“We are the doctors who have to watch these people die,” said Dr. Emily Wood of the California Psychiatric Association, which sponsors guardianship bill SB 43. I must say that as of now there is no legal basis for taking them to the hospital. ”
Under current state law, being unintentionally admitted to a hospital as a result of mental illness or alcoholism is a danger to yourself or others, or if you are unable to find food, clothing, or shelter. Possibly. Physicians want to include substance use disorders in legislation and their inability to look after their own safety and medical care. (The mental health guardianship scheme is separate from the probate guardianship scheme that Britney Spears was retained.)
Dr. Wood, who practices in Los Angeles, gave two examples of people she and her colleagues tried to care for but slipped through the cracks under current rules. He was on medication for schizophrenia and did not understand the consequences of not managing either condition. He was brought to his ER with dangerously high blood sugar levels on multiple occasions, but no one asked him to take either medication because poor health care is not a trigger for guardianship. I couldn’t even force it.
Another man had a developmental disorder that was never treated as a child and became addicted to methamphetamine in his 20s. His family has asked doctors to treat him, but they cannot because drug abuse does not trigger conservatorship.
For Dr. Wood, treating these people, even if they disagree, is a compassionate and moral thing to do.
“It is imperative that all patient rights are respected, including the right to receive treatment from us,” she said.
But other advocates and those with mental illness see the issue very differently.Attorneys at the nonprofit Disability Rights California say the expansion of guardianship and the CARE courts’ advances have gone awry. It says it focuses on depriving people of their freedom and privacy rather than investing in better voluntary mental health services that preserve their dignity and civil rights. The group has filed a lawsuit to block enforcement of the CARE Courts.
They are concerned that people of color, especially black residents who are over-represented in the homeless population and diagnosed with schizophrenia, will be disproportionately targeted by these stronger measures. increase.
“When people are told that they have to court what they voluntarily get in the community, and then get a plan of care that subjects them to services that still don’t meet their cultural needs, it’s not compassion. No,” said Kerith Myrick, an advocate who has schizophrenia and has experienced homelessness.
The opposition’s other main objection focuses on capacity. Once people are forced into treatment, where do they go in an overstretched and understaffed public mental health system? Michelle Doty Cabrera, executive director of the California Association of Behavioral Health Directors Already there are not enough psychiatric beds, adequate substance abuse centers, or housing options for those who need them.
“Broadening the guardianship system will not solve structural problems such as lack of housing or funding for treatment services,” she said.
Cabrera’s group also questions the assumption that compulsory treatment works. Especially when it comes to substance use disorders, research shows that compulsory treatment is less effective, can be even harmful, and increases the risk of overdose. were twice as likely to die from an overdose than those who voluntarily received treatment.
More broadly, the ultimate goal of compulsory treatment is to reduce homelessness and alleviate the moral distress of seeing the sick sleeping on the streets or using drugs outdoors. In some cases, legislators are writing the wrong prescriptions, some researchers say.
“The problem with homelessness is that people don’t have housing,” said Dr. Margot Kushel, director of UCSF’s Benioff Homelessness and Housing Initiative. “Even if we had all the treatments in the world and no housing, we would still have this problem.”
She likens the homeless to a game of musical chairs, with a child standing on crutches when the music stops. In California, she has 24 units of affordable housing for every 100 ultra-low-income households, and people with mental illness and substance use disorders struggle the most to compete for these scarce places. she said there is. That’s why they’re overrepresented among the homeless population, she said, not because the guardianship laws aren’t strong enough.
“Trying to fix the homelessness problem by tinkering with the health system won’t do any good,” Kushel said.
Proponents of involuntary commitment say both treatment and housing are necessary. The same lawmakers who support expanding the guardianship system and CARE courts also support efforts to increase housing supply, including a $3 billion bond initiative to build small, neighborhood-oriented housing for people with mental illness. are doing.