COMMUNITY COMMENTARY: Is outpatient treatment more appropriate than jail for the severely mentally ill?

Battle lines are drawn. On one side are advocates for Laura’s Law; on the other side are activists against it. The outcome will directly affect public safety and our county’s budget. With so much at stake, why has Laura’s Law coverage been under-reported, vague and confusing? What is Laura’s Law, who does it affect, who are the partisan advocates and what do they contend?
AB 1421 was signed into law at the end of 2002. Known as Laura’s Law, now California Welfare and Institutions Code 5345, allows court-ordered, assisted outpatient treatment for a small population of mentally ill individuals who revolve in and out of jails, hospitals and homelessness. The operative words are “assisted outpatient treatment.” Unfortunately Laura’s Law was not state funded; county government must ante-up.
Currently the Lanterman-Petris-Short, or LPS, act addresses civil commitment for mentally ill citizens. It provides for involuntary commitment (hospitalization) of citizens only if they pose an immediate danger to themselves, to others or are judged to be “gravely disabled” (unable to care for themselves).
Once one of these obstacles is overcome, an individual may be committed to an emergency psychiatric unit for a 72-hour holding period. In other words, a treating psychiatrist has 72 hours to evaluate and treat the individual. With that said, it’s extremely difficult to treat an individual using LPS. As a result, mentally ill individuals enter into what is called the “revolving door syndrome” of hospitalization, jail or homelessness — an extremely expensive and ineffective cycle.
Advocates for Laura’s Law speculate: Why wait for a mentally ill person to severely decompensate in order to help them when W&I 5345 will enable a qualified person to petition a local Superior Court for treatment of the individual? The county mental health director must then conduct an investigation to determine if the individual qualifies for an outpatient treatment program.
Advocates against Laura’s Law opine assisted outpatient treatment is involuntary treatment; involuntary treatment doesn’t work. They say mental health treatment works best when it’s done in full partnership between the consumer and mental health professionals. “Forcing treatment on someone shatters all trust. Singling out mentally ill people as dangerous is discriminatory and stigmatizes them.” They suggest voluntary treatment as herbs, meditation and peer counseling.
Main proponents of Laura’s Law are the California Treatment Advocacy Coalition, the California Psychiatric Association, the Police Chiefs Association and the National Alliance on Mental Illness.
The main opponents are the California Network of Mental Health Clients, the Psychiatric Survivors Movement, the Church of Scientology and surprisingly, the federal government. It has an indirect but influential role in undermining Laura’s Law. Specifically, the Department of Health and Human Services, Substance Abuse and Mental Health Services Administration provides funding to obstructionists programs like Protection and Advocacy for Individuals with Mental Illness. These taxpayer-funded organizations are lobbying against the passage and/or implementation of assisted outpatient treatment.
In Dr. Sally Satel’s May 28, 2007, article “Sane Mental Health Laws,” Dr. Satel states “Federal advocates are standing in the way of reform.” Satel cites Rael Jean Isaac and Virginia Armat in their book “Madness in the Streets” as documenting proof Protection Advocacy programs have become a “playground for anti-psychotropic medication activists.”
Just like Jared Loughner’s violent action in Arizona and the Virginia Tech shooting, San Diego has potentially violent mentally ill citizens too. The sad thing about these individuals is through repeatedly entering the criminal justice system’s revolving door, they telegraph tragic future events. We, the community, know who they are. Even though their numbers may be small, their acts far outweigh their population proportions.
Laura’s Law provides the least restrictive process to address paranoid and potentially violent mentally ill citizen’s protection from tragic events. For the sake of public safety, press your Board of Supervisors to do the right thing and implement W&I 5345 in San Diego County.

William D. Hardy is a Carlsbad resident.

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