In the Know: The “gravely disabled”
Keshav Tadimeti: From the Daily Bruin, I’m Keshav Tadimeti, and this is “In the Know.”
This time on the podcast, we revisit a moving story from fall quarter: a piece about Westwood’s homeless population – specifically those who need medical help but don’t want it.
Fall quarter is over and winter break is in full swing. Mariah Carey is blasting from every shopping center. Talk of Christmas deals and warm, sugary drinks fill the air. Winter break is when a lot of students can decompress and escape Westwood’s grueling quarter system.
For some, though, staying in Westwood isn’t an option; leaving it isn’t it either.
In 2017, Westwood was home to nearly 40 homeless individuals. The year before, Westwood officials counted 33 homeless individuals. These residents often take shelter on streets such as Broxton Avenue and Westwood Boulevard, bundling up to fight the cold. Hundreds of others in Los Angeles will be doing the same this holiday season in other parts of the city because officials have struggled to address the many causes and effects of homelessness.
Today, though, we take a look at a subset of that population – a subset California labels as “the gravely disabled.” To do that, I talked to someone who reported on this topic for the better part of fall quarter.
Teddy Rosenbluth: Hi, I am Teddy Rosenbluth, and I am the Daily Bruin’s science and health editor.
KT: Usually I start off the podcast with a couple of warm-up questions, and then we go into the meaty subject matter. For this podcast, though, everything seems really meaty, so I want to start off with the title of the podcast: “the gravely disabled.” What does that phrase mean and where does it come from?
TR: So “gravely disabled” is a term that officials have to prove in order to institutionalize someone. So, basically, in legal terms, this means that someone can’t provide food, water or shelter for themselves because of a mental illness. And this was part of the (Lanterman-Petris-Short Act), which was passed in 1967, which was kind of a reaction to mass institutionalization in California – a way to kind of hold people accountable and have more of a process for institutionalizing people.
KT: With that said, I want to jump into the center of this podcast, which is talking about the reporting that you’ve been doing. Usually “In the Know” podcasts are about something in the news, something relevant to the news cycle. But this time we’re doing something special: We’re pegging this to the Daily Bruin’s quarterly magazine, called PRIME. The story you’ve written for this quarter’s PRIME magazine is about a subset of the population that is homeless, has a mental illness and has a medical condition. And you’ve been reporting on this since the beginning of the quarter, so I want to start off with: How did you find this story?
TR: Initially, I thought this story was going to be very different from what it ended up being. I thought that the biggest issue in Westwood – the Westwood homeless population – would be that there were not enough resources – that’s what a lot of people think is the major problem. Basically, if you have enough beds and if you have enough medical resources, there wouldn’t be an issue. But in my reporting, I actually found that, at least in Westwood, there are lots of resources. The issue is getting people to accept these resources because of mental illnesses.
So, I would walk around with Donovan Wilkes, the outreach specialist for Westwood who was hired about a year ago. He walks around at 5:30 in the morning, checking on the regulars. He would point out, “Oh, you know, he has a tumor in the back of his head,” “She can’t stand without stabilizing herself,” and he would say, “I keep trying to get them resources, but every time they decline.” He has all these resources; the real issue is getting people to accept them. And, he has said he’s called people to come out and talk to them, say, “Would you want to come get housing?” and every time they say, “No, thank you, I’m fine.”
KT: So what you’re saying is that you’ve sort of been following Westwood’s outreach specialist, who’s in charge of helping the homeless population in Westwood Village and in the neighborhood. And when he goes around trying to help individuals, they decline his help.
TR: Yes, that’s correct.
KT: Could you sort of walk us through some of the instances that you saw? How were the interactions between the people Wilkes spoke to and the homeless individuals who, at least from what Wilkes seems to be saying, clearly needed help but didn’t want it?
TR: I think the best example of this is Miss Mary. Miss Mary has been on the streets of Westwood for as long as anyone can remember. I think she’s been there the longest out of any the homeless individuals there. She’s an elderly woman, and she has pretty serious medical issues as well. Her legs are extremely swollen. She can’t walk without stabilizing herself with a shopping cart. She’s developed some skin issues. He’s tried every morning: He says, “Miss Mary, do you want some help, do you want some resources?” She’s not rude, but she’s very clear in saying no thank you. And although she’s not formally diagnosed, a lot of people think she has paranoid schizophrenia. She talks a lot about the government preventing her from going to her house, and so on and so forth.
