Forced entry

This photo of Paul Ellison was shot months ago, when he was homeless. This week, we talked to his sister Elizabeth, who says Paul’s off the street now and in housing. She’d like to see more funding for programs like the one Paul’s in.

Elizabeth Ellison carries a copy of Laura’s Law in her pocket—except she doesn’t call it that.

“The pro side calls it Laura’s Law; the anti side calls it AB 1421,” she says.

Named after Laura Wilcox, a 19-year-old northern California girl who was gunned down on Jan. 10, 2001, by a mentally ill man in the behavioral-health clinic where Wilcox worked, Laura’s Law—Assembly Bill 1421—was intended to help people with severe mental illness who, like Wilcox’s shooter, refuse treatment.

The law, though, isn’t mandatory—county boards of supervisors have discretion over enacting it—and in the more than eight years since it was passed, only tiny Nevada County (population 97,000), where Wilcox lived, has fully implemented it.

Under Laura’s Law, a mentally ill person who meets certain criteria—like having been hospitalized two or more times in the last three years—and who refuses voluntary treatment can be ordered into what’s known as “assisted outpatient treatment” (AOT) by a judge. Referred to as a “least-restrictive intervention,” AOT involves a range of services intended to stabilize people who have a history of cycling in and out of hospitals and jails.

Carla Jacobs, cofounder of the nonprofit Treatment Advocacy Center and a proponent of Laura’s Law, says that some people call it “5149 and a half,” a reference to 5150, the state code for the process under which a seriously mentally ill individual can be involuntarily confined to a psychiatric facility. Laura’s Law is a stop-gap measure, Jacobs says, meant to catch someone before the point of forced hospitalization or, worse, incarceration.

“It would be if the person is deteriorating and it appears as if they would be soon reaching the level of 5150,” she says.

The law’s opponents, though, say that forcing people into treatment not only raises civil-rights issues, but could also compromise a person’s chances for long-term recovery. And, they argue, with looming cuts to mental-health services, now’s not the time to allocate scarce resources to a new program.

Ellison is the regional coordinator for the California Network of Mental Health Clients, a patient-advocacy group. Though her organization opposes Laura’s Law, Ellison says the debates the law’s sparked have put a focus on why some people choose to seek treatment and others don’t.

“Unfortunately this thing has become an issue of opposing sides and it doesn’t have to be,” she says. “Everyone needs to get at the table and figure out what we’re doing wrong [and] what we can do better.”

Ellison’s watched her brother Paul struggle with mental illness and chronic homelessness, cycling in and out of programs. Not too long ago, “he looked like a bag of bones,” she says. “I was so worried about him.”

Forcing him into a program wasn’t an option.

“He had done Salvation Army, he had done St. Vincent de Paul,” she says. Then a bed opened up for him in Interfaith Community Services’ 18-month program for homeless vets.

“He knew that they were going to be able to give him what he had been seeking all along,” Ellison says. “So, why aren’t we creating more like that program? Why are there only 15 beds?”

“They are cutting to the bone mental-health treatment,” says Ann Menasche, an attorney with Disability Rights California, another group that opposes Laura’s Law. “I have a number of clients who are trying to keep their psychotherapy—they want it and they’re being told that they’ve run out of sessions, no more, sorry.”

Menasche says Laura’s Law would not only be costly—it requires, for instance, a thorough investigation before a petition can be filed with the court—but would be a step back for mentally ill folks’ rights. Passed in 1967 by then-Gov. Ronald Reagan, California’s Lanterman-Petris-Short Act, or LPS, ended involuntary hospitalization of mentally ill persons except when certain findings are made.

“Now, under the LPS Act… a person has to be a danger to themselves, others or gravely disabled,” Menasche says, “and that’s the only time that their rights can be taken away.”

Even though Laura’s Law requires outpatient treatment—hospitalization occurs only if a licensed clinician deems it necessary—it “expands the criteria for forcing treatment on a person,” Menasche says. “Somebody can fall into the forced-treatment system based on, basically, a prediction that somebody might become dangerous in the future.”

Menasche says she’s yet to see good evidence that court-ordered treatment is the best tack.

“I have had so many clients who’ve been so traumatized by even the LPS forced system—which has a higher criteria and protects clients way more than what we’re talking about here—that they won’t seek services once they’re out,” she says.

On Jan. 6, the San Diego County Department of Mental Health put out a statement saying it opposes implementing the law “due to its flaws and other factors, like cost, that do not represent sound public policy.” One of the requirements of Laura’s Law is that no existing programs be cut to fund it.

Alfredo Aguirre, the county’s director of mental health services, declined an interview through a spokesperson, saying only, “We continue to study the issue.”

“If it’s truly coming down to money, that’s ridiculous,” says Paul Cumming, a longtime mental-health advocate who wants to see the county implement Laura’s Law. “They’re helping the easiest ones, the ones who want to have treatment. But those who aren’t seeking treatment, who think they’re fine, those are the ones this is trying to address.

“Nobody wants or supports involuntary treatment, but it’s a necessity,” Cumming says. “You have to do it sometimes. If somebody’s really sick, that’s what you have to do.”

In 2010, the California State Association of Counties recognized Nevada County for the savings it’s realized by implementing Laura’s Law. At the November forum, Michael Heggarty, Nevada County’s director of mental health, said that of the 22 people who’ve been referred for treatment under Laura’s Law, only four cases required a court order. Most opted to enter treatment voluntarily—known under the law as a settlement order—rather than go through the judicial process.

“Overall, we have seen a huge decrease in hospitalization, in homelessness, in arrests and jail days,” Heggarty told attendees at a November Laura’s Law forum sponsored by San Diego County. “Prior to [Laura’s Law], we had to wait for someone to be in an emergency condition…. Now we can intervene earlier. We can offer treatment earlier—outpatient treatment, unlocked. They can go home at night and live their normal lives.”

Jacobs says that Los Angeles County has recently implemented a pilot program under the auspices of Laura’s Law, using assisted-outpatient treatment as a discharge plan for people who’ve revolved in and out of the county’s psychiatric hospital. So far, she says, the L.A. program’s been successful.

“Our system is failing a lot of people,” Jacobs says, “and if we can prevent a group of individuals who are very, very ill from ineffectively eating up services, then there’s going to be more for everybody.”

Laura’s Law is simply another tool, Jacobs adds.

“It’s for people who are so ill that they don’t even know they’re ill and, as a result, wind up revolving through our hospitals and our jails.”

Write to kellyd@sdcitybeat.com and editor@sdcitybeat.com.