by Melissa Evans
 |
| Danielle Curtiss of Long Beach sought a mental health conservatorship for her son, who has schizophrenia, for two years. Photo by Thomas R. Cordova. |
Danielle Curtiss, exhausted and angry, was consumed with a question: why should it be so hard for a mother to help her son?
At 18, he was diagnosed with schizophrenia. During the next two years, he was either hospitalized or placed on involuntary psychiatric holds some 20 times. He repeatedly threatened to kill himself. “I don’t want to live anymore,” he would say.
Over the years, Curtiss says she filed at least a dozen missing person reports after he ran away from home or bolted from treatment programs, often taking shelter in homeless encampments. After leaving one program in Downey, he walked 50 miles to Glendora, where he was hospitalized for a week due to renal failure from extreme dehydration.
Curtiss says her son has been arrested multiple times for non-violent offenses, with the exception of two. Once as a juvenile and then as an adult, he was taken into custody for battery against her. She told police he had, among other acts of violence, slapped and choked her.
Dating back to middle school, he’d been prescribed an array of psychopharmaceuticals but mostly stuck to weed, which he started smoking at 12, eventually moving on to meth and ketamine as he got older.
For these reasons and dozens of others, Curtiss, who is a nurse, says she became convinced that the only way her son could be saved was if he was placed under an involuntary mental health conservatorship, giving her access to his records and control of his care. She believed he surely met the requirements because he was gravely disabled, a potential danger to himself and others.
But if her son’s troubles weren’t painful enough to face, she would now be forced to confront a mental health system that left no statutory pathway for a despondent mother or other loved one to obtain the kind of highly restrictive court-ordered conservatorship she was seeking.
Currently, under state law, only a physician in a hospital can initiate that process, which requires strong communication between public and private medical providers and a willingness by hospitals, insurers and doctors to take action—all of which are in short supply.
As homelessness rises among severely mentally ill individuals, she found herself at ground zero in a growing debate in California over whether restrictions for such measures should be loosened to confront the new realities on the street or kept strict to guard against potential violations of an individual’s rights.
“The system is designed for people to give up,” says Curtiss, adding that the only way to make it work for her and other similarly situated families is through the kind of sheer will she would need to summon in her two-year effort.
“I knew my son needed a conservatorship early on,” she says, “but I was continuously told that he was not ‘sick’ enough or that he hadn’t been in the hospital enough. What a travesty it is to know that your son is so very ill and so very lost and be told he’s not sick enough.”
A clash of rights and realities
Despite wide acknowledgement of the conservatorship system’s shortcomings in addressing rising mental illness among the unhoused, recent legislative efforts to reform the 56-year-old law that governs mental health conservatorships have failed.
Strong pushback over the years has come from those who fear the state could regress to the era before 1967, when tens of thousands of people were locked away in state psychiatric hospitals—heavily medicated, subjected to experiments and stripped of their rights and freedom.
“Conservatorship is the most extreme form of deprivation of civil liberties, aside from the death penalty,” Susan Mizner, director of disability rights for the American Civil Liberties Union, said recently.
Reform advocates, meanwhile, say that as homelessness has reached crisis levels and the public regularly encounters severely mentally ill people on the street, the question they ask is: Why is no one doing anything?
“It’s the question we’re all asking,” says Jessica Cruz, executive director of the National Alliance on Mental Illness, which supports reforming conservatorship requirements to make them less restrictive.
The kind of conservatorship Curtiss was seeking was created under the Lanterman-Petris-Short Act, or LPS, which was passed in 1967. It is reserved specifically for people with diagnosed mental health disorders, usually schizophrenia or bipolar disorder.
The law authorizes only hospitals and in-patient physicians to petition a county to obtain one—a statutory precaution against individuals being unnecessarily committed to locked-down mental health facilities. But records show that such measures are rarely sought.
Although 1,200 unhoused people in Long Beach said they suffered from severe mental illness during the 2023 homeless count, Long Beach hospitals sought only 20 LPS conservatorships in fiscal year 2021-2022, according to Los Angeles County data.
Long Beach Memorial sought one, while St. Mary Medical Center didn’t seek any. College Hospital, which has a contract with LA County to provide mental health services, sought 10, and the VA Hospital in Long Beach sought nine.
In that same 12-month span, a total of 388 LPS conservatorships were sought by general acute care hospitals overall in Los Angeles County, and the majority came from public hospitals run by the county, none of which are in Long Beach. Jails, courts, state hospitals and other specialized psychiatric facilities recommended 354 conservatorships to the county.
Of the total of 742 that were referred for LPS conservatorships, 700 were pursued by the county, records show. Of those, more than half, or 450 people, were placed into conservatorships, with the courts naming the county as the conservator for 284 people, and assigning private conservators, such as family members, for the rest.
These court-ordered arrangements can be denied for a number of reasons, which include physicians not showing up to court to testify, or the person being able to prove to a judge they are not gravely disabled.
Connie Drexler, the county’s deputy public guardian, cited one case in which an unhoused man successfully argued that he was able to care for himself because he had a tent on Skid Row and that he could get food from a nonprofit.
