Laura's Law

Overview
Laura's Law, (Assembly Bill 1421, ],Davis), which became effective on January 1, 2003, is a California statute that allows for court-ordered outpatient commitment of mental health clients who refuse voluntary treatment with psychotropic medications. The law was named after Laura Wilcox and was modeled on Kendra's Law, a similar statute enacted in New York. The measure was passed by the California legislature in 2002 and signed into law by then Governor Gray Davis. Enforcement of the statute can only take place in counties that choose to enact outpatient commitment programs based on the measure (as of 2004, only one county had chosen to do so, on a limited basis).

Background
Laura Wilcox, a 19-year old sophomore from Haverford College, was working at Nevada City'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 mental patient who resisted his family's attempt to seek treatment.

Implementation at county discretion
Because the legislation authorizing Laura's Law did not include state funds for implementation (estimated at more than $300 million for the entire state), the decision is entirely up to counties whether or not to underwrite the costs. Laura's Law allows California counties to decide whether to opt into implementing a community-based, court-monitored outpatient treatment program. A major obstacle, for counties that implement the law, is that they cannot use funds already set aside for outpatient treatment of the mentally ill.

As of 2004, only Los Angeles County has implemented Laura's Law, and only on a limited basis. Other counties have generally cited budgetary concerns for delayed implementation, although the California Network of Mental Health Clients(CNMHC) has suggested that there may be additional obstacles in the bill that make it difficult for counties to implement.

In those counties that adopt outpatient commitment, an AB 1421 program will ensure medications are administered to certain patients, only those determined to be severely disabled, who have been referred by family members, law enforcement, or other agency, and provided with community treatment, housing, and medication monitoring.

Proposition 63 impact
In early November 2004, California voters passed Proposition 63, the California Mental Health Services Act (MHSA), to rectify what is generally considered to be a glaring lack of mental health services. The situation is usually traced back to the late 1960s and then Governor Ronald Reagan's decision to curtail inpatient treatment by closing state run psychiatric hospitals. Reagan slashed 1,700 hospital staff positions and several state-operated aftercare facilities. Proposition 63 levies a 1% tax on individuals earning more than $1 million per year, and is projected to raise $750 million in the 2005-2006 fiscal year. This new funding is expected by some to result in widespread county implementation of Laura's Law.

Prior to the passage of Proposition 63, and during the statewide stakeholder input process that followed, voters were told that funds from the MHSA would only be used for voluntary, client-centered and community-based services. But 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. Mental health clients throughout the state have spoken out against these provisions at the stakeholder meetings.

Outpatient commitment eligibility criteria
A person may be placed in an assisted outpatient treatment if, after a hearing, a court finds that the following criteria 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:
 * 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
 * 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:
 * A serious risk of harm to himself or herself or others; or
 * Gravely disabled (in immediate physical danger because 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.

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 Chief's Association, and the National Alliance on Mental Illness (NAMI). In an editorial endorsement of the law, the Los Angeles Times touted then Governor Grey Davis's support, while limiting its comments on opponents to mentioning that "a subgroup of the Church of Scientology, which opposes virtually all psychiatric treatments, sponsored a rally at the Capitol against Laura's law."

Backers of Laura's Law cast the measure in a humanitarian light, asserting everyone "has the right to live in a world free of psychotic delusion." They believe that some people with mental illness, perhaps the most severely disabled, are unable to recognize their own symptoms and pose an unacceptable threat to the community in which they live. This position is viewed as fearmongering by opponents.

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, casting such legislation as a regressive and reprehensible scheme to enforce coerced drug treatment regimens against the will of patients, while asserting that the legislation was a regressive and reprehensible means of enforcing drug treatment regimens. The Church of Scientology also gained attention as an opponent of the new law.

CNMHC has also acted as a plaintiff in a suit against Los Angeles County challenging its implementation of AB 1421. The suit was settled in the summer of 2005, allowing the county to proceed with implementation. Presently, the county is the only one which has implemented the law, and has only done so on a limited basis.

In reaction to provisions for implementing Laura's Law using MHSA funds set forth by the DMH in early 2005, CNMHC released a position paper strongly opposing forced treatment. According to CNMHC, outpatient commitment allowed by the statute means that patients can be rehospitalized for a variety of infractions, some of which it considers minor, such as not taking medication, or a patient being judged by a lay person to be vulnerable to further deterioration. The group warns that implementation of Laura's Law in would mean forced drugging in the sanctity of one's home, and the possibility that clients could more easily be place into a psychiatric hospital against their will. Opponents are also critical of the potential for using the law for purposes of intimidation and for fostering the further erosion of civil rights. African Americans and other people of color have been disproportionately subjected to court-ordered forced outpatient treatment in New York. Furthermore, critics contend, coerced treatment:
 * Precludes recovery and permanent remission
 * Destroys trust between clients and health care providers (Jean Campbell and Ron Schraiber's study)
 * Creates fear and dependency
 * Violates human and civil rights
 * Is costly and diverts money from recovery-oriented services

Outpatient commitment and Program for Assertive Community Treatment (PACT) are often linked. In PACT, patient compliance with drug treatment is rendered through financial and housing incentives to take drugs. PACT, according to critics, is very much based on a coercive biological psychiatry model.

Randall Hagar, chief lobbyist for the California Psychiatric Association, has been continuously criticized for his unethical lobbying tactics and for his inattentiveness to the facts surrounding the American River College American College Testing Service (ACT) score Black Chalks deletion scandal. In combination, these facts show AB 1421 and the other laws that Hagar has lobbied for (California Assembly Bills 1792 & 1793) to be flawed efforts at addressing the issues of the mentally ill, and amounting to no more than false imprisonment.

Reference

 * OceanPark.com - 'Laura's Law' (text of AB 1421)

Information

 * National Mental Health Consumers' Self-Help Clearinghouse

Opponent views

 * MindFreedom.org - 'Bill for More Forced Psychiatry Passed by California Legislature, Goes to Governor', California Network of Mental Health Clients (September 3, 2002)
 * NAMISCC.org - 'California Battles Forced Psyciatry...Again', National Alliance on Mental Illness Santa Cruz County (April 12, 2001)
 * NAMISCC.org-"Randall Hagar...removed...by NAMI..." National Alliance on Mental Illness Santa Cruz County, California

Proponent views

 * 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)