Contradictory legal opinions on Laura's Law
By FRANK HARTZELL Staff Writer
Fort Bragg Advocate News
Updated: 12/08/2011 08:03:02 AM PST
(Note: Only two groups oppose Laura's Law. 1. Mental Health Directors who don't like the idea that Laura's Law can require them to treat the most severely ill, as opposed to cherry-picking the easiest to treat for admission to their progams; and 2. People who believe that being psychotic is an exercise of free will, rather than the inability to exercise free will. This story quotes liberally from that opposition.)
When they ponder Laura's Law this month, Mendocino County supervisors must take a side in a passionate split that divides legal minds, as well as advocates, for the mentally ill.
If the supervisors vote yes, Laura's Law (AB 1421) would set up a process where certain officials, and family members of mentally ill people who refuse to seek treatment on their own, can be compelled into a court-ordered Assisted Outpatient Treatment (AOT) process in which their mental illness is treated at home rather than in the mental hospital.
Nevada County, which is similar to Mendocino County in population and demographics, reluctantly implemented Laura's Law as part of a legal settlement in 2004. Officials there now are strong supporters of the law and have documented how it has saved the county money. "While there are isolated objections to Laura's Law, the overwhelming experience of implementing AOT has been exceptionally positive throughout the nation: in lives saved and improved outcomes and in money saved," said Nevada County Superior Court Judge Tom Anderson. But can and should Mendocino County try to follow that lead? There are opposite and dogmatic answers to this question from within the mental health community.
Daniel Brzovic, associate managing attorney of Disability Rights California, says using Mental Health Service Act (MHSA) funds for Laura's Law is illegal. "All treatment under AB 1421 is pursuant to a court order and is therefore involuntary. AB 1421, itself, specifically prohibits using funds for voluntary services to implement AB 1421," Brzovic wrote in a memo circulated at a recent Mendocino County Mental Health Board meeting. Opponents say Laura's Law is an idea whose time is past and a law that takes away hard won civil rights and would likely lead to greater loss of rights. They say other, newer, community-based treatment programs, can also save money and help pull people out of the legal system.
Nevada County officials are among the proponents who say it is perfectly legal and effective to use Mental Health Service Act (MHSA) funds to support Laura's Law. "The [Laura's Law] statute and policy letter clearly stipulate that an individual's legal status shall not prevent an individual from accessing MHSA funded services. AOT is allowable; no locks, restraints, seclusion, or forced medication," Nevada County Mental Health Director Michael Heggarty said. Heggarty says Laura Law saves people on the decline from falling into places where they lose all their rights — like jail, the mental hospital and conservatorships.
None of those interviewed for this story were aware of any legal precedent or lawsuit filed that might help the county navigate a legal dispute that mostly pits groups representing family members of the mentally ill against civil rights groups. Nevada County pays for Laura's Law with a combination of state MHSA monies and federal Medi-Cal funds. Mendocino County, which faces a budget crisis, wouldn't implement Laura's Law unless MHSA state funds could be used. Tom Pinizzotto, head of the mental health branch in Mendocino County, said at a recent mental health board meeting that he understood it wasn't allowable to use MHSA funds for Laura's Law. Since then, he has been navigating through the conflicting opinions offered. The investigation is turning up some new possibilities and directions for mental health care in Mendocino County.
The legal debate boils down to differing interpretations of "voluntary." For example, a letter sent to county mental health directors by the state interpreting the MHSA includes the following two sentences quoted by both sides — with opposite interpretations. "Individuals accessing services funded by the MHSA may have voluntary or involuntary legal status, which shall not effect their ability to access the expanded services under this ActŠ.. Programs funded under the MHSA must be voluntary in nature." Brzovic interprets the paragraph to mean that only programs patients volunteer for without pressure. "AOT is voluntary in the same sense a plea bargain in a court case is voluntary. One wouldn't say someone who agreed to a plea bargain volunteered to go to jail," Brzovic said.
Advocates say MHSA funds are intended for a program like Laura's Law. "The directors who don't want to implement Laura's Law quote the second sentence and ignore the first. Taken together, the letter clearly meant to tell local mental health directors it is OK for the court to order someone into treatment and for that treatment to take place in the same programs where voluntary patients are also treated," said D.J. Jaffe, executive director of Mental Health Illness Policy.org. "If you are a lawyer, and don't want to use Laura's Law, you could intentionally misread rules and regulations to conclude whatever you want."
