True Help on Mental Illness

Los Angeles is the only county to implement the state’s 2002 “Laura’s law,” which allows a judge, under closely monitored circumstances, to order severely and often violently mentally ill people to accept treatment.

The other 57 counties, which tend to view the law as controversial and expensive because it lacks state funding, should look at Los Angeles County. A limited pilot program has stopped dozens of people from cycling in and out of jails, hospitals and prisons.

Marvin Southard, the director of the county’s mental health department, found money to begin implementing Laura’s law (named after a young woman killed by a mentally ill man in a Northern California clinic) by transferring some seriously mentally ill people out of guarded psychiatric wards -- where they each cost the county about $100,000 a year -- and into supervised, locked board-and-care facilities where they cost from $28,000 to $56,000.

Using savings generated by the transfers, Southard established a program in which mental health teams closely followed a small number of seriously mentally ill people after their discharge from jail. Before the passage of Laura’s law, such people were typically released with a sheet of paper referring them to a mental health clinic. Then they were forgotten. Today, if one of the lucky few in the pilot program fails to comply with his treatment plan, the team can find him, drive him to a clinic or other prescribed social service and give him a chance to get back on track.

Critics of Laura’s law argue that it, in its coercion, drives the ill away from treatment. Tell that, however, to Amy Cabonce, who last summer argued to Mateo County mental health professionals that they ought to compel her 41-year-old son, Jerry, to be treated after he had stopped taking medications to control his schizophrenia.

The officials told her that because they had not implemented Laura’s law, they could not compel Cabonce to be treated, even though he had stabbed his brother-in-law after stopping medication a few years earlier.

Just weeks later, Jerry Cabonce stuck a butcher knife into two San Francisco police officers. Three weeks ago, San Mateo Superior Court Judge Craig Parsons found him too mentally ill to stand trial. He is expected to be sent to a state psychiatric hospital, where he will cost state taxpayers about $100,000 a year.

There’s no empirical evidence to prove that Laura’s law is cost-effective: It is too new and its implementation too limited to have been academically documented. But had San Mateo County treated Cabonce, it could have billed the federal government for at least 50% of the cost of his care through Medicaid. Since Washington doesn’t reimburse state psychiatric hospitals or prisons, the county now shoulders the whole cost.

California counties should implement Laura’s law, even partly, because it’s the morally right thing to do. Given the state’s current budget crisis, the money-saving potential should also be better explored.