The Mental Health Conservatorship is part of the Lanterman-Petris-Short (LPS) Act 1967. An LPS Conservatorship is the legal term used in California that gives one adult (the conservator) the responsibility for overseeing the comprehensive medical (mental) treatment for an adult (conservatee) who has a serious mental illness. Guidelines for the involuntary mental health treatment are under the California Welfare and Institutions Codes 5200.
First, it is important to build a powerful written case for mental health treatment for your love one. Your written case will be used to acquire resources necessary for treatment, help you to place your love one in the hospital and/or utilize Department of Mental Health Treatment Programs, and is useful if your love one is incarcerated. Your case should include a mental health history, their symptoms and characteristics which they exhibit, and describe their gravely disabled status. Your written case will help to acquire treatment including the LPS Conservatorship should this treatment be needed. A well-written case will help the doctor to better diagnose and treat your love one. (This should NOT include the person’s social security number.)
The format, as seen in this template example, can be copied to a word document. Then delete what does not apply for your love one and add what does apply. It is just fine to copy and paste, if the text is applicable. Often, our tendency is to write pages of information. This is not a wise idea. The doctors have heard it all before in one form or another. Their time is limited, so a concise, well-written paper is more effective in acquiring the appropriate treatment for mental health recovery.
Use your written case to help you get the treatment needed for your love one. Give the case (medical history, symptoms and gravely disabled) to the police and to the psychiatric evaluation team (PET) when you request help to place your love one in the hospital. At the hospital, give a copy of this information to the social worker there, and request that they give this information to the doctor. Give a copy to the public guardian’s office only after the referral for the LPS Conservatorship is filed. Also, use the written case for treatment when applying for SSI/SSDI and Medi-Cal. If health care providers refuse your information, provide them a copy of the CA Welfare and Institutions Code 5008.2, which states health care providers MUST take your information. This law is written under the Law Section. Also, use your case when you request Department of Mental Health programs such as the Assisted Outpatient Treatment or the Full Service Partnership program.
FAQ on LP Conservatorship
1. Why is an LPS Conservatorship important to obtain?
An LPS Conservatorship is a tool that gives the conservator the power to work with the doctor to achieve recovery treatment for a mentally ill individual beyond the standard of “stable.” It helps the conservator in guiding the treatment team to get your loved one’s life back as they knew it to be before they became ill. It is involuntary treatment, especially for those who have no insight into their illness and are non-compliant with treatment and medication. The patient cannot refuse medication, which is the essence of the LPS Conservatorship.
2. What is an LPS Conservatorship?
A Lanterman Petris Short (LPS) Conservatorship is the legal term used in California which gives one adult (conservator) the responsibility for overseeing the comprehensive medical treatment for an adult (conservatee) who has a serious mental illness. Under the LPS Conservatorship, medication can be mandated.
3. How long is an LPS Conservatorship granted?
An LPS Conservatorship is granted for one year term, but can be renewed for another year. It is important to pay attention to the requirement required for renewal from the court and mark that date on your calendar. Once the conservatorship is terminated, the process must begin from the beginning.
4. Who can be conserved?
Conservatorships are only granted by the court for adults with a mental disorder as listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) and who are gravely disabled. Conservatorships are granted for people with:
- Bi-Polar disorder (manic depression)
- Schizoaffective disorder
- Clinical depression
- Obsessive compulsive disorder
- Chronic alcoholism
5. What types of LPS Conservatorships do the courts grant?
There are two types of LPS Conservatorship that the court can grant.
- The first is an LPS Conservatorship of the Person. A qualified psychiatrist initiates a petition to the public guardian’s office, which in turn petitions the court for the conservatorship of the person.
- The second is an LPS Conservatorship of the Estate. The public guardian’s initial investigation determines if there is a need for the LPS of the Estate Conservatorship. The family can also request that the public guardian petition the court for the estate conservatorship at the time of the LPS Conservatorship hearing. Or, they can request the LPS of the estate at some time later, when the person is still under the LPS Conservatorship. The doctor is not involved with the LPS of the estate.
6. What are the conservator’s responsibilities with respect to the conservatee?
As a conservator, you will be responsible for approving or disapproving a place for the conservatee to live, and approving or disapproving the treatment and the medication program for the conservatee. You should also participate in developing and overseeing a treatment plan that supports and encourages the conservatee to regain his/her life as close as it was prior to the illness. It is a good idea for you to learn about mental disorder. This can be done by taking the free Family-to-Family class offered by NAMI.
