July 28, 2020
The Governor of California
President pro Tempore of the Senate
Speaker of the Assembly
Sacramento, California 95814
Dear Governor and Legislative Leaders:
As directed by the Joint Legislative Audit Committee, my office conducted an audit of the implementation of the Lanterman‑Petris‑Short Act (LPS Act) in Los Angeles County, San Francisco County, and Shasta County. The LPS Act permits involuntary mental health treatment when, because of mental illness, individuals pose a risk of harm to themselves or others or cannot provide for their basic needs. We conclude that the LPS Act’s criteria for involuntary treatment allows counties sufficient authority to provide short‑term involuntary treatment to people. Expanding the LPS Act’s criteria to include additional situations in which individuals may be involuntarily treated could potentially infringe upon people’s liberties—and we found no evidence to justify such a change. Nonetheless, California has not ensured adequate care for individuals with serious mental illnesses in its broader mental health care system.
Perhaps most troublingly, many individuals were subjected to repeated instances of involuntary treatment without being connected to ongoing care that could help them live safely in their communities. For example, almost 7,400 people in Los Angeles County experienced five or more short‑term involuntary holds from fiscal years 2015–16 through 2017–18, but only 9 percent were enrolled in the most intensive and comprehensive community‑based services available in fiscal year 2018–19. Also, counties in California have not widely adopted assisted outpatient treatment—a community‑based approach to mental health treatment that could help prevent involuntary treatment in institutional settings. Assisted outpatient treatment is an effective approach to serving individuals in their communities, and we make recommendations to expand access to this treatment.
Because the State’s current public reporting related to mental health services relies on disjointed and incomplete tools, policymakers and other stakeholders do not have the information they need to assess the effect of the billions of dollars California invests in its mental health system each year. An overhaul of mental health reporting requirements is necessary to bring greater accountability to this system. In the interim, immediate changes to state law could direct Mental Health Services Act funds toward people leaving involuntary treatment to ensure that they receive effective, community‑based care.
ELAINE M. HOWLE, CPA
California State Auditor