Benton County judge censured for parking lot incident

BENTONVILLE, Ark. (KNWA/KFTA) —On January 21, the Arkansas Judicial Discipline and Disability Commission (JDDC) announced that a Letter of Censure has been issued to Judge Brad Karren of the 19th West Judicial Circuit, Division 2.

The censure follows a heated verbal exchange involving Judge Karren that happened in the Benton County-owned court parking lot in April 2021.

The letter explains that the confrontation involved Judge Karren and three other individuals, and arose after one of them parked in a spot reserved for the judge. In the document from the commission, Karren’s actions at the time are described as inappropriate and avoidable.

A man involved in the encounter described Judge Karren as “rabid” in a social media post, and explained that he saw “a very angry man with a gun on his hip and a cane berating my son and wife.”

The letter explains that Judge Karren was accompanied by a bailiff and that “at one point the judge throws his cane as if to clear his hands and adopts an aggressive stance.”

He resigned as the Benton County judge administrator after the incident. He is still a Benton County judge and is presiding over multiple high-profile cases, including one involving the killing of a Pea Ridge police officer.

In a response letter, Judge Karren accepted full responsibility for the incident.

Without question, I accept full responsibility and public censure today. I know that integrity, independence, and impartiality are key prerequisites for an effective and functional judiciary and judicial system.

Judge Brad Karren

Multiple attorneys co-signed Judge Karren’s response letter and attested to his remorse and regret regarding the encounter, as well as his fairness in the courtroom.

An agreement between Judge Karen and the JDDC included several remedial measures:

• Judge Karren “proactively enrolled and attended the class on ‘Mindfulness for Judges’ through the National Judicial College. This was a four day, recommended class.
• The judge submitted proof of participation in professional counseling offered through the Judges and Lawyers Assistance Program and agreed to continue meetings until he and the counselor both agree the sessions are no longer needed.
• Judge Karren read and reviewed a report on bullying and sexual harrassment, and is expected to understand the “issues, standards and examples of bullying in the legal profession.”
• An agreement by the judge to have no more complaints resulting in a finding of probable cause leading to public charges or discipline.
• Officially reiterating his apology to those involved and to the public for his actions that “reflected poorly on the judiciary.”

Judge Karren was previously sanctioned in 2012 after speaking to the parents of a juvenile in custody without having a prosecutor present and without notifying the prosecutor’s office. He issued the parents a visitation order that he admitted “did not follow the standard juvenile detention policy.”

He told a witness that all he was trying to do was “help the mother out.” The juvenile refused to meet with his family and the visitation did not occur that day.

Judge Karren was elected to his position in 2012 and re-elected in 2014 and 2020. His current term is set to expire on December 31, 2026.

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Benton County judge censured for parking lot incident

Conflicts between nursing home residents are often chalked up to dementia – the real problem is inadequate care and neglect

Eilon Caspi, Assistant Research Professor of Health, Intervention, and Policy, University of Connecticut

Conflicts between residents with dementia occur often in long-term care settings. CasarsaGuru/E+ via Getty Images

Frank Piccolo was a beloved high school chemistry teacher in Ontario, Canada, until his retirement in 1998. “His trademark was to greet all of his students at the door at the start of class to make sure everyone felt welcomed there,” wrote a former student. “He had extensive knowledge of his subject matter, passion for his craft, and empathy for his students.”

But after Frank’s retirement, he developed dementia. When his condition declined, his family moved him to a Toronto nursing home. One evening in 2012, another resident – a woman with dementia – entered Frank’s bedroom. She hit Frank repeatedly in the head and face with a wooden activity board. Staff found Frank slumped over in his wheelchair, drenched in blood. He died three months later.

The Ontario Ministry of Health and Long-Term Care investigated. It found that the woman had a history of pushing, hitting and throwing objects at staff and other residents. But the nursing home didn’t address the woman’s behavioral expressions for weeks before the attack on Piccolo, the agency determined. “There were no interventions implemented, no strategies developed,” the report stated.

