To the editor: Thank you for your editorial on self-determination and mental illness in the context of the Lanterman-Petris-Short Act, the 1967 law on treating mentally ill people in California. I practice as a nurse caring for adults and children who are hospitalized on involuntary holds.
I strongly agree with your conclusion that the problem with the LPS Act is not that it goes too far in protecting self-determination but, rather, the nonexistence of a system for community-based care or permanent supportive housing.
Last month, UCLA researchers published a study of LPS conservatorship among homeless adults with severe, disabling mental illness. We found there is a serious “bottleneck” effect in psychiatric hospitals, where individuals who are stabilized have very lengthy stays because there is nowhere else for them to go. The only options are to keep people in locked, restrictive settings, or to turn them out to the streets. There is almost nothing in between.
This leads to two serious problems. First, individuals with severe, disabling mental illness who are under conservatorship are unable to transition to community-based living, even when they are stabilized and ready for a lower level of care.
Second, psychiatric hospitals filled with individuals on LPS holds or conservatorships cannot function as intended — stabilizing acute psychiatric emergencies. This, then, has backlog effects on hospital emergency rooms, where individuals experiencing psychiatric emergencies end up stuck for days or even weeks.
I see an immediate need for expanding community-based mental health services, less restrictive residential treatment centers and permanent supportive housing. I don’t believe that further undermining the self-determination of people with mental illness is the solution.
Kristen Choi, Los Angeles
The writer is an assistant professor at the UCLA School of Nursing and the UCLA Fielding School of Public Health.
To the editor: You are correct that the failure of the LPS Act is largely due to the unwillingness of the government to provide the facilities and staff necessary to accommodate housing and care for these needy people.
But you don’t state that this funding has been available in many communities and has been diverted to the law enforcement empire. The idea that jails should be the destination for people in a mental health crisis is counterintuitive but politically sellable.
In addition, the public health departments are not without fault. Too often they agree to such plans (and even “staff” them to a small degree) because they do not want the burden of caring for difficult clients. They fill up their available treatment beds with the most amenable patients and then turn away the hard cases, who end up in jail.
We need not only more funds for this critical humanitarian chore, but also the political will to accept that involuntary detention in a non-criminal facility may be appropriate.
Glen Mowrer, Santa Barbara
The writer served as the Santa Barbara County public defender for 24 years.
To the editor: As an LPS conservator for 10 years, I applaud The Times for bringing attention to our failure to provide support for seriously mentally ill people.
There are many erroneous beliefs about the rehabilitative efficacy of medications, acute hospitalizations and brief psychological and social therapies. Most mental health workers are underpaid, and long-term residential facilities and programs are severely rationed.
Changing this requires not only more funds, but also the recognition that psychosis is a disease like cancer, and its victims deserve the appropriate care.
Charles Healy, Los Angeles
This story originally appeared in Los Angeles Times.