Our Fall 2022 issue of SMI Advocate covers legislative news from June 30 to October 4. With most state legislatures having already adjourned and Congress on summer recess during the majority of this period, we have the chance to dive deeper into a series of bills in California in addition to sharing several other updates.

The California State Legislature passed Gov. Gavin Newsom's CARE Court program, designed to disrupt the revolving door of homelessness, short-term hospitalization and incarceration those with untreated severe mental illness often experience. The legislature also passed reforms to the Lanterman-Petris-Short Act  (responding to feedback from stakeholders last year on ways to improve the law) and a bill allowing assisted outpatient treatment courts to hold status hearings and be more involved in treatment.

The Maryland Department of Health has proposed a regulation to define "danger" in Maryland, where the lack of statutory definition has long been a barrier to timely treatment. A bill to establish a psychiatric deterioration standard is still active in Ohio, and legislatures in Massachusetts and Michigan passed bills related to the psychiatric bed shortage.

Congress reconvened from summer recess in early September. Treatment Advocacy Center is advocating for President Biden's new Advanced Research Projects Agency for Health, tasked with developing leaps in innovation in biomedical and health research, to include direly needed clinical research on SMI. We continue to closely watch the progress of bills in the U.S. House and Senate to reauthorize and improve the Assisted Outpatient Treatment grant program, incorporating our recommendations to broaden its pool of eligible applicants. 

Don't miss our Winter 2022 issue of SMI Advocate in December which will recap the entire year of legislative accomplishments!

California Updates

CARE Court program enacted

The California State Legislature passed SB 1338 to enact Gov. Gavin Newsom's CARE Court proposal on August 31, the final day of the legislative session. Treatment Advocacy Center applauds the legislature for passing this ambitious bill to bring desperately needed treatment and services to Californians with schizophrenia and other psychotic disorders, a population that is all too often forgotten. The program will connect a person in crisis with a court-ordered CARE plan to include comprehensive treatment, housing and supportive services for up to 12 months.

We sincerely thank each person who responded to our May action alert encouraging lawmakers to maintain three key provisions during their deliberations on the bill. We are thrilled that the final version of the law includes the following elements that the Treatment Advocacy Center supported as essential ingredients for the success of the program: (1) prioritizing individuals with schizophrenia and other psychotic disorders, (2) holding counties accountable and (3) giving families and loved ones access to petition courts for treatment. Read Treatment Advocacy Center's full statement on the passage of the bill for more details. 

Reforms to the Lanterman-Petris-Short Act and Laura's Law enacted

A number of bills were introduced this session in response to findings from a 2020 State Auditor Report and recommendations from a December 2021 California Assembly Health and Judiciary committee hearing on ways to improve the Lanterman-Petris-Short Act, California's statute governing civil commitment and conservatorship for grave disability. Stakeholders also spoke to shortfalls in Laura's Law, California's AOT statute. Read more about the hearing and how Treatment Advocacy Center was involved. 

• SB 1035 allows AOT courts to conduct status hearings and require reporting on treatment adherence, including adherence with medications. Following best-practices from AOT judges, this change to Laura's Law will enhance the "black robe effect" for judges as they may hold status hearings to be more involved in participants' treatment progress.
• SB 929 expands the Department of Health Care Services' existing responsibility to collect and publish information about involuntary detentions under the LPS Act to include clinical outcomes, services provided, demographic data, numbers and types of detentions and conservatorships and availability of treatment beds. Both the State Auditor's report and the LPS hearing highlighted the lack of data available to study the outcomes of the LPS Act. Legislators passed this bill to provide more robust data for future decision making.
• SB 1227 permits a second, intensive treatment period of up to 30 days for individuals under an inpatient commitment order (5270 hold) who need more treatment time to stabilize in order to continue treatment in the community.
• AB 2242 requires that a care coordination plan be followed when discharging those who have been involuntarily detained for purposes of evaluation and treatment or placed under a conservatorship. Many stakeholders in the LPS hearing testified to the lack of care coordination between programs across the California mental health system.
• AB 2275  makes clarifications to the processes for involuntary detentions but does not substantively change the LPS Act.

We were disappointed that SB 1416, Sen. Susan Eggman's bill to modernize the definition of "gravely disabled" within LPS did not make it out of the Assembly Judiciary Committee. Thank you to our advocates in California who responded to our April action alert and urged your lawmakers to support this important bill that would have expanded the definition to better meet the needs of those with SMI. We look forward to working together again in 2023 on this critical issue. 

Additional State Updates

Danger to be defined in Maryland regulations 

The Maryland Department of Health published proposed regulations on August 12 to define the danger standard for emergency psychiatric evaluation and involuntary hospital admission. While Treatment Advocacy Center supports the proposed definition because it would partially define dangerousness in Maryland and improve access to severe mental illness treatment, the definition should be expanded to more completely address the state's current vague and inadequate dangerousness criteria and should ideally be defined in statute rather than regulation.

