Debate Continues Over Laura's Law, Mental Health Care

by Pat McConahay, California Healthline Regional Correspondent

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SAN FRANCISCO -- The Board of Supervisors this month postponed a proposal to adopt what is known as Laura's Law. The measure gives courts the power to compel outpatient treatment for severely mentally ill people who have refused help. Following an Aug. 3 hearing, Supervisor Michela Alioto-Pier sent the hotly debated measure back to committee until fall.

Aide Catherine Stefani said the supervisor hopes to use that time to have further discussions with opponents like Mitch Katz, San Francisco's public health director. Katz, who would be involved in implementing and enforcing the law if and when it passes in San Francisco, argues the measure doesn't have enough teeth.  

"Psychosis requires medication, and Laura's Law does not increase our ability to require medication," Katz told supervisors. In a letter to the San Francisco Chronicle, he wrote that people assume using the term "treatment" involves medication, and in this case, it doesn't necessarily mean that. 

Michael Heggarty -- director of Behavioral Health for Nevada County, which implemented Laura's Law in 2008 -- disagrees. "It does require the person to be participating in treatment. As long as we keep talking to the person, establishing a relationship, the chances that they voluntarily take medication go up." 

Laura's Law (AB 1421) is named after Laura Wilcox, a 19-year-old college student who was working in a Nevada County public mental health clinic when she was gunned down by a 41-year-old man with a history of violence who had resisted receiving treatment. When Laura's Law took effect in 2002, the state left it up to counties to implement it, essentially making it an optional law counties could adopt or ignore.  Nevada County was required to implement the law as part of a settlement agreement with Wilcox's family. Los Angeles County also adopted the law, creating a small pilot project for people in the criminal justice system. 

"The fact that only two counties have adopted the law is a sign that it's not a workable solution to a real vexing problem," said Steve Fields, director of the Progress Foundation, a not-for-profit behavioral health provider.  Fields added that many counties don't have enough money to provide mental health services for people who want them, let alone money for programs under Laura's Law. He said, "It's very clear that you cannot be reducing existing behavioral health services at the same time you're seeking a broader commitment capability."

Alternative to Forced Institutionalization

Laura's Law supporter John Rouse, of the UCSF Department of Psychiatry, urges officials to take a close look at the reasons why counties are reluctant to implement it, admitting that there's some confusion over what's allowed and what isn't. But he said he sees Laura's Law as a tool that will keep state and county governments from going back to the days of forced institutionalization of the severely mentally ill.

"What we need now are structures that will keep people in treatment and functioning well in the community and serve as early warning systems so that when they start to decompensate, when they go off their medication we get an early heads up, and we get to intervene at that point," Rouse said.

Under the resolution, a mentally ill person committed to treatment must be a least 18 years old with a history of violent behavior that's landed them in jail or the hospital.

Much of the resistance to Laura's Law comes from patients and community agencies that say it would violate the civil rights of the mentally ill.

"People have a right to choose what kinds of treatment they're willing to accept and in this case ... a court is making that decision for you," said Rod Libbey, interim director of the Mental Health Association of San Francisco.  

How Law Works in Nevada County

Nevada County's Heggarty said at first he was concerned that Laura's Law would violate a person's civil rights, but since implementing the resolution, he's changed his mind.

"The reason I feel differently is we provide many other types of programs that you can make the same argument that they violate people's rights. For example, we have people on probation through criminal court, and they're ordered into treatment as part of the terms of their probation, and we've always treated those folks," Heggarty said.

Since 2008, Nevada County has referred 22 people to court under Laura's Law. One person required treatment. The others opted to do it voluntarily, and Heggarty said that proves just going through the process may encourage people to voluntarily seek help.  

Heggarty admits he's seen some problems with Laura's Law in his county.

"It's hard for us to move fast enough through the legal proceedings because the patients are protected by having a lawyer assigned to them, scheduling a court appearance, and sometimes the patients have gotten bad so quickly they couldn't get the help fast enough and ended up hospitalized anyway," Heggarty  said.

Debate Continues in S.F., Other Counties

The debate continues in San Francisco.  Allioto-Pier said she's not giving up. Supporter Rouse said he will look at what can be done under existing provisions of the law.

"I think there is room for creativity. If we can get this done without going through another major change in the state law, it would be a great thing," Rouse said.

Meanwhile, opponents, who say involuntary outpatient commitment isn't more effective than voluntary services, are gearing up to fight Laura's Law efforts in other counties, including Marin and Contra Costa.   


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