Staff Issues Critical Report on Enacting Laura’s Law

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Orange County CEO Tom Mauk at a county Board of Supervisors meeting. (Photo by: Violeta Vaqueiro)

Monday, Oct. 17, 2011 | Orange County health officials have issued a highly negative report on the possibilities of using Laura's Law, a California statute aimed at providing treatment for severely mentally ill adults.

Among other issues, the report, given to members of the Orange County Board of Supervisors Oct. 14, noted that no state money was provided when the law was enacted in 2003 and stated "it is doubtful" the county could use money from later legislation.

In addition, it said local programs put into effect in the years since Laura's Law was enacted duplicate or are better than portions of the law.

The report estimated only about 120 severely mentally ill adults would need treatment each year under Laura's Law but estimated it would cost $5.7 million to $6.1 million a year for the county's Health Care Agency, public defender, and county counsel to implement the program.

"As a result," the report reads, "funds for the program would very likely have to come from a general fund budget augmentation."

The Board of Supervisors requested the report in August after the death of severely mentally ill transient Kelly Thomas, who died after being beaten by Fullerton police officers. No date has been set for discussion of the report by the supervisors.

Nevada County, which is much smaller than Orange County, is using state funds to run its Laura's Law program, and Los Angeles County, which operates a pilot program for portions of the law, also uses state funds.

Backers of the law immediately expressed disappointment with Friday's report and pointed to what they said were factual errors, including the section on how it could be financed.

And the report didn't mention potential cost savings that supporters of the law say would result if the law was implemented. Officials in Nevada County have said it created substantial county savings in jail and emergency room costs.

"It's really surprising given the things that have gone on in Orange County that there appears to be the lack of will to make the small changes to help the small number of people with that kind of mental illness," said Kristina Ragostak, legislative and policy counsel for the Treatment Advocacy Center, a national organization that supports laws to help treat people with severe mental illnesses.

Carla Jacobs of Tustin, a Treatment Advocacy Center board member, has been trying to get statewide treatment for those who are severely mentally ill since 1990, when her sister-in-law, Elizabeth Jacobs of Anaheim, stabbed and shot her 78-year-old mother.

The family had worked without success to get treatment for Jacobs, who was schizophrenic. A section of Laura's Law allows family members who see a relative deteriorating to seek help.

"It appears as if a lot of it [the Health Care Agency report] is based on old documents that aren't up-to-date with the funding situation," said Jacobs.

"I'm hoping the Board of Supervisors will recognize their responsibility to cut through the bureaucratic gobbledegook and do the right thing," she added.

The report offers the supervisors three options: implement Laura's Law, don't implement it or "implement a pilot program of voluntary outpatient services" that includes portions of Laura's Law and qualifies for state financing.

"I think our report was pretty straightforward," said Mark Refowitz, the Health Care Agency's deputy director of the behavioral health department. "It talked about the strengths and weaknesses of the law."

Help for Most Severe Cases

Laura's Law is similar to New York's Kendra's Law, which serves about 1,000 patients statewide each year. The California law was named for Laura Wilcox, who was killed by a mental patient in Nevada County.

Among other things, it allows the courts to order involuntary outpatient treatment to those over 18 who are severely mentally ill, refuse treatment and appear to be a danger to themselves or to be deteriorating dangerously.

A list of strict guidelines must be met for a patient to be locked up for involuntary treatment, but supporters say just getting those with severe mental illness to speak with health providers and be offered services — possibly under threat of forced medication — can encourage some adults to accept treatment on their own.

To take effect in any county, Laura's Law requires that county's board of supervisors to adopt it. So far, only Nevada County has done so, and that was a condition of settling a lawsuit.

The Health Care Agency in it's 12-page report stated that in the years after Laura's Law was enacted, the county created a number of other programs to help those with mental illness and spends about $45 million a year on such services.

The report described in general terms a series of outreach programs but didn't discuss one key issue: How does the county currently reach and treat the 120 or so adults who are severely mentally ill and resistant to treatment?

Those adults often don't believe there is anything wrong with them and refuse help. They also stop taking medications because of side effects.

This is the group that would benefit most from Laura's Law, supporters argue.

Kelly Thomas suffered from severe schizophrenia and resisted taking medications, according to his father, Ron Thomas. His son lived on the streets of north Orange County, including the parking lot of the Fullerton bus terminal, where the fatal police beating occurred.

Jacobs noted that news reports about Scott Evans Dekraai, accused of fatally shooting his ex-wife and seven others at a Seal Beach beauty salon, said he was taking medication for mental illness.

One major section of Laura's Law gives families the ability to seek medical help when they see a relative deteriorating. But the county report indicated federal privacy laws might prevent families from helping with a patient's treatment after the initial report is made.

In addition, significant opposition has developed in the past from civil liberties organizations opposed to involuntary treatment of mental illness.

"While many family members and other advocates have sought to have the program implemented," the report said, "it has met with opposition from clients, service providers, advocates and disability rights attorneys."

The report also noted Laura's Law is set to expire at the end of 2012 unless it is extended by the Legislature. In the past, the Legislature has extended it.

The Nevada County Experience

Michael Heggarty, director of Nevada County's behavioral health department, said last month that although the county has a population of only 100,000, the program, in effect since 2008, has saved $500,000, mostly in reduced jail and hospital costs.

"This isn't forced treatment," he said. "This is court-ordered treatment. They [patients] can turn around and walk out the door if they don't want to do it, and some of them do. It's not successful with everyone."

He said the county had no increased court costs because it has 32 people undergoing treatment as part of Laura's Law but only one had to be ordered to do so by a judge.

"In our experience, assisted outpatient treatment has been a very helpful tool," he said.

Please contact Tracy Wood directly at twood@voiceofoc.org and follow her on Twitter: twitter.com/tracyVOC. And add your voice with a letter to the editor.

 

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