Passed
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California Assembly
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Lead sponsor
Mental health and psychiatric advance directives.
(1) Existing law establishes the requirements for executing a written advance health care directive that is legally sufficient to direct health care decisions. Existing law provides a form that an individual may use or modify to create an advance health care directive. Under existing law, a written advance health care directive is legally sufficient if specified requirements are satisfied, may be revoked by a patient having capacity at any time, and is revoked to the extent of a conflict with a later executed directive. Existing law requires a supervising health care provider who knows of the existence of an advance health care directive or its revocation to record that fact in the patient's health record. Existing law sets forth requirements of witnesses to a written advance health care directive. A written advance health care directive or similar instrument executed in another jurisdiction is valid and enforceable in this state under existing law. A person who intentionally falsifies, forges, conceals, defaces, or obliterates an individual's advance health care directive or its revocation without the individual's consent is subject to liability of up to $10,000 or actual damages, whichever is greater, plus reasonable attorney's fees. Existing law authorizes an appeal of specified orders relating to an advance health care directive. Existing law generally prohibits involuntary civil placement of a ward, conservatee, or person with capacity in a mental health treatment facility, subject to a valid and effective advance health care directive. Existing law prohibits specified entities, including a provider, health care service plan, or insurer, from requiring or prohibiting the execution or revocation of an advance health care directive as a condition for providing health care, admission to a facility, or furnishing insurance. Existing law requires the Secretary of State to establish a registry system for written advance health care directives, but failure to register does not affect the directive's validity and registration does not affect a registrant's ability to revoke the directive. Under existing law, an advance psychiatric directive is a legal document, executed on a voluntary basis by a person who has the capacity to make medical decisions and in accordance with the requirements for an advance health care directive, that allows a person with mental illness to protect their autonomy and ability to direct their own care by documenting their preferences for treatment in advance of a mental health crisis. An individual may execute both an advance health care directive and a voluntary standalone psychiatric advance directive. This bill would extend the above-described advance health care directive provisions to psychiatric advance directives and would make conforming changes. The bill would specify that a psychiatric advance directive is a legal written or digital document, executed as specified, that allows a person with behavioral health illness to document their preferences for treatment and identify a health care advocate in advance of a behavioral health crisis. Under the bill, a written or digital psychiatric advance directive may include the individual's nomination of a health care advocate who is in agreement to uphold the person's preferences for treatment in the case of a behavioral health crisis. If the health care advocate is informed of the directive's revocation, the bill would require them to promptly communicate that fact to the supervising health care provider and any health care institution where the patient is receiving care. The bill would specify that a psychiatric advance directive is legally sufficient if it contains the date of its execution and is signed by the individual, their health care advocate or another adult in the individual's presence and at the individual's direction, and one additional, unrelated witness. (2) Existing law requires a court determining whether to grant or deny a conservatorship petition to consider the person's abilities and capacities with current and possible supports. Existing law requires the Judicial Council's conservatorship alternatives program to provide information relating to less restrictive alternatives to conservatorship. This bill would specify that a person's current and possible supports to be considered by a court in a conservatorship determination include psychiatric advance directives and health care advocates. The bill would specify that less restrictive alternatives to conservatorship include psychiatric advance directives for purposes of the conservatorship alternatives program. (3) Existing law sets forth various requirements and procedures for mental health treatment, community mental health services, and for a person with a psychiatric advance directive that allows a person with mental illness to protect their autonomy and ability to direct their own care by documenting their preferences for treatment in advance of a mental health crisis. Existing law requires directions in an advance health care directive to be considered in formulating a written treatment plan for a person who is the subject of a petition for involuntary treatment. This bill would require a designated facility evaluating if a patient is in need of involuntary mental health services to keep a record that includes if the person detained has an advance health care directive or a psychiatric advance directive. If a person who is the subject of a petition for involuntary treatment has a psychiatric advance directive, the bill would require directions in that directive to be considered in formulating their written treatment plan. Existing law authorizes a person experiencing a serious mental disorder who meets specified criteria to be a respondent in a CARE plan to provide an individualized, appropriate range of community-based services and supports. Existing law authorizes the respondent to designate a supporter to assist them to understand, make, communicate, implement, or act on their own life decisions during the CARE process, and sets forth the duties of a supporter. This bill would authorize a health care advocate to be a supporter in the CARE process. The bill would authorize a supporter to provide information to the respondent about advance health care directives or psychiatric advance directives and would authorize the supporter to be present in a meeting, proceeding, or communication relating to interacting or communicating with the chosen health care advocate. The bill would prohibit a supporter from creating a psychiatric advance directive without explicit authorization by the respondent with capacity. (4) Existing law establishes the Behavioral Health Services Oversight and Accountability Commission, also known as the Mental Health Services Oversight and Accountability Commission, to promote transformational change in California's behavioral health system through research, evaluation and tracking outcomes, and other strategies to assess and report progress. This bill would require the commission, at least annually from 2025 to 2030, inclusive, to assess the extent to which digital psychiatric advance directives have been implemented and submit recommendations on ways to improve the adoption and effectiveness of digital psychiatric advance directives to specified committees of the Legislature. (5) Existing law establishes a statewide system of child welfare services and foster care. Existing law requires a caseworker or probation officer and representatives of a participant in the foster care system to provide the youth or nonminor dependent with assistance and support to develop a written plan with options in the 90-day period before the participant transitions out of the system. Existing law establishes the jurisdiction of the juvenile court, which is permitted to adjudge children who have suffered abuse or neglect to be dependents of the court under certain circumstances, and prescribes various hearings and other procedures for these purposes. Existing law requires a county welfare department to submit a report verifying that certain information, documents, and services, including an advance health care directive form, have been provided to a dependent child. This bill would specify that the 90-day transition plan may include options for creating a psychiatric advance directive and choosing a health care advocate, as well as information regarding the psychiatric advance directive written or digital form. The bill would require a county welfare department to provide a dependent child with an advance health care directive or psychiatric advance directive written or digital form. By increasing the duties of county welfare departments, this bill would impose a state-mandated local program. (6) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.