There was one instance in which she wasn’t responsive when people tried to wake her in the morning, and (Wilkes) got this call. He automatically went to, “Oh my god, she’s dead.” This is something he constantly worries about all the time, he told me. He ran down there, and she was awake but she couldn’t really walk. Her legs were so incredibly swollen she couldn’t stand up without leaning on (Wilkes). He called the ambulance, and he was thinking the whole time, “Please accept help. Please accept help.”
The paramedics arrive. They said, “Do you want help?”
She said, “No, thank you, I’m fine.”
“How are you going to walk?”
So she’s still out there. When I talk to her, she always says, “I got to get off the streets. I have got to get home.” People steal her blankets; it’s not fun, but because of her mental illness, she really can’t get these resources.
KT: How many individuals like Miss Mary would you fathom that there are in Westwood at least?
TR: The ones that I’ve seen, probably five or six. I’m sure there are more like this – these are just, in the limited time I’ve had to go out into Westwood, those are the cases I’ve seen.
KT: There are other outreach specialists in other parts of the city. How effective have they been in getting people like Miss Mary get the medical care that they at least appear to need?
TR: I’ve talked to not just outreach specialists like (Wilkes), but also medical professionals. I talked to one woman who said she can predict when people are going to die, whether it be in the next week or next six months – and there’s literally nothing she can do about it because these people won’t accept the help. And this is where you kind of get into the debate about should we help people against their will, which is uncomfortable, but the debate that a lot of people are struggling with.
KT: What’s sort of been the stance that the city, or at least the state government, has taken in this debate?
TR: The Los Angeles Supervisors agreed to encourage California – because this is a state law – to make an amendment to the Lanterman-Petris Act to expand the definition of “gravely disabled” to include the people who can’t get medical attention. The bill went through the State Assembly with very little opposition, but it ended up stopping in the State Senate before it was even presented because of some practicality issues. I think right now, in terms of the morality of the bill, many people are in favor of it. The largest issue is practical concerns, but I think in lower levels – not government – people are concerned that this will start to infringe on people’s basic right to deny care, which is really dangerous considering California’s history of institutionalizing people who didn’t need to be institutionalized.
KT: You mentioned something about practicality concerns. Could you touch a bit more on that?
TR: Yeah, so basically expanding the definition of “gravely disabled” would allow officials to institutionalize many more people. The issue is: Where are these people going to go? There’s already pressure on the mental health system. People already have to go from mental health care facilities to these waiting grounds in ER facilities, which are not ideal places for people with mental illness to wait for treatment. The concern is that without providing more resources to the mental health care system in California, this would just flood the system with people without having anywhere to put them.
KT: As I understand it, you also spoke to state officials. What is the sense you got from speaking to them about their stance on this bill or just the general debate surrounding involuntarily institutionalizing someone into a hospital or medical facility?
TR: I think this debate kind of gets at two fundamental rights that many Americans believe in – I think it’s the right to deny care and the right to live. Historically, I think a lot of officials have seen this bill as a pendulum swinging between these two rights. Before the Lanterman-Petris Act, I think many people thought it swung way too far to the right to live, and in the process completely absolved everyone of choice. But now, I think, many people are worried that it’s swinging too far in the other direction and we’re allowing people to die in the streets when there could have easily been medical intervention that could have saved their lives.
I think the hope for all of the people who are in favor of expanding this bill, the hope is that they want people after they get help to say, “Wow, thank you. I really wanted that, and I wish someone had done that maybe even sooner.” The danger is that you don’t know that people would want that, and so you’re kind of making this assumption that people would want care when you’re not entirely sure.
KT: So what’s been the tactic that outreach specialists have used to, I guess, basically do their jobs if homeless individuals don’t want their help or don’t want the services the city is offering to them?
TR: I think, unfortunately, it’s devolved into begging almost. I know Dr. Susan Partovi, a family medicine doctor who works at UCLA who has also worked on the streets, helping homeless individuals for almost 15 years, would say she offer people cigarettes. She would say, “Please, I will buy you this, I will buy you food. Will you please get medical help?” I know in the case of Miss Mary, (Wilkes) has tried everything. He’s really worried about her just on a human level. He really cares about her. And, it’s really hard to watch someone that you see every day, their health just deteriorate, and there’s literally nothing you can do to stop it.
