Orange County on Tuesday became the first large county in California to adopt a controversial law that allows court-ordered outpatient treatment of adults with severe mental illnesses.
Following an outpouring of emotional testimony, mostly in support of the measure, the five county supervisors voted unanimously to adopt Laura’s Law.
“We cannot allow our jails to be the predominant location” for housing mentally ill people, said Supervisor John Moorlach, who has been a strong advocate of the law.
“We have an obligation to do whatever we can to assist those who really have no remedy,” said Supervisor Todd Spitzer. “They don’t know how to help themselves.”
The issue drew strong opinions from the 18 speakers who addressed the board.
“Through your yes vote, lives will be saved, and the quality of lives enhanced,” said Steve Pittman, president of the National Alliance on Mental Illness’s affiliate in Orange County.
Opponents questioned the very notion of court-ordered outpatient treatment, saying it would violate people’s freedom to make decisions about their own medical care.
“As a civil libertarian my red flags start to go up,” said Richard Krzyzanowski of the California Association of Mental Health Peer Run Organizations. “This is is a slippery slope that I jealously want to guard.”
Spitzer said those liberties do have limits.
“You don’t have your liberty when you can’t control your own person,” said Spitzer.
“When you are not in control of your destiny, society has obligations,” he added.
Laura’s Law, which is set to be implemented in October, will apply to severely mentally ill adults who've had two psychiatric hospitalizations or incarcerations in the past two years and engaged in violence or attempted violence over the last four years.
They must also be unlikely to safely survive in the community without supervision and their condition must be “substantially deteriorating.”
If all of those conditions exist, immediate family members, law enforcement officers or medical professionals could ask the court to order these individuals to receive medical treatment on an outpatient basis. If a person refuses, there are no civil or criminal penalties.
The purpose, according to supporters of Laura’s Law, is to employ a “black robe effect,” using the courts to help convince severely mentally adults they need medical treatment.
Most of the residents who spoke Tuesday pleaded for the law’s adoption.
Carla Jacobs, whose mentally ill sister-in-law couldn’t get treatment and later killed her mother, said assisted outpatient treatment has been studied extensively in the United States, with largely positive results.
“It reduces hospitalization. It reduces homelessness. It reduces more importantly, human tragedy,” said Jacobs, who was a co-author of Laura’s Law when it was approved by the legislature in 2002.
She thanked supervisors for “giving Orange County the chance to save lives.
Richard McCaunghy, who chairs the county’s Mental Health Board, also supported its adoption.
“I think this is a potentially very cost effective program,” said McCaunghy. “And it’s humane. I urge you to vote in favor of it.”
Other speakers argued that Laura’s Law is unjust and unnecessary given the other treatment programs that already exist.
“This program risks renewing trauma and driving people away from mental health services altogether,” said Ann Menauche, an attorney with Disability Rights California.
The 2011 Fullerton police beating death of Kelly Thomas sparked the recent push for Laura’s Law.
Thomas’ father said his son did well when he was took his medication, but “spiraled” when he stopped.
Ron Thomas urged supervisors to adopt the new law, which he said could have helped stabilize his son.
“He may not have even been in Fullerton, if Laura’s Law was here,” he said.
One county supervisor, meanwhile, opened up about the difficulty that mental health issues presented to his family.
Spitzer said one of his cousins developed schizophrenia as an adult and revolved in and out of the criminal justice system.
“I watched it just grind away at my uncle Rick,” said Spitzer.
That type of impact on family members should be given thoughtful consideration, he said.
“We have to deal with the guilt and the frustration and the obstacles that the families are dealing with, because they’re watching their loved ones deteriorate,” said Spitzer.
Additionally, supervisors emphasized the importance of monitoring data on how well the new program works in tackling homelessness, incarceration, hospitalization and other issues.
“We need to have strong performance metrics in this program so we know we’ll have outcomes like Ms. Dolan,” said Supervisor Pat Bates, referring to a speaker who said she improved dramatically in treatment.
County staff said they’ll be required to collect data, like the number of days prior to and after the program that person is incarcerated, hospitalized or employed.
County officials also plan to have a university or other research organization gather and analyze the data.
Orange County, the third largest in California, is the biggest county to adopt Laura's Law, which went into effect in 2003. Until Tuesday, only Nevada County was using the law.
While Orange County supervisors focused on the importance of metrics for Laura’s Law, it’s unclear how often they review data for the more than $140 million in mental health programs already funded by the county each year.
After they approved Laura’s Law, county supervisors adopted a series of contracts and plans surrounding mental health issues without any discussion of data.
The approvals included more than $35 million in contracts for mental health services and a three-year, $428 million spending plan for mental health taxes.