I’m going to need everyone to do better. Recent work has made me realized that a lot of professionals still are unwilling to apply certain legal standards. Keeping someone who is clearly gravely disabled should not be like pulling teeth. I fully understand that legal standards exist to protect due process rights yet we find ourself discharging clearly sick persons back into detrimental, dangerous, and overall unstable living situations. Take the following matter:
ISSUE OF CURRENT GRAVE DISABILITY AND NEED FOR LPS CONSERVATORSHIP LPS Conservatorship law mandates that a qualified professional may petition the court for LPS Conservatorship of a gravely disabled person under Welfare and Institutions Code § 5350 and § 5008 (h). In order to make the appropriate finding of grave disability, the hospital psychiatrist and other involved professionals must make a finding that the patient is currently unable to provide for their food, clothing, or shelter
I have spent a better half of a week preparing evidence to support this finding in legal terms for a 14 hold where the standard of proof is extremely low. Even when faced with obvious evidence both in photographic form and written declarations, the hospital still wished to discharge the patient back to a very dangerous situation citing that the patient chooses to live in such a way. When presented with all of the relevant evidence the hospital chose to say that living in feces and urine was a matter of choice and that there was no danger in eating rotten expired food. Again legal standards so exist but common sense must pervade. Presenting credible evidence to the hospital that discharging someone back to such a place with no effective safe third party assistance was not enough. If the below is not met the patient can be discharged:
Even if a third party offers assistance, the court may still determine that the assistance offered, though well-intentioned, is not sufficient to permit the conservatee to survive safely in re Conservatorship of Johnson, 235 CA3d at 698
Yet this case refers to a LPS Conservatorship matter not a simple 14 day hold. Yet we had to pull citations of several cases of current grave disability and lack of proper third party assistance to convince the hospital to continue the hold. Sometimes the effort required felt like a LPS Conservatorship trial with a full standard of proof showing GD beyond a reasonable doubt, the same as criminal matters. Yet it wasn’t. We ended up with something like 15 pages of documentation of grave disability and dangerousness to self just to continue the hold and convince the treating physician to submit a referral for LPS Conservatorship. We are not talking about a P-con hearing... just 14 day holds and referrals. I have seen people LPS conserved for far less evidence.
Failure to apply common sense for hold that requires low standard of proof leads to needing to submit more emotionally damaging evidence and pulling of strings that do not have to be pulled. There is a reason people state that conservatorship work can break families and irrevocably harm families. In the name of keeping their loved one on a hold detrimental statements are made further harming relations as the patient eventually hears these statements and not understand the need to state such to overcome bureaucratic hospital policy. Instead they feel betrayed when in face such admission are a “necessary evil”. We’d love to spare emotions at all cost but sometimes everyone involved feels like they are trapped with no other way out.
Not everyone involved in a loved family member’s case has the time nor the resources to conduct such research, general legal citations, pull all kinds of strings, and deliver numerous copies to the hospital. They are simply seeking help for the family member and there needs to be better structures in place to ensure continuity of care rather than letting that revolving door continue to slide.
Disagree with me or not but I strongly aver that if a family member is a regular should we be paying closer attention with each hold. Look for increased risk of grave disability and need for LPS Conservatorship. Obtain more collateral if needed and then if ya’ll are out of space or staff then we should move to reduce the shame of just saying we don’t have enough space. However, after pulling teeth and more documentary and legal evidence the patient was continued on his hold making me believe otherwise. The hospital cites that “three is the magical number” for LPS Conservatorship yet in the same breath dismisses recidivist patients as bothersome and prepares for early discharge. We need to do better for the sake of our patients, the mental health legal profession, and the healthcare industry. Because if the last week spent trying to get those 72 hour and 14 days was that much work ya'll I worry about how challenging this upcoming LPS Conservatorship petition may be.
Juvenile Dependency and