‘I won’t let you go and be homeless’ Judge orders man to remain in jail until son takes him home

During the May 21, Ozark County Circuit Court, Judge Craig Carter heard from 13 defendants, including Timothy Kendrick of Springfield.

Kendrick is charged with driving while revoked in January 2023 and was originally arraigned in circuit court on Aug. 9, 2023. The case was continued because of the death of Kendrick’s father and Kendrick’s continued physical rehabilitation from a stroke. After the case was continued several more times over the next two years because of Kendrick’s health and hospital stays and failing to appear in court several times, Kendrick was discovered to be in the Greene County Jail in May 2025, where he was serving a 120-day sentence for stealing a 2001 maroon Dodge truck in Springfield in December 2024.

Kendrick told the court he stole the truck “cause my daughter had conservatorship and I got tired” of being homeless. Kendrick said he found the truck with keys in it and stole it and then realized it was “a piece of crap without a clutch.”

Judge Carter asked him why he stole a truck without a clutch. “You don’t get to test drive it when you steal it,” Kendrick answered.

After learning that Kendrick still had no home to go to, Judge Carter ordered that Kendrick remain in the Ozark County Jail until someone could get him. “If you get your son to come and sign for you I’ll let you go. But I’m not going to let you go and be homeless.”

Public defender Chase Opolka was appointed to defend Kendrick in the Ozark County case.

Kendrick appeared before the court on June 18 accompanied by his son. 

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‘I won’t let you go and be homeless’ Judge orders man to remain in jail until son takes him home 

Stuck in a hospital, hoping for a place of his own

A 29-year-old man with cerebral palsy has been in WakeMed for more than three months waiting for an affordable, safe and supported home.

Tylor Freeman in happier times. Credit: Tylor Freeman

by Rose Hoban

Tylor Freeman would like to go home.

His problem? There’s no home to go to. 

Instead, the 29-year-old has been cooling his heels at WakeMed hospital in Raleigh for more than 100 days.

Freeman’s odyssey began last fall when he needed to have a minor medical procedure. He has cerebral palsy, along with having a history of anxiety and depression. He was living in supported housing with a roommate in Burlington, a situation where he alleges that the caregiver working with him was abusing alcohol. 

So, after his procedure was completed at a hospital in Concord, he refused to return to where he had been living. His family’s dynamics preclude him living with any immediate family members.

Because he didn’t have a home to return to, he first tried living with friends out of state, but that became complicated for him and for his friends, given his extensive care needs and the limitations of what state Medicaid programs can pay for outside of North Carolina. Freeman uses a power wheelchair and needs assistance with everyday activities such as bathing, using the bathroom, dressing, preparing food and more.

“I can feed myself as long as it’s cut up. Soup, cereal, that’s kind of tough,” Freeman said. In the past, he said, he’s been able to use a urinary bag system, as long as it doesn’t leak. “So I could be left alone for a couple of hours, as long as I’m in my wheelchair.”

Freeman spent time in a South Carolina hospital, which eventually threatened to discharge him to a homeless shelter. That’s when friends in Raleigh suggested he make his way to the Triangle. On March 5, he got onto a Greyhound and made his way to WakeMed hospital, where he was admitted to be treated for bladder and body pain. 

That’s where he remains, even though his medical issues were taken care of long ago. 

Freeman’s not alone in his predicament.

For years, people with disabilities have been getting stuck in treatment facilities across North Carolina, even as they strive for the opportunity to live independently. 

The federal Americans With Disabilities Act, passed in 1990, and subsequent Supreme Court and state court rulings require the state to provide services and housing to people with mental health disabilities. One of those rulings is part of a 2012 lawsuit settlement with the U.S. Department of Justice and North Carolina to ensure that such populations are able to live in the least restrictive settings of their choice. The landmark U.S. Supreme Court Olmstead decision in 1999 laid the foundation for such a settlement by prohibiting the unnecessary segregation of people with disabilities and underscoring their right to receive services within their communities.

Bumping up against all those legal mandates is a profound lack of affordable housing in North Carolina, including in Wake County — where the median home cost $474,750 in April, and rent easily tops $1,200 a month (according to Zillow). Both hospital and state officials say that’s the primary reason they’ve had trouble finding a place for Freeman, on top of a shortage of direct service professionals to provide him with the help he needs to live independently. 

And though the state has made efforts to help Freeman and others in similar situations, it continues to be challenging for those who want to help him. Even if there is a physical place to go, given Freeman’s challenges, not every place is the right one. 

“I lived in several places that were not accessible …  you know, I couldn’t fit in the bathroom [with his motorized wheelchair],” he said.

So, Freeman sits at WakeMed, at a cost to taxpayers that’s easily running into the hundreds of thousands of dollars — sums approaching the price of building or buying him his own place.  

Court rulings and federal law 

North Carolina’s system of care for people with mental illness, intellectual and developmental disabilities has been in crisis for the past several decades. Part of the turmoil has been driven by the limited amount of appropriate housing available.

In the past, North Carolina relied on adult care homes, group homes and large state-run facilities to house people who weren’t relying on family members for care. That situation spurred the 2012 action by the U.S. Justice Department, which found that North Carolina had an “institutional bias” for providing care — something that contradicts the Americans with Disabilities Act and the Olmstead decision. 

Despite those rulings, North Carolina has continued to lag in creating housing opportunities for people with disabilities.

In 2022, a judge forced the state’s hand with the Samantha R ruling, saying that North Carolina needed to provide more in-home disability services over the coming decade. That ruling was reinforced by a settlement between North Carolina Disability Rights and DHHS this spring.

That means there’s money for Freeman. He’s eligible for services under the state’s Transitions to Community Living initiative, which came out of that 2012 Justice Department settlement. He’s also one of the fortunate recipients of a place in the coveted Medicaid Innovations Waiver program, which provides extended services for people with disabilities so they can live and thrive in their home communities. Finally, he’s eligible for funding under the state’s Money Follows the Person program, which provides funds for people like him to have a home and services to keep him there.

In theory, Freeman should have multiple avenues to get a place, but theory and reality often don’t match up. 

“We in the disability community want the same ability to make these choices as individuals who may not have a recognizable disability,” said Julia Adams, a lobbyist at the legislature for people with disabilities who also is someone with a disability. “The problem that we have is we do not have enough housing options that allow for choice.”

“Even for those lucky people with an Innovations Waiver slot, it’s no magic ticket,” said Corye Dunn, the policy lead for Disability Rights North Carolina. “Our community service system is thin and desperately in need of investment to ensure a waiver slot provides meaningful access to services and supports.” 

Inappropriate placements

WakeMed and Freeman’s state-supported managed care organization (known as an LME-MCO), Alliance Health, are the organizations that have the responsibility to find Freeman housing. And, to a certain extent, so is the state Department of Health and Human Services.

“The people at Alliance keep saying, you know, ‘Oh, we’re looking, we’re looking, we’re looking,’” Freeman said. “They are telling me because my case is so complex for [Transitions to Community Living], they are telling me now there is a barrier. The occupational therapist, the physical therapist have to look at my case, before we can move forward.”

Alliance declined to discuss Freeman’s case, telling NC Health News that the organization maintains “an organizational policy of not discussing the treatment of our members in the media even if a member formally authorizes us to do so.”

