commissioner, Berkeley/Albany Mental Health Commission

Anna Lubarov, Assistant Coordinator, Contra Costa County Office for Consumer Empowerment; Coordinator, Service Provider Individualized Recovery Training (SPIRIT)

Douglass Murphy, Client Consultant for the Santa Clara County Department of Mental Health; former Director, Phoenix Self-Help Center, Palo Alto

Andrew Phelps, grassroots organizer and activist in "mental patient liberation" since the 1960's; Professor of Computer Information Technology, San Jose City College

Syl Plowright, self-help advocate; former member, Sonoma County Mental Health Board

More information:  http://www.alternatives2006.org/

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More Headlines from the Cal Net Gazette: 

Clients Continue to Fight AOT | Cross-Disability Advocates Rally at the Capitol | CNMHC Holds Day at the Capitol | Zinman Responds to MHSOAC | Client Forum 2006 Report

Cross-disability advocates rally at the Capitol

By Michele Curran and Sally Zinman

California Network of Mental Health Clients (CNMHC) members from across the State joined with other statewide disability organizations to hold an educational forum and legislative day at the Capitol June 1.  Participants gathered in Sacramento to hear advocates speak to the various policy issues.

CNMHC Executive Director Sally Zinman was a main speaker during the educational forum.  She focused on the hope and struggle that is represented by the Mental Health Services Act.  Sally also reminded all of us in the disability community that we must continue to be vigilant as we strive for our goals of self-determination, dignity and choice.  A representative of the CNMHC served on the event's planning committee.

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Large client/survivor turnout for CNMHC 'Day at the Capitol'

By Michele Curran and Sally Zinman

On May 17, the California Network of Mental Health Clients (CNMHC) held its annual “Day at the Capitol”.  It turned out to be a perfect day, with a nice breeze and lots of shade on the North lawn.  Many client advocates came from throughout the state, from the Far South to the Far North, with large contingents from Los Angeles, the  Central Valley, and the Bay Area.  The morning began with an educational forum on the lawn in front of the Capitol.  

Many speakers shared with the attendees the importance of client involvement on all levels during this vital period of system transformation.  After the forum and lunch, attendees entered the Capitol to do legislative visits.  Educational packets explaining the positions of the Network were delivered to attendees’ local legislators and legislative leaders, and clients spoke on the hope of the MHSA and the challenges that some had encountered. Senator Wesley Chesbro (D-Arcata) sponsored a room within the Capitol for the CNMHC to gather and distribute additional educational materials. It was a high-energy day, and it felt great to share knowledge and power with others.  

Read more, including speeches by Dave Hosseini, Evelyn Abouhassan and others, in the Cal Net Gazette June 2006 E-Zine Edition, pages 3-6.

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Sally Zinman responds to MHSOAC on 'future financial challenges'

By Michele Curran and Sally Zinman

Recently, the Mental Health Services Oversight and Accountability Commission (MHSOAC) asked each statewide mental health advocacy organization to respond to the issue of "future financial challenges for mental health". The California Network of Mental Health Clients (CNMHC) response, given by Executive Director Sally Zinman, directed the Commission to those issues on which clients are the experts.  

Click here to download the CNMHC's April presentation to the MHSOAC, in the June 2006 E-Zine Edition of the Cal Net Gazette, page 10.  

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Client Forum 2006: A huge success

By Michele Curran

The California Network of Mental Health Clients (CNMHC) Client Forum 2006 was held at the San Mateo Marriott Hotel on January 13 – 15.  The theme of the conference was "Esperanza y Lucha (Hope and Struggle): California Clients Leading the Way".  The theme states: “We remain forever hopeful that the principles we have advanced for so long will be implemented.  On the other hand; we are forever in struggle against entrenched attitudes and systems that aggressively resist change. We must keep this balance of esperanza for a service system that is based on recovery values of choice and freedom and respect, and la lucha in our on-going advocacy for change.”

The Forum was one and a half days of workshops, institutes and caucuses, with the final day devoted to membership meetings.

Client Forum 2006 had the following goals:

  • To provide knowledge and skills to mental health clients;
  • To enhance statewide and regional networking of clients;
  • To work on organizational issues and other common issues at membership meetings.

Most of the twenty workshops and four institutes fell into five tracks: self-help; public policy; cultural competency; anti-stigma/discrimination; and employment.

Click here to download the full article on the CNMHC Client Forum, including synopses of the institutes and captioning from the plenary speeches, in the June 2006 E-Zine Edition of the Cal Net Gazette, pages 13-22.

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CNMHC open letter to Senate Appropriations Chair Kevin Murray

Kevin Murray, Chair
Senate Appropriations Committee
California State Capitol
Room 2206
Sacramento, CA 95814


June 21, 2006

POSITION: Oppose AB 2357 (Karnette, D-Long Beach)

Honorable Kevin Murray:

The California Network of Mental Health Clients (CNMHC), a solely consumer-run organization whose membership consists of affiliates and individuals throughout the State, is the formal advocacy statewide voice for California’s mental health consumers.

CNMHC represents the voice of the mental health consumer and as such is a critical participant, stakeholder, and advocacy agent in all statewide mental health policy processes. CNMHC also lends critical support to self help and mutual support groups and programs throughout the state.

Extending the sunset deadline of AB 1421 will provide a viability to outpatient commitment which is antithetical to the transformation that is taking place in California through the implementation of the Mental Health Services Act (MHSA.)


More important to the Appropriations Committee, AB 2357, an AB 1421 extension bill, would be extremely expensive to implement, because of the administrative infrastructure and court and legal costs necessary. Based on New York State’s Mental Hygiene Law # 9.60, Kendra’s Law, which the authors of AB 2357 use to justify AB 2357, New York State spent almost double the cost of programs and services on infrastructure, court, and legal costs. In California, the same or better outcomes have been achieved by the AB 2034 programs, and will be achieved by the MHSA programs and services which are based on the 2034 programs, for half the cost – without the outpatient commitment court processes.

