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==Background==
==Background==
Laura Wilcox, a 19-year old sophomore from [[Haverford College]], was working at [[Nevada City, California|Nevada County's]] public mental health clinic during her winter break from college. On January 10, 2001, she and two other people were shot to death by Scott Harlan Thorpe, a 41-year old American citizen who resisted his family's attempt to force psychiatric treatment.<ref>[http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2006/03/21/EDGU9GJFMH1.DTL Carry out 'Laura's Law'], editorial, ''[[San Francisco Chronicle]]'', March 21, 2006.</ref><ref>[http://yubanet.com/in_memoriam.shtml In memoriam: Laura Wilcox], YubaNet.com</ref> Thorpe was found [[competency evaluation (law)|incompetent to stand trial]] and was sent to [[Atascadero State Hospital]] and was later transferred to California's [[Napa State Hospital]]. After the incident Laura’s parents chose to advocate for forced treatment of individuals considered to have mental illness. **CORRECTION: Scott Harlan Thorpe tried on several occasions to get help from Nevada County Mental Health by going in-person and pleading with the staff to get psychiatric treatment. He was denied treatment on all occasions and told there was nothing the County could do, which was a severe contributing factor to the shooting.**
Laura Wilcox, a 19-year old sophomore from [[Haverford College]], was working at [[Nevada City, California|Nevada County's]] public mental health clinic during her winter break from college. On January 10, 2001, she and two other people were shot to death by Scott Harlan Thorpe, a 41-year old American citizen who resisted his family's attempt to force psychiatric treatment.<ref>[http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2006/03/21/EDGU9GJFMH1.DTL Carry out 'Laura's Law'], editorial, ''[[San Francisco Chronicle]]'', March 21, 2006.</ref><ref>[http://yubanet.com/in_memoriam.shtml In memoriam: Laura Wilcox], YubaNet.com</ref> Thorpe was found [[competency evaluation (law)|incompetent to stand trial]] and was sent to [[Atascadero State Hospital]] and was later transferred to California's [[Napa State Hospital]]. After the incident Laura’s parents chose to advocate for forced treatment of individuals considered to have mental illness. Scott Harlan Thorpe tried on several occasions to get help from Nevada County Mental Health by going in-person and pleading with the staff to get psychiatric treatment. He was denied treatment on all occasions and told there was nothing the County could do, which was a severe contributing factor to the shooting.{{cn}}


==Implementation at county discretion==
==Implementation at county discretion==

Revision as of 17:30, 19 June 2012

Laura's Law is a California state law that allows for court-ordered assisted outpatient treatment or forced anti-psychotics in most cases. To qualify for the program, the person must have a serious mental illness plus a recent history of psychiatric hospitalizations, jailings or acts, threats or attempts of serious violent behavior towards [self] or others. A complete functional outline of the legal procedures and safeguards within Laura’s Law has been prepared by NAMI San Mateo.[1]

The law was named after Laura Wilcox, a mental health worker who was killed by an American citizen who had refused psychiatric treatment. Modeled on Kendra's Law, a similar statute enacted in New York, the bill was introduced as Assembly Bill 1421 by Assemblywoman Helen Thomson, a Democrat from Davis. The measure passed the California Legislature in 2002 and was signed into law by Governor Gray Davis. The statute can only be utilized in counties that choose to enact outpatient commitment programs based on the measure. As of 2010, Nevada County has fully implemented the law and Los Angeles County has a pilot project. In 2010 the California State Association of Counties chose Nevada County to receive its Challenge Award for implementing Laura’s Law.[2] Subsequently in 2011, a National Association of Counties Achievement Award in Health was awarded to Nevada County for the Assisted Outpatient Treatment Program.

Background

Laura Wilcox, a 19-year old sophomore from Haverford College, was working at Nevada County's public mental health clinic during her winter break from college. On January 10, 2001, she and two other people were shot to death by Scott Harlan Thorpe, a 41-year old American citizen who resisted his family's attempt to force psychiatric treatment.[3][4] Thorpe was found incompetent to stand trial and was sent to Atascadero State Hospital and was later transferred to California's Napa State Hospital. After the incident Laura’s parents chose to advocate for forced treatment of individuals considered to have mental illness. Scott Harlan Thorpe tried on several occasions to get help from Nevada County Mental Health by going in-person and pleading with the staff to get psychiatric treatment. He was denied treatment on all occasions and told there was nothing the County could do, which was a severe contributing factor to the shooting.[citation needed]

Implementation at county discretion

The law is only operative in those counties in which the county board of supervisors, by resolution, authorizes its application and makes a finding that no voluntary mental health program serving adults, and no children's mental health program, was reduced in order to implement the law.[5]

In 2004, Los Angeles County implemented Laura's Law on a limited basis.[6] Since the passage of the MHSA [see below Prop. 63] Nevada County fully implemented Laura's Law in May 2008 and several other counties are discussing it, notably San Francisco County,[7][8][9] San Mateo County, San Diego County, Marin County and others.