Freeman said he’s been offered group home placement or placement with a family that’s not his own — neither of which he wants. 

“Not every individual wants to live in a group home or an Innovation Waiver group home, because maybe that is not where they are at this point of their lives,” Adams said. “They have relationships. Some of them have boyfriends, girlfriends. That’s difficult in a group home setting.”

That’s the case for Freeman, who said he has a boyfriend in the Triangle area. He said they’re not at a place in their relationship where they could live together. 

Tylor Freeman has worked on statewide initiatives to reform North Carolina’s guardianship program, in addition to other
advocacy efforts. Now he’s advocating for himself. Credit: Rose Hoban

 
Housing shortage gums up other priorities

WakeMed Chief Medical Officer Charles Harr said they see situations like this too often, where the hospital has trouble finding a place for patients who are being discharged.  

“Some of them are from people who have physical disabilities and require differing levels of care, or they’re close to independent but not totally independent,” Harr said. 

Harr said he knows the hospital isn’t the right place for Freeman, but they’re not going to just turn him out. 

There are a “significant number of folks who come in who don’t have a medical need,” Harr said. “Maybe it’s behavioral, maybe it’s homelessness, whatever has brought them to the emergency room, people just don’t know what to do. 

“Those we do not admit to the hospital, we maintain them in the emergency department until we can get appropriate placement for them.”

But Harr said that this reality means that often people sick with medical issues end up waiting in the emergency department for a bed upstairs that’s occupied by someone who’s simply waiting for someplace to go.  

“That’s happening to us one to two to three times a week now,” Harr said. 

And he said he’s not sure how to undo this Gordian knot that’s tied his organization’s hands.

“We as a hospital can’t force the patient to take an option, on the other hand, we have no … we have no sway over who the LME-MCO is,” Harr said. “I mean, Alliance, they’re getting money from the state, they’re placing people. So we’re collateral damage, just like those patients are. Because we can’t make anybody do anything in that situation.”

Harr estimated that the cost for Freeman’s care had long ago passed the $150,000 mark. 

“A hospital’s an expensive setting for care, and it is the most restrictive setting for someone to be in,” Adams said. “A hospital is not supposed to be a housing option.”

Piecing it all together

“Housing is really complex,” Kelly Crosbie, head of the Division of Mental Health, Developmental Disabilities and Substance Use Services for the state health department, told NC Health News. 

Crosbie said her department has been able to get thousands of people with disabilities out of congregate settings and into their own housing — with supports — over the past decade.

“We’ve invested lots of money, not only in housing, but also the transitional supports to get folks housing, and then the supports to help people maintain their housing. And lots of people’s lives have been changed dramatically,” Crosbie said.

But there still are an untold number of people like Freeman, who still don’t have the right housing or direct support workers to help them once they’re there.

“For folks who are lucky enough to have an Innovations Waiver slot, we still have problems staffing those slots because of direct care workforce shortages,” Adams, the lobbyist, said. “An innovation waiver slot does not really, you know, does not provide the array of choice for the housing portion.”

Crosbie noted that the department is launching a program to encourage people to become part of the direct support professional workforce. The department has also developed other plans and resources that they’re putting in place to create options for people like Freeman. 

While she said that she can’t speak directly about Freeman’s case, she did say that she was aware of his situation. 

“Now we have to make sure that housing stock is available, people know their choices and we have enough workforce to support people in this kind of independent living situation,” Crosbie said. “We don’t do housing, per se, but we’re trying to work with housing people to make sure that we have safe stock for people that have accessibility issues.”

But all these future plans don’t address what Freeman needs now, which is a place to go.  

“Until we sit down and have a real conversation about how do we provide choice, and supports, we are going to have folks who have a waiver and still have limited options,” Adams said.

“The entire reason why we have an innovation waiver is to provide a robust home and community-based support setting for folks. But we’re still not meeting that,” Adams added.

Freeman said he’s hanging in there after being in the hospital for months, but the wait is wearing on him. Recently he found an agency that will provide him with a personal care aide. All he needs now is a place to go. 

“I’m just speechless,” Freeman said. “But I will continue fighting. I’m fighting not just for myself, I’m fighting for other people. Because this is ridiculous.”

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Stuck in a hospital, hoping for a place of his own

New California law addressing mental illness, addiction among homeless delayed by Valley counties. Here's why

 by MARIJKE ROWLAND

Community Medical Center's CareLink Mobile Outreach Team leaves water and snacks at an empty encampment in Stockton hoping their patient returns to find the supplies on Nov. 9, 2023.
Vivienne Aguilar/CVJC

Historic changes to California’s conservatorship law, which will expand who can be placed in involuntary care and treatment in an attempt to address the state’s ongoing homelessness crisis, will have to wait in the Central Valley.

The board of supervisors in San Joaquin and Stanislaus counties have opted to defer the new law, which otherwise would have gone into effect in January. Officials in both counties will now have an additional two years to comply with the changes.

The bill from Sen. Susan Eggman, D-Stockton, signed by Gov. Gavin Newsom this October, represents the first major changes to the state’s landmark 1967 Lanterman-Petris-Short Act. Signed by then Gov. Ronald Reagan, the legislation upended how California dealt with the “gravely disabled” and ended the state’s previous practice of warehousing those with mental illnesses in state hospitals or psychiatric facilities.

Stanislaus and San Joaquin counties are joined by other Central Valley counties, including Kings, Merced, Fresno, Sacramento and Kern, as with much of the state in postponing implementation. Once enacted, the law will give officials greater leeway in who can be placed in involuntary short-term psychiatric holds, longer detention and treatment programs.

Currently, only those deemed “gravely disabled” can be placed in involuntary mental health care or conservatorship, including 5150 holds initiated by law enforcement or health providers that detain people in psychiatric facilities for 72-hours.

The new law expands that definition to include “severe substance use disorder” without any accompanying mental illness. It also broadens the criteria for those with existing mental health disorders to include those who cannot provide for their “personal safety or necessary medical care.” Previously only those who could not provide for their own food, clothing and shelter could be eligible for involuntary care.

While groups like the NAMI (National Alliance on Mental Illness) California and California State Association of Psychiatrists have supported the bill, its signing was not without controversy. Disability Rights California, Human Rights Watch and other disability and mental health organizations have argued it would infringe on the civil rights of an already vulnerable population, and could lead to more mass involuntary conservatorships.

The behavioral health services directors for both Stanislaus and San Joaquin counties successfully asked their supervisors for more time to implement the changes. They cited worries of insufficient capacities at county behavioral health facilities, area emergency rooms and drug treatment facilities among the reasons for the additional two-year window.

Stanislaus County Behavioral Health and Recovery Services Director Tony Vartan told the board last week that the changes would have an impact beyond his department. Law enforcement, courts, hospitals and other mental health providers in the region will also have to grapple with the new expanded definition of “gravely disabled.”

He said without sufficient existing treatment programs or care facilities, it would force “hospitals to be stuck with a lot of patients in an involuntary hold,” which could mean less beds for other sick or injured patients.

The California Hospitals Association has reached out to county administrators across the state, including in Stanislaus and San Joaquin counties, urging them to delay implementation.

