More California counties are turning attention to an 11-year-old law allowing judges to order involuntary outpatient treatment for people with severe mental illness.
LOS ANGELES — At a public meeting on Feb. 25, the Alameda County, Calif., Board of Supervisors wrestled with a decision that could have a major impact not only on the mentally ill in their jurisdiction but also those across the state.
Before the five supervisors was a proposal to adopt an 11-year-old state law — dubbed “Laura’s Law” for a college student who was murdered by a mentally ill man — that allows judges to order involuntary outpatient treatment for those persons whose “mental illness is so severe it prevents them from seeking help.”
Since Assembly Bill 1421 was passed in August 2002, only rural Nevada County, where Laura Wilcox was killed, has fully implemented the law amid concerns over funding and possible civil rights abuses. California had previously permitted only “5150” holds — 72-hour detentions of mentally ill adults who are considered a danger to themselves or others.
If Alameda becomes the first large, urban county in California to approve a Laura’s Law program, the law might finally gain some traction. The county used 5150s on 10,849 occasions last year.
“I need to protect him but I can’t,” Liz Rebensdorf, head of the East Bay chapter of the National Alliance on Mental Illness, told the supervisors, referring to her mentally ill son. “I can’t protect him from his inner demons, or from his own self.”
The financial concerns have been eased since the Legislature clarified last year that money from Proposition 63, a ballot initiative passed by California voters in 2004, can be used to support “assisted outpatient treatment” programs. Nevada County has said its program saved more than $500,000 in hospital and incarceration costs over a period of 31 months.
At the Alameda County meeting, however, emotions ran high as one important constituency — the mentally ill themselves — expressed their opposition to Laura’s Law.
“I want to have a say-so in my recovery,” said Christina Murphy, a 35-year-old woman who has struggled with mental illness and argued that forcing the mentally ill to seek treatment is ineffective.
In Orange County, another of California’s largest counties, momentum has been building to adopt Laura’s Law since Kelly Thomas, a homeless schizophrenic, died after a brutal altercation with Fullerton police in 2011.
“Had Kelly Thomas been receiving the intensive services provided by ‘Laura’s Law,’ it is likely Kelly Thomas would not have been on the street to be beaten to death,” Carla Jacobs, a long-time advocate for the mentally ill and an Orange County resident, told MintPress in an interview.
But with the issue of whether the mentally ill should be compelled to receive treatment still so polarizing, the future of the law remains in doubt.
“Both sides are afraid and the stakes are high,” said Randall Hagar, legislative director of the California Psychiatric Association.
“The patient group fears, sometimes to the point of terror, a return to the bad old days of state [mental] hospitals,” he noted. “Involuntary treatment is the boogeyman.”
It was on Jan. 11, 2001 that Scott Harlan Thorpe went on a shooting rampage in the Nevada County social services building, killing three people. He was a registered client of the behavioral health clinic, but his attendance at counseling sessions was purely voluntary and his family had been trying to get more intensive treatment for him. One of his victims was Laura Wilcox, a 19-year-old intern at the clinic.
In the “bad old days,” Thorpe very likely would have been confined to a mental hospital. But in the 1960s, California, like many other states, had adopted a policy known as “deinstitutionalization,” whereby the mentally ill were taken out of hospitals and treated in their communities, instead. The Lanterman-Petris-Short Act of 1967 ended indefinite, involuntary commitment to hospitals and provided for only 72-hour commitments of those deemed to have a dangerous mental disorder.
Those who weren’t dangerous, but “very, very sick,” says Jacobs, were left “out in the cold,” often condemned to cycling through 5150s and the criminal justice system after being arrested for minor offenses. In the five years leading up to his death, for example, Kelly Thomas was arrested more than 20 times.
AB 1421 was designed to plug the gap in the LPS Act by helping those whose mental disorder is so severe that it prevents them from even recognizing that they need help.