In those counties that adopt outpatient commitment, an AB 1421 program will ensure individuals are provided the services and medical treatment (including medication) that will enable the person to have a good chance to recover. Nevada County Director Michael Heggarty bests describes it as part of the recovery movement.[10]

Proposition 63 impact

In November 2004, California voters passed Proposition 63. When the California Department of Mental Health (DMH) released its draft plan requirements for county mental health administrators on February 15, 2005, they contained a provision that would allow MHSA funds to be used for "involuntary services" if certain criteria were met. Nevada County's Laura's law program and Los Angeles County's AOT pilot project are utilizing MHSA funding for services.

Assisted outpatient treatment eligibility criteria

As stated above the patient must have a serious mental illness plus a recent history of psychiatric hospitalizations, jailings or acts, threats or attempts of serious violent behavior towards self or others. The recipient must also have been offered an opportunity to voluntarily participate in a treatment plan by the local mental health department, yet fails to the point that, without a Laura’s Law program, he or she will likely relapse or deteriorate to the point of being dangerous to self or others. "Participation in the assisted outpatient program is the least restrictive placement necessary to ensure the person’s recovery and stability." While a specified group of individuals may request an investigation to determine is a person qualifies for a Laura’s Law program, only the County mental health director, or his or her designee, may file a petition with the superior court for a hearing to determine if the person should be court ordered to receive the services specified under the law.

A person may be placed in an assisted outpatient treatment if, after a hearing, a court finds that the following criteria[11] have been met. The patient must:

  • Be eighteen years of age or older
  • Be suffering from a mental illness
  • Be unlikely to survive safely in the community without supervision, based on a clinical determination
  • Have a history of non-compliance with treatment that has either:
  1. Been a significant factor in his or her being in a hospital, prison or jail at least twice within the last thirty-six months; or
  2. Resulted in one or more acts, attempts or threats of serious violent behavior toward self or others within the last forty-eight months
  • Have been offered an opportunity to voluntarily participate in a treatment plan by the local mental health department but continue to fail to engage in treatment
  • Be substantially deteriorating
  • Be, in view of his or her treatment history and current behavior, in need of assisted outpatient treatment in order to prevent a relapse or deterioration that would likely result in the person meeting California's inpatient commitment standard, which is being:
  1. A serious risk of harm to himself or herself or others; or
  2. Gravely disabled (in immediate physical danger due to being unable to meet basic needs for food, clothing, or shelter);
  • Be likely to benefit from assisted outpatient treatment; and
  • Participation in the assisted outpatient program is the least restrictive placement necessary to ensure the person's recovery and stability.

If the court finds that the individual meets the statutory criteria, the recipient will be provided intensive community treatment services and supervision by multidisciplinary teams of highly trained mental health professionals with staff-to-client ratios of not more than 1 to 10, and additional services, as specified, for persons with the most persistent and severe mental illness. The law specifies various rights of the person who is the subject of a Laura’s Law petition as well as due process hearing rights. The bill also provides for voluntary settlement agreements as an alternative to the hearing process.[12]

Debate over bill's efficacy and propriety

Supporters

Passage of the bill was supported by organizations such as the California Treatment Advocacy Coalition (an affiliate of the Treatment Advocacy Center), the California Psychiatric Association, the Police Chiefs Association, Mental Illness Policy Org. and the National Alliance on Mental Illness (NAMI). In an editorial endorsement of the law, the Los Angeles Times touted then-Governor Gray Davis's support, while limiting its comments on opponents to mentioning that the Citizens Commission on Human Rights which opposes virtually all psychiatric treatments, sponsored a rally at the Capitol against Laura's law.[13] The San Francisco Chronicle[14][15][16][17][18][19] and The San Francisco Examiner[20] have published positive articles on the topic. The Los Angeles Times won a Pulitzer Prize, in part for its coverage of Laura’s Law.[21]

Opposition

MindFreedom International and the California Network of Mental Health Clients (CNMHC), along with allies in the psychiatric survivors movement, also fought the measure and its earlier versions, accusing such legislation as a regressive and reprehensible scheme to enforce coerced drug treatment regimens against the will of patients. The Church of Scientology and the Citizens Commission on Human Rights have also gained attention as an opponent of the new law.[22][23][dead link‍]

Outpatient commitment opponents make several varied arguments. Some dispute the positive effects of compulsory treatment, questioning the methodology of studies that show effectiveness. Others highlight negative effects of treatment. Still others point to disparities in the way these laws are applied. The psychiatric survivors movement opposes compulsory treatment on the basis that the ordered drugs often have serious or unpleasant side-effects such as anhedonia, tardive dyskinesia, neuroleptic malignant syndrome, excessive weight gain leading to diabetes, addiction, sexual side effects, and increased risk of suicide.

