Patients’ Rights Advocate Training 2013
LPS (5150)Bed Shortage
Comprehensively Understanding the Problem and
Discussion of Potential Solutions
Cynthia White, LMFT, Chief PRA
Brandon “Brandy” Mansouri, LMFT, PRA
San Bernardino County ■ (800) 440-2391 ■ (909) 421-4657
Lisa Long, PRA
Sacramento & Yolo County ■ (877) 965-6772 ■ (916) 333-3800
Training Agenda
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Sample Case
Pertinent Background
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Relevant Laws & Regulations
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 Lanterman Petris Short Act
 Types of Facilities
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Welfare & Institutions Code (WIC)
Emergency Medical Treatment & Active Labor Act (EMTALA)
Health & Safety Code (H & S)
Constitutional Rights
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Availability of Facilities
Issues Impacting the System
Loss of Psychiatric Beds
Patient-to-Bed Gap
The LPS Bed Shortage
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Revisiting the Case Sample
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Innovative Solutions in Sacramento County
Resources
 Activity & Discussion
 Issues Impacting the System
Consider the Following Case:
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Law Enforcement 5150’s Client
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Law Enforcement takes Client to the closest
Emergency Room (ER), which is not an LPS
Designated Facility
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Client “eventually” ends up at a LPS Facility
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PRA meets Client in preparing for Certification Review
Hearing
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Client indicates she was in the ER, tied to a gurney for
8 days before getting transferred to LPS Facility
Pertinent Background
Lanterman Petris Short Act
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History:
 In 1967, CA legislature instituted a bill called Lanterman Petris Short
Act to change how persons with mental disabilities are treated.
 Mandated least restrictive treatment setting & given due process in
court if involuntarily detained.
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Relevant Intent:
 Indicated in Welfare & Institutions Code, Division 5, Part 1, Chapt. 1
 End inappropriate, indefinite, involuntary commitment of mentally
disabled person & protect them from criminal acts
 Provide prompt evaluation & treatment of persons with serious
mental disorders
 Safeguard individual rights through judicial review
 Encourage full use of all existing agencies, professional personnel &
public funds to accomplished these objectives
Types of Facilities
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General Acute Care Hospitals:
 Health & Safety Code, Division 2, Chapter 2, Article 1, §1250 (a)
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Psychiatric Health Facility:
 Health & Safety Code, Division 2, Chapter 2, Article 1, §1250.2
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Acute Psychiatric Hospitals:
 Health & Safety Code, Division 2, Chapter 2, Article 1, §1250 (b)
 California Code of Regulations, Title 22, Division 5, Chapter 2
 Sub-Types:
 County
 Private
 Free-Standing
Relevant Laws & Regulations
Welfare & Institutions Code (WIC)
 Division 5, Chapt. 2, Article 1: Detention of Mentally
Disordered persons for Evaluation and Treatment
 WIC §5150: “…take…the person into custody & place him or her
in a facility designated by the County & approved by the State
DMH as a facility for 72-hour treatment & evaluation.”
 WIC §5151: “If the facility for 72-hour treatment & evaluation
admits the person, it may detain him or her for a period not to
exceed 72 hours.”
 WIC §5152: (a) “Each person admitted to a facility for 72-hour
treatment & evaluation…shall receive an evaluation as soon
as possible after he or she is admitted & receive whatever
treatment & care his or her condition requires for the full period
he or she is held.”
Emergency Medical Treatment & Active
Labor Act (EMTALA)
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42 USC 1395dd or Section 1867 of Social Security Act
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When a person comes to a hospital seeking medical care
regardless of their ability to pay, the hospital must preform an
Medical Screening Exam to determine if there is an emergency
medical condition and if so, must stabilize it prior to discharging
or transferring the patient.
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5150 patients are, by definition suffering from a Psychiatric
Emergency Medical Condition but if the facility is not LPS
designated, it cannot admit the patient involuntarily & must
transfer the involuntary patient to one that is LPS designate.
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Even if no apparent medical emergency, 5150 patients often
brought to an acute care hospital ED because of location or to get
medical clearance
Health & Safety Code (H & S) 1799.111
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Also referred to as “Hospital ER 24 Hour Rule”
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In Jan 2008, California extended the 8 hour rule that allows
General Acute Care Hospitals to detain for up to 24 hours
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Detainment extension was to arranged for mental health treatment
services for any person who is:
 Gravely disabled
 Danger to self
 Danger to others
 As a result of a mental disorder
 And cannot be safely released.
Constitutional Rights
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The Bill of Rights and 14th Amendment
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The overwhelming majority of court decisions that define American civil
liberties are based on the Bill of Rights, the first ten amendments added to
the Constitution in 1791. Civil liberties protected in the Bill of Rights may be
divided into two broad areas: freedoms and rights guaranteed in the First
Amendment (religion, speech, press, assembly, and petition) and liberties
and rights associated with crime and due process. Civil rights are also
protected by the Fourteenth Amendment, which protects violation of rights
and liberties by the state governments.
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Title 42, U.S.C., Section 1997
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The Department of Justice has the ability to initiate civil actions against
mental hospitals, retardation facilities, jails, prisons, nursing homes, and
juvenile detention facilities when there are allegations of systemic
derivations of the constitutional rights of institutionalized persons
The LPS Bed Shortage
The Problem
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Availability of Facilities
 25 Counties with no Inpatient Psychiatric Beds
 Only 13 Counties have child and/or adolescent Beds
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Loss of Psychiatric Beds
 Either eliminated psychiatric inpatient care or closed hospital completely
 30% Loss of Beds since 1995
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Patient-to-Bed Gap Increasing
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Absolute minimum is 50 public psychiatric beds per 100,000 population
Assumes availability of appropriate outpatient services in community
1995, California short by 1,400 (only 29.5 beds per 100,000)
2010, California short by 3,600 (only 17.67 beds per 100,000)
Increasing population & need for services
Decreasing beds, cuts in funding & diminishing availability of appropriate
outpatient services in the community
Adult Psychiatric Beds
25 Counties have no inpatient
psychiatric services (white):
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Del Norte
Siskiyou
Modoc
Trinity
Shasta
Lassen
Tehama
Plumas
Mendocino
Glenn
Lake
Colusa
Sierra
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Yuba
Nevada
Amador
Alpine
Calaveras
Mono
Mariposa
Madera
San Benito
Inyo
Kings
Imperial
Child/Adolescent Psychiatric Beds
Only 13 Counties have have
child &/or adolescent inpatient
psychiatric services (orange):
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San Francisco
San Mateo
Solano
Contra Costa
Alameda
Sacramento
San Joaquin
Ventura
Los Angeles
San Bernardino
Orange
Riverside
San Diego
Revisiting the Case Sample:
Activity
Group Discussion
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For Discussion:
 What are the relevant issues?
 What are the potential consequences?
 How could the issues be addressed & resolve?
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Case Facts:

