Laura’s Law: S.F. to let courts compel treatment for mentally ill

By Victoria Colliver

October 25, 2015

Citywide director Dave Fariello (right) talks to a client standing outside the large group room at Citywide Case Management Programs on Monday, October 20, 2015 in San Francisco, Calif.

San Francisco will become the fifth county in the state next week to implement Laura’s Law, the state measure that allows the courts to compel mentally ill people who have resisted care to get outpatient treatment.

Almost 16 months after the San Francisco Board of Supervisors agreed to enact the law — and after years of debate weighing public protection and the civil rights of mentally ill patients — the city has set up its program and determined how patients who are court-ordered to seek treatment will get the care they need.

“We have a mental illness crisis across our country, and we see it every day in San Francisco,” said Supervisor Mark Farrell, who introduced the legislation last year to implement Laura’s Law in San Francisco. “It’s visible among our homeless population, and there are countless families and other individuals.”

With mental illness clearly on display — with people regularly shouting incoherently on the streets and even lunging at passersby — it’s easy to see Laura’s Law as a catchall for anyone who has fallen through the cracks in San Francisco. But it won’t solve all the city’s homeless crisis and other social problems that accompany mental illness, city officials say. Laura’s Law provides just another tool to help those who need care.

“It’s important for families, and it’s important for law enforcement officers who are witnesses to the mental health deterioration on our streets and in the homes,” Farrell said.

Counties slow to adopt law

The law allows family members, roommates, mental health providers, police or probation officers to petition the courts to compel a mentally ill person to get outpatient treatment. While medication can’t be forced, the theory is that the “black robe effect” of having a judge order treatment will persuade someone who is reluctant to finally accept care.

Despite passage by the Legislature in 2002, counties have been slow to embrace Laura’s Law, which was named for Laura Wilcox, a 19-year-old college sophomore who was working at Nevada County’s mental health clinic in 2001 when she was shot dead by a psychiatric patient who had resisted his family’s efforts to get care.

While Laura’s Law is a state measure, it’s up to individual counties to implement it. Nevada County took it up in 2008 and for years was the only place that did so.

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Contra Costa County adopts mental health care law

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Laura's Law passes easily in S.F. supervisors' vote

In 2013, the Legislature clarified that counties can adopt the law using money from Proposition 63, which levied a 1 percent tax on millionaires to expand mental health services. Since then, many counties have jumped in.

San Francisco’s program officially starts next Monday.

“We really have no idea what we’re going to see,” said Angelica Almeida, a psychologist and director of the Assisted Outpatient Treatment program, the city’s three-person Laura’s Law team that will serve as the first stop for people whose mental health issues could land them in court for mandated care.

“We know it won’t work for everyone,” she said, “but if it works for a few, that’s a huge success.”

Robust services in S.F.

The city’s public health officials have estimated as few as 100 people a year will qualify because the law singles out a specific group of people. It applies only to individuals who already have a mental health diagnosis, were previously in treatment but lapsed, or who have been incarcerated or involuntarily hospitalized within the past three years and now resist care.

Citywide Case Management Programs client Mona Hamilton (right) listens to Naomi Marcus (left), Citywide Case Management Programs education specialist, speak during Job Club at Citywide Case Management Programs on Monday, October 20, 2015, in San Francisco, Calif.

San Francisco, compared with other counties, has a relatively robust system of mental health services that could help make judge-ordered outpatient care a last resort, the program’s supporters said.

Before going to the courts, the Assisted Outpatient Treatment program will work with patients and their families to get the client into care, Almeida said. “Most people accept services long before the cases end up in the court process,” she said.

If patients do end up in court and get ordered to seek care, they will wind up at Citywide Case Management Programs, which contracts with the city to provide services for the mentally ill and is operated by UCSF and San Francisco General Hospital’s psychiatry department.

Located on Mission near Sixth Street, the center runs five programs serving more than 1,200 seriously mentally ill patients. The programs connect patients with various city services, help them get treatment if they have been jailed because of mental illness, and even assist them in finding employment. Laura’s Law will be the center’s sixth program.

“If a client refuses and continues to refuse treatment and they meet the criteria … then we’re the treatment.” said David Fariello, a licensed clinical social worker with UCSF and director of Citywide.

Boost for patients, families

The Assisted Outpatient Treatment team members said they planned to do everything possible to encourage patients to get care. Unlike other counties, San Francisco’s Laura’s Law program will include a peer specialist and family liaison to help patients and their families go through the process.

The family liaison, Charles Houston, said the team will do whatever it takes, from visiting patients and their families to accompanying clients to therapy sessions. “It’s about letting them know they’ve been heard and that they’re not alone,” he said.

Cedric Fotso, the peer specialist, said he knows what’s it’s like for people with mental illness because he has a mental health diagnosis and has resisted treatment in the past.

He said the social stigma of the illness is one of the biggest hurdles to overcome. “It takes a lot of grit to be able to work toward recovery,” he said. “It’s an ongoing progress, one that never really ends.”

Victoria Colliver is a San Francisco Chronicle staff writer. E-mail: vcolliver@sfchronicle.com Twitter: @vcolliver