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.

"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

"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

"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

"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