Helping the “Gravely Disabled”: A Status Report
Over the past year, advocates for the homeless watched the progress of California Assembly Bill 1971 with anticipation. The bill was created by the Steinberg Institute to help California’s mentally ill homeless population get the medical care they need. The Institute’s solution was to expand the legal definition of “gravely disabled” to allow medical treatment for those who don’t realize that they need it because their mental illness is so advanced. But the bill sparked a complex legal and ethical debate over an individual’s civil rights and at what point the county should intervene to detain someone for medical treatment.
Everyone can agree that something must be done. In Los Angeles County alone, around 30% of the over 50,000 homeless people are mentally ill; 38% have two or more major medical illnesses; and in 2017 more than 800 deaths occurred from medical conditions considered treatable. Adriana Ruelas, Legislative Affairs Director at the Steinberg Institute, said they drafted the bill in response to the alarming number of people dying on the streets. “It is such a sad situation,” she said, “because a lot of these deaths could have been prevented quite easily.”
Crisis intervention teams have their hands tied when it comes to medical care. Often a homeless individual’s mental illness has progressed so much that they aren’t aware of the physical danger they’re in, and they refuse treatment. According to Ruelas, if crisis intervention workers saw “someone on the street that was suffering, clearly from a physical ailment, because of the way the LPS Act works, they couldn’t bring them in.”
The LPS (Lanterman-Petris-Short) Act allows a person with a mental health disorder to be forcibly held only if they are a danger to themselves, a danger to others, or are gravely disabled. By state law, a person is “gravely disabled” when a mental health disorder makes them “unable to provide for…basic personal needs for food, clothing, shelter, or medical treatment where the lack or failure of such treatment may result in substantial physical harm or death.” The LPS Act is interpreted differently by different counties, and has been insufficient to treat the medical conditions of homeless individuals who can’t understand that they are ill. By the time a person meets the legal definition of gravely disabled, it is usually too late to help them survive.
AB 1971 sought to expand the definition of gravely disabled to allow detainment of individuals who need urgent medical treatment, not just those in dire, critical condition. According to Ruelas the bill would have permitted “a medical clinician to look at the progression of a person’s physical illness and say, ‘clearly this person is gravely disabled; their mental illness doesn’t allow them to take care of themselves physically.’”
When the bill reached the California Senate Judiciary Committee, it faced resistance from civil rights groups opposed to any change to the LPS Act or erosion of an individual’s civil rights. As a result, revision was limited to a pilot project in LA County and a “Death with Dignity” clause that required a doctor’s acknowledgment that the individual “would die within 6 months.” According to Brittany Weissman, head of the LA chapter of the National Alliance on Mental Illness, it would be difficult for any doctor to make that assessment. “[The bill] got so diluted through the legislative process and they put so many pigeonholes in it, that it wasn’t going to be very effective.”
Even then, civil rights groups opposed the bill. The Steinberg Institute believed that the Death with Dignity clause violated the spirit of the LPS, which Ruelas said is “about helping someone live the best life they can…. That was the breaking point for us to drop the legislation.”
But hope springs eternal, and new initiatives are being pursued, including a state audit of the LPS Act by the Steinberg Institute, and a plan in LA County to increase the number of mental health hospital beds. “It’s OK that it failed,” concludes NAMI’s Weissman. “There are other, possibly stronger, things in process.”
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