I think more than anything, for these outreach specialists, it’s an internal debate. I know (Wilkes) struggles a lot with this question because it’s his job to make sure these people are safe, but he also is very aware of people’s rights and he doesn’t want to say, “Oh, just because this person has a mental illness, they can’t choose these things for themselves.” I don’t think it’s the homeless individuals who are saying, “You can’t take away my right to choose – my right to deny care.” Pretty much, it’s an internal conflict, and he’s very hesitant to call the department of mental health to have someone institutionalized, although I know in Miss Mary’s case he has done that.
KT: In your piece, you talk about an interaction you had with Miss Mary. Can you walk us through it? How as the experience? What was it like? What did she have you do? How was the conversation?
TR: Miss Mary is a really nice lady. I’ve kept in contact with her even after I’ve finished reporting for the story. She’s from the East Coast. She said she was in banking, details are a little fuzzy there. She’s not what you would think of as “crazy.” She’s really a kind person. I’d go down there, I would go get her coffee because she has trouble crossing the street – takes her a long time. We would chat for a bit. Over time, she kind of started to expect me and Amy, our photographer, to be there.
I ran into her in front of CVS – that’s where she panhandles in the day. I was picking up a prescription, and I was like, “Hi, Miss Mary, what have you been up to?” And she was like “Oh, just looking for you guys.” She’s really a nice woman, which makes it so much harder to see this happen to her. It’s been getting worse. I think everyone, including the other homeless individuals in Westwood, are really worried about her. They try to give her blankets, there are other homeless individuals, they give her anything extra they have. She says, “No, thank you, I’m fine.” She’ll give it to someone else. It’s really hard, especially knowing her on a personal level. I can see why (Wilkes) has this internal conflict.
KT: You did something that a lot of students usually wouldn’t do: You interacted with people who are homeless who either stay the night in Westwood or stay the day in Westwood, interacting with members of the community. What are some of the misconceptions that people in Westwood have, or even students in Westwood have about the homeless population here – or even just like the debate regarding this debate about involuntary hospitalization and providing medical care to those who need it?
TR: I think a lot of misconceptions, in terms of this debate, is that it’s very easy to say we should protect these people’s freedom of choice, that’s a fundamental right – that sort of thing. It’s a lot harder to interact with many of these individuals on an individual level, get to know them, have to watch their health deteriorate. And I know this is a criticism a lot of people I talk to have of the people who are against this bill. They say, “Well, they don’t really have a first-person perspective; they don’t know how it really is,” and I think that’s true. I don’t think that negates their argument, but it’s a lot easier said than done.
KT: We started off the podcast looking at the title, “the gravely disabled.” Did you see anybody who was “gravely disabled” in your reporting?
TR: So, a question I’ve thought about a lot, and I know (Wilkes) has too, is if Miss Mary would be one of those people that, after being institutionalized, would come back and say, “Thank you so much. I didn’t like living on the street.” That sort of thing. I don’t really know the answer to that, but I do think Miss Mary does want to live. I don’t think she wants to die on the street. This is kind of what (Wilkes) has told me: She still panhandles. She still gets up in the morning. She doesn’t just sit there. That makes me think that she still wants to live, and I would hope she would want to get better. But, it’s impossible to know.
KT: Clearly there’s a catch-22 here. On one hand, mental illnesses directly contribute to people who are homeless and their chances of potentially dying, and the state – not to mention the public – is sort of worried about this. But, on the other hand, though, some of these individuals refuse care, and policymakers don’t want to infringe on their individual rights. Is there a resolution to this dichotomy?
TR: I don’t really have a great answer to this question. I think this is the question that everyone is struggling with. I know a lot of people think this bill will be reintroduced later this year. And it’s hard to balance these two rights that are kind of fundamental to being an American, you know? I don’t know, I kind of like the analogy of a pendulum: It kind of just swings back and forth because there are kind of two identical forces pulling on it, and I think that will leave it in constant motion.
KT: Thank you, Teddy.
TR: You’re welcome, Keshav.
KT: That’s it for this week’s “In the Know” podcast. We’ll be back winter quarter with a new set of podcasts and a new set of topics. Got any ideas in the meantime for what we should talk about for a future show? Let us know at [email protected]
From the Daily Bruin, I’m Keshav Tadimeti, and this is “In the Know.”