CSAC Bulletin Article

Audit of County Implementation for Involuntary Holds Released

July 30, 2020

The Bureau of State Audits released its audit of county implementation of the Lanterman-Petris-Short Act (LPS Act) for involuntary mental health treatment this week, finding that while counties implement the Act properly, a lack of treatment options, care coordination, access to data, and funding transparency hampers positive outcomes for those who are frequently held or conserved involuntarily.

The audit, titled “The Lanterman-Petris-Short Act Report 2019-119: California Has Not Ensured That Individuals with Serious Mental Illnesses Receive Adequate Ongoing Care,” focused on three counties: Los Angeles, San Francisco, and Shasta County. The Legislature requested the audit in 2019 to principally examine county implementation of LPS criteria. In Auditor Elaine Howell’s words, the audit “found no evidence to justify any changes to the criteria.”

However, the auditors did delve into how individuals on involuntary holds or under conservatorships often wait significant periods of time for state hospital treatment beds, residential-based services, and coordinated follow up care.  While the audit indicates that “no more than 9 percent of individuals were connected with ongoing care,” the definition of ongoing care within the audit was enrollment in a county Assisted Outpatient Treatment (AOT) program. Known as Laura’s Law, counties may opt to offer AOT services in their communities, but these services are not the only follow up services available to individuals after an involuntary hold or conservatorship.

The audit also suggested that the Mental Health Services Oversight and Accountability Commission (MHSOAC) become the repository for comprehensive new data on county behavioral health system spending and outcomes for all programs. Currently, the MHSOAC’s scope is limited to oversight and approval of county Mental Health Services Act innovation project spending.

The Legislature is required to hold a hearing on each completed audit, but with the shortened time frames within the Legislature due to coronavirus and the end of session looming on August 31, a hearing may be postponed until either the fall or early next year.

CSAC, along with the County Behavioral Health Directors Association (CBHDA) and the California Association of Public Administrators, Public Guardians, and Public Conservators (CAPAPGPC), are working to highlight the county strengths outlined in the report and to draw attention to the need for additional resources for AOT services and conservatorship efforts. We also wish to thank the three counties who took part in the audit for their efforts to ensure a thorough and fair report to the Legislature.

Resources
The Lanterman-Petris-Short Act Report 2019-119: California Has Not Ensured That Individuals with Serious Mental Illnesses Receive Adequate Ongoing Care, July 28, 2020 (HTML)
https://www.auditor.ca.gov/reports/2019-119/index.html

Summary (HTML)
https://www.auditor.ca.gov/reports/2019-119/summary.html

Fact Sheet (PDF)
https://www.auditor.ca.gov/pdfs/factsheets/2019-119.pdf

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