The July death of a schizophrenic homeless man after an altercation with Fullerton Police has focused attention on care for the mentally ill. Orange County supervisors might now adopt “Laura’s Law” so clinic workers can go into the streets to treat the mentally ill. Laura’s Law is in effect only in Nevada County, east of Sacramento. Officials there say it’s humane and cost-effective.
A metal detector and a uniformed guard greet visitors at the door of the Nevada County Behavioral Health Department. Security in the otherwise folksy lobby wasn’t always so tight, but 10 years ago, a severely mentally ill patient shot up the department’s front office and a restaurant nearby. He killed three people — among them 19-year-old Laura Wilcox, a mental health clinic volunteer on winter break from college.
"In January of 2001 our daughter was working at the Nevada County behavior health clinic, and she never came home that day," says Nick Wilcox, Laura's father.
Scott Harlan Thorpe was her killer — 41 years old at the time, suffering from severe delusions. He also refused medication to control those delusions. His family and the mental health system couldn’t do anything.
"We came to realize that this rampage shooting was really triggered by deficiencies in the mental health system," Nick Wilcox says. "So not being able to do anything about our daughter because she was dead, we tried to work on correcting the system."
The result? Laura’s Law, which allows counties, if they choose, to require medical treatment for a unique segment of the mentally ill community. It applies only to patients with severe mental illness and a history of multiple hospitalizations or jail time. The law lets a judge order such patients into “assisted outpatient treatment.”
"If we didn’t have assisted outpatient treatment, the only way you can really intervene with seriously mentally ill people who refuse treatment is to wait until something horrible happens," says Michael Heggarty, Nevada County's behavioral health director, "and then you can use involuntarily hospitalization or incarceration. But that’s a terrible outcome to have to wait for."
What’s more, says Heggarty, for every dollar spent on Laura’s Law, Nevada County saves $1.81 because fewer people end up in jail or in a mental hospital. Still, Heggarty says he was skeptical about the need.
"Part of my ignorance at the time was not really understanding fully the number of people that are seriously mentally ill," Heggarty says, "and because of their mental illness ... refuse to be in treatment because they don’t consider themselves to be sick."
Debra understands. She’s the mother of a 30-year-old schizophrenic son. She talked about him but wouldn’t give her last name.
"Truthfully, it’s like living on a roller coaster from hell," Debra says. "When he’s on medications he’s stable and he’s a joy to live with." And when he’s not, verbal and physical aggression overtakes him.
At Friday's Homeless Commission hearing, supporters and opponents of the law echoed arguments that have been made since the mid-1990s, when the state Legislature first began considering a law to help severely mentally ill people without violating their rights.
County mental health officials emphasized costs at Friday's meeting, and Ron Thomas, father of Kelly Thomas, reacted: "What I hear a lot is money. It's always about the money. … Let's start taking care of some of the people."
Those in favor of the law, primarily parents or siblings of adults with severe mental illness, recounted events in which current law kept them from coming to the aid of their relatives.
"God dammit, I want people to be mad like I was," said Jennifer Hoff. Her mentally ill son turned 18 in March and now is living on the streets in Santa Ana because he's not taking prescribed medications, she said. Current law prevents her from getting help for her son, she complained.
Once someone turns 18, they may make their own medical decisions. One of the most challenging effects of schizophrenia and some other illnesses is that those who are seriously ill have no sense there is anything wrong. They frequently refuse to take medications.
Federal privacy laws and existing state laws make it difficult for parents, relatives or friends to work with doctors on behalf of the ailing adult, speakers said.
But advocates for the rights of mentally ill people worry that new laws or local adoption of Laura's Law could mean mentally ill adults will receive treatment against their will, even if forced medication isn't allowed.
"My body belongs to me," said Charmaine Asher. Laura's Law is "a slippery slope of civil rights violations," she said.
In an effort to protect those rights, Laura's Law requires that the person have a history of not complying with prescribed medical treatment. That failure must have been a factor in the adult being sent to a hospital, prison or jail at least twice within the past 36 months.
The law also stipulates that if the mentally ill person wasn't in jail or hospitalized, he or she must have threatened or attempted serious violent behavior to themselves or others within the past four years.
The person also must have been offered the chance to voluntarily participate in a local treatment plan but continued to refuse, according to the law. Conditions must also be deteriorating "substantially" and require outpatient treatment to prevent persons becoming a danger to themselves or others or unable to care for themselves.
In addition, they must be found to be likely to benefit from the outpatient treatment.
County mental health officials did not go into much detail about how a locally adopted program might work. Most of the discussion involved costs and whether such a program would qualify for state mental health bond funds. Nevada and Los Angeles counties are using state money for their programs.
Nevada County officials have said Laura's Law saved taxpayers money, mainly because the costs of housing mentally ill people in jails and treating them in emergency rooms were substantially reduced after the county's adoption of Laura's Law.
Despite Nevada County's experience, Orange County officials made no mention of savings, only potential increased costs and other difficulties.
Supporters of Laura's Law say Orange County officials are reluctant to implement it because, once a treatment plan is approved by the courts, judges would hold the county accountable for following through and providing the treatment as well as keeping in contact with the patient.
The reliability of Orange County's estimates is uncertain. In October, Orange County mental health officials estimated Laura's Law would cost $6.1 million a year to care for about 120 patients.
