- Category: Crisis Response, Involuntary Commitment Barriers, Jail Instead of Hospital, No Bed, No Placement, Refusal Treated as Capacity
- Tag(s): Anosognosia / Lack of Insight, Homelessness, Incarceration, Severe Deterioration, Violence or Threat Toward Others
- Location(s): CA, San Diego
My 64-year-old cousin, Ed, has lived with diagnosed schizophrenia for nearly 40 years — a serious genetic illness that has also affected other members of our family. He also has a diagnosed but currently untreated seizure disorder that has resulted in grand mal seizures.
He is severely delusional, unable to care for himself, and at times poses a danger to others. For more than two decades, he has been chronically homeless and has cycled repeatedly through the criminal justice system due to violent acts committed while in a psychotic state.
In 2022, he was additionally diagnosed with Antisocial Personality Disorder, defined as a long-term pattern of manipulating, exploiting, or violating the rights of others without remorse. He has been incarcerated three times for violent assaults on strangers with intent to cause serious bodily harm. He experiences command hallucinations instructing him to kill his mother. In 2025 alone, he violated a restraining order protecting her 21 times. We have installed four security cameras on her 700 square foot home to monitor her safety.
The system’s response has been repeated incarceration.
Our family has pursued every available avenue to secure appropriate treatment and long-term care, only to encounter systemic barriers erected in the name of protecting his rights. He also suffers from anosognosia — a neurological condition that prevents him from recognizing his own illness — leading him to refuse the very treatment he desperately needs.
There comes a point when protecting an individual’s autonomy without acknowledging their incapacity ceases to be compassionate. Individuals with severe mental illness deserve a system that can recognize when they are no longer able to make safe decisions for themselves and intervene accordingly. Thoughtful, structured intervention is not a violation of dignity — it is often the only path to preserving it.
*Each story is shared by someone impacted by untreated SMI, lightly edited for clarity, never for meaning.
THE ASK
The author’s message for legislators:
1. Strengthen and Fully Fund CARE Court Implementation
California’s **CARE Court (Community Assistance, Recovery, and Empowerment Act)** was designed to intervene earlier for people with untreated schizophrenia and other psychotic disorders.
* Is CARE Court fully funded in our county?
* How are outcomes being tracked?
* What happens when someone repeatedly refuses treatment but clearly lacks capacity?
The law must move beyond paperwork and actually result in treatment, housing, and medical supervision — not just another court appearance.
2. Expand and Enforce Assisted Outpatient Treatment (Laura’s Law)
Under **Laura’s Law (Assisted Outpatient Treatment)**, counties *can* mandate outpatient treatment — but implementation varies widely.
* Why is it not uniformly and aggressively implemented in every county?
* What barriers prevent families from initiating AOT petitions?
* Can the state standardize and streamline access?
Families should not have to navigate a maze while their loved one deteriorates.
3. Reform LPS Conservatorship for Severe Mental Illness
The **Lanterman-Petris-Short (LPS) Act** was written to prevent abuse — but in practice, it often prevents intervention until after violence occurs. I am asking for:
* A clearer standard for incapacity when anosognosia is present
* The ability to intervene before repeated criminal conduct
* Faster pathways to conservatorship when someone demonstrates chronic psychosis and danger
Civil liberties matter — but so does the right to safety and treatment.
4. Create Secure Long-Term Treatment Facilities
California has dramatically reduced state hospital beds without replacing them with appropriate long-term psychiatric care.
* Where are individuals with chronic, violent psychosis supposed to go besides jail?
* Why are prisons functioning as de facto mental hospitals?
* What is the plan to build secure, therapeutic long-term facilities?
Incarceration is not treatment.
5. Address Anosognosia in Policy
Many individuals with severe psychotic disorders lack insight into their illness. Refusal of treatment in these cases is often neurological, not willful.
I would ask lawmakers to:
* Incorporate medical insight into capacity standards
* Allow treatment decisions that prioritize safety and stabilization
* Recognize that autonomy without capacity is abandonment
I am not asking you to take away rights. I am asking you to protect dignity, safety, and the right to effective treatment. When someone is chronically psychotic, repeatedly violent, homeless, and refusing care because their illness prevents insight, our current system is not compassionate — it is negligent.
What will you do to fix that?
share this story:
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3 Responses
I am a daughter, sister, mother, and aunt — and the mother of someone living with a major mental illness: bipolar disorder and schizophrenia.
I have also been a psychiatrist for over 20 years.
I would be honored to join your movement in any capacity.
I have lived many of the challenges described here. And despite my titles, training, and knowledge, help for my own family has at times been delayed, fragmented, or simply unavailable. I have been dismissed. I have been told I was trying to control my son or control outcomes — when in reality, I was trying to keep him safe and supported.
What this journey has taught me is humility.
My own recovery — as a mother — has been essential. I have had to learn how to connect with my son, not with his illness. To see him beyond symptoms. To separate the disease from the person I love.
At the same time, I believe deeply that our systems need significant change. Families should not have to fight this hard for care, for respect, or for collaboration.
Thank you for creating this movemnet. I would be grateful to contribute in any way I can.
Thank you for sharing this. Living in both worlds, as a mother and as a psychiatrist, brings a perspective that many families rarely see acknowledged.
What you describe, being dismissed or told you are “trying to control outcomes” when you are simply trying to keep someone safe, is something we hear from caregivers again and again.
We’re grateful you reached out and offered your voice. Please look for an email from us soon. We would be honored to continue the conversation.
Related to my family’s struggle with mental illness:
https://www.sandiegouniontribune.com/2026/03/22/pressure-mounts-for-resumption-of-court-ordered-mental-health-evaluations/
https://www.sandiegouniontribune.com/2025/12/07/san-diego-family-struggles-with-all-too-familiar-cycle-of-mental-illness/
https://calmatters.org/health/mental-health/2025/12/care-court-profiles/
https://tradeoffs.org/2026/02/05/mental-illness-left-their-loved-ones-on-the-streets-californias-big-fix-hasnt-helped/
https://kpfa.org/episode/upfront-january-30-2026/