MOORLACH UPDATE — Laura’s Law Variants — February 10, 2014

With the passage of SB 585 (Steinberg), allowing Mental Health Services Act (Prop. 63) funding to pay for implementing Laura’s Law, there is movement around the state to adopt it, or a variation of it. Consequently, the media is taking note of counties that are moving forward with adoption and implementation of Laura’s Law. The San Francisco Chronicle provides their statewide review on the subject below.

Small shift toward implementing Laura’s Law in California

John Coté


Laura Wilcox of Penn Valley (Nevada County) was shot dead at work by a psychiatric patient in ’01. Photo: Associated Press

When California Gov. Gray Davis signed Laura’s Law in 2002, there wasn’t exactly a rush to implement it.

The law, patterned after one in New York and named for Laura Wilcox, a 19-year-old college student who was gunned down in 2001 by a mentally ill man while working as a receptionist at the Nevada County Behavioral Health clinic, gave each county the choice to opt in.

Compelling outpatient treatment – although not medication – for the severely mentally ill remains a topic freighted with concerns about individual rights, effectiveness and potential misuse.

Slowly, though, sentiment in some parts of the state appears to be shifting toward at least trying the approach, as stories mount from parents of seriously mentally ill adults who refuse treatment and often don’t believe they need it.

Only two counties – rural Nevada and Yolo – now implement Laura’s Law as written.

In June, Yolo County’s supervisors approved a one-year pilot program. The program is tiny, but it includes the option for the court to compel treatment – other pilots, including Los Angeles County’s variant, do not.

The Alameda County Board of Supervisors is expected to vote on its own pilot project this month, and Orange County is to take up legislation in May to enact it there, Supervisor John Moorlach said. Both would include court-ordered treatment.

S.F. pilot program

San Francisco Mayor Ed Lee in 2011 implemented a pilot program he has called "San Francisco’s version of Laura’s Law," although it has significant differences and is voluntary.

What San Francisco and Los Angeles are currently doing is "not Laura’s Law," said D.J. Jaffe, founder of Mental Illness Policy Org.

"It’s apples and oranges," Jaffe said. "Laura’s Law is by definition for people who won’t comply with treatment. If they don’t have the court to compel treatment, it’s not Laura’s Law. Someone who refuses treatment won’t be helped by this."

Los Angeles County was the first county credited with implementing a version of Laura’s Law, but its approach was voluntary and limited to mentally ill criminal defendants.

It was a diversion program for low-level criminals’s where people accepted treatment instead of jail, and it worked well for years until jail overcrowding led to shorter sentences, said Dr. Marvin Southard, director of the Los Angeles County Department of Mental Health.

Rather than entering an intensive treatment program for six months or one year, defendants could be out on streets quicker if they just did their time, Southard said.

"The public defender was saying … ‘Why not serve your week in jail?’ " Southard said.

Los Angeles County tweaked the program in 2010 to become primarily an option for mentally ill patients in locked settings to get into outpatient treatment if they agreed to the treatment regimen.

Incarceration time for those in the program dropped 68 percent compared with the time they spent in jail before the treatment, and hospitalization for psychiatric reasons among the group dropped 88 percent, according to a 2012 report the county provided to the California Department of Mental Health.

Expansion advised

But Los Angeles County’s program is small, with space for about 20 patients at a time, Southard said.

After months of study, including a fact-finding trip to Nevada County, Los Angeles County’s Department of Mental Health is preparing to recommend dramatically expanding the program to 360 treatment slots and fully implementing Laura’s Law, Southard said.

"We’ll run it as a major expansion that will mirror what they have in Nevada County," he said.

The cost is projected at $10 million per year for the treatment, with some of that offset by federal Medicaid reimbursement, Southard said.

The costs of implementing Laura’s Law, often a reason for opposing it, were less than expected in Nevada County, which has been operating under the full version of the law the longest.

"We believe there is actually a net savings in our Laura’s Law program" from reduced hospitalization and incarceration, said Michael Heggarty, director of the Nevada County Behavioral Health Department.

Another reason is the anticipated costs to the courts haven’t materialized there, Southard said.

"As the program actually operates, 90-something percent of the individuals end up agreeing to voluntary rather than court-supervised treatment," Southard said.

But even as Nevada County is held up as the example, it was compelled to implement Laura’s Law – as long as funding became available – as part of a 2004 settlement with Wilcox’s family after her death in 2001.


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