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From: "Mental Illness Policy Org" <office@mentalillnesspolicy.org>
Subject: California Mental Illness Update
Date: November 2nd 2011

Special edition of Mental Illness Policy Org Update focusing on California Only. Forward to others in California. Future issues will cover all states.

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A series of high-profile violent incidents involving people with untreated severe mental illness have helped Californians realize that Laura's Law (California's version of Assisted Outpatient Treatment) not only serves the interest of the ill, it serves the interest of the well. Time Magazine did an article which featured Mary Highland Palafox speaking out. We wrote how 10 years after the death of Laura Wilcox, Laura's Law is still rarely used because counties prefer to transfer care of the most severely mentally ill to shelters, jails and morgues.

To join statewide effort to implement Laura's Law contact Carla Jacobs of the California Treatment Advocacy Coalition and Randall Hagar of the California Psychiatric Association. Carla's personal experience with mental illness and violence and her advocacy was featured in the OC Register and Voice of OC YouTube has a video of Randal explaining the issues.

New Laura's Law Site is constantly updated county by county. Bookmark it.

New Fact Sheet: Myths About Laura's Law is a useful tool to address misinformation being spread about Laura's Law. Excerpts are at end of this newsletter.

Powerpoint presentation by Dr. E. Fuller Torrey on Future of Psychiatric Services in California

Several family members of people with mental illness have come forward to tell their story to the media further amplifying the call to implement Laura's Law. Talking to the media and legislators is the most important thing families of people with mental illness and people with mental illness can do to help improve care. Contact us if you would like to speak out

Mental Health Services Act Funds not going to seriously mentally ill

California passed Prop 63 which became the Mental Health Services Act (MHSA) which imposed a 1% tax on millionaires specifically to fund mental health services for those with "severe mental illness". However much of the money is being spent on the worried well leaving the seriously ill to fend for themselves. We documented where the money is going in Capital Weekly, a California Policy Journal and on Huffington Post. Amy Yannello wrote a terrific article on how MHSA funding is creating a two-tiered mental health system, where new less ill patients get cadillac services and the severely ill are relegated to inferior services.

Governor signs law to increase safety in psychiatric hospitals

The law streamlines procedures to medicate individuals incompetent to stand trial. What is interesting is that while some still claim people with untreated serious mental illness who have a past history of violence are no more violent than others, there were

8,300 aggressive incidents throughout the state hospital system in 2010 resulted in 5,100 injuries to patients and staff, resulting in lost work days, and additional worker's compensation and overtime costs.

Orange County

Note: Orange County advocate Brian Jacobs started a site specifically focused on OC.

Kelly Thomas was allegedly untreated, suffered from severe mental illness and was homeless when he came into contact with police in Fullerton, CA and died after a severe beating. While not defending what appears to be the use of excessive force by police we noted

"When it comes to treating people with the most serious mental illnesses, the police will react where California's mental health system won't. Police are almost never out on a call regarding mental illness unless one condition is met: the mentally ill person has been abandoned by the mental health system. That's when they deteriorate, become psychotic, delusional and dangerous."

The Kelly Thomas incident has garnered massive attention thank to his family's efforts. Kelly's father Ron has been quoted in several sources as favoring implementation of Laura's Law in OC.

As a result of the incident, the OC Board of Supervisors asked the OC Health Care Agency to prepare a plan to implement Laura's Law. The agency prepared an exceedingly biased and misleading report. Mental Illness Policy Org prepared a point by point rebuttal that was picked up by the Orange County Register and other media and we summarized it for Huffington Post. NAMI

Orange County and the California Treatment Advocacy Coalition also prepared a joint rebuttal to the OC Health Care Agency report.

Also in Orange County, Scott Dekraai was allegedly bipolar, having trouble with his treatments, and killed six in a Seal Beach, CA, salon. We observed

If media reports are true, Scott Dekraai -- hereinafter to be saddled with the "Seal Beach Salon Shooter" sobriquet -- had bipolar disorder, a history of violence, wouldn't stay on treatment, and was a perfect candidate for Laura's Law except for one fact: Orange County mental health officials -- like mental health officials throughout California -- refuse to implement Laura's Law.

Mendocino County

Like Kelly Thomas and Scott Dekraai in Orange County, Aaron Bassler in Mendocino County had severe mental illness and refused treatment and became involved in an incidence of violence. Aaron killed two including a City Councilman, escaped to the woods where he was hunted down and shot by police. His father wrote a heartbreaking account of his heroic efforts to get treatment for Aaron, but how he failed because Laura's Law didn't exist. James Bassler has since become Mendocino's leading advocate for the law. The Supervisors are supposed to consider the issue at their December Meeting. The Press Democrat endorsed it.


The SF Chronicle ran a terrific op-ed by Gary Tsai after allegedly mentally ill Peter Woo allegedly stabbed his parents and killed his mother before ultimately being shot and killed by police. The SF Chronicle , a vigorous supporter of Laura's Law asked the Mayoral Candidates whether they support Laura's Law (most did). We blogged about the misinformation that led some to oppose it, and the SF Chronicle picked up our blog. This blog by Dr. Paul Linde of SF General Hospital Psych Emergency Services does a great job of explaining the problems in SF.

