Update on Conservatorships

Some of our local and state officials recognize that the current 50-year-old system of handling conservatorships is inadequate and needs to be modified and updated; they are asking for new laws to use as treatment tools.

Under current California laws, the only ways to help severely mentally ill individuals who refuse treatment are 5150 holds and conservatorships. However, the historical rationale for these methods may not apply to today’s circumstances, especially with the increasing numbers of mentally ill and addicted homeless people.

A conservatorship is a way for someone to assume legal guardianship over an adult when the individual in question does not have the capacity to make decisions on their own behalf. This is a serious responsibility that involves denying specific aspects of an adult’s freedom for a period of time. California law proscribes criteria to establish whether an individual is capable of knowing and understanding their actions or whether he or she is gravely disabled. These criteria include determining if a person is unable to provide for the basic personal needs of food, clothing and shelter and if the individual is a danger to self or others.

A 5150 hold (a section of the California Welfare and Institutions Code from the Lanterman-Petris-Short Act) authorizes a 72-hour hold, an involuntary admission to a hospital, to prevent a person from harming self or others. This hold must be initiated by a police officer, psychiatrist or mental health personnel; the purpose is to treat the patient in order to stabilize him or her. If the treating psychiatrist sees the need for continued treatment for stabilization, the psychiatrist may initiate a 5250 hold for an additional 14 days. The doctor may then request a Conservatorship investigation from the public guardian’s office, which can eventually lead to the appointment of a public or private guardian, or a family member conservator.

The 1967 Lanterman-Petris-Short (LPS) Act was designed to prevent inappropriate lifetime hospitalization of mentally ill people by making it harder to compel their commitment. However, this act, combined with the closure of mental hospitals without the promised addition of community mental health facilities, left people with inadequate options to get the mental health care they needed.

Two recent California Senate bills (SB 1045 in 2018 and SB40 in 2019) were attempts to update the LPS Act by authorizing orders for assisted outpatient treatment and by establishing a temporary conservatorship if a person has been detained for eight 5150 holds in a 12-month period. In San Francisco, for example, that means about 100 people a year would be eligible to be compelled to accept treatment.

In his State of the State Address on Homelessness last January, Governor Newsom called for policies regarding conservatorships to be tailored to reflect today’s realities of street homelessness, which are so different from the times when the original laws were enacted. Newsom stated: “It’s time to respond to the concerns of experts who say that thresholds for conservatorships are too high and should be revisited.”

Additional reform bills that were going to be considered in 2020 were not advanced, partly because the coronavirus stopped non-coronavirus-related bills in the legislature. Another reason is the ongoing debate over civil rights, with the ACLU and other organizations declaring that involuntary holds are inhumane and advocating for severely mentally ill individuals to remain on our streets if that is what they want. Let’s stay alert for news of any proposed legislation around conservatorships, keep informed about the issues, and provide support for updates to legislation that will help the gravely disabled homeless people currently languishing on our streets.

Author:Pam McGranahan Source: Pacific Palisades Task Force on Homelessness