In San Joaquin County, Behavioral Health Director Genevieve Valentine said the extra time is needed to build-out infrastructure and staffing. While statewide it is predicted the changes will result in an about 10% conservatorship increase, Valentine said in San Joaquin County they expect an increase of 20% to 25% because of the need in the region.

“I would hate to rush something when someone’s life is at risk — when their civil rights are at risk,” Valentine said. “I want to make sure in San Joaquin County we are very strategic in how we put this into place.”

She called the law another “tool” in their toolkit to help deal with the state’s mental health challenges, particularly among its homeless population. The passage of SB 43 follows the state’s implementation of the CARE Act, which established specialized courts (called CARE Courts) in each county. County mental health providers, first responders, family members and others can petition the court to give individuals with mental illness voluntary services and treatment.

New psychiatric facility planned

Stanislaus County is part of a seven-country pilot program that launched its CARE Court this October. The rest of the state has until December 2024 to finalize the new courts.

While the two laws are not related, they both represent significant changes to how the state handles those with severe mental health disorders in an effort to address California’s ongoing homeless crisis.

To implement SB 43, San Joaquin County officials plan to build a new from-the-ground-up psychiatric facility across from the existing county general hospital. If approved and funded, the up to 90-bed facility would begin construction this coming summer.

In Stanislaus County, supervisors have asked Vartan to return to the board in January to give a more detailed timeline, and possibly earlier deadline, for SB 43’s implementation.

“I look at this as a godsend,” said Supervisor Terry Withrow during last week’s board meeting. “We’re talking about saving lives…I can’t think of a better way for us to spend our time and resources than to try to get this thing up and running as quickly as possible.”

The governor has also been vocal in his displeasure in what he called the “slow-walking” of the new conservatorship criteria. Most counties have opted to delay implementation, which was allowed in the act, with San Francisco and San Luis Obispo counties the only ones so far indicating they’d be ready for the changes by Jan. 1.

“We can’t afford to wait,” Newsom told reporters last week. “The state has done its job; it’s time for the counties to do their job. … They have to understand people are dying on their watch.”

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New California law addressing mental illness, addiction among homeless delayed by Valley counties. Here's why

In SF and Across California, People With Severe Mental Illness Languish Untreated in Jails, Hospitals

Written by David Sjostedt

San Francisco Fire Department ambulances outside of Zuckerberg San Francisco General Hospital on August 22, 2022. | Justin Katigbak for The Standard

As public pressure mounts on San Francisco and other cities to force people who are mentally ill and homeless into treatment programs, many of those already confined under what’s known as “conservatorship” have no place to go.

There are at least 56 people in regular short-term treatment hospitals such as Zuckerberg San Francisco General Hospital, as well as six people in the city’s jails, who are under a San Francisco court-ordered mental health conservatorship but are waiting for a long-term treatment bed to open up.

One individual in a local jail has been waiting for a treatment bed for nearly 1,200 days, according to Kara Chien, managing attorney of the SF Public Defender’s Mental Health Unit. 

The problem extends far beyond SF: In a statement, the California Department of State Hospitals said that it is currently 99 people over its contracted bed allotment for individuals under conservatorship. 

“Even though conservatorship is the last level of care, there’s no care available,” Chien said.

Conservatorships grant the courts or other guardians legal authority over a person who has been deemed unable to care for themselves. They have gained new attention as the homelessness crisis explodes, with many calling for more aggressive use of conservatorship for people struggling with drug addiction and mental illness.

A new state program called CARE Court—created by the Community Assistance, Recovery and Empowerment (CARE) Act—could end up bringing even more people into conservatorship and worsening the backlog.

Health care providers, advocates and local leaders are blaming a shortage of intensive mental health facilities at the state level, as well as a lack of services to help people avoid conservatorship altogether.

“Nobody at the state level is taking responsibility for these problems,” said SF Supervisor Rafael Mandelman, who has advocated for increased conservatorship. “We need another state mental hospital […] and that wouldn’t even begin to scratch the surface of the need.”

SF Supervisor Rafael Mandelman, at a press conference on Tuesday, Sept. 6, 2022 in San Francisco, Calif. | Paul Kuroda for The Standard

San Francisco primarily sends people to Napa State Hospital, one of the state’s six mental hospitals, which has approximately 1,255 beds. In SF, there are 94 city-contracted treatment beds for people under mental health conservatorship. Yet currently, the city conserves nearly 600 people in various types of mental health conservatorship, which are assigned based on a patient’s diagnosis and propensity for violence.  

At a recent hearing, nurses from SF General Hospital described dangerous conditions in the city’s emergency units thanks to a revolving door of patients in severe mental health crises. The Department of Public Health acknowledged in a statement to The Standard that the city’s long-term mental health facilities are usually at capacity, leaving mentally ill patients waiting in regular hospitals while competing for a limited number of beds at the state level. 

The California Department of State Hospitals pointed to investments by Gov. Gavin Newsom intended to help localities build more mental health infrastructure, including $2.2 billion in grants for new behavioral health facilities and $1.5 billion for “bridge housing” for homeless individuals with behavioral health conditions.

Governor Gavin Newsom speaks at a press conference on Wednesday, Feb. 9, 2022, in Oakland, Calif.. | Aric Crabb/MediaNews Group/East Bay Times via Getty Images

Alex Barnard, a sociology professor at New York University who has written extensively about conservatorships in California, said that the state needs to improve coordination among counties that are fighting for treatment spots. 

In a general hospital setting, conserved patients run the risk of infection, and nurses that are trained in providing stabilizing care are unequipped to provide long-term mental health rehabilitation. 

“An acute care hospital is not a place for people to live,” Barnard said. “It’s demoralizing for the staff. Your training is to deal with acute crises and instead you have somebody who’s just lingering.”

Several nurses at SF General Hospital declined to be interviewed for this story due to the sensitivity of the issue. Dignity Health, a nonprofit that operates two hospitals in San Francisco, said in a statement that they have seven conserved patients this month.

“These patients typically stay with us for long periods of time as finding a safe destination is difficult due to the shortage of long-term custodial and psychiatric care facilities,” the statement read. “When conserved patients are boarded at acute care hospitals but do not need acute care services, we lose the opportunity to help another patient in crisis.”

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In SF and Across California, People With Severe Mental Illness Languish Untreated in Jails, Hospitals

Using conservatorships to deal with gritty urban issues

By Sydney Johnson

Homeless people line Ellis Street between Taylor and Jones streets in the Tenderloin in March.

As San Francisco grapples with overlapping crises of homelessness, drug overdoses and lagging mental health resources, political momentum is building toward expanding the use of conservatorships to legally compel more people into treatment.

But the revival of forced treatment has prompted deep concern among mental health and disability advocates, as well as civil liberties experts. Conservatorships have traditionally been reserved for last-resort cases where severely disabled individuals are unable to care for their own basic needs, not street-level homelessness or drug issues. Moreover, critics note that compelling people into treatment falls flat when there are still too few housing options and care facilities.

“This is definitely something I’ve noticed is gaining support over the last five years,” said Raia Small, an organizer with the San Francisco advocacy organization Senior and Disability Action. “And I have a lot of concerns about it. This is not what people who are homeless are asking for or people who have struggled to access housing or treatment care.”

There are different types of conservatorships in California, including mental health conservatorships specifically for people who are considered to be “gravely disabled,” meaning they have a mental health disorder that prevents them from providing their own food, clothing and shelter. Those who are conserved for mental disabilities can be subject to confinement in a locked facility, although some may live in open facilities or group homes.

