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.
» 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 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.