Originally posted at California Health Report.
By Linda Childers.

Fifteen years ago, Laura Wilcox, a 19-year-old college student, was killed by a man with a history of mental illness while she was working at a mental health clinic in Nevada County. After her death, Wilcox’s parents pushed for legislation they believed would prevent similar tragedies and in 2002, the California State Legislature passed that legislation, known as Laura’s Law, giving county courts the right to order assisted outpatient treatment to severely mentally ill patients at the request of a family member or other concerned party.

Despite the fact that Laura’s Law was passed in California over 13 years ago, and that 44 other states have similar laws in place, adoption of Laura’s Law has been slow. Most counties who have attempted to adopt the law have faced strong opposition by mental health consumers, legal organizations and advocates from underserved and marginalized communities. The organization Disability Rights California has lobbied heavily against the law since 2002, threatening to sue counties that implemented Laura’s Law, saying assisted outpatient treatment doesn’t work.

Nevada County adopted Laura’s Law in 2008 and other counties were given the choice to opt-in to Laura’s Law after their Board of Supervisors passed a resolution. After endless delays and arguments over perceived civil rights violations, Contra Costa became the most recent county to adopt a three-year Laura’s Law program that began in Feb. 2016.

After the state Legislature clarified in 2013 that counties can adopt Laura’s Law using money from Proposition 63 (which levied a 1 percent tax on millionaires to expand mental health services), more counties adopted the law. Today, Alameda, El Dorado, Kern, Los Angeles, Mendocino, Nevada, Orange, Placer, San Diego, San Francisco, San Mateo and Yolo have Laura’s Law programs in place.

Those in support of the law say it should be viewed as a bridge to recovery, and a way to stop the revolving door of repeated hospitalizations, homelessness and jailings. Other mental health officials have expressed concerns over Laura’s Law, claiming the law could violate civil rights by coercing those with psychiatric disorders to take medication against their will or intimidating them to comply with drugging themselves.

Melinda Bird, director of litigation for Disability Rights California, says that rather than expanding use of forced treatment that infringes on a patient’s rights, more efforts should be put towards increasing the number of voluntary treatment services.

“We have a lot of concerns about Laura’s Law including privacy, personal liberties and how the law could further stigmatize people with mental illness,” Bird says. “We don’t want the perception to be that everyone with mental illness is violent because that isn’t true.”

Eduardo Vega, executive director of San Francisco’s Mental Health Organization, also has concerns about Laura’s Law.

“In my over 25 years of work in the mental health field, I’ve seen that forcing people into mental health services with threats of incarceration or hospitalization rarely works,” Vega says. “It damages the relationship between patients and their providers. A more effective solution is community-based outreach and engaging people in productive conversations about their health, their employment and their living situation”

Vega worries that Laura’s Law could violate civil liberties and that the act of forcing people into an outpatient mental health programs via the courts could have the effect of criminalizing and further stigmatizing mental health issues.

A report by the Center for the Human Rights of Users and Survivors of Psychiatry noted that people of color are more likely to have their behaviors diagnosed as “schizophrenia” than whites, and are more likely to be subjected to coercive forms of mental health treatment including forced inpatient and outpatient hospitalization and restraint and seclusion.

And while public health officials estimate the cost of Laura’s Law treatment at $40,000 per person, per year in San Francisco, some wonder if the funding might be better used elsewhere.

“I’d like to see efforts to create a jail diversion system for patients with mental illness rather than having them warehoused in jails,” Vega says. ‘Instead of forcing treatment on people with mental illness, we’d like to see psychiatric respite care, expanded homeless outreach teams, and mobile and site-based peer respite services.”

Counties Optimistic About Laura’s Law Successes

Yet advocates of Laura’s Law say the law is working, and are adamant the law only applies to the most seriously mentally ill, who have fallen through the cracks of the mental health system. Statistics from 2015 show that since 2008, more than 100 people were referred to the program in Nevada County and 37 of those were placed under a formal order. About six people each year are referred to Laura’s Law in Nevada County, according to county records.

To be eligible for treatment under Laura’s Law, individuals must be 18-years-old, have a severe untreated mental illness and are unable to survive in the community without supervision, have been hospitalized two or more times within the previous 36 months due to their mental illness, and have a deteriorating mental health condition.

Angelica Almeida, a psychologist and director of San Francisco’s assisted outpatient treatment team, says that while the program only began accepting referrals last November, they have witnessed some early successes.

“To date we’ve had 45 individuals referred to the program, and we’ve had contact with 23 of the referrals who meet the criteria,” Almeida says. “Twelve of the individuals have voluntarily accessed the care they need, and we haven’t had to go to court.”

Vega says this data confirms how concentrated engagement and voluntary services are more likely to benefit individuals with mental illness who may be homeless or disengaged.

To date, Almeida notes that most of the referrals have come from family members who are desperate to get help for their mentally ill loved ones, and feel powerless to help them.

“I believe the program is offering them hope,” Almeida says. “Our program here in SF is unique in that we offer a peer specialist and family liaison to help patients and their families navigate the process, accompany patients to their appointments, whatever is needed.”

Almeida acknowledges that a lot of misconceptions surround Laura’s Law.

“Some people have expressed concerns that the assisted outpatient treatment program might be using funds that could be better used elsewhere, “ she says. “Yet the law is very clear that no current programs can be reduced or cut to fund Laura’s Law programs.”

Funding for the Laura’s Law program typically comes from a variety of sources, including Medi-Cal/Medicare reimbursements, Mental Health Services Act funds and county general fund money.

Contra Costa, one of the most recent counties to adopt Laura’s Law, began accepting referrals on Feb. 1.

David Seidner, mental health program manager, Contra Costa County Health Services, says his team is focused on offering opportunities to mentally ill individuals who are eligible under Laura’s Law rather than using coercion or intimidation.

“Our goal is to have voluntary participation in the program,” Seidner says. “The reality is we’re obligated to file a petition with the courts for assisted outpatient treatment if a mentally ill individual is refusing treatment and poses a threat to themselves or others.”

Although the Contra Costa program has only been operating for several weeks, Seidner says they have received referrals from families who have a loved one who has been cycling in and out of psychiatric emergency and are looking to partner with services that can help their loved one.

“If their family member doesn’t meet the criteria for Laura’s Law, then we’ll connect them with other services,” Seidner says. “If someone has walked away from existing treatment providers, then we will work with them to access and receive the treatment they need.”