I’d like to post a review of Bebe Moore Campbell’s work, 72 hour hold. In my opinion, her book among one other is very good at depicting what the mental health system is like. Too few books cover the process of involuntary holds and the difficulty that family members face when trying to obtain involuntary mental health treatment. Campbell writes with eloquence and clearly reflects her own pain and frustration with the mental health system while persevering to get the treatment desperately needed. Because of Campbell’s own struggles with working with a harsh and underfunded system, her realism really carries through to this work of fiction.
I will be covering some passages and explaining how close Campbell was to the reality of working with the OPG, hospitals, and PERT.
All quotes come from her work 72 hour hold: Campbell, B. M. (2006). 72 Hour hold: a novel. Anchor Books.
Maybe you should get conservatorship," Mattie said. "You could have him put in a locked facility"... "That's a hard choice to make". Locking up your own kid- the thought made me shudder.
It is here that Campbell introduces us to the idea of LPS Conservatorship. When parents and caretakers first hear of LPS Conservatorship they are unable to consider it as they often hear of being locked up for a long time and forced medication. Campbell does an excellent job of reflecting the same emotions. Parents often want to try every other avenue before having their children involuntarily committed.
Let the kid run while; lock the kid up. Conservatorship. Maybe that was my north star, if I needed one.
Campbell again reflects on this idea of forcing involuntary treatment. As the novel progresses, the character has struggled with getting involuntary treatment and failing to have successful 5150 petitions on her daughter. Because of this she considers LPS Conservatorship as her “north star” to freedom from the stress and pain of watching untreated mental illness.
“F- a conservatorship, which could take months, years to get”.
Another character in the novel informs the protagonist that conservatorship is very hard to get. Although the actual process once the Dr’s petition is sent in takes around 30 days or a little longer if there are continuances or a jury trial, the notion that getting to the point where the hospital will comply and consider that the patient has a sufficient record of grave disability can take months if not years. For the public guardian’s office, they wish to see that the patient is gravely disabled and that all other measures have been tried and failed.
Conservatorship would give the legal right to place my child in a locked facility, to force her into a place where she would receive her medication regularly. The office of the public guardian was charged with helping people get conservatorship.
This statement is mostly accurate. The OPG is charged with getting LPS Conservatorship for mentally ill persons but when calling the number online will take you to the office for the administrator, guardian, and conservator. To ensure you talk to someone who knows LPS Conservatorship ask for an “LPS Conservatorship duty worker or supervisor”. This way you can obtain accurate information. You cannot call the OPG and ask them to initiate an LPS Conservatorship. Only the doctor can be the one to send in the declaration and request for an investigation.
“It's a pretty difficult proposition without your daughter being on a hold”.
“What do I have to do?” “First of all, she must be evaluated by a psychiatrist who is on staff at a designated hospital. I can send you a form to give to the doctor. Once it’s filled out, you mail it to my office with a request for an LPS conservatorship. The court will then give you a hearing date. Your daughter will have to be personally served with the papers, because she has to be present in court.”
This is the biggest reason family members struggle with getting LPS Conservatorship. Most OPGs need the patient to be in a hospital on a 14 day hold. They cannot conserve someone off the street or living in their home. LA is working on a pilot outpatient LPS Conservatorship program but again most cases have to come from a hospital while the patient is on an involuntary hold.
“Mrs. Whitmore, if I were you, I’d try to get her placed on a hold. Once your daughter is in the hospital, everything will be a lot easier. The psychiatrist there can do the paperwork.”
The above applies to this statement.
“Mrs. Whitmore, if your child is as sick as you say she is, there will come a day when she won’t be able to control herself. Really, it’s easier to get an LPS if your daughter is in the hospital on a hold.”
This statement although well intentioned is not really true. There are so many mentally ill persons out there who are suffering and severely mentally ill and gravely disabled. They cannot get the treatment they need and often end up in the jail system where they are not taken care of. PERT will also leave a severely mentally ill person who may be acting out alone if that person comports themselves during the 5150 wellness check. Getting family statements into PERT can be very hard and without proper collateral, the PERT team will leave.
I spoke quickly, filling him in on what had been going on with Trina. Thirty seconds, max. “I’ve been calling. Did you receive my fax. Will you support me on conservatorship?” He promised to fill out the papers whenever I got them to him and to testify on my behalf in court.
Campbell wrote this section to fit into the narrative but often it takes far more than that. Most doctors and social workers will not tell families anything or very little if there is no release of information. Faxes and emails can work but again it takes a lot of persistence with demanding to talk to supervisors, legal departments, and charge nurses. Most family members do not have the time to do this by themselves.
We shouldn’t let our relative’s illness become our lives.
