Frustrated by chronic homelessness, they found an answer hidden in plain sight
SAN DIEGO – Light rain pounded the pavement in San Diego’s East Village on a recent morning, forcing homeless people to disperse while others huddled under tents or slept in water.
I was walking with Dr. Aaron Meyer, a psychiatrist frustrated by California’s most visible problem: The failure to provide help to many people who need it most, despite all the programs that have been rolled out over the years, and all the billions of dollars spent.
We see them in parks, sidewalks and other public places in distress, and we have heard endless conversations and political promises of better days. The problem goes beyond homelessness: Thousands of seriously ill people live with angry family members struggling to get help for their loved ones.
“We have a history of services that ended up prioritizing the worst people over the worst,” said Meyer, a clinical professor of psychiatry at UC San Diego who spoke on behalf of the university.
In search of answers, Meyer met with a lawyer Ann Marie Council, a former San Diego deputy city attorney who previously worked in drug court. He was impressed by the number of clients who navigated the system many times without receiving treatment for addiction or mental illness.
“I was so sick and tired of watching people go to jail without getting the help they needed,” said Council, who retired from public service and started Quarter Turn Strategies, a non-profit organization focused on effective solutions to human rights violations.
It turns out that a doctor and a lawyer make a great team. In their research, they found a tool that could deal with serious mental illness and addiction, and it was hiding in plain sight: in California’s statute book, Section 5200 of the California Social Services and Institutions Code.
The state law governing the involuntary commitment and conservatorship of people with severe mental illness is known as the Lanterman-Petris-Short Act, and includes Section 5150 which is often used for those considered “severely disabled.” The process starts with a 72-hour hold that can lead to a longer commitment, but usually doesn’t.
Section 5200 features a more comprehensive inspection and maintenance schedule than 5150. The 5200 process can be initiated by anyone concerned about a person who is severely disabled or a danger to themselves or others (with penalties for a misdemeanor for abusing the right to report).
Dr. Susan Partovi, who has worked as a street mediciner in Los Angeles for many years, has a word for holding 72 hours under 5150:
“We call it the 72-second hold,” he said.
I have written before about Partovi’s moral outrage over the number of seriously ill people who may not be considered “severely disabled” or who repeatedly turn around during the three-day seizure and return to the same self-harming ways. I have heard him speak of himself who is among his clients you will probably die next.
Partovi is a member of the Grave Disability Workgroup of California, which approved the research paper in 5200, “The Lost Legal Approach to Mental Health Care,” co-authored by Meyer and Council and released a few weeks ago by Quarter Turn. It detailed the frustrations of families, outreach workers and first responders and concluded that 5200 could help break down some of the legal barriers to life-changing mental health care.
In San Diego, as Meyer and I passed a woman trying to pitch a tent in the rain and someone sleeping in a weedy area, I asked her to explain the difference between a 5150 and a 5200.
Under a 5150 commitment, he said, a person is usually brought to the emergency room to be evaluated by someone who is not a behavioral health professional. A decision is then made as to whether the person meets the legal criteria for automatic arrest.
“If they don’t, they’re released, and there’s no need to interact with care,” Meyer said. Under 5200 years, a comprehensive medical examination is required with a multidisciplinary team, “and requires a coordinated care plan at discharge,” which raises “the hope of leading to something important.”
In their research, Meyer and the Council found that the 5200 is not known to be used in any of the 58 states of the state, and government officials do not know or feel that it is an unnecessary tool that has been given to other programs over the decades, and the cost of use can be a problem.
Meyer says the state spends billions without addressing obvious needs, and 5200 would be less expensive than people who use roller-coasters through hospitals, courts, jails and prisons without putting them on a healthy path.
Meyer said he has received pushback from civil libertarians and disability rights groups, both of which have long opposed forced medical treatment and instead championed more resources in housing and health care, as well as more access that could lead to voluntary treatment.
I understand the pitfalls of forced therapy, having been in it A 20 year journey and someone who initially resisted help and refused medication. It is true that forced treatment does not always have the desired effect, and it can have negative effects if it makes a person resistant to treatment.
But some people can be too sick to make decisions that are in their best interest, that is why we have seen many of them at the door of death, living in violence and despair, suffering from mental illnesses or chewing deadly drugs.
Care Courts, which were intended to help deal with this, have not had the expected impact, either some families have felt discouraged. Meyer and the Council said that while those courts could use 5200, that hasn’t happened yet.
The fact that 5200 is so little known and never used is “another example of a system failure,” said former congressman and Sacramento Mayor Darrell Steinberg.
Steinberg said that while 5200 is not a one-stop solution to homelessness or untreated acute mental illness and addiction, it should be implemented given the “set of existing programs that don’t respond to people who are seriously ill.”
Jon Sherin, former head of LA County’s mental health department, called 5200 “one of the most powerful tools” available and said he tried to use it a few years ago but faced the same resistance Meyer described.
“If you use it thoughtfully and powerfully, you can have a big impact,” said Sherin, who urged those running for governorship to “bring 5200 to the limelight and ensure resources in the regions.”
The same can be said for the Los Angeles Mayor’s race. Despite some progress, homelessness is still a social crisis, and the seriously ill represent a policy failure.
Supporters of 5200 include Bay Area resident Teresa Pasquini, a mental health reform advocate whose brother and son both deal with serious mental illness. Pasquini, its causes include “Working Mothers” and “Housing that Heals,” he told me that his son, now in his 40s, has gone through the 5150 turnstile 40 times.
Pasquini said that people in his situation are accused of wanting to end their problems by locking up their children. What he really wants, he said, is for her to be housed and safe and given proper care.
“We need all the tools we can get … and we need 5200,” Pasquini said. “I’ve watched my son walk out the front door in handcuffs over 40 times. Therapy is not a bad word.”
steve.lopez@latimes.com
