Conservatorship: Inside California's System of Coercion and Care for Mental Illness

by Alex V. Barnard

Overview

Winner, 2024 Eliot Freidson Outstanding Publication Award, Medical Sociology Section, American Sociological Association

Is involuntary psychiatric treatment the solution to the intertwined crises of untreated mental illness, homelessness, and addiction? In recent years, politicians and advocates have sought to expand the use of conservatorships, a legal tool used to force someone deemed “gravely disabled,” or unable to meet their needs for food, clothing, or shelter as a result of mental illness, to take medication and be placed in a locked facility. At the same time, civil liberties and disability rights groups have seized on cases like that of Britney Spears to argue that conservatorships are inherently abusive.

Conservatorship is an incisive and compelling portrait of the functioning—and failings—of California’s conservatorship system. Drawing on hundreds of interviews with professionals, policy makers, families, and conservatees, Alex V. Barnard takes readers to the streets where police encounter homeless people in crisis, the locked wards where people receiving treatment are confined, and the courtrooms where judges decide on conservatorship petitions. As he shows, California’s state government has abdicated authority over this system, leaving the question of who receives compassionate care and who faces coercion dependent on the financial incentives of for-profit facilities, the constraints of underresourced clinicians, and the desperate struggles of families to obtain treatment for their loved ones.

This book offers a timely warning: reforms to expand conservatorship will lead to more coercion but little transformative care until government assumes accountability for ensuring the health and dignity of its most vulnerable citizens.

Product Details

ISBN-13:	9780231210256
Publisher:	Columbia University Press
Publication date:	09/26/2023
Pages:	416
Sales rank:	655,585
Product dimensions:	6.12(w) x 9.25(h) x (d)

About the Author

Alex V. Barnard is an assistant professor of sociology at New York University. He is the author of Freegans: Diving Into the Wealth of Food Waste in America (2016).

Table of Contents

Preface
Introduction: The Other Magna Carta
Part I. The Conservatorship Continuum
1. Outpatient
2. Crisis
3. Emergency Room
4. Inpatient
5. Public Guardian
6. Court
Part II. Care and Coercion Under Conservatorship
7. Locked In
8. Stepped Down
9. Neglect and Abuse
10. Stabilization and Recovery
Part III. Reform
11. Paving a New Pathway
12. Asylum for the Dying
13. Sharing Authority, Restoring Autonomy
Conclusion: Beyond Miracles
Methodological Appendix
Chronology of “Abdicated Authority”
Glossary of Terms, Procedures, and Facilities
Acknowledgments
Notes
Index

Editorial Reviews

It is rare that a book saturated in ambivalence and complexity is so eminently readable and insightful. Barnard has at least two gifts that serve him well. He writes well and he narrates with unfailing empathy. This is a significant accomplishment, especially for the topic....In an ethnography executed with such skill, Barnard’s insistence that the state assume more responsibility over conservatorship—even to the point of expanding it—is a persuasive argument and not simply an exhortation. As tempting as it may be, Barnard never abdicates his responsibility as a judicious social scientist. Gimme more.

Social Forces

In California, the state has abdicated its authority over the conservatorship process by delegating state functions to a fragmented field of actors. Cutting through overly simplistic accounts of conservatorship, Barnard uses rich data and sharp theory to delve into the pitfalls of this abdication of authority.

Josh Seim

The subject and title of Conservatorship is perhaps the most important yet least studied power of domestic governance. As Alex Barnard's meticulous study of California’s system for protecting those most disabled by mental illness shows, this power is left to a largely unaccountable and invisible system of local and market actors. At a time of much interest in new legal solutions to our severe crisis of unhoused, untreated, and mentally ill citizens, Barnard’s findings suggest the priority of addressing our even deeper crisis of authority.

Jonathan Simon

This study analyzes the fraught relationship between law, medicine, and government that too often produces a mental health system with deadly results...Highly recommended.

Choice

A heartbreakingly insightful ethnographic deep dive into the failure of mental health care in the United States that everyone refuses to pay for—and for which no public authority takes responsibility. Barnard strategically takes us through each dysfunctional interstice of California’s iconically mismanaged mental health system that manages to maximize costs, minimizes benefits, and tortures everyone involved—especially people with psychosis spectrum disorders whose lives are cut short by the public/private bureaucratic quagmire that has been waging war on itself for the past half century.

Philippe Bourgois

I recommend this very comprehensive book to anyone who is interested and ultimately frustrated by how our state has failed so many it purports a desire to help.

Southern California Psychiatrist

Vivid case studies and probing interviews humanize this journey through the fraught terrain of involuntary care. Barnard pulls few punches in describing the more offensive stretches of the roadmap but avoids veering into unalloyed condemnation or praise. His thoughtful exploration yields reasons for hope that our better angels might prevail.

Roderick Shaner

Conservatorship delivers the kind of critical analysis that...would require California politicians, more comfortable with increasing budgets than investigating outcomes, to expose themselves to more blame.

City Journal

A heartbreakingly insightful ethnographic deep dive into the failure of mental health care in the United States that everyone refuses to pay for–and for which no public authority takes responsibility. Barnard strategically takes us through each dysfunctional interstice of California’s iconically mismanaged mental health system that manages to maximize costs, minimizes benefits and tortures everyone involved–especially people with psychosis spectrum disorders whose lives are cut short by the public/private bureaucratic quagmire that has been waging war on itself for the past half century.

Philippe Bourgois author ofIn Search of Respect: Selling Crack in El Barrio and co-author of Rig