California lawmaker wants to reform conservatorships for those with severe mental illness

By Lindsey Holden

About 75 percent of lifetime cases of mental illness begin by age 24, according to the National Institute of Mental Health. But the average delay between onset and intervention is 8 to 10 years, meaning people could go years before getting help. By Jim Donaldson

A California lawmaker will again try to reform the state’s conservatorship system to make it easier for people caring for those with severe mental illness to compel treatment. Sen. Susan Eggman, D-Stockton, announced legislation Wednesday to amend the definition of “gravely disabled,” the term used to describe eligibility for a court-appointed conservator to assume decision-making powers for individuals because they can’t provide their own food, clothing or shelter. She unveiled the bill alongside the National Alliance on Mental Illness California and mental health care advocates, other legislators and mayors of San Francisco, San Diego, Anaheim and San Jose. Eggman’s bill would add criteria specifying the person is unable to ensure their own safety due to an untreated mental illness or substance abuse. The measure, Senate Bill 43, would also ask courts to take into account whether the person understands their illness and is able to make sound decisions based on the state of their mental health.

In addition, the bill would allow medical experts who have not directly treated a person being considered for a conservatorship to testify at court hearings without having their statements considered hearsay. Another bill in Eggman’s package would create a real-time online dashboard showing information about inpatient psychiatric beds, residential mental health facilities, crisis stabilization units and licensed substance abuse treatment facilities. “We’re still operating on laws that were a good idea at one point in our in our history and have now become obsolete and a barrier to care, versus a protection for people,” Eggman said during the news conference. Reforming California mental health care The state’s existing mental health care system dates back to the late 1960s, when California largely shut down its hospitals and left behavioral treatment to counties and cities.

The Lanterman Petris Short Act established a framework for involuntary mental health care ranging from short-term hospital stays to long-term conservatorships. But some families who believe their relatives would benefit from a conservatorship struggle to access that system, even if their loved ones suffer from severe untreated mental illness. That is because the current standards for that level of intervention are threats of harm to the mentally ill person or others or “grave disability.” Under existing criteria, it can be challenging for even very ill unhoused residents to reach eligibility for a conservatorship if they can minimally care for themselves. Eggman has previously attempted to reform the conservatorship system, but faced opposition from civil liberties organizations, such as Disability Rights California. Advocates from these groups say changing the current system would make it easier to push mentally ill Californians into conservatorships and force treatment against their will.

Her 2022 measure, Senate Bill 1416, died in the Assembly Judiciary Committee after failing to get a hearing. Disability rights advocates also lobbied against Gov. Gavin Newsom’s Community Assistance, Recovery and Empowerment (CARE) Court program, which he signed in September. That program establishes a system of mental health courts and requires counties to provide behavioral health care for residents with severe untreated bipolar disorder or schizophrenia who are experiencing psychosis. Disability Rights California in January filed a lawsuit against Newsom alleging CARE Court is unconstitutional and strips mentally ill people of their rights.

Eggman on Wednesday emphasized the CARE Court program is one part of an effort to reform mental health treatment in California. CARE Court would attempt to compel treatment on a voluntary basis, but lack of compliance with court-assigned plans could be a factor in determining conservatorship eligibility. Eggman said her new bill expanded the gravely disabled criteria based on feedback from mental health professionals. She said the newly-elected Assembly may be helpful to pushing it through the Legislature. “Last year, we got all the way to the very end with two no votes, I think, in the entire 120-body Legislature, and we weren’t able to get a hearing in the committee,” Eggman said. “This year, we feel very optimistic that we’ll be able to get all the way to the end. And we’ve had good talks with the administration about signing the bill when it reaches (the governor’s) desk.”

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California lawmaker wants to reform conservatorships for those with severe mental illness