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Santa Clara County supervisors consider mandatory mental health treatment for those with severe illness

Board has until the end of June to make a final decision

Santa Clara County could soon allow for court-mandated mental health treatment. Photo by Magali Gauthier.

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.

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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.

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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.

Kevin Forestieri writes for the Mountain View Voice, a sister publication of PaloAltoOnline.com.

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Santa Clara County supervisors consider mandatory mental health treatment for those with severe illness

Board has until the end of June to make a final decision

by / Mountain View Voice

Uploaded: Sun, May 23, 2021, 9:50 am

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.

Kevin Forestieri writes for the Mountain View Voice, a sister publication of PaloAltoOnline.com.

Comments

Jeremy Erman
Registered user
Midtown
on May 23, 2021 at 1:04 pm
Jeremy Erman, Midtown
Registered user
on May 23, 2021 at 1:04 pm

If "between 20 and 50 may be subject to a court mandate" and "estimates show Laura's Law would cost close to $4 million", then the county could end up paying $200,000 to $80,000 per person.

However, it would be interesting to compare these costs to the costs of incarceration or hospitalization or other services already incurred. It could be that this program would save money in the long run. Of course, if successful, the humanitarian benefits might far outweigh any monetary costs in many peoples minds.

There are no easy solutions to these issues. Forced care is a troubling concept on the face of it, but equally troubling is the way our society is willing to incarcerate or hospitalize people who essentially cannot survive on their own and then throw them back onto the streets or another untenable situation.

I know homeless people who have been arrested and hospitalized and then returned to the streets. They deserve better.


Myrtle Baur
Registered user
Mountain View
on May 23, 2021 at 2:14 pm
Myrtle Baur, Mountain View
Registered user
on May 23, 2021 at 2:14 pm

[Portion removed.]

Just how much jurisdiction will the county have if this program is fully implemented?


Eppie Rosenberg
Registered user
Another Palo Alto neighborhood
on May 23, 2021 at 9:28 pm
Eppie Rosenberg, Another Palo Alto neighborhood
Registered user
on May 23, 2021 at 9:28 pm

Hopefully the judges making these crucial decisions will have some training and/or experience dealing with mental health issues and a familiarity with comprehensive diagnostics.

Otherwise, anyone can be put away based on unsubstantiated allegations.


Easy8
Registered user
Green Acres
on May 23, 2021 at 10:49 pm
Easy8, Green Acres
Registered user
on May 23, 2021 at 10:49 pm

Second generation antipsychotics can be very effective, and have much fewer side effects than older medications. I am a physician who sees a lot of these patients treated by my psychiatry colleagues, and am always surprised how lucid and functional some of them can become.

The problem is, one has to take these medications for at least a few weeks for them to start being effective. And that's the huge Catch-22 that has been created. There is no way a person who is in the throes of full blown schizophrenia, psychosis, or other mental illness will want to voluntarily take medications for the necessary time period, because they are not able to make rational decisions.

Once the medications start to take effect, many patients become quite functional and will want to take their medications voluntarily, and can then be moved to outpatient supervised status. The plan is never for lifelong institutionalization. I hope this proposal is approved.

The other big category of homeless are those addicted to drugs and alcohol. At some point, involuntary drug rehab programs need to be considered as well. There are many free mental health and drug rehab programs open to the homeless, but many do not voluntarily avail themselves of these opportunities.


Smith
Registered user
Downtown North
on May 24, 2021 at 8:53 pm
Smith , Downtown North
Registered user
on May 24, 2021 at 8:53 pm

I agree with the physician. However, despite the newer drugs they have side effects and that's the problem. A pill is not the complete solution.
Especially when one is chemically dependent upon meth.
To hell with the cost, these people need help in real rehabilitation centers.
Otherwise, despite Judge Manleys court and the various centers I've seen my son languish in. It's off to Prison where it costs even more.
The Public Guardians office is a joke!
Just been there in this county too long n know too much.
Sounds good but spend a night in any one of these places and let's get these people in where the rich go.


Common Sense Speaks
Registered user
Another Palo Alto neighborhood
on May 24, 2021 at 11:48 pm
Common Sense Speaks, Another Palo Alto neighborhood
Registered user
on May 24, 2021 at 11:48 pm

As a family member of a now deceased person who was court ordered. It was such a relief to get help.

By implementing the court order it allowed us to get close enough to safely help this loved one. Without it he would have lived and died in horrible circumstances. With the court order he was able to stabalize enough to go home without taking other people in family down with him. He could not get good help without the meds. He would not accept help until he was on meds. He lived without dignity and with his rights infringed traumatically and sometimes unexpectedly when vulnerable with an active mental disorder. I have heard family member with life threatening, self & others intentionally or more often accidentally, level additions have the same experience.

Luckily this family member lived with another elderly family member in reciprocity. He then died in a clean caring hospice as an elder with family there. This is rather than on the streets as a middle aged man who caused much harm to those closest to him.

Easy 8 has it right.

Smith I would ask you to compare the side effects of the medication to the side effects of uncontrolled brain disorder/dis-ease on the individual, their family and the community at large.


Common Sense Speaks
Registered user
Another Palo Alto neighborhood
on May 24, 2021 at 11:57 pm
Common Sense Speaks, Another Palo Alto neighborhood
Registered user
on May 24, 2021 at 11:57 pm

Correction of my previous comment
(since I can not get in to edit though within the 5 minutes or didn't see how!):

I have heard family members with a family member with a life threatening level of addiction have similar experiences dealing with their ill loved one.

The loved one who is in dire straits due to the addiction like the severely MI (chronic or periodically acute) will harm themselves or others, most often accidentally/not intentionally.

This is not a theoretical situation for people who are helping.
Who are helpers. Who care. Who want to help.
With court ordered medications this is possible.
There are a lot of safety and regulations to follow to do this.
It is not easy to do get the court order which is reasonable to expect in an fair system.

This include family, friends, neighbors, community organizations, and public services workers like police, EMT, fire fighters, maintenance workers, health care workers, shop keepers, food providers, etc etc


Virginia Smedberg
Registered user
Old Palo Alto
on May 25, 2021 at 3:37 am
Virginia Smedberg, Old Palo Alto
Registered user
on May 25, 2021 at 3:37 am

Many who exhibit mental illness symptoms are deficient nutritionally. For example, lack of B vitamins can cause many symptoms. Many so called mental health "treatments" harm more than they help. I highly recommend looking at the information from Citizens Commission on Human Rights, whose purpose is to keep people from being drugged with substances that have bad side effects, or worse yet electro shocked (yes that is still being done), when other options are available. So a mandatory "treatment" needs to be proven effective before it will be acceptable to me. There are also drug rehab systems that do not use other drugs to substitute, but actually clean the person's body of the drug residue which so often brings a person back into taking a drug because the craving turns on when a bit of the drug comes out of "storage" in the body. I want to see people helped - but truly HELPED, long term. Someone mentioned housing - that is important too - some stability of location. And a quiet environment, without constant harassment and invalidation, can really help de-stimulate a person.


Jennifer
Registered user
another community
on May 25, 2021 at 10:28 am
Jennifer, another community
Registered user
on May 25, 2021 at 10:28 am

Mental illness is sad. I wonder if anyone can effectively deal with the mentally ill, including mental health professionals. It's not an exact science, nor is it an illness that can be detected through blood work, monitored on a machine, etc. I don't have any family or friends who struggle with mental illness (that I know of) but I've met people through the years. A former neighbor was bi-polar and she told me she resented having to talk to a psychiatrist to receive medication, so she made it up as she went along just to get through therapy, and get her meds. Wow. I would like to see people truly helped too.


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