SACRAMENTO — When Julie Rodriguez drove herself and her two young children into the muddy depths of the Sacramento River last spring, she wasn't the same person her parents had raised. She had become someone else, they say, someone distorted by illness and suffering.
William and Elvira Gonzalez couldn't help her. The way they see it, they weren't allowed to.
Rodriguez, 31, refused treatment for her deepening paranoia and psychosis. And despite her family's pleas to counselors, doctors, children's protective services officials and the police, no one felt able to force her into a hospital.
"They wouldn't do [anything] unless she did something real drastic," Elvira Gonzalez said. "I said, 'Are you going to wait for a tragedy to happen? By then it will be too late!' "
Last May, Gonzalez was proved horribly right. Rodriguez, once a doting mother, ended three lives with the turn of a steering wheel. Efrain was 4, Priscilla 2.
Citing sensational crimes and lesser-known tragedies like these, as well as dramatic improvements in psychiatric medications, critics of California's commitment law want to make it easier to force resistant mental patients into treatment.
"No one wants to go back to the days when it was too easy to hospitalize someone and throw away the key," said Rosalyn Kalmar of Los Angeles, who has struggled to get care for her daughter. "But we've gone too far in the other direction."
These reformers--mostly health care providers and families of the mentally ill--face a rock wall of opposition from patients rights groups and civil libertarians. They insist that the 1969 law and subsequent protections are in place for a good reason: to prevent any repetition of past psychiatric abuses.
At issue is the strict, complex set of rules that California has developed over the past 30 years governing detention and treatment of psychiatric patients against their will. Before they were enacted, patients could be hospitalized indefinitely after what critics considered perfunctory court hearings. Hospital staff determined how long they were held.
Now, people can be committed to hospitals for evaluation only if doctors find them dangerous to themselves or others, or so gravely disabled that they can't care for their basic needs. A person can be detained for three days before a hearing must be scheduled.
In the name of public and patient protection, reformers want to allow involuntary commitment when patients' conditions have deteriorated markedly, for example, or when their histories show poor judgment about their own care. Reformers also want to broaden use of outpatient commitments--court-ordered medication and monitoring in the community--so that care is not restricted to brief, expensive hospital stays.
Many patients, former patients and civil libertarians cringe at the very notion, recalling psychiatry's sordid history of drastic, misguided treatments administered in the name of science: lobotomies, sterilizations, clitoridectomies and convulsive "therapies."
Some have themselves been involuntarily hospitalized, placed in restraints, misdiagnosed and drugged repeatedly against their wills. To them, the freedom to refuse treatment is a fundamental right rooted in long-standing medical precepts and constitutional protections of life, liberty and the pursuit of happiness.
"Give me liberty or give me death!" said Sally Zinman, executive director of the California Network of Mental Health Clients, which has 1,115 members.
Retorts E. Fuller Torrey, a psychiatrist and national proponent of legal reform: "Being psychotic on the streets is not being free. You are imprisoned by your brain dysfunction."
In California, the already raging debate appears destined to intensify during the next legislative session, when reform proposals are expected to be introduced.
Meanwhile, other states have forged ahead. New York legislators were shocked into action by two recent incidents in which unmedicated mental patients pushed strangers under subway cars. In August, the state passed a law named after one of the victims, Kendra Webdale, that makes it far easier for the courts to order outpatient mental treatment.
For the last 30 years, California has been headed mostly in the opposite direction, toward greater patient freedom. This state eagerly emptied state mental hospitals, and went on to pass the trailblazing Lanterman-Petris-Short Act, which built tough civil rights protections into mental health law. The protections were emulated throughout the nation.
Now that safer, more effective medications can treat and perhaps forestall illness, and patients don't necessarily need to be hospitalized, the question is whether California will change its course.
