What do you do when people need help but don’t want it? Or when people want help from others, but do not help themselves? These questions arise frequently when it comes to outreach to the mentally ill homeless, and they reflect a very real issue that transcends Skid Row.
Understanding the law.
A problem reported in the LA Times describes social workers trying to get needed mental health services to people on the streets. They find they are unable to convince most mentally ill clients that they need help, and to convince authorities that these clients meet the legal standard for “involuntary psychiatric treatment.”
The article explains that under California’s Lanterman-Petris-Short Act, police can take a person into custody for psychiatric treatment if it’s believed the person is in danger to themselves or others, or is gravely disabled, due to a mental disorder. The problem lies in gaining a mutual understanding of whether being “gravely disabled” is what is preventing the person from securing food, clothing, or shelter.
According to Herb Smith, president and CEO of Los Angeles Mission, a broader understanding of the law and the ability to impose treatment on those clearly diagnosed with mental health issues would go far in protecting people and preventing them from harming others.
The right to care.
Conversely, some homeless people feel they have a “right” to medical treatment, without having a larger picture of their behavior or its consequences. Smith says at the Mission for example, a client might feel they are owed mental health services, but are not willing to take their medications or stay in a facility for observation. Or they may feel entitled to medical detox, but want to “bring their bottle with them.” Some clients are inclined to want to place the burden of recovery on someone else, rather than to work together to get better.
The right thing to do.
Smith says the right thing to do in both situations is to reach out to the person and negotiate the trust to achieve the changes needed. For example, the Mission’s approach is to convey: “We agree you need help. You know you cannot continue to drink and get healthy. Come into the Mission and let’s work on your issues. Ultimately, we can find the best solution for proper medical care, mental health care, employment, stable housing, and community relationships to achieve your goals.”
It is the stance of LA Mission that they can make recommendations and provide treatment options, but they cannot force anyone to do the right thing even if it’s to their own detriment.
Smith says this approach turns the tables away from “You must comply with government regulations,” or “You have the right to assistance,” to “You want to make changes. Let us help you find the tools.”
To do this, Smith says, requires a team-based approach of service providers, medical experts, and family members or friends working together on a client’s behalf. Together, they must work to diagnose the mental illness, which can be challenging since many clients who enter a program often have a dual diagnosis (e.g., having both mental illness and substance abuse issues). Patient confidentiality laws and other well-meaning rules often compound the problem and can prevent voluntary assistance.
Yet, it is imperative to better define this issue within society and help prevent the downward spiral that can occur and end with homelessness, suicide, or other violent acts. Only with better understanding and greater support by everyone can we all be prepared to do the right thing.
Steve Pomeroy is the founder of Big Change Advisors, a Los Angeles M&A advisory firm of business advisors and capital sourcing advisors for startups and middle-market companies. Since 1992, Big Change leaders have completed over 38 transactions including M&A, Capital Sourcing, and Public Offerings representing over $800 million in total transaction value. Big Change Advisors donates a percentage of all fees to help serve the homeless through the Los Angeles Mission. To request a free consultant, contact us.