New proposals

Rising rates of homelessness and overdoses across California backdrop the growing interest in conservatorships. While San Francisco saw a 3.5% drop in homelessness over the pandemic, likely due to a dramatic increase in funding for homelessness services and housing through Proposition C, many individuals still can’t access the kind of housing or care they need.

Gov. Gavin Newsom recently unveiled a proposal, called CARE Court, which would connect individuals with a 12-month court-ordered care plan. It targets those living with homelessness, substance use disorder and schizophrenia or another psychotic disorder. It’s an attempt to prevent incarcerations, but if participants can’t successfully complete their care plans, they could be placed under a conservatorship. That means the court would appoint someone else to take over the individual’s finances, medical and other important personal decision-making, and could place the individual into a locked mental health facility.

The governor’s plan, which is now making its way through the state legislature, would also enable family members, first responders, clinicians and others to refer an individual to CARE Court.

There’s also a plan by Michael Shellenberger, an author and now a gubernatorial candidate. He has proposed creating Cal-Psych, a statewide psychiatric and addiction care system that comes alongside his proposal that California should ban illegal outdoor camping.

Although the legal mechanics and heavy-handedness differ between the two approaches, they find common ground in a philosophy that people experiencing homelessness and substance use disorder need a stronger push toward care.

Mayor London Breed has backed a handful of state bills aiming at reforming conservatorships, citing frustration with a lack of options for residents she sees struggling in the streets.

But those who work closely with conservators across the state say there are vast misunderstandings from all sides about their profession. Even those who support increased funding and resources for conservatorships question the expansion of eligibility criteria.

“Half the state thinks we conserve too many people, and the other half thinks we don’t conserve enough,” said Scarlet Hughes, executive director of the California State Association of Public Administrators, Public Guardians, and Public Conservators. “The public thinks, ‘just put them on conservatorship and then you can control them.’ Not so much. We don’t have power and control over their lives to the extent people think we do.”

Public conservator programs are guided by state law but do not receive any state or federal funding; counties fund the programs entirely. That can create discrepancies on a county-to-county level about how conservatorships operate. And it puts financial strain on caseloads for public conservators who already oversee unsustainable caseloads, Hughes said.

“Most of our members have caseloads of 60 to 80 clients, and you’re totally responsible for their life. We see clients about once every three months, which isn’t enough,” said Hughes. “We make really critical life decisions for people. You want to have as reasonable of a caseload as possible, but the funding structure hasn’t changed in 40 years.”

Conservators in San Francisco have a more moderate caseload of around 40 conservatees, according to Jill Nielsen, deputy director of programs at San Francisco Human Services Agency, who oversees the county’s public conservator program. Most of their communication with clients is over the phone or in person at residential facilities where clients live.

“The conservator is an advocate. They will call and ask for help with issues that may come up at the client’s facility, for example. We are trying to help them problem solve or support effective decision-making,” she said, adding that The City supports Newsom’s CARE Court proposal. “The goal is to move our clients into recovery and out of conservatorship.”

Meanwhile, legal experts are raising the alarm about infringing on people’s rights.

By expanding eligibility for conservatorships to individuals who could benefit from wider access to other solutions like housing, health care and overdose prevention, “you’re taking people’s liberties away without committing a crime,” said Kim Lewis, managing attorney at the National Health Law Program. “These laws are designed to seek this coercive compliance.”

A San Franciscoexperiment

Here in San Francisco⁠ — often the focal point of national conversations around homelessness, substance use and mental illness⁠ — public conservatorships are not new, or entirely rare.

In fact, San Francisco has a higher number of conservatorships compared with 12 other large California counties according to a January report from the Budget and Legislative Office. And that number has been on the rise in San Francisco since 2014, going from 626 in 2014 to 769 in 2020.

At the same time, referrals to conservatorships have exceeded discharges over the last four years, the report shows, meaning more people are being conserved for longer periods of time. Discharges dropped by 16% from 2014 to 2020.

But some local officials say it hasn’t been enough.

“I think there plainly are lots of people dying because they are not getting the right kind of care and we ought to do much better job. Sometimes that requires caring for them even when they insist they don’t want or need it,” said San Francisco Supervisor Rafael Mandelman, who has advocated for using conservatorships to get more people into treatment when other interventions have failed.

The supervisor points out how increasingly common it has become to see people suffering on the streets who may not voluntarily take themselves in for care.

“This is not a new thing; this has been an option in California for decades,” Mandelman said “But the need for it becomes more acute as the institutions that might once have held some of these folks have closed and we are now in the process of decarcerate and closing prisons and jails. There are many people with great needs who need intervention and care and oversight.”

In 2018, California opened a new housing conservatorship program to compel individuals with mental illness and substance use disorders into treatment. San Francisco officials gave it a shot. The City was facing a disastrous homelessness and substance use disorder crisis, and local leaders were ready to try all possible solutions.

The 2018 state bill, SB 1045, created the Housing Conservatorship Program for unhoused adults with serious mental illness and substance use disorder. The program targeted individuals frequently landing in places such as jail or the emergency room. Between 50-100 people were estimated to qualify for the program in San Francisco.

Only three individuals have been treated under the program so far, and one of those is no longer under conservatorship.

Those who initially supported the program were hopeful it could connect a small group of vulnerable individuals to the treatment they may not even recognize could help them.

But the bill was watered down in the legislative process, making it more difficult to qualify, its supporters say. An early version of the bill would have required only three 5150 holds within a year, meaning an individual is involuntarily detained for a 72-hour psychiatric hospitalization. The final version required eight annually before steps toward conservatorships could be initiated.

“It is very disappointing that at this point we have not been able to utilize the housing conservatorship program to the extent that we had hoped,” said Neilson. “Many eligibility requirements were added into the bill and the number of individuals who we have been able to help is very small.”

The flopped results of the program have led some homelessness and mental health advocates to question and oppose the expansion of who could qualify for court-ordered care when they say there’s little evidence that expanding eligibility for conservatorships could solve homelessness or drug overdose rates.

“Talking about expanding ways to lock people up is very politically popular. Unfortunately, it doesn’t work. That is our system already,” said Jennifer Friedenbach, executive director of the Coalition on Homelessness. “We are totally dependent on (72-hour holds) to connect people with the mental health system. Most people’s first experience with the mental health system is in the back of a police car in handcuffs.”

Friedenbach and others argue instead for increasing the availability of affordable and supportive housing and low-barrier health care. People in crisis often must wait weeks and months for placements into residential treatment in San Francisco.

Many cases, few resources

Before 1960, most mental health services took place in large state-run hospitals known for having disastrous conditions and rampant abuse and segregation. In 1967, the Lanterman-Petris-Short (LPS) Act created a statewide civil process for the involuntary detention of people who could not care for themselves due to mental disabilities.

Many state-run hospitals closed as a result of the reform, which aimed to improve patient experiences and more clearly define rights. But adequate funding for alternative care facilities never followed, leaving a major gap in the state’s mental health care system.

Moreover, conserving people living on the street will not guarantee they have timely access to housing or high-quality mental health treatment.

