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Alameda County grapples with implementing Laura’s Law

Flickr user andersdenkend
If implemented, Laura's Law would allow courts to compel those suffering from severe mental illness to outpatient treatment.

The shooting at Seattle Pacific University marks the latest gun-related tragedy in the U.S. It follows the attacks in Isla Vista at UC Santa Barbara. The country is talking about whether or not to require treatment for the severely mentally ill. In California, this has been an ongoing conversation, ever since the creation of Laura’s Law.

Laura Wilcox was 19 years old when she died in 2001. A college sophomore on winter break, she was working at a health clinic in Nevada County where she was shot and killed by a man with severe mental illness.

The next year, California adopted Laura’s Law, or AB 1421. The law empowers courts to compel people who suffer from severe mental illness to receive outpatient treatment. It is an opt-in law, and individual counties were left to figure out whether to implement it on their own. After more than a decade since its passage, only two -- Nevada County and just recently Orange County -- have fully adopted it.

Alameda County is currently debating a version of the law. It’s been controversial: On one side, parents and relatives say they need Laura’s Law to help their loved ones. On the other side are many who’ve dealt with mental illness themselves -- who say their civil liberties are at stake.

A Mother's Fight

Candy Dewitt is an advocate for families seeking treatment for their loved ones who refuse it. She’s doing so because of her son, Daniel, who she describes as a sensitive, shy boy.

“He always had this inner strength,” she says. “He wasn’t one of those kids who you had to teach right from wrong...Everybody liked Daniel, there wasn’t nothing not to like about him.”

Dewitt says she first noticed a change around the end of Daniel’s senior year. There were typical signs of mental illness: paranoia, delusions. By the end of that summer, she says, he had his first psychotic break.

At the time, Dewitt and her husband had no experience with mental illness. Furthermore, her son couldn’t recognize that he was sick. For people like her son, Dewitt says, delusions are real.

“You can sit and say, ‘No no no that’s not true -- look!’ And you can show them physically how it’s not true,” she says. “And they will look at you and say, ‘Yes, it is true. You don’t know. you don’t understand.’”

At times Dewitt looked to the police for help, calling them under a code called 5150. If a person suffering from mental illness looks like they might hurt themselves or other people, a 5150 allows officers to forcibly take that individual to a hospital to get evaluated and treated for up to 72 hours.

For Dewitt, it was always a traumatic experience. She says she had little control over what took place, and that doctors “slammed” her son with medications.

Daniel was eventually diagnosed with paranoid schizophrenia. But that was just the beginning of a long battle to get him help, during which he was rehospitalized again and again. He would try to stay on his medication, she says, but couldn’t understand it, or the fact that something was wrong.

“No matter what we did, no matter what we said, no matter how many letters we wrote, no matter what doctors we talked to, we could not keep him in treatment,” says Dewitt.

Dewitt was worried about what might happen -- but she could never have imagined what actually did. In 2012, Daniel was charged with murder. Dewitt declined to discuss the details for legal reasons, so it’s unclear exactly what happened. Daniel has been in a locked psychiatric facility at Napa State Hospital ever since.

“To love somebody for 18 years, and to see that person when they were well, when they were happy, when they were in school, when they were “normal”,  get ill --  it feels like they’re thrown away by the system,” she says.

Dewitt believes Daniel’s fate could have been avoided. She created the Voices of the Mothers Project to find another way for families to help loved ones who refuse treatment. Currently, the group is channeling all its efforts to support a new pilot program that would enact a version of Laura’s Law in Alameda County.

The program centers on what proponents call “Assisted Outpatient Treatment” or AOT. It would let courts compel adults like Daniel to get long-term, outpatient care -- the kind of treatment that could help them fully recover.

Yet not everyone agrees that AOT is truly “assisted” treatment. Opponents counter that the program uses force. But Dewitt says we already use force through 5150s, and she believes AOT would be a more compassionate and effective alternative.

How the Program Works

According to Alex Briscoe, head of Alameda County’s Healthcare Services Agency, Alameda County currently 5150s more people per capita more than any jurisdiction in the state.

Back in February, the Agency proposed the AOT model to the Board of Supervisors. Briscoe says at most, it would only involve 5 people, through a very selective process.