Campbell hits the nail on the head with this statement. So many family members feel conflicted about this because they wonder how can they properly advocate and keep their family member safe while maintaining their own sanity. The process is long and tough which makes it hard for family members to keep up with their own lives. However it can be just as gut wrenching to watch a family member become very mentally ill and become homeless.
“Sure. I have conservatorship now. They were in a locked facility for a year. They seemed better. I let them come out. Took them to another facility. No locks. They weren’t able to maintain their sobriety. They’d leave the premises and get high. After a while, they stopped taking the meds. Everything started all over again.
This statement is also very true. Conservatorship allows a family member to spend some time in a structured living environment and learn the skills necessary to live out in the world again. The IMDs allow the patients to learn these skills while getting the mental illness stabilized. However, once in a step down facility there are no promises that the conservatee will not AWOL or stop their medication. In an ILF or half way house the conservatee can stop medication and the director has no legal authority to force medication. That is why almost all LPS Conservatees first go to an closed locked IMD. Likewise when the conservatorship terminates there is nothing stopping the conservatee from using drugs again, stopping their medication, or becoming homeless. However, the goal of LPS Conservatorship is to get them stable enough where they can gain more insight, accept medication, and learn the skills needed to function in society.
For a minute I couldn’t speak. It was bewildering to think that conservatorship didn’t bring complete deliverance…. Don’t expect too much; just because you have a conservatorship doesn’t mean everything will get better.
Most parents are shocked to learn this but it needs to be said as conservatorship is not an end all be all kind of thing.
“Mrs. Whitmore, we are going to need to release your daughter,” a sincere young woman told me. Release her to where? was my question.
Campbell addresses the classic problem and mistake hospitals make. Due to many factors, hospitals frequently release patients before they are ready or not with an LPS Conservatorship. These families are distressed as they know they have to face the fight of getting a 5150 again which was very hard in the first place to obtain. Also, hospitals have a very common problem with dumping patients at shelters or unstable living arrangements.
“You’ll be going to court in two days,” I told her when I visited her that afternoon. “Why?” “I’m trying to become your conservator.” It was the first time I’d broached the subject, and I could tell she was confused. I quickly explained that I was seeking the right to be able to force medical treatment on her. “But I’m in a hospital now,” she said. “Why can’t I come home after that?” “Trina, we tried that before. You stopped taking your medication and got sick again.”
Many conservatees find themselves getting upset and confused when they are told that they are going to be conserved. They ask their family members or the doctors, why do I need to be conserved. I will take my medication. However, due to lack of insight, grave disability, and refusal to take medication, LPS Conservatorship is necessary. They may not understand now, but once stabilized and educated they will understand that it was for their own safety and good.
From time to time, people would drift off to courtroom 95A or 95B, where their fates might be handed over to relatives or the state.
Campbell accurately notes the sadness and despair within the mental health court. No one is here because they want to be or because they are doing well. And for a lot of conservatees they can feel as if their life or fate is being indefinitely handed to their relatives. However, the LPS Conservatorship has to be renewed and reviewed annually.
Dr. Bellows, Trina’s psychiatrist, underwent about fifteen minutes of testimony. I had agreed to pay him for his time, including travel to and from the court: $450.
I am not sure how true this is in the real world. Often the attending psychiatrist will have the most expertise with treating the patient. The court wants to see the most recent evidence of grave disability which would come from the doctor who wrote the petition. The court usually will not accept psychiatrists from past treatments to testify at the hearing. However, counties run their LPS Conservatorship programs differently so the best way is to ask the local OPG.
“Trina, do you know why you’re here?” the judge asked. “Yes.” “And why is that?” “My mother wants to send me away.” “Trina, I think your parents feel that you need help. Do you know why?” “I’m not crazy.” “No one said you were.”
Again, a lot of conservatees find that they are fighting their relatives on mental health treatment. No one wants to be forced to engage in treatment, but mental illness and grave disability has gotten so severe at this point that they cannot survive safely on their own. Because of this court involvement is necessitated. Regardless this is very hard on family members and conservatees because both feel like they are betraying the other.
Judge Neulander leaned forward again. “Trina, I think you need help, dear. Your parents want to help you, and I’m going to let them. Conservatorship granted.”
This is true. With a judge who knows mental health and how involuntary treatment and LPS Conservatorship works, they will understand that the family member becoming conservator is the best for the conservatee’s own well being. With relative testimony, the judge can see ever better for himself that the person’s mental illness is so severe that no amount of outpatient voluntary care will help.
Overall, I find her book very accurate and is a definite read for anyone. She has many non LPS Conservatorship related passages that I didn’t cover but I did not want to make this too long. Her work does demonstrate that we need more people serving as advocates and legal guides for families navigating the LPS Conservatorship system.
Campbell is an amazing writer who clearly understands the real struggles of the mental health system and writes very realistically. She does not exaggerate nor resort to theatrics thus making her work even the more compelling.