In addition, the report and evaluation of all counties implementing AB 1421 mandated in AB 2357, if done in a manner that provides useful information, will be extremely costly.
Such a report and evaluation, to measure the significance of the court order in an AB 1421 program, should be a double blind study, comparing a court ordered program to one providing the same services but without the court order.


The Cost Story from New York

The author of AB 2537 uses Kendra’s Law in New York City in her promotion of AB 1421. Following is a snapshot of the costs to the New York Office of Mental Hygiene and to a County/City associated with the Law.

New York Office of Mental Hygiene was given responsibility to implement the New York State law.  Following are cost findings:

•    $2 - 4 million for State Mental Health Authority infrastructure—this includes NY OMH coordinating staff, data collections and reporting duties, and other needed staff to assist county coordinators.

•    $40 million statewide for Mental Hygiene Law § 9.60 administrative needs. NY State installed a State IOC coordinator and 5 Regional coordinators plus office staff members. Each county required investigative staff hours, psychiatric assessment staff hours, legal staff hours and program/service staff.

•    $5 million was required for jail staff and hospital staff time. These personnel were increased to supply the hours necessary for increased activity load, increased numbers of clients, hours spent on discharge planning and increased requests for blood and urine testing and reports.

•    $50 million was allotted to county origins of care to be used for increased programs and services (referred to in Mental Hygiene Law § 9.60 as Service Enhancements). These services included case management personnel and hours, housing services (accompanied by supported housing) and employment programs.


AB 1421 is optional for California counties. In order to equate the costs of Mental Hygiene Law § 9.60 to a county in CA we look at the budgeted costs of New York City as an example of the potential costs to a large county of comparable population and demographics.

•    New York City in the 2001 Budget Year allotted $6.8 million dollars for IOC implementation and planning. This amount was for infrastructure only and did not include costs for program services. These infrastructure costs were used for pre-court hearing responsibilities that include the filing of petitions, the investigative duties, tracking and documentation. This amount does not reflect the costs for court involvement (defense personnel, judges, court costs and law enforcement). The $6.8 million was internal and for New York City administration alone and does not reflect the monies coming from the New York State budget.

It is an accurate reflection of this snapshot to say that almost half the costs of New York State’s Mental Hygiene Law § 9.60 were for infrastructure and administration. By inference, the implementation of AB 1421 nearly doubles the cost of the successful  California AB 34/2034 programs.


The Cost of an Effective Evaluation Study

The author of AB 2537 sites positive outcomes for Kendra’s Law in New York City in her promotion of AB 1421. (There are no California outcomes because there has been no full implementation of AB 1421 in California.) However, in California, these kinds of positive outcomes have been achieved with voluntary community services alone such as the AB 34/2034 programs upon which the MHSA is based. The expectation is that with the implementation of the MHSA these positive outcomes will be repeated.  For example, under the AB 34/2034 programs,  the number of days hospitalized has decreased by 55.8 %, the number of days incarcerated has decreased by 72.1 %, the number of days homeless has decreased by 67.3 %, the number of days employed (full time) has increased by 65.4 %, and the number of days employed (part time) has increased by 53.1%. 

In analyzing New York’s outcomes, it is important to know that New York State put millions of dollars into enhanced services for court ordered people. A 1998 study of outpatient commitment in New York City found that, when comparing a control group to persons court ordered to outpatient commitment, there was no difference in any qualitative or quantitative outcomes. The positive element with both the court ordered and non court ordered groups was the enhanced community services offered to both. It is not the court order, but rather the enhanced community services that lead to positive outcomes, an explanation inferred in a Rand Study that was commissioned by the California Senate Committee on Rules during the legislative course of AB 1421.

To effectively measure the success of involuntary outpatient commitment independent of the enhanced services or the role that the court order has in the success of an AB 1421 program, the evaluation study should be a double blind study with a control group. New York’s legislature, in fact, mandated this kind of comparative study when it extended the sunset deadline for Kendra’s Law. This “gold standard” research is very expensive.


Coercive Treatment is Ultimately Ineffective and Costly

The expansion of forced treatment will not stop “treatment noncompliance,” which is viewed as a problem that more forced treatment will solve. In fact, researchers have found that forced treatment causes noncompliance. The Well Being Project, a research project supported by the California Department of Mental Health, found that 55 % of clients interviewed who had experienced forced treatment reported that fear of forced treatment caused them to avoid all treatment for psychological and emotional problems.
Given this finding, coercive treatment often leads to “treatment noncompliance” and thus ultimately more cost for mental health and other related services.

For all of these reasons, we urge you to oppose AB 2357, the AB 1421 extension bill.


Sincerely,

Sally Zinman
Executive Director

Cc: Senate Appropriations Committee members
       Assemblymember Betty Karnette


References

◊    Effectiveness of Integrated Services for Homeless Adults with Serious Mental Illness, A Report to the Legislature, Grantland Johnson, Secretary California Health and Human Services Agency and Stephen W. Mayberg, PhD., Director of California Department of Mental health, May 2003.

◊    Final Report, research study of the New York City Involuntary Outpatient Commitment Pilot Project. Policy Research Associates, Inc. December 4, 1998.

◊    The Effectiveness of Involuntary Outpatient Treatment, Empirical Evidence and the Experience of Eight States,  RAND Corporation, 2001.

◊    The Well-Being Project: Mental Health Clients Speak for Themselves, Campbell, Jean; Schraiber, Ron. California Network of Mental Heath Clients, California Department of Mental Health, 1989.

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