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California’s Conservatorship Crisis

Recently I was following a conversation on the app ‘Next Door’ about homelessness. The participants were complaining that tents, RVs and individuals seem to have taken root in the community, like where the old Burlington Coat Factory used to be.

A City Councilmember chimed in saying every person experiencing homelessness in the city has been offered shelter and services. He suggested that nothing more could be done to clean up the community or about those living unsheltered.

My mind recalled the countless conversations I’ve had with the family members of the mentally ill. They’ve told me about restraining orders, searches in back alleys and shelters for their child, and arguments with law enforcement over illnesses that cause odd and threatening behavior. These family members wished there was some way to compel their loved ones into treatment but arcane laws and antiquated rules tie the hands of law enforcement and public health systems. Dr. Drew Pinsky talks about how absurd the current situation is here.

In California, the fifty-four old Lanterman-Petris-Short Act (LPS) governs conservatorship – the appointment by a judge of a guardian or protector to manage the daily life of another due to mental limitations. According to El Dorado County District Attorney Vern Pierson, LPS all but ended the practice of institutionalizing patients against their will. LPS was a product of its time and based on outdated scientific/medical information. We now understand that these are brain diseases and that 50% of those with psychosis cannot recognize they are sick due to cognitive impairment. In the first year after LPS was enacted, the number of mentally ill people entering the criminal justice system doubled.

Now, a new report by Alex V. Barnard of New York University, demonstrates that California’s conservatorship law is creating incentives to hospitals, mental health professionals, and law enforcement to use the streets as the dumping grounds of California’s mentally ill.

According to Barnard, communities are electing to put fewer people into long-term conservatorships and, instead, are using more short-term ‘holds.’ The maze of regulations necessary to conserve someone is so great, and the funding and staffing necessary to conserve is so expensive, public entities resort to superficial and inconsistent decisions. Decision making is not clear, standards are ever-changing, and a lack of placements creates a sense of futility where the street becomes the easiest solution.

“Police see people who are high, and a

5150 is an easy way to get them off the

street. The ER won’t admit them, and

they come back. The system is kind of

functionally-dysfunctioning.”

– County MH Director

According to the Hospital Association of Southern California, it’s estimated that approximately 1,000 individuals are on a 5150 hold in an emergency department on any given day. California hospitals see more than 1 million individuals with a behavioral health diagnosis in their emergency departments annually. In addition to the high threshold for conservatorships, the scarcity of psychiatric beds creates a “no room at the inn” scenario for those suffering with mental illness.

The lack of facilities, funding, and the complexity of the way to help those suffering on the street has created conversations about whether people are “successfully homeless.” Barnard quotes one County Public Guardian saying, “We’ve had clients who are homeless by choice…You or I may not feel that’s good for them, medical health wise or mental health wise, but it’s their choice, and if they can articulate that, ‘I go to the soup kitchen, I go to Goodwill, I have Social Security, and I use that income to buy those clothes, and I have a sleeping bag, that’s what I want,’ well, the doctor may not feel that’s appropriate, but if they’re able to articulate that…we may reject that referral.”

The Councilmember cited previously may identify with the Public Guardian – that there is little we can do. But that ends up as a system of managing suffering and destitution instead of solving and treating the needs of the unhoused mentally ill.

The truth is that LPS is overdue to be reformed or replaced. This antiquated and ineffective law has directly caused untold deaths, human suffering, and community destruction. What’s needed is for those complaining on Next Door to contact their state legislators and help them connect the dots that thin mental health services and out-of-date laws are contributing to the destruction of communities and the decompensation of people living exposed and vulnerable.

By Paul Webster

Paul is an advocate, legislative and policy expert, and the Director of Hope Street Coalition. Hope Street focuses on the intersection of homelessness, mental illness, and chronic addiction. He has worked at the local, state, and federal levels most recently as a Senior Policy Advisor at the U.S. Department of Housing and Urban Development.