“There is a belief we can fix homelessness like somehow we have a magic wand, but we don’t have any more access to (housing) placement than any other entity,” said Hughes. “We can authorize medications and sign someone who is under a conservatorships into a locked facility if the court authorizes it. But we can’t control the behavior of clients on the street. We don’t have more control over that individual than anyone else.”

In addition to a massive housing crisis, California is facing a shortage of psychiatric beds at all levels of adult inpatient and residential care, according to a 2021 study by the Rand Corporation and California Mental Health Services Authority. The report estimates the state needs to add about 1.7% more psychiatric beds in the next four years.

San Francisco is working toward meeting a goal of adding 400 mental health care beds, including 30 beds for individuals with co-occurring mental illness and substance use disorder.

Critics also argue there are enough individuals who want mental health treatment and struggle to get it.

“What the state hasn’t spent a lot of energy trying to do is find more effective ways to seek people’s interest in getting care by offering enough services in the community” said Lewis. “People can’t even get in when they want to. So this idea we push people to the front of the line who don’t want it doesn’t make sense anyway.”

Correction: This story previously stated 4,000 individuals could qualify for a housing conservatorship program in San Francisco. It is estimated to be closer to 50-100. The story has been updated.

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Using conservatorships to deal with gritty urban issues

California communities must show they can CARE

Andrae Gonzales

By ANDRAE GONZALES

Cities across California are at the forefront of responding to the persistent crisis of homelessness.

Since 2018, when the Bakersfield City Council declared a homeless emergency shelter crisis, Bakersfield has invested in over 600 new shelter beds. Even during a global pandemic, we built the very successful Brundage Lane Navigation Center, which has moved nearly 140 individuals from the shelter into permanent housing through comprehensive case management. The 2022 Point-in-Time homeless count indicated that, for the first time in years, there were more people in shelters than on the streets this past winter.

The city continues to address issues related to encampments by investing in bio-hazard clean up teams in Downtown and Old Town Kern, Public Works Clean City Teams, the Bakersfield Homeless Center’s Jobs program, the reestablishment of the Bakersfield Police Department’s Impact Teams and Code Enforcement’s Rapid Response Teams. In 2021, the Rapid Response team alone received 6,217 complaints, cleaned up 4,690 encampments and collected over 5.93 million pounds of trash.

Bakersfield has also developed one of the Central Valley’s first housing trust funds to spur additional investment in housing production to provide permanent housing solutions to unhoused individuals. Since 2019, we’ve invested over $14 million into the fund. We’ve allocated another $10 million in ARPA funds for affordable housing, and have received millions of dollars in additional state and federal grants. As a result, over 136 new affordable housing units were completed last year, 217 units are under construction and development and 154 units are set to be rehabbed.

Yet, despite our best efforts to chip away at the problem, there are far too many people with severe mental health and addiction issues roaming our streets and living in encampments. These are our aunts, uncles, sons, daughters, cousins who are suffering from untreated schizophrenia spectrum or psychotic disorders, left on our streets to wither away.

Look around, in Bakersfield and throughout California, it’s clear that the status quo is not working. While we must continue to provide support for those seeking emergency shelter, it is obvious that more must be done. But there are limits to what city governments can do. The state must step up.

This is why I am asking that my colleagues on the City Council join me in adopting a resolution in support of Gov. Gavin Newsom’s CARE Court Model. The Community Assistance, Recovery and Empowerment (CARE) Court is a new proposal to get people with mental health and substance abuse disorders the care and support they desperately need. The new CARE Court model will hold everyone accountable — individuals and local governments — with court orders for care, and consequences for not following through for both parties.

CARE Court will connect a person struggling with untreated mental illness with a court-ordered CARE plan for up to two years. Each plan can include clinically prescribed, individualized interventions with several supportive services, medication and a housing plan, and will be managed by a care team in the community.

The focus of CARE Court is on stabilizing people with the hardest-to-treat behavioral health conditions, without taking away their rights. Each person will be provided with a public defender and a new supporter, on top of their full clinical team, to provide supported decision making-not substitute decision making, as happens in conservatorships.

CARE Court is for a subset of individuals who lack medical decision-making capacity — before they get arrested and committed to a state hospital, and before they become so impaired that they end up in a Mental Health Conservatorship.

Let’s be clear: There are many reasons why people find themselves homeless. No single solution will solve this societal issue. But CARE Court is a necessary next step in helping some of the most vulnerable individuals get off of the streets and into housing with the support that they desperately need.

 Newsom is not only calling for this new approach but supporting this effort by including $65 million for initial costs to implement CARE Court.

This plan is currently moving through the Legislature.

Bakersfield Mayor Karen Goh, along with California’s Big City Mayors, has endorsed this proposal. The National Alliance on Mental Illness, California Professional Firefighters, the California Medical Association and the California Hospital Association have also joined the coalition in support of CARE Courts.

California must act with urgency to address the mental health crisis on our streets. If you agree, call your state representatives and encourage them to support the CARE Court Framework.

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California communities must show they can CARE

California mental health court won’t help homeless, advocates say. ‘This idea is broken’

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

Last month, Gov. Gavin Newsom unveiled a plan to create a civil court system to compel treatment for people suffering from serious untreated mental illness, saying it’s time for the state to “take some damn responsibility to implement our ideals.” Newsom presented his proposal — the Community Assistance, Recovery and Empowerment Court, or CARE Court — as a way to help unhoused residents with conditions that cause psychosis. The policy is moving through the Legislature in the form of two bills — Assembly Bill 2830 from Assemblyman Richard Bloom, D-Santa Monica, and Senate Bill 1338 from Sen. Susan Eggman, D-Stockton, and Sen. Thomas Umberg, D-Santa Ana.

The bill is getting push-back from disability rights advocates, who say CARE Court forces treatment on mentally ill people with little regard for their civil rights. They also argue it wastes money that would be better spent on public education, early intervention and programming that doesn’t involve coercion. “We are neglected throughout the whole process, up until the point our condition is so severe that we can’t control it and we start doing things like breaking the law,” said John Vanover, legislative committee chair for the Depression and Bipolar Support Alliance of California. “And at that point, now, the governor wants to step in and make us criminals. So fundamentally, this idea is broken, just from that.”

How would CARE Court work? CARE Court would effectively create a new wing of the civil court system in all 58 of California’s counties that would allow a judge to order a mental “care plan” for those dealing with severe untreated mental illness. The program would apply to everyone who meets the criteria, but Newsom has repeatedly referenced it as a tool to help the homeless population. A person qualifies for CARE Court if they’re at least 18, diagnosed with “schizophrenia spectrum or other psychotic disorder,” are not receiving treatment, and lack “medical decision-making capacity,” according to SB 1338. California was home to nearly 162,000 homeless people in 2020, according to U.S. Department of Housing and Urban Development data. Nearly 38,000 people from that population — about 23% — were considered “severely mentally ill.”

CARE Court is meant to target the 10,000 to 12,000 people dealing with schizophrenia and psychosis who may qualify for the program, said Jason Elliott, a senior counselor to Newsom. The CARE Court program would enable a host of people — including family members, first responders and behavioral health professionals — to petition the court to create care plans for those who meet the criteria, according to SB 1338. County behavioral health departments would be responsible for carrying out the care plans. Those who don’t comply with their plans could be subject to California’s existing system of involuntary hospital stays and conservatorships.

