Readers React: Speaking up for Laura’s Law in L.A.

To the editor: British psychiatrist Tom Burns says that he doesn’t expect Laura’s Law to make a big difference. Yet the results of his study in the medical journal Lancet show that steady, flexible and persistent outreach, coupled with high quality and well-coordinated mental health services (voluntary or not) produce the best long-term outcomes. (“Can Laura’s Law help the mentally ill? Researcher Tom Burns’ surprising conclusion.,” Op-Ed, July 22)

This is exactly what Laura’s Law requires and what L.A. County’s implementation seeks to deliver. Almost all of it will be voluntary. Many stakeholders agree that L.A.’s plan represents new hope for some of our most vulnerable people.

When it comes to compulsory treatment, Burns says that “If I have a seriously ill schizophrenic patient who is neglecting himself, not taking his medicine, and I know he’s going to get worse, I can say that it’s a ‘danger’ to his health.”

This broad European definition of “danger” sounds a lot like the “likelihood of substantial deterioration” described in Laura’s Law. In those instances in which a court finds a likelihood of substantial deterioration, Laura’s Law permits intervention for the same seriously ill individuals that Burns would also treat because he considers them to be in danger.

That could make a very big difference for L.A. County— by saving lives.

Roderick Shaner, MD, Pacific Palisades

The writer is medical director of the county’s Department of Mental Health.

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To the editor: Patt Morrison’s interview of Burns is puzzling. The “high-quality research” cited found that patients with compulsory treatment did no better than controls “if [the control patients] are getting decent care otherwise” (emphasis added).

Of course this is true — the targets of Laura’s Law are not patients who are already getting decent care but instead are those receiving little or no care because their illness-impaired judgment leads them to refuse treatment.

Burns is correct that one of the necessary skills of a psychiatrist is to form a trusting relationship with patients who are frightened or delusional about treatment. Yet no amount of interpersonal skill will permit this to happen if the patient refuses to even appear for treatment. If Laura’s Law is enforced so that at least the patient is required to attend treatment, surely some of the patients can be reached.

Cyril Barnert, MD, Los Angeles

The writer is a retired professor of clinical psychiatry at UCLA.