County Backs Forced Care of Mentally Ill

April 22, 2015

"Laura's Law" allows courts to require outpatient treatment

By Joshua Stewart • U-T11:40 a.m.April 21, 2015Updated4:41 p.m.

The San Diego County Board of Supervisors voted Tuesday to implement "Laura's Law," which will give courts power to order treatment for mentally ill people under certain conditions. Supervisor Bill Horn cast the lone opposing vote.The San Diego County Board of Supervisors voted Tuesday to implement "Laura's Law," which will give courts power to order treatment for mentally ill people under certain conditions. Supervisor Bill Horn cast the lone opposing vote.

San Diego — The county Board of Supervisors on Tuesday approved “Laura’s Law,” a measure that allows courts to force certain mentally ill and violent people into compulsory outpatient psychiatric care.

The vote came 13 years after the state gave counties the authority to implement the law and more that four years after the county started an in-home outreach program for psychiatric patients.

The supervisors set their course in January, when they directed a task force to determine how the law could be enacted.

“San Diego County has taken critical steps over the years to help people with serious mental illness,” County Supervisor Dianne Jacob said. “It was clear that we really, really needed to do more.”

Supporters said Laura’s Law follows successes made by the In-Home Outreach Team program and is another tool to help people with serious psychiatric illness get care. The measure passed on a 3-1 vote. Chairman Bill Horn was the lone dissenter on Tuesday, as he was in January when the board formed the Laura’s Law task force.

Horn said the measure stepped on people’s civil rights.

“This concerns me deeply. We’re talking about adults here, and these adults have rights, and it should not be the place of the courts to make decisions for any individual,” he said.

Supervisor Ron Roberts, who is on a San Diego Regional Chamber of Commerce trip to Mexico City, was absent.

Now, the county’s director of purchasing and contracting is charged with issuing a request for bids from private organizations to provide care to Laura’s Law patients. The contract is for one year with an option to renew for four more years. It will cost $2.29 million in the first year, and is expected to provide care for 114 patients. The contracting process is expected to be completed by the end of the year and will take effect on Jan. 1.

The first referral is expected sometime in spring of 2016. In order for a patient to receive care under the law, the county’s In-Home Outreach Team must first determine if a person meets all nine specifications in a list of criteria. IHOT must conduct a face-to-face evaluation, and patients are given an opportunity to voluntary begin care before their case is referred to Superior Court.

From there, the county can petition the court for compulsory care, and a judge can order outpatient care for 180 days. The duration of treatment can be extended, and the court must receive updates on a patient’s progress every 60 days.

If the treatment is refused, that person can be held for up to three days under the existing law, commonly known as 5150, a section of the state’s Welfare and Institutions Code.

Among the criteria for the law to apply, a person must be at least 18 years old, mentally ill as defined by the law, have a history of not cooperating with treatment, is unlikely to survive safely without supervision and has a condition that is “substantially deteriorating.”

The law is named after Laura Wilcox, who was shot to death at age 19 along with two other people in 2001 while she was working at Nevada County’s public mental health clinic in Northern California. The man who shot them had refused psychiatric treatment.

Harold Wachs of Point Loma said on Tuesday he was relieved when supervisors voted in favor of the law. His son, Michael Wachs, struggled with mental illness before he died over a decade ago at the age of 31. Harold Wachs said he thinks Laura’s Law could have potentially saved his son’s life, and it will likely spare San Diego County families the pain of losing a loved one to mental illness.

Michael Wachs was committed to a care facility, but spurned psychiatric interventions. He and other patients who were there involuntarily could have left their treatment at any time. Harold Wachs said it would have been great to have another way to help his son.

“It would have been a marvelous thing to have a chance to do,” he said.

After his son’s death and the state passed the policy, Wachs and others pushed the county to implement the law.

“It was on my bucket list,” said Wachs, who is 89.

The American Civil Liberties Union of San Diego and Imperial Counties opposed implement of Laura’s Law. In a letter to supervisors, the group said that involuntary outpatient treatment is likely to have a series of unwanted consequences, including a disproportionate impact on people of color.

The ACLU also said the law “buys into” stereotypes that individuals with psychiatric disabilities are violent and incapable of making decisions regarding their health care. The organization also said that forced treatment could damage the important relationship between caregiver and patient.

Concerns about civil liberty violations and the effectiveness of involuntary treatment programs aside, the ACLU suggested that the county allow the impacts of a recent increase in spending for its In-Home Outreach Team program to play out before Laura’s Law is implemented.

“The County should trust in its decision to expand IHOT and allow time for the program to make an impact before forging ahead with implementation of (involuntary outpatient treatment),” the ACLU’s letter said.

The county will continue to fund IHOT services, and besides continuing its in-home care program, IHOT will be responsible for determining if people meet the conditions required to qualify for court-ordered outpatient care.

The group’s patient data show that just under a third of patients in IHOT’s care program would meet all nine of Laura’s Law’s criteria. Between January 2012 and September 2014, IHOT had 413 patients in its outreach program. Of those, 125 people, or 30.3 percent, were determined to potentially qualify for court-ordered care under the law.

The law’s supporters do not think the new policy is a panacea for helping the most challenging cases but is rather another option that may lead to success.

“We don’t view this as the be-all, end all, but another tool in the toolbox,” said Dimitrios Alexiou,CQ the president and CEO of the Hospital Association of San Diego and Imperial Counties.

Harold Wachs said passing Laura’s Law earlier might not have saved his son’s life, but it would have given another means to intervene.

“It certainly might have. There’s never a guarantee, but it was an opportunity,” he said.

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