1. BASIC ADVOCACY SKILLS: THE MISSION Kathleen Piché Mona Sparks
2008
PATIENTS’ RIGHTS
ADVOCATES TRAINING

2. 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

3. Mission Statement
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.

4. Advocacy Principles
Client Choice and expressed interest as the guiding light in effective advocacy
Partnerships that promise quality advocacy work
Culturally and linguistically accessible advocacy

5. Kinds of Advocacy
Individual Advocacy
System Advocacy

6. Advocacy Should create the path to: Respect Dignity Independence
Self Esteem

7. Advocacy Each step creates a new direction
Each moment moves us beyond the past
Each experience empowers the human spirit
Each new path establishes opportunity
Each link with others creates partnerships
Each risk influences growth
Each truth frees the spirit to be all that it can be

8. Representing the Client
Communication Skills
Introduce yourself to the client
Explain:
Nature and purpose of visit/hearing
Role of hearing participants
Evidence that will be presented
Legal hold
Possible outcome of hearing
Interview the client

9. LPS - The Men Frank Lanterman (R) Pasadena Native Son
Music Major USC (organist/soloist)
Legislator for 14 terms
Died April 1981 at Glendale Adventist Medical Center
Nicholas Petris (D)
Oakland Native Son
Journalism/Attorney, Stanford
Alan Short (D)
Native Son of San Francisco
College of the Pacific &
Hastings Law College

10. LPS – The Act
Prior to LPS - insufficient standards for who could be placed involuntarily into the hospital or for how long
Criminals had more due process rights than mental health patients
No rights once hospitalized

11. 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).

12. 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).

13. 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)

14. Why is a 5150 written? (continued)
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.)

15. Why is a 5150 written? (continued)
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.

16. People v. Triplet 144 Cal.app.3d 283 (1983)
“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.”

17. 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.

18. 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).

19. Criteria Definition
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.

20. Indications of Grave Disability FOOD
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

21. Indications of Grave Disability CLOTHING
Engages in public nudity or inadvertent exhibitions
Wears filthy or grossly torn clothing unsuitable to the climate possibly jeopardizing health
Repeatedly destroys clothing
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

22. Indications of Grave Disability SHELTER
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.

23. Criteria Definition
Gravely disabled minor definition – as a result of a 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 )
Minors should only be admitted for treatment when parental authorization for treatment is not available. When 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 ).

24. 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.

25. 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.

26. 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 )

27. 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)

28. WELFARE AND INSTITUTIONS CODE SECTION 5325-5337 Patients’ Rights:
(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.

29. Patients’ Rights
(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.

30. Patients’ Rights
(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.

31. Rights may be denied for good cause (title 9, 865.2)
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

32. 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 ):
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

33. 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:
• 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:
• 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.
• If the patient consents but does not sign the form, a note must be placed in the chart with the unsigned form.

34. EMERGENCY When can a patient be medicated without consent?
“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?
If they are conserved, with power 8A (in Los Angeles)
During an emergency
After a Riese Hearing (until legal status changes)

35. REPORTING 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.

36. PSYCHIATRIC JARGON Poor Short Term Memory Psychotic Agitated Depressed
Threatening
Assaultive
Isolative
Marked Loosening Of Association
Impaired Judgment
Non-compliant
Hostile
Poor Insight
Unpredictable
Refuses To Cooperate
Responding to Internal Stimuli

37. Questions and Answers
Please ask any questions at this time

38. Office of Patients’ Rights
Los Angeles County
Office of Patients’ Rights
Mona:
Kathleen: