Friday, September 4 , 2015, 12:08 pm | Mostly Cloudy 74.0º




Mental Health Community Taking a Closer Look at Laura’s Law

Assisted outpatient treatment stokes interest of Mental Health Commission but Santa Barbara County's acceptance far from certain

By Lara Cooper, Noozhawk Staff Writer |

Spurred by a Noozhawk series on a Santa Maria family’s ordeal with the local mental health system, murmurs about one possible solution have been building over the last several weeks among mental health advocates.

The remedy is Laura’s Law, a California law enacted in 2002 that proponents say increases the rights of patients who need mental health treatment and the alternatives their families have to secure it.

Laura’s Law was the center of a meaty discussion at Friday’s Santa Barbara County Mental Health Commission meeting. Although the commissioners took no immediate position on the law, they agreed to revisit the topic after they had learned more.

Under the current law, the Lanterman-Petris-Short Act, or LPS for short, patients must present a danger to themselves or others, or be deemed gravely disabled, to be taken in for emergency psychiatric treatment involuntarily. But Laura’s Law revolves around assisted outpatient treatment for people who are unable — or won’t — access mental health services voluntarily. The law was devised in 2001 after the death of Laura Wilcox, a Nevada City social worker who was shot and killed by a mentally ill patient who had refused his family’s attempts to get him help.

Under Laura’s Law, any adult with whom an individual with mental illness resides, as well as a set of other qualified people, can petition the local Superior Court for treatment for the individual. The county mental health director then must conduct an investigation to determine whether the individual qualifies and, if so, the person is placed in a six-month outpatient treatment program.

The assisted outpatient treatment approach relies on both a court order and an intensive community treatment plan. Los Angeles and Nevada counties are the only California counties to have opted in on the law, and Los Angeles County has established a small pilot project with a hospital discharge plan. A similar law — Kendra’s Law — is in place in New York.

Local discussion of Laura’s Law began after Noozhawk published a three-part series on Cliff Detty, a 46-year-old Santa Maria man who died while in restraints and in seclusion earlier this year at the county-run Psychiatric Health Facility. His father, Rich Detty, had reached out repeatedly for help from law enforcement and mental health officials but was denied assistance and information on his son’s paranoid schizophrenia.

Noozhawk checked in with Detty last week for his opinion of Laura’s Law, and whether he thought it would have made a difference in his son’s case.

“If Santa Barbara or San Luis Obispo counties had adopted Laura’s Law, Clifford would most likely be alive today,” Detty told Noozhawk.

He said he was shocked to learn that only two of the state’s 58 counties had adopted the law, and that the only reason Santa Barbara and San Luis Obispo counties hadn’t done so apparently was because of funding.

“Maybe if someone like me sued both counties they might change their minds about Laura’s Law,” Detty said.

Cliff Detty was arrested 17 or 18 times in about eight years, his father said, and “everyone knew he was a mental case.” Detty said authorities at both the Santa Barbara County and San Luis Obispo County jails even went so far as to separate his son from other inmates.

“Once I spoke to a nurse at the SLO County Jail about Clifford and giving him medications,” Detty said. “I was told all they could do was offer him meds, but they could not force him to take them unless it was court-ordered.

“Of course, he didn’t take them because he thought nothing was wrong with him and they were trying to poison him.”

Before Friday’s Mental Health Commission meeting, Noozhawk caught up with mental health advocate Randall Hagar, a member of the LPS Reform Task Force who helped write Laura’s Law. He talked about some of the differences between LPS and assisted outpatient treatment. LPS has a conservatorship process, for instance, prompting some to ask how Laura’s Law differs from what’s currently in place.

“The conservatorship process (with LPS) is much more limited,” said Hagar, who maintains that the current process draws on many more resources and is more restrictive of an individual’s liberties. And it only takes effect if an individual is gravely disabled or a danger to himself or others.

“A lot of people who get services could be intercepted a long time before they do that dangerous act that gets them arrested,” he said.

Investigations take place during a conservatorship, and Hagar said there’s no less than a 30-day investigation, which can cost a minimum of $1,000 per day. He said it usually takes 30 days just to get a judicial hearing.

“Judges can take away every single right to determine anything in their life,” Hagar said of the current situation. “Laura’s law doesn’t; it leaves people in the community.

“The judge decides what powers that particular conservator can decide, if the person can be hospitalized, if they can completely control their money and where they live — all those things that go into every single aspect of a person’s life.”

A public guardian is usually appointed to be a conservator as many families avoid doing so because it can lead to power struggles, according to Hagar. Because Laura’s Law allows different groups, like a family member, to petition the judge for treatment, “the first cut is with somebody saying this person might qualify. It’s a much less formal process,” he said, and the best-case scenarios appear before a judge within three to four days.

“The huge selling case is quick intervention in somebody’s arc toward some kind of personal tragedy,” Hagar said.

The pros and cons of Laura’s Law vs. the traditional LPS approach raise philosophical questions, to be sure. Only the two counties have adopted it, and Hagar says that could be because an older generation of mental health directors, as well as some younger ones, may want to eliminate involuntary treatment altogether.

“Most training programs still incorporate these ideas of the 1960s and ‘70s,” he said.

When Hagar and his co-authors crafted the law, however, he said they looked at “every existing due-process protection in the LPS” and made sure those elements were preserved.

“There is a huge amount of due process,” he said. “The judge has to jump through a lot of hoops. We already have involuntary commitments and they put you in the hospital. This allows people to receive treatment in a much less restrictive way in the community.”

Keeping people safe is also paramount — among patients and the public.

“Somebody may get hurt and that’s what happened to Laura Wilcox,” Hagar said. “This is very serious stuff.”

Hagar said the law has been “under a huge microscope by legal experts.” The constitutionality of the New York law has been challenged three times in court, and has lost all three times.

Funding is also an issue. The original Laura’s Law bill had $50 million attached to it, but the funding was stripped out as state budgets became tighter. If that hadn’t happened, Hagar said, 10 to 12 counties would have adopted the law immediately. Still, in spite of California’s woeful budget situation and the strain it has placed on mental health departments throughout the state, discussions about the law have taken place this year among boards of supervisors in Contra Costa, Marin and San Francisco counties.

“Crisis breeds opportunity,” Hagar said.

Discussion among the county’s mental health commissioners demonstrated a willingness to learn more about the law, and one commissioner suggested talking to Nevada County’s mental health director to see how the program has worked there.

Dr. Edwin Feliciano, medical director of the Santa Barbara County Department of Alcohol, Drug and Mental Health Services, gave a summary before Friday’s discussion, describing Laura’s Law as an “outpatient involuntary commitment,” a description that drew an immediate rebuke from commissioners.

“It’s not involuntary commitment, it is assisted outpatient treatment,” said Commissioner Ann Eldridge, adding that use of the word involuntary “waves a red flag to consumers.”

Commissioner Roger Thompson agreed.

“By using the word involuntary, it becomes a lot harder for consumers to sign on to something that I think would be of great benefit to them,” he said.

Feliciano contended that “there’s a group of people that would say ‘assisted’ softens the word ‘involuntary.’” He also pointed out what he called a “lack of research” with the law, as well as the funding issues.

Afterward, Eldridge took issue with Feliciano’s presentation.

“I’m sorry, but it sounds as if you’re coming from a point of view that is definitely negative toward considering this,” she said.

“Even though (Nevada County) is a small little county, they’re the only ones in California who have fully implemented this,” Eldridge said. “I’m pretty sure their mental health director would at least get on a conference call with us to tell us what that experience has been.”

Eldridge said many states have assisted outpatient treatment programs.

“New York is probably the best example,” she said, although New York’s program is state-mandated while the California Legislature has said that counties could only implement the program if their boards of supervisors had approved.

Eldridge said Santa Barbara County had a big meeting on Laura’s Law several years ago, but “decided at that time not to do it because of the money issue.”

Of the 20 individuals in Nevada County who have had to appear in court for assisted outpatient treatment, she said, “more than half of them settle, they didn’t have to go to a hearing” agreeing to treatment. “I think we have a lot more to talk about on this,” she said.

Feliciano apologized to Eldridge and said the issue is not a new one. In fact, he said, outpatient commitment is available in more than 40 states.

“I’m just thinking of all the people out there who are treatment resistant,” said Commissioner Jan Winter, adding that mental health patients are falling through the cracks because they don’t accept treatment, no matter how good the system is.

“As a family member, I know there’s this terrible frustration and we saw it in the story in Noozhawk about this father whose son died in PHF, and trying to get services for his son, who didn’t want services,” she said.

ADMHS Director Ann Detrick asked what the consequences were if an individual refuses treatment. Feliciano said that in Philadelphia, where he had previously worked and which has an assisted outpatient program, a patient can be admitted on a “5150” if they don’t comply. The term 5150 refers to a situation in which a person can be deemed unsafe to himself or others and be taken in for emergency psychiatric treatment.

“This discussion raised a lot of great questions, and that was the point of it,” Thompson said at the end of the meeting. He added that he’ll be working with the National Alliance on Mental Illness to better understand Laura’s Law, and he requested more information for the commission going forward.

Noozhawk staff writer Lara Cooper can be reached at .(JavaScript must be enabled to view this email address). Follow Noozhawk on Twitter: @noozhawk or @NoozhawkNews.