Frank Piccolo and his wife, Theresa, traveling together in Italy in 2001. Theresa Piccolo, CC BY-NC-ND

As a gerontologist and dementia behavior specialist, I’ve written a book on preventing these incidents. I also co-directed, with dementia care expert Judy Berry, a documentary on the phenomenon called “Fighting for Dignity.” The film sheds light on the emotional trauma experienced by family members of residents harmed during these episodes in U.S. long-term care homes.

Reporting and stigmatizing

Resident-to-resident incidents are defined by researchers as “negative, aggressive and intrusive verbal, physical, material and sexual interactions between residents” that can cause “psychological distress and physical harm in the recipient.”

These incidents are prevalent in U.S. nursing homes. But they are largely overlooked by the Centers for Medicare and Medicaid Services, the federal agency overseeing care in approximately 15,000 nursing homes across the country. Consequently, such incidents remain untracked, understudied and largely unaddressed.

An elderly man with severe injuries, including cut marks and bruises, across his face and forehead.

These interactions don’t just result in injuries and deaths among residents. They also leave behind devastated families who then must fight for answers and accountability from nursing homes.

Making matters worse, government reports, research studies and media coverage commonly describe these episodes with words that stigmatize people with dementia. Researchers, public officials and journalists tend to label the incidents as “abuse,” “violence” and “aggression.” They call a resident involved in an incident a “perpetrator” or an “aggressor.” News outlets described the attack on Piccolo by the woman with dementia as “aggressive” or “violent.” And when reporting on the phenomenon in Canada, the Toronto Star called it “abuse.”

Getting to the root of the real problem

Most incidents, however, do not constitute abuse. A growing body of evidence suggests the true cause of these injuries and deaths is inadequate care and neglect on the part of care homes. Specifically, there is a lack of the specialized care that people with dementia require.

Two of every three residents involved in these incidents have dementia. One study found that the rate of these episodes was nearly three times higher in dementia care homes than in other long-term care homes. A recent study also found an association between residency in a dementia care home and higher rates of injurious or fatal interactions between residents.

But for these residents, the conflicts occur mostly when their emotional, medical and other needs are not met. When they reach a breaking point in frustration related to the unmet need, they may push or hit another resident. My research in the U.S. and Canada has shown that “push-fall” episodes constitute nearly half of fatal incidents.

Another U.S. study found that as residents’ cognitive functioning declined, they faced a greater likelihood of injury in these incidents. Those with advanced dementia were more susceptible to inadvertently “getting in harm’s way,” by saying or doing things that trigger angry reactions in other residents.

The Centers for Disease Control and Prevention has stated that what it calls “aggression” between residents is not abuse. Instead, the CDC noted that these episodes may result when care homes fail to prevent them by taking adequate action. And a study on fatal incidents in U.S. nursing homes has shown that many residents were “deemed to lack cognitive capacity to be held accountable for their actions.”

How incidents often occur

In one study, researchers examined situational triggers among residents with cognitive impairments. The strongest triggers involved personal space and possessions. Examples include taking or touching a resident’s belongings or food, or unwanted entries into their bedroom or bathroom. The most prevalent triggering event was someone being too close to a resident’s body.

That study also found that crowded spaces and interpersonal stressors, such as two residents claiming the same dining room seat, could lead to these episodes. My own work and a different Canadian study came to similar conclusions.

Other research shows that when residents are bored or lack meaningful activity, they become involved in harmful interactions. Evenings and weekends can be particularly dangerous, with fewer organized activities and fewer staff members and managers present. Conflicts between roommates are also common and harmful.

Residents with dementia who are meaningfully engaged in activities are less likely to become involved in harmful incidents with other residents. Morsa Images/DigitalVision via Getty Images

A growing body of research suggests that most incidents between residents are preventable. A major risk factor, for example, is lack of adequate supervision, which often occurs when staff are assigned to caring for too many residents with dementia. One U.S. study found that higher caseloads among nurses’ aides were associated with higher incident rates.

