Rafik Wahbi: The conversation around involuntary commitment deals with very serious and real issues. It deals with real needs. There are people who are suffering. There are people who are abandoned. One of the things I really dislike is this narrative that people like myself oftentimes are painted as like, we just want people to be left alone. Let them overdose on the street, let them get infections, like let them sleep. No, that's not what any serious advocate thinks in California. No one who has real relationships with unhoused people in California says I want them to stay there. That's asinine and it's pretty offensive to us. What we do say is that the solutions that are provided in California are always the same, It's the same thing, it's not addressing the root cause, it doesn't address the root cause of our ridiculous housing market. It's the funnel, right? It's like a funnel that keeps bringing people in. You can build the greatest homeless response team in the entire universe, but you haven't stopped this, like, California faucet of producing homelessness. And CARE Courts, SB43, all these bills don't touch those things. Not a little bit.
Jesse: This is Committable, a podcast about involuntary commitments. I'm Jesse Mangan, and over the previous two episodes, we started to discuss mental health laws in California. We talked about the 5150, which is a 72 hour hold. We talked about the 5250, which is 14 days of detention. And we talked about CARE Courts, a new civil court system that seems designed to funnel unhoused people into stricter forms of coercive control.
But the expansion of commitment laws in California is an ongoing landslide of legislative activity that includes policies and proposals such as SB43, AB531, and SB326. A lot of letters, a lot of numbers, and a lot to try and make sense of. So to help us better understand all of this, I spoke with Leah Harris. Leah is a psychiatric survivor, journalist, and activist who focuses much of their work on psychiatric abolition and the elimination of all forms of involuntary psychiatric intervention. And as we began our conversation, my first question for Leah was, what is SB43?
Leah Harris: So with SB43, it's really important to understand the backdrop of Lanterman-Petris-Short, which was a law that came about in the late 1960s and enacted in the early 1970s that was really designed to address the issue of mass institutionalization of people with psychiatric disabilities. So it established the 5150 hold, which said you could only hold people for 72 hours before there'd be some kind of a process to determine whether or not they could continue to be held. So it, you know, involved very limited standards, danger to self or others, as well as grave disability, which under Lanterman-Petris-Short was being unable to meet your basic needs. So what SB 43 is looking to do, they, the way they're spinning it and promoting it is as “reforming Lanterman-Petris-Short”, right? So what it's doing is vastly expanding the criteria for involuntarily confining disabled people under 5150 holds. It's looking at not just mental health disabilities, but substance use. So it's kind of taking on this whole other category of people that now can be rounded up and detained against their will. And they've also expanded the definition of grave disability. So. That basically means that if you are determined by the state to be unable to meet your needs for “medical care and personal safety”, you could now also come under state control.
And then this also feeds into conservatorship as well, it makes it a lot easier to put people under conservatorship. It streamlines the process. It allows testimony that had previously been considered hearsay, testimony based on medical records from so called expert witnesses, and that can include people who have no direct knowledge of the person involved. So it's highly, highly, highly disturbing to me that they're just kind of sweeping away these really, really important protections, as inadequate as they were before this point, but they're really just now opening the door to the mass detention and institutionalization of people. And I should say, of course, that this is targeted towards unhoused people as all of these policies and laws are that are coming out of the Newsom administration.
Jesse: So SB43 expands the base criteria for the commitment process in California to include substance use disorders, and redefines grave disability in such a way that I sincerely don't know where the limits are. Pretty much anyone can be, at some point, suspected of being unable to provide for their own safety against some undefined potential threat. For instance, I go on a lot of long walks. Those long walks could arguably be connected to my eating disorder, which has been clinically categorized as severe. So if someone is concerned that while on one of these long walks I might be attacked by a bear, and that I would be unable to provide for my own personal safety during such an attack, does that now meet the criteria for grave disability? And, if so, what then? Does this obviously ridiculous and yet potentially legally acceptable suspicion now satisfy the base criteria to have me detained in a locked facility? And who is going to pay for that detention? Where is that money coming from? Which brings us to AB531.
