Laura’s Law – Time to Bring it to Your County? By Adam Dougherty, MPH, MS III
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MENTAL ILLNESS HAS TOUCHED most of us in some way − be it a personal struggle, a loved one’s troubles, a news story of mass murder, or simply witnessing a disturbed soul on the street corner. Fortunately, there is growing recognition of the importance of mental health services as a mainstay of comprehensive medical care. But what if an individual is too ill and disorganized to even seek out care? Tragically, people with the greatest need are the same ones with the most trouble navigating the system. If these people are lucky enough to find some mental health services, it is usually limited to acute short-term hospitalization or care within the criminal justice system after a crime has been committed. Our patients with mental illness are forever in a revolving door between the emergency department, county mental health clinics, and jail psychiatric services. With no ability to provide sufficient follow up, doctors are forced to discharge these patients back to the streets until they fall into the cycle again. This was the case in 2001 when Scott Thorpe, an untreated schizophrenic, made headlines for gunning down 19-year-old Laura Wilcox and two other employees in a Nevada City clinic. Following the tragedy, the California Legislature passed Laura’s Law. It expands services to severely ill, often-untreated individuals. The law allows counties to require Assisted Outpatient Treatment (AOT) for needy people who have a history of violence and repeated hospitalization and have failed voluntary treatment. More specifically, AOT is court-ordered therapy that is designed to intervene before an individual further deteriorates into the vicious
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cycle. Unlike high-cost acute hospitalization, AOT includes a menu of options tailored to an individual’s unique needs and circumstances. It focuses on outpatient services such as psychotherapy, medication management, crisis intervention, in-home nursing and social services. Counties have the prerogative to decide whether to implement the law or not; and unfortunately for most of California’s severely mentally ill, only one county − Nevada County − has done so. Local government has been hesitant to implement the law, given a sense that it limits people’s autonomy. However, many of us would argue for a greater good to promote public safety and a moral responsibility to help those who truly can’t help themselves. AOT shouldn’t be construed as “forced treatment,” but rather it is an opportunity to bring relief to a vulnerable, high-risk and costly group, providing services to those who have been unable to benefit from the medical system other than re-hospitalization or incarceration. For every Scott Thorpe, there are hundreds more who don’t make headlines, but continue to suffer in the community − many with malnutrition, medical illness and treatable mental health conditions that severely limit their ability to become functioning members of society. Governor Jerry Brown recently signed legislation extending Laura’s Law to 2017, and it is time for Sacramento and surrounding counties to take a closer look at the benefits of implementation. Not only would it save lives, but AOT also makes fiscal sense. In a recent study of the law’s implementation, the Nevada County Behavioral Health Department found