Reconsidering Grave Disability Standard

So courts hold that, in the context of the LPS Act, the term "gravely disabled" is sufficiently precise to exclude unusual or nonconformist lifestyles, in that it connotes an inability or refusal on the part of the conservatee to care for basic personal needs of food, clothing, or shelter, and that it is not an unconstitutionally vague and overbroad standard. Additionally, this standard has been drafted so that a conservatee presumed to be a person of common intelligence can understand the purpose of determining the sufficiency of this statute. Conservatorship of Chambers (1977) 71 Cal.App.3d 277, 279 [139 Cal.Rptr. 357] This reasonableness standard ensures that a statute is written in clear enough terms so that a person of common intelligence mustn't need to guess at its meaning and differ as to its application. If a statute is unconstitutionally vague, it essentially violates the first essential of due process of law. Now the courts in ruling on these statutes, rest upon the presumption that these statutes employ words or (eve. phrases with technical special meanings) that have well enough known meaning to enable those who rely on interpreting said statutes are able to correctly apply them in various settings. There are two points of contention that I have with this interpretation of grave disability and the findings in the Chambers court. Firstly the Chambers court at the time stated that it was sufficiently precise to exclude unusual or nonconformist lifestyles. However, we have had several cases that have had to clarify the "nonconformist" lifestyles clause including Conservatorship of Smith (1986) 187 Cal.App.3d 903, 905 which clarified that bizarre or eccentric behavior, even if it interfered with normal intercourse with society, does not warrant conservatorship except when it renders patient helpless to fend for herself/ destroys ability to meet basic needs. Only then does the interest of the state override their individual liberty interests and GD can be found. Other cases are in pari materia indicating that the Chambers court's assertion about being "sufficiently precise" is misplaced. Yes case law serves to clarify the legislature's intent but with the amount of case law surround this concept of GD indicates that Conservatorship of Chambers should be reconsidered as "good law". The second contention is with the fact although GD standard as proscribed under the LPS Act and Welf. & Inst. Code §§ 5008(h) requires a causal nexus between a specifically defined and diagnosed mental disorder and related inability to care for one's basic personal needs, the standard for finding grave disability is the highest standard offered by the law; proof beyond a reasonable doubt, given that a finding of grave disability implicates serious personal liberty rights & the "good name of the individual". Therefore courts have found that the safeguard of proof beyond a reasonable doubt is required to ensure patients are not unduly adjudicated gravely disabled. Conservatorship of Roulet (1979) 23 Cal.3d 219, 221 [152 Cal.Rptr. 425, 590 P.2d 1]. In my opinion this controverts this notion of the aforementioned easy to prove "casual link" between a mental illness and inability to care for ones needs. Many practitioners in the mental health field will attest to the difficultly of proving GD due to this high standard. This trickles down to non conservatorship proceedings such as 5150s and 5250s where the burden of proof is "lower" but still hospitals and doctors will hesitate to "cosign" on this nexus out of fear of being wrong or adding more legal work down the road. At the LPS conservatorship hearing phase this notion of GD not being unconstitutionally vague or overly broad is lost is in this overarching fear that a finding of GD implicates "an inevitable unbroken and indefinite period of state-sanctioned confinement where a theoretical maximum period of [LPS conservatorships] is lifelong as successive petitions may be filed . . . ." Conservatorship of Roulet (1979) 23 Cal.3d 219, 223-224. No matter how much training we do on mental health laws, anosognosia, and the consequence of inappropriate discharge (revolving door and subsequent untimely death), until this concept of grave disability standard is completely reframed as best interest of the patient standard and professionals move away from similarly situating mental health clients with criminal defendants we shall not see much progress with improving professionals understanding and correctly applying the grave disability standard. So my proposal has always been to align mental health patients with children in the dependency system. When it comes to minors the prevailing standard is the best interest of the child. Dependency proceedings are civil in nature (like LPS/MH) and said proceedings and court rules are designed not to prosecute a parent, but rather to protect the child. In re Malinda S., 51 Cal. 3d 368, 372. This child's best interest standard is the sine qua non of most legal process governing dependency issues and language as you will see adheres to this precedent. The import of the LPS act (albeit often in name only), like dependency, is to "end the inappropriate, indefinite, and involuntary commitment of persons with mental health disorders" and provide treatment and protection of the public (and patient). Prosecution of the mentally ill and punishment is not the end goal of LPS. However, because this intent of the LPS act is lost in the fight for procedural safeguards for the patient, it has become more aligned to criminal proceedings whereas dependency has relatively stayed close to its intent of protecting and safeguarding the minor's best interests. If we reimagine LPS and grave disability within the same framework of "best interest" rather than prosecution, then we may observe better deference to the grave disability over misplaced fear of indefinite commitment of conservatees. For example both dependency and LPS only require a single criterion to be met in order to initiate court proceedings to protect the patient/minor. In dependency the juvenile court's jurisdiction may rest on a single allegation under Welf. & Inst.Code § 300 et seq in order safeguard the minor's physical and mental safety. We have similar rules for LPS (GD can be based on an inability to provide for food, clothing, or shelter; it does not require a finding that a pt cannot provide for all three Welf. & Inst.Code § 5008(h)(1)(A). But because the best interest of the child is the prevailing standard over a parents civil liberties [citation], dependency culture is far more favourable to the "best interest" and the legal language reflects such: "As long as there is "one unassailable jurisdictional finding, it is immaterial that the evidence may be insufficient to support another basis". In the same vein many treatment advocates observe that a patient's noncompliance with treatment and medication has to border on so extreme that they will perish before a court will interfere with more serious legal remedies. The converse is true in dependency in which the best interest of the child is so important that Welf. & Inst. Code § 364 states that failure of a parent to participate regularly in any court ordered treatment program shall constitute prima facie evidence that the [dangerous] conditions which justified initial assumption of jurisdiction still exist and that continued [court] supervision is necessary. Imagine if we had this for CARE court or AOT court. We do not have such language in AOT or CARE provisions as the courts in these areas shy away from any punitive measures. SB 1338 subdivisions (4) and (5) state: The patient's failure to comply with an order shall not result in a penalty outside of this section, including, but not limited to, contempt or a failure to appear. The respondent’s failure to comply with a medication order shall not result in any penalty. Drawing from this comparison of statutes if we reflected the same concern in LPS and CARE proceedings then perhaps the legal language surrounding grave disability petitions, historical course of illness, and LPS conservatorship legislative frameworks would shift so that proving grave disability and need for higher levels of care would not be such a tall order.