Leah Harris: Okay, so AB531 is, it's a bond measure, okay? And it's really important to understand how these laws are all working together. So SB43, which is a law that was passed, it's a done deal. It was overwhelmingly passed in the California legislature. And so how AB531 works with that, it's called the Behavioral Health Infrastructure Bond Act, you know, again, being marketed as modernization. So, unlike SB43, this is actually going to be put to the voters in a package in March 2024 under a package called Proposition 1. Okay, so this would actually allow for the infrastructure to put away all of these people who are being identified by the state as being in need of involuntary treatment. So this is a multi billion dollar bond, it was originally supposed to be $4.68 billion, but the big city mayors and supervisors got involved, which again, really, you know, to me shows that this is about disappearing unhoused people and people of color from the streets. So because of their lobbying, the amount was increased to over $6.4 billion. And how this is being spun is that this is about expanding access to housing, but that is absolutely not what is happening here. I believe only about 1.6 billion of the 6.4 billion is to be spent on housing for veterans and other unhoused people. It's called, “permanent supportive housing”, but it's completely undefined. So those remaining billions actually provide grants. I mean, this is free money to investors from the state for the construction of 10,000 behavioral health beds. What's terribly frightening about this is that the original bond measure had included language that would prohibit the use of funds for locked facilities. It's, you know, repeatedly the Newsom administration said this is voluntary, this is unlocked, this is just expanding access to voluntary care, right? That's how it was sold. And then they did this absolutely atrocious bait and switch in the final week of the legislative session, I mean, you cannot make this stuff up, the words unlocked and voluntary were just stripped from the bill text. And I actually have a fact sheet from June that I found archived that showed all of that language of community based and voluntary and unlocked and that has all been completely scrubbed from the internet. And I'll just say, you know, I wrote about this in the Disability Visibility project, this is really paving the way it's, I believe it is not hyperbole, It is paving the way to literally rebuild the asylums.
Jesse: So SB43 expands the base criteria for the commitment process, which will almost certainly lead to a significant increase in the number of people who get pushed into that process. And AB531 establishes billions of dollars that can be used to build locked psychiatric facilities. But what about voluntary, community based resources? What impact might these bills have on access to those forms of support? And that brings us to SB326.
Leah Harris: So SB326 is the Behavioral Health Services Act, also known as Mental Health Services Act Modernization. So again, just notice they have really consistent branding. I'm so curious about the PR firm that they engaged to develop all of this spin. But essentially what it's doing is decimating, I mean, that's the language that advocates have used decimating the existing Mental Health Services Act, which came about 20 years ago. It was a 10 year effort largely driven by people with lived experience to create a, you know, recovery oriented peer driven system in California. There was a tremendous amount of lobbying and advocacy that came about to make this happen and what they're really doing is slashing a lot of the funding for county mental health services in half. At the same time that they're expanding the population of people to receive services under this act to include again substance use, right? So it's consistent across the board that providers are being asked to serve, you know, a whole other group of people with no additional funding. Sacramento County, for example, testified that this would force the county to cut critical outpatient services by 65%. Peer driven supports are looking at being completely cut and eliminated. I mean, these are services that are created by people who understand what's happening on the ground the most. It also, I think this is another piece of it, is that it diverts services to “housing interventions”. So again, taking away these voluntary community driven supports to divert them towards housing interventions, and I more than anyone want people to have access to permanent supportive housing. You know, this is not about whether or not people should have housing, but what housing interventions are is tremendously unclear. The money can absolutely be used for short term clinical treatment facility stays, including involuntary and locked facilities.
And it's super, super important to note that neither 326, or any other bill, including AB531, will create any kind of entitlement to housing for people who are unable to work. It will not comprehensively house people who are unhoused. And we know that, you know, the way they're spinning this, I should say, and this is not specific to 326, but to all of this legislation. You know, part of the rationale is that the vast majority of people become unhoused because of mental health or substance use issues and that is completely not true. There was a huge survey that UCSF conducted just this year of unhoused people and the vast majority of them said, the reason we became unhoused is because rent is too expensive. We fell behind on our rent and like a $300-$400, you know, cash assistance would have kept us out of houselessness. But instead of doing what makes sense, right? What is a logical response. They're pushing this whole treatment not tents rhetoric, right? So it's just, you know, demonizing people who are victimized by these absolutely horrific housing policies and housing injustice that exists in California and across the nation.
