Grave Disability
"I once had a patient ask me what a conservator was; he said one of the staff told him it was a person that takes care of you when you leave the hospital. No one mentioned that having a conservator meant you lose your right to freedom. Sadly enough, because they are conserved, a lot of the time a patient won’t know they are headed to a locked facility. They are not filled in with details of what a conservatorship means or how the Public Guardian plays a hand in it.
The world of conservatorship has multiple layers of confusion. How does it work? What does it mean? How does it affect me? Often times I would come across patients that were in a panic because they were heading to court to present in front of a judge and some “person I don’t even know” (in other words the PG) would stand and make a case for a patient to be locked up.
Some hospitals keep the truth of what a conservator does or sugar coats it to keep the peace so to speak. God forbid we inform the mentally ill of their pending fate should they get conserved and end up being transported to an institution. Keeping the mentally ill in the dark is wrong. So, how can we work to find ways to educate the mentally ill when they are admitted to a psych ward so they are clear on the legal ramifications of acquiring a PG to facilitate their fate. It is their life. And they have a right to know what’s up!"
The legal criteria for establishing an LPS conservatorship is grave disability beyond a reasonable doubt. So what does all of this mean. To begin, grave disability is when someone cannot care for their own food, clothing, or shelter. They do not know how to get the resources to pay for food or obtain free food. They may refuse to eat or eat inedible items. They purposely starve themselves. They fail to dress properly or refuse to wear clothing at all. They are homeless or have been kicked out of their apartment many times due to poor housekeeping. They do not know how to find a shelter or do not care to live in one. In order to establish grave disability, the doctor must prove beyond a reasonable doubt. This is the highest standard of review that the law has. The doctor has to prove grave disability in front of a judge. The doctor does not have to prove all three to establish grave disability. He must only prove one of the three criteria. Most often the court will focus on shelter and food.
Other factors that are not explicitly stated but essential for review is past history, medication compliance, and number of hospitalizations in a given year. If the patient has a poor adherence to their treatment, this may count against them during their hearing. If they have had many hospitalizations in recent years, this may also show inability to live in the community. Usually for an LPS conservatorship, only serious mental illnesses are considered. Serious mental illnesses include schizophrenia, schizoaffective, and bipolar affective disorder. Other factors include
(1) Lacks of insight into his or her mental illness
(2) Thinks that he or she does not need medication
(3) Cannot provide for his or her basic needs without medication
(4) Will not take medication without supervision based on evidence from past history and circumstantial evidence.
The person must be presently gravely disabled. They cannot be conserved based on future possibility of grave disability. If there is a jury trial, all twelve jurors must agree. It must be an unanimous vote.
The world of conservatorship has multiple layers of confusion. How does it work? What does it mean? How does it affect me? Often times I would come across patients that were in a panic because they were heading to court to present in front of a judge and some “person I don’t even know” (in other words the PG) would stand and make a case for a patient to be locked up.
Some hospitals keep the truth of what a conservator does or sugar coats it to keep the peace so to speak. God forbid we inform the mentally ill of their pending fate should they get conserved and end up being transported to an institution. Keeping the mentally ill in the dark is wrong. So, how can we work to find ways to educate the mentally ill when they are admitted to a psych ward so they are clear on the legal ramifications of acquiring a PG to facilitate their fate. It is their life. And they have a right to know what’s up!"
The legal criteria for establishing an LPS conservatorship is grave disability beyond a reasonable doubt. So what does all of this mean. To begin, grave disability is when someone cannot care for their own food, clothing, or shelter. They do not know how to get the resources to pay for food or obtain free food. They may refuse to eat or eat inedible items. They purposely starve themselves. They fail to dress properly or refuse to wear clothing at all. They are homeless or have been kicked out of their apartment many times due to poor housekeeping. They do not know how to find a shelter or do not care to live in one. In order to establish grave disability, the doctor must prove beyond a reasonable doubt. This is the highest standard of review that the law has. The doctor has to prove grave disability in front of a judge. The doctor does not have to prove all three to establish grave disability. He must only prove one of the three criteria. Most often the court will focus on shelter and food.
Other factors that are not explicitly stated but essential for review is past history, medication compliance, and number of hospitalizations in a given year. If the patient has a poor adherence to their treatment, this may count against them during their hearing. If they have had many hospitalizations in recent years, this may also show inability to live in the community. Usually for an LPS conservatorship, only serious mental illnesses are considered. Serious mental illnesses include schizophrenia, schizoaffective, and bipolar affective disorder. Other factors include
(1) Lacks of insight into his or her mental illness
(2) Thinks that he or she does not need medication
(3) Cannot provide for his or her basic needs without medication
(4) Will not take medication without supervision based on evidence from past history and circumstantial evidence.
The person must be presently gravely disabled. They cannot be conserved based on future possibility of grave disability. If there is a jury trial, all twelve jurors must agree. It must be an unanimous vote.