It's been more than four years since San Diego County first explored implementing a state law that's divided the mental-health community over how to get seriously ill folks into treatment. But with a key hurdle—how to pay for that treatment—out of the way, the county Board of Supervisors on Jan. 27 will take another look at Laura's Law.
Named after 19-year-old Laura Wilcox—who was gunned down by a mentally ill man in 2001—Laura's Law says that a person who meets certain criteria, like refusing treatment, showing signs of being a threat to himself or others or having a history of hospitalization and/or incarceration, can be court-ordered to follow an "assisted-outpatient treatment" plan. If that person refuses treatment, she or he can be held in a psychiatric hospital for up to three days, but Nevada County, where Wilcox lived and which, until this year, was the only county to fully implement Laura's Law, found that that rarely happens. Nevada County's become an evangelist for Laura's Law. In 2012, its grand jury found that for every $1 spent on the program, the county saved $2 by keeping people out of jail and preventing emergency hospitalizations and police calls.
Laura's Law is a paradigm shift for a mental-health system in which treatment is rarely proactive, said Therea Bish, who, in 2011, chaired San Diego County's Mental Health Board (MHB) when it voted in support of the county implementing Laura's Law. Right now, Bish said, if someone refuses treatment, you have to wait until that person's deteriorated to the point of qualifying for an emergency psychiatric hold.
"I know parents who triage their adult children every day," she said; involuntary hospitalization is the only way to get help.
Despite the MHB's support, county mental-health officials opposed the law, largely due to questions of how to pay for it. Because it doesn't come with any funding, Laura's Law is discretionary. Nevada County implemented it in 2008, but only as part of a legal settlement with Wilcox's family, and used money from the Mental Health Services Act (MHSA)—approved by California voters in 2004—to pay for it. But elsewhere, including San Diego County, there was disagreement over whether MHSA money could be spent on involuntary treatment—and threats by Laura's Law's opponents to sue if it was.
A 2014 law, authored by then-state Senate President Pro Tem Darrell Steinberg, cleared up questions over whether MHSA money could fund Laura's Law. In May, Orange County became the second county to adopt the law, spurred by the 2011 police-beating death of Kelly Thomas, a mentally ill homeless man. Los Angeles and San Francisco counties voted in July to enact the law. A few smaller counties have either implemented Laura's Law or launched pilot programs.
The item on the Jan. 27 Board of Supervisors agenda asks supervisors to authorize the county's Health and Human Services Agency to put together a team of representatives from county law-enforcement agencies, the court and patients' rights groups to "prepare a plan for implementation of Laura's Law" and report back to supervisors within 90 days.
Right now, the agenda item appears to have the support of at least three of the five county supervisors.
Luis Monteagudo, spokesperson for Supervisor Greg Cox, said in an email that Laura's Law is "a very complex issue" but that Cox "will probably vote for it, because it's the first step in the process." A spokesperson for Supervisor Dianne Jacob pointed to a recent statement she'd made to NBC 7, saying that she was looking forward to Laura's Law coming back to the board for discussion. And Supervisor Dave Roberts, a vocal proponent of Laura's Law since he was elected to the board in 2012, described it as a treatment approach that should be available to county residents.
"One tool might not work for your family or your loved one, but it may work for others," he said. "The more tools we can offer to our county, the better off we are."
A spokeperson for Supervisor Ron Roberts said his boss "is looking forward to reviewing the details and listening to the public comments before making a decision." And, a spokesperson for Bill Horn said the supervisor "generally doesn't comment on agenda items before they come to the Board."
Opponents, meanwhile, have been consistent in their reasons why Laura's Law is bad policy. They argue that involuntary treatment raises the ugly specter of institutionalization and forced medication, outlawed in the early '70s (though, Laura's Law supporters emphasize that the law mandates outpatient treatment only and forbids forced medication).
"The way the AOT statute is drafted is extremely broad," said Ann Menasche, an attorney with Disability Rights California, which opposes Laura's Law. "You don't have to be dangerous to yourself or others, you don't have to be incompetent to make decisions, you don't have to be gravely disabled—you don't have to meet any of the criteria for a [psychiatric] hold....
"It's this preemptive strike here," she said, "which is actually very harmful because of the trauma involved in forced treatment."
Menasche said the system first needs to be able to serve patients who voluntarily seek help—and, right now, that's not happening. On Jan. 20, she sent a letter to the Board of Supervisors describing a "significant unmet need for mental health services."
"Many San Diego residents with severe mental health disabilities are turned away each year from voluntary services such as Full Service Partnerships and case management," Menasche wrote, "and rationing severely restricts the availability of longterm psychotherapy."
Some Laura's Law supporters worry that the timing of the vote will give supervisors a reason to delay action. In a Jan. 13 email to supervisors, Tom Behr and John Sturm, both former members of the Mental Health Board, pointed out that a new advisory board, the result of the merger of the county's Alcohol and Drug Advisory Board and the MHB, won't have its first meeting until February and won't have a chance to weigh in on Laura's Law until the spring.
"Our purpose in informing you is not to oppose nor encourage adoption of Laura's Law," Behr and Sturm wrote. "Rather, our purpose is to highlight the implications of such an accelerated adoption process as it relates to the new Behavioral Health Advisory Board."
Bish, the former MHB chair, said a delay is unwarranted. "Our Mental Health Advisory Board had done the work," she said, "and, yes, it was going to be sound public policy."
She pointed out that untreated mental illness is only becoming more costly for the county, which recently added two positions to its conservatorship program and, later this year, will consider increased funding for its Psychiatric Emergency Response Team which, as CityBeat reported earlier this month, hasn't been able to keep up with a significant increase in calls for service.
Meanwhile, at the state level, Assemblywoman Marie Waldron, whose district includes Escondido and San Marcos, has authored a bill that would make Laura's Law mandatory statewide. Waldron acknowledged that it's a hard sell, since it would make the law an unfunded mandate. And, for this reason, she said, the bill's "still in flux." But she wants to see the state step up to fund it.
"Money has to be put in," she said. "You have to be committed as a state to fund the programs, and then you reap the benefits. Our problem is that California has not really stepped up to fund the program enough to make it workable."
Waldron's bill would also extend Laura's Law's court-ordered treatment period from six months to a year for people who meet certain criteria, and it would get rid of the law's Jan. 1, 2017, sunset date.
Waldron says that while she understands opponents' concerns that Laura's Law undermines civil-rights protections for mentally ill folks, untreated mental illness could put someone in an even worse place.
"If they don't get treatment, they end up in jail, or in an emergency room or a hospital situation," she said, "if they don't end up dead."