Decentralized mental health responsibilities to the local level, requiring each county to establish a mental health department to plan, operate, and assess prevention, support, and treatment services.
The system is based on concepts arising from the deinstitutionalization movement of the 1960s, in which emphasis on mental health services was placed on local, community-based systems rather than state-run hospitals.
In 1969, with the passage of the amended Short-Doyle Act (1968), county mental health programs became mandatory for counties with a population of 100,000.
In 1973, such programs became mandatory in all counties.
Currently, two city programs—the City of Berkeley and the Tri-City Mental Health Center (Pomona, La Verne, and Claremont)—remain in operation and continue to receive direct funding from the State Department of Mental Health (DMH).
Of the 2000, or so, proposed CMHCs, only about 750 were actually built (In 1980, 754 CMHCs existed).
Many of the CMHCs were located in less urbanized areas.
A shortage of professional personnel was another problem.
From their very beginnings, CMHCs dealt largely with individuals who were experiencing problems in living rather than with those with serious mental disorders; psychotherapy was the major focus.
Nor did centers provide coordinated aftercare services and continuing assistance to individuals who had been discharged from mental hospitals.
Mental patients transferred from institutions to nursing homes, group homes, sheltered care, isolated rooming houses, general hospitals, board and cares, prisons and jails, families and relatives, and homeless situations (transinstitutionalization).
As managed care has evolved and different benefit structures have been implemented, the overwhelming trend in the managed care industry, relevant to mental health/substance abuse benefits, has been toward carve-out programs.
These programs are insurance plans that separate mental health and substance abuse benefits from the general health plan.
Carve-outs operate independently from enrollees' general medical insurance, maintaining their own provider networks, coverage rules, administrative services, and other insurance functions.
Administrative and management services usually include case management, utilization review, claims processing, development and maintenance of a provider network, and quality assurance.
In 1987, the California State Court of Appeals found that patients had the right to exercise informed consent to the use of antipsychotic drugs, absent an emergency, and, should they reject medication, "a judicial determination of their incapacity to make treatment decisions" was necessary before they could be involuntarily treated.
To provide pharmacological treatment for such a patient, the treating physician must petition the court to have the patient declared unable to consent for such treatment.
This petition, the Riese petition, can only be filed after the psychiatrist has made repeated efforts to obtain the patient's consent.
After the petition is filed, a "Riese" or capacity hearing is held, the goal being the determination of whether or not the patient has the capacity to consent or refuse the administration of medication.
If the patient is found to lack capacity to provide informed consent, the patient can be required to take the psychotropic medication prescribed by the treating physician.
1. A right to treatment services which promote the potential of the person to function independently. Treatment should be provided in ways that are least restrictive of the personal liberty of the individual.
2. A right to dignity, privacy, and humane care.
3. A right to be free from harm, including unnecessary or excessive physical restraint, isolation, medication, abuse, or neglect. Medication shall not be used as punishment, for the convenience of staff, as a substitute for program, or in quantities that interfere with the treatment program.
4. A right to prompt medical care and treatment.
5. A right to religious freedom and practice.
6. A right to participate in appropriate programs of publicly supported education.
7. A right to social interaction and participation in community activities.
8. A right to physical exercise and recreational opportunities.
9. A right to be free from hazardous procedures.
Any person who is subject to detention shall have the right to refuse treatment with antipsychotic medication (section 5325.2).
1. 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.
2. To have access to individual storage space for his or her private use.
3. To see visitors each day.
4. To have reasonable access to telephones, both to make and receive confidential calls or to have such calls made for them.
5. To have ready access to letter writing materials, including stamps, and to mail and receive unopened correspondence.
6. To refuse convulsive treatment including, but not limited to, any electroconvulsive treatment, any treatment of the mental condition that depends on the induction of a convulsion by any means, and insulin coma treatment.
7. 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.
8. 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.
It is the intent of the legislature that persons with mental illness shall have rights including, but not limited to, the following (this list is not exhaustive; section 5325.1):