Come fall, San Luis Obispo County may begin using its power to legally compel a person into mental health treatment should their illness be proven to represent a threat to public safety.
County officials say the law would affect only a small number of people but could prevent a catastrophic tragedy. Patients’ rights advocates, however, are wary of the law and will closely monitor the program that they say has the potential to infringe upon a person’s civil liberties.
On Tuesday, following nearly a year of discussion, the county Board of Supervisors unanimously voted to approve local implementation of Laura’s Law and incorporate the cost into the 2016-17 budget.
Laura’s Law — named after Laura Wilcox, a 19-year-old Nevada County mental health clinician who was shot to death by a man who resisted his family’s attempts to treat his mental illness in 2001 — has been on the books in California since 2003 with individual counties having the discretion to implement it locally. Nine counties have implemented full or pilot versions of the law, according to the county.
Laura’s Law allows a Superior Court judge to order individuals with severe mental illness and a history of arrests or violence to get outpatient mental health treatment. That treatment includes psychiatric counseling and services that may include housing and vocational training.
Officials estimate that approximately 10 to 12 people will qualify under the law every year in San Luis Obispo County.
Since its first report in September, county staff has proposed contracting with Transitions-Mental Health Association to provide the services. The agency already operates a Full Service Partnership program with the county that provides outreach and voluntary treatment. That route will be more cost efficient and effective, according to a staff report.
The cost to the county of implementing Laura’s Law, whittled down significantly since the Board of Supervisors heard the report in September, comes to about $442,000 a year. That figure also includes administrative costs and the cost to hire a full-time administrative services officer and a part-time mental health therapist.
Since Laura’s Law was passed, civil rights and patient rights advocates across the state have raised concerns about court-ordered treatment. However, the law has specific criteria for those it would affect, county Behavior Health Administrator Anne Robin said.
The law is only for individuals with a history of not complying with the terms of treatment, whose mental illness has been a major factor in them being hospitalized or incarcerated at least twice within 36 months of coming before a judge, or whose illness has resulted in one or more acts, attempts, or threats of serious violent behavior within the previous 48 months.
“It’s our responsibility to verify if a person meets that criteria. At each step in the process, a person’s given the opportunity to get treatment voluntarily,” Robin said. “In each step there are safeguards.”
At the court stage, for example, individuals will have representation provided from the county public defender’s office.
There are no automatic consequences if a person doesn’t follow the court order and enter into treatment, said Joe Madsen, a Transitions-Mental Health Association division director who would oversee the program.
“They are looking at Laura’s Law as having the ‘black robe’ effect to entice people into treatment,” Madsen said. “This is not a criminal court. It’s a civil procedure. I think we’re all expecting that people will say yes to the service. … We’re looking forward to the challenge and to the hope that this can offer our hard to reach clients.”
The law, passed by Gov. Gray Davis in 2002, was to sunset in 2013 but was extended by the Legislature through Jan. 1, 2017. Currently, no bill has been entered to the state Legislature to extend the law again, but Robin said county officials are confident the law will again be extended.
“It’s got a life of its own,” Robin said of the state law. “We wouldn’t be doing all this work if we thought it would be up after a few months (of local implementation).”
Pat McConahay, communications director for patient advocacy group Disability Rights California, said the organization is not expressly opposed to Laura’s Law, but finds that voluntary treatment is always preferable to imposing treatment on a person. She said more important than mandating treatment is reducing barriers to and expanding services.
“If you want to get someone into treatment, you have to make those services available and there have to be enough of them,” McConahay said.
A downside to the law, she said, is that it may stigmatize mental illness and perpetuate discrimination. Moreover, some people could be forced into treatment who don’t require it.
“It’s not a perfect world. People do fall through the cracks and mistakes can be made,” McConahay said.
McConahay added that her organization is active on oversight committees in other counties that have enacted Laura’s Law to make sure that scenario doesn’t happen.
County Supervisor Adam Hill, who will sit on a board committee with Supervisor Debbie Arnold to monitor progress of the program, said Friday that there have long been concerns about a small percentage of county residents with untreated mental illnesses who go in and out of the court system with no legal means to get them help.
“It’s meant to prevent tragedies, be it a murder or a suicide. It’s hard to put a monetary value on that,” Hill said. “There are concerns (about forcing somebody into treatment), but ultimately it’s the most compassionate thing we can do for them.”
Hill said the purpose of the local law is not to stigmatize the mentally ill and that the vast majority of people suffering some form of mental illness in the county are not violent and are voluntarily treating their disability.
A spokesperson for the National Alliance on Mental Illness’ San Luis Obispo chapter could not immediately be reached for comment on the law.
Following Tuesday’s vote, the law will proceed to be incorporated into the county’s Behavioral Health Department budget in June. Robin, the county Behavioral Health administrator, said the full program would be up and running by early fall.