And with poor staffing levels in up to half of U.S. nursing homes, staff members do not witness many incidents. In fact, one study found that staff members missed the majority of unwanted bedroom entries by residents with severe dementia.

Residents with dementia are not to blame

In most of these situations, the person with dementia does not intend to injure or kill another resident. Individuals with dementia live with a serious cognitive disability. And they often must do it while being forced to share small living spaces with many other residents.

Their behavioral expressions are often attempts to cope with frustrating and frightening situations in their social and physical environments. They are typically the result of unmet human needs paired with cognitive processing limitations.

Understanding the role of dementia is important. But seeing a resident’s brain disease as the main cause of incidents is inaccurate and unhelpful. That view ignores external factors that can lead to these incidents but are outside of the residents’ control.

Frank’s wife, Theresa, didn’t blame the woman who injured her husband or the staff. She blamed the for-profit company operating the nursing home. Despite its revenue of $2 billion in the year before the incident, it failed in its “duty to protect” Piccolo. “They did not keep my husband safe as they are required to do,” she said.

This article is republished from The Conversation, a nonprofit news site dedicated to sharing ideas from academic experts. It was written by: Eilon Caspi, University of Connecticut.

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Conflicts between nursing home residents are often chalked up to dementia – the real problem is inadequate care and neglect

CEO with Down syndrome runs successful cookie company that helps others with disabilities get jobs

By Caitlin O'Kane

In high school, she was bullied. After college, it was difficult to find a job. But through all the difficult times, Collette Divitto, has had one thing that makes her happy: baking. Divitto, who has Down syndrome, decided to channel her passion into a career, opening her own cookie company.

"So actually, I always loved baking, since I was 4 years old. From high school, I had been taking baking classes," said Divitto, 31. "It was a hard time for me. I had no friends, I didn't have a social life. I got bullied, I got picked on. And that's why I had been taking baking classes."

After high school, Divitto went to Clemson University in South Carolina, but after graduating, it was difficult for her to find jobs. So, she turned to her mom, who helped her create her own job: CEO of Collettey's Cookies. 

Collettey's Cookies, which is run out of Boston, was founded by Divitto in 2016 and has already brought in more than $1 million in revenue over the last five years. And if starting her own business in her 20s isn't impressive enough, Divitto is also an author of two children's books, is featured on the docuseries "Born for Business" about entrepreneurs with disabilities, and runs a nonprofit.

"There's lots of amazing things happening," Divitto said of the opportunities coming her way. She says her favorite part about running her business is hiring people with disabilities.

Divitto's mom, Rosemary Alfredo, helped her start her own business, which Divitto is CEO of.

 

Collettey's Leadership Org helps people with disabilities prepare for their careers, by offering workshops and mentoring. A percentage of proceeds from Collettey's Cookies, which ships nationwide and to Canada, goes towards the nonprofit.

In 2020, just 17.9% of people with a disability were employed. But Divitto believes many want to work, and even when they do, federal law does not require employers to pay them minimum wage. That means companies can pay people with disabilities whatever they think they're worth – something Divitto is working to change.

Collettey's Cookies

She has created a petition to help create more jobs for people with disabilities, which she hopes gets the attention of Congress. And not only does she advocate for people with disabilities through her nonprofit, she also hires them to work at her own company.

"My whole mission is creating jobs for people with disabilities," she said. "For people who do have disabilities...some want to have a job so badly."

Collettey's Cookies now has 15 employees, and about half of them are people with disabilities, Divitto said. And they have a strong leader to look up to. "No matter who you are, you can make a great difference in this world," Divitto said. "Don't let people bring you down ... Do not focus on your disabilities. You only need to focus on your abilities."

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CEO with Down syndrome runs successful cookie company that helps others with disabilities get jobs

Kansas attorney disbarred for ‘ghosting’ clients, the courts and investigators

by: Michael Dakota 

SALINA, Kan. (KSNT) — A Salina attorney has been disbarred for “ghosting” his clients, the courts, and investigators in cases that date back as far as 2017, according to court administrators. The Kansas Supreme Court disbarred James D. Sweet in an opinion filed Friday.

