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S.F. should take up Laura's Law again


by Amy Yannello

San Francisco Chronicle, 12.20.13

(PDF Version)

It's nice to get meaningful Christmas gifts.

Rep. Tim Murphy, R-Pa., a psychologist, gave families with loved ones living with untreated mental illnesses a huge present this year with the introduction of HR3717 - the Helping Families in Mental Health Crisis Act.

It's important to note that this resolution isn't another in a long line of "feel-good" mental health bills, peppered with words such as "resiliency" and "self-determined life." No, what makes this legislation so markedly different from the many so-called reforms of its predecessors is that it actually deals with mental illness and the mentally ill.

Some of the most significant changes it seeks to include are:

-- Requiring states to have commitment criteria broader than "dangerousness" and to authorize assisted outpatient treatment in order to receive federal Community Mental Health Service Block Grant funds.

-- Allocating $15 million for a federal assisted outpatient treatment block grant program to fund 50 grants per year for new assisted outpatient treatment programs.

-- Releasing the "HIPAA handcuffs." The bill carves out an exemption in the Health Insurance Portability and Accountability Act to allow a caregiver to receive protected health information when a mental health care provider "reasonably believes" that disclosure to the caregiver is necessary to protect the health, safety or welfare of the patient or safety of another.

These reforms alone (and the potential funding they might bring) should be enough to get the San Francisco Board of Supervisors to take up again the discussion of implementing Laura's Law. Laura's Law, a state law passed in 2002, allows a court to compel treatment of a mentally ill individual who refuses treatment. The law only applies after each county's board of supervisors passes a resolution authorizing its application. So far, only Nevada County, the home of Laura Wilcox, for whom the law is named, has fully implemented the law. Los Angeles County has a pilot project. San Francisco supervisors have not addressed Laura's Law since August 2010, when the board tabled the issue until an "undetermined" future time.

Yet the untreated mentally ill remain an issue of community concern and debate. Despair over the presence of a large population of homeless individuals on San Francisco's streets and in the public squares, is a recurring theme in letters to the editor and in online postings. Officially, there were more than 7,000 homeless adults and youth on San Francisco's streets and in shelters, according to the Housing and Urban Development's January 2013 annual Point-in-Time Homeless Count. According to the National Institutes of Mental Health, between 5 and 8 percent of the general population suffers from of a serious mental illness; for the homeless, the consensus is that about 26 percent live with serious mental illness.

Yet, as shown in its own records, the county of San Francisco has served roughly 1,800 "full-service partnership" clients since 2005, and at a cost of more than $6.1 million. (This is under the "whatever it takes" mantra of the Mental Health Services Act passed by voters in 2004 and designed to get the homeless mentally ill off the streets, into housing and treatment. How do you think it's working?)

Dr. E. Fuller Torrey, a research psychiatrist and assisted outpatient treatment advocate, notes that little research has been done on the question of how many people could benefit from assisted outpatient treatment other than estimates that some 10 percent of seriously mentally ill individuals are the most problematic (e.g., have repeated incarcerations, homelessness, repeated hospitalizations, etc.) and that other research notes that 10 percent of those who are problematic (1 percent of the total) are a danger to themselves or to others.

Using Torrey's analysis, it is estimated that some 14,500 California residents would be eligible for treatment under Laura's Law. Implementing the law statewide would save roughly $700 million in reduced incarceration/hospitalization costs, even with increased community assistance costs, according to numerous studies on the issue.

Murphy's federal bill seeks to tweak a proviso in Medicaid law in order to open up desperately needed federal funding for acute-care psychiatric hospital beds. The provision Murphy seeks to change excludes Medicaid from making payments to "institutions for mental diseases."

San Francisco General Hospital just closed its 22-bed psychiatric acute-care ward 7B, citing "financial constraints."

"We do not preclude any other adult with a severe illness from obtaining a drastically needed hospital bed, and we certainly don't dump their care onto a law enforcement officer," said Carla Jacobs, co-founder of the California Treatment Advocacy Center.

Murphy's proposed law would change mental health law to focus on the most seriously mentally ill rather than devoting resources to diagnosing mental health problems across the population. The mental health parity required of private insurers under the federal Affordable Care Act has little relevance to the seriously mentally ill, who most often have no private insurance. Murphy's resolution would devote funding to public health services, allowing communities to care for, rather than incarcerate, mentally ill individuals.

Families are right to see hope in this proposed legislation, for it tackles issues long since seen as taboo with regard to funding and policy priorities in Washington D.C. Our California congressional delegation, state and local officials would be wise to follow suit.

Amy Yannello writes on social justice, health care and mental health issues from Sacramento.

(PDF Version)


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