Mark Refowitz, the Orange County director of mental health programs, on Jan. 27 proposed general outlines for a local program to treat those with the most severe mental illnesses.

The pilot program would include teams to work with severely mentally ill adults, support for their families and immediate shelter for needy individuals while they are being evaluated.

It would be aimed at the same group of severely mentally ill and hard-to-reach adults as Laura’s Law. But it drops the key section of Laura’s Law that allows a judge to order outpatient treatment for an adult who is severely ill and refuses medication.

Refowitz did not provide much more specifics during his presentation to the Commission to End Homelessness, but he made it clear that implementing Laura’s Law in Orange County is off the table.

Reforwitz said the county’s lawyers advised him it wasn’t legal to use state funds to fully implement Laura’s Law, which is designed to help those with serious mental illness, because of the provision allowing courts to order outpatient treatments.

The law permits a court to act if an adult with a history of not complying with necessary mental health treatment refuses to voluntarily cooperate with medical professionals. The patient also must be unlikely to survive without treatment.

The issue has been in the spotlight since last summer, when Fullerton police officers beat to death Kelly Thomas, a homeless transient who had been diagnosed with severe schizophrenia.

This month, Iraq War veteran Itzcoatl “Izzy” Ocampo, 23, of Yorba Linda, was arrested on suspicion that he is the serial killer who stabbed to death four homeless men in North Orange County. Ocampo, whose father is homeless, reportedly suffers from psychological problems.

Advocates for adults with severe mental illness have urged the Board of Supervisors to adopt Laura’s Law, which was enacted in 2003 but requires each county to individually authorize its use.

But in October, county health officials gave the board a highly negative report on Laura’s Law stating that it would cost $5.7 million to $6.1 million a year to implement and would apply to only about 120 severely mentally ill adults.

Refowitz said Friday the county counsel reported that “due to the involuntary nature of the [Laura’s Law] program,” money from a later law that provides funds for other local mental health projects couldn’t be used to finance implementation of Laura’s Law.

Backers of Laura’s Law contend the opportunity to seek a judge’s order for the sickest and most resistant patients is critical to reaching those who adamantly refuse medication.

Many patients in those cases don’t believe there is anything wrong with them. But he possibility of facing a judge — the so-called “black robe effect” — can persuade seriously ill adults to begin voluntary treatment, say advocates of Laura’s Law.

Refowitz said his proposal would be entirely voluntary with no court option. He also suggested consideration of conservatorships as part of a pilot program. Refowitz is to provide more specifics at the commission’s March meeting.

The commission is discussing Laura’s Law and its alternatives because mental illness is a significant cause of homelessness.

During public comments, advocates for the homeless urged the commission to get to work on specifics for ending homelessness.

“We need a sense of urgency here,” said Cathleen Murphy, executive director of iHOPE, which helps those who are homeless in San Clemente.


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