The Deputy Disciplinary Administrator Kathleen Lippert said the disbarment stems from two complaints filed by two clients representing four different civil cases.

Lippert appeared before the Kansas Supreme Court and outlined a list of complaints against Sweet, saying the investigation had lasted five months and Sweet had never met with an investigator.

Sweet had been hired to defend a bar owner identified only as E.G. and another client identified as J.M. in three civil suits. Both clients said Sweet failed to appear for court hearings, failed to prepare for hearings, and failed to inform clients of settlement offers.

Although Sweet was given an opportunity to appear by Zoom videoconference, he notified the court he would not be able to appear for a hearing.

Sweet faced either disbarment or indefinite suspension. The court chose to disbar Sweet.

The respondent’s actions and inactions wasted resources of the trial court and the investigators. More importantly, those things respondent did and failed to do caused great financial and emotional harm to his clients.”

The Kansas Supreme Court

The court ordered Sweet to cover the cost of the proceedings.

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Kansas attorney disbarred for ‘ghosting’ clients, the courts and investigators

Protecting seniors from guardianship fraud and abuse

By Rep. Charlie Crist (D-Fla.), opinion contributor 

In Florida, seniors are valuable members of our communities. Having chosen our beautiful state to live out their golden years, they expect peace, relaxation, and sunshine. But what is supposed to be a reward for a lifetime of hard work can quickly become a nightmare if they become victim to guardianship abuse.

Legitimate guardianships are established by state courts when it is determined that an individual is unable to attend to their financial and personal affairs. The appointed guardian is given vast control over the individual under their care, including power of attorney, control over their bank accounts, property, and assets, and the ability to make medical decisions. Unfortunately, these wide-ranging responsibilities leave room for bad actors to take advantage of those under their care — lining their pockets with the assets they were tasked with administering.

Like sharks hunting prey, unscrupulous guardians are on the hunt for vulnerable seniors to isolate, abuse, and defraud. What makes this problem especially difficult to solve is the lack of oversight, transparency, and accountability within state-administered guardianship systems. For example, we don’t even know how many Americans are under guardianship, deprived of their personhood or their ability to make critical decisions for themselves.

It is common practice for an individual who is appointed as a guardian for a senior or person with a disability by a state court to also be appointed as a representative payee by the Social Security Administration (SSA). That means the guardian receives and manages the Social Security benefits of the person they’ve been tasked to care for.

Unfortunately, state courts and SSA aren’t always talking to each other. If a court removes a guardian for abuse, fraud, or neglect, that guardian could still receive those Social Security checks in perpetuity. This is where the Senior Guardianship Social Security Protection Act comes in.

This legislation would direct state courts to notify Social Security if a guardian has been removed for cause, giving SSA the ability to remove the former guardian as representative payee. If there is one thing I have learned in my time in Congress, it’s that agencies work best when they are talking to one another. If you are not suitable to serve as an individual’s guardian, you aren’t suitable to collect their Social Security benefits either. That’s just common sense!

The bill also directs the SSA to report to Congress biannually on the number of Social Security payments being diverted to non-family representative payees, so that we can finally begin to determine how many Americans are actually under guardianship.

To further address guardianship fraud, I have also introduced two bipartisan bills with Rep. Nancy Mace (R-S.C.) — the Freedom and Right to Emancipate from Exploitation (FREE) Act to give those under guardianship an escape hatch from abusive private guardians, as well as the Guardians Aren’t Above Prosecution (GAAP) Act to clarify that fraud commissioned under a guardianship is still fraud punishable by law. Additionally, I co-introduced the bipartisan Guardianship Accountability Act along with Reps. Darren Soto (D-Fla.), Gus Bilirakis (R-Fla.), and Debbie Dingell (D-Mich.) to implement further oversight and data collection of the guardianship system.

