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Orange County might adopt a law that is “better” than the state’s Laura’s Law, Supervisor John Moorlach said of efforts to treat the small number of the county’s homeless who are severely mentally ill.
Moorlach offered his comments in an interview Friday after more than three hours of presentations to a special county commission. More than 100 people attended.
At Moorlach’s request, the Board of Supervisors had referred the matter to the Commission on Ending Homelessness by 2020 after Fullerton police officers beat Kelly Thomas, a transient who suffered from severe schizophrenia. Thomas died July 10, five days after the beating.
“Maybe we can do something better than Laura’s Law in Orange County,” said Moorlach, who under the normal rotation will become chairman of the Board of Supervisors next year.
The commission will advise the Board of Supervisors on whether it should adopt the state law on outpatient treatment for those with acute mental illness but refuse medical care. Moorlach is chairman of the commission, which will meet again in January to continue discussing the issue.
Laura’s Law creates a system of outpatient treatment for those with severe mental illness who have resisted seeking help or taking prescribed medicines. In the case of those most resistant, courts can order an outpatient treatment program.
Known as the “black robe effect,” the court-ordered treatment was included in the law as a way to add clout behind efforts to persuade those most reluctant to seek treatment. The law stops short, however, of allowing forced medication of patients.
Laura’s Law went into effect in 2003, but it was written so each county must individually adopt it. Only Nevada County has fully enacted the law, a requirement of a legal settlement. Los Angeles County is running a pilot program.
The state law is due to expire in 2013. A previous expiration date was extended by the state Legislature.
Whose Rights Are Most Important?
At Friday’s Homeless Commission hearing, supporters and opponents of the law echoed arguments that have been made since the mid-1990s, when the state Legislature first began considering a law to help severely mentally ill people without violating their rights.
County mental health officials emphasized costs at Friday’s meeting, and Ron Thomas, father of Kelly Thomas, reacted: “What I hear a lot is money. It’s always about the money. … Let’s start taking care of some of the people.”
Those in favor of the law, primarily parents or siblings of adults with severe mental illness, recounted events in which current law kept them from coming to the aid of their relatives.
“God dammit, I want people to be mad like I was,” said Jennifer Hoff. Her mentally ill son turned 18 in March and now is living on the streets in Santa Ana because he’s not taking prescribed medications, she said. Current law prevents her from getting help for her son, she complained.
Once someone turns 18, they may make their own medical decisions. One of the most challenging effects of schizophrenia and some other illnesses is that those who are seriously ill have no sense there is anything wrong. They frequently refuse to take medications.
Federal privacy laws and existing state laws make it difficult for parents, relatives or friends to work with doctors on behalf of the ailing adult, speakers said.
But advocates for the rights of mentally ill people worry that new laws or local adoption of Laura’s Law could mean mentally ill adults will receive treatment against their will, even if forced medication isn’t allowed.
“My body belongs to me,” said Charmaine Asher. Laura’s Law is “a slippery slope of civil rights violations,” she said.
In an effort to protect those rights, Laura’s Law requires that the person have a history of not complying with prescribed medical treatment. That failure must have been a factor in the adult being sent to a hospital, prison or jail at least twice within the past 36 months.
The law also stipulates that if the mentally ill person wasn’t in jail or hospitalized, he or she must have threatened or attempted serious violent behavior to themselves or others within the past four years.
The person also must have been offered the chance to voluntarily participate in a local treatment plan but continued to refuse, according to the law. Conditions must also be deteriorating “substantially” and require outpatient treatment to prevent persons becoming a danger to themselves or others or unable to care for themselves.
In addition, they must be found to be likely to benefit from the outpatient treatment.
County mental health officials did not go into much detail about how a locally adopted program might work. Most of the discussion involved costs and whether such a program would qualify for state mental health bond funds. Nevada and Los Angeles counties are using state money for their programs.
Nevada County officials have said Laura’s Law saved taxpayers money, mainly because the costs of housing mentally ill people in jails and treating them in emergency rooms were substantially reduced after the county’s adoption of Laura’s Law.
Despite Nevada County’s experience, Orange County officials made no mention of savings, only potential increased costs and other difficulties.
Supporters of Laura’s Law say Orange County officials are reluctant to implement it because, once a treatment plan is approved by the courts, judges would hold the county accountable for following through and providing the treatment as well as keeping in contact with the patient.
The reliability of Orange County’s estimates is uncertain. In October, Orange County mental health officials estimated Laura’s Law would cost $6.1 million a year to care for about 120 patients.
Officials in San Diego County, which is almost identical to Orange County in population, say they could handle nearly five times as many severely mentally ill adults at about one-third of Orange County’s cost estimate.