 

President Ronald Reagan and Nancy Reagan at the Capitol in Sacramento. Mitch Toll Sacramento Bee file

Such programs have been in place since the 1960s, following the state’s shift away from mental health hospitals and toward community-oriented care.

Since California dismantled the hospital system, the state has primarily made use of the Lanterman-Petris-Short Act and Laura’s Law to care for people who suffer from severe mental illnesses. LPS — which then-Gov. Ronald Reagan signed in 1967 — ended the practice of long-term involuntary commitments to mental health institutions. However, it does allow involuntary hospital stays for those deemed a danger to themselves or others. The most well-known of these hospitalizations is the 5150 hold — nicknamed for the section of legal code in which it appears — which requires someone to receive treatment for 72 hours. LPS also created the conservatorship system, through which other people take responsibility for a gravely ill individual’s medical care and personal assets. Laura’s Law, passed in 2002, created an assisted outpatient treatment program that can be court-ordered after a person who’s mentally ill has repeatedly been hospitalized or arrested.  (Click to continue reading)

 

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California mental health court won’t help homeless, advocates say. ‘This idea is broken’

California judges could order help for homeless Californians under Newsom’s new plan

A resident of a homeless encampment in downtown Los Angeles sits on the street in January.
(Irfan Khan / Los Angeles Times)

By Hannah Wiley

As California cities struggle to address a homelessness and mental health crisis on their streets, Gov. Gavin Newsom’s administration on Thursday unveiled a proposal to push more people with severe psychiatric disorders and addiction issues into court-ordered care that includes medication and housing.

The proposal, which Newsom is calling the Community Assistance, Recovery and Empowerment Court, is the state’s latest effort to address one of California’s greatest struggles, and a recognition that something more robust is needed to solve the problem. Newsom allocated $12 billion for homelessness in the state budget last year and proposed an additional $2 billion in his January financial blueprint.

But implementing a court-ordered response to mental illness and substance abuse disorders would accelerate the state’s multipronged strategy to help thousands of people get much-needed services, while acknowledging that the current system is not working as it should.

“Rather than reforming in the margins a system that is foundationally and fundamentally broken, we are taking a new approach,” Newsom said during a Thursday news conference. “We are offering a new strategy and new partnerships. But we are offering it in a way that we haven’t in the past, and that’s with resources.”

Newsom said the new initiative would come with “unprecedented investments” that could total in the “billions and billions of dollars” over several years to set up the infrastructure and establish the workforce needed to accomplish the plan. He said CARE Court aims to address the urgency and magnitude of the homelessness crisis, and contains accountability provisions to ensure people follow the program.

“This is about accountability, but it is about compassion, and it’s about recognizing the human condition,” he said.

Sarah Dusseault, co-chair of the Blue Ribbon Commission on Homelessness in Los Angeles County, welcomed the announcement. Dusseault has worked in local government for years on solutions to homelessness, inspired by her experience advocating on behalf of her brother and navigating a system that has made it difficult for him to receive care for his schizophrenia.

“I’m incredibly excited about increased access to care,” Dusseault said. “People get lost in the current system and we have to create accountability measures so that people don’t get lost.”

All of California’s 58 counties would have to participate in the program through their civil courts, and local governments could face sanctions if they don’t comply with its requirements. A person would not have to experience homelessness to participate in CARE Court, and families, clinicians, counties, behavioral health providers and first responders could all ask judges to implement a plan. To determine if someone qualifies for a CARE plan, a judge would have to order a clinical assessment.

Participants could include those who were just arrested and released, or are exiting a short-term involuntary hospital hold. A plan could be ordered to last for 12 months, with the possibility of a 12-month extension. If unsuccessful, a participant could instead be hospitalized or ordered into a conservatorship. Criminal cases that were paused while participants entered CARE Court could then resume if the plan didn’t work.

Conservatorships, which are usually reserved for those with serious mental illnesses, hand legal decision-making power to someone else. The practice is highly controversial, and some critics argue that it unfairly strips people of their rights, while proponents claim it is often the best option for those experiencing crisis. The Newsom administration said CARE Court instead would emphasize “individualized interventions” through a “client-centered approach,” and participants would have access to a public defender and a care team throughout the process.

On a Thursday call with reporters, administration officials said the new program aims to save lives and prevent incarceration and homelessness among the state’s most vulnerable residents through a modernized approach that doesn’t default to conservatorship.

“CARE Court is really not a replacement for conservatorship,” said Jason Elliott, Newsom’s top advisor on housing, adding that it is a “new tool.”

Thursday’s announcement deviates from what Newsom suggested during his January budget proposal when he hinted at “leaning into conservatorships” this year, though he offered few details at the time on what that could include. 

Dr. Mark Ghaly, California’s health and human services secretary, said the plan would help alleviate “one of the most heartbreaking, heart-wrenching and yet curable challenges that we face in our communities and on our streets.”

“For a community, a population of individuals who lives in the shadows, lives often without voice, today is about lifting them up and prioritizing their needs,” Ghaly said.

Jessica Cruz, executive director of the California chapter of the National Alliance on Mental Illness, said the proposal is something for which families have advocated for years.

“This is an opportunity for families who have been in so much pain and suffering for so many years, this gives us at least an opportunity to get the treatment our loved ones need,” Cruz said. “This is an opportunity to save lives and heal families.”

Cruz also said that the CARE Court framework not only presents an alternative to conservatorship, but would also give new hope to those who haven’t had success with prior treatment.

“It’s a different road for people, a different door that people can really open that has never been unlocked before,” Cruz said.

Ghaly said the new program will focus on clinical services for people experiencing psychotic disorders such as schizophrenia, along with treatment plans for substance abuse disorders. Another important element of the plan is providing housing services, Ghaly said.

In response to the announcement, however, the California State Assn. of Counties in a statement raised concerns with the proposal, including that it contains sanctions.

“Building off of past collaborative successes between the state, counties and cities is important. Counties are all in to do our part to solve homelessness and rebuild behavioral health infrastructure. Sanctions are not the way to do it,” Graham Knaus, the association’s executive director, said in the statement.

The association also warned that behavioral health infrastructure has suffered from decades of insufficient funding. Though CARE Court would help a “narrow population,” the association wrote, more housing and systemic change is needed, which means the program “will have limited success.”

Though the plan so far is just a policy framework, the administration said it is working with the Legislature on a bill that would codify the proposal. Newsom also said CARE Court could be included in the budget, which would be the fastest way to implement it. The deadline to pass legislation is Aug. 31, but the Legislature approves the budget each year in June.

Elliott said it is imperative that lawmakers work quickly to pass legislation so the plan can become law.

“We don’t have any time to waste here,” Elliott said.

Full Article & Source:

California judges could order help for homeless Californians under Newsom’s new plan 

Officials look to expand conservatorship law to get homeless into care

The growing homeless population is getting out of hand for providers and city leaders. Now some want to create a new way to help those who can't help themselves. KPBS reporter Tania Thorne says it would mean changing conservatorship laws.

 

By Tania Thorne

When you hear “conservatorship,” you likely think of Britney Spears and the Free Britney movement.

Last November, a judge put an end to her 14-year probate conservatorship, which meant her father was assigned to care for her and manage her assets.