An unaccountable, opaque system that allows a fraudster to essentially imprison a human being with an ongoing stream of revenue — be it a Social Security check or in Britney Spears’ case, global record sales and tours — invites corruption of the worst order and demands reform. This suite of bills is an important start to protect seniors, persons with disabilities, and anyone else who finds themselves trapped by abusive guardians or conservators.

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Protecting seniors from guardianship fraud and abuse 

Britney Spears case drives California bid to limit conservatorships

“Conservatorships should be rare, and the last resort,” said Judy Mark, president of Disability Voices United, a Southern California advocacy group.

Disability rights activists and advocates for Britney Spears backed a California proposal Wednesday to provide more protections for those under court-ordered conservatorships, while promoting less-restrictive alternatives.

Their move came as the volatile Spears case again boiled over in a Los Angeles County courtroom.

The hearing to settle lingering issues in the aftermath of Spears’ conservatorship, which was terminated in November, quickly descended into a series of angry accusations between attorneys for Spears and her father, and the case appears headed for a long trial to determine the truth of allegations of misconduct against him.

The case is Exhibit #1 for groups including Disability Voices United, Disability Rights California, Disability Rights Education and Defense Fund, and Free Britney L.A. who say that what are known as probate conservatorships are overused and misused in California.

They most often involve people with developmental or intellectual disabilities or those with age-related issues like dementia or Alzheimer’s.

But the advocacy groups contend that conservatees like Spears can become trapped in a system that removes their civil rights and the ability to advocate for themselves.

The Professional Fiduciary Association of California, which represents many of those appointed as conservators, did not immediately comment, but said answers to many questions about the process can be found on a website.

“Conservatorships should be rare, and the last resort,” said Judy Mark, president of Disability Voices United, a Southern California advocacy group. “The default should be that people with disabilities retain their rights and get support when they need it.”

Britney Spears with her father Jamie Spears in Las Vegas. The pop star and her father have been locked in a court battle over her conservatorship.Denise Truscello / WireImage file

The groups backed legislation by Democratic Assemblyman Brian Maienschein that will also make it easier to end conservatorships for people who want out.

They are promoting instead what are known as “supported decision-making” agreements as a less restrictive alternative. They allow people with disabilities to choose someone to help them understand, make and communicate their choices, but allow the person to still make the decision.

That option has already been adopted in Alaska, Colorado, Delaware, Illinois, Indiana, Louisiana, Nevada, North Dakota, Rhode Island, Texas, Washington, Wisconsin and Washington, D.C., advocates said.

California law says conservatorships should only be ordered if a judge rules they are the least restrictive alternative. But the advocates contend they are often imposed without examining other options.

Maienschein’s bill would require that before granting a conservatorship, judges first document that all other alternatives including supported decision-making have been considered.

It would write supported decision-making into California law and back that alternative with grant programs, training and technical assistance.

The bill also would make it easier to end probate conservatorships by mandating a periodic review, including asking conservatees if they want to make the conservatorship less restrictive or end it entirely.

Conservators would also be required to consult with the conservatees and make decisions that reflect the conservatee’s wishes or previously expressed preferences.

Before his election to the Legislature, Maienschein was a law clerk for a San Diego Superior Court judge who oversaw conservatorships.

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Britney Spears case drives California bid to limit conservatorships

Lafayette attorney disbarred for multiple alleged violations

Photo by: Louisiana Supreme Court

The state Supreme Court has disbarred a Lafayette attorney accused of failing to properly handle a client's case, then lying to investigators about it.

Brad Thomas Andrus, who already was ineligible to practice law, was formally and finally disbarred, a ruling from the court released Wednesday states.

The case against Andrus centered on his handling of a case for a Branch man who made a claim with his insurance company after a broken water pipe damaged his home. The man hired Andrus to handle the matter.

During his handling of the man's claim, the court found that Andrus "engaged in serious attorney misconduct. He neglected his client’s legal matter, charged and collected an unreasonable fee, converted client funds held in his trust account, failed to return his client’s file upon request, and engaged in deceptive and dishonest behavior in the course of this disciplinary proceeding. This misconduct amounts to a violation of the Rules of Professional Conduct as found by the disciplinary board."

