Laura's Law could provide a middle ground between the old norm of total institutionalization and the new one of total abandonment. But the statute is struggling to reconcile forestalling tragedies with patients' rights.

For at least a year before he shot and killed Laura Wilcox, Scott Thorpe had been convinced that the Federal Bureau of Investigation was out to get him. He told his older brother Kent that they had planted a chip in his brain and were using it to track him. He was certain that at some point he and the lead agent in charge of his case would end up in a big shoot-out, and that this shoot-out would determine his fate. In secret, he took pains to prepare for this reckoning: He converted his farmhouse into a battle fort, covering windows, barricading doors, and storing weapons and ammunition in every room, as well as in his truck. He also purchased a gas mask and night vision goggles, just in case.

Kent knew enough to be worried about Scott. Mental illness ran in the Thorpe family; the brothers’ father had committed suicide after a long struggle with depression, and Scott himself had both depression and agoraphobia. It was after a few bad episodes that he moved to a small farm up in the Sierra Nevada foothills of Nevada County, California, and settled into a quiet, reclusive life. He was a sweet but bashful soul; his neighbors would later tell inquiring reporters how he couldn’t bear to slaughter his own pigs, and how when he got too anxious to leave his house, they would bring him groceries.

Scott had been a patient at the Nevada County mental health clinic for several years, and, by the end of 2000, Kent had spent several months trying to convince the psychiatrist there to have his brother committed to a psychiatric hospital, involuntarily if need be. He wanted Scott to be protected from himself until his illness could be brought under control. But the psychiatrist would not return Kent’s calls, and on the few occasions when Kent actually did get through, he would only cite patient privacy laws and decline to talk further. Kent’s wife Sharon had also pleaded with the psychiatrist to hear them out. We aren’t trying to obtain information, she explained. We’re trying to provide it. It was no use.

Laura Wilcox. (Photo: Courtesy of Nick and Amanda Wilcox)

Laura Wilcox. (Photo: Courtesy of Nick and Amanda Wilcox)

As court records and an internal audit would later show, Scott’s doctor knew very well how sick he was. But involuntary psychiatric hospitalizations are expensive, and the county was strapped financially. There was no inpatient psychiatric facility in Nevada County, and there were hardly enough beds in the surrounding counties for the patients who wanted care, let alone for those who did not.

So nothing was done. And on January 10, 2001, Scott decided that his moment of reckoning—the day of his big shoot-out—had finally come. When he arrived at the mental health clinic for a scheduled appointment, he picked up the gun he’d been carrying around in his truck, entered the building, and fired several rounds through a glass windowpane, killing two people: Pearlie Mae Feldman, a 68-year-old caregiver who was visiting someone in the building, and Laura Wilcox, a 19-year-old college student who was filling in at the front desk during her winter break. He then drove to a nearby restaurant, where he believed his food was being poisoned, and shot and killed Mike Markle, a 24-year-old manager.

Only afterward—after the killings, and his arrest, and the trial that followed—did the state finally remand Scott Thorpe, permanently, to a psychiatric facility down in Napa County.

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By now the narrative is so familiar, it’s almost a cliché. A person with a serious mental illness enters a delusional state or becomes suddenly threatening or violent. Family members struggle mightily to get that person help. They call doctors and hospitals and police officers, to no avail. The sick person doesn’t believe he’s sick and so won’t accept help voluntarily. Police are bound by laws that say only those who pose an “imminent danger” can be taken into custody against their will and brought for observation. And hospitals are bound further still by a cataclysmic shortage of psychiatric hospital beds. Psychiatric institutions began closing en masse back in the late 1980s as part of a concerted effort to improve the lives and protect the rights of people suffering from serious mental illnesses. But those institutions have yet to be replaced with anything substantial.

