Responding to a crisis in plain sight, California policymakers are taking a fresh look at the law that governs when the state can compel treatment for individuals on our streets whose mental-health illness risks their own safety and demands compassion from our communities.
The issue stirs great passions, as was evidenced at a day-long legislative hearing last month on the status of the Lanterman-Petris-Short Act, which limits the government’s ability to force anyone into mental-health treatment.
This week, Governor Newsom hinted he will call to change the law to make it easier for authorities to force individuals into treatment. Opponents say the change would deny people who have suffered mightily their right to self-determination, taking a step backward to a chilling era when many were indefinitely locked up against their will.
Wherever one stands on that spectrum, it is premature to engage in that debate.
The reality is that the system we now have for intervening to protect the vulnerable is severely overwhelmed. No state agency collects data, but best estimates indicate at least 120,000 people are in conservatorship each year.
Until the framework for overseeing treatment for the vulnerable is shored up and strengthened, it is foolhardy to even discuss statutory changes that would do nothing more than inflate public expectations.
If you hear the word “conservator” and think of Britney Spears and her father, think instead of souls for whom there is no prospect of self-gain by managing someone’s affairs.
Public conservators are county employees appointed by a judge to direct the mental health treatment and placement of individuals deemed to be gravely disabled, or unable to care for their own basic needs.
All 58 California counties operate public conservator programs, and all are at full capacity. The typical caseload for public guardians and public conservators is already 63% beyond what research has shown to be the maximum for effective case management, and demand is growing.
Largely because of diversion programs in which courts place mentally ill defendants into treatment rather than jail and a rise in the number of defendants found mentally incompetent to stand trial, the populations we help have grown by more than a third in recent years.
Most health and social service programs in the state have dedicated tax revenues and statewide mandates for care. But public guardian/conservator programs must rely on discretionary county general fund revenues.
Counties critically need state financial and administrative support to serve those who because of serious mental illness are unable to provide for their own basic needs — and who, without assistance, are at risk of serious injury to themselves or others.
There is broad consensus that California must invest more in the community-based mental health programs that were promised but never delivered decades ago when the state mostly emptied its psychiatric hospitals. Indeed, last year’s budget made a significant commitment to increase behavioral health infrastructure.
This year, blessed with a substantial budget surplus, the Legislature and Gov. Newsom have an opportunity to build on that investment. One essential component must be to finally fund public guardian/conservators so that we can adequately address the needs of those in our care and act in their best interests.
A $200 million annual state investment would help ensure that our crucial safety net programs continue to protect Californians who desperately need our help now. Only after that foundation is securely in place can a meaningful discussion take place on how better to deal with the unsettling evidence of unmet mental health needs on our streets.
Scarlet Hughes is the executive director of the California State Association of Public Administrators, Public Guardians, and Public Conservators.