Jesse: Over the past few years on this podcast, we have actively been trying to deconstruct mental health laws throughout the United States. And every time I read one of these laws, I have a visceral reaction. I am instantly brought back to the experience of being strapped down and detained, inpatient. At one point, simply seeing an email with a written statement about commitment policies left me decimated, curled into a ball, crying on the floor for almost an hour. My wife heard the muffled sobbing, walked in to see me in that state, and she just held me. Held me until the shuddered, gasping tears began to fade.
I don't know how to communicate to people in positions of authority what it feels like to constantly see the thing that caused the most traumatic moments of your life get more funding.
I don't know how to convince policy makers that the people who are forced into these systems are still people.
I don't know how to explain the experience of just trying to exist in this society, knowing that everyone around me has just been given the power to strip me of my rights and disappear me in the name of treatment.
How do you explain that experience? How do you prevent something like that from happening?
Rafik Wahbi: We have to be ahead of the systems that try to profit off of deputizing people to do more harm.
Jesse: This is Rafik Wahbi.
Rafik Wahbi: Hey everyone, my name is Rafik Wahb and I am a community health scientist and educator. I focus on, kind of the intersection of mental health, substance use, and criminalization. So I really try to study and understand why is it that we take health issues, things that have clear health solutions, community solutions, and kind of apply these more carceral modalities, carceral approaches. And, uh, that's just a little bit about my work. And, um, I also love music and hip hop and love to try and mix that. But, yeah, I love to always just think about how music, art and food can communicate things that words cannot.
Jesse: I wanted to talk with Rafik to try to process all of this. And to try and figure out what to do when faced with policies that seem designed to separate, to isolate, designed to take people who are visibly struggling and make them just disappear.
Rafik Wahbi: This is something that I've been thinking about so much is this idea of separation and isolation and, you know, forced treatment is the epicenter of that. And what we're talking about is that, like, the act of doing that to someone is isolating, it's meant to separate, it's meant to remove connections. And so what I've noticed is like that's just in line with really any carceral policy, any sort of carceral approach. Prison, jail, it's all about disconnection, separation. And so when I think about what's been happening in California I just think it is like putting the pedal to the metal and like really putting it down and wanting to push even more this idea of separation. So I think the answer to this is organizing and coming together, but it's really resisting the idea that the way that we solve any of these issues is by further isolation, but it's really the opposite. It's about, um, come together with a group of people, people you're advocating for, people who have suffered and said this system isn't working for me. Identify a part of it to say we want to study, learn more about it, and then we want to not just advocate and demand for this change, but we want to actually build it on a small scale. If it's just a block, like hey, you've been interested in mental health crisis response systems, like that's something that has been a hot topic across the country. Well, just like anything else, the state has taken that over too and everything I've heard from, you know, the 988 number is that it's not really working as a lot of people wanted it to. I'm not trying to hate on it, like, I think this is how things happen and develop and progress, but If you're waiting for your county, your city to kind of come down from on high, present you with the funds and the system that you've kind of been reading about, dreaming about, it's just not going to happen. And I think the further isolation makes us feel hopeless and makes us feel like, all right, you can take it away Gavin Newsom, you know, do your thing.
Jesse: One of the things that scares me most about something like 988 and things like CARE Courts, is that in both instances, I think 988 has been incredibly successful because it gave people something to say. You hear it on radio, you hear it on TV, if you have concerns about what you just heard call 988. And CARE Courts, it gives people something to do. You can fill out a petition, you can fill out an application, and you don't need to worry about what happens next. You've done something. And I feel like those, those actions, giving people something to say, giving people something to do, is based on sort of like, you know it when you see it. You'll know the person who needs this when you see them, and you'll know the situation when you see it. And that just takes the bias, or the confusion, or the misunderstanding that was there, and supercharges it. Now people aren't going to question that bias. They're just going to think, well they've given me something to do, and they've told me they want me to do it so, I'm just going to act. I'm just going to react because you know it when you see it. And that, I think that's what really scares me because we all need to be questioning that. We all need to see someone who makes us uncomfortable and think, I don't know what is going on for them. I don't actually know if they're dangerous or not. I don't know what they need. I can either take the time to ask and try to figure out what's going on here, or maybe I should leave them alone and it's not really my place to get involved. We need to be doing more of that and not giving people something to do just for the sake of doing.