So the sick person goes untreated. And sometimes nothing much happens. Sometimes the person merely continues to suffer, cycling through emergency rooms and jails and homeless shelters in a way that is prolonged and needless, but also anonymous. Far too often, though, the very worst comes to pass: The sick person is killed by a cop or a criminal, or he commits suicide. Or he kills others in some horrific way: hacks an immediate family member to death, pushes a stranger off a subway platform, shoots up a classroom or movie theater or shopping center. Then come the headlines, and the clamor for change, and the lengthening of our grim list: Newtown. Tucson. Aurora. Virginia Tech. The University of California–Santa Barbara. Umpqua Community College, in Roseburg, Oregon.

And those are just the tragedies that make headlines. Many others—the vast majority, in fact—do not. To take just a random sampling from this past November: A Portland man suffering a mental health crisis and threatening suicide was shot and killed by police; a Sebastopol, California, man killed both his parents with a sword; and a mentally ill Pennsylvania man beat and critically wounded a stranger with a hammer, hours after nearly strangling his mother. In the latter two cases, family members had tried repeatedly to get help for the men involved, and both men are now facing years in prison.

In Nevada County, California, where Scott Thorpe shot and killed Laura Wilcox in the waiting room of the county mental health clinic, the clamor lingered long after the headlines had come and gone. Why did this happen? Couldn’t it have been prevented? Scott Thorpe had an attentive and engaged family that was expressing grave concern. He had contact with a mental health provider who saw clearly that he was deteriorating. But still, nothing happened. “There was no pathway open to receiving information from families or to investigating family member concerns,” says Carol Stanchfield, the director of Turning Point Providence Center, a community center in Nevada County that provides services for people with serious mental illnesses. “The system was fear-based and closed.”

But communication wasn’t the only problem. Like many people with bipolar disorder or schizophrenia, Thorpe suffered from anasognosia: the inability to grasp the true nature or extent of his own illness. “We tried many times to dissuade his ideas,” his sister-in-law Sharon says. “But he just wouldn’t hear us. His delusions kept getting more and more grandiose, and there was no making him see how illogical they were.” Thorpe was taking his medication faithfully and seeing his psychiatrist at least sporadically. But in the months leading up to the killings, his condition continued to deteriorate and he refused his loved ones’ efforts to provide him with additional support. He wouldn’t let them into his home, or heed their attempts to reason with him by phone. And he never had the opportunity to submit himself to inpatient care.

In California, as in most other states, the standards for involuntary psychiatric commitment are so tight that by the time a person meets those standards it is often already too late. Even if Thorpe’s doctor had been willing to have him committed, and even if a psychiatric bed had been available for him somewhere, those things would still probably only have happened after Thorpe had already acquired multiple firearms and the urge to use them. Because who would remove someone from their home and lock them up in an institution for merely thinking violent or delusional thoughts? There are limits in place. In principle, those limits protect civil liberties; in practice, they often force sick people and their families into a dangerous game of chicken with the system that’s supposed to be helping them.

What Scott Thorpe really needed, then, was two kinds of help: a community-based system that could provide him with support at the earliest signs of trouble; and laws that enabled judges and doctors to force him to accept that support before he reached the point of hospitalization.

At the time of Laura Wilcox’s death, the California legislature was considering a bill based on exactly those two premises. It would have enabled mental health workers to seek court orders against a specific subset of patients who were dangerously ill but refusing treatment, and would have compelled them to accept outpatient psychiatric care as a condition of living in their communities. Proponents were calling it assisted outpatient treatment, or AOT. A similar statute had just been passed in New York, named Kendra’s Law after a 32-year-old woman who had been pushed off a subway platform by a man with schizophrenia. And Florida and Michigan—each prodded by its own tragedy—were starting to take up the same cause. Treat people with serious mental illness before something awful happens, the thinking went, not after. In fact, more than 30 states already had laws on the books that allowed for involuntary outpatient programs. Permissive powers, they were called, but nobody ever used them, in part because few people knew they existed, and in part because of a general bureaucratic muddiness: Courts and clinics were not naturally linked to one another, and whatever the existing laws stated, it remained unclear who could order whom to do what, and under what circumstances. It wasn’t until the idea of attaching the names of individual victims to newly proposed laws caught on that a movement emerged: the families of those with serious mental illnesses and the families of their victims lobbying for some compromise between total institutionalization and total abandonment.