Law Enforcement 5150’s Client

Law Enforcement takes Client to the closest Emergency Room
(ER), which is not an LPS Designated Facility

Client “eventually” ends up at a LPS Facility

PRA meets Client in preparing for Certification Review Hearing

Client indicates she was in the ER, tied to a gurney for 8 days
before getting transferred to LPS Facility
Issues Impacting the System
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Transportation
Funding
Voluntary status & transport
Recidivism
Impact on Client
 No prompt evaluation & treatment
 Further traumatized or decompensating while sitting in ER
 Decreased confidence in mental health system; less likely to access
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Impact on Collaterals
 Good intentions gone bad
 Guilt, frustration, relational issues
 Decreased confidence in mental health system; less likely to access
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Impact on Providers
 Helpless; no trained or prepared for behavioral health
 Frustrated
 Confusion; unclear of mental health system
Innovative Solutions
In Sacramento County
Sacramento County
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The Problem
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Budget Cuts
Mental Health Patients’ Civil Rights
Patients in non-designated hospital over 24 hours
Sequential 5150s
Other Issues
The Solution Process
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Consultation
Correspondence with Mental Health Director
Response from Mental Health Director
Procedural changes
Process of change in non-designated facilities
Education
Resources
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California Hospital Association Report, (2/27/12):
http://mentalillnesspolicy.org/states/california/calpsychbedshortage.pdf
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No Room at the Inn: Trends and Consequences of Closing
Public Psychiatric Hospitals 2005 – 2012, (July 19, 2012):
http://tacreports.org/storage/documents/no_room_at_the_inn-2012.pdf
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Impact of the Mental Healthcare Delivery System on
California Emergency Departments (February 2012),
Western Journal of Emergency Medicine:
www.ncbi.nlm.nih.gov/pmc/articles/PMC3298229/pdf/wjem-13-01-51.pdf
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California Department of Mental Health Laws & Regulations