The court decided that Andrus violated his duty to his client, and caused actual harm to the man. They found that Andrus' conduct was "knowing and intentional" and that the rules say he should be disbarred.

As aggravating factors, the court noted that he once ditched a process server by claiming he was his own twin brother, and asked for a delay in turning in his response to accusations, claiming his response was on a laptop that had been stolen from his vehicle. Church Point Police found "inconsistencies" in his story - including the fact that there was no report of a vehicle burglary on the date he claimed his laptop was stolen. 

"While we do not minimize the seriousness of his misconduct as it relates to his client... we suggest that respondent’s numerous instances of deceptive behavior are the most disturbing aspect of this matter. From the incredible tale of a vehicle burglary offered as justification for failing to timely respond to the disciplinary complaint, to his attempt to evade service of a subpoena by claiming to be his identical twin brother, and finally to submitting fabricated receipts and invoices to the ODC, respondent has violated the most fundamental duty of an officer of the court," the ruling states. "The utter absence of candor respondent has demonstrated in these proceedings calls his good moral character into serious question and warrants disbarment."

In addition to his disbarment and the requirement that he pay all costs of the investigation against him, the Court also ordered Andrus to participate in a fee dispute resolution program in order to make his former client whole.

According to their firm's website, Brad Andrus was practicing with his twin brother. Their firm office is located in River Ranch.

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Lafayette attorney disbarred for multiple alleged violations

Nurse’s aide accused of sexually assaulting 79-year-old patient at SW Houston facility

by Sabirah Rayford

HOUSTON – A certified nursing aide has been charged with injury to the elderly after Houston police said she sexually assaulted a patient at the Houston Transitional Care facility located in southwest Houston.

Police say in May of 2021, Natalia McDaniel forcefully held down a 79-year-old patient at the facility and sexually assaulted her.

Prior to this charge, McDaniel was convicted of delivering cocaine back in 1997.

“That employee should’ve been vetted a little more and also watched a little better,” Executive Director of Nixon Homecare Shay Tatum said.

Tatum said she isn’t affiliated with this case, but explained why criminal histories may not be flagged. She said it’s not uncommon for people with records to hold a CNA license because there’s a statute of limitations.

“As long as you have not committed any animal abuse, elderly abuse, and aggravated assault, or any assaults in nature, some things have a statute of limitations,” she explained. “This individual we’re talking about today had a cocaine charge from 20 years ago. Well, the state only requires a five-year clean record.”

She said there are ways to better protect your loved one.

”You need to make sure you come by [at] different times to visit, different times to check on her,” Tatum said. “See if their attitude has changed [or] their mental space has changed.”

KPRC 2 reached out to Houston Transitional Care. They provided the following statement:

“At Houston Transitional Care we are committed to providing high-quality care to our residents, and our staff’s exemplary efforts throughout the pandemic underscore that. While HIPAA privacy and personnel laws prevent us from commenting on many of the questions you raise, we can say that as a matter of public record, the state health oversight agency investigated the incident you reference and found no culpability with regard to HTC and our former employee,” said Spokesperson for Houston Transitional Care Dan Kramer.

KPRC 2 also reached out to Texas Health and Human Services to ask if they are aware of the charges against McDaniel.

They said, in part, “HHSC reviews and investigates allegations of abuse, neglect or misappropriation of resident property by nurse aides. If there’s a finding of an alleged act of abuse, neglect or misappropriation, the nurse aide may request both an informal reconsideration and a formal hearing before the finding is placed on the registry. Certified nursing aides must pass criminal background checks. Employers also are required to check the Nurse Aide Registry to ensure the CNA has not been barred from employment in Texas due to a confirmed allegation of abuse, neglect or exploitation.”

On their website, McDaniel’s is still listed as employable and has an active license.

HPD has a warrant out for her arrest.

“It’s very disheartening when something like this happens to an elderly,” Tatum said.

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Nurse’s aide accused of sexually assaulting 79-year-old patient at SW Houston facility

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