Willingness to Accept Treatment Voluntarily is a Consideration in Grave Disability, Not an Exemption
In Conservatorship of K.P., 489 P.3d 296 (Cal. 2021), the California Supreme Court reviewed a split of authority on the appropriate role that a proposed conservatee’s acceptance of voluntary treatment plays in a conservatorship trial. Specifically, the court considered whether willingness to voluntarily accept treatment is a relevant factor for the trier of fact to consider on the issue of grave disability, or if it is a separate element that must be proven. In this case, K.P. appealed the reappointment of a conservatorship challenging the trial court’s refusal to modify jury instructions to require, as a separate element, a finding of his unwillingness or inability to accept meaningful treatment. The California Supreme Court ruled that willingness to accept treatment is relevant but not a separate consideration in determining grave disability.
Facts of the Case
Beginning in May 2008, the Los Angeles County Superior Court first granted conservatorship for then 23-year-old K.P. under California’s Lanterman-Petris-Short Act (LPS Act; Cal. Welf. & Inst. Code, § 5000 et seq. (1967)). (All statutory references are to the Welfare and Institutions Code). Under § 5350, the LPS Act allows for a one-year appointment of conservatorship for an individual who is “gravely disabled as a result of a mental health disorder or impairment by chronic alcoholism.” According to 5350(d)(1), the individual in question is also entitled to either a court or jury trial to determine grave disability. Over the following nine years, the court continuously granted annual renewals of the conservatorship. In April 2018, the Los Angeles County public guardian again filed a renewal petition for conservatorship, and K.P. requested a jury trial.
During the trial, a psychologist who treated K.P. at his residential facility testified that K.P. has schizophrenia, providing examples of his symptoms, and argued that he lacked “significant insight” into his mental condition and that he required continuous supervision to maintain consistent treatment. K.P.’s mother also testified, and while she affirmed that she would help him to continue his treatment, she could not provide housing for him. During K.P.’s testimony, he agreed to see a psychiatrist and a therapist upon release from the facility, and agreed to remain at the facility until he could find housing. But, he denied having a mental illness and testified that he believed that he was better off without psychiatric medications and planned to stop taking his medications if released from conservatorship. He also provided a plan to supplement Social Security funds with moneys from becoming an entrepreneur.
The court provided two instructions to the jury from the Judicial Council of California Civil Jury Instructions (CACI). The first instruction for the jury, CACI No. 4000, involved determining whether, beyond a reasonable doubt, K.P. has a mental disorder and if he is gravely disabled as a result of the mental disorder. Pursuant to CACI No. 4002, when “determining whether [K.P.] is presently gravely disabled, you may consider whether he is unable or unwilling voluntarily to accept meaningful treatment” (Conservatorship of K.P., p 299).
K.P. requested that CACI No. 4000 be modified to reflect that a separate element be introduced, requiring a finding that he was “unwilling or unable” to accept treatment voluntarily. Additionally, he made an argument to the court that the final sentence of CACI No. 4002 was inadequate due to it being “thrown in at the bottom of [a] less consequential later jury instruction” (Conservatorship of K.P., p 301). The jury found K.P. to be gravely disabled, and the conservatorship reappointment petition was granted. K.P. appealed, challenging the court’s refusal to modify CACI No. 4000. The Court of Appeals concluded that no error was present. The case was further appealed to the California Supreme Court.
Ruling and Reasoning
The California Supreme Court agreed with the appellate court’s conclusion after review, thus ending the challenge to the conservatorship. The court interpreted K.P.’s complaint regarding jury instructions to be, in essence, a claim that “unwillingness or inability to accept voluntary treatment is required for a conservatorship to be established” (Conservatorship of K.P., p 302). In the court’s statutory analysis, the court noted that chapter 3 of the LPS Act (§ 5350 et seq.) requires that willingness or ability to accept voluntary treatment must be considered when a conservatorship proceeding is initiated for a person who is an inpatient but not for an outpatient or reappointment. The court also noted that section 5350 does not include any requirement that the proposed conservatee’s willingness to accept voluntary treatment be decided as a separate consideration during the trial. The court added that no such requirement is present within the statutory definition of grave disability. In addition, the court referenced a 1989 amendment to section 5350 that grave disability is not met when a potential conservatee may obtain assistance from another party to meet basic needs, but that it did not add any requirement pertaining to the amenability to receive treatment voluntarily. But, the court added that a conclusion may be drawn by the trier of fact that a potential conservatee may not be gravely disabled if sufficient evidence exists that the person’s willingness and ability to accept voluntary treatment would result in meeting basic survival needs. Relying on multiple prior cases, the only question to consider in a conservatorship trial is whether a mental illness renders the proposed conservatee gravely disabled.
The California Supreme Court then considered K.P.’s interpretation of prior cases, Conservatorship of Davis, 177 Cal. Rptr. 369 (Cal. Ct. App. 1981) and Conservatorship of Walker, 242 Cal. Rptr. 289 (Cal. Ct. App. 1987). K.P. argued that both Davis and Walker included instructions to jurors that a separate finding of the proposed conservatee’s unwillingness or inability to accept treatment is required in order for the trier of fact to find the individual gravely disabled. The court, based on prior case rulings and later enacted amendments to the LPS Act, disapproved the applicability of both Davis and Walker because they strayed too far from the statutory framework.
K.P. also asserted that federal and state due process principles require that a state must prove beyond a reasonable doubt that a conservatee is unable or unwilling to accept voluntary treatment. K.P. argued that “limiting the jury’s consideration to the sole issue of grave disability as defined by the statute would seriously infringe on the conservatee’s due process rights” (Conservatorship of K.P., p 308). Although the court acknowledged the significant liberty interests at stake and agreed that the fact finder must be allowed to consider all credible evidence relating to the topic of grave disability, including the proposed conservatee’s amenability to voluntary treatment, the court did not agree that the state or federal constitutions require a separate finding on the proposed conservatee’s willingness to accept voluntary treatment. The court determined that K.P.’s argument took too narrow a view of the meaning of grave disability in a conservatorship trial, and noted that K.P. did not explain why a proposed conservatee’s constitutional rights are not protected by the fact finder’s consideration of amenability to voluntary treatment. Thus, the California Supreme Court ruled that the CACI instructions given during the trial were appropriate, the jury’s finding of grave disability was sufficient for conservatorship to be reappointed, and that willingness to accept voluntary treatment was properly considered during the trial.
Discussion
The ruling by the California Supreme Court provides further guidance as to what constitutes grave disability due to a mental illness, and under what grounds an individual is suitable for LPS conservatorship. In essence, the ruling further expands suitability for LPS conservatorship for those with mental illness, thereby increasing the population that would meet the criteria to be under conservatorship. The court justified its rejection of making the criteria stricter by acknowledging and deferring to the legislature’s attempts to provide more access to care for those deemed gravely disabled: The Walker and Davis cases “upset the carefully calibrated statutory approach through which the Legislature has endeavored to protect both the mentally ill and the public, and to ensure that those in need can receive prompt, appropriate treatment tailored to their individual condition and circumstances” (Conservatorship of K.P., p 307). In a state caring for a large number of individuals with severe mental illness, the court is supporting the state’s efforts to better care for its constituents. This is particularly pertinent as more persons with mental illness are increasingly released into the community because of diversion programs, and jail and prison reform.
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