The complicated birth of the Lanterman-Petris-Short Act

It is not hyperbole to call the Lanterman-Petris-Short Act of 1967 one of the most impactful pieces of California legislation of the last 60 years. The law, named for its three primary authors, fundamentally changed how this state deals with the mentally ill. The ramifications of those changes are now felt every day in virtually every community across California, for better and worse. In this piece, our Dan Morain offers an unvarnished look at the origins of this historic measure.

Sen. Alan Short was the first author to denounce the legislation that bore his name, the Lanterman-Petris-Short Act that led to the emptying of California state hospitals and remains all but unchanged 56 years later.

In later years, the other two principals, Republican Assemblyman Frank Lanterman and Democratic Sen. Nicholas Petris, the main drivers behind what they at one time proudly called the Magna Carta for state hospital patients, would acknowledge the flaws as well.

For more than five decades, the Lanterman-Petris-Short Act has been the foundation for how California treats or fails to treat people with severe mental illness. Now, legislators from both parties seek to overhaul it in ways that reflect advances in medicine, and a better understanding of its failings.

The Lanterman-Petris-Short Act of 1967 was the product of idealism, shrew legislating, hubris, power politics, and compromises and omissions that ensured it would fail the people it was intended to help.

Short, a Democrat first elected to represent Stockton in 1954, was in his final term on Aug. 2, 1973 when he spoke up at a legislative committee hearing in his hometown of Stockton. Lawmakers were grappling with the future of Stockton State Hospital, the state’s first psychiatric hospital and a source of steady, well-paying jobs for Short’s constituents.

In the early moments of the hearing, Sen. Alfred Alquist, a San Jose Democrat and the committee chairman, asked the hospital’s medical director whether he thought the Lanterman-Petris-Short Act ought to be changed. Freeman began answering when Short broke in and recalled how his name came to be added to the legislation.

“I put in a simple bill on the Senate side to give counties more community mental health money from the state,” Short said. “When it came back from the Assembly, the LPS Act had been amended into it. …

“I had nothing to do with their tacking the name [Short] on it in the Assembly, and to tell you the truth, I am very unhappy that my poor little Senate bill ended up as the Lanterman-Petris-Short Act.”

Short, Lanterman and Petris have long since died. But details about their legislation can be found in the bill file and in Gov. Ronald Reagan’s file on the legislation in the Secretary of State archives, and in documents at the Lanterman family home, which is a museum in La Cañada Flintridge.

Sen. Alan Short was the first author to denounce the legislation that bore his name, the Lanterman-Petris-Short Act that led to the emptying of California state hospitals and remains all but unchanged 56 years later.

“If it needs changing, let’s change it,” Short said. “Patients are being denied admittance into a state hospital facility when they should be admitted. Let’s change it so that we can do that. If they are being prematurely released, let’s stop it and let’s change the law so that no one goes to any lesser facility, or is released when he shouldn’t be released.”

Short was at the end of his career and like all lame ducks, his clout was waning. Lanterman, who would serve until 1978, and Petris, who served until 1996, were still believers.

Lanterman had been in office for 17 years in 1967 and was considered the Legislature’s expert on matters related to mental health care. Though he was a Republican in the Assembly dominated by Speaker Jesse Unruh, he was so admired that he was known as Uncle Frank.

At their peak in 1959, California’s 12 state hospitals housed 37,489 people. That was the first year of Gov. Edmund G. “Pat” Brown’s tenure. Brown steadily reduced the population, down to a little more than 26,000 by 1966, the year he lost reelection to Reagan.

Problems persisted even as the patient census declined. At Lanterman’s behest, two of the Capitol’s best commenced an investigation. One was Arthur Bolton, who later became a consultant on mental health care law. The other was Steve Thompson, who became Speaker Willie Brown’s top policy aide and director of the California Medical Association.

Together, they produced a report in 1966 documenting a fundamental lack of due process. Judges spent an average of 4.7 minutes hearing cases before sending people to state hospitals, often for a lifetime.

At one hospital, residents sat in assigned seats in an auditorium watching television. When the television went on the blink, they would stare at the snow on the screen.

At DeWitt State Hospital east of Sacramento, a staff physician, an alcoholic, prescribed an enema to a patient with a bloated stomach. The patient turned out to be pregnant. Clearly, something had to change.

On May 2, 1967, Lanterman and Petris unveiled their response, the Community Mental Health Act, AB 1220. It was a product of its times, introduced as young people and people of color were demanding greater rights, and protesting injustice at home and abroad in Vietnam.

The L.A. Times, the San Francisco Chronicle and the Sacramento Bee all covered the story, though the Bee was only paper to play the story on the front page, below the fold.

“It will set a new standard for humanitarian treatment and care of the mentally ill person,” Lanterman told reporters, as quoted in the Bee.

The announcement might have received more attention, except on May 2, Bobby Seale led two dozen members of the Black Panther Party for Self-Defense into the Capitol. They were carrying unloaded pistols and rifles, protesting what they saw as an infringement of their Second Amendment right–legislation to ban carrying of firearms in public places.

The legislation, authored by Republican Assemblyman Don Mulford who represented the Oakland Hills, was a reaction to armed patrols Panthers had been carrying out in Oakland intended to protect Black residents against police abuse.

Legislators, outraged that their sanctum had been breached, fast-tracked Mulford’s bill. With the National Rifle Association’s support, Reagan signed the bill on July 28, 1967, and declared there was no need for anyone to openly carry a firearm.

The Lanterman-Petris bill, AB 1220, ran 36 pages. In its own way, it was revolutionary. It sought to shift the responsibility for caring for people with psychiatric disorders away from state-run asylums to counties.