Related Stories

» Click here for the first story in Noozhawk’s series on the Cliff Detty case: While Son Struggled with Mental Illness, Father Fought His Own Battle

» Click here for the second story in Noozhawk’s series: Seclusion, Restraints and Screams Marked Man’s Final Hours at Psychiatric Unit

» Click here for the third story in Noozhawk’s series: Seclusion and Restraint Practice Poses Risks, Prompts Questions

» Click here for a Noozhawk slide show

» Click here for a related commentary: Brian Stettin: Laura’s Law Might Have Saved Cliff Detty

» Click here for mental health care resources that are available 24 hours a day.




comments powered by Disqus

» on 09.21.10 @ 08:59 AM

Assisted outpatient commitment (AOT) under Pennsylvania’s Mental Health Procedures Act of 1976 is not used because the individual with a mental illness must be a “clear and present danger to self or others” for both inpatient and outpatient treatment.  Because people do not receive the timely help they need, there are two identical proposed pieces of legislation, HB 2186 and SB 251, that would change the criteria just slightly for outpatient treatment to “likely to be a clear and present danger.” 
In the third article in this series on the use of restraints in a hospital, Pennsylvania was also lauded because they do not use restraints on patients in a hospital anymore.  While that may be true, we should not to be considered to be the “model nationwide for patient-centered mental health care” because for those with severe mental illness who lack insight to seek and remain in treatment, our outdated treatment law precludes timely, effective treatment.

» on 09.24.10 @ 03:47 PM

Hagar, come to your senses!
Laura’s Law will only make people with mental health issues fearful of professionals and make them avoid treatments. Laura’s Law dictates that anyone with two inpatient hospitalizations in two years be subjected to court ordered out patient MH treatments. This will make it so no one will ever seek out voluntary treatments that they know they need for fear of being forced in to more treatments than they like. Causing more deranged people on the streets than ever before. Under Laura’s Law the only time anyone will ever get treatments is after they do something rash and law enforcement intervenes and not before.

» on 09.24.10 @ 04:10 PM

Involuntary treatments by any other name are still involuntary treatments. There is now irrefutable, documentary evidence that it was the German psychiatrists, particularly prominent professors of psychiatry, and psychiatry department heads, who were chiefly responsible for initiating and administering the infamous T4 program, which involved the mass murder of over 200,000 mental patients and thousands of sick and disabled children and adults during the holocaust. The Term “assisted” treatments to describe involuntary commitment is just as cruel a euphemism as the terms euthanasia and mercy death to describe the WW2 murderous T4 programs of NAZI Germany.

» on 09.24.10 @ 08:58 PM

Coercive treatment is ultimately ineffective.
The expansion of forced treatment will not stop “treatment noncompliance,” which is viewed as a problem that more forced treatment will solve. In fact, researchers have found that forced treatment causes noncompliance. The Well Being Project, a research project supported by the California Department of Mental Health, found that 55% of clients interviewed who had experienced forced treatment reported that fear of forced treatment caused them to avoid all treatment for psychological and emotional problems. Moreover, coercion seriously undermines the therapeutic relationship between a client and his/her therapist.

» on 10.04.10 @ 06:10 PM

Without the use or threat of force, fascism could not exist.  Machiavelli, Mussolini, Hitler knew this.  All dictators, would-be dictators, and bullies know this basic fact.  And this is the case with psychiatry.  Without the use and threat of force, institutional psychiatry would die.  Lots of psychiatrists would be out of a job.  I wish that would happen! Psychiatry gets its authority and power to force, imprison, involuntarily commit, and treat individuals against their will from the state. In institutional psychiatry in fascist states, forced treatment is the rule, not the exception.

» on 10.07.10 @ 02:33 PM

Chuck,

What I did in 2002 was to go to a state prison, during the tour we where walking by yard 1, which was the psych area.  Then I asked if I could talk to some of the prisoners.  The correctional officers allowed me to talk to three.  My request was spontaneous, so I appreciated their accommodations.

I explained to the prisoners about Laura’s Law.  I also told them my psych profile was such that I never got into trouble, sought treatment so I didn’t feel I was one to have an opinion, hence “nothing about us, without us.”

All three said essentially you got to be kidding, any law that would have provided them with outpatient treatment would be better than jail.

During the debate prior to the law being passed I didn’t hear anyone speak up for prisoners, nor those that might be candidates for a Laura’s Law program.  This made me uncomfortable then, and it makes me uncomfortable now. 

The people who are effected by Laura’s Law need to be heard!

There has been no effort by the CNMHC or other opponents to Laura’s Law to develop prison outreach programs, nor even organize prison visits to be aware of the plight of our fellow consumers who are serving time.  It has been eight years since the law passed, and no outreach to those at risk.

It is easy to ask anyone, including the prisoners if they would like forced treatment.  No one wants forced treatment, period.  Except when reality bites. It is Laura’s Law that is addressing reality.

