"I really feel that if we move forward without full and adequate funding of our mental health system this may be leading to a false hope of safety in our neighborhoods...and I worry that there's a danger of further stigmatizing people with mental illness."
By Lynne Shallcross
The San Francisco Board of Supervisors voted 9-2 Tuesday afternoon to enact Laura's Law, with Supervisors John Avalos and Eric Mar voting no.
It’s been more than a decade since California enacted Laura’s Law, allowing courts to compel mentally ill people into treatment. But that doesn't mean it's in force statewide. It's up to counties to implement the law, and they've been slow. Since the law was passed, just two of California's 58 counties have adopted it -- Orange and Nevada counties -- while Yolo and Los Angeles counties are experimenting with versions of the law.
Supporters of Laura’s Law say it helps assist those who are too ill to realize or accept that they need treatment, while the law’s critics say it risks stripping away a person's civil rights and won’t adequately address the issue of mental health treatment. They say a better approach would be to simply expand the availability of community mental health services.
Laura’s Law was named for Laura Wilcox, who was killed in 2001 by a behavioral health client in Nevada City, a small community northeast of Sacramento. The law allows a family member, roommate, mental health provider, police officer or probation officer to ask the court to order a mentally ill individual into outpatient treatment. The law has clear stipulations: it can apply only to people who have been hospitalized or jailed twice in the previous three years due to mental illness -- or those who have been violent to themselves or others in the previous four years. Additionally, anyone subject to this law must be given the chance to voluntarily enter treatment and then refuse.
Two mental health experts and the politician behind bringing Laura’s Law to San Francisco discussed their differing perspectives on the law on KQED’s Forum Tuesday morning.
Mark Farrell is the San Francisco supervisor, representing District 2, who introduced the proposal to implement Laura's Law. He said that of the more than 40 million Americans who suffer from mental illness, close to 10 million suffer from severe mental illnesses, such as schizophrenia and bipolar disorder — and half of those go untreated.
In San Francisco, Farrell said, about 40 percent of people who are homeless suffer from mental illness. “This is not a panacea to cure homelessness, but it is a tool in a toolbox that we need as a city and county.” Most importantly, he said, the law will help those who are severely mentally ill receive the treatment they deserve.
Farrell points to data from counties in the state that have implemented the law, as well as other states that have similar laws on the books. He said the results show that not only do the laws help mentally ill individuals and their families, but they also alleviate the burden on public safety departments.
John Rouse, a psychiatry professor at UC San Francisco, said the power of the court under Laura’s Law lies in forcing a person back to the hospital for treatment or evaluation.
“The people who have put this into practice have told me that with each patient, they pretty much have to do that once, and at that point, the patient will realize how it works,” Rouse said. “And the next time you say, ‘Look, we really don’t want you to have to go back to the hospital, let’s get you back to the clinic.’ And it usually works from then on.”
But Eduardo Vega, executive director of the Mental Health Association of San Francisco, believes this law misses the mark. Vega said that while his group doesn’t ordinarily oppose a call for expanded mental health services, he said in this case the city needs to do better.
“What we’ve seen, unfortunately, with this particular legislation -- and the reason we’ve opposed it the last two times it came to the Board of Supervisors -- is that there’s a court order attached to what is otherwise a nice frame for intensive services,” Vega said. The court order, he said, works against people’s rights and doesn’t help the therapeutic relationship.
“The one thing I’ve come away with after 25 years of working with people with the most serious psychiatric issues is that when you approach people in the spirit of human kindness, with genuine outreach and positive engagement, you can make progress with them,” Vega said. “When you approach people with a stick behind your back, or a threat to their dignity and to their self-determination, that relationship is not the same and it never will be.”
The Forum guests could not even agree on the data surrounding the impact of legislation like Laura’s Law. Vega said that no study has been able to show that a court order alone makes a difference in whether mentally ill people engage successfully with treatment.
Rouse, on the other hand, pointed to data from New York, which has a similar law called Kendra’s Law. The data there, Rouse said, indicates that people who were ordered into treatment had no greater sense of coercion and in fact felt more “connected” to their treatment, including greater attachment to case managers and sense of participation in their own treatment.