California Legal Brief

The Rule of Conservatorship of A.B. is that a person may be found presently gravely disabled if clear and convincing evidence shows they lack insight into their mental illness and will not take medication necessary to provide for basic needs without a court order, under circumstances where the evidence demonstrates a longstanding pattern of decompensating when not under mandatory medication orders despite repeated cycles of hospitalization.

Appeal from renewal of conservatorship and involuntary medication orders pursuant to Lanterman-Petris-Short Act in Superior Court, San Francisco County.

Defendant Appellant was A.B. — a 42-year-old man with schizoaffective disorder who challenged renewal of his LPS conservatorship and involuntary medication order.

Plaintiff Respondent was Public Guardian of San Francisco County — the petitioner seeking renewal of conservatorship and involuntary medication authority over A.B.

The suit sounded in LPS conservatorship proceedings for grave disability and involuntary medication authorization.

The key substantive facts leading to the suit were A.B.'s 15+ year history of mental illness with numerous hospitalizations, repeated pattern of medication noncompliance when not under court order leading to decompensation, threatening and assaultive behavior toward his mother when off medication, and October 2023 incident where he barricaded himself and moved household items into his room believing neighbors would attack.

The procedural result leading to the Appeal: The trial court granted the petition for renewal of conservatorship and involuntary medication order, ruling that A.B. was presently gravely disabled because he lacked insight into his mental illness, would not comply with medication without court order, and could not provide shelter for himself without medication since his mother would not allow him to live with her absent mandatory medication compliance.

The key question(s) on Appeal: 1. Whether substantial evidence supported finding A.B. currently gravely disabled when he acknowledged having mental illness and needing medication after October 2023 incident 2. Whether substantial evidence supported finding A.B. incompetent to give informed consent regarding medication

The Appellate Court held that A.B. was presently gravely disabled based on substantial evidence showing his lack of insight into his mental illness, inability to provide shelter without medication, and unwillingness to consistently take necessary medication without court mandate, despite his trial testimony claiming newfound understanding, where the trial court properly credited testimony from his mother and psychiatrist about his longstanding pattern over his contrary testimony.

The case is inapplicable when the conservatee demonstrates genuine insight into their mental illness with reliable voluntary medication compliance, has not established a pattern of decompensating when court orders are lifted, or has viable alternative housing arrangements that do not depend on medication compliance.

The case leaves open questions about how much weight should be given to conservatee's claimed newfound insight versus established historical patterns, what constitutes sufficient evidence of sustainable independent living arrangements, and the duration of stable behavior needed to overcome a longstanding pattern of noncompliance.