Officials in San Diego County, which is almost identical to Orange County in population, say they could handle nearly five times as many severely mentally ill adults at about one-third of Orange County's cost estimate.
A metal detector and a uniformed guard greet visitors at the door of the Nevada County Behavioral Health Department. Security in the otherwise folksy lobby wasn’t always so tight, but 10 years ago, a severely mentally ill patient shot up the department’s front office and a restaurant nearby. He killed three people — among them 19-year-old Laura Wilcox, a mental health clinic volunteer on winter break from college.
"In January of 2001 our daughter was working at the Nevada County behavior health clinic, and she never came home that day," says Nick Wilcox, Laura's father.
Scott Harlan Thorpe was her killer — 41 years old at the time, suffering from severe delusions. He also refused medication to control those delusions. His family and the mental health system couldn’t do anything.
"We came to realize that this rampage shooting was really triggered by deficiencies in the mental health system," Nick Wilcox says. "So not being able to do anything about our daughter because she was dead, we tried to work on correcting the system."
The result? Laura’s Law, which allows counties, if they choose, to require medical treatment for a unique segment of the mentally ill community. It applies only to patients with severe mental illness and a history of multiple hospitalizations or jail time. The law lets a judge order such patients into “assisted outpatient treatment.”
"If we didn’t have assisted outpatient treatment, the only way you can really intervene with seriously mentally ill people who refuse treatment is to wait until something horrible happens," says Michael Heggarty, Nevada County's behavioral health director, "and then you can use involuntarily hospitalization or incarceration. But that’s a terrible outcome to have to wait for."
What’s more, says Heggarty, for every dollar spent on Laura’s Law, Nevada County saves $1.81 because fewer people end up in jail or in a mental hospital. Still, Heggarty says he was skeptical about the need.
"Part of my ignorance at the time was not really understanding fully the number of people that are seriously mentally ill," Heggarty says, "and because of their mental illness ... refuse to be in treatment because they don’t consider themselves to be sick."
Debra understands. She’s the mother of a 30-year-old schizophrenic son. She talked about him but wouldn’t give her last name.
"Truthfully, it’s like living on a roller coaster from hell," Debra says. "When he’s on medications he’s stable and he’s a joy to live with." And when he’s not, verbal and physical aggression overtakes him.
At Friday's Homeless Commission hearing, supporters and opponents of the law echoed arguments that have been made since the mid-1990s, when the state Legislature first began considering a law to help severely mentally ill people without violating their rights.
County mental health officials emphasized costs at Friday's meeting, and Ron Thomas, father of Kelly Thomas, reacted: "What I hear a lot is money. It's always about the money. … Let's start taking care of some of the people."
Those in favor of the law, primarily parents or siblings of adults with severe mental illness, recounted events in which current law kept them from coming to the aid of their relatives.
"God dammit, I want people to be mad like I was," said Jennifer Hoff. Her mentally ill son turned 18 in March and now is living on the streets in Santa Ana because he's not taking prescribed medications, she said. Current law prevents her from getting help for her son, she complained.
Once someone turns 18, they may make their own medical decisions. One of the most challenging effects of schizophrenia and some other illnesses is that those who are seriously ill have no sense there is anything wrong. They frequently refuse to take medications.
Federal privacy laws and existing state laws make it difficult for parents, relatives or friends to work with doctors on behalf of the ailing adult, speakers said.
But advocates for the rights of mentally ill people worry that new laws or local adoption of Laura's Law could mean mentally ill adults will receive treatment against their will, even if forced medication isn't allowed.
"My body belongs to me," said Charmaine Asher. Laura's Law is "a slippery slope of civil rights violations," she said.
In an effort to protect those rights, Laura's Law requires that the person have a history of not complying with prescribed medical treatment. That failure must have been a factor in the adult being sent to a hospital, prison or jail at least twice within the past 36 months.
The law also stipulates that if the mentally ill person wasn't in jail or hospitalized, he or she must have threatened or attempted serious violent behavior to themselves or others within the past four years.
The person also must have been offered the chance to voluntarily participate in a local treatment plan but continued to refuse, according to the law. Conditions must also be deteriorating "substantially" and require outpatient treatment to prevent persons becoming a danger to themselves or others or unable to care for themselves.
In addition, they must be found to be likely to benefit from the outpatient treatment.
County mental health officials did not go into much detail about how a locally adopted program might work. Most of the discussion involved costs and whether such a program would qualify for state mental health bond funds. Nevada and Los Angeles counties are using state money for their programs.
Nevada County officials have said Laura's Law saved taxpayers money, mainly because the costs of housing mentally ill people in jails and treating them in emergency rooms were substantially reduced after the county's adoption of Laura's Law.
Despite Nevada County's experience, Orange County officials made no mention of savings, only potential increased costs and other difficulties.
Supporters of Laura's Law say Orange County officials are reluctant to implement it because, once a treatment plan is approved by the courts, judges would hold the county accountable for following through and providing the treatment as well as keeping in contact with the patient.
The reliability of Orange County's estimates is uncertain. In October, Orange County mental health officials estimated Laura's Law would cost $6.1 million a year to care for about 120 patients.
Officials in San Diego County, which is almost identical to Orange County in population, say they could handle nearly five times as many severely mentally ill adults at about one-third of Orange County's cost estimate.
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