Alex Vosick Barnard

Takes a closer look at policy and practice in California–where politicians are seeking to expand the use of conservatorship while disability rights groups fight against them–to reveal how, in practice, conservatorships frequently fail to provide either needed treatment or the control that families and the public are demanding, instead subjecting individuals to repeated, ineffectual, and traumatic coercion.

Provides context to recent legislative history in California, which has seen multiple proposals to expand the use of involuntary mental health treatment to address a perceived crisis of homelessness. Shows how three key pieces of legislation reflect the distinctive kinds of homelessness–people who are perceived as "dying on the street," causing public disruption, or turning down useful services–that policymakers in Los Angeles, San Francisco, and San Diego see as the most problematic.

Examines the functioning—and failings—of California’s conservatorship system. Argues that California’s state government has abdicated authority over this system, leaving the question of who receives compassionate care and who faces coercion dependent on the financial incentives of for-profit facilities, the constraints of underresourced clinicians, and the desperate struggles of families to obtain treatment for their loved ones.

Examines media coverage of California's Lanterman-Petris-Short (LPS) Act in an effort to understand how the framing of challenges posed by people with severe mental illness to the social order has evolved over time. Highlights a shift in media framing from emphasizing the fear of violence to a new focus on mentally ill individuals "dying in the streets" and the need for re-institutionalization to save them.

Draws on an analysis of the French mental health system to challenge four common assumptions in U.S. mental health care: that deinstitutionalization requires eliminating hospitals, that public and private funding are interchangeable, that involuntary commitment should be based on "dangerousness," and that care must constantly expand.

A 2005 reform to France's disability system sought to provide new services and supports to help people living with severe mental illness live independently in the community. Based on months of observations and interviews in a French disability office, the paper shows how the decision-making tools and heuristics used by disability bureaucrats nonetheless excluded this population from many of the benefits to which it was entitled.