Scott Thorpe. (Photo: Courtesy of the Thorpe Family)

Scott Thorpe. (Photo: Courtesy of the Thorpe Family)

Laura Wilcox’s parents, Nick and Amanda, are Quakers who oppose the death penalty and believe strongly in the power of civic engagement. They understood, even in their grief, that Scott Thorpe was not an evil man, just a very sick one who had been denied urgently needed psychiatric care. As Nick would tell reporters, the last conversation he had with Laura, his only daughter, was about how abysmal conditions were at the mental health clinic. The heat in the building wasn’t working, she told him. Staff morale was terrible, and patients weren’t treated well. After her funeral, the Wilcoxes became active proponents of assisted outpatient treatment. They allowed Laura’s name to be attached to the California bill, which had been languishing, and they joined other lobbyists—most of them the family members of people with serious mental illnesses—in the fight to get it passed.

And a fight it was. 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. MindFreedom, a non-profit group that advocates for the rights of the diagnosed mentally ill, writes on its website, “Chemical restraint, forced sedation, forced drugging, the coercive administration of psychiatric drugs, is a grossly invasive, cruel and unusual, decimation of the human right to bodily integrity. In all situations, in all cases, it is excessive force, excessively invasive, humiliating, and profoundly violent and traumatizing.” The group makes no distinction between court-ordered inpatient and outpatient programs. Coercive is coercive, they argue. Full stop.

In California, a group calling itself the psychiatric-survivors movement attended every hearing on the proposed bill, and registered its dissent in as dramatic a fashion as possible. Its members came hours early, often by the busload, and filled every seat in the hearing room. Sometimes they wore matching T-shirts with black triangles, the symbol used to label the mentally ill in Nazi concentration camps. They dubbed Helen Thomson, the councilwoman behind the statute, Nurse Ratched after the famously inhumane character in One Flew Over the Cuckoo’s Nest; they passed out buttons with her picture on them. Some opponents also criticized the Wilcoxes directly. “There were articles and testimonies from the opposition that referred to us specifically, as ‘violence-mongers’ and ‘spreaders of stigma and hatred,’” Amanda Wilcox says. “It hurt because that was the furthest thing from what we were trying to do. We never said a bad word about Scott Thorpe, and he killed our daughter.”

Legislators on both sides of the aisle found common cause with the protestors: The left worried about human-rights violations, the right about civil liberties, and with the state newly broke from the recent energy crisis, both sides worried about where the money for any new programs would come from. Mental health workers also objected. The proposed law would be nearly impossible to implement, they said. Forget the involuntary component. What about the treatment component? How could they possibly establish programs that met the requirements of this new law when they were barely managing to meet the responsibilities they already had? However good it sounded on paper, they argued, assisted outpatient treatment would only pile more work atop a system that was already overburdened.

Still, Laura’s Law went into effect in January 2003, after a bruising political battle, and with two big stipulations. First, the statute would be unfunded: no money could be used for involuntary programs as long as voluntary ones were still struggling to provide services. And second, because the state wasn’t providing any financial support, it would not force any municipality to implement the law but would instead allow each county to decide for itself whether to opt in or opt out. It was a law in name only. And at first all of the state’s 58 counties chose to ignore it.

In Nevada County, the Wilcox family pressed on, filing a lawsuit, which they settled for $100,000 and a promise: The county where Laura Wilcox died would implement the law that now bore her name as soon as the state made funding available. Laura’s parents donated a third of their settlement to the campaign to get an additional funding bill passed. That campaign succeeded in 2005. A few years later Nevada County became the first in California to implement an assisted outpatient treatment program.

