The mentally ill on the streets

Aof the homelessness crisis in Los Angeles and around California is the simple fact that thousands of people spend their nights beneath overpasses, beside freeways and on the street because they cannot afford other places to live.

There is a significant subset that is homeless because mental illness leaves them incapable of doing much of the day-today business of living beyond finding a place to sleep, something to wear and a little to eat; but for most of those street-dwellers as well, the problem is essentially the same: There is no other place for them to go. The community-based residential and outpatient treatment facilities that were supposed to go hand in hand with the closure of state psychiatric hospitals beginning in the 1960s never got the promised funding or political support.

Society broke its promise, and the solution — even 50 years later — is simple: Stop breaking it. Build and staff the residences and clinics.

So it’s odd that so much attention is devoted instead to making it easier for authorities to force mentally ill homeless people into involuntary treatment even if they are not an immediate danger to themselves or to others. Once we grab them — and remove them from whatever comfort or support structure they have managed to create — where do we put them? If we force them into hospitals for medical treatment they say they don’t want, then what? It won’t be long before we have to send them back out to the street, to the same conditions that contributed to their medical problems in the first place.

That’s the quandary surrounding two bills moving through the state Legislature. One is Assembly Bill 1971 — a proposal by Los Angeles County to amend the landmark Lanterman-Petris-Short Act to make it easier to involuntarily commit mentally ill people.

But California’s failure is on the service supply end. Current law already gives officials the ability to take into custody people who can’t see to their most basic care. But it doesn’t actually supply any of the care. Neither would the proposed change.

The move to amend the law arises from the best motivation — to help those who cannot help themselves. More than 800 people died on the streets of Los Angeles County last year, frustrating officials who believe they could have saved them with timely, if unwelcome, medical intervention.

But proper motives do not by themselves make workable policy. Under the bill, officials would be able to check people into hospitals against their will if the officials believe “a failure to receive medical treatment [would result] in a deteriorating physical condition or death.”

“Deteriorating physical condition” is almost certainly an unconstitutionally vague term that could apply to any person living on the street, with or without a mental illness. That raises the specter of homeless sweeps and re-institutionalization, an unwelcome prospect that some bill supporters — although not its authors — say they would like to see.

But the bill neither requires nor provides any housing or clinical care, either in the near term or on a continuing basis. Without them, changing the law to get more people off the street just makes the revolving door of street-to-hospital-to-street spin faster.

The bill wouldn’t apply just to the homeless, and could in theory be used to commit anyone suffering with a potentially deadly addiction, or even anorexics who are starving themselves. Proponents say they want only to reach seriously sick, mentally ill homeless people — but their bill is not similarly limited.

Hospitals oppose the bill because they know they could not legally release people who have no place to go, nor could they legally treat them in the first place against their will, absent an emergency or a timeconsuming court hearing and judicial order.

The second bill making its way through the Legislature, Senate Bill 1045, suffers from similar shortcomings, although its reach is limited to homeless people.

As written, the bills express good intentions but would do more harm than good. They should be recrafted to ensure a workable plan for housing and healthcare for people forcibly removed from the street for medical treatment. They should be more narrowly tailored to cover only those who cannot be reached under existing law. They should better respect the right of people to make their own choices about their medical care.

And perhaps these bills should take a back seat to efforts to finally do what California committed to do more than 50 years ago: build enough community-based residential and outpatient clinics and supportive housing to meet the needs of people evicted from inadequate and often abusive state psychiatric institutions.