But the job is only half done.  The Act includes those disabled by reason of mental illness.  The law, strengthened by court decisions including the U.S.Supreme Court, requires states, counties and cities to treat those with psychiatric disabilities as disabled persons.  The existence of several hundred such persons in our community is clear to any observer of our streets and homeless encampments and it is clear that our treatment of this group of disabled persons fails to meet any minimum standard of care.

This failure is manifest in the failure to address, evaluate and treat a gravely disabled person who is unable to care for his or herself.  An extreme, but not entirely unique, case is that of Dana James whom Oroville police found incoherent and unable to care for herself and she was abandoned at the County landfill.  In the past year in Butte County 915 people were identified as gravely disabled under Welfare & Institutions Code section 5150 and only nine were admitted to a crisis facility.  The default is to place an incompetent person in the Butte County jail, and there is no treatment available in the jail.

The cry to treat these disabled persons exists on many levels.  There is the desire for the community to have streets and parks free of incompetent, homeless persons.  There is the cost of jailing or imprisoning a person at more than $100,000 a year without treatment.  There is the suffering of a mother or father who wants help for a son or daughter.  A disabled person may not recognize his or her illness, a condition called anosognosia, but treatment even given involuntary can relieve symptoms and change the disability.

We cannot accept the current process.  The forces of change will come in many ways including changes in the laws and court action.  Proposition one will add housing.  Senate Bill 43 will increase conservatorships and aid parents and others to intervene.  Care Court will expand the role of parents and others to help in treatment. Some changes will require stronger measures.  Several counties have been sued in the United States District Courts for failure to meet minimum legal standards.  The  LLC, Wellpath that provides services to the jails, including Butte County was found by the District Court to be in contempt for failure to comply on forty-three requirements at issue and given six months to comply or face imposition of a fine of $25,000 for each requirement.

In some counties judges and the courts have taken the lead in developing holistic programs such as “Stepping Up” adopted in more than 500 counties nation-wide.  Some District Attorneys have redirected their efforts away from incarceration of the disabled and toward treatment.  Some Public Defenders are using the Constitution and laws to move disabled offenders from jail toward less restrictive placements.  Some County Behavioral Health Agencies are actively moving the disabled homeless toward “board and care facilities. But there is little evidence of such activity in Butte County.  The truancy of these entities is obvious and disappointing.

The problem cries for bold and courageous leadership. There is evidence of such on the state level.  Governor Newson and legislators like Susan Eggman have shown a determination to find solutions.  And the American people that developed the Americans Disability Act still exist with the same determination to aid the disabled.  Change will come and this change will make the world a better place.

Ronald Reed has been a public defender for 35 years. He is the president of Base Camp Village, Inc. a non-profit devoted to helping the homeless.

Then an unkempt man shouting incoherent obscenities approaches me. The hallucinations tell me he is schizophrenic, a human being made in God’s image but disabled by an ugly malady. There are about 200 schizophrenics living on our streets or jail and after 35 years as a Public Defender I have come to know a few of them.

One is Kelly. When I first represented her she was a beautiful 16-year-old just showing manifestations of schizophrenia. As the illness progressed and her delusions took over she lost family and social support and was left to the horrors of the street.

When her conduct was too objectionable she was sent to jail. Her verbal out-bursts got her a conviction for “criminal threats” and two years in state prison. She has been in and out of jail over a dozen times. She was 35 when I last saw her in a holding cell at the court. Her head was shaved and she was in a jail garb reserved for someone with a sexually transmitted disease. She swore at me and pounded on the wall. The jail released her back to the street after her 90-day-sentence ended.

Another, I will call HC, developed schizophrenia at age 17, and was arrested for assaulting his mother.  Declared incompetent to stand trial he has spent 18 months in jail without treatment.  HC’s mother has been to court over 20 times and her plea is always, “I love my son, please help him.” It is clear to her that jail and prison are readily available for a mentally disabled person but secure, humane treatment facilities are not available in our county.

Treatment for a schizophrenic person usually requires an involuntary placement in a secure facility, therapy and medication. The individual must come to realize that they have an illness, and with treatment they can overcome the illness and become the person they desire to be. HC’s mother has come to recognize that the legal framework for involuntary treatment is a conservatorship but this is not being provided in Butte County.  Despite the existence of caring, dedicated professional workers the system is broken.

California  provides for a person who is gravely disabled as a result of a mental health disorder through the Lanterman-Petris-Short Act.  An LPS conservatorship may be involuntary and include a secure facility.  The Act includes due process protection for a subject’s rights including the right to a jury trial. The law requires placement in the least restrictive placement.  A person may be placed in a “Board and Care” or other secure placement in a community setting. But Butte County lacks this resource.  An August 2022 study in Rand Health Quarterly calculates a need in California for 50.5 inpatient psych beds per 100,000 adults, Butte County has one Psychiatric Health Facility (PHF) with a capacity of 16.  As a result of the lack of facilities a person gravely disabled will not be accepted for an LPS conservatorship leaving them to remain on the street

Don’t say there is no money.  It costs $106,000 a year to house a prisoner in state prison, $60,000 for a cell in jail. On March 3, 2022 Governor Newsom proclaimed the establishment of a new sector within the court system, CARE Court, devoted to aiding individuals suffering from schizophrenia.  SB 43 recently signed by the Governor expands LPS conservatorships.  Grant money is being provided to counties to pay for Board and Care facilities. We are spending more now to pay for the ravages of this illness than treatment would cost.

Schizophrenia illness is a community problem.  There is an entanglement between this aliment and our community.  As we provide for those in our midst who are gravely disabled we will enhance the true beauty of our community.

Ronald Reed has been a public defender for 35 years. He is the president of Base Camp Village, a non-profit devoted to helping the homeless.