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Discussion of Laura’s Law Takes on a Personal Cast

Mental health consumers, advocates voice support for assisted outpatient treatment recourse

Paul Cummings has always been a treatment seeker for his mental illness, but he’s had friends who haven’t. He’s had friends end up in jail because they weren’t able to get services for their illnesses. Nearly 30 percent of inmates in the Santa Barbara County Jail are using mental health medications, and jail often ends up being the ultimate last resort for those who can’t get mental health help or refuse to.

Because California law does not allow people with mental illness to be taken in for treatment involuntarily unless they’re a danger to themselves or others, or have a grave disability, many fall through the cracks. Although the law is mindful of individual civil rights, Cummings said it sometimes goes too far.

Advocates for mental health services like, from left, Roger Thompson, Emily Allen, Leah Juniper and Paul Cummings, are leading the charge for local implementation of Laura's Law — even as they acknowledge they need to become more familiar with some of the details of the assisted outpatient treatment tool.
Advocates for mental health services like, from left, Roger Thompson, Emily Allen, Leah Juniper and Paul Cummings, are leading the charge for local implementation of Laura’s Law — even as they acknowledge they need to become more familiar with some of the details of the assisted outpatient treatment tool. (Lara Cooper / Noozhawk photo)

“In jail, what they call it is ‘dying with your rights on,’” he said. “While they’re in jail and civil rights advocates are defending their rights to refuse everything, they’re sitting in jail while people who have no chance of getting in the same situation are defending their rights to refuse everything.

“That’s the dilemma. It’s an awkward situation.”

Cummings, along with several other mental health consumers and advocates, met with Noozhawk over coffee last week to talk about a new law that could reach out to people who refuse mental health treatment. 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.

Instead of waiting until a person destabilizes enough to be taken to treatment involuntarily, Laura’s Law allows any adult with whom an individual with mental illness resides, as well as a set of other qualified people, to 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.

Laura’s Law, also known as AB 1421, was at the center of a lengthy discussion at a recent 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.

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.

New York has a similar law, Kendra’s Law, which was enacted in 1999 after a young woman died after being pushed off a subway platform by a man with a history of untreated mental illness.

“It has been our experience that Kendra’s Law has improved accountability, access to services and a range of important outcomes for its recipients,” according to Jill Daniels, public information director for the New York State Office of Mental Health.

Daniels referred to several reports that document New York’s success with the law. According to a 2005 report issued by her agency, “there have also been significant improvements reported in self-care and community functioning, and a 44 percent decline in the incidence of harmful behaviors,” which include suicide, self harm and harm to others.

“During participation in the AOT (assisted outpatient treatment) program, rates for hospitalization, homelessness, arrests and incarcerations have declined significantly, and program participants have experienced a a lessening of stress associated with these events,” the report states.

Another report, a 2009 independent study evaluating New York’s assisted outpatient treatment program, found a substantial reduction in the number of psychiatric hospitalizations of AOT participants. Assisted outpatient treatment also reduced the likelihood of being arrested, and patients were far more likely to consistently receive medications appropriate to their conditions. New York’s program “was accompanied by a significant infusion of new service dollars,” making the program the most comprehensive assisted outpatient treatment program in the country.

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.

In the past, some consumer groups, like the California Network of Mental Health Clients, have opposed Laura’s Law. But Roger Thompson, a Santa Barbara County mental health commissioner and executive director of the Consumer Advocacy Coalition, said local consumer groups support it.

So why haven’t other groups gotten behind it? Cummings said he think’s the law is misunderstood.

“Because it was passed in 2001, it’s taken on a myth of its own,” he said. “People didn’t understand it when it was being brought through the legislative process, and they don’t understand it now.”

Thompson said he can understand the opposition, just by looking at the history of mental health in California.

“We were getting frontal labotomies in the 1970s and ‘80s,” he said. “I wouldn’t have a heck of a lot of trust in regards to the government, living in that generation.

“But in this generation, I see it as very progressive because it’s assisted outpatient treatment, not someone forcing pills down your throat if you don’t need them.”

Thompson said individuals throughout California are routinely denied care because of their mental illness, and it’s up to policy makers to retract from what he called a “prejudicial, almost medieval, approach.”

Also present during last week’s conversation was mental health advocate Emily Allen, who has been working to gain support for Measure S, a half-cent sales tax that would pay for the construction of a new North County jail, as well as put $5 million toward programs that target recidivism. As with Measure S, Allen challenged people to read through Laura’s Law so that they understand it.

Allen first got involved with the issue of mental illness when Casa del Mural, a group home for the severely mentally ill that incorporated medication management, was threatened with closing.

“We’ve just lost that, people end up on the street or in a locked institution,” she said, adding that she’d like to learn more about Laura’s Law herself.

Leah Juniper, a mental health consumer and member of the Consumer Advocacy Coalition, said she still feels as if she needs to know more about the law, but added that she cared “about people being safe.  People being empowered ... knowing what their options are.”

Thompson, who has bipolar disorder, asked his relatives what they had to say about Laura’s Law.

“I called them and said ‘If I’m not taking my meds and you know they work, and I’m flipping out, would you rather have a law on the books that helps me out or would you rather me continue to go in and out of jail?” he said. “That got them behind Laura’s Law just like that.”

Advocates say that the top 100 consumers of mental health services within counties use up a huge amount of resources, and that targeting some of those people would help reduce costs.

While on a jail tour several years ago in San Diego, Cummings said he approached several prisoners when they got to the mental health section of the facility. When he asked them their thoughts about assisted outpatient treatment, he got an incredulous response.

“They said, ‘You’ve gotta be kidding me. Anything that’s outpatient is better than prison,’” said Cummings, who added that many of those voices are not represented in the talks about implementing the law in counties around the state.

He said much of the consumer movement has centered around the mantra “Nothing about us without us.”

“This is the one bill and issue that’s ‘everything about them, without them,’” he said. “It’s stunning to me to hear people who I know have done well all their lives and have a slight mental illness — as opposed to a serious mental illness — who are treatment-resistant, speaking out as if they’ve ever been in that situation.”

Thompson spoke positively of the discussion that took place at the Mental Health Commission.

“It seems like people on the board are seeing the broader picture,” he said, adding that he would like to see the law implemented statewide. “I’d like to see this county lead the way, and I’d like to see the state be more progressive on how it treats those who have severe mental illness.

“The bottom line is there are progressive steps moving forward to make life a little bit more tolerable for those who suffer.”

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.

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