San Diego county makes mental health progress, but Laura’s Law has yet to pass

The Board of Supervisors for San Diego County recently approved expansion of the In-Home Outreach Team, a county organization that helps get reluctant individuals in need of mental health treatment to proper education and resources they need. According to 10 News, the local ABC affiliate, a recent approval of $2.3 million in funding for mental health programs in the county will help IHOT cast a broader net. County staff will also provide quarterly reports back to the Board.

However, the news source spoke to one woman, Theresa Bish, former chair of the county’s Mental Health Board, who didn’t feel that the IHOT expansion was enough. Bish’s brother, Vincent, was diagnosed with schizophrenia and had trouble with medication compliance. According to Bish, he cycled in and out of jails and hospitals over the course of 15 years. Then, in 2003, he committed suicide. According to Bish, what Vincent needed beyond his medication, case management and a team of dedicated mental healthcare workers was Laura’s Law. As Bish explained, the IHOT program is voluntary, while Laura’s Law requires court-ordered outpatient treatment.

A mental health law legacy

On Jan. 10, 2001, Laura Wilcox, 19, was working at California’s Nevada County Behavioral Health Clinic in Grass Valley, Calif., north of Sacramento. A client came into the clinic for a schedule appointed, and without provocation drew a handgun and shot Wilcox several times. The patient then continued through the clinic and in a nearby restaurant. Two were injured that day, and three were left dead, including Wilcox. The shooter, Scott Thorpe, had a history of untreated mental health problems.

Laura’s Law was passed by the California Legislature in 2002, only one year later. It became the de facto name for the assisted outpatient treatment program, in which untreated and mentally ill individuals receive court-ordered assistance from mental healthcare providers. Like similar laws in other states, such as New York’s Kendra’s Law, the assisted outpatient treatment can be viewed as a bridge to greater stability, improved discharge management from inpatient treatment and reintegration into a community.

According to the Treatment Advocacy Center, assisted outpatient treatment – such as Laura’s Law – works. The news source looked to both government and academic studies of such programs, which indicate that assisted outpatient treatment can reduce re-hospitalizations, length of hospital stays, arrests, incarcerations, suicide attempts, victimization and violent behavior.

But Laura’s Law is only used in three of California’s 58 counties, including Nevada County, where the shooting took place. Los Angeles County is currently trying out a pilot program of Laura’s Law on a smaller scale, according to the Treatment Advocacy Center, and San Diego City Beat noted that Yolo County, which borders Sacramento, is also giving a pilot program a shot. For people like Bish, there was some hope that San Diego County might be the next.

A board divided
According to San Diego City Beat, one of the most divisive topics among the behavioral health community in San Diego is how to treat mentally ill individuals who refuse care. In San Diego, a group of advocates have nicknamed Laura’s Law “5149 ½,” a play on numbers referring to “5150,” the current state code for he involuntary confinement of an individual to a psychiatric facility. As the advocates put it, Laura’s Law helps mentally ill individuals before forced hospitalization, jail time or – as seen in the past – tragedy. Furthermore, according to a 2012 Nevada County Grand Jury report, for every dollar the county invested in Laura’s Law, it saw $2 in savings from reduced hospital and jail stays.

City Beat noted that how the county actually feels about Laura’s Law depends on who you speak to. For instance, while the 2011 county Mental Health Board, which advises the county supervisors on policy, voted unanimously in favor of implementing the law, it was called “flawed” by county staff, according to City Beat, and shelved.

The law was brought back on the table by Supervisors Dave Roberts and Dianne Jacob just this summer, but was shelved again in favor of the IHOT program.

Roberts doesn’t see the vote to table Laura’s Law again as a failure, however. He calls it progress. And any expanding of mental health services is a huge step, he noted.

“What we specifically did was begin to change the dialog and really focus on why mental-health services are so important,” Roberts told City Beat. “You have to remember, not all of my colleagues are going to support Laura’s Law, so you have to take incremental steps in order to get to where you want to go from a policy perspective, and you have to make sure that you’re covering all the needed ground.”

The $2.3 million will definitely cover a good amount of ground, helping to establish better coordinated care for those in need in San Diego County. And with time, advocates for Laura’s Law may yet see the ruling on assisted outpatient treatment they’re hoping for.