“It may not be your or my first choice, but he had a plan for food, shelter and clothing, and the judge said that was acceptable,” she says.
At wit’s end
The turning point—the boiling point—for Curtiss in getting an LPS conservatorship for her son came in 2019.
By then, she had compiled a 10-page chronicle of his deteriorating mental health in all its manifestations, from his 5150 psychiatric holds to his brushes with the law to his turbulent relationship with his mother. She had to piece together some of his medical odyssey after he turned 18 because she could not directly access his records. (At Curtiss’ request, the Post agreed to withhold her son’s name to protect his privacy.)
Her “declaration in support of conservatorship” was intended to demonstrate that action was needed immediately, given his long history of life-threatening—and worsening—mental health crises.
“I have received NUMEROUS telephone calls from concerned police officers, security and members of the public whom he reaches out for help,” she wrote, detailing incidents in which he had been beaten bloody on the street, become lost after aimlessly riding trains and buses and plagued by paranoid fantasies of being tracked by “The Cartel,” among others.
She recounted one frightening incident while he was still in middle school.
One morning, he rode his bike to his former campus—where he’d experienced bullying—instead of his current one. There, he was arrested when staff discovered a Bowie-style knife in his backpack. His mother says he was placed in a juvenile diversion program.
Curtiss wrote that she agreed to a recommendation that her middle-schooler be given medication for a diagnosis of ADHD. His grades improved a bit, she said, but that didn’t last. Soon, he was getting busted at school and by police for having marijuana pipes and other paraphernalia.
His troubles mounted even as he played football at Poly High, then at Wilson, with dreams of someday suiting up for Notre Dame. Curtiss enrolled him in multiple diversion and treatment programs, and doctors prescribed an array of medications, including Seroquel, Trazodone, Prozac, Haldol and Abilify.
As his illicit drug use escalated in his late teens, he began “to be motivated by some unknown internal stimulus to suddenly need to leave,” his mother wrote. “It is now so bad that he can not stay in any one place for greater than a few hours before this sensation drives him to leave.”
At 18, he was taken to Orange County’s St. Jude Hospital by Fullerton police after threatening suicide in a call to his mother, with whom he was no longer living. When Curtiss arrived at St. Jude, her son was rocking back and forth, holding his head in his hands, shouting “turn the cameras off.”
He was placed on a short-term involuntary hold—one of many over the years—before being transferred to College Hospital in Long Beach and then to a Kaiser outpatient psychiatric program. It was there that he was diagnosed with schizophrenia and acute psychosis. He continued to spiral out of control.
In 2019, with her son now 20, Curtiss was at wit’s end. She took her 10-page litany of trauma to the Los Angeles County Probate Court and applied for a conservatorship that did not need to be initiated by a doctor in a medical facility, like an LPS conservatorship.
Probate conservatorships can be requested by family members or concerned caregivers. They’re typically sought for older adults with debilitating conditions such as dementia and, thus, are usually permanent.
LPS conservatorships are reviewed annually with the goal of giving a person back their autonomy.
The probate court appointed an attorney to represent the interests of Curtiss’ son in the proceeding, a breakthrough for his mom, who had filed her document in the court record.
With the history supplied by Curtiss, the attorney assigned to the case prevailed upon a psychiatrist at Del Amo behavioral health hospital in Torrance, where Curtiss’ son was then being treated, to sign a “capacity declaration” stating that the patient was unable to provide informed consent for his medical care because of his impaired mental functions.
“Patient in the past will have periods of stability,” the treating psychiatrist wrote, “but frequently decompensates due various factors leading to behaviors that complicate his existing condition of schizophrenia.”
Ultimately, Curtiss’ probate court request was rejected when the court ruled that the son’s schizophrenia diagnosis would specifically require an LPS conservatorship initiated by a doctor.
But with the psychiatrist’s declaration in hand, Curtiss was able to persuade the Torrance hospital to begin the LPS process, which was completed just months later and named her as the conservator of her son’s affairs. She placed him in a locked facility in Long Beach.
“The conservatorship is the ONLY way I’ve been able to help him, the only way I have been able to participate in his care, advocate for him, develop a care plan for him,” Curtiss wrote in a recent email to the Post, adding: “I had to keep pressing everyone to do something. I couldn’t let up.”
A system bursting at the seams
As Curtiss’ experience illustrates, the hurdles to obtain LPS conservatorships remain high. Beyond questions of rights and freedoms, advocates contend that hospitals and physicians are disincentivized to participate for other reasons, including money.
The state’s insurance provider, Medi-Cal, pays hospitals the highest rate for providing acute care, when a patient is facing an emergency. Reimbursement rates are nearly cut in half if a patient is stabilized but waiting for a bed somewhere else or waiting for the conservatorship process to be finalized.
In Curtiss’ case, this took several months. Throughout that period, her son was kept in the emergency room at Del Amo hospital without access to activities or personal items. Curtiss says she shuttled back and forth between her nursing shifts to bring him fresh clothes and other necessities.
“He was miserable,” she says. “He was begging me to take him home.”
