The following is an excerpt from the March 2018 Pacific Palisades Taskforce on Homelessness Newsletter. To read this newsletter in full, please click here.
Mentally Ill Homeless People Who Refuse Help: What to Do?
In our third year, PPTFH faces the hard fact that six of the homeless individuals on our Palisades streets have remained here for over a year. Our outreach professionals and volunteers worry that they are in failing health. Yet they refuse our offers of help. At our community meeting January 29, we sought the advice of two experienced professionals.
Dr. Emily DeFraites, a psychiatrist at the Greater Los Angeles Veterans Administration, and Brittney Weissman, Executive Director of the National Alliance for Mental Illness, Los Angeles County Council (NAMI LA), offered guidance on how to help our most troubled homeless residents.
DeFraites explained that it takes time for a psychiatrist to diagnose and treat a new patient. With medication, many can be started on the path to accepting services and eventually permanent care and shelter. But efforts are hampered when the person refuses medication and there’s too little time to develop an individual treatment plan.
In an emergency, when an individual is a danger to himself or others (such as wandering on PCH or threatening people with a weapon), police have ordered an ambulance to take the person to an Emergency Room. But the law requires formidable evidence to hold someone involuntarily in a hospital beyond 72 hours (called a “5150 Hold”). So far, our mentally ill people have been discharged after three days and simply returned. Their decline continues.
DeFraites and Weissman advocate “treatment before tragedy.” They favor expanding the legal definition of “gravely disabled” to allow a court to order involuntary treatment for people—not just if they are a danger to themselves or others, but if they can’t make sound medical decisions for themselves. A bill to this effect will be considered by the California State Assembly.
While protecting those who are incapable of protecting themselves, it’s important to preserve the individual’s freedom of choice. To balance those goals, DeFraites and Weissman stressed that outreach workers, medical professionals, and related agencies should:
Exhaust all efforts to get the individual to accept voluntary help.
Make sure the individual understands the recommended treatment and can express a choice before seeking involuntary treatment.
Carefully record evidence of long-term dysfunction, such as the person’s trips to the ER, rejected offers of professional help, harassing behavior, citations by LAPD, and observations by nurses.
Increase the number of conservators. Court-appointed conservatorship is legally complex but potentially an effective step toward recovered health and a life in shelter. A conservator could make decisions for the person’s health, maybe for as few as six months. The conservatorship could be withdrawn as soon as the person can safely transition into the appropriate care and housing. NAMI helps support citizens willing to serve in this role.
Weissman and DeFraites said PPTFH is doing the right thing. We brought in Glanda and Maureen as fulltime outreach professionals. Our volunteers have tried to reunite our troubled people with their families. Dr. DeFraites urged us to share what we have done with other communities.