BASIC ADVOCACY SKILLS:
THE MISSION
Kathleen Piché
Mona Sparks
2008
PATIENTS’ RIGHTS
ADVOCATES TRAINING
EXPRESSED
vs.
BEST INTEREST
Advocates represent the client’s
interests as defined by the client,
as long as those interests are
consistent with statutory
requirements and are
appropriately achievable
Mission Statement
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The California Department of Mental Health,
entrusted with leadership of the California mental
health system, ensures through partnerships the
availability and accessibility of effective, efficient,
culturally competent services. This is accomplished
by advocacy, education, innovation, outreach,
understanding, oversight, monitoring and the
provision of direct services.
Advocacy Principles
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Client Choice and expressed interest as the
guiding light in effective advocacy
Partnerships that promise quality advocacy
work
Culturally and linguistically accessible
advocacy
Kinds of Advocacy
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Individual Advocacy
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System Advocacy
Advocacy
Should create the path to:
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Respect
Dignity
Independence
Self Esteem
Advocacy
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Each
Each
Each
Each
Each
Each
Each
be
step creates a new direction
moment moves us beyond the past
experience empowers the human spirit
new path establishes opportunity
link with others creates partnerships
risk influences growth
truth frees the spirit to be all that it can
Representing the Client
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Communication Skills
Introduce yourself to the client
Explain:
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Nature and purpose of visit/hearing
Role of hearing participants
Evidence that will be presented
Legal hold
Possible outcome of hearing
Interview the client
LPS - The Men
Frank Lanterman (R)
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Pasadena Native Son
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Music Major USC (organist/soloist)
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Legislator for 14 terms
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Died April 1981 at Glendale Adventist Medical Center
Nicholas Petris (D)
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Oakland Native Son
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Journalism/Attorney, Stanford
Alan Short (D)
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Native Son of San Francisco
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College of the Pacific &
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Hastings Law College
LPS – The Act
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Prior to LPS - insufficient standards for who could
be placed involuntarily into the hospital or for how
long
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Criminals had more due process rights than
mental health patients
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No rights once hospitalized
Lanterman-Petris-Short Act
(passes 1969)
Purpose: To end the inappropriate, indefinite, and
involuntary commitment of mentally disordered
persons, developmentally disabled and persons impaired
by chronic alcoholism, prompt evaluation, to guarantee
and protect public safety, safeguard individual rights
through judicial review (WIC 5000).
What is an application for involuntary
admission?
5150 is an application for involuntary admission, not an
admission form. It gets the individual to the door, then
the “professional person in charge of the facility or his
or her designee shall assess the individual in person to
determine the appropriateness of the involuntary
detention” (face to face assessment) (WIC 5151).
Why is a 5150 written?
"When any person, as a result of mental disorder, is a
danger to others, or to himself or herself, or gravely
disabled, a [authorized person] may upon probable
cause, take, or cause to be taken, the person into custody
and place him or her in a facility designated by the
county and approved by the State Department of Mental
Health as a facility for 72 hour evaluation.
(WIC 5150)
Why is a 5150 written?
(continued)
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Criteria must be linked to a mental
disorder.
Mental disorder is not defined by law and the
initiator is not required to make a medical
diagnosis of mental disorder.
Initiator should articulate behavioral
symptoms of mental disorder either
temporary or prolonged
(All of the above are based on People v Triplett.)
Why is a 5150 written?
(continued)
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The LPS Act does not provide a definition of probable
cause, so we look to case law for the answer.
Probable Cause – a definition based on case law
(People v. Triplett). The case law contains a working
guideline to decide if probable cause exists.
The case indicates a lay decision not a clinical one.
The decision does not require a medical diagnosis.
People v. Triplet
144 Cal.app.3d 283 (1983)
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“To constitute probable cause to detain a person pursuant to
California Welfare & Institution Code §5150, a state of facts
must be known that would lead a person of ordinary care and
prudence to believe, or to entertain a strong suspicion, that the
person detained is mentally disordered and is a danger to
himself or to others or is gravely disabled.”
“In justifying a particular detention, the officer must be able to
point to specific and articulable facts which, taken together with
rational inferences from those facts, reasonably warrant his/her
belief or suspicion.”