Rafik Wahbi: Yeah, I love that. I think the curiosity piece has been so non existent and, you know, seeing someone in a crisis, there's no level of curiosity. There's so much that's already been decided and determined. And this is, you know, it's not something that's an individual. It's really a thing that we as a society have determined. We're like, we have all these laws and all these narratives and all these things in place that say like, here's how the right way to act is when you see something like this. And I think it's, it's going to be a big shift. Like, again, when I talk to people, just my friends or whoever else, like, you know, one quick story is I remember talking to someone and they were saying like, yeah, I carry a knife now. And I was like, okay, why do you carry a knife now? And they're like, well, I was on the train one time and like this, you know, homeless man came in and was yelling. And I was like, yelling at you? And he's like, no, he's yelling at himself. And I was like, You're telling me this story about you having a knife because you were going to stab this person? And I'm just listening and I'm like, what is wrong with people right now? I've been seeing unhoused people come on the train and yell for 25 years, it's not new. And I'm not saying that there's not a need there, I'm not saying that there isn't something that could be potentially frightening there. But I think like, wow, you want to now bring a knife to this.
Jesse: Yeah, and now everyone has been given a knife in the form of a CARE Court application, and feel free to use it.
Rafik Wahbi: Not just individuals, but like people in power. Now it's like, hey, what's being done? What are you doing about the homeless crisis? Every mayor and every politician in California now can say CARE Court. And one last thing I'll close on is they can say that because every elected official, every single one, I think minus two, and they were Republicans, were in favor of CARE Courts. It's really important that listeners know that in a state like this, every single one except like, again, two, voted yes. This is pretty unheard of in California. You don't have bills that monumental, without even a peep. No question, no resistance, just yes. Take billions of dollars, shift them, yes, no questions asked. There's something about that that is, you know, very concerning because it's like, there's a lot of pieces moving and just a lot of people in power who are very in support of it. And so, you know, really questioning that and answering like, why is that? And I think to your point, it's because now they can say like, well, here's what we're doing. We're doing a whole lot, let me tell you what we're doing. We got CARE Courts. We got SB43. We got, I mean, it's a whole thing and they can all now say that. It sounds amazing. And that's like, I would love if I was getting paid to promote CARE Courts, oh my gosh, I would do amazing. I could promote the crap out of this thing. And that scares me. Because it feels like it's packaged in a way that it's giving so many people something to do, or something to say, or something to point to, and all of it is In my opinion, not the right things.
Jesse: Many of the people who are forced into these systems are genuinely struggling with something; a personal tragedy, a medical issue, trauma, poverty, discrimination. There is usually a very real and very serious struggle in that person's life that needs to be addressed. And if you hear about those struggles and an involuntary commitment feels like it could be a helpful response then, please, take a moment and close your eyes.
Close your eyes and imagine a person that you think these policies might apply to. Imagine that person in crisis. Imagine that crisis being responded to with handcuffs, confinement, a court order. Imagine that person being strapped to a gurney for no reason other than policy. Imagine that person seeing a needle, an injection, prepped and referenced as a threat to make them comply. Imagine that person, in court, seeing medical and legal experts that they have never once spoken to testify, under oath, that this person, this is a person who isn't fit to be free. Imagine that person, going through all of that and then when there's no longer funding to perpetuate the experience being discharged to a curb with nothing but hospital garb and an expectation from the facility that they'll be seeing this person again, real soon.
Imagine that person going through all of that and now imagine that person is you.
Because with these laws, it could be.
If these laws go unchallenged, if these proposals become policy, then we all become more vulnerable. Because as Clare Cortright so eloquently established in the first episode of this series, if this doesn't stop with us, then it doesn't stop with us.
Jesse: Committable is produced by Jim McQuaid, Michelle Stockman, and me, Jesse Mangan. All music is from the song Reasonable by Christopher G. Brown.