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The Nevada County courthouse sits along a hilly road outside downtown Nevada City, an old mining town with the kitschy tourist shops to prove it. One Monday this past July, a middle-aged woman named Deborah, dressed in white capris and a floral blouse, sat in a third-floor hallway with half a dozen others, waiting for her turn with judge Tom Anderson.

Deborah has bipolar disorder and has been under an assisted outpatient treatment order since February; she had come, as she does every other Monday, for a status review of her case. The eligibility standards for such an order are tight: A person must not only suffer from a serious mental illness but also have been recently hospitalized or incarcerated as a result of that illness, or they must have threatened or attempted to commit violent acts against themselves or others. They also must have refused to accept voluntary treatment, and must be deteriorating to the point that barring an intervention they are likely to end up back in a hospital or jail or worse. Deborah declined to elaborate on the specific chain of events that landed her in the program, except to say that at some point last year she stopped taking her medication and started “hanging around the wrong group of people.”

She was doing much better now, she said. She still cried a lot, but after months of being “literally manic,” she was finally starting to feel more like herself. The cognitive behavioral therapy that the judge had ordered as part of her treatment plan was helping with her self-esteem. And she had come to really appreciate the weekly check-ins. It was nice to feel looked after, she said. And Judge Anderson was just the nicest person.

“You’re doing all the things you need to,” he told her during that day’s hearing. “You’re taking responsibility for your health and you’re being proactive. Is there anything else you need from us?”

“I need more time,” she said, referring to the amount of attention she was getting from her caseworker, or personal service coordinator. Anderson nudged her to think about going back into individual therapy. She said she wanted to wait until she had found a place to live.

“Can I tell you my perspective on that?” he asked. “The stress of searching for a house is a good reason to see a counselor. Rather than waiting until after you’ve managed the crisis.” She nodded, and they agreed to meet again in two weeks. Anderson thanked her for coming in. The entire exchange took less than 10 minutes and had the tone of a high school guidance counselor advising one of his better students. It was congenial, warm even.

(Photo: Joe Toreno)

(Photo: Joe Toreno)

Anderson takes pains to keep it that way. “When they first come before me,” he says, “I explain: ‘This is not criminal court. No matter what happens today, you are going home afterwards.’ I do that because I want them to feel empowered. I also want to try to get them to accept help, as opposed to having them feel like it’s being forced upon them.”

Anderson was Scott Thorpe’s public defender and more than a decade later can still remember even small details from the case: how everyone who knew Thorpe described him as gentle, quiet, and sweet; how the families of the victims and the family of the killer consoled one another in court; how the killings cast a dark shadow over the entire county; how that shadow stretched across time. Anderson had not planned to become a judge. He started out wanting to be a public servant of some kind, and only went to law school after getting involved in some death-penalty work. But in the years since the Thorpe/Wilcox case he has made it his personal mission to prevent anything like that from ever happening again.

In court, Anderson has a reputation for being methodical and fair. For each new assisted outpatient treatment case, he goes through the plan that the psychiatrist has submitted and negotiates line-by-line with the client in question. If they refuse to take medications, he asks them to at least see the psychiatrist once a week, and to participate in whatever programs have been recommended—usually a combination of cognitive behavioral therapy and substance-abuse counseling, and sometimes a job-placement program. Then he makes both the client and the treatment provider sign an agreement. “I turn to each side,” he explains, “and I say, ‘You agree to this, this, and this, and I expect this, this, and this.’” After that, he follows up every two weeks. He gives praise when it’s due, and stern talk when it’s needed. Week by week, check-in by check-in, he tries to win each client over.

The secret to assisted outpatient treatment, proponents say, is not the power it gives mental health workers to compel clients against their own will, but rather the effect that judges tend to have on anyone who ends up in their courtrooms—“the black-robe effect,” they call it. Anderson’s knack for capitalizing on this effect is legendary. Carol Stanchfield, of the county’s Turning Point mental health center, remembers one client for whom assisted outpatient treatment was a last-ditch effort. “Nothing was working,” she says. “So we tried AOT. And it turned out the client knew Judge Anderson as his former public defender. He walks into court and goes, ‘Toooom!’ And the judge says ‘So-and-So! You going to take your meds?’ And he says, ‘Yeah, OK, sure thing, Tom.’ Nobody saw that coming.”