Los Angeles and Nevada counties both implemented Laura's Law after extensive legal reviews and the state department of mental health has signed off on both efforts, Jaffe said.
Jaffe said the reason the 10-year-old law has been implemented in only two counties is that programs for people with minor mental illnesses look better on paper than investing in a program for the most troublesome and difficult clients, who often can't get or keep housing or jobs.
"Laura's Law not only commits the patient to accept treatment, it commits the mental health system to providing it. Hence many mental health directors oppose it because they can no longer simply send the most severely ill to the end of the line for services," said Jaffe.
Laura's Law was launched onto the local stage this summer by two murders in Fort Bragg, followed by a five-week manhunt in the redwood forest for suspect Aaron Bassler, who himself was killed at the end. James Bassler had repeatedly sought to get his reluctant son into mental health treatment but found there was no mechanism for doing so. Bassler has joined the Mendocino County Mental Health Board and is fighting for Laura's Law to give other families the mechanism to compel treatment. What do opponents of Laura's Law have to offer people like the Bassler family who are unable to get a reluctant and declining person into treatment? To Brzovic, such tragedies are a sign existing laws are not being used, not that a new one is needed. "When somebody who has never been through the system before suddenly does something, we have an outcry we need this new law.'" When the new law is implemented and something bad happens again, do people ask for yet another new law?" Brzovic asks.
Mendocino and Nevada counties share one important cost and problem, mental patients must be driven to hospitals far outside the county boundaries, a trauma for both the patient and the county budget. Home is a much better place for treatment, mental health professionals agree.
Brzovic said having local crisis beds is one example of a way to improve mental health care without adding a new law.
"So often people just cycle through the jail, the mental hospital and there is no follow up by the mental health system," he said.
He also offers an intriguing solution that county officials might use to get dangerous people into treatment, without committing them to far away mental hospitals.
He said other sections of the Welfare and Institutions Code could be used to compel assisted outpatient treatment, possibly without the out-of-county commitment mandated by Section 5150. He says only a few counties now use these options and they would need to be explored further by the county to see if it could work here. He gave examples of other laws on the books that, if followed, would greatly improve mental health service delivery.
Advocates for Laura's Law who were contacted were dubious about using WIC codes 5250, 5300, 5350 and others discussed with Brzovic and said none of these solutions will help either desperate family members or those mentally ill people who are the hardest to help. "It is a very complex part of the law and rarely used as a result. In none of these cases can the family initiate the holds," said Carla Jacobs, president of the California Treatment Advocacy Coalition. Delphine Brody, with the California Network of Mental Health Clients, has many concerns with Laura's Law beyond the legal back and forth. For one, she and other opponents interviewed refuse to call it Laura's Law, referring to instead as AB 1421 in all cases. "One reason we don't call it Laura's Law is we don't know if Laura Wilcox would approve," said Brody. Wilcox was one of three people murdered in Nevada County in 2001 by a deranged man whose family backs Laura's Law, along with Wilcox's parents, who blessed the use of their daughter's name. Brody is also concerned about cases where family members may be part of the problem. "Family members are not always our allies and I include myself in that," said Brody, who survived on the streets of San Francisco before her current career. She feels the idea is to get troublesome people medicated.
In Nevada County, anti-depressants are often but not always part of the plan that people agree to. Once on medication, formerly reluctant people often become big champions of it, Nevada County officials said. Former mental patients were among those who unsuccessfully pleaded San Francisco Supervisors to pass the law. Nevada County officials say the plans are flexible enough to accommodate cultural differences and people who want to try alternative remedies. Brody says the broad net that Laura's Law could cast would make being a mental patient who wants to make his or her own choices much more difficult if the law were passed. "This comes from people who think medication is the answer and should be forced on those who are running the other way. This is truly problematic from both a therapeutic and civil rights perspective," said Brody.
Heggarty has monitored the time that the 30 people referred into the program have spent in county jail and in the mental hospital both before and after the passage of Laura's Law. This study shows Nevada County has saved $1.81 for every $1 spent, Heggarty said. Studies of Kendra's Law in New York State, which Laura's Law is modeled on, show even more encouraging long-term savings and reductions in redicivicism.
Orange County is considering implementing the law after Kelly Thomas, a mentally ill homeless man, was killed in a confrontation with two Fullerton police officers. Los Angeles County has a small pilot program that would conform with the law. By the end of 2010, only 10 people had participated in that program, with mixed success — two were hospitalized and two left voluntarily. The others were either sent to lower levels of care or jailed, according to the Press-Telegram in Long Beach.