Second of two parts. Read part one here.

Wednesday, Sept. 7, 2011 | For years Elizabeth Jacobs’ family tried in vain to get treatment for her increasingly serious schizophrenia.

Then on in October 1990, Jacobs, who called herself Victoria Madeira, dressed in military fatigues, took a taxi from her Anaheim home to La Canada Flintridge, then stabbed and shot her 78-year-old mother while the woman was pleading for help on the telephone with sheriff’s deputies.

The 43-year-old Jacobs was found mentally incompetent to stand trial for the murder and was sent to a state mental hospital. She remains in one today.

“We tried everything to get her help,” said Carla Jacobs, her sister-in-law who lives in Tustin. “She never received treatment until she murdered her mother.”

After the murder, Carla Jacobs began a 12-year effort to lobby the state Legislature for a law that would help keep a similar tragedy from happening to another family.

Carla Jacobs achieved some success in 2003 with the passage of Laura’s Law, which allows counties to provide special voluntary and court-ordered outpatient treatment for the severely mentally ill. But there had been several more violent deaths at the hands of seriously mentally ill people and lobbying by families of their victims before the law was enacted.

Since its passage, however, Laura’s Law has been fully implemented by only Nevada County, and that was to settle a lawsuit after three workers — including 19-year-old Laura Wilcox, the law’s namesake — were shot and killed in 2001 in a Nevada County public mental health clinic by a patient, Scott Thorpe.

This month in response to the beating death of schizophrenic transient Kelly Thomas by Fullerton police, Orange County supervisors will discuss implementing the law.

A Tortured History

The story of Laura’s Law is another layer of California’s tortured and ultimately unsuccessful effort to deal effectively with severely mentally ill people who can’t or won’t seek medical help. They constitute as much as 40 percent of the state’s homeless population.

There have been concerted efforts to deal with the issue, including voter approval in 2004 of Proposition 63, which provides funds for mental health treatment, including the requirements of Laura’s Law.

Yet overcrowded county jails and state prisons have become California’s de facto mental hospitals. By 2008, according to a report by National Public Radio, the largest mental hospital in the United States, with 1,400 patients on an average day, was the Los Angeles County Twin Towers Jail.

The U.S. Supreme Court this spring ordered California to dramatically reduce its prison overcrowding, partly because mentally ill prisoners were being denied treatment.

Until the late 1960s, California, like many states, operated a series of large mental hospitals for long-term care of adults with serious mental disabilities.

In 1967, the Legislature passed and Gov. Ronald Reagan signed the Lanterman-Petris-Short Act, ending involuntary, indefinite commitment of mental patients to institutions in California. The state was leading a national trend away from locking up for years people with mental illnesses.

The idea, the late Assemblyman Frank Lanterman (R-La Canada) said at the time, was to have community clinics treat the long-term patients. But local treatment centers statewide never materialized.

Among the people Carla Jacobs contacted when she took up her cause was then-Assemblywoman Helen Thomson (D-Davis), who as chair of the Assembly Health Committee was involved with mental health issues. Thomson introduced a bill in 2000 that would allow courts to order treatment for adults with a demonstrated history of severe mental illness.

But court-ordered mental health treatment is also a major personal rights issue. Opponents fear that courts would order psychiatric treatment for people who simply are eccentric or an inconvenience to their relatives.

Thomson said it took three years for the bill to clear the Legislature and be signed by then-Gov. Gray Davis. “Oh, my God,” she said, “it was a major fight.”

She said that at each hearing, a large group of demonstrators picketed the Capitol wearing T-shirts with a photo of nurse Mildred Ratched, the villain of the 1962 novel and 1975 movie “One Flew Over the Cuckoo’s Nest.”

The major obstacle to the bill, said Thomson, “was people who believe if someone is mentally ill, they ought to be able to willingly and knowingly” ask for help.

Severe schizophrenia is one of the disorders that can seriously affect a patient’s judgment without their realizing it, said Dr. Anthony F. Lehman, chairman of the Department of Psychiatry at the University of Maryland School of Medicine.

Some who are seriously schizophrenic may hear voices or believe someone or some group is spying on them.

“Obviously, if someone doesn’t believe they have an illness ,why would they take their medicine?” said Lehman.

Treatment for such seriously ill patients, he said, requires “really skilled outreach teams” who can talk to frightened, disoriented, frequently homeless adults and gain their trust.

Thomson said Laura’s Law was written as carefully as possible to protect mentally ill adults’ rights should courts require them to seek specially designed treatment.

Each county had to independently decide whether to implement the new law, but no state money was provided to pay for it.

The California measure was patterned after New York’s 1999 Kendra’s Law, named for Kendra Webdale, who was pushed in front of an oncoming subway train and killed. The man who pushed her, Andrew Goldstein, 29, was mentally ill but not taking medication. Unlike California, New York included financing in its law, which was immediately implemented throughout the state.

The Nevada Experience

When the families of those killed in Nevada County worked out a court settlement, Laura Wilcox’s family insisted the county adopt the terms of the new law.

The county agreed reluctantly, but now Michael Heggarty, director of Nevada County’s Behavioral Heath Department, is a strong supporter.

“We had an awful lot of stuff to figure out,” he said, but the county discovered that implementing Laura’s Law was “not more complex than a lot of stuff we do all the time.” And since it was fully established in 2008, he estimated, the program has saved the county about $500,000, mostly in reduced jail and hospital costs.

Presiding Judge Tom Anderson of the Nevada County Superior Court said he strongly supports Laura’s Law. “It boggles me why the whole state isn’t jumping all over this program,” he said.

“The magic of it is the personal outreach,” said Anderson.  Besides saving the county a significant amount of money, those with serious mental illnesses don’t have law enforcement or medical workers “grabbing them and taking them to the emergency room and forcing them to take their [medication],” Anderson said.

Anderson suggested one reason Laura’s Law hasn’t been adopted statewide is that it “makes [county mental health] departments accountable.” They would have to demonstrate to the courts and others that they have “an assisted outpatient treatment program in place.” They can’t simply say they offered a general treatment and the mentally ill person turned it down.

Michael Biasotti, police chief of New Windsor, N.Y., and a strong advocate of laws similar to Laura’s Law, said part of the problem of enacting such laws is politically polarized elected officials.

Those on the extreme right say it’s a “nanny state” solution to severe mental illness, he said, while politicians on the “extreme left” argue it’s a violation of personal privacy.

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