In seven years, Stanchfield says, she has encountered only six truly adversarial cases. “We have data showing over 80 percent of our AOT clients are very happy with the program,” she says, “and whenever I present this data, people say, ‘Wait, you mean they like being court-ordered?’ It sounds odd, but yes, they do, eventually. Because it works.” Stanchfield has traveled the state talking about assisted outpatient treatment in Nevada County, and she has scores of success stories at the ready for her skeptics. For example, Drew, a 29-year-old college student, did so well in his treatment program that he voluntarily extended it to three years. “I honestly loved my experience with Judge Anderson,” Drew says. “I was super apprehensive to get in the program at first, because it felt like I was being punished for something I hadn’t done, and it didn’t seem fair. But Judge Anderson was super understanding the whole way through. And when it was time to leave, I thought, ‘I should probably keep with it. I’m doing really well now and this is a great support system.’”

The core of that support system, Anderson insists, is neither the judge nor his chambers, nor even the law itself. “The black-robe effect only gets you so far,” he says. “To really help people with serious mental illnesses, you need something much more comprehensive.”

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Back in the late 1960s, a research sociologist by the name of Mary Ann Test was working at the Mendota Mental Health Institute, a state psychiatric hospital in Madison, Wisconsin, with patients who suffered from chronic schizophrenia. Test worked specifically with the most intractable cases, the ones who could not seem to stabilize under the existing treatment protocols. Her mandate was to find innovative approaches to help get them back into the community, and by the summer of 1970, she was floundering. The morale among her team of clinicians was awful, because none of the programs were helping their clients. They would stabilize patients in the hospital and discharge them into the community, only to have them relapse and return a few weeks later. No matter how smart Test’s ideas seemed, or how hard her team worked to implement them, the same patients kept returning to the unit.

There was one social worker, though, whose patients seemed to cycle back through the hospital far less frequently than the others. She handled only a few patients at a time, as her approach was involved. It was also wildly unorthodox for its time, in that she continued to work with her patients after they were discharged. She helped them move into their apartments and group homes. She rode buses with them until they got used to it. She went to the grocery store with them and taught them to shop. She even gave their landlords her personal phone number, for use in emergencies. Rather than wait for them to get so sick that they needed to be re-hospitalized, she was treating her patients out in the community. And it appeared to be working.

At an impromptu staff meeting, Test and her team decided to follow that social worker’s lead and go help their patients in the community too. They dubbed this new approach assertive community treatment, or ACT. Almost immediately, its benefits became apparent to them. Instead of subjecting each patient to a maze of disconnected agencies, Test’s caseworkers began assisting in all areas of living: health, employment, housing. This approach made treatment easier for the clients because they only had to deal with one agency now. It also made it easier for the caseworkers, because they could address the complex interactions between patients’ symptoms and their ability to function in the world. Patients who tended to self-medicate with drugs, for example, could be moved to the suburbs, where drugs were less available; and patients whose social anxiety prevented them from keeping certain jobs could be steered more quickly toward others. This continuity of care made it easier for caseworkers to invest in each client’s success, because finally, the buck could stop with them.

Carol Stanchfield: "There was no pathway open to receiving information from families or to investigating family member concerns." (Photo: Joe Toreno)

Carol Stanchfield: "There was no pathway open to receiving information from families or to investigating family member concerns." (Photo: Joe Toreno)

There were other benefits too. It turns out that preventing mental flare-ups from progressing into full-blown psychotic episodes prevents irreparable brain damage. The more often patients suffer such episodes, Turning Point’s Stanchfield says, “the more difficult it is to get them back.”