Laura’s parents donate more money to Prop 63 than any other individuals.  They want to see people recovery, they also don’t want to see the bad things that happen when civil rights trump common sense. 

Who do represent?  Consumer who’s profile is such that they will never be a candidate for Laura’s Law, or those that are doing very poorly, are at risk of hospitalization, jail, or the inability to care for themselves, with pending, or current homelessness?

I found it interesting that at Alternatives last week, the 1,200 consumer national conference held in Anaheim that there where only clean cut consumers.  Again, not close to a representation of the population with various manifestations of mental illness that would put them at risk of Laura’s Law and its outpatient programs.

Outpatient …. outpatient … that is a key word in the law and its programs.  It may not be a big deal to you, but if I went back to the prison I visited and gave those three inmates an option of outpatient, I don’t think they would be posting your arguments to any Noozhawk articles.  Rather, I think they would gladly be in an outpatient program, recovering!

Please take the time to tour a prison, or even the local jail, talk to the mentally ill.  It is my belief that you will learn more in 10 minutes, than being at Alternatives for 5 days.  How do I think that, because I did it, and it changed my perspective forever.

» on 02.18.11 @ 09:19 PM

For mental health clients who are homeless and those at risk of becoming homeless, lack of access to truly affordable housing has persisted at a crisis level for years.

People diagnosed with serious mental illnesses account for 20 to 25% of the homeless population in the US.

While AB 1421 proponents blame homelessness on untreated mental illnesses, the National Coalition for the Homeless notes that many homeless people diagnosed with mental illnesses are willing to accept services, but that inadequate funding is a barrier to successful implementation of supported housing programs and other services.

The need among mental health clients for access to affordable housing has never been greater. California’s monthly SSI/SSP individual grant is currently $845. For a single adult who relies on SSI/SSP as their sole source of income, $253.50 in monthly rent is affordable. In 2009, the Fair Market Rent for a studio apartment in San Diego Counties exceeded the SSI/SSP grant by $299.

NCH notes that access to permanent supportive housing and developing better, more coordinated mental health services would combat homelessness and improve mental health, and outreach programs are more successful when workers establish a trusting relationship through continued contact.

Besides these tried and true approaches, innovative solutions are needed to help mental health clients get and maintain housing. MHSA Housing and Innovations should fund more independent housing options to meet the diverse needs of homeless and at-risk clients. Client-owned and run supportive housing maximizes client autonomy, cultural and linguistic
competency. Rental subsidies could be offered for scattered-site permanent housing with or without built-in supports.

The untold thousands this bill would spend on outpatient commitment could be better spent on real solutions that heal and empower clients and address the root causes of homelessness.

» on 02.18.11 @ 09:29 PM

For mental health clients who are homeless and those at risk of becoming homeless, lack of access to truly affordable housing has persisted at a crisis level for years.

People diagnosed with serious mental illnesses account for 20 to 25% of the homeless population in the US.

While AB 1421 proponents blame homelessness on untreated mental illnesses, the National Coalition for the Homeless notes that many homeless people diagnosed with mental illnesses are willing to accept services, but that inadequate funding is a barrier to successful implementation of supported housing programs and other services.

The need among mental health clients for access to affordable housing has never been greater. California’s monthly SSI/SSP individual grant is currently $845. For a single adult who relies on SSI/SSP as their sole source of income, $253.50 in monthly rent is affordable. In 2009, the Fair Market Rent for a studio apartment in San Diego Counties exceeded the SSI/SSP grant by $299.

NCH notes that access to permanent supportive housing and developing better, more coordinated mental health services would combat homelessness and improve mental health, and outreach programs are more successful when workers establish a trusting relationship through continued contact.

Besides these tried and true approaches, innovative solutions are needed to help mental health clients get and maintain housing. MHSA Housing and Innovations should fund more independent housing options to meet the diverse needs of homeless and at-risk clients. Client-owned and run supportive housing maximizes client autonomy, cultural and linguistic
competency. Rental subsidies could be offered for scattered-site permanent housing with or without built-in supports.

The untold thousands this bill would spend on outpatient commitment could be better spent on real solutions that heal and empower clients and address the root causes of homelessness.

Support Noozhawk Today

You are an important ally in our mission to deliver clear, objective, high-quality professional news reporting for Santa Barbara, Goleta and the rest of Santa Barbara County. Join the Hawks Club today to help keep Noozhawk soaring.

We offer four membership levels: $5 a month, $10 a month, $25 a month or $1 a week. Payments can be made through PayPal below, or click here for information on recurring credit-card payments.

Thank you for your vital support.

 

Daily Noozhawk

Subscribe to Noozhawk's A.M. Report, our free e-Bulletin sent out every day at 4:15 a.m. with Noozhawk's top stories, hand-picked by the editors.