The Santa Clara County Board of Supervisors is set to decide whether to use court-ordered treatment to help those suffering from severe mental illness, opening the door for coerced care for those who refuse help.
This Tuesday, the board is scheduled to take up the controversial issue of assisted outpatient treatment, better known as Laura's Law, and has until the end of June to make a final decision. If implemented, court judges would be empowered to compel residents into mental health treatment if they've failed to stick to voluntary programs and have landed in jail or the hospital multiple times as a result of the illness.
Proponents say Laura's Law would go a long way helping those suffering from mental illness who have not received treatment — many ending up homeless on the street — and are too mentally ill to even recognize their own condition. County supervisors Joe Simitian and Otto Lee have already recommended implementing Laura's Law at a committee meeting in March, with Simitian calling it one more tool to help those who need it.
"These are folks who continue to suffer from untreated illness," Simitian said in a May 17 statement. "They're folks whose families have been told again and again that there is nothing we can do to help them if their loved ones don't agree to accept care. They have a right to mental health care, and now, we have the chance to finally get them some help."
Laura's Law has been in effect since 2002, but most counties — including Santa Clara — have declined to implement the program. Along with concerns that mandatory treatment violates civil liberties, county health officials insist that time and money would be better spent beefing up voluntary programs and question the value of court-ordered care as a means to treat sick patients. The Law Foundation of Silicon Valley has also been skeptical, and says Laura's Law reinforces the misconception that people with mental health disabilities are violent and cannot make decisions about their treatment.
Though the law is nearly two decades old, Laura's Law is back in the spotlight. A new state law, Assembly Bill 1976, requires all counties to opt into Laura's Law by default, and those opting out must do so by the end of June with a clear rationale for the denial. San Bernardino County will be opting out, at least in part due to concerns that mandatory treatment will disproportionately affect communities of color, according to Santa Clara County officials.
A letter in support of Laura's Law, signed by 40 people including leaders of environmental, business and mental health groups, urged county supervisors to opt in. The letter notes that assisted outpatient treatment is narrowly focused on some of the most difficult cases. People eligible for court-ordered treatment must be adults with a severe mental disorder and be "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.
Santa Clara County estimates, while broad, suggest that between 39 and 236 residents would meet the criteria for Laura's Law each year, of which between 20 and 50 may be subject to a court mandate.
"AOT (assisted outpatient treatment) would serve to benefit the most vulnerable members of our society: severely mentally ill individuals who refuse to receive the care that they need," the letter states. "It is not compassionate, equitable, nor fiscally responsible to allow the revolving door between emergency rooms, jails, and streets to continue."
Some Bay Area counties, including San Francisco and San Mateo, have implemented Laura's Law in recent years and found success, with a massive reduction in incarceration and admittance into psychiatric hospitals among the participants. Advocates for the program say housing stability is a significant factor in the success of assisted outpatient treatment, and that it should come in tandem with treatment.
Though county behavioral health staff are seeking to reject assisted outpatient treatment, Simitian said it's getting harder to justify opting out when so many counties are able to implement Laura's Law with positive results. He said he grappled with concerns about civil liberties and due process in the past, but that he has since changed his mind.
"I am now convinced that the law is crafted narrowly enough, and has enough protections built into it, that these concerns have been alleviated," Simitian said.
Early estimates show Laura's Law would cost close to $4 million, which would not be paid for by the state and must come from county coffers. Simitian said the costs are warranted.