Involuntary Mental Health Holds in California: Fragmented, Obscure, and Ready for Overhaul

California faces a deeply intertwined, highly visible homelessness and mental health crisis; approximately a quarter of California’s homeless population have a severe mental illness. This crisis has spurred increased societal and political attention on the California law governing involuntary detentions, one of the primary sources of treatment for homeless patients with a severe mental illness: the Lanterman-Petris Short (LPS) act. One major challenge to improving treatment for patients receiving involuntary treatment under the LPS Act (referred to here as LPS patients) is the fractured nature of mental health services in California. Mental health services are funded by a patchwork of different funding streams, each with its own requirements, restrictions, and goals. While agencies and providers with specific subject matter expertise help LPS patients with needs they can address, there is no centralized body responsible to evaluate and improve the overall LPS patient experience. This results in a lack of coordination to ensure that these streams effectively cover care for LPS patients both during and after their involuntary holds. Additionally, data on these services are often difficult to obtain, and legislators and advocates often cite insufficient data as a major barrier to reform. This lack of data on costs and outcomes makes it difficult to understand how much of California’s state and local budgets are taken up by involuntary hold costs and whether or not programs need adjustment to better serve patients. If spending is determined to be significant, the crisis would likely gain greater attention.

Our report focuses on how the state can better understand and address the fragmentation around care for LPS patients. In collaboration with our client, the Steinberg Institute, we identified three key research questions to examine.