Involuntary Detainment Criteria
 Mental Disorder in practice is usually defined as any major condition set forth
in the current Diagnostic and Statistical Manual of Mental Disorders (DSM IV).
 Danger to self can be manifested by threats or actions indicating the intent to
commit suicide or inflict serious bodily harm on oneself, or actions which place
the person in serious physical jeopardy, if these actions are due to a mental
disorder.
 Danger to others can be manifested by words or actions indicating a serious
intent to cause bodily harm to another person due to a mental disorder. If the
“dangerous to others” finding is based on the person's threats rather than acts,
the evaluator must believe it is likely that the person will carry out the threats.
 Gravely Disabled means a condition in which a person, as a result of a mental
disorder (rather than a chosen life style or lack of funds) is unable to provide
for his or her basic personal needs for food, clothing or shelter.
Criteria Definitions
Standards for commitment to mental institutions are
constitutional only if they require a finding of
dangerousness to others or self
(Doe v Gallinot 1982).
Criteria Definition
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Gravely disabled adult - a condition in which a
person, as a result of a mental disorder (rather than
a chosen life style or lack of funds) is unable to
provide for his or her basic personal needs for food,
clothing or shelter (WIC 5008). The threat to harm
oneself may be through neglect or inability to care
for oneself (Doremus v Ferrell).
If a person can survive safely in freedom with the
help of willing and responsible family members,
friends or third parties, then he or she is not
considered gravely disabled.
Indications of Grave Disability
FOOD
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Cannot distinguish between food & non-food
Eats food not fit for human consumption
Endangers health by gross negligence in diet &
nutrition
Is dehydrated or malnourished
States intentions not to eat
Demonstrates excessive & constant food preferences
or aversions -except for genuine religious reasons which endanger health
Indications of Grave Disability
CLOTHING
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Engages in public nudity or inadvertent exhibitions
Wears filthy or grossly torn clothing unsuitable to the
climate possibly jeopardizing health
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Repeatedly destroys clothing
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Has no realistic plans for obtaining clothing
Note: A person's predilection for unconventional dress,
whether due to cultural or personal preference, does
not by itself indicate an inability to provide clothing
Indications of Grave Disability
SHELTER
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Is unable to locate housing and make appropriate arrangements
or accept assistance by others to do so
Is unable to manage own, household in such a way to avoid
clear dangers to health
Has no realistic plans for obtaining suitable shelter
Note: A transient lifestyle and or lack of shelter may be due to
personal preference or poverty.
Remember that the inability to provide shelter must be the result of
a mental disorder in order to justify involuntary detention.
Criteria Definition
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Gravely disabled minor definition – as a result of a
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Minors should only be admitted for treatment when
parental authorization for treatment is not available. When
mental disorder is unable to use the elements of life which
are essential to health, safety and development, including
food, clothing, shelter, even though provided to the minor
by others. (WIC 5585.25)
any minor, as a result of mental disorder, is a danger to
others, or to himself or herself, or gravely disabled and
authorization for voluntary treatment is not available, an
[authorized person]may, upon probable cause, take, or
cause to be taken, the minor into custody… (WIC
5585.50).
Criteria Definition
Dangerous to self can be manifested by threats or
actions indicating the intent to commit suicide or
inflict serious bodily harm on oneself, or actions
which place the person in serious physical jeopardy, if
these actions are due to a mental disorder.
Criteria Definition
Dangerous to others can be manifested by words or
actions indicating a serious intent to cause bodily harm
to another person due to a mental disorder. If the
dangerous to others findings is based on the person’s
threats rather than acts, the evaluator must believe it is
likely that the person will carry out the threats.
Criteria Definition
Mental retardation, epilepsy, or other developmental
disabilities, alcoholism, other drug abuse, or repeated
antisocial behavior do not, by themselves, constitute a
mental disorder. (WIC 5585.25)
Competency
No person may be presumed to be incompetent
because he or she has been evaluated or treated for
mental disorder or chronic alcoholism, regardless of
whether such evaluation or treatment was voluntary
or involuntarily received.
