Why LA County wants to expand involuntary psych holds for some homeless

Los Angeles County is preparing to ask the state legislature to expand the legal definition of "grave disability" to give officials more power to put certain homeless individuals on involuntary psychiatric holds. The move, which takes the county into uncertain ethical territory, is motivated by a desire to provide crucial medical help to those with mental health issues who refuse to get the care they need.

The County Board of Supervisors voted 4-1 Tuesday to ask staff to come up with legislative proposals "that would consider an individual's inability to provide and/or access urgently needed medical care for him or herself due to a mental disorder as part of the criteria for grave disability." The recommendations are due in 60 days.

"In some cases, the limits of the law, as currently written, insist that first responders turn away from providing life saving help," said Brittney Weissman, executive director of the National Alliance on Mental Illness Los Angeles County Council.

Weissman conceded that changing the law could lead to more people being placed under the care of a court-designated conservator. But what’s most important is getting more people the medical care they need, she said.

"My colleagues, I know, have the best of motives, but I could not disagree more," Supervisor Sheila Kuehl said Tuesday before casting the lone no vote on the motion.

Kuehl has expressed concerns about creating conditions under which people who don't need to be committed are forced to enter a psychiatric institution.

"Because, as The King says in the King and I, ‘Might they not protect me out of everything I own?'" Kuehl said.

The motion, introduced by Supervisors Kathryn Barger and Hilda Solis, cites a Los Angeles Homeless Services Authority estimate that nearly 16,000 of the county's homeless suffer from "a serious mental illness."

The county is in the midst of a broad-ranging initiative to reduce homelessness.

Under the voter-approved Measure H, a new 1/4-cent sales tax is expected to generate as much as $355 million a year for housing and other services for the homeless.

Last month, the supervisors unanimously voted to pursue several suggestions made by Dr. Jonathan Sherin, L.A. County's director of mental health. His recommendations included beefing up psychiatric mobile response teams, which assess people who are in crisis and determine whether to hold someone in a hospital for 72 hours. 

The board also agreed to explore increasing the number of mental health beds in the county, to accommodate people who have been deemed gravely disabled by a mental illness in less hospital-like settings. And it said it would look into Sherin's suggestion that the county file more petitions in the courts for forced medication. 

A previous version of this story was updated to clarify Brittney Weissman's title.