LOS ANGELES – The Los Angeles County Board of Supervisors voted Tuesday to re-evaluate how it manages conservatorships for mentally ill individuals unable to care for themselves, including potential changes to state law.
The state conservatorship system is governed by the Lanterman-Petris-Short Act, signed into law in 1967 by then-Gov. Ronald Reagan. The act was designed to end abuses of mental health patients and limit the time individuals could be held involuntarily in a psychiatric facility.
Supervisors Sheila Kuehl and Kathryn Barger joined in the motion to review the law and the way it is put into practice in Los Angeles County.
“It’s a really complicated system,” Kuehl said.
The move represented a shift for Kuehl, who warned in April about the county taking on the responsibility of deciding who is and isn’t severely impaired. At that time, she stressed the civil rights of mentally ill individuals to refuse medication or other treatment and said it would take years to make any changes to the state law.
Kuehl told colleagues Tuesday that she was moved to act by the one-year anniversary of the death of homeless advocate Mollie Lowery, who spent three decades fighting to establish permanent supportive housing and led multiple nonprofits providing homeless services.
“Molly’s devotion to each individual person … (with) their own form of mental terrors” inspired her, Kuehl said.
Barger has been pushing for a more aggressive approach for months. It was something her predecessor, Michael Antonovich, also sought, though more often in the name of public safety. Barger has stressed the benefits to those suffering from mental illness.
“We really want to get to the root cause” of trying to keep mentally ill homeless individuals from cycling endlessly between hospital emergency rooms, jail and the street, Barger said.
“The consequences of not placing gravely disabled individuals on conservatorship when legally indicated can be dire in some cases given the life and death consequences of untreated mental illness,” the board motion states. [View the motion here.]
Under the law, those judged to be a danger to themselves or others or “gravely disabled” can be held against their will in a psychiatric facility for up to 72 hours. This is commonly called a 5150 hold based on the relevant government code.
“Gravely disabled” means that someone cannot provide for their own basic needs, including food, clothing and shelter, due to a mental disorder.
The standard can be difficult to meet in practice.
Roughly 2,700 individuals in Los Angeles County are currently under LPS court-mandated conservatorship.
An initial conservatorship is temporary and lasts for 30 days while the court investigates the need for yearlong supervision. Of the more than 900 referrals in 2016, about two in three ended in a one-year commitment that must be reviewed by the courts annually.
All conservatorships, even those instigated by family members, are overseen by the county’s Office of the Public Guardian. Caseloads there are heavy, with deputies handling on average between 60 and 80 cases.
“The scope of work … is very, very broad and the caseloads are very, very high,” Dr. Jonathan Sherin, director of the Department of Mental Health, told the board, adding that the conservatorship process could be streamlined.
The OPG also handles probate conservatorships for individuals unable to care for themselves due to physical illness or cognitive impairment, though that is not the focus of the review.
The board directed staffers to look at ways to increase the success rate of conservatorship hearings and improve residential placement options, as well as a system for tracking individuals with a history of repeated 5150s or psychiatric emergency services.
The working group will also look at whether changes to state law are appropriate.
A report is expected back in four months.