When Nevada County opted in to Laura’s Law, back in 2005, Turning Point was asked to implement the treatment component of the law, with Stanchfield leading the effort. She knew she wanted a holistic program, one that looked not at symptoms and diagnoses but instead focused on individual people, adapting protocols to suit each client’s needs and enlisting the clients in their own treatment plans. Assertive community treatment was a perfect fit for what she had in mind.

Every client at Turning Point has his or her own personal service coordinator, a sort of cross between a case manager and a life coach. The ratio of patients to coordinators is capped at 10 to one, so that every client gets lots of personal attention. This past July, there were just 90 clients divided among 10 caseworkers.

Every weekday morning at 9:00, the personal service coordinators meet with the rest of Turning Point staff—the director, the manager, the staff nurse, and the psychiatrist—to update one another on cases and to coordinate care. A lot of that amounts to playing taxi driver. Clients need rides to and from doctors’ appointments, court appearances, and group-therapy sessions. They need their medications delivered to them at the same time every day; they need help with housing issues and family troubles; and they need support during crises of all kinds, from drug overdoses and suicide attempts to squabbles with roommates.

On a recent Saturday night, for example, one client landed in the hospital after fleeing her apartment with only her cell phone and a kitchen knife. She had become convinced that people were hiding in the bushes waiting to kill her, and had run to a stranger’s house for help. The stranger called the police, who brought her to the emergency room, where attendants recognized her and called Turning Point. Her personal service coordinator—a sunny woman who went to high school with Laura Wilcox—came and found her at the hospital, and held her hand through the transfer from emergency room to intensive care unit. (The patient’s heart rate was alarmingly high, and she had tested positive for methamphetamines.) A few hours later, another client called that same coordinator and asked to be taken to the psychiatric hospital because he was struggling with delusions that involved talking insects. The coordinator brought him to psychiatric admissions, waited there with him—and brought him back home when the staff there declined to admit him.

Personal service coordinators help in other, more mundane ways too. Deborah remembers that, during a particularly dark period, her coordinator colored her hair. “She made me feel more like myself,” she says. “It was very sweet.”

The vast majority of Turning Point clients participate willingly. Assisted outpatient treatment is reserved for a small subset who refuse to accept help and are in danger of hurting themselves, hurting someone else, or being re-hospitalized. “It’s clients who, if you look at their files and their history, you know exactly what’s coming,” says Darryl Quinn, a program manager in Nevada County’s behavioral health department. “You know that unless we intervene in some way they are going to go through the same cycle—hospitals, jails, homeless shelters, and worse—not just once or twice, but over and over again, until something really terrible happens, to them or to the people around them.” This past July, just 12 Turning Point clients out of 90 were under court orders, which Stanchfield says is typical.

It’s also somewhat beside the point, she says, because the goals for all clients are the same, whether they’re under a court order or not. “We want to get each client so immersed in the Turning Point community that the court doesn’t have to order anything,” Stanchfield says. “They participate because they want to. And then eventually they stabilize.”

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It would be foolish to suggest that any one law could possibly have prevented the constellation of tragedies that have resulted from untreated mental illness in recent years. There are failures of gun policy and of criminal justice to consider, and questions worth asking about the state of political discourse. Even when you focus on our treatment of the mentally ill, you still have privacy laws to think about, and legacies of abuse to grapple with, and resource shortages that obscure everything else. When we can’t even get past the debating stage long enough to actually try anything, it’s hard to know what might or might not prevent mentally ill people from hurting themselves and others.

And when we do finally try, there is still this: The problem itself is difficult. Assisted outpatient treatment was designed for the most precarious cases, the people who are not only sick but also actively spinning out of control. Not everyone in that state responds to court orders in the same way. Some clients make it only a few months before refusing to cooperate. Others never even make it into court. Don is a good example of the latter. Don is one of Turning Point’s toughest cases: chronically homeless, he never takes his medication and is almost always in crisis. He can usually be found wandering through town, unwashed and shouting at the top of his lungs. The police pick him up at regular intervals and deposit him in the emergency room, where doctors forcibly inject him with antipsychotic medications and then, eventually, discharge him to the street. He’s had about 10 go-arounds in the past 10 months, the last one when he was found defecating on some outdoor furniture. Stanchfield says that assisted outpatient treatment is not really an option for Don, because he doesn’t have any real insight into his own condition. “We do what we can for him,” she says. “But in cases that severe, the options are very limited.”

