Tribune special report

Treatment for the mentally ill — is there a hole in the system?

Recent local killings have focused attention on a law that allows counties to force dangerously unstable people to get treatment and take their medications — but there’s disagreement about whether SLO County should participate

nwilson@thetribunenews.comJune 3, 2012 


Last month, 36-year-old Paso Robles resident Sunni Jackson was arrested and charged with stabbing and beating her 61-year-old mother to death. She was later found mentally incompetent to stand trial.

Some advocates of Laura’s Law say that if the county had enacted the legislation here, Jackson’s mother, Earlene Grove, never would have died. And, they add, the costly criminal justice expense to the state in housing, treating and prosecuting Jackson, particularly if she returns to competency, could have been avoided.

Because of Jackson’s history of run-ins with authorities for mental health-related outbursts and criminal arrests, under Laura’s Law she could have been ordered to undergo assisted outpatient treatment or required to take anti-psychotic medications.

The case against Jackson marked the third murder in the county in less than a year and the fifth since 2010 involving a suspect with mental illness.

Other local murders involving psychotic suspects include John Woody’s alleged brutal stabbing of a stranger in a Paso Robles laundromat in March 2011 and the double homicide committed by schizophrenic Andrew Downs in Santa Margarita on Christmas Day 2010. Downs was ultimately found not guilty by reason of insanity after a jury trial.

Downs had been “cheeking,” or pretending to take his medication, which worsened his symptoms, according to a county probation report that cited the observations of a health specialist.

County mental health officials say they’ve considered Laura’s Law carefully, making it the focus of a county mental health board meeting last year. The board is a state-mandated body, including 16 county residents, that advises the Board of Supervisors. But the mental health board decided against recommending it to supervisors for enactment — citing concerns that include costs and patients’ rights.

“The many programs and services we already have are showing really good results,” said Karen Baylor, the county’s mental health director. “Research has shown that forcing people into treatment isn’t effective.”

Roger Gambs, an Atascadero resident and Cal Poly professor emeritus in biology, is a Laura’s Law advocate who tried desperately to keep a family member with mental illness on track for more than 20 years, including psychiatric therapy.

But the relative’s behavioral problems led to hospitalization at Atascadero State Hospital stemming from a court case involving threats to family members after refusing treatment; the family member pleaded not guilty by reason of insanity.

After returning to the family home for a year after his release, the relative decided to move away. The last that Gambs heard, the person had been arrested again in Colorado.

“Had Laura’s Law been available in our county, I believe that our family member could have had a far better opportunity to live well and with dignity in the community,” said Gambs, an active member of the county’s National Alliance on Mental Illness. “Each time someone goes through a major psychotic episode, it seems like there’s a decline in functionality and the worse off they get.”

Laura’s Law

The California Legislature passed Laura’s Law in 2002 after the shooting deaths of 19-year-old mental health worker Laura Wilcox and two other people in 2001. They were killed by a man in Nevada County who refused psychiatric treatment. A similar law exists in New York called Kendra’s Law.

Advocates of the law say it provides a vital mechanism to aid those who’ve repeatedly been hospitalized, jailed or violent — and who don’t want to accept professional help.

Formal recommendations are made for those who might qualify for the program for a judge’s review of the case.

The judge decides if a history of noncompliance with treatment has contributed to at least two hospitalizations or incarcerations within the past 36 months or resulted in one or more acts, attempts of serious threats or violent behavior within the last 48 months. Those who qualify also must have been offered voluntarily treatment.

Judicial orders last six months, though they may be renewed.

Laura’s Law must be enacted by a county’s board of supervisors.

So far, two counties have implemented the law — Nevada County in Northern California and Los Angeles County, where a pilot program exists.

Without it, treatment can’t be forced on individuals with mental illness unless they’ve committed a crime. If they’re considered a danger to themselves or others, or gravely disabled, they can only be placed in a mental health facility in lockdown for 72 hours against their will.

In Nevada County, research has shown that the number of hospital days among participants of Laura’s Law, who had previously been unable to access voluntary community services because of their illness, was reduced by 61 percent and incarceration days dropped by 97 percent.

“We estimate we have saved $1.81 for every $1 we have spent on this program,” wrote Michael Heggarty, Nevada County’s behavioral health coordinator, in a recent report.

Laura’s Law is set to expire at the end of this year statewide, though a bill has been introduced to continue it to 2018.

Limited use

The reasons more counties haven’t enacted the law are largely tied to massive cutbacks in the state budget and questions about its effectiveness in light of existing programs. Also, the law prohibits diverting funding from existing voluntary treatment programs to Laura’s Law.

But Carla Jacobs, a national mental health advocate of Laura’s Law and former director of California’s National Alliance for Mental Health, says it’s too costly not to fund the program. And creative budgeting can make it work, she added.

“Laura’s Law reduces the most expensive form of treatment: hospitalizations and jailings,” Jacobs said. “Counties are paying for it through the tragedies that happen because they do not give the most sick amongst us the help that could keep them well.”

Jacobs said the program likely would take about a year to set up in the county. The law hasn’t been extended yet, but she said “these sort of extensions occur in many pieces of legislation.”

“It would hurt nothing right now for the board to pass a resolution to implement if the legislation is extended,” Jacobs said. “They actually could advocate for that extension if they wanted to help the most severely mentally ill people in SLO County and their families.”

Though some counties’ lawyers, such as in Orange County, have opined that state Mental Health Services Act funds can’t be used toward Laura’s Law, health advocates disagree and note they’re already being used by Nevada and Los Angeles counties.