But there’s another type of conservatorship that some lawmakers see as a tool to combat the homelessness crisis.

The Lanterman-Petris-Short Act, or LPS Act, allows a judge to appoint a conservator over a person with a mental health disorder.

“We're not talking about an extremely wealthy, very famous celebrity, ” said San Diego Mayor Todd Gloria. “We're talking about the sickest and most vulnerable people that live on the streets of San Diego and on the streets of cities across the nation.“

Gloria wants to expand the LPS Act to force more mentally ill homeless people to go into treatment.

Currently, the law says people who courts rule as “gravely disabled” can be placed under conservatorships and put in a healthcare facility, even if it’s against their will. Gloria wants to expand that definition.

“A portion of these folks end up in the criminal justice system, which I hear very clearly from the public, they are not comfortable with," he said. "There has to be some choice other than leaving them on the streets or incarcerating them in prison. We have to have a better option."

But some providers say that even changing the law and putting more homeless people under conservatorships doesn't change that there are not enough places for them to go.

“How does anything change the day after that law is signed if we don't have more treatment beds, more housing, more funding for services?” said Michelle Cabrera with the County Behavioral Health Directors Association of California.

Cabrera said people stand a better chance at long-term recovery when they enter into services voluntarily.

“The vast majority of people, including people with serious mental illness and or substance use disorder needs, voluntarily and willingly accept both services as well as housing when it is offered to them," she said. "Our problem in California is that we have a major deficit of housing that meets the needs of very low-income Californians."

Services are scarce right now, said Greg Anglea, the CEO of Interfaith Community Services, which provides supportive services in San Diego.

“Far too often we have to ask somebody where did you sleep last night and is it safe to sleep there again because help is not available today,” he said.

He said addressing conservatorship reform before expanding resources is a backward way of thinking.

“Until we have access to these resources, taking away people's rights who want to access those resources, but who can't, is going too far and it is not something we would advocate for,” he said.

Keri Souza has been homeless since 2016 and knows she has a mental illness.

“I let them know that I have a mental illness and that I need help with my medication and that I need to have an eval, but I don't think a lot of people know to say that,” she said.

She questions what will happen if someone rejects a conservatorship.

“What if you don't want to do what they're asking you to do?“ she said. “Is that going to affect me negatively? Am I now not going to get the services that I need? That would be pretty pertinent.”

Every Wednesday, Souza goes to a Humanity Showers event for a shower, food and clothes.

Jordan Verdin, who runs the program, is worried that conservatorships could violate people’s trust.

“Coming out here and speaking to people, you’ll see a lot of the underlying issues are really deep-rooted in trauma and displacement," he said. "These policies will actually perpetuate the trauma deeper by displacing them and removing them from their communities.”

But Gloria said the problem can’t continue as it has and something has to be done.

“San Diegans see this every single day, people who are clearly not capable of caring for themselves being left on the streets where they're vulnerable, sick, in some cases dying,“ he said. “It's absolutely unacceptable, we have to do something different and that's why we need to change our state's conservatorship laws.”

He will spend the next year working to change the law.

Full Article & Source:

Officials look to expand conservatorship law to get homeless into care

Conservatorships Keep the Homeless in Psychiatric Wards Too Long: Study

by Alan Mozes

WEDNESDAY, Jan. 19, 2022 (HealthDay News) -- Homelessness is difficult enough, but when it's compounded by serious mental health issues the result can be an inability to function at even the most basic level.

Sometimes that leads to round-the-clock involuntary hospitalization, and when that happens a state-appointed psychiatric conservator can take over, making critical health care decisions for a person deemed mentally unstable.

But new research conducted in California warns that once a conservatorship is set up, there's a very real risk that a homeless individual will end up stuck in a psychiatric hospital for weeks or months — far exceeding what's needed and much longer than inpatient care provided to patients who aren't homeless.

The bottom line, according to lead researcher Kristen Choi, is that "our mental health care systems are falling short in meeting the needs of individuals who are homeless at every level." She's assistant professor in the schools of nursing and public health at the University of California, Los Angeles (UCLA).

Taxpayers also pay a hefty price: Choi's team estimates that it costs $767 per day (nearly $280,000 per year) to care for a homeless person on a psychiatric ward in California, compared to less than $14,000 to provide them with year-round housing. Most of the patients in the study were uninsured.

Last-resort option

In their research, the UCLA team tracked the progress of nearly 800 Los Angeles residents, aged 18 to 56, who were involuntarily hospitalized within a non-profit "safety net" psychiatric facility sometime between 2016 and 2018.

A little more than half of the patients did have housing and never ended up being placed in a conservatorship. In these cases if they were hospitalized it was typically for less than two weeks, Choi's team found.

But nearly half of admittees to psychiatric care were homeless. Among that group, about one in every seven were placed under a mental health conservatorship, according to the report.

Once that step was taken, these patients often faced "very lengthy hospital stays," averaging about five months, although some went even longer, Choi said.

A mental health conservatorship is "a strict legal process," she added. In California, it's a kind of highly restricted last-resort option, intended for limited durations in order to protect mentally impaired patients for whom "all other treatment options have been exhausted," Choi explained.

"Mental health conservatorships are for individuals who are 'gravely disabled' by serious mental health illness, such as schizophrenia, bipolar disorder, or other mental health disorders," she said. If unable to feed, clothe or house themselves, such patients can be deemed in need of a guardian who can step in to make mental health treatment decisions.

(As such, this arrangement is not to be confused with the much-publicized case of Britney Spears, whose conservatorship was of the financial affairs/probate variety; the pop star never lost her ability to make her own health care decisions.)

Once patients become stable enough, mental health conservatorships are meant to end, with patients shifting from an involuntary psychiatric hospital setting to a voluntary, community-based care model instead.

But housing is crucial to that transition.

"It is difficult, if not impossible, to stabilize mental illness for individuals who do not have their basic needs met, including housing," Choi explained.

And even if psychiatric stability is achieved, all patients face "a very long waitlist for beds at lower levels of care, such as in psychiatric step-down facilities, psychiatric rehabilitation facilities, and group homes," she added.

That means that patients under conservatorship often "have no choice but to wait in the hospital" after stabilization, Choi noted, sometimes for weeks or months.

Too few options

That wait ends up being a particularly heavy burden for homeless patients, given that 14% of the study's homeless patients were placed in a conservatorship compared to just 3% of patients with housing.

Overall, even though homeless admittees to psychiatric care under conservatorships made up just 6% of all the patients in the study, they ended up accounting for more than 40% of the total time spent hospitalized over the study period, the researchers found.

None of this is good for anyone, said Choi. But she believes that "hospitals have few options" when it comes to handling such patients, because there's been so little progress in improving access to either housing or community-based mental health services.

"It is important to note that the vast majority of people experiencing homelessness do not have mental illness," Choi stressed. "Homelessness is ultimately a problem of lack of housing, not lack of mental health care, and we must be cautious to not conflate homelessness and mental illness."

But she believes that "conservatorships are not appropriate or humane for the majority of people with mental illness," homeless or otherwise.

Hoping to address the situation in Los Angeles, Choi said she and her colleagues are linking street-based homeless outreach teams — such as L.A.'s Homeless Outreach and Mobile Engagement (HOME) program — with inpatient psychiatric services at facilities such as Gateways Hospital and Mental Health Center.

