For Lynne Gibbs, having a daughter with an untreated mental illness homeless and adrift in Santa Barbara was one of the most harrowing things she’s ever gone through.
“To have a child on the street who’s psychotic and helpless ... It’s one of the worst experiences a parent can have,” she said.
That was exactly where Gibbs found herself when her daughter refused to take medication that helped her function in everyday life.
(Gibbs asked that her daughter’s name and exact condition not be disclosed because she is doing well now, but shared that her child was diagnosed at 14 and had responded well to medication.)
“She would do well for a period of time when she would stay on her medications, and then for one reason or another would stop taking them,” Gibbs said.
Soon, the young woman became one of many who cycle in and out of Santa Barbara County’s revolving door between temporary housing and the streets.
She lived in her car for long periods of time before giving the vehicle away, and there were times when she would disappear altogether, Gibbs said.
Because her daughter was over 18, Gibbs had no legal right to be involved in her treatment plan or get any information on her whereabouts.
“She had the right to live on the street untreated,” Gibbs said.
Now, families in Santa Barbara County may be a step closer to having a new tool for reaching out to those with untreated mental illness — before they end up homeless or behind bars.
County officials are exploring a legal framework that would allow judges to order people into a treatment program if they meet specific criteria.
It’s called Laura’s Law, and is being championed by District Attorney Joyce Dudley as well as officials at the county’s Department of Alcohol, Drug and Mental Health Services.
Dudley and two other officials traveled several weeks ago to Nevada County, where the law originated, to see how it has affected that Northern California community.
The law grew out of a 2001 shooting rampage in Nevada City carried out by Scott Thorpe, a man with an untreated mental illness. Thorpe entered a county psychiatric facility and gunned down several people, including 19-year-old Laura Wilcox, who was working at the clinic during her winter break from college.
After her death, Wilcox’s parents joined up with the Treatment Advocacy Center to put together Assembly Bill 1421. With its enactment, the law gives judges the ability to order a six-month treatment program for an adult with an untreated mental illness who is unlikely to survive safely in the community.
Many parents of adult children with mental illness say learning how to navigate the county’s somewhat Byzantine mental-health system is like joining a “club” they never knew existed.
It’s a world full of legal restrictions, police calls in the middle of the night, and a steep learning curve into what rights people do and do not have.
Even to those not directly affected by the mental illness of a loved one, the costs on the general public are steep.
“It affects all of us,” explained Michael Craft, who works at ADMHS as an assistant clinical director, and traveled with Dudley to Nevada County to get a closer look at the law.
The costs of untreated mental illness are enormous, he said, and letting someone devolve into mental-health crisis is the most expensive way to approach the issue. It’s also the most traumatic to that person.
People deemed a danger to themselves or others — known as 5150s in reference to a section of the California Welfare and Institutions Code — often will end up in the county’s Psychiatric Health Facility (PHF), a locked hospital for those in crisis.
The cost for a patient to stay there for 24 hours is $1,732 to the county, and the costs when a person ends up in jail or a local emergency room are even higher.
The criteria to treat someone involuntarily in California are some of the strictest in the nation, so many people with mental-health problems do not qualify to go to the PHF for treatment.
Craft, who has a clinical background as a therapist, is skilled at bringing the human cost into focus.
“The average adult with a serious mental illness lives 25 years less than the rest of us,” he said, adding that patients who also have substance-abuse issues live an average of 35 years less.
“As human beings, they suffer and the people who love them suffer,” he said.
The public-safety concerns — for the person with mental illness as well as the general public — are also on the minds of those exploring Laura’s Law.
After the incident, the Yolo County district attorney sent an email to Dudley.
“He said, ‘I guess you’ll be thinking about Laura’s Law again,’” Dudley said, adding that the Yolo County Board of Supervisors recently adopted the law there.
Dudley said everything she knows about Rodger’s case points to Laura’s Law not being applicable, but there have been other high-profile cases of violence in the county in which it might have made a difference.
She cited the 2008 shooting rampage in Santa Maria in which Lee Leeds, a man who had untreated paranoid schizophrenia, shot and killed four people at an auto-salvage yard.
