LRO (Least Restrictive Care) options are available for any state which has something like the Baker’s Act, Kendra Act, Joel’s Law Petition, ect available. What it means is that you collect all information which shows a person is “grossly incompetent” or “disabled” meaning usually that they are unable to care for physical and daily health and wellness needs without assistance. Once this evidence is gathered, you submit it to the local court, where a judge will review the petition and see if service intervention with a 72-109 hour hold. WA state with Joel’s Law actually has one of the best policies in this regard. It guarantees 5 days for a mental health assessment instead of the usual 3 and will try and connect other’s to mental health and outpatient housing options, although like everything in the space the waiting list is massive. In other words, getting on the list sooner rather than later is the best available course of action.
This is called among the MH circles, the “Most Restrictive Care Option”. In a court hearing, it means that a patient is stripped of all of their rights to refuse care BUT the state by obligation MUST provide and attempt all other available avenues of treatment and continuing support services.
The “Least Restrictive Care Option” is an order, also granted by the court, which allows the COURT and local health officials to intervene as soon as a patient either A) Does not improve on their current round of Tx. Especially if they are in danger to themselves or others. or B) Does not continue with scheduled appointments and talking to the local health officials. While they cannot force them to take meds, somewhat ironically, if they don’t take meds OR follow up with therapy and timely personal checks from the Social Services (they genuinely do their best to get people situated with jobs, housing, or other Disability Aide and help/healthcare/money, options) then, they go back to Involuntary commitment. An LRO is usually what is put into place after an Involuntary Commitment Order, in order to get follow up care to these patients. The care team for your brother, as it sounds as though he was put in without your consent but via the assessment of the MH team, actually means they may be able to help file a court petition, so long as you outline how often he hasn’t been compliant with Tx.
The doctor wanting to retry Invega (if he has already had it before with little success) may actually warrant more follow up services coming to home or making sure that he attends Appt. With these meds, my brother is not yet able to drive but MAY (key word may) be able to get into a community car pool. This is faster than Community Transit, and allows him to have more weekly freedom when it comes to shopping. Disability Transit is good, but they have a problem with others either disallowing large items or on regular busses, things being stolen or scammed off of the mentally ill. (Someone literally offered my brother $40 for a brand new touch screen phone. It wasn’t the best model out their but the person in question wanted to hock it for drugs.)
This is a last resort after the patient has made repeated failures to show up for or attend treatment. It doesn’t mean they go to jail, but very often they are forced to talk to mental health professionals, and through them, get a different variety of treatment which may help their case better than their current medication regimen. What it means, is that for the most part, the entire apparatus makes it impossible for the Mentally Ill to be missed out by the legal, medical, and social care system. Given the number of people who have anosognosia or have never been fully Dx for Tx and medication because of their families shame/legal inability to intervene in an adults MI, it is a life saving law. Contrary to many of the naysayers, most patients resolve with either Tx or more support services (regardless of medication status) and allows them to have a degree of independence and community integration that otherwise would not have been possible under strictly voluntary and criminal or interpersonal violence and detention prevention measures. These have been the status quo since the 1960’s and their continued failure is why most states are trying this approach now.
Anecdotally although it doesn’t hold up to an objective assay, my brother has for the first time, been stable. He interacts with his care team, even IF he regularly throws abuse my way. He cannot and does not have the ability to harass us via his delusional thinking. Contrary to popular belief, the MH care police and Social Services unit has been nothing but kind and helpful to him, making follow up calls and counseling appointments to his permanent housing. He has a stipend for monies that takes what he needs out of his rent and has a health care aide that helps with things he can’t manage on his own. (Cooking anything outside of microwave, or dealing with his septic wounds. Gross, but absolutely a complication of his lack of hygiene due to MI and periods of homelessness.) He went to the dentist for the first time in YEARS. While he needs tons of work done, it means that he can eat more than mushed rice and soggy vegetables. He has put on 30 pounds of much needed weight.
NAMI has a list of resources on states which have involuntary commitment petitions, as a warning, most states are not so integrated with the legal precedence that it takes to get one of these petitions passed. We were denied with our version of the petition 3 separate times before my brother was FINALLY forced into hospital care for stabilization. He hasn’t been rotting in a jail cell without help as he has done in the past. He has a place to stay away from my parents but with enough supervision, that we as a family, have some peace of mind that should anything happen to us, something will be there to help him. With the lives we’ve lived, I’m never one to assume someone ends up homeless just because they’re mentally Ill or Lazy or worth less for picking jobs that don’t pay (or more realistically) haven’t paid a market rate, with a market share for housing, that is accessible to EVERYONE.
I know I will get labeled as a “Damn Communist” for one, but working with the MI and homeless for as long as I have, no one, no one really sees what it means to be homeless. Every movement that proports to “save the homeless and the youngest generation” has been a lie. Instead of insuring legislation works to afford multi-unit AND valuable stick built housing units (thereby also improving land usage rates and local wildland preservation) nothing has been done. bureaucratic toe stepping, and a quagmire of inaction has ruined whole sections of Seattle, San Francisco, and Denver. Taking action would mean that instead of waiting for people to cycle on the poverty breadline where they cannot care for their homes, they learn skills, have health and safety nets that mean they cannot or will not be in such a horrible place, when it comes time to work or retire or live. In a partnership with local land regulation, people could have solved the problem of homelessness, by doing what most of Europe has already done, make minimum land provisions that allow people to have affordable housing be built without exemption, into the land use code. If there isn’t some proportion of the population being guaranteed quality housing, regardless of economic status, it isn’t going to be built.
Letting go of the idea of “Not in my back yard” and actually providing land and healthcare and job opportunities that actually builds up viable cities will save people in the long run. The average lifespan of a homeless member of the population is 45. This is a life expectancy roughly equivalent to a pauper working dog-hours in Bangladesh or a blue collar tradesman, 100 YEARS AGO. This is unacceptable. It effects me. Has impacted my parents, and has meant that my early twenties was largely spent taking care of my brother instead of laying in my career roots, all because of a lack in social safety nets. This needs to change. There is no such thing, in my mind, as a “Pull yourself up by your bootstraps” mentality. Yes, you have to motivated to work, but almost everything is driven by convergent forces of opportunity and misfortune that we cannot control. Housing, healthcare, and education/retraining provision means that NO ONE has to face a reality where they die, of dehydration, of hunger, of poverty, of illegal drug overdoses, if only people were willing to look out for one another.
Ugh. Sorry. If you couldn’t tell, I have a passion for cutting through the B.S. Instead of telling me when the buck has stopped, tell me, the housing went through, that contractors and city officials actually got out of their padded offices and took care of someone. That they watched people seize from a Benzedrine Overdose on the street. That they bandaged gangrenous feet of a junkie and MH patient that couldn’t be housed because of insufficient patient care and follow up with medication and housing. The political jerrymandering has to stop some time, and the time is now.