Editor’s note: This story originally ran in Friday’s paper. We are reprinting it today as part of the story was accidentally cut off before printing.
Last year lawmakers agreed to create a narrow 5-year pilot program that makes it easier for three counties (San Francisco, Los Angeles and San Diego) to conserve homeless individuals with serious mental illnesses or substance abuse disorders. The program allows courts to conserve individuals who have been placed under a 72-hour psychiatric hold at least eight times in a year. A second law, passed this year, expanded the rules to allow 50 to 100 more people in San Francisco to be placed under conservatorship.
Civil rights advocates have raised serious concerns: In 2018, Susan Mizner, the disability rights program director for the ACLU, described conservatorship as “the biggest deprivation of civil rights aside from the death penalty” and said the law would incentivize police to repeatedly detain homeless individuals.
So far, only San Francisco has adopted it. That reflects another reality: Different counties have different rules. Even without the pilot program, depending on where you live, public defenders, judges, public guardians and others have different interpretations of the law.
“It varies from county to county, it varies within counties,” said Randall Hagar, government relations director for the California Psychiatric Association. “What is ‘gravely disabled’ here may not be considered ‘gravely disabled’ there.”
Because counties must use local funds to pay high placement costs — and because not all counties have the same types of services available — variations are a significant concern.
Disability rights advocates insist that maintaining the standards outlined by Lanterman-Petris-Short is essential to protect people’s civil rights. Most people with serious mental illnesses aren’t refusing help, they say — appropriate help just isn’t available.
Lynn Rivas, associate director of Oakland-based Peers Envisioning & Engaging in Recovery Services, understands that families feel desperate. She knew a woman with paranoid schizophrenia who lived on the streets of Richmond. Mental health workers tried repeatedly, but couldn’t get her to come inside.
Even though “it breaks my heart,” Rivas said, she’s willing to live with that consequence.
“I think involuntary imprisonment is worse,” she said.
Heather, a program coordinator at the organization, has herself experienced involuntary treatment. In the hospital, she said, everything was taken from her and her entire schedule revolved around medication.
“I think it’s just really cold the way they treat you,” she said. “It’s like you have a disease…they treat you like you’re not a human being.”
Once she stabilized, she said, the hospital discharged her back to the streets, without addressing her underlying issues. The experience not only didn’t help her, she said, it made her afraid to seek help.
Some worry that public dismay about the current homelessness crisis will encourage lawmakers to strip people of their rights.
“It’s still political failures that are trying to be masked with solutions that may decrease the visibility of individuals on the street,” said Curtis Child, director of legislation at Disability Rights California. He also compares the situation of people with mental illness to that of people with developmental disabilities. For the latter group, deinstitutionalization was accompanied by the creation of regional centers, he said, “in which everyone gets a plan, everyone gets a worker.”
“With mental illness, we did nothing.”
For Child, and many other advocates, the solution is not more conservatorship — it’s creating affordable housing and more robust mental health services.
“The volume of individuals who are entering homelessness on a given day is overwhelming all of our systems,” said Michelle Cabrera, executive director of the County Behavioral Health Directors Association of California,. “We’ve got a serious problem on our hands.”
Dr. Amy Barnhorst, vice chair of community and hospital services for the UC Davis Department of Psychiatry agrees that the focus should be on building out the mental health system, not changing the law.
“It’s like cutting more doors into an empty building,” she said. “There’s not the services there. We don’t have the workforce. We don’t have the treatments. We don’t have the infrastructure. ”
Even if a change in law permitted more people to be conserved, a shortage of placements and “a gross lack of funding” for county programs means there would be nowhere to send many of them, said Hughes, of the California State Association of Public Administrators, Public Guardians and Public Conservators.. Earlier this year, a state budget proposal to increase the amount of funding for public guardians by 35% — or $68 million — failed.
County conservators receive no direct state funding, and in the past five years have received a huge influx in clients diverted from the criminal justice system, Hughes said. Some counties went from five referrals a month to 30 or 40, she said.
“They are drowning,” she said.
Simultaneously, the number of facilities that can take them is shrinking, said Chris Koper, a legislative analyst for the organization. At one point, she said, she and some friends started listing the facilities in that county that had shut down. They stopped when they got to 35, she said: “It was too depressing.”
That leaves many conservatees in a “placement pending” status, stuck in jails or hospitals. In some cases, conservators have resorted to having staff members care for people with mental illness in hotel rooms rather than leave an individual on the streets, she said.
Most state hospital beds are now reserved for people in the criminal justice system. Inmates with mental illness can wait in limbo for months or even years in county jails before a bed opens up. Five years ago, an average of 343 inmates with mental illness were awaiting placement. Last year, the average was 819.
“The easiest legislative fix is to expand conservatorship,” Koper said. “It then will appear that the Legislature is trying to do something. But as is often the case with social problems, the wound is so much deeper than that. And the wound will require a lot of money.”
As San Francisco has assumed new authority to place people under conservatorships, The San Francisco Chronicle found a backlog. In a locked ward at San Francisco General Hospital, individuals who were conserved were waiting four months for placement in Napa State Hospital, and even longer for a residential facility.
A woman who answered the phone at the public guardian’s office in Solano County, where Rippee lives, said she didn’t have time or permission to talk, repeating several times “we’re extremely short-staffed.”
Gerald Huber, the county’s director of Health and Social Services, noted that even if Rippee were to be conserved, there are very few facilities in the state that accept people with traumatic brain injuries — and they are always full with waitlists.
Rippee’s sisters are aware.
“If they tell him, ‘Mark, you’re conserved’—” Privatte began.
“—where are they going to put him?” Hanson concluded. “There’s no place.”
