Tom Anderson can’t understand why Orange and other California counties remain reluctant to adopt Laura’s Law, the state measure that creates a system of outpatient treatment for adults who are severely mentally ill.

“It’s a very effective tool that has proven to save lives … and save and ease a burden on service providers,” said Anderson, the Superior Court judge in charge of Nevada County’s program, the only fully operational implementation of Laura’s Law in the state.

“And it saves tons of money,” he added.

Anderson’s comments followed a panel discussion Tuesday in Huntington Beach among leading supporters and opponents of the 8-year-old law. The discussion was part of the Behavioral Health Symposium sponsored by the California Hospital Association.

The issue of adopting Laura’s Law in Orange County originated last summer after mentally ill transient Kelly Thomas was beaten by six Fullerton police officers and died.

In October, Orange County’s Health Care Agency issued a highly negative report on Laura’s Law after members of the Board of Supervisors expressed interest in learning more about it.

The Orange County Commission to End Homelessness by 2020 is studying Laura’s Law and may make recommendations about it to the supervisors.

Hospitals face treatment and financial issues caused by uninsured, seriously mentally ill patients who appear again and again in emergency rooms, according to hospital representatives.

Anderson said that one result of Nevada County’s adoption of Laura’s Law in 2008 was to substantially reduce the numbers of emergency room visits and jail sentences. County jails have become major treatment centers for mentally ill adults.

As part of a legal settlement, Nevada County adopted Laura’s Law, named for a woman who was killed there by a severely mentally ill man.

“We’re a beta,” he said of the small county’s groundbreaking work. Asked why large counties, including Orange, don’t study the Nevada County experience as a pilot program, he replied, “It boggles me.”

Part of the reason, he suggested, for general opposition to Laura’s Law by county health departments statewide is that the courts would hold them accountable for actually providing the treatment they promise.

Some opponents of Laura’s Law have cited conservatorships as a better alternative. Conservatorships give parents or others who care for severely mentally ill adults the legal authority to determine their care, including treatment in a locked medical facility and drugs to treat their behavior.

But it intentionally is difficult to obtain court agreement to conservatorships, said one panel member. Greg Knoll, executive director and chief counsel for the Legal Aid Society of San Diego and an opponent of Laura’s Law, said California’s mental health history contains “a lot of horrific stories.”

A change in state law in 1972, Knoll said, plus other legal actions, now “make it very difficult” to force someone who is mentally ill into “protective care” or conservatorship. That, said Knoll, is “as it should be.”

“I don’t think you’re going to want to make that pendulum go back again,” he said.

Only a small number of mentally ill adults have an illness severe enough to require treatment under Laura’s Law, according to those who support it.  Officials have estimated that about 120 people in Orange County would qualify.

Typically, these are people who refuse medications or other treatment, and because of schizophrenia or other illnesses, they often don’t believe there is anything wrong with them.

Anderson said that if the situation reaches the point where a patient is referred to his court, an attorney is provided and the patient participates in the treatment discussions.

And before a formal hearing is held, he said, the patient with his or her lawyer participates in an informal meeting with the judge and the county medical staff who are recommending treatment.

The list of items on the treatment proposal — doctor visits, medications and others — are presented to the patient, who can tell the judge which ones he or she is willing to use without a formal court order.

Anderson said he will approve that type of initial step “and see how it goes.” The advantage, he said, is “mutual accountability.” Both the patient and those providing treatment are required to report back.

He said severely ill patients may need the likelihood of a court order before they will agree to initial treatment. Once they feel they are being approached with respect and are participating in treatment decisions, they generally go along, he added.

“Just coming into court” means “you can have very frank conversations,” said Anderson. Patients are free to say “I don’t agree with the diagnosis” and “I’m willing to do this, this and this,” he said.

“If you get them involved,” said Anderson, “you’re already on the road.”

Correction: Tom Anderson was misidentified in a previous version of this story. We regret the error.

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