Prop. 1 sets up a Sisyphean task for Kern’s Behavioral Health team

Yes, indeed, Kern Behavioral Health and Recovery Services is having one devil of a time trying to figure out how to implement the particulars of Newsom’s Proposition 1, SB 43 and Reagan’s 1967 Lanterman-Petris-Short Act (LPS). These, in combination with our Constitution’s Fifth and 14th amendments, present us with a Gordian knot that not even Alexander the Great would be able to slice through. I felt sorry for Director Stacy Kuwahara then, and Director Alison Burrowes now, as they found themselves then and now tasked with implementing the impossible.

Let’s break it down: In short, Prop. 1 tries to redefine “grave disability” as it relates to Welfare and Institutions Code (WIC) 5150, 5250, et seq. SB 43 elaborates on the particulars of the LPS Act to try to give “grave disability” greater bite and wider applicability vis-a-vis mental health outpatient treatment to deal with our population of the chronically voluntarily homeless comprised of a mix of the mentally ill, the drug-dependent addled and addicted, and simple vagabonds who prefer to live under the great open skies unrestricted by the boundaries of the law.

Reagan’s 1967 LPS Act was the original law that made it possible to involuntarily hospitalize those who were formally adjudicated in civil court as mentally ill and to be treated and stabilized and maintained in a locked hospital until ready to be released when no longer a danger to self, danger to others or gravely disabled.

I’m old enough to have had hands-on clinical training and experience in a state mental hospital before, during and after LPS went into effect. I witnessed firsthand the slow-motion train wreck that LPS became and from which we are still reeling. Gives meaning to the saying, “no good deed goes unpunished.”

So, what’s the problem? There are two, both with legal and ethical aspects: First, an irremediable conflict between the Fifth and 14th amendments — both of which state that no one can be deprived of life, liberty or property without the due process of law — and our state laws, which strive to force or threaten hospital-confined treatment on those who by right claim they don’t need or want it.

And second, the new laws around forced treatment and hospitalization are barking up the wrong tree. They should be expanding the meaning not of “grave disability” — which is broad enough and is arguably subjective, on a continuum, lifestyle values laden, and encompasses a wide variety of lifestyle choices, habits and conventions — but of “danger to others,” which is more clear-cut and publicly and statistically demonstrable.

Homelessness, as but one manifestation of mental illness, occurs within a constellation of related primary and secondary public health and safety dangers, not the least of which are public intoxication from both alcohol and drugs; public urination and defecation; theft; property damage from break-ins and fires; violence; threatening panhandling; rape and other sexual assaults; squatting in vacant homes and businesses; prostitution; public code violations of all sorts; trashing of public places and spaces; illegal encampments; blocking public walkways; breaking and entering; obstructing business entrances; depriving proprietors of customers; and the list goes on.

A two-pronged test of program eligibility would be the presence of major mental illness combined with any of the above.

A second problem in implementing the involuntary treatment programs is seen in the wide divide between the criteria used to determine program participation by civil judges versus by clinicians. I’ve sat in mental health civil hearings where if a barely together and newly stabilized person can give the judge their birth date, their Social Security number, their home address and an unconvincing promise they’ll remain in treatment and on meds, they’re released.

Never mind that the patient will disappear, toss his meds due to their terrible, often permanent Parkinson’s-like side effects or sell them for drug money the minute they hit the sidewalks. Whatever the outcome, the cycle repeats, the patient’s illness and homelessness return, he or she suffers, our public health and safety suffer. It’s been that way from the start of LPS nearly 60 years ago, and there’s no reason to believe anything will ever change.

Alison, my dear Alison, you have my best wishes and sincerest condolences. I pray you’re not our newest Sisyphus.