7. What are the responsibilities for the conservatee with respect to the estate?
As conservator of the estate, you will be responsible, but not personally liable, for all financial matters pertaining to the estate. You do not need an estate conservatorship to be the representative payee for their SSI benefits.
8. What qualifies a person to be placed under an LPS Conservatorship?
To qualify for the LPS Conservatorship, the person must be gravely disabled and have a serious mental illness. If there are no other alternatives to help them in the recovery of their impairment, LPS Conservatorship applies.
9. How do I know if my loved one is considered a harm to himself or others?
You do not need to wait until your loved one tries to commit suicide or tries to hurt someone or themselves before you seek treatment for them. Here are examples are some red flags that will help you get your loved one hospitalized, which is usually the first process in acquiring a conservatorship: If your loved one has delusional conversations expressing the need for knifes or other items to protect them; if they walk in front of moving cars, oblivious of the vehicles; if they seemed obsessed with others killing them; if they leave gas burners on after cooking; if they are losing weight because they are afraid the food is contaminated. It is easier to conserve person is in the hospital than jail. If a person is in jail, the treating doctor at the jail must initiate the LPS Conservatorship.
10. What defines gravely disabled?
Gravely disabled means the mentally ill person cannot take care of his/her basic needs for food, clothing, and/or shelter. With that said, state law states that if another person provides for their food, clothing or shelter, or if a person can get food or clothing from the shelters, then they are not considered gravely disabled. The fact that a mentally ill person lives on the streets does not mean that they are gravely disabled, either.
It is still possible to establish gravely disabled and get the person in treatment under the LPS Conservatorship, even when they are living on the street. Refer to their basic needs as a safety problem and/or health risk, such as:
Shelter: “They have no place to live safely. They cannot handle a board and care or shelter safely.”
Food: “They have lost significant weight causing a health risk.”
Clothing: “They wear their clothes for long periods of time causing excess build-up of bacteria on their skin resulting in a health risk.” Or, they take their clothes off at inappropriate times or places, or they dress inappropriate for the weather.
The lack of their ability to not be able to provide for only one of their basic needs of food, clothing, or shelter is necessary to establish gravely disabled. They do not need to have the inability to provide for all three.
11. How does a person get a gravely disabled status?
When a person with mental illness is hospitalized or incarcerated for being a harm to self or others, then the family or others can provide pertinent information to establish “gravely disabled” for food, clothing or shelter. Gravely disabled by California definition means a person cannot provide for their food clothing “or” shelter. But, if someone else provides for their food, clothing or shelter, they are not considered gravely disabled. Meeting any one of these three criteria can establish gravely disabled.
Gravely disabled can be established if the person has 1. No place to live safely; they may not come home unless they are under the LPS Conservatorship and have gone through treatment, and/or 2. If the person has lost significant weight or is paranoid about food, or they have compulsive eating causing them to be overweight, and/or 3. A person creates a health risk by dressing inappropriate for the weather, resulting in a health risk, or they take their clothes off at inappropriate times or places, or they wear their clothes for long excessive periods. This is very important in requesting an LPS Conservatorship. In addition, if the person is not compliant with treatment and medication, this helps to build a case for the LPS Conservatosrship.
To prove that a person cannot provide food or clothing is extremely difficult. because if they can go to the Salvation Army or a dumpster to acquire clothes, panhandle for money, or find food kitchens. If this is the case, then they are not considered gravely disabled.
12.Who can be the conservator?
- Public guardian, paid for by the state
- Private professional conservator
- You, a relative or a friend (the state prefers a family member for conservator)
13. Why is it necessary to seek an LPS Conservatorship?
If a person with mental illness does not have insight into their illness, and they are not compliant with their medications, it is very wise to seek an LPS Conservatorship to keep them safe, out of the revolving doors for the hospitals, and out of jail — but especially to help them on their road to recovery. Lack of treatment results in brain deterioration. Because treatment and medication can be given under the LPS Conservatorship, it has been found that the brain will not have to continue to suffer further damage. An LPS Conservatorship is one significant tool that can help your loved one regain his/her life.
14. How much does it cost to acquire an LPS Conservatorship?
You can hire an attorney to help you acquire the conservatorship, but this is not always necessary. The attorney cannot force the doctor to seek the conservatorship. Attorneys can be expensive.
When the person is in the hospital or jail, then the treating doctor can initiate the LPS Conservatorship with the public guardian’s office.
The public guardian submits a report to county counsel recommending that the person be conserved and adds whether or not a family member should be appointed as the conservator. County counsel that represents the public guardian petitions the court for the LPS Conservatorship. The county counsel deals with these situations regularly. They are very knowledgeable and understand the proceedings of the conservatorship court. If the court sees a need for an attorney, the court can assign an attorney to represent the conservator. The judge will select from the court’s panel of attorneys at the court’s cost.
