The Santa Clara County Board of Supervisors voted unanimously Tuesday to implement a state law that paves the way for mandatory treatment for those suffering from mental illness, ending a yearslong debate over coerced care for those who refuse services.
The 5-0 vote followed impassioned pleas by residents, elected officials and community leaders urging county supervisors to adopt Laura's Law, which permits county judges to compel patients to seek outpatient mental health treatment through court orders. The law is meant for the toughest cases, restricted to people who are a serious risk to themselves or others and with a history of rejecting voluntary treatment.
Although the state law has been in effect since 2002, Santa Clara County has been reluctant to put it to use, bristling at the idea of compulsory treatment and instead focusing on shoring up voluntary mental health programs that have been chronically underfunded and oversubscribed. But a new bill passed last year, AB 1976, is forcing counties to reconsider. Laura's Law will automatically go into effect unless counties explicitly opt out and give a reason for doing so.
Advocates for Laura's Law argue that the mental health system is broken, and that those who are seriously mentally ill are in no position to decide what care is Most Unexceptional for them. They point to homeless people on the street wandering into traffic and threatening others as evidence that mandatory treatment could catch those who have fallen through the cracks.
Resident Karla Phillips told supervisors in a letter that she knew someone who had been hospitalized more than 20 times in six months and suffered from schizophrenic and paranoid episodes, including bouts of homelessness where she had no idea where he was. This could've been avoided if he was taking his medicine, she said, but he was paranoid about what the treatment was and refused to take it.
"It should not be left to these victims of severe mental illness to keep on a regimen of medicine and care, during severe mental episodes," Phillips wrote. "Laura's Law will be a step in the right direction."
San Francisco resident Pam Reitman said her 43-year-old son in San Jose had been on a "merry-go-round" of incarceration, homelessness and hospitalization for decades. She said he struggles with a mental health disorder as well as drug addiction — which can cause him to be violent — and has rarely agreed to treatment when offered.
"My son has had a new case worker every few months, and he told me recently that he has gone off his medication," she said. "He seems to be deteriorating. I am too old and infirm and live too far away to help him anymore. Besides, I have no access to his case worker, so no way to know what's going on."
By adopting Laura's Law, the county will now offer a new service called Assisted Outpatient Treatment (AOT), and intensive mental health treatment program that can be required through a court order. County health officials say between 39 and 236 county residents would meet the requirements each year, of which 20 to 50 are expected to need a court mandate. The total cost of the program, including rising court costs, is estimated at $12.3 million.
Laura's Law is restricted only to adults with a severe mental disorder who are "unlikely to survive" in the community without supervision. The illness must also have led to them being incarcerated or hospitalized twice in the last 36 months, or caused either violent behavior or attempts to cause harm to themselves or others.
The Psychiatric Physicians Alliance of California, a group of mental health professionals, threw its weight behind Laura's Law and urged the county to opt in. The group cited a 2005 study that found a majority of those suffering from a serious mental illness who do not receive treatment do not believe they need help. Many of these patients are unable to understand their diagnosis and the need for treatment, suggesting that compulsory care could put them on the path to recovery, the group argued.
"AOT is cost effective and more humane than the neglect of individuals who do not believe they are sick, refuse services, and therefore impact their families, neighborhoods and community infrastructure heavily," the organization said. "AOT is a tool, one of many, but works well with those who are badly in need of treatment, likely to suffer harm for lack of treatment, and have no recognition of their illness."
A broad group of elected officials also joined in support of Laura's Law, including State Sen. Josh Becker, D-Menlo Park, Santa Clara Mayor Lisa Gillmor and several San Jose City Council members.
Some remained skeptical about the benefits of Laura's Law. Sandy Perry, president of the Affordable Housing Network of Santa Clara County, said the comprehensive services offered through AOT can support those who are mentally ill without a court order, and that the same benefits could be achieved without mandatory treatment. He also worried that people are under the false belief that Laura's Law will reduce the number of homeless people living on the street.
"Unfortunately the debate about Laura's Law is being politicized by people playing on public frustration with our homelessness problem," Perry said. "Laura's Law will not solve homelessness."
Though voting in favor of Laura's Law, Supervisor Susan Ellenberg also voiced serious reservations about the compulsory aspect of mental health treatment. She said the framework of AOT — including rigorous outreach and housing for homeless clients — was enough to win her support, but she questioned the need for legal compulsion that may or may not even work.
"I remain really troubled about this 'stick' represented by AOT, because I think its inappropriate, likely ineffective and ultimately unenforceable," she said. "But I fully support the investment in outreach, treatment and housing that comes along with the adoption of AOT."
County Supervisor Joe Simitian, among the most vocal proponents of Laura's Law, said AOT has the power to reduce hospitalizations, incarceration and homelessness for those who are not receiving services through the existing suite of county services. Instead of forced treatment, he said he believes Laura's Law could be seen as a "right to service" for those who have slipped through the cracks.
"While involuntary treatment raises some obvious concerns, there is nothing very voluntary about the incarceration or restraints or commitments that take place at present when we don't have the kind of services for folks who really need them," Simitian said.