The bill would permit people with severe mental illness to be held against their will, but for no more than 72 hours without a hearing, and only if psychiatrists deemed them to be gravely disabled, unable to care for themselves, and a danger to themselves or others–a standard that would be altered under current legislation.

Anyone who was so ill they needed to remain in institutions could refuse surgery. They could wear their own clothes, have money for use at the hospital canteens, although few had any money to spend, speak privately by telephone, and receive unopened mail. Upon release, their medical records would be sealed. In its most revolutionary step, the legislation would end indefinite commitment.

On a basic level, the bill represented a union between conservatives who sought to cut spending–state hospitals were costly–and civil libertarians, who believed people who had not committed crimes should be free, except in very rare and extreme circumstances. Because of Lanterman’s gravitas and Unruh’s support, the Assembly easily approved the legislation and sent it to the Senate.

“The bill makes badly needed procedural reforms but does not enact new financing or administrative changes on the state or county level.”

There, Sen. Short had a different vision, and bottled up the Lanterman-Petris bill in the Senate. A decade earlier, in 1957, Short co-authored one of the nation’s first bills that provided money for local governments to care for previously hospitalized people. In 1967, he won Senate approval of his bill, SB 677, to increase that funding.

Lanterman and Unruh, determined to get a deal, held Short’s bill hostage in the Assembly. Negotiations commenced.

Local officials embraced Short’s version, which would give them more money, and worried the Assembly version would add new costs. Law enforcement believed crime would spike if patients were released. After hearings, Lanterman would cross the street to his booth at the Senator Hotel bar and over a tumbler of Fundador confer with reticent lobbyists, scribble notes on napkins, and tweak the bill.

The impasse ended on Aug. 4, the last day of the 1967 session, in the form of a rewritten SB 677. Short would deliver more money for local governments, and Lanterman and Petris would retain the civil rights provisions they sought.

Omitted was any requirement that local governments provide care. Lanterman described the changes in a memo to himself:

“The conference committee has eliminated:

• “All sections requiring counties to develop county plans
• “All sections pertaining to county costs …
• “There is no required additional state or county cost in the bill …

“In summary–the bill makes badly needed procedural reforms but does not enact new financing or administrative changes on the state or county level.”

Democratic and Republican legislators unanimously supported the compromise, and the Lanterman-Petris-Short Act was born.

Ronald Reagan, not yet nine months into his first term as governor, had expressed support for the concept of the legislation. But his Department of Finance warned that costs could skyrocket. Lanterman, who would become one of Gov. Reagan’s closest legislative allies, worked more magic.

As detailed in an internal memo to Reagan from Spencer Williams, Reagan’s health and human services secretary, a side deal with Lanterman made clear that the state “assumed there is no legal or moral obligation to fund, regardless of the total cost, the services proposed by local government.”

Alan Short underscored that point in a letter urging Reagan to sign the legislation: “The bill makes badly needed procedural reforms but does not enact new financing or administrative changes on the state or county level.”

In other words, California would empty state hospitals, and shift the responsibility to care for people with mental illness and brain damage to local authorities. The state abdicated itself of legal obligation to pay for that care and did not require that counties deliver care.

The bill’s implicit hope was that once out, families would care for patients. It was at best naïve. What of people who had no family or whose family could not or would not help?

If reliance on family wasn’t its fatal flaw, the legislation contained no provision to provide shelter for people who would have once been housed in state asylums. That failure to guarantee housing reverberates to this day, on streets in every city in California.

In that first year in office, Reagan presided over an execution, signed legislation legalizing abortion, and raised taxes to balance the budget. He focused on welfare, spending, and civil unrest. His priorities did not extend to questions about how best to care for people with severe mental illness, though he trimmed the Department of Mental Hygiene’s budget.

Reagan signed the Lanterman-Petris-Short Act on Sept. 2, 1967. There was no fanfare. To give counties time to prepare, the legislation would not take effect until July 1, 1969, though the law did not require local governments to do much. By the time Reagan left the governor’s office at the start of 1975, only a few thousand patients remained in state hospitals.

Lanterman was in his final term in office in June 1977 when President Carter’s commission on mental health care, led by First Lady Rosalynn Carter, convened a hearing at the Sheraton Palace Hotel in San Francisco. Lanterman testified, telling the commission: “In the rip-off of the dollars for the state hospitals, the dollar has not followed the patient.”

The bill’s implicit hope was that once out, families would care for patients. It was at best naïve. What of people who had no family or whose family could not or would not help?

The following year, the Philadelphia Inquirer produced the ground-breaking series “The Moveable Snake Pit,” detailing problems that have only grown worse: people with severe mental illness seek care in community facilities that don’t exist, or they don’t seek care and end up living and dying on the streets, or in jail or prison.

“I have devoted my life to taking care of the mentally ill, the handicapped, the developmentally disabled,” Lanterman told the Inquirer. “And apparently it is coming to a rather sad and confused conclusion.”

Separately, Petris explained in an oral history in 1989 that his goal had been to protect patients by giving them rights. But instead, he saw more homelessness and incarceration.

“I was tormented personally,” he said. “I just didn’t know what the right thing to do was. I didn’t know whether these horror stories which we started to get were just a drop in the bucket and were inevitable (or) whether a change in the other direction would get us back to where we were before. Nobody wanted to do that.”

In the decades since, Reagan became an easy target for some Democrats looking for someone to blame for homelessness among people who are mentally ill. But Democratic legislators supported the 1967 compromise, and governors since Reagan generally have not focused on the issue, until now.

Homelessness is now a top voter concern, and Gov. Gavin Newsom has made it and mental illness top-tier issues. And in the Legislature, his allies have again set about efforts to correct the flaws written into a landmark law 56 years ago.