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The streets of Santa Monica are filled with homeless people in desperate need of housing and services, but only those with the most severe mental illnesses and substance abuse disorders can be forced into inpatient treatment.
The Lanterman-Petris-Short Act, California’s guiding conservatorship law, allows an individual to be involuntarily confined and treated if they are a danger to themself, a danger to others or gravely disabled because of their mental illness. An individual is considered gravely disabled if they are unable to provide their own food, clothing or shelter, have no third party to help them meet those basic needs and are unwilling or unable to accept treatment.
Police officers and government officials are authorized to take an individual to a psychiatric facility for 72 hours, where a doctor decides whether they should be released or kept in the facility for another 14 days.
Under the LPS Act, conservatorships may only be administered by the Office of the Public Guardian, which initiates the process if a doctor determines that an individual is still gravely disabled after the 14-day hold. The Public Guardian reviews clinical evidence from the doctor and petitions the court to approve a 30-day conservatorship.
The office then investigates whether the individual needs to be placed on a one-year conservatorship, taking into account all possible alternatives, and presents the case at a conservatorship hearing.
If the court rules that a one-year conservatorship is necessary, it appoints a conservator, who could be a friend, family member or the Public Guardian. The court also decides whether the individual should live at home, with their conservator or in a local or state facility. Individuals can challenge a conservatorship ruling through a jury trial.
The Public Guardian must decide after one year whether to extend or end the conservatorship. There are no limitations on how many times a conservatorship may be renewed, so some individuals may be put under conservatorship for a number of years.
The LPS Act, which was signed into law by Governor Ronald Reagan in 1967, was intended to prevent people with mental illnesses, developmental disabilities and substance abuse disorders from being forced into state institutions, where patient abuse was rampant.
But lawmakers have sought to reform the LPS Act since the 1980s, when it became apparent that the bill’s emphasis on deinstitutionalization and the lack of guaranteed funding for community-based mental health treatment had resulted in thousands of people with mental illnesses and substance abuse disorders living on the streets. In Santa Monica, almost two-thirds struggle with mental illnesses, substance abuse disorders or a combination of the two, according to a 2019 survey.
State legislators and local officials are once again calling for reform as the state grapples with a worsening homelessness crisis, although their approaches have differed.
In 2018, the California State Legislature approved a bill introduced by San Francisco state senator Scott Wiener that created a five-year pilot program in the counties of San Francisco, Los Angeles and San Diego to conserve any individual who has been placed on a 72-hour psychiatric hold eight or more times in one year.
“Too many people are deteriorating and dying on San Francisco’s streets, and we have a moral responsibility to help them,” Wiener said in a statement after the San Francisco Board of Supervisors voted last June to implement the bill. “It’s neither progressive nor compassionate to stand by while people die. We need to offer voluntary services to those in need, but for people incapable of accepting services, we need to consider helping them via conservatorship.”
Other bills that would broaden the definition of gravely disabled to include individuals who are unable to make informed decisions about their care have died in committee, with disability rights advocates and progressive lawmakers arguing the definition was overly vague and would threaten the civil rights of people with mental illnesses.
Critics of the bills also said expanding conservatorship would have to be preceded by a huge investment in mental health facilities. In a position letter on a failed conservatorship bill that Orange County state senator John Moorlach re-introduced in January, Disability Rights California legislative director Curtis Child said the bill would bring more individuals into a system ill-equipped to house them and provide services.
“There is nothing in this bill that expands services or creates more housing or physical or mental health care, which is what the real problem is,” Child said.
Connie Draxler, deputy director of the Los Angeles County Office of the Public Guardian, said mental health patients, particularly those under conservatorship, get stuck in hospitals for months before they can transition to the next level of care because of a countywide and statewide shortage of beds in state hospitals, psychiatric facilities, residential care homes and supportive housing. The capacity of mental health hospitals has also been impacted as patients languish in what are supposed to be short-term beds.
The county Board of Supervisors voted last December to add 500 mental health beds throughout the county over the next two years, Draxler added.
“The shortage of beds is our biggest challenge, in L.A. and across the state,” Draxler said.