Hospitals readily acknowledge there simply aren’t enough alternative places, like subacute facilities, for patients like Curtiss’ son to go, says Sheree Lowe, vice president of the California Hospital Association, a trade and advocacy group.
According to a 2022 RAND study, Los Angeles County has just 5.2 subacute psychiatric beds per 100,000 residents, the lowest rate in the state. To meet the existing need, that number should be 24.6, according to the study.
Gov. Gavin Newsom in March proposed a 2024 bond measure to raise an estimated $1 billion annually for thousands of new mental health beds, from subacute to residential.
“It’s unacceptable what we’re dealing with, at scale, in the state of California,” the governor said at a media event.
Waiting for the courts to act, combined with this shortage of subacute options, means patients awaiting possible conservatorships are often discharged back to the street once they’re stabilized.
What’s more, such crucial decisions might be made without the benefit of knowing a patient’s full medical history because of inadequate communication between hospitals where an individual may have been earlier treated. They might not know, for example, such basic information as whether this is a patient’s first or 10th psychiatric hold or any previous attempts at outpatient treatment.
It’s advantageous when a patient is treated at the same facility multiple times so physicians have at least some history, says Lowe of the hospital association, noting patient privacy laws are very strict about sharing medical data.
“There’s really no way around that,” she says.
Pushing for change
Curtiss and many others have lobbied hard for changes to the law that governs LPS conservatorships, including recent efforts to loosen the standard of who qualifies.
A state bill introduced in March would expand the criteria to include any condition that causes an individual to be “at risk for serious harm” due to a mental illness or a substance use disorder—a new category of illness that could be taken into account for LPS conservatorships.
Although a similar measure failed in 2022, state Sen. Susan Talamantes Eggman, D-Stockton, who has authored several bills over the past five years to change mental health law, says the increasingly visible toll of mental health and homelessness could open a window for this one to succeed.
“Decades have passed and we’re still operating on laws that were a good idea at one point in our history, but are now obsolete and a barrier to protect vulnerable people,” she says.
The 1967 Lanterman-Petris-Short Act came in the wake of a public outcry over the conditions of state psychiatric hospitals, where tens of thousands of patients were held indefinitely and subjected to horrific treatment, such as electric shock therapy and lobotomies.
The legislation, signed by then-Gov. Ronald Reagan, effectively shut down all but five state mental hospitals. But funding for a new community-based approach did not materialize.
Today, the state’s five state mental hospitals, including Metropolitan in Norwalk, have a total of 6,078 beds, compared to more than 50,000 beds in the 1950s. Of those, only 617 are occupied by LPS conservatees. The remaining 90% are occupied by those with mental illness who are accused of committing crimes or have been convicted of them.
A February staff report for the county’s Board of Supervisors said the wait time for transferring an LPS conservatee to a state hospital last year was 394 days. The wait time for a specialized or subacute care facility, meanwhile, was 141 days.
Despite the intent of the LPS Act, one of the original authors, Sen. Nicholas C. Petris, said in a 1989 interview that mistakes were made: “In this overemphasis to get away from this tyrannical and oppressive system … of incarcerating people so easily, we went overboard the other way.”
The act made it extremely difficult to hold someone against their will longer than 72 hours. As a result, short-term holds in California have risen from about 75,000 annually in 1980 to about 125,000 in 2018. At the same time, conservatorships have plummeted from about 12,000 in 1980 to 6,000 statewide.
Officials are hopeful that the governor’s new CARE Court model will fill the gap between 72-hour psychiatric holds and conservatorships. These courts would function more like a social service agency than a legal venue. Some are scheduled to start in December, including in Los Angeles and Orange counties.
Families, nurses, social workers, police and other concerned parties would be able to directly petition the CARE courts to enroll someone in the program, in which regular appearances would be required and services, including housing, would be provided. Participation would be voluntary, unlike the more restrictive LPS conservatorships.
If individuals refuse or fail to complete CARE Court requirements, they could then be referred for an LPS conservatorship.
Curtiss, who has supported the CARE Court concept, says she’s hopeful it will provide another option for families desperate to help loved ones. But she’s skeptical about LA County’s ability to provide the promised services that will be crucial to its success. Just getting the key players in her son’s conservatorship case to communicate with her has been a challenge, she says.
In fact, at her son’s most recent conservatorship hearing in February, Curtiss celebrated a big win for a woman who for years has camped out in administrative offices and pestered politicians on behalf of her son: Her lawyer persuaded a judge to order LA County and Kaiser to work with her to devise a discharge plan—including housing and care—once her son’s conservatorship ends.
“I know the end is coming,” she says. “It’s just a matter of time.”
Asked what would be a best-case scenario for her son, she struggles for an answer. She would love for him to be somewhere structured, where he can feel supported but also develop some autonomy.
“My hope,” she says, “is that someday he can advocate for himself.”
She says she also hopes for a sea-change in a system that should not require those with severe mental illnesses to endure so much trauma before they can get help.
This story was edited by special projects editor Joel Sappell.
Photography by Thomas R. Cordova, with submitted art from Danielle Curtiss.
Video by Cheantay Jensen.
Full Article & Source:
‘The system is designed for people to give up’
No comments:
Post a Comment