Evidence of Efficacy

Studies on Kendra's Law

Many of the studies on the efficacy of assisted outpatient treatment (AOT) are done on Kendra's Law (on which Laura's Law is based). Two notable studies were released in 2005[24][dead link‍] and in 2009.[25] A briefing of these and other studies was prepared by The Treatment Advocacy Center.[26]

The 2005 study[citation needed] found:

Specifically, the OMH study found that for those in the AOT program:

  • 74 percent fewer experienced homelessness;
  • 77 percent fewer experienced psychiatric hospitalization;
  • 83 percent fewer experienced arrest; and
  • 87 percent fewer experienced incarceration.

Comparing the experience of AOT recipients over the first six months of AOT to the same period immediately prior to AOT, the OMH study found:

  • 55 percent fewer recipients engaged in suicide attempts or physical harm to self;
  • 49 percent fewer abused alcohol;
  • 48 percent fewer abused drugs;
  • 47 percent fewer physically harmed others;
  • 46 percent fewer damaged or destroyed property; and
  • 43 percent fewer threatened physical harm to others.
  • 100 percent had a basic human right violated (The right to bodily integrity)

As a component of the OMH study, researchers with the New York State Psychiatric Institute and Columbia University conducted face-to-face interviews with 76 AOT recipients to assess their opinions about the program and its impact on their quality of life. The interviews showed that after receiving treatment, AOT recipients generally endorsed the program, with 62% reporting that being court-ordered into treatment had been overall a good thing:

  • 38 percent of them reported that AOT helped them gain control over their lives;
  • 81 percent of them said that AOT helped them to get and stay well; and
  • 90 percent of them consider themselves more probable to keep appointments and take medications because of AOT.

Additionally, 87 percent said they were confident in their case manager's ability to help them—and 88 percent said that they and their case manager agreed on what is important for them to work on. AOT had a positive effect on the therapeutic alliance.

In 2009,[27] an independent study by Duke University into alleged racism found "no evidence that the AOT Program is disproportionately selecting African Americans for court orders, nor is there evidence of a disproportionate effect on other minority populations. Our interviews with key stakeholders across the state corroborate these findings."

A 2010 study on Kendra's Law by Gilbert et al. showed that "the odds of arrest for participants currently receiving assisted outpatient treatment (AOT) were nearly 2/3 lower (OR .39, p<.01) than for individuals who had not yet initiated AOT or signed a voluntary service agreement."[28] Another 2010 study from Swartz et al. tracked Medicaid claims and state reports for 3,576 AOT consumers from 1999-2007. They found that "the likelihood of psychiatric hospital admission was significantly reduced by ~25% during the initial six-month court order (odds ratio [OR]=.77, 95CI=.72-.82) and by over 1/3 during a subsequent six-month renewal of the order (OR=.59, CI=.54-.65) compared with the period before initiation of the court order. Similar significant reductions in days of hospitalization were evident during initial court orders and subsequent renewals (OR=.80, CI=.78-.82, & OR-.84, CI=.81-.86, respectively)."[29]

