State Policy/Court Orders Keep Mentally Ill Homeless on the Streets of California

California has 50% of the nations homeless.  By many estimates 90% of the California homeless are drug addicts, alcoholics and/or mental ill.  It is the policy of the State—and court orders—that keep these sick people on the street without help or chance of recovery.  A few are saved—not by government but by private organizations.

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“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 wait lists.

Literally, government does not provide the money needed for health care , protection or rehabilitation.  While San Fran is spending half a billion to stop cars from driving on Market Street, they do not have the money to get the mentally ill off the streets and into recovery.  Government priorities are the problem.  No wonder President Trump is looking at taking over the homeless problem—the problem is NOT the homeless it is the government.

“We’ve lost our compass.” For California’s most visible mentally ill, is a return to forced treatment a solution — or a false promise?

By Jocelyn Wiener, CalMatters,  12/30/19    

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The sightings of James Mark Rippee are all over his sisters’ Facebook.

Someone spotted him sleeping by a furniture store in Vallejo. Someone walked him to a gas station for coffee. Someone prayed for him at Nations Giant Hamburgers.

Rippee, 56, developed schizophrenia after a horrific motorcycle accident more than three decades ago caused a traumatic brain injury and the loss of his eyesight. His delusions range from being an alien, to getting chased by the KKK, to being prevented from collecting his lottery winnings, his sisters say.

In September, he stepped into traffic and was hit by a car, his sisters say, then developed a brain abscess. After weeks in the hospital and a board-and-care, he walked out and  his 62-year-old twin sisters – Catherine Hanson and Linda Privatte – weren’t alerted.

Now they couldn’t find him.

Complicating things further: Hanson is bedridden with blood cancer; Privatte is legally blind and cannot drive. They’ve come to depend on a Facebook community, “Mark of Vacaville,” to be their “eyes and ears” on their brother’s situation.

The existence of the 2,000-plus member group is at once a moving testament to a community’s compassion and an indictment of a system that often leaves the most vulnerable to fend for themselves.

Why do people as sick as James Mark Rippee sleep on our streets? Some blame laws that prioritize civil rights over forced treatment; others point to an under-resourced and uneven mental health system that has failed to provide people like Rippee with long-promised care.

Everyone struggles with the same underlying question: What should be done?

“When we allow people to deteriorate on the streets, or interface with law enforcement that leads to incarceration, what are we doing?” asks Dr. Jonathan Sherin, director of the Los Angeles Department of Mental Health. “We’ve lost our compass.”

State lawmakers are watching a controversial new pilot program to expand forced treatment in San Francisco.

In the meantime, families watch in desperation as loved ones cycle between homelessness, emergency rooms and jail cells. Short courses of medication may lead to the quieting of voices, which, in turn, leads to a release to the streets. Often, as in James Mark Rippee’s case, the family is simultaneously shut out of the conversation and blamed for abandonment.

Some of these families are aware of the downsides of involuntary treatment, the miserable side effects of psychiatric medications, the critical shortage of inpatient facilities. They recognize that conservatorship – in which a court-appointed conservator manages another person’s living situation, medical decisions and mental health treatment — is no panacea, and should be a last resort.

James Mark Rippee himself puts it this way: “I don’t need to be in a locked-up facility. It was like I was a hostage.”

In recent years, Rippee’s twin sisters — Hanson, the red-headed warrior, Privatte, the blonde diplomat — have redoubled their decades-long effort to get him help. They worry their own health problems might someday leave no one to fight for him.

“He is the worst-case scenario of anybody being so vulnerable on the streets,” Hanson said. “Every winter we wonder: Is this going to be the year that he dies?”

In 1967, a law passed that transformed the treatment of people with mental illness in California.

Until then, it had been fairly easy for a family member to call police to force someone into mental health treatment. Conditions in the state hospitals were frequently abhorrent:  Patients wore gunny sacks, sometimes bathed just once a week, and were subjected to lobotomies and electric shock treatments. Too often, people were locked away for life.  

Republican Assemblyman Frank Lanterman and Democratic Sens. Nicholas Petris and Alan Short proposed a radical overhaul, which Gov. Ronald Reagan signed into law. 

When the Lanterman-Petris-Short law took effect a few years later, it established strict criteria for involuntary treatment. It imposed specific timeframes for involuntary confinement and limited involuntary holds to those deemed a danger to themselves or others, or gravely disabled. This included the 72-hour hold that police term a 5150.

But within a few decades, Sen. Petris noticed growing numbers of people with serious mental illnesses appearing on the streets and in jails.

In a 1989 oral history, Petris lamented that while the law had promised funding to treat people with mental illness in the community, Gov. Reagan diverted tens of millions allocated back to the state general fund.

“That took the guts right out of this state money for local treatment,” Petris said. “It emptied out the hospitals, but there was no follow-up treatment….In this overemphasis to get away from this tyrannical and oppressive system… of incarcerating people so easily, we went overboard the other way.”

Even when funding was available, “Not In My Back Yard” resistance also made it challenging to locate residential and community treatment facilities. In the half-century since, much of the debate about helping people like Rippee has centered on the Lanterman-Petris-Short law. The state auditor is currently examining it; a report is anticipated this spring. 

In recent years, several bills in the Legislature have sought to modify the law, focusing on redefining the term “gravely disabled.” Rippee’s sisters petitioned and testified last year on behalf of a bill that sought to define “gravely disabled” to include not just those who can’t provide for their own food, clothing and shelter, but also those who don’t seek needed medical treatment. It failed, in part because opponents considered it ineffective and dangerously expansive.

More than 5,000 people in the state were on permanent conservatorships, and close to 2,000 were on temporary conservatorships, as of 2016-17, according to data collected by the Department of Health Care Services. The data is incomplete; Scarlett Hughes, executive director of the California State Association of Public Administrators, Public Guardians and Public Conservators calls it “extremely inaccurate.” 

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.

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