A cautious Orange County Board of Supervisors is scheduled today to decide whether Orange will be the first large California county to adopt Laura’s Law, authorizing court-ordered outpatient treatment of severely mentally ill adults.
The debate pits two of the state’s largest mental health advocacy groups against each other -- the federal and state grant-financed nonprofit Disability Rights California vs. the medical and pharmaceutical industry funded National Alliance on Mental Illness or NAMI.
Disability Rights California and others argue that Laura's Law infringes on the rights of adults to refuse treatment, while NAMI and its supporters contend some cases of mental illness are so severe that medications are a necessity.
In the middle, according to advocates on both sides, are families of severely mentally ill adults and the seriously mentally ill adults themselves.
Supervisors generally have supported attempts to bring Laura’s Law to Orange County, but have moved cautiously on the volatile issue at least partly out of fear of lawsuits.
“It’s a very broad, complex and subjective area,” said Supervisor John Moorlach, who has led Orange County efforts to adopt the 12-year-old Laura’s Law. “The issue is, parents are asking for an assist and it just seems we should make it available in those cases where it might be helpful.”
How It Would Work
If supervisors approve county use of Laura’s Law, it would go into effect in October. An estimated 120 adults a year could qualify for the court-ordered, outpatient treatment.
The projected cost would be more than $5.4 million, with roughly $4.4 million in state mental health tax funds and about $1 million more to be allocated later from the county’s general fund. State law prohibits the county from using mental health funds to pay court costs and the public defender’s office for their work on Laura’s Law.
Orange County receives more than $100 million annually in state mental health dollars.
If adopted, Laura’s Law would apply to severely mentally ill county residents 18-years-old or older who've had two psychiatric hospitalizations or incarcerations in the past three years. And, according to the law, in the past four years the actions of these adults would have to result in violence or attempted violence toward themselves or others.
Further, they must 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 mentally ill adult would be represented by a public defender and could challenge the order every two months.
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.
This is needed, supporters say, because one of the most difficult aspects of mental illness is that many patients don’t realize they are mentally ill.
In addition, medicines for treating many severe conditions have significant side effects that cause patients to stop taking them.
Historical Abuses Mean Caution Today
Orange County began looking at adoption of Laura’s Law in 2011, weeks after mentally ill transient Kelly Thomas was beaten to death by Fullerton police.
The California law was named for 19-year-old Laura Wilcox, who was killed in 2001 by a mental patient in Nevada County.
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, said the late Assemblyman Frank Lanterman, R-La Canada, at the time, was to have community clinics treat the long-term patients. But the Legislature never provided the money for the local treatment centers.
Laura’s Law was approved by the 2002 Legislature and went into effect in 2003. But each county had to independently vote to adopt it and up to now, only Nevada County has fully implemented the law. Los Angeles and Yolo Counties have pilot programs underway.
One deterrent to fuller implementation was uncertainty about whether tax funds from Proposition 63, approved by voters in 2004 as the Mental Health Services Act could be used to finance the program. The money comes from a tax on income above $1 million.
Last year, with support from Moorlach and the board of supervisors, the Legislature made it clear the Prop. 63 money could be used for Laura’s Law.
Opposing the change, among other groups, was the 36-year-old Disability Rights California, which lobbies and files law suits on behalf of individuals with disabilities, a group with a long history of facing discrimination, including mental health issues.
It argues better law enforcement training, expanded voluntary treatment programs and more state and local community programs are a more appropriate approach than court-ordered, outpatient medical treatment.
On the opposite side is NAMI and its supporters, like Carla Jacobs of Tustin, who was instrumental in helping get Laura’s Law adopted.
Jacobs’ sister-in-law, Elizabeth Jacobs, was severely mentally ill but family members couldn’t get treatment for her.
In October 1990, Elizabeth Jacobs 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 Elizabeth 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. "She never received treatment until she murdered her mother."