The danger standard in Maryland's involuntary emergency evaluation and hospital commitment law requires that a person with mental illness "present a danger to the life or safety of the individual or of others." However, the law fails to define "danger." Without a definition, police, physicians and judges interpret the standard inconsistently across the state and often unnecessarily require imminent suicidal or homicidal behavior when making emergency petition or commitment decisions. This ambiguity is a barrier to early intervention and prevents those too ill to recognize their need for treatment from accessing desperately needed treatment.

Working closely with Evelyn Burton, Treatment Advocacy Center board member and advocacy chair for the Maryland Chapter of Schizophrenia & Psychosis Action Alliance, Treatment Advocacy Center distributed a campaign inviting advocates to send their comments urging the Maryland Department of Health to make the following three improvements to the proposed definition: (1) include an explicit statement that the danger need NOT be imminent, (2) clarify that "psychiatric care" is medical care and "significant psychiatric deterioration" is a form of harm to self and (3) add language specifying that an individual's personal, medical, and psychiatric history, if available, must be considered. Thank you to each person who took the time to use our form and share your story. 

While defining danger in regulations is an important first step, Treatment Advocacy Center will continue our efforts to have an adequate danger definition codified in statute in order to prevent the tragic consequences of delayed treatment. 

Beds & transportation bills enacted

• Massachusetts  - H 4578 authorizes $24 million towards the one-time costs of opening new behavioral health or substance use disorder treatment beds.
• Michigan (2) - HB 4043 creates a registry that identifies available psychiatric beds in the state categorized by patient gender, acuity, age and diagnosis. SB 0101 allows for the establishment of a county mental health transportation panel for the purpose of creating an alternative transportation mechanism to a peace officer transporting an individual when required under the code.

Key psychiatric deterioration bill still active in Ohio 

• Ohio - HB 439 would establish a psychiatric deterioration standard by expanding the definition of dangerousness to include "mental deterioration." The bill would enable law enforcement and other designated professionals to intervene in instances in which a person has a history of untreated mental illness, is too ill to appreciate their need for treatment and without treatment is likely to suffer mental deterioration and, as a result, become a danger to self or others. The Ohio General Assembly returns to session on November 15 and has only a few weeks before adjourning at the end of the year. HB 439 was reported out of committee in June and still needs to be scheduled for a House floor vote before it can cross over to the Senate. Treatment Advocacy Center is working closely with our coalition to get this bill through the process this year. The coalition includes our board member Judge Elinore Stormer, NAMI Ohio, the Ohio Judicial Conference, the Ohio Psychiatric Physicians Association and the Ohio Psychological Association.

Federal Updates 

Advanced Research Projects Agency for Health  

The Advanced Research Projects Agency for Health is a new agency within the U.S. Department of Health and Human Services that will "support transformative high-risk, high-reward research to drive biomedical and health breakthroughs--ranging from molecular to societal--that would provide transformative solutions for all patients." President Biden proposed the agency, and Congress authorized funding to establish it in March. 

As the agency is established and its agenda set, Treatment Advocacy Center has been advocating to ensure the severe mental illness community is not left out. In an opinion piece, "ARPA-H is our moonshot for schizophrenia," Executive Director Lisa Dailey writes, "We must not accept this status quo as an inevitability: The next breakthrough in schizophrenia research is waiting for us to decide that we must find it. This is our chance."

Congress is currently in budget negotiations for the fiscal year 2023. Treatment Advocacy Center supports language affirming the need to invest in SMI research that was included in the House Appropriations Committee's June report, which details congressional intent regarding proposed funds in the Health and Human Services appropriations bill. The Committee included $2.75 billion to fund ARPA-H ($1.75 billion above FY 2022 levels). In the report, the Committee urges ARPA-H to "consider mental health research, including diagnosis and treatment of SMI to address widespread behavioral health issues to spur industry developments and new academic partnerships."

Reauthorizing the Assisted Outpatient Treatment Program

• Mental Health Reform Reauthorization Act of 2022 (S 4170) - We are thrilled that S 4170 not only reauthorizes the Assisted Outpatient Treatment Program but also incorporates several of our recommendations. The following three key improvements for which Treatment Advocacy Center advocated are included: (1) increasing the pool of grantees by making existing programs eligible; (2) clarifying that AOT is in a civil (as opposed to criminal) court by adding "civil" to the definition and (3) requiring more robust data collection and reporting by requiring the Substance Abuse and Mental Health Services Administration to report on how AOT impacts participants' rates of psychiatric hospitalization and arrest (in addition to homelessness and incarceration currently required) and to study the impact of variations in program design among grantees. Among many other provisions in the bill is a section to end harmful opt outs from federal mental health and addiction parity requirements for nonfederal government health care plans.
• Restoring Hope for Mental Health and Well-Being Act of 2022 (HR 7666) -  While not identical to S 4170, this bill also reauthorizes the Assisted Outpatient Treatment Program with our recommended improvements and removes the harmful opt outs from federal mental health and addiction parity requirements for nonfederal government health care plans. HR 7666 also includes a section requiring the Department of Health and Human Services to conduct a study on the cost of serious mental illness. The study would include costs related to employment and caregiving in addition to costs to the healthcare and criminal justice systems.