Under existing law, the bill’s author said, there was no way to allow such people access to a court-ordered outpatient program, “even though they have a history of repeated holds, deteriorating symptoms without treatment and repeatedly refused offers to engage in voluntary treatment.”
Laura’s Law allows a judge to order involuntary outpatient treatment for a person 18 years or older who is severely mentally ill, who refuses voluntary treatment and who appears to be at risk for self-harm or grave disability. The mentally ill person is represented at court hearings by a public defender and has other due-process protections.
The law “is useful for a very narrow segment of the population that can’t be helped effectively by other, voluntary means,” Hagar told MintPress. “Just over 50 percent of those with severe mental illness don’t believe they are sick and Laura’s Law is targeted at those folks at that moment in time when they are deteriorating and refusing treatment.”
Jacobs notes that 72-hour hospitalizations do not provide nearly enough time to even stabilize a severely mentally ill person. “Three days is nothing more than a shave and a shower,” she said.
No state funding, however, was appropriated for the law and the Legislature left it up to individual counties to “opt in” to it.
Only Nevada County initially accepted the invitation. Since the county began to offer assisted outpatient services in May 2008, 55 people have been referred and evaluated, with the majority engaging in treatment without a court order.
“Laura’s Law has provided life-saving services to individuals suffering from mental illness and kept many from the trauma and brain damage associated with involuntary commitments to mental health facilities,” Thomas M. Anderson, the presiding judge of Nevada County, wrote in a letter to the Orange County Board of Supervisors in September 2011.
The law, he added, had provided a return of $1.80 for every $1.00 spent.
But other counties have shied away from the law, including Mendocino County, where a mentally disturbed man, Aaron Bassler, murdered two foresters in September 2011 before being shot to death by a police SWAT team. Los Angeles and Yolo counties have implemented only pilot Laura’s Law programs.
“It is a very emotional issue,” Jacobs observed. “And it’s something that has to be emotional because you’re talking about people’s rights and people’s lives.”
Things certainly got emotional at the recent Alameda County Board of Supervisors meeting. One speaker was Candy Dewitt, whose son has been charged with killing a stranger in Berkeley after repeated 5150s due to his schizophrenia.
“I hope for my son what you have one day,” she told a group of Alameda County constituents who have been successful in battling their mental illnesses. “But he can’t do that and there are many others who can’t do that. We need something else.”
An anguished Board President Keith Carson didn’t mince words in sharing his own experience of dealing with a schizophrenic family member. “I have personally seen that person force-fed medication and I continue to live with that person’s disability,” he said. “This is not something I read about. It’s something I fucking experience every fucking day. I understand the pain that people are going through, on both sides, because I lived it.”
Ultimately, though, the board tabled a decision, asking health officials to spend three months trying to hash out a “more compassionate” pilot program.
“I think we were hoping for some closure,” one official said. “This has been polarizing.”
In Orange County, meanwhile, the county mental health board has unanimously approved spending $4.4 million on Laura’s Law outpatient treatment for the severely mentally ill in the 2014-15 fiscal year. “Families that are dealing with children who have mental health issues need another tool in the toolbox,” County Supervisor John Moorlach has said.
The county had been waiting for the Legislature to pass Senate Bill 585 authorizing the use of Proposition 63 funds for such programs. A vote by the board of supervisors is still pending.
SB 585 was “extremely important” because some groups opposed to Laura’s Law had threatened to sue any county that took Prop 63 money, Jacobs said. “Those threats to sue put a shadow on things.”
Other states have embraced assisted outpatient treatment. In New York state, courts have found its assisted outpatient treatment law, known as Kendra’s Law, constitutional. What Laura’s Law needs, Jacobs says, is for a large county to come on board.
“It will show that California’s system is capable of providing Laura Law’s services,” Jacobs said.
One way or the other, she predicts, 2014 will be a “watershed year” for the law.
“Is it going to solve serious mental illness?” she asked. “No, it’s not a panacea. But it is going to help some people.”