“I’m hoping to have a system in place that prevents any violence against the community,” she said. “If we see someone slipping ... We want to get them treatment so they don’t hurt themselves or hurt others.”
Laura’s Law takes place in the civil courts and will have nothing to do with the District Attorney’s Office, but Dudley is undeterred.
“I’m there because I’m all about crime prevention, and it seems to me if we get people into treatment, we’re going to have less crime,” she said.
How It Works
Under Laura’s Law, people can be ordered to engage in a six-month treatment program that allows them to stay in their home or community and even keep working in their job, if they have one, according to Michael Heggarty, director of Nevada County’s Behavioral Health Department.
There are conditions: The person must have been placed in psychiatric hospitalization or incarcerated in the last 36 months and/or committed violence toward themselves or others in the last 48 months, and must have been offered voluntary treatment and failed to engage and be substantially deteriorating.
Many family members of people with untreated mental illness say the law gives them more ability to help their loved ones.
A family member, law-enforcement officer, housemate, hospital or health agency director, or director of a nonprofit agency can petition for a referral, and a judge will ultimately decide whether the person qualifies for court-ordered treatment.
However, most people decide to accept treatment before they even get to court, Heggarty said.
For Gibbs, the mother who watched her child become homeless, this makes all the difference from the current system, because many people with serious untreated mental illness are unaware they even need help.
A lack of insight into a person’s own condition even has a medical term: anosognosia.
Anosognosia affects approximately 50 percent of people with schizophrenia and about 40 percent of those with bipolar disorder, according to Carol Stanchfield, who works with Laura’s Law referral clients in Nevada County.
That percentage goes up drastically if the person reaches psychosis, she said.
“Think of someone with Alzheimer’s,” Gibbs said, adding that her father was in a nursing home with Alzheimer’s and had a similar lack of insight. “They don’t know that there’s something wrong.”
There are 449,889 adults with untreated schizophrenia or bipolar disorder in California, according to recently released numbers from the Treatment Advocacy Center, which examined data over a 12-month period.
“Individuals with untreated schizophrenia or severe bipolar disorder are the most at-risk populations for a host of poor outcomes that affect them and their communities,” according to a statement from the center.
One of those living the nightmare of that poor outcome is Diana Abbott, who estimates her daughter, Angela, has been in and out of County Jail at least 10 times since being diagnosed with schizophrenia eight years ago.
At first, Angela was taking medications and doing well, able to work and had housing. But things took a darker turn when she ended up in prison after stabbing an abusive boyfriend.
She was released in April, and her mother said she’s been kicked out of all of the local homeless shelters, and in and out of the Santa Barbara Cottage Hospital emergency room, even though she is uninsured.
“They can’t do much other than sedate her and have her under security watch,” she said.
Since then, it’s been a rotation between the county’s PHF, the emergency room and jail.
“The family can’t handle her mental illness,” Abbott said. “She’s able to work and function in society, but right now she’s so far gone.”
Angela’s parole officer is working to get a mental health conservatorship for her, which is what the family is hoping for.
Abbott didn’t know much about Laura’s Law, but said that what her daughter would benefit most from is court-ordered treatment.
“She needs a structured environment,” she said. “That’s the bottom line. It’s been a vicious cycle with her.”
Santa Barbara County isn’t the only jurisdiction looking into the law.
The Board of Supervisors in San Francisco, which has a significant population of people with untreated mental illness, approved Laura’s Law earlier this month, and the Orange County Board of Supervisors adopted it in May.
Officials from more than 20 other counties have visited Nevada County to look into the law, Heggarty said.
Nevada County’s statistics are impressive, from both a clinical and budget perspective.
Since 2008, 81 referrals have come through Nevada County’s system — all people who didn’t meet the criteria to be involuntarily hospitalized.
“Out of those 81 people, we’ve been able to see huge reductions in hospitalizations, incarceration and days spent in homelessness,” Heggarty said.
Thirty-six were court ordered into treatment, and the rest decided to get treatment voluntarily before even needing to go to their first court hearing.
Because of those cost savings, Nevada County has been able to put more money into voluntary mental-health programming, and even increase offerings from its mental health department.
The county has documented a savings of $1.81 for every dollar spent, after factoring in the reduced costs of hospitalization, time that would be spent in jail, and treatment savings.
