Understanding Mental Health Conservatorship

Imagine you get a call for therapy services and the person on the phone tells you that he is the conservator for his 23 year-old daughter and would like her to get treatment with you?  How does this affect your clinical practice with the daughter?

First, what exactly is a mental health conservatorship?

A mental health conservatorship is used only for people who have a psychiatric disorder so severe that it prevents them from providing for their most basic personal needs such as food, clothing, and shelter. The legal term for such condition is gravely disabled.

According to the Superior Court of California, "The purpose of mental health conservatorships is to provide individualized treatment, supervision, and living arrangements for people who are seriously mentally ill while still protecting their individual rights. Mental health conservatorships, which are sometimes called LPS conservatorships because they are governed by the Lanterman-Petris-Short Act, can involve confinement in a locked psychiatric facility, which means the person is deprived of personal liberty. Therefore, there are strict legal procedures and laws that must be followed by doctors and hospitals and which involve review and monitoring by the Probate Court."

What should a social worker or MFT know about Mental Health Conservatorships as they relate to clinical practice?

• Family members or other private parties cannot start a mental health conservatorship. Only the professional treatment staff at the hospital where the person is being treated can begin the process.

• An investigation by the Office of the Public Conservator will determine whether to file a petition with the court.  The evaluation is done by a trained psychiatrist or psychologist. It is out of the scope of practice of an MFT or social worker to evaluate a patient and determine whether a Mental Health Conservatorship petition is called for.

• According to the Superior Court of California, the conservator and the conservatee share the right to make decisions about the conservatee’s health care. In other words, the conservator or the conservatee may authorize medical treatments. However, a conservator may not arrange for a particular treatment if the conservatee objects to it.

• The conservatee has a right to confidentiality but the conservator is the holder of privilege. So the conservator does not need to be present for treatments but if the records are subpeanoed, it is the the conservator who would waive privilege.

So let’s apply all this to the clinical example. Let's say the adult daughter mentioned above has Bipolar I and Borderline Personality is being released from a psychiatric hospital and seeking mental health services. The client’s father is the conservator. Both the father and the client can consent for treatment, and both should be included if available but it isn't required. If the father wants to attend sessions or be part of the treatment planning, it would depend on whether there were sound clinical reasons for including him. If the records were subpoenaed, the father, as the conservator, would be the holder of privilege.

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