Judge Thomas M. Anderson: "When they first come before me, I explain: 'This is not a criminal court. You are going home afterwards.'" (Photo: Joe Toreno)

Judge Thomas M. Anderson: "When they first come before me, I explain: 'This is not a criminal court. You are going home afterwards.'" (Photo: Joe Toreno)

Despite what critics say, when all the gentle pleading and stern suggesting fail, community-based caregivers can’t actually force anyone into much of anything. “We do our best to encourage people,” says Lisa Wiener, Turning Point’s registered nurse. “I try to make the medication part of it as normal as possible. Like, ‘Guess what day it is, everyone? Injection Day!’ Because plenty of patients gets injections, and no one should feel embarrassed about it. But at the end of the day, we can’t force them to take anything they don’t want to.” Several times, patients in assisted outpatient treatment at Turning Point have refused medications they really needed, and the staff have scheduled hearings to decide what to do. Could Judge Anderson threaten the person with hospitalization? Could the person be compelled in some other way? But in each instance those questions became moot, because the client landed back in the hospital before any hearing could take place. “The irony is, it’s the ones for whom AOT doesn’t work who end up getting forcibly injected,” Wiener says, “because they end up in the hospital, which is the only place that you can actually do that.”

What’s more, the court can only keep someone under an assisted outpatient treatment order for six months. Laura’s Law was written that way to appease legislators worried about civil liberties. No one should be stuck under a court order for any longer than absolutely necessary, the thinking went, especially if they haven’t violated any laws. Studies have since shown that outpatient commitment is far more effective if it lasts for longer than six months, and New York has already responded by expanding its assisted outpatient treatment law to allow for year-long court orders. But other states, including California, have yet to follow suit, and the six-month limit can leave judges and caseworkers feeling hamstrung. “There are some people who are doing well at that six-month point, but it’s clear that their view of themselves is still of not having a mental illness,” Stanchfield says. “And as soon as the court order ends they go off their meds. And then we’re back in same situation in three to four months.”

Despite these shortcomings, studies show assisted outpatient treatment to be effective. It has brought about a reduction in arrests, incarcerations, homelessness, suicide attempts, and violence toward others, and not just for participants compared with non-participants, but for participants compared with themselves before they entered a program. In Nevada County, a 2010 assessment showed that outcomes were exceptional—incarcerations and homelessness were down by 61 percent and 65 percent, respectively—and that assisted outpatient treatment was actually saving money by cutting down on arrests and hospitalizations.

Spurred on by this success, by another horrific shooting (in Isla Vista in 2014), and by a growing problem with homelessness resulting from mental illness, several more California counties have signed on to Laura’s Law in just the past few years, including San Francisco and Los Angeles. There are still holdouts, though. Stanchfield remembers one recent hearing in the southern part of the state. She and Anderson had been invited to present their data and discuss their experiences implementing Laura’s Law, but when they went up to speak, they were challenged by the audience. “They just blast anyone speaking in favor of AOT,” she says. “They think it means forced medication. They say there’s no evidence that it works. And they’re wrong on both counts.”

Last year, Tim Murphy, a Republican congressman from Pennsylvania, introduced a new piece of legislation in the House of Representatives called the Helping Families in Mental Health Crisis Act. The bill has yet to come to a full vote, but the portion that provides federal funding for assisted outpatient treatment programs has met with fierce opposition. The idea that individual liberties should never, ever be taken away unless a crime has been committed is one on which people of all faiths and political denominations agree. It’s not something we are likely to change our minds about anytime soon—even if, in practice, it means that Scott Thorpe’s right to be sick trumps Laura Wilcox’s right to be alive.

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Lead Photo: (Photo: Joe Toreno)

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