(WIC 5331)
WELFARE AND INSTITUTIONS CODE
SECTION 5325-5337
Patients’ Rights:
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(a) To wear his or her own clothes; to keep and use his or her
own personal possessions including his or her toilet articles; and
to keep and be allowed to spend a reasonable sum of his or her
own money for canteen expenses and small purchases.
(b) To have access to individual storage space for his or her
private use.
(c) To see visitors each day.
Patients’ Rights
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(d) To have reasonable access to telephones, both to make and
receive confidential calls or to have such calls made for them.
(e) To have ready access to letter writing materials, including
stamps, and to mail and receive unopened correspondence.
(f) To refuse convulsive treatment including, but not limited to, any
electroconvulsive treatment, any treatment of the mental condition
which depends on the induction of a convulsion by any means, and
insulin coma treatment.
Patients’ Rights
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(g) To refuse psychosurgery. Psychosurgery is defined as those
operations currently referred to as lobotomy, psychiatric surgery,
and behavioral surgery and all other forms of brain surgery if
the surgery is performed for the purpose of any of the
following:
(h) To see and receive the services of a patient advocate who
has no direct or indirect clinical or administrative responsibility
for the person receiving mental health services.
Denial of Rights
Rights may be denied for good cause (title 9, 865.2)
Good cause exists when the professional person in charge has good reason to
believe one or all of the following:
1. The exercise of the right would be injurious to the patient, or
2. The right, if exercised, would be seriously infringe on the rights of others; or
3. The facility would suffer serious damage if the right were not denied, and
4. There is no less restrictive way of protecting the interest specified in 1, 2, or 3
 The reason given for the denial must have a clear relationship to the right denied
 Denial of rights cannot be punitive
 Rights are not considered a privilege to be earned
 The denial must be documented
RIGHTS THAT
MAY NOT BE DENIED
Mental health patients have the same constitutional rights as every other
citizen. Under California law, the following rights may never be denied
(WIC 5325.1):
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Treatment services that are the least restrictive
Dignity, privacy, and humane care
To be free from harm
Prompt medical care and treatment
Religious freedom and practice
Participation in appropriate forms of public education
Social interaction
Physical exercise
To be free from hazardous procedures
INFORMED CONSENT TO
ANTIPSYCHOTIC MEDICATIONS
The patient must be able to make an informed decision regarding taking
antipsychotic medications. They must be provided with information by the MD
prescribing the medications, including:
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The nature of the patient’s condition
Reasons for taking the medication
Reasonable alternative treatments, if any
The type, range, frequency and amount (including PRN’s), method (oral or
injection), and duration of taking the meds.
Probable side effects
The right to withdraw consent at any time
MAINTENANCE OF RECORDS:
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The facility shall maintain a written record of the patient’s signed consent to
take medications and document that the above was discussed with them by the
prescribing physician.
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If the patient consents but does not sign the form, a note must be placed in the
chart with the unsigned form.
EMERGENCY
“Emergency” means a situation in which action to impose treatment over the
person’s objection is immediately necessary for the preservation of life or the
prevention of serious bodily harm to the patient or others, and it is
impracticable to first gain consent.
It is not necessary for harm to take place or become unavoidable prior to
treatment.
When can a patient be medicated without consent?
1) If they are conserved, with power 8A (in Los Angeles)
2) During an emergency
3) After a Riese Hearing (until legal status changes)
REPORTING
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Adult/Elder Abuse WIC 15630)
Dependant adult - Any person residing in this state
between the ages of 18 and 64, who has physical or
mental limitations that restrict his or her ability to
carry out normal activities or to protect his or her
rights including, but not limited to, persons who have
physical or developmental disabilities or whose
physical or mental abilities have diminished because
of age.
Mandated reporters shall complete reporting form for
each report of a known or suspected instance of
abuse (physical, sexual, financial, neglect, isolation
and abandonment) involving an elder or dependant
adult.
PSYCHIATRIC JARGON
Poor Short
Term Memory
Isolative
Hostile
Questions and Answers
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Please ask any questions at this time
Los Angeles County
Office of Patients’ Rights
213-738-2524
1-800-700-9996
E-mail:
Mona: msparks@dmh.lacounty.gov
Kathleen: kpiche@dmh.lacounty.gov