Sonoma County

Op-ed: Sonoma County needs to adopt 'Laura's Law'

Kern County

Op-ed: Laura's Law is necessary

San Mateo County

Like in Orange County, San Mateo mental health officials issued a misleading and biased report on Laura's Law. To understand what is wrong with it read our response to Orange County's report and Myths about Laura's Law

Siskiyou County

Op-ed: Laura's Law helps

Los Angeles County

The Vera Institute released a report on overcrowding in LA Jails. Chapter four is about people with mental illness



What is interesting in California, compared to other states, is that the resistance to implementing Laura's Law is being led by the county mental health directors, the people who are supposed to want to improve care. We believe the reason they oppose the law is that it will hold them accountable for their failure to treat the most seriously ill, inhibit their ability to turn treatment of the seriously ill over to shelters and jails, and require them to prioritze seriously mentally ill, an often hard to treat population and inhibit their ability to pick and choose the easiest to treat for admission to their programs. To avoid responsibility they are making false claims:

MYTH: There is wide opposition to Laura's Law

REALITY: Laura's Law has wide support from constituencies as diverse as the National Alliance on Mental Illness, National Sheriff's Association, California Psychiatric Association, National Crime Prevention Council and consumers in AOT.

MYTH: Prop 63/Mental Health Services Act money can not be used to fund Laura's Law

REALITY: Both Los Angeles and Nevada County use MHSA money (plus Medicare, Medicaid, private insurance, and patient fees) to fund Laura's Law.

MYTH: Voluntary programs have to be cut to fund Laura's Law

REALITY: Per California Department of Mental Health, voluntary programs that provide services (ex., medication, case management, housing, CSS, etc.) may also serve individuals under court orders. There is no need to close these programs, merely open them up to people under court orders.

Myth: Laura's Law is expensive.

REALITY: Nevada County found they saved $1.81 for every $1.00 invested. The Mental Health Director found it decreases hospitalizations, length of hospitalizations, and use of 911, arrest, trial, incarceration and parole; and can be funded with existing sources.

MYTH: If there were more voluntary services, Laura's Law would not be needed.

REALITY: Voluntary programs and AOT currently serve two mutually exclusive populations. Voluntary programs serve those who 'voluntarily' accept services. Laura's Law by definition is for those won't accept voluntary services. Laura's Law does not preclude anyone from accepting voluntary services.

MYTH: Existing community programs serve the same people who would be served by Laura's Law

REALITY: Laura's Law is the only community program that serves people who refuse treatment. MYTH: Laura's Law does not confer any benefits beyond those of LPS (5150)

REALITY: LPS only allows for inpatient commitment. Laura's Law allows for court ordered outpatient treatment, a less restrictive, less expensive, more humane alternative.

MYTH: Court orders do not provide any benefit

REALITY: The 2009 study of NY's version of Laura's Law found "The increased services available under AOT clearly improve recipient outcomes, however, the AOT court order, itself, and its monitoring do appear to offer additional benefits in improving outcomes."

The likelihood of a hospital admission over six months was "highly statistically significant" and lower among AOT recipients than among voluntary recipients.

AOT patients were less likely to be arrested than their voluntary counterparts

Persons receiving AOT for 12 months or more had a substantially higher level of personal engagement in treatment than those receiving services voluntarily.

MYTH: Laura's Law doesn't work.

REALITY: Nevada County's experience with Laura's Law found it works. Per Judge Anderson it saves people from severe mental health deterioration, increases voluntary participation in mental health care, increases stability, decreases crisis. Studies of the NYS version of Laura's Law show it

Helps the mentally ill by reducing homelessness (74%); suicide attempts (55%); and substance abuse (48%) Keeps the public safer by reducing physical harm to others (47%) and property destruction (43%) Saves money by reducing hospitalization (77%); arrests (83%); and incarceration (87%).

MYTH: AOT will lead to a roundup of mentally ill individuals who will be forced into treatment. REALITY: Laura's Law's narrowly-focused eligibility criteria, stringent multi-layer administrative requirements, independent judicial review and strong due process protections protect against misuse. Nevada County and Orange County estimate less than .003% of the population would be allowed into the program. This is consistent with NYS findings.

MYTH: AOT is unconstitutional ("violates rights")

REALITY: AOT has survived constitutional challenges in multiple states. A 2009 NYS study found: "(I)t is now well settled that Kendra's Law is in all respects a constitutional exercise of the states police power, and its parens patriae power. Further, the removal provisions of the law have withstood constitutional scrutiny. AOT also cuts the need for incarceration, restraints, and involuntary inpatient commitment, allowing individuals to retain more liberties.

MYTH: Laura's Law will frighten consumers away from seeking voluntary services

REALITY: A study in Psychiatric News of involuntarily treated discharged psychiatric patients found that 60 percent retrospectively favored having been treated against their will. A 2005 NYS study of consumers in their version of Laura's Law found:

75% reported that AOT helped them gain control over their lives;

81% said that AOT helped them to get and stay well;

90% said AOT made them more likely to keep appointments and take medication.

The 2009 independent study found:

"On the whole, AOT recipients and non-AOT recipients report remarkably similar attitudes and treatment experiences. That is, despite being under a court order to participate in treatment, current AOT recipients feel neither more positive nor more negative about their mental health treatment experiences than comparable individuals who are not under AOT."

MYTH: Assisted Treatment forces people to take medications.

REALITY: There is no provision for forced medication in Laura's Law.


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