15. Where is the conservatorship court?
In Los Angeles County, the court is located at: 1945 S. Hill Street, Los Angeles, CA 90007. The hearings are usually heard on the fourth floor. Prior to any hearing, double-check with the public guardian’s office the location of the court. This facility is temporary; the mental health court will be moved to a refurbished courthouse in Hollywood.
16. What is the usual process in seeking an LPS Conservatorship?
First, the person who exhibits harm to self or others is placed on a 72-hour hold (5150) by a qualified police officer, psychiatrist or mental health personnel. Usually someone will call either the police or the crises intervention team to initiate this process. To prevent the person from being harmful to others, the police will make sure the person is contained. The crisis intervention team evaluates the individual and makes a recommendation for the 72-hour hold. Note: when the person is transported, they are usually handcuffed to keep them safe.
After the 72-hour hold in the hospital, the treating psychiatrist may initiate a 14-day hold, AKA a 5250 hold, to continue the treatment for stabilization. A 14-day hold must have a probable cause hearing within 4 working days of the hold. Often, families are not aware the probable cause hearing has taken place. This hearing allows the hospital to hold the patient for the 14 days. It does not mean the hospital will hold the patient for the full 14 days.
After the probable cause hearing, the doctor may request an LPS Conservatorship investigation from the public guardian’s office. The public guardian will review the application and may petition the court for a Temporary Conservatorship AKA T-Con. They will also set the date for the LPS Conservatorship court hearing. The person will be held in the hospital under the Temporary Conservatorship, AKA T-Con, until the LPS court hearing. The T-Con can hold the person in the hospital up to 30 days.
The treating psychiatrist initiates the LPS Conservatorship request with the public guardian’s office.
The public guardian will visit and evaluate the patient and make a recommendation to the court to either proceed or dismiss the LPS Conservatorship case.
It is important to contact the public guardian’s office and submit the written case of the history and symptoms. Also, be sure to give a copy of these papers to the treating psychiatrist as soon as the person is taken to the hospital. If you don’t know what hospital the person will be transported to, then you might give those papers to the crisis intervention team to deliver them to the hospital. You can contact DMH Family Advocate or Patient Advocate to locate your loved one if you do not know where they were transported. The transport is a civil matter, so the police can inform you where they are transporting the patient. Once they cross the hospital threshold, then HIPAA laws take place.
An estate conservatorship is initiated through the public guardian’s office and not through the psychiatrist. The family member may discuss the estate issues with the public guardian investigator. Or, the family conservator may request, if needed, the Estate LPS Conservatorship even after they are appointed as conservator of the person.
If the person is in jail, then the treating doctor can initiate the LPS Conservatorship.
17. What is a Riese hearing?
This hearing is held at the hospital, often because the patient is becoming violent or agitated, and needs medication, but is unwilling to voluntarily to take medications. It is a capacity hearing that is held to require the patient to take medication to calm him/her.
18. Who can initiate a 5150 hold?
- Certain trained designated officials may initiate the 72-hour hold/section 5150.
- Police officer
- Approved mental health professional
- Approved psychiatrist
Transportation to the hospital must be arranged by one of the above. In some counties if beds are not available, then the Crisis Intervention Teams may not respond because they have no place to put the person. Therefore, it is usually wise to contact the police first and have them contact the crisis teams. The police have access to the beds. Otherwise, if a bed is not available, then the crisis team will not be able to process the transportation and will have to release the person.
Police are usually contacted for “harm to self or others” while the psychiatric evaluation teams are requested, if the person is gravely disabled.
19. How do I get hospitalization for my loved one?
There are many ways to get hospitalization. Often, a person is willing to go to the hospital because they know something is not right. If they are not willing to go and they are harmful to themselves or others, you should contact the police and explain the situation. It is important to let the police know why you think the person is a possible harm to themselves or others. Just because a person is psychotic does not, by law, allow for a 5150 hold.
If your loved one has private insurance or Medi-Cal or Medicare, then the police can transport your loved one to a hospital and it is covered by the insurance. Otherwise, a county hospital is where they will usually transport them. County hospitals employ good psychiatrists and offer good treatment.
20. Does my loved one need Medi-Cal or insurance to get hospitalization?
No. But if you do not have insurance, the psychiatrist will tend to stabilize and put your loved one back on the streets. It is wise if you ask social security to help you fill the forms to apply for SSI and Medi-Cal, so you can give these forms to the social worker at the hospital to get your loved one to sign them. Without resources, the hospital will not be reimbursed. The doctor appreciates your initiate.
