They roam the city of Modesto, pushing shopping carts overflowing with whatever.
Weathered faces, dirty clothing, and often incoherent, it is clear these folks suffer from some type of mental illness. Fifty years ago, a doctor or even a relative could have gotten them committed to mental health facilities for treatment. But many patients were institutionalized indefinitely, left there with no rights or advocates to get them out if they responded well to treatment.
California’s Lanterman-Petris-Short Act of 1967 changed that, leaving it to the courts to impose involuntary commitment through conservatorships. In essence, it set a higher bar for commitment – enabling them to refuse treatment and medications – and thus contributed to so many folks like the aforementioned living on the streets as well as others with mental illnesses.
“It probably went too far the other way,” Modesto psychologist Phil Trompetter said.
Since the law went into effect, a person must be deemed gravely disabled, meaning unable to take care of himself/herself to the point of being a danger to themselves or to others. But simply being homeless and living in tents, sleeping on the ground in sleeping bags, or huddling in doorways on cold, rainy nights doesn’t prove a grave disability, Trompetter said.
It usually takes some kind of emotional outburst or other obvious condition before law enforcement can take them to the behavioral center for a 5150 hold for anywhere from 72 hours to 14 days, and even then they aren’t likely to get longterm help. It is a cycle that is counterproductive and fails to address their problems before its too late, critics maintain.
Which is why nearly 130 people attended meetings last week regarding Laura’s Law, which allows counties to seek court-ordered patient help for those with serious mental disorders. It would enable law enforcement, mental health officials or family members to bring an individual with serious mental illness before a judge, where the individual would have the opportunity to voluntarily accept an outpatient treatment program, working with caseworkers. If the individual then quits the program, a judge can order more structured treatment, including conservatorship.
That stated, conservatorships require rooms and beds. There were 560,000 beds available to mental patients in the United States in 1955. There are fewer than 37,000 today, per the Pew Trust. The number of psychiatric beds nationally has decreased by nearly 6,000 since 2010 though California has added 600 in that time.
Stanislaus County in 2016 administrated 178 conservatorships, 64 of which were new while 33 ended. The county, through its public guardian with a $1.3 million budget, contracts with eight board-and-care operators locally, including highly regarded Davis Guest Homes, which has five facilities and a sixth due to come on line in a few months. It also contracts with lockdown facilities in Modesto, Stockton, Merced, San Leandro and, in past years at least, Redding, Deputy County Counsel Mark Hartley said.
Costs can range from $100 a day to over $300 a day per board-and-care client, depending upon the facility. Officials simply look for the best available situation for the client, Hartley said.
“One that’s the least-restrictive, and most appropriate place for their functionality,” he said.
Likewise, other counties send their conservatees to facilities in Stanislaus County. Davis said he contracts with 28 counties to fill his 165 beds, with 48 more beds once his latest acquisition in Salida is remodeled.
“I don’t need them,” Davis said, meaning more clients from other counties. “But we’d like to have more of them from our own county.”
Davis learned long ago to include in his contracts that if a county severs the conservatorship, they have to remove the client from his care. It’s not uncommon, he said, for that to happen, citing one current client named Robert, who is psychotic. Conservator San Francisco County sent him to a board-and-care home in Novato.
“They would have kept me, but I wouldn’t take a shower,” Robert said. So they sent him to a facility in Butte County and then to Salida.
“I took off and walked to Modesto,” he said, and Davis confirmed. After more than a half-dozen trips to the behavioral center in Modesto, Robert was conserved by Stanislaus County taxpayers to Davis’ facility.
“We end up taking in people from other counties,” Davis said.
The need for available mental client beds will outpace anything Focus on Prevention, the county’s 10-year plan for addressing the root causes of homelessness, can address in the short term.
Indeed, there are people on our streets who need help through intervention. A well-intended 50-year-old law instead is standing in their way.