MHSA funds are allowable for any county that enacts the law, according to the websites of the Mental Illness Policy Org think tank and the nonprofit Treatment Advocacy Center.

San Luis Obispo County expects to receive about $6 million in MHSA funds in the fiscal year beginning July 1.

But the advisory committee that gives input on how to spend MHSA funding in 2012-2013 has recommended divvying up the anticipated $6 million to several programs it believes are effective — a list that doesn’t include Laura’s Law.

Those programs offer psychological therapy and case management services including academic, housing and life skills assistance. Programs target numerous groups, including children, adults, the homeless, Spanish speakers and seniors.

Under the proposal, outreach workers also would work with homeless people in encampments, shelters and on the streets to point them toward possible health care and treatment services and follow up on their progress.

County perspective

The county’s mental health board recommended against pursuing Laura’s Law, and it has never come to a vote by the Board of Supervisors.

County Supervisor Jim Patterson said he attended a county mental health board meeting on Feb. 16, 2011, that included concerned family members of adults with mental illness.

“The feeling was that it (Laura’s Law) wasn’t necessarily the best solution,” Patterson said. “A number of people in the profession spoke against the adoption of Laura’s Law and in favor of programs that they felt were better.”

Patterson said he deferred to the opinions of the experts about what programs work best (they’ve cited transitional housing and outreach coordination among them), but remains open to considering Laura’s Law in the future.

Baylor recently cited costs to implement Laura’s Law locally to be about $500,000 to $800,000 annually, saying that intensive assistance for individuals is expensive.

That cost estimate was questioned, however, by D.J. Jaffe, a national mental health treatment advocate and founder of Mental Illness Policy Org, who said “the services currently serving voluntary patients may be used to serve involuntary patients.”

Baylor also contends that the law impinges on patients’ rights by forcing people into treatment. The effectiveness of other programs and their success stories typically don’t make the news, Baylor said.

“People can’t be forced into treatment who don’t want to be in treatment,” Baylor said. “Many of our programs implement strategies of wellness, recovery, and help families to navigate the system.”

What is Laura’s Law?

The Legislature passed Laura’s Law in 2002 in the wake of the shooting death of 19-year-old Laura Wilcox and two other people in Nevada County in 2001 by a man suffering from mental illness.

The law allows court-ordered treatment and forced anti-psychotic medication for people with severe mental illnesses and a history of hospitalizations, criminal arrests, and threatening and violent behavior. Those who qualify have refused treatment because of an inability to make rational decisions.

Each county’s Board of Supervisors must pass the state law for enactment. So far, Nevada County in Northern California has enacted the legislation, and Los Angeles County has a pilot program.

The law expires at the end of this year. But Assemblyman Michael Allen, D-Santa Rosa, has introduced legislation to extend it through 2018. If the law expires, it will end throughout California. The legislation already was extended once, from 2008 to 2013.

SLO County offers various services

San Luis Obispo County has a number of programs available to assist the mentally ill. Among them are:

Transitional housing: Serves disabled single adult residents of the county or the potentially homeless. The goal for all program residents is successful independent living within 12 to 24 months.

County behavior court program: Allows criminal offenders with a mental condition to voluntarily sign a contract to comply with requirements as part of probation. Typically they must not use drugs or alcohol, they must regularly take medication, and they must attend assigned court meetings with a judge for 12 to 18 months.

Forensic re-entry: County Mental Health Department officials meet with inmates in County Jail to identify goals and objectives upon release. The program helps connect them with community services to live stably after re-entering the community.

Crisis intervention training for law enforcement: Provides police personnel the insight into the needs of the mentally ill and how they can effectively and safely deal with people in crisis.

Jeff Hamm, director of the county’s Public Health Department, said the current budget climate isn’t good for advancing initiatives that carry a price tag. And he noted that some people in treatment fall through the cracks.

“Some of the folks who have found themselves in the news were in various forms of treatment,” Hamm said. “Sometimes it’s folks who already were in treatment who fall off the wagon.”

The county also has sought to promote the message to families of getting help for anyone who needs it, particularly through its SLO the Stigma campaign, which included documentary screenings about mental illness and community outreach. For those families who may be embarrassed to seek help for a relative, the message is to be brave, not afraid.

“The worst possible outcome is that stigma and fear should keep anyone from getting treatment,” said Jill Bolster-White, executive director of the local nonprofit Transitions-Mental Health Association.

Atascadero resident Diane O’Neil said her son, Gregory O’Neil, suffered from severe bipolar disorder for more than two decades and was hospitalized 27 times before he died of a heart attack at age 40 in 2002.

Diane O’Neil — who has been closely involved with the National Alliance on Mental Illness — said she initially felt shame and embarrassment when her son experienced his first manic episode at 17. That caused her to blame herself and keep her son’s illness quiet.

“I didn’t want to tell anyone,” O’Neil said. “I now know that getting help is very, very important.”

She sought medical support for her son shortly after his first incident at 17 after conferring with a doctor, but it took her six years to open up and talk with others about her struggles.

Her son’s manic episodes involved speaking unintelligibly, acting as if he were all-knowing and wildly spending money. He once spontaneously married a woman in Las Vegas.

Yet O’Neil said with proper treatment her son was able to function at a high level and graduate from UCLA with a degree in computer science in five years.

O’Neil — who supports Laura’s Law — has talked to many groups about her son’s story to help break a stigma she says hurts some families in dealing with mental illness. “What helped me was meeting other people in the same situation that I was in,” O’Neil said. “It moved me from being a victim to an advocate.”

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