Why is it so hard to get mentally ill Californians into treatment? Three bills tell the tale

By Jocelyn Wiener

For years, Diane Shinstock watched her adult son deteriorate on the streets.  Suffering from severe schizophrenia, he slept under stairwells and bushes, screamed at passersby and was arrested for throwing rocks at cars.

Sometimes he refused the housing options he was offered. Sometimes he got kicked out of places for bad behavior.  Shinstock, who lives in Roseville and works on disability issues for the state of California, begged mental health officials to place him under conservatorship—essentially, depriving him of his personal liberty because he was so sick that he couldn’t provide for his most basic personal needs of food, clothing and shelter.

But county officials told her, she said, that under state law, her son could not be conserved; because he chose to live on the streets, he did not fit the criteria for “gravely disabled.”

“I was devastated,” she said. “I cried for days.”

So Shinstock—along with her husband Joe, a policy consultant who works for Republican leadership in the Assembly—set out to change state law. Their uphill battle illustrates the complex philosophical, legal and ethical questions that surround conservatorship in California.

What responsibility does government have to protect people with serious mental illnesses who refuse treatment?  How should it balance the right to liberty with the need for care?

At the heart of the long effort to answer these questions is a law signed in 1967 by then-Gov. Ronald Reagan. Aimed at safeguarding the civil rights of one of society’s most vulnerable populations, the Lanterman-Petris-Short Act put an end to the inappropriate and often indefinite institutionalization of people with mental illnesses and developmental disabilities.

It also provided them with legal protections, such as the now-familiar rules in California limiting involuntary holds on people deemed a danger to themselves or others to 72 hours, better known as a 5150 hold.

Those who want to change the law, like Shinstock, believe Lanterman-Petris-Short’s protections too often prevent very sick people from accessing the help they need. Others say people who suffer from mental illness need better care and support from society, not intrusions on their civil liberties. If the state wants to help those with serious mental health issues, they say, it should address the housing crisis and the under-resourced community mental health systems.

It’s an argument that has repeatedly stymied bills to force seriously mentally ill people to get care. This year, several were proposed. At the moment, only one—Senate Bill 1045—is left.

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