Los Angeles County is poised to join two other large California counties in implementing a discretionary state law that allows court-ordered treatment for people struggling with serious mental illnesses.
The Board of Supervisors is expected to vote Tuesday on a proposal that would increase money for outpatient treatment of people with a history of mental illness and expand efforts to identify potential patients. The vote would also set in motion a process that would allow family members, treatment providers and law enforcement officers to seek a court order to make people take part in the program, under which people can be ordered to undergo treatment but can't be forced to take medication.
Supervisor Michael D. Antonovich, who has pushed to adopt Laura's Law in L.A. County, said in a statement that the move would provide "comprehensive medical treatment and a path to recovery for the severely mentally ill — many of whom are incapable of recognizing their illness." He added that the law "is a compassionate, cost-effective approach, proven to reduce incarceration and homelessness."
The law has also been hailed by some advocates, who say it will save lives and give another option to overburdened families.
"It's not going to be a panacea for what our system needs, but it is going to save more people than we are able to save right now," said Carla Jacobs, an Orange County-based mental health advocate and former member of Los Angeles County's mental health commission.
Others, like Dave Pilon, chief executive of treatment provider Mental Health America of Los Angeles, argue that forced treatment violates patient's rights.
County officials said the emphasis will still be on persuading people to voluntarily agree to treatment, going to court only as a last resort. But Pilon said he worries that the county will lean too heavily on the courts if they have trouble getting people to comply willingly.
"We feel like mental health treatment is always more effective when it's free and voluntary," he said.
Laura's Law was passed in 2002 but until recently had been fully implemented only by sparsely populated Nevada County. The push to create the law originated there in 2001 when a 19-year-old mental health clinic worker, Laura Wilcox, was shot to death by a man who had refused psychiatric treatment.
In part, counties were reluctant to adopt the law because of concerns about costs. A bill that passed last year clarified that they could use state mental health money to implement the law. Since then, San Francisco and Orange counties have moved to implement it.
Los Angeles County — the state's largest — launched a limited program soon after Laura's Law took effect, but it has remained purely voluntary for people coming out of psychiatric hospitals or the criminal justice system.
County officials say the small program has shown good results in reducing hospitalizations and jail time among participants. They now hope to expand it from 20 to 300 treatment slots and set up a team tasked with finding potential patients, persuading them to enter treatment and managing the court filing process when necessary.
County mental health leaders have convened meetings with advocates and officials from the court, district attorney and public defenders' offices over the last year to look at how to expand the program. Marv Southard, director of the county's mental health department, said the turning point came when a team from L.A. County visited Nevada County. Based on what they saw there, Southard said he and the other L.A. County officials decided the program's "costs were manageable and the truly involuntary aspects were minimal."
Abby Moreno, a home caregiver in the Antelope Valley, said she thinks Laura's Law could have helped her 22-year-old son, Jacob. He has had a series of psychotic episodes over the last three years and cycled in and out of jail. In December 2011, Moreno said, her son attacked her with a knife. A few months later, he began refusing to eat, drink or even wear clothes. One day, she found him playing basketball naked on a court by their home. He is now awaiting trial on vehicle theft charges after he took her car during an episode.
Moreno said she has looked into applying for conservatorship of her son but was told he wouldn't qualify. In the early stages of his illness, she said, he was willing to see a psychiatrist. But as it progressed, he refused to get help, and she couldn't get him admitted to a psychiatric facility.
"I'm so sick of the system," she said. "He doesn't get treatment.... We tried when he's outside, and he doesn't get it. We tried when he's in jail, and he doesn't get it."