Oct. 19 2011 12:12 PM

Advocates for the mentally ill question whether new county program will compel folks into treatment

Photo by Kelly Davis

Like most laws named after someone, Laura's Law was the result of a tragedy.

In 2001, 19-year-old Laura Wilcox was gunned down in Nevada City, Calif., at the behavioral-health clinic where she worked, by Scott Thorpe, a mentally ill man who'd been in and out of treatment. After Thorpe murdered Wilcox, he went to a nearby restaurant and killed the 24-year-old manager.

A year later, the state Legislature approved a law allowing a mentally ill person who shows signs of being a threat to himself or others to be court-ordered into what's known as "assisted outpatient treatment" (AOT). AOT involves a range of services intended to stabilize people who have a history of cycling in and out of hospitals and jails.

Laura's Law gave counties discretion over whether to implement it—and it came with no extra funding. Nine years after it was passed, only Nevada County, where Wilcox lived, has fully implemented the law—and only thanks to a settlement of a lawsuit brought by Wilcox's family.

In San Diego, though, the county's Mental Health Board, which advises the county Board of Supervisors on policy matters, voted earlier this year in favor of Laura's Law's implementation, the county's Health and Human Services Agency remains opposed to it.

"It'll probably take some egregious killing" for the law to be reconsidered here, said Theresa Bish, chair of the county's Mental Health Board.

Meanwhile, at least two other counties are taking another look at the law in response to tragedies, and supervisors in Los Angeles and San Francisco have vowed to renew a push to see the law implemented.

In early August, the Orange County Board of Supervisors asked its Health Care Agency to revisit Laura's Law. The board's action was in response to the death of Kelly Thomas, a mentally ill homeless man who died after a July 5 altercation with Fullerton police. According to media reports, Thomas was schizophrenic and had refused treatment and medication despite his family's efforts to get him help. (The Health Care Agency submitted its report to supervisors on Oct. 14; the report found that the law would cost up to $6.1 million annually and would apply to roughly 120 people a year, according to a story by voiceofoc.org reporter Tracy Wood. San Diego County, meanwhile, has estimated Laura's Law's cost at $2.2 million a year to serve 540 people.)

Mendocino County, too, is taking another look at the law after a mentally ill man killed a Fort Bragg City Council member and a county official last month.

Alfredo Aguirre, San Diego County's director of mental health services, said scarce resources are the main reason for not implementing the law here.

"We really have limitations," he said. "It does reduce the availability of really precious inpatient beds."

While Laura's Law doesn't require hospitalization, a person who refuses treatment under the law can be held in a psychiatric hospital for up to three days. Patients-rights advocates say this raises civil-rights issues and could potentially compromise a person's chance for long-term recovery.

But someone who's seriously mentally ill could be heading toward forced hospitalization anyhow, the law's proponents say. In an interview with CityBeat in January, Carla Jacobs, cofounder of the nonprofit Treatment Advocacy Center and one of the law's most vocal supporters, referred to Laura's Law as "5149 and a half"—5150 is the state code for the process under which a person can be involuntarily confined to a psychiatric facility. Laura's Law, Jacobs said, is supposed to catch someone before the point of forced hospitalization, incarceration or worse.

In Nevada County, where the law's been in place since 2008, the majority of folks voluntarily choose treatment, said Michael Heggarty, Nevada County's mental health director, at a Laura's Law forum held in San Diego last November. Heggarty said, too, that while the law costs the county roughly $20,000 per person, that's been balanced by savings from reduced jail and hospital stays.

San Diego County mental-health officials hope they've found a compromise. Called In-Home Outpatient Treatment, or iHOT, the program will consist of three mobile outreach teams that will, according to a program summary, provide "assessment, crisis intervention, case management and support services" to seriously mentally ill individuals and their families.

"There is not the court-ordered outpatient commitment that you have in Laura's Law," Aguirre said, but all the same treatment components are there. "Assertive community treatment, whatever it takes, 24/7. You provide some support for housing, you do a lot of outreach with families, work with other providers, work with law enforcement."

The county put out a request for proposals in July and will choose a provider by January 2012, Aguirre said. The program's first-year budget is $1.1 million, paid for by state Mental Health Services Act money, and is expected to serve between 300 and 360 people.

Law proponents remain skeptical. Eric Revere, who heads the San Diego County Laura's Law Steering Committee, said there needs to be what's known as "the black-robe effect"—the authority of a judge to get a person to agree to treatment.

"They're going to say no," said mental-health advocate Judy Belinsky.

Belinsky said she had to create her own version of Laura's Law for a mentally ill family member through what's known as a conservatorship—a legal process by which a person's who's been deemed gravely disabled is put under the care of a conservator.

"That's how he got better," she said. "We kept a case manager on him to monitor him. Laura's Law is to catch them before they get so unstable that they end up having to be in a locked-down facility for months."

Email kellyd@sdcitybeat.com or follow her on Twitter at @citybeatkelly.


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