When Andy was 20 years old he had his head bashed into the cement during an unprovoked attack. Severely beaten, his mother thought he was gone, but Andy survived. A month later, he started hearing unexplained voices.
Andy’s symptoms worsened during the next few months, and his mother, Kathryn, took him to San Jose Medical Center which admitted him into psychiatric care. Over the next year as he lost touch with reality, he was diagnosed with schizophrenia, a severe mental illness that not only affects a person’s ability to think clearly, but also causes psychosis. Yet throughout his treatment plan, no doctor ever considered his traumatic brain injury as the cause for his sudden change in behavior.
“The excuse they used was it would disrupt the insurance billing if they changed the diagnosis,” Kathryn told San José Spotlight. The family has asked that only their first names be used to protect their privacy.
For the next 28 years, Kathryn became entangled in California’s broken mental health care system, stripping her of any power to advocate on her son’s behalf, while the laws enabled Andy to have complete authority over his care. The result left Andy psychotic and unable to care for himself.
Kathryn became the unwanted beneficiary of the state’s 50-year revamp to its mental health system, which put patient rights ahead of medical care. With limited options, she fought unsuccessfully to get Andy hospitalized while petitioning for a Lanterman Petris Short (LPS) Conservatorship, she said.
State Sen. Susan Eggman is looking to amend the LPS language under Senate Bill 43 to improve the odds for families like Kathryn’s, while incorporating guardrails to help defuse the opposition. The behavioral health bill passed through the Assembly Judiciary Committee on July 11 with bipartisan support. Advocates are hopeful it will make its way to Gov. Gavin Newsom’s desk.
The modernization of LPS
LPS, enacted in 1967, is for adults deemed to have serious mental illnesses such as schizophrenia and other psychotic disorders. The petition for this involuntary commitment can only be requested by the psychiatrist treating the individual. It’s then submitted to Santa Clara County Superior Court Probate Division and, if approved, the individual becomes a ward of the county’s public guardian for an undetermined period of time.
The bar for approval is high due to the subjective definition of “gravely disabled”—a mental health disorder where the individual is unable to provide for their basic personal needs such as food, clothing or shelter.
Under SB 43, the newly proposed language would add the inability to manage medical care and personal safety, and include individuals with substance use to the current definition of gravely disabled criteria.
The guardrails would require other alternative treatments including Assisted Outpatient Treatment (AOT) and CARE Court to be considered before a conservatorship is recommended.
“All along the principle has been: what is the less intrusive level of care an individual needs to be safe and supportive,” Randall Hagar, a mental health advocate who’s worked with Eggman for more than 10 years on legislation, told San José Spotlight. “The question is where does the person belong, it’s a clinical determination. Could they survive safely in the community with AOT or CARE Court.”
The revolving door
As Andy’s mental health deteriorated at San Jose Medical Center, doctors advised Kathryn to move her son into the county system at Santa Clara Valley Medical Center (VMC) to capitalize on wraparound services that included long-term treatment and housing. But moving from private pay to MediCal didn’t pan out as hoped.
“From that point he was constantly struggling. He never was stable. He was moved around from hospital to hospital,” Kathryn said. “He would stay with me in between hospitalization, but then be moved into a board and care facility where no one managed his care.”
Andy’s life became a revolving door of hospitalization failures. He’d be hospitalized for three months to help him stabilize, discharged and then shuffled off to another board and care facility that provided limited support. The cycle was never-ending and Andy never got better.
Kathryn said the last seven years, from 2015 through 2022, were exceptionally bad when he was connected with a county provider—which she doesn’t want to name for fear of retaliation—that moved him into five different substandard board and care homes. One time he was given a mattress in a garage surrounded by chemicals and unsafe items. Another time he was crammed into a garage that housed 12 mattresses, his mother said.
Every time he became symptomatic, the provider called him out for bad behavior as an excuse to move him. It wasn’t his fault, Kathryn said. They did nothing to help stabilize his psychosis and paranoia. The stress become so severe Andy would punch himself in the face, causing large cysts that became infected. When the paramedics came to move him for the fifth time, they took one look and transported him to San Jose Regional Medical Center.
“I begged them to keep him there until there was an opening at VMC, but they just let him go,” she said. “He was so sick. Off his meds. It was just awful. He walked away and became homeless.”
Kathryn had lost her son to the streets after trying everything to get him conserved. She went to the Santa Clara County Board of Supervisors. The county mental health board. She pleaded with hospitals, told them she had filed for AOT, but every avenue turned into a dead end because families have limited rights once their child is no longer a minor and patient privacy laws kick in.
Dozens of groups oppose SB 43
Law Foundation of Silicon Valley attorney Melanie Roland said voluntary treatment should always be the goal. Her organization along with dozens of groups are vehemently opposed to SB 43.
By including new language pertaining to individuals with substance use, SB 43 expands the definition by an “incredible amount,”Roland told San José Spotlight.
Involuntary treatment is not a solution, she said, adding California is a coercive system that causes more people to be picked up by law enforcement and placed on involuntary holds that can lead to long-term hospitalizations. This results in a lack of available beds for others who need them, Roland said.
“The system we have created is one of mental health duress,” she said.
Roland said Sen. Eggman has a false impression about how SB 43 will better help those needing the most acute level of care.
“The expanded criteria will allow more people to be taken in on holds and that’s it,” Roland said. “It doesn’t mean anyone will be given more medical treatment. Absent a court order, no one will have to do anything.”
In Santa Clara County, 313 people were temporarily conserved and 566 were permanently conserved between 2020-21, according to the California Involuntary Detention Data Report. The number of individuals placed on a 72-hour hold in the county was 128 and 117 were put on 14-day holds. Statewide, more than 2,000 people were put on temporary conservatorships and 8,368 people were placed on permanent conservatorships, not including those in jails. The number for statewide 72-hour holds was roughly 120,000 people and about 48,000 for 14 days.
Santa Clara County Superior Court Judge Stephen Manley said the expansion of the gravely disabled definition could lead to more petitions filed if SB 43 becomes law. Manley has been an outspoken critic of the dire need for more beds and residential treatment facilities, as the state’s various initiatives and programs look for ways to house the chronically mentally ill who are homeless.
“The court would be (and already is) left with very few options and long wait times in trying to help place individuals in appropriate treatment,” he told San José Spotlight.
Manley’s denunciation over the lack of mental health and substance use services is one point everyone agrees on. On one end, Roland said if involuntary treatment wasn’t the default, and more community treatment centers were available, her clients could be receptive to medications on their terms. Hagar said the lack of a continuum of care throughout the state affects capacity and creates ongoing bottlenecks, causing people to fall through the safety net and relapse as they try to step-down in their recovery.
Kathryn’s safety net shredded decades ago.
But she refused to give up and sometimes prayers are heard. In December 2022, as Kathryn turned the corner to pick up a McDonald’s order for her 86-year-old passenger, there was Andy sitting on the curb.
After filing six missing person reports, happenstance brought them to the same spot a year and a half later. It took Kathryn 30 minutes to convince the police to take her son across the street to VMC emergency psychiatric services. The police kept telling her he had his rights and if he didn’t want to go they couldn’t make him.
“I am thinking, ‘He has poop all over his pants and you don’t think that qualifies as gravely disabled?'” she said.
This time the doctors filed for the conservatorship, and at age 48 Andy is finally receiving proper treatment. It’s been six months and Kathryn said her son is beginning to show insight into his illness. She has no doubt why.
“I consider this conservatorship as saving my son’s life,” she said.
Moryt Milo is San José Spotlight’s editorial advisor. Contact Moryt at [email protected] or follow her at @morytmilo on Twitter.
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