by Dominique Sanz-David
Before “Jenny” punched her father in the face, her 80-year-old parents had reached out to authorities on nine prior occasions because they feared for their safety – and Jenny’s. On each occasion they were told by police that it was a “civil” matter and law enforcement intervention was impossible. Jenny had not yet physically abused them, though the abuse they suffered was very real.
June 15, 2016 marks the tenth World Elder Abuse Awareness day. Ten years have gone by and elder abuse is even more common than it was a decade ago. It’s time to do more than raise awareness. It’s time to take a much closer look at how our mental health treatment laws contribute to this growing epidemic—and to finally find solutions. Jenny’s case is just one example of the urgent need.
Jenny suffers from schizophrenia and bipolar disorder. She lived independently and successfully treated her mental health conditions with medication for many years. Four years ago, she suffered a mental breakdown and lost her job. She moved in with her parents – her only support system. She stopped taking her medication and became abusive.
She screamed obscenities and insults at her parents, often waking them in the middle of the night to accuse them of trying to kill her. Jenny prevented her parents from receiving phone calls and visitors. Jenny’s parents were scared, isolated, and embarrassed. Despite her parents’ pleas that she go back on her medication, Jenny insisted she was cured.
Jenny was twice placed on involuntary psychiatric holds under Welfare & Institutions Code section 5150. She was evaluated and treated in a designated facility. However, these 48-hour holds didn’t result in formal conservatorship or treatment with antipsychotic medication. Jenny was merely released back into her parents’ care, where her destructive behaviors resumed. Adult Protective Services suggested her elderly parents get a civil elder abuse restraining order to remove her from their home. But the couple didn’t want Jenny to be homeless or end up in jail. They wanted her to get treatment and improve. Instead Jenny’s condition and abuse worsened.
As a result, the couple’s health deteriorated, and they came to the difficult conclusion that they could no longer live with their daughter. Overwhelmed and depressed, they reluctantly asked me to file a restraining order against her.
The day I went to court was the day Jenny punched her father in the face. She was placed on her third involuntary psychiatric hold. Today, Jenny’s parents believe she was moved to a voluntary treatment facility.
While cases like Jenny’s represent only one of the many elder abuse scenarios, this type of case will become more common as the population ages. Los Angeles is home to a rapidly growing senior population. Every day, 10,000 residents turn 65. According to the U.S. Census, there are currently 1.2 million seniors in Los Angeles County; by 2030, that figure will more than double to three million. As our senior population expands, so too does its vulnerability to abuse.
Elder abuse devastates lives. Victims have triple the risk of premature death, are four times more likely to be admitted to a nursing home, are hospitalized twice as frequently, and have higher rates of illness and depression.
At Bet Tzedek we receive a new report of elder abuse almost every day. We know the true numbers are grossly underestimated. Elderly victims rarely report abuse, especially when the abuser is a child. Elderly victims feel protective of their children and don’t want to subject them to the legal repercussions—often a jail sentence—of disorders they’ve attempted to manage for years. Even in cases where an elderly parent seeks court intervention through a criminal or civil restraining order, they’re often reluctant to enforce it. Enforcement of the order is completely dependent on the victim, and elderly parents often can’t, or won’t, turn away their children.
There’s a dangerous imbalance in the legal infrastructure designed to protect the elderly. The Elder Abuse and Dependent Adult Civil Protection Act (EADACPA) recognizes the elderly are a particularly vulnerable class of people who need protection. EADACPA defines elder abuse broadly, gives incentives for attorneys to litigate elder abuses cases, and awards extra damages to victims of elder abuse.
Meanwhile, the Lanterman-Petris-Short Act (LPS) governs involuntary civil commitment for psychiatric treatment, provides treatment, supervision, and placement services by a conservatorship program for “gravely disabled” persons. The Code defines “grave disability” narrowly, as the inability of a person with a mental health disorder to provide for his or her own food, clothing, or shelter. This inability must result in physical danger or harm to the individual, and the individual is not considered gravely disabled if family members are willing and able to care for his or her basic needs. So, individuals like Jenny whose parents are providing food, clothing, and shelter, are not considered gravely disabled, despite multiple involuntary psychiatric holds.
The LPS Act is reactionary rather than preemptive. It essentially prohibits family members from asking the court for authority, through a conservatorship proceeding, to get mental health treatment for a loved one who has no insight into his or her disorder and refuses voluntary treatment. Designated health care facilities must initiate mental health conservatorships only after a crisis or emergency has already happened. Unlike the individual’s family, these facilities often have little knowledge of the patient’s mental health history, including homelessness, hospitalization, imprisonment, medication non-compliance, and violence toward themselves or others. Facilities generally assess the individual’s present mental health condition. Then, the court uses an unreasonably high criminal standard – beyond a reasonable doubt – to determine if conservatorship, a civil proceeding, is necessary to provide treatment, supervision, or placement for gravely disabled individuals who refuse voluntary help.
The LPS Act needs significant reform. It works for individuals who have insight into their disorders and accept voluntary treatment; it fails those who don’t. The Act also fails to protect the families of these individuals, who often take on the emotional and physical responsibility of managing their loved one’s disorders at the expense of their own health and safety.
We must reform our mental health treatment laws if we are truly committed to protecting our growing elderly population. The LPS Reform Task Force II published a report in 2012 recommending fourteen reforms, including broadening the definition of “grave disability” to address the incapacity of the individual to make informed medical decisions. The report also recommended allowing community members to apply for conservatorship over individuals with mental health disorders and lowering the high standard for granting conservatorship from “beyond a reasonable doubt” to “clear and convincing.” California should propose and pass legislation that adopts these reforms – and move from awareness to solutions.
Dominique Sanz-David is an attorney with Bet Tzedek, a nonprofit providing free legal assistance to low-income, elderly Angelinos. For the past eight years, she has represented seniors seeking protection from physical, financial, and other forms of abuse, and community organizations frequently invite her to address the issues of elder abuse and prevention with their constituents.