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LA County Gets More Power To Force Severely Mentally Ill Homeless Into Treatment

A tent stands on a streetcorner near Skid Row in downtown Los Angeles, California on June 20, 2017. (Photo by Frederic J. Brown/AFP/Getty Images)
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There's a new law in California aimed at getting some of California's most vulnerable homeless out of a life that takes them from the streets to emergency rooms to jail and back to the streets.

Gov. Jerry Brown signed SB 1045 last week. It will give more power and flexibility to judges in Los Angeles, San Diego and San Francisco counties to order treatment for certain people suffering from mental health and addiction -- even if they don't want it.

In L.A. County, 52,765 people are homeless, according to the Los Angeles Homeless Service Authority's 2018 homeless count. Around 60 percent of that overall population just lives in the city of L.A.

L.A. Mayor Eric Garcetti is eager to implement the new law.

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"Ending homelessness in California demands that we identify the most vulnerable on our streets and provide them with the wrap-around services that are proven to break a cycle that sends too many people into emergency rooms and the criminal justice system, and inevitably back onto the streets," Garcetti's spokesman Alex Comisar told LAist in an email.


Before we get to that, let's review what current law says.

In 1967, then-Gov. Ronald Reagan signed a law, known as the Lanterman-Petris-Short Act. It ended the practice of institutionalizing mentally ill and developmentally-disabled people against their will.

And it gave patients more legal protections by limiting how long they could be involuntarily held if they posed a threat to themselves or others: up to 72 hours. This is known as a "5150 hold," after that section of the law.

If after a 5150 hold a person is still deemed a danger to themselves or others and/or is determined to be "gravely disabled," a clinician can petition the courts to order someone be placed in a conservatorship.

In L.A. County, if a judge approves the petition, then the Department of Mental Health could become the conservator and can put the person temporarily or indefinitely in a locked psychiatric facility.

The judge makes the decision based on how "gravely disabled" the patient is after coming off of the 72-hour hold. This is also the time that a judge can reject the petition for conservatorship if someone appears coherent.

Advocates of the new law say, too often, that just means the patient is once again cycling from the streets to jail and back to the streets.

Under SB 1045, state law for the first time permits conservatorships for homeless people dealing with severe mental illness and drug addiction.

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The new law, authored by State Sen. Scott Wiener from San Francisco, will give judges in the three counties the power to consider an individual's medical history in the last 12 months when considering a petition for conservatorship.

Now, judges may appoint a conservator for someone who has been the subject of "frequent detention for evaluation and treatment" in the previous year -- and it defines "frequent" as at least eight 5150 holds in a year.


Opponents of SB 1045 believe the law will do further harm to an already vulnerable population, because it forces people into what can be substandard care.

"Currently, there is an inadequate amount of mental health services in the community and pursuing conservatorship in a county that lacks the services is unfair and dangerous," Anne Hadreas, a lawyer for Disability Rights California, told LAist. "It is patently unfair to force someone into treatment when they aren't able to get the treatment that they need."


But Wiener counters that the severely mentally ill are already losing their rights when they're locked up in a different kind of facility.

"We already have a robust conservatorship program that's called jail," Wiener told LAist. "We should not be relying on the criminal justice system for mental health and drug addiction services. We should be providing services before people go to the jail."

Right now, nearly one in three inmates in L.A. County Jails are considered to be mentally ill.

Wiener said the people affected by the new law are only a small percentage of the chronically homeless. Arguing that they're "unraveling on our streets," he said, "let's get them into a safe and healthy setting so they get the housing and health care and the rehab services that will save their lives."


The law establishes a five-year pilot program for the three counties.

For L.A. County to participate, the Board of Supervisors has to determine:

  1. It has adequate housing and wrap-around resources.
  2. The pilot wouldn't take away from certain existing mental health and conservatorship programs.

Depending on how quickly the supervisors act, SB 1045 could go into effect in L.A. County as early as Jan. 1, 2019.

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