February 23, 2013
AB 1569 was recently signed into law, which means authority in the Laura’s Law statute for a county to operate, establish or continue a program of Assisted Outpatient Treatment (AOT), has been extended until December 31, 2017.
On June 8, 2010 Board of Supervisors Resolution (#100751) was issued authorizing the implementing of Laura’s Law in the City and County of San Francisco, but was never voted on by the Board.
The Department of Public Health initiated a voluntary version of the law last year to treat a handful of people who were patients in the psychiatric ward of San Francisco General Hospital. However, under San Francisco’s Community Independence Pilot Project, patients must voluntarily agree to participate once they’re already hospitalized. But it puts the severely mentally ill in charge of their own self-destructive and dangerous behavior. This is not Laura’s Law.
It is time for San Francisco to implement Laura’s Law, not a watered-down version.
Laura’s Law in a nutshell:
Laura Wilcox, a 19-year old sophomore from Haverford College, was working at Nevada County’s public mental health clinic during her winter break from college. On January 10, 2001, she and two other people were shot to death by Scott Harlan Thorpe, a 41-year old mental patient who resisted his family’s attempt to seek treatment. Thorpe was found incompetent to stand trial and was sent to Atascadero State Hospital and was later transferred to California’s Napa State Hospital.
Laura Wilcox’s death was the impetus for passage of AB 142 in 2002, an AOT program, which has since become known as Laura’s Law.
For the uninitiated, an AOT program allows court-ordered, intensive outpatient treatment for people with severe mental illnesses who refuse medication because their illness impairs their ability to make rational decisions.
People with psychotic disorders who received court-ordered treatment for 180 days had significantly better outcomes than those who were given either intensive treatment alone, or a court order alone. Thus, AB 1421 provides for a 180 day period of intensive treatment under the supervision of the court. Currently AOT can only be used if a county’s board of supervisors enacts a resolution to implement and independently fund a discrete Laura’s Law program. Now, an AOT program is available statewide as a tool that can be, but is not required to be, used to efficiently treat the most problematic patients.
A 2000 Duke University study demonstrated that people with psychotic disorders who received court-ordered treatment for 180 days reduced hospitalizations by up to 74 percent, reduced arrests by 74 percent, reduced violence up to 50 percent, reduced victimization by 43 percent, and improved treatment compliance by 58 percent. That’s why AB 1421 incorporates these findings by providing for 180 day periods of intensive treatment under the supervision of the court.
AB 1421 was modeled after New York’s “Kendra’s Law.” Among the targeted hard-to-treat population, Kendra’s Law resulted in 74 percent fewer homeless; 83 percent fewer arrests; 87 percent49 percent less alcohol abuse; and 48 percent less drug abuse. Assisted outpatient programs have also worked in Iowa, North Carolina, Hawaii, and Arizona.
Kendra’s Law was held in all respects to be constitutional. (In re Urcuyo, 714 NYS.2d 862 (Sup. Ct. Kings County, 2000)) If challenged, I have no doubt that the constitutionality of Laura’s Law would also be upheld.
Fortunately, money should no longer be an issue since voters overwhelmingly passed Proposition 63 in 2004, which established a one percent tax on personal income above $1 million to fund expanded health services for mentally ill children, adults, and seniors. Nothing in Proposition 63 prevents these funds from being used to implement Laura’s Law. Nevada County, for example, is now using Proposition 63 funds to implement Laura’s Law.
Laura’s Law has been implemented in Nevada County and Los Angeles County opted for a small pilot project of AOT. That means 56 of the 58 California counties have not enacted Laura’s Law. In Nevada County, where the killings took place, the law has been fully implemented and proven so successful that the county was honored in 2010 by the California State Association of Counties. In announcing the recognition, CSAC said Nevada County offset public costs of $80,000 with savings estimated at $203,000 that otherwise would have been spent on hospitalization and incarceration of program participants.
We have heard much hand-wringing about what to do with the homeless — many of whom are chronically mentally ill — who are picked up off the streets. They may or may not be placed in a treatment facility, if one is available. Once they complete treatment, they are too often dumped back on the streets with no housing, jobs, money, or followup by a professional case manager. In a short time, these homeless are back on the street. Laura’s Law could be invoked for those who refuse medication because their illness impairs their ability to make rational decisions, and utilize court-ordered outpatient treatment and provide for a 180 day case-managed followup.
Laura’s Law cannot be used to forcibly medicate people. Forced medication can – and should – only happen in a licensed hospital. It is about prioritizing highest-need patients and the monitoring and case management that accompanies those patients under the law so that they have the support to stay on their treatment plan, which may include medication.
An estimated 3.6 million Americans suffer from untreated severe bipolar disorder or schizophrenia. Oftentimes, they are too ill to recognize their own need for treatment. AOT does not take away someone’s civil rights. Severe mental illness, not its treatment, restricts civil liberties. By assuring timely and effective intervention for the disabling medical condition of severe mental illness, AOT restores the capacity to exercise civil liberties and reduces the likelihood of the loss of liberty or life as a result of arrest, incarceration, hospitalization, victimization, suicide, and other common outcomes of non-treatment.
While we as a society must safeguard the civil rights of the unfortunate, we also have an obligation to care for those who are unable to care for themselves. Laura’s Law provides such safeguards.
San Francisco has stuck its big toe in the water with a pilot project. Now is the time to take the plunge and implement Laura’s Law.