Is Court-Ordered Treatment What Santa Barbara’s Mentally Ill Population Needs? - Pacific Standard

Is Court-Ordered Treatment What Santa Barbara’s Mentally Ill Population Needs?

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A pilot Laura’s Law program in Santa Barbara County will help mental-health officials learn the best way to allocate the county’s limited funds.

By Kate Wheeling

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(Photo: Alex Naanou/Flickr)

In Santa Barbara County, California, a relatively small number of treatment-resistant mental-health patients account for an outsized portion of the Department of Behavioral Health’s annual budget. This month, county supervisors voted to fund a small pilot program called Laura’s Law for 10 of Santa Barbara County’s “frequent fliers,” the Santa Barbara Independentreports.

Over three years, the county will devote $1.8 million toward outpatient mental-health services for these 10 patients, and the law would give judges the authority to compel treatment-resistant patients to seek out and stick with outpatient mental-health care. Santa Barbara is just the latest California county to implement Laura’s Law, which was passed in a statewide ballot in 2002 but allowed each county to decide whether or not to opt in to the program. None did until 2005.

Last year, Jeneen Interlandi chronicled the controversy surrounding the law — and the difficulties its proponents have faced in gaining support — for Pacific Standard.

Assisted outpatient treatment programs like Laura’s Law attempt to strike a balance between a patient’s rights and public safety; these programs provide patients with a support system so that they might continue to live within the community, and provide caregivers with a legal means to push patients to accept treatment when those patients don’t believe they are ill in the first place.

The concept of forced treatment — even outpatient treatment — doesn’t sit well with everyone, Interlandi reports:

Involuntary psychiatric treatment has a long, dark history. It was not so long ago, after all, that homosexuality was considered an illness worthy of imprisonment. And if proponents of Laura’s Law saw outpatient commitment as a more-humane, less-restrictive option than institutionalization, opponents saw something far more sinister: a return to the days when psychiatric patients were forcibly restrained and subjected to injections and shock therapies against their own vehement protestations. To the people who remembered those times, and to those who argued that they had not entirely passed into history, any type of coercive therapy was simply unacceptable.

But the notion that Laura’s Law forces patients to accept treatment is a misconception, according to Alice Gleghorn, head of the county’s Department of Behavioral Wellness. “There have been a lot of misconceptions about what this type of program can and cannot do,” she says. “Even though there is the specter of a court process associated with assisted outpatient treatment, a client can still refuse to go to court, and there’s really nothing that can be done about that. If they do go to court and are ordered to have medication they can say no.”

The involvement of the court hinges on patients succumbing to the “black robe effect” — people’s tendency to accept the authority of judges. Even if courtrooms can’t actually coerce patients to accept treatment, Laura’s Law requires that courts be ready to see patients who meet the criteria set by the law. For Santa Barbara County, that means dedicating time and money to working with the courts to ensure that a proper system is in place for patients who meet Laura’s Law criteria.

“There have been a lot of misconceptions about what this type of program can and cannot do.”

For more than a decade, Nevada County, California — where the law’s namesake, Laura Wilcox, was shot and killed at a mental-health clinic by a man who had refused treatment — was the only county in the state to implement Laura’s Law.

After the state allowed counties to fund Laura’s Law programs with money from the Mental Health Services Act, more counties began to support the law. Prior to 2013, the state didn’t provide counties with any additional funding for Laura’s Law programs, and they weren’t allowed to siphon money away from already-struggling voluntary mental-health programs. Orange County, Yolo County, Los Angeles County, and San Francisco County all quickly adopted Laura’s Law, and at least five other counties have since followed suit. But it still faced opposition in Santa Barbara County.

That’s in part because there’s little evidence the court process associated with Laura’s Law does patients much good. While the assistive community care aspects of Laura’s Law have been shown to reduce homelessness, arrests, incarcerations, and psychiatric hospitalizations, Gleghorn says her department found little evidence that the court-ordered process contributed to those declines.

“If you look at data from California counties, L.A. shows a 78 percent reduction in incarceration and an 80 percent reduction in hospitalizations, but they’re looking at everybody who was referred for Laura’s Law treatment, and that they attempted to engage in care,” Gleghorn says. “It doesn’t separate out the very few people who went before a judge.”

In Los Angeles County, for example, where Laura’s Law was passed 10 months ago, only one patient of the 150-plus who met the criteria received a court order for treatment. “The question for California counties is ‘is there an added value to layering in the kind of mandated process — the court-ordered process — to motivate resistant clients to engage in care?’” she says.

The feasibility pilot program in Santa Barbara, though still in the planning stages, will soon attempt to help us determine that.

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