Housing and health care

The problem isn't confined to California, of course. Alleviating mental illness among the homeless is an uphill battle everywhere, according to child and adolescent psychiatrist Dr. Nicole Kozloff.

"A lack of stable housing makes managing a serious mental illness a near-impossible task," said Kozloff, who is associate director of the Slaight Family Centre for Youth in Transition at the Campbell Family Mental Health Research Institute in Toronto.

In a perfect world, mental health treatment involves psychotherapy appointments, daily medication regimens, bloodwork, and medical check-ups, Kozloff said. But life on the streets is far from a perfect world.

"It is very difficult to maintain this routine if you have to prioritize your basic needs, don't have a private place to store your belongings, (and) can't afford transportation," Kozloff said. "Furthermore, the stress of being homeless can exacerbate existing mental health problems."

Kozloff agreed with Choi that solutions lie in improved access to permanent affordable housing, coupled with a wider availability of "mental health supports geared to a person's needs and choices."

Choi's team published their findings recently in the online issue of Psychiatric Services.

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Conservatorships Keep the Homeless in Psychiatric Wards Too Long: Study

Will a conservatorship help homelessness in San Diego County?

While there's no plan in place yet, some are excited while some say it's not the solution.

 

 

Author: Regina Ahn, CBS News 8 Team

SAN DIEGO COUNTY, Calif. — The homelessness crisis in San Diego has been a priority for state and local leaders.

With a diverse population, there's a lot to be done to help combat the situation, and one tool is a conservatorship program for the homeless. While there's no plan in place yet, some are excited while some say it's not the solution.

"This year, I’m pushing for state action on conservatorships," San Diego Mayor Todd Gloria said in his State of the City address on Wednesday.

Conservatorships in which a court appointed conservator manages another person's living situation, medical decisions, and mental health treatment – has gotten support from both Mayor Todd Gloria and Governor Gavin Newsom.

"We have more treatment programs, more conservatorships," said Gov. Newsom.

However, San Diego attorney Scott Dreher, who has worked with homeless people for over 20-years says it may not be the answer.

He says the issue and solution is too complex. 

In San Diego, it’s extremely difficult to get a conservatorship, according to experts. It requires a judge’s order and there are limited conservatorships, and a family member must be present.

"Anyone who thinks that ‘oh, we’ll just put everyone in a conservatorship’ and that’ll take care of that…that’s never going to happen, that’s not the way around this," said Dreher.

Dreher says while it may be a solution for some people, there are more pressing things that could help. "What's going to solve the problem is giving people a place to be that may not have a place to be," said Dreher.

Mayor Gloria and Dreher both say housing is the biggest issue to combat homelessness.

"The shortage of homes every day San Diegans can afford is splitting up families," said Mayor Gloria.

But there’s also the issue of being mindful and compassionate towards the homeless population,

Amie Zamudio is the homeless outreach director with “Housing 4 The Homeless” and says there are no simple solutions.

"What we’re seeing is there are some people who cannot take care of themselves and no matter how much support we offer, they refuse support,” said Zamudio. “They just can’t take care of themselves it’s not humane to leave people out on these streets to decay and die."

Full Article & Source:

Will a conservatorship help homelessness in San Diego County?

Mental health conservatorships led to lengthy inpatient stays among homeless people with mental illness

Reviewed by Emily Henderson, B.Sc.

At a time when public and private agencies and the legal system are grappling with how to best assist people who live at the intersection of homelessness and mental illness during a global pandemic, UCLA researchers have found mental health conservatorships for people with disabling, severe mental illness who are also homeless can result in lengthy psychiatric hospitalizations.

"Our study found that mental health conservatorships resulted in very lengthy inpatient stays for those who were homeless when conserved, sometimes as long as months or even a year," said Dr. Kristen Choi, UCLA Fielding School of Public Health assistant professor of health policy and management. "We observed a 'bottleneck' effect in this study. There are very few long-term housing options for people who are disabled by mental illness and in need of supportive housing in Los Angeles. When these individuals are stabilized and ready for a lower level of community-based care, there is no place for them to go."

Choi, a psychiatric nurse who is also an assistant professor with the UCLA School of Nursing, led the current study, "Mental Health Conservatorship Among Homeless People With Serious Mental Illness." Mental health conservatorships, known as a Lanterman-Petris-Short Act (LPS) Conservatorship in California, are highly restrictive and thus reserved only for individuals with severe, ongoing disability from mental illness who cannot accept voluntary treatment. There is a strict legal process for initiating such conservatorships that involves review and monitoring by the courts.

"It is important to note that the majority of people experiencing homelessness do not have mental illness," said Dr. Enrico Castillo, a psychiatrist with the UCLA Center for Social Medicine and Humanities. "Homelessness is not the same thing as mental illness and as such, the solution to homelessness is housing, not psychiatric treatment."

The most recent measurement, the 2020 Greater Los Angeles Homeless Count, found 66,436 people in Los Angeles County experiencing homelessness; the 2021 survey was suspended because of the COVID-19 pandemic. At the same time, across the United States, the best available estimate of homelessness is some 580,466 people, according to the U.S. Department of Housing and Urban Development. Twenty-one percent of individuals who are homeless have serious mental illness, compared with 5 percent in the general U.S. population. Mental illness among people who are homeless is associated with higher risk for mortality, disability, substance use disorders, and suicide.

Publication of the study is pending in an upcoming edition of the peer-reviewed journal Psychiatric Services, published by the American Psychiatric Association. It is currently available on-line. The researchers from the UCLA Fielding School and the UCLA Center for Social Medicine and Humanities examined a sample of 795 adults, 18 years of age or older, who were hospitalized on an involuntary psychiatric hold in Los Angeles between 2016 and 2018. They examined discharge and mental health conservatorship outcomes for patients who were homeless. The researchers found that inpatient stays were almost four weeks longer for individuals who were homeless when admitted compared to those who were housed.

For the minority of people experiencing homelessness who also have severe and disabling mental illness, such as those in our study, supportive housing options that combine treatment with housing are greatly needed in Los Angeles."

Dr Marissa Seamans, Study Co-Author and Assistant Professor of Epidemiology, UCLA Fielding School of Public Health

The study was conducted in partnership with Gateways Hospital and Mental Health Center, a safety net mental health system in Echo Park that aims provides mental health care to all people regardless of their ability to pay. In response to their growing homeless patient population and the results of this study, Gateways Hospital has formed a new partnership with the Homeless Outreach and Mobile Engagement (HOME) Team pilot program to link street-based psychiatric treatment with inpatient, outpatient, and residential treatment in the Gateways system.

"This partnership will enable us to better meet the needs of homeless individuals who are living in the streets due to their mental health related impairments," said Dr. Shayan Rab, a street psychiatrist with the HOME Team. "Street-based mental health services can be a first step in addressing long-term treatment needs. At the same time, more residential treatment options in Los Angeles is ultimately the solution we need most."

Source:

UCLA Fielding School of Public Health

Journal reference:

Choi, K. R., et al. (2021) Mental Health Conservatorship Among Homeless People With Serious Mental Illness. Psychiatric Services. doi.org/10.1176/appi.ps.202100254.

Full Article & Source:

Mental health conservatorships led to lengthy inpatient stays among homeless people with mental illness