“These are the very very very small number of people who are on the revolving door of EMS to psych emergency to inpatient to discharge to the park to back to EMS,” he says. “These are the people who are 5150’d and coursed into care multiple times a month.”

Under Alameda county’s version of Laura’s Law, parents and treatment providers can petition for a loved one to enter AOT. Yet, Briscoe says, the participants can only join the program with the approval of the Agency’s Mental Health director. They could be required to spend one day a week in court, where the judge would discuss their treatment plan with mental health professionals.

Under the State law, if the participants refuse to comply with their treatment, they are technically eligible to be sent to the hospital for a 72-hour evaluation, much like a 5150. But Briscoe says Alameda County’s pilot wouldn’t resort to such measures. He says the emphasis is not on threatening consequences, but on connecting people to resources.

Briscoe says other consumers -- those who receive mental health services -- will reach out to the individual. For those who continue to refuse treatment, Briscoe says he’ll continue to be patient. “We’ll send another outreach team out with consumers who know your experience…and they’ll say, “Hey I’ve been there. ‘You don’t want to be held for 72 hours against your will, do you? There are things that work -- See? it worked for me.’”

And if they refuse? Briscoe says they will be persistent and ask, “Can I come back tomorrow and ask you again?”

Briscoe says that while he wants to honor every individual’s right to choose the life they want to lead, he doesn’t feel they have the right to suffer without support.

A Consumer’s Experience

Sally Zinman is against the AOT pilot program, and Laura’s Law as a whole. “I know that people want to be compassionate and caring and help people,” she says. “[But] helping people that don’t want to be helped ... can equally be horrendous.”

Zinman is executive director of the California Association of Mental Health Peer Run Organizations. But for her, it’s also a personal matter.

One day back in the early ‘70s, she woke up and no longer knew who she was. She didn’t accept that her name was Sally Zinman. She thought that everybody around her was lying.

She was living on the east coast at the time, and her parents committed her to a private institution. “I was literally imprisoned,” she says. “I couldn’t get out.”

Zinman cites her experience as one akin to abuse: She says she was both beaten and sexually molested by her doctor, and was in and out of institutions for years. She eventually got out and recovered on her own. But she says her experience with forced treatment wrecked her trust in the mental health system.

“What I needed at the time that I broke with reality was to have control over my life,” she says. “And instead what happened was that control was taken away from me. That’s sort of the core of why I think outpatient treatment is wrong. Is when people are sick and upset, they need to have …. some kind of involvement in their treatment. Not have it taken away.”

What happened to Zinman is less likely to happen today. In 1975, a Supreme Court ruling drastically limited forced psychiatric treatment, except for in extreme circumstances. States were left to decide how to enact laws around this issue; that’s what led California to Laura’s Law. But for Zinman, this law is a step backwards.

“It’s not just about outpatient commitment,” she says. “It’s a much bigger fight. It’s about the direction of the mental health system, and are we going to create a system that’s voluntary ... or keep doing the same thing that’s based on force?”

Now, Zinman is a leading advocate for mental health consumer rights. She says what happened to Candy Dewitt’s son doesn’t represent the majority of people with mental illness -- most aren’t perpetrators of violence. Zinman says we can’t use that perception to take away people’s civil rights.

“The people you’re talking about are adults, they’re 18 or over,” she says. “And ultimately the decisions about their life and their treatment and services has got to be them...We have to have the same rights as anybody else.”

“We have to try”

People on both sides of the debate agree on at least one thing: The current system isn’t working. Alex Briscoe says even he isn’t sure the County’s version of Laura’s Law will be successful. Yet, he says, “This is my own personal position, [but] I believe we have a moral and ethical obligation to see. To try.”

Right now they are trying to find a middle ground.

When Briscoe first proposed the pilot program to the Board of Supervisors in February, they sent him and the agency back to the drawing board. They asked: Can you achieve the goals of Laura’s Law without adopting it at all?

The pilot program is still on the table, but the agency will bring other ideas to the Board of Supervisors when it reconvenes later this month.


Correction: The proposed pilot program for Alameda County says participants could be required to visit the court one day a week, but the frequency of court visits is not specified.