21. Does my loved one need SSI or Social Security to get hospitalized?
No. But we suggest that you go immediately to the social security office and ask them to help you fill the papers for SSI for your loved one. Let them know your loved one is in the hospital and the social worker will get them to sign the forms. This establishes an application date. When SSI is granted, the payments will be retroactive to the date in which you submitted the initial application. It is also important to request to be the “representative payee.” The doctor can complete a form to be given to the social security office, stating that the patient is not capable of managing their money. When he/she is hospitalized, this is the best time to notify the social security office and inform them your loved one is in the hospital.
Social security must have a doctor evaluate your loved one for approval for SSI. When they are in the hospital, this is the best time to have them evaluated. If the patient is turned down for SSI, you need to appeal the decision within the 60-day time period. If social security has a copy of your written case for treatment, it is rare to have to appeal their decision. The case most likely will be approved.
When you are approved for SSI, then usually MediCal is approved simultaneously. You can receive Medi-Cal without SSI. Therefore, also apply for Medi-Cal, if SSI is refused.
22. All these officials! Who are they and what are their roles?
Office of the County Counsel: they represent Los Angeles County in all legal proceedings, including Public Guardian in establishing conservatorship;
Attorney: the mental health court utilizes a panel of private attorneys and draws from this panel to assign the conservator an attorney when needed. This attorney may be paid for by the court. A conservator may also choose to retain their own attorney.
Public Defenders: they represents person to be conserved and not the family
Public Guardian: they investigate LPS Conservatorship referrals and makes recommendations to the court
District attorney: they represent the hospitals with involuntary treatment; also can be more involved in criminal matters
Court: The court ensures fairness and compliance with the laws in all proceedings involving involuntary treatment and conservatorships
23. What are the powers and responsibilities of the conservatorship?
Generally these authorities are granted by the court, but occasionally some are not granted by the judge to the conservator.
To place the conservatee in a private residence, licensed psychiatric or non-psychiatric residential care facility, board and care, nursing or other State licensed facility where the conservatee has free access into or out of the premises
To place the conservatee in a portion of a private acute care psychiatric hospital, State or County hospital operated by the Regents of the University of California or by the United States Government, where the conservatee has free access into or out of the hospital.
To place the conservatee in a licensed medical acute psychiatric hospital or psychiatric nursing facility (Institute for Mental Disease AKA IMD) or other State or County licensed facility, where the conservatee does not have free access into or out of the premises. Pending further order of the Court, this power shall terminate within one year.
To require the conservatee to have treatment related specifically to remedying or preventing the recurrence of his her being gravely disabled.
To require the conservatee to accept psychotropic medications.
24. What limitations are suspended for the Conservatee? These limitations can be re-instated with the courts approval.
The privilege of possessing a license to operate a motor vehicle is suspended. This power can be returned with the court’s approval while under an LPS Conservatorship. The conservator can ask the psychiatrist to petition the court to allow the person to drive. It is up to the court to grant permission for driving and it is the DMV that evaluates and issues the license. Don’t ask for this during the LPS hearing.
The privilege of possessing, controlling or maintaining custody of a firearm or any other deadly weapon is suspended.
The right to refuse or consent to psychiatric treatment related specifically to the conservatee’s being gravely disabled. In other words, they must take the medications when the conservator consents and approves of the medications.
The right to enter into any contract, in which the consideration for performance is money or property, is suspended. This power can be returned to the conservatee with the court’s approval.
The right to refuse or accept medical treatment is suspended. The court must approve the medical treatment for the conservatee.
25. What do I do if the conservatee refuses to take their medication or leaves a treatment facility?
The court has taken away the right of the conservatee to refuse medication. The CA Welfare and Institutions Code 5358.5 states that the conservator has the right to request a peace officer transport the conservatee to a treatment facility when the conservator deems necessary. Speak with the Watch Commander at the police station. Politely give them a copy of the law, copy of your conservatorship and a written statement requesting police transport. Do not wait for your love one to decompensate to harm to self or others. Do this also if the person leaves their treatment facility.
26. Why should I keep a journal?
It is important to keep a journal to document hospitalizations, medications, behaviors and symptoms and their side effects. Your journal will help to cover the doctor’s blind spot. It will assist the doctor and treatment teams to better evaluate and assess the treatment for diagnosis and recovery.
What to do when a family member is incarcerated
When a treating doctor refuses to speak with you and the person is under LPS Conservatorship