“It’s a benefit to everybody,” he said.
In Santa Barbara County, Sheriff Bill Brown has frequently lamented that severely mentally ill people too often end up in County Jail, which isn’t an appropriate place for them and isn’t equipped to provide the treatment they need.
Nevada County has seen that problem, too, Heggarty said, but has been able to make headway in the number of people who are incarcerated.
Of the 19 people who were court-ordered into treatment, the number of days they spent in jail went down 52 percent after their treatment course.
“That’s fantastic for us,” Heggarty said, “because the jail is run out of the county general fund,” which is always under strain.
More important, he said, “we don’t think mentally ill people should be in jail. It doesn’t rehabilitate them. They don’t get good quality treatment in jail, and they deserve be getting treated.”
Of the 81 people tracked, only five resulted in adversarial hearings where a public defender contested the need for treatment.
“That’s a very small percent,” he said. “Most people when presented with the option, say, ‘I’ll try it out.’”
To critics who might worry the process would use up an excess of court time, “that has not been our experience at all,” Heggarty said.
Because Laura’s Law qualifiers have their cases heard in civil court, time is saved in criminal court, avoiding jury trials and the like, “which do take a lot of time,” he said.
Not everyone sees Laura’s Law as a good thing.
Opposition has come from several mental-health organizations, including California Network of Mental Health Clients, that say the law is just another version of forcing treatment on mentally ill people against their will. They cite civil-rights concerns with the law.
Gibbs, who is on the public policy committee of the National Alliance on Mental Illness’ Southern Santa Barbara County chapter and also a member of Families ACT!, said she understands the concern, but doesn’t see the state regressing back to the scores of involuntary commitments that resulted in the 1940s and ’50s in California.
“The point of the law is helping people stay in the community for treatment,” she said.
Concerns also have been raised about the costs to implement the law, and the fact that counties can’t use certain mental-health funds for involuntary treatment.
Nevada County was able to successfully to use Mental Health Services Act monies, a state fund, for Laura’s Law because the people receiving treatment are in an unlocked setting, Heggarty said, noting that the involuntary components of the law came from the courts, not from the mental health system.
Still others point out that Laura’s Law originated in a rural county with a small population, and say that scaling the law to any larger jurisdiction would be difficult.
Nevada County is rural, with a population of about 100,000 people, less than a quarter the size of Santa Barbara County.
Heggarty is undaunted, however, and points to success in places such as New York City, which has implemented a nearly identical legislation called Kendra’s Law, which was put into place after a young woman was killed after being pushed in front of a subway train by a man with an untreated mental illness.
“It’s received almost identical results that we’e seeing in northern, rural California,” he said.
Santa Barbara County already has a mental-health treatment court, which usually reaches out to people who have substance-abuse issues and have committed a criminal act.
Dudley says she hopes to sit down with Craft and others, and then make a report on July 21 to her Isla Vista Safety Committee, on which Third District Supervisor Doreen Farr also serves. Farr’s district contains Isla Vista.
“She’s interested and active, as they all are,” she said, adding that she’ll then be turning to the courts, county counsel, mental health and the public defender about putting Laura’s Law in place.
“I view my role as an advocate to hopefully get the county to embrace this,” she said.
For Gibbs’ daughter, who was mentioned at the beginning of this story, a turning point came three years ago.
She stopped eating and ended up in the PHF, where she stayed for “three months but wasn’t getting any better,” Gibbs recalled.
What happened next was unusual.
Her daughter was put under conservatorship, a legal status in which another adult, a conservator, oversees the treatment of the mentally ill person as well as supervising other areas of their lives, such as making financial decisions for them.
It’s the strictest legal mechanism available to people with mental illness besides locking them in the PHF, but Gibbs called it a blessing.
Her daughter eventually went through 18 months of residential treatment, and is now doing well, and has even signed up for college courses in the fall.
“With conservatorship, you do lose all of your rights,” she said. “But there’s nothing between conservatorship and the person being able to make their own decisions. That’s the gap where we need to focus.”
“(Laura’s Law) is for someone who is at a very low point,” she said. “We really need this in Santa Barbara County.”