See also

References

  1. ^ "Laura's Law A Functional Outline", NAMI San Mateo, retrieved 2010-10-27
  2. ^ "California Challenge Award Recipients 2010", California State Association of Counties, 2010, retrieved 2010-10-27
  3. ^ Carry out 'Laura's Law', editorial, San Francisco Chronicle, March 21, 2006.
  4. ^ In memoriam: Laura Wilcox, YubaNet.com
  5. ^ Welfare and Institutions Code 5349 leginfo.ca.gov. http://www.leginfo.ca.gov/cgi-bin/displaycode?section=wic&group=05001-06000&file=5345-5349.5
  6. ^ [1]
  7. ^ Nevius, C.W. (2010-07-20), "Laura's Law faces battle with supervisors", San Francisco Chronicle, retrieved 2010-10-27
  8. ^ Nevius, C.W. (2010-07-31), "Katz, supes need to give Laura's Law a chance", San Francisco Chronicle, retrieved 2010-10-27
  9. ^ Gordon, Rachel (2010-08-03), "Alioto-Pier pulls back Laura's Law", San Francisco Chronicle, retrieved 2010-10-27
  10. ^ McConahay, Pat (2010-08-19), "Debate Continues Over Laura's Law, Mental Health Care", California Healthline, retrieved 2010-10-27
  11. ^ Laura's Law. AB 1421. September 28th, 2002. leginfo.ca.gov. http://leginfo.ca.gov/pub/01-02/bill/asm/ab_1401-1450/ab_1421_bill_20020928_chaptered.html
  12. ^ Laura's Law. AB 1421. September 28th, 2002. leginfo.ca.gov. http://leginfo.ca.gov/pub/01-02/bill/asm/ab_1401-1450/ab_1421_bill_20020928_chaptered.html
  13. ^ Helping people off the streets: Governor, sign Laura's Law, The Los Angeles Times, September 28, 2002
  14. ^ Fagan, Kevin (2010-05-12), "Why Laura's Law has had limited impact", San Francisco Chronicle, retrieved 2010-10-27
  15. ^ Martin, Fred (2010-03-22), "San Francisco chooses jail over treatment", San Francisco Chronicle, retrieved 2010-10-27
  16. ^ Nevius, C.W. (2010-07-20), "Laura's Law faces battle with supervisors", San Francisco Chronicle, retrieved 2010-10-27
  17. ^ Nevius, C.W. (2010-07-31), "Katz, supes need to give Laura's Law a chance", San Francisco Chronicle, retrieved 2010-10-27
  18. ^ Cummings, Stephen (2010-08-01), "Laura's Law will save mentally ill, S.F. budget", San Francisco Chronicle, retrieved 2010-10-27
  19. ^ Stettin, Brian (2010-08-17), "Correcting the record on Laura's Law", San Francisco Chronicle, retrieved 2010-10-27
  20. ^ Griffin, Melissa (2010-05-27), "Griffin: Laura's Law is sane choice", San Francisco Examiner, retrieved 2010-10-27
  21. ^ "Housing, Homelessness, and Mental Illness - Recommendations for President Bush's New Freedom Initiative Commission on Mental Health Services", NAMI, 2002-11-13, retrieved 2010-10-27
  22. ^ Community Fights the Psychiatric Steamroller, article on a Scientology website
  23. ^ [2]
  24. ^ Carpinello, Sharon (March 2005), "Kendra's Law Final Report on the Status of Assisted Outpatient Treatment", Office of Mental Health NY, retrieved 2010-10-27
  25. ^ Swartz, Marvin (06-30-09), "New York State Assisted Outpatient Treatment Program Evaluation" (PDF), Office of Mental Health NY, retrieved 2010-10-27 {{citation}}: Check date values in: |publication-date= (help)
  26. ^ "Assisted outpatient treatment: Results from New York's Kendra's Law", Treatment Advocacy Center, 12-09-09, retrieved 2010-10-27 {{citation}}: Check date values in: |publication-date= (help)
  27. ^ Swartz, Marvin (06-30-09), "New York State Assisted Outpatient Treatment Program Evaluation" (PDF), Office of Mental Health NY, retrieved 2010-10-27 {{citation}}: Check date values in: |publication-date= (help)
  28. ^ Gilbert, AR; et al. (2010). "Reductions in arrest under assisted outpatient treatment in New York". Psychiatric Services. 61: 996–999. PMID 20889637. {{cite journal}}: Explicit use of et al. in: |author= (help)
  29. ^ Swartz, MS; et al. (2010). "Assessing outcomes for consumers in New York's assisted outpatient treatment program". Psychiatric Services. 61: 976–981. PMID 20889634. {{cite journal}}: Explicit use of et al. in: |author= (help)
Opponent views
Proponent views
  • [3] Mental Illness Policy Org. Laura's Law Home Page
  • Psychlaws.org - 'A Guide to Laura’s Law: California's New Law for Assisted Outpatient Treatment', The California Treatment Advocacy Coalition and the Treatment Advocacy Center (January, 2003)
  • PsychLaws.org - 'Landmark Legislation, Laura's Law, Brings Much-Needed Reform to California: AB 1421 will help those with severe mental illnesses who are too sick to help themselves' (opinion), Mary T. Zdanowicz, Treatment Advocacy Center (September 30, 2002)
  • PsychLaws.org - 'Gov. Davis Signs Laura's Law: AB 1421 will help those with severe mental illnesses who are too sick to help themselves' (November 22, 2002)
  • The Treatment Advocacy Center - 'Laura's Law'
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