Laura's Law
   HOME

TheInfoList



OR:

Laura's Law is a California state law that allows for court-ordered assisted outpatient treatment. To qualify for the program, the person must have a serious mental illness plus a recent history of psychiatric hospitalizations, jailings or acts, threats or attempts of serious violent behavior towards self or others. The law was named after Laura Wilcox, a receptionist who was killed by a man who had refused psychiatric treatment. Modeled on
Kendra's Law Kendra's Law, effective since November 1999, is a New York State law concerning involuntary outpatient commitment also known as assisted outpatient treatment. It grants judges the authority to issue orders that require people who meet certain cr ...
, a similar
statute A statute is a law or formal written enactment of a legislature. Statutes typically declare, command or prohibit something. Statutes are distinguished from court law and unwritten law (also known as common law) in that they are the expressed wil ...
enacted in
New York New York most commonly refers to: * New York (state), a state in the northeastern United States * New York City, the most populous city in the United States, located in the state of New York New York may also refer to: Places United Kingdom * ...
, the bill was introduced as Assembly Bill 1421 by Assemblywoman Helen Thomson, a Democrat from Davis. The measure passed the
California Legislature The California State Legislature is the bicameral state legislature of the U.S. state of California, consisting of the California State Assembly (lower house with 80 members) and the California State Senate (upper house with 40 members). ...
in 2002 and was signed into law by
Governor A governor is an politician, administrative leader and head of a polity or Region#Political regions, political region, in some cases, such as governor-general, governors-general, as the head of a state's official representative. Depending on the ...
Gray Davis Joseph Graham "Gray" Davis Jr. (born December 26, 1942) is an American attorney and former politician who served as the 37th governor of California from 1999 until he was recalled and removed from office in 2003. He is the second state governor ...
. The statute can only be used in
counties A county () is a geographic region of a country used for administrative or other purposesL. Brookes (ed.) '' Chambers Dictionary''. Edinburgh: Chambers Harrap Publishers Ltd, 2005. in some nations. The term is derived from the Old French denoti ...
that choose to enact
outpatient commitment Outpatient commitment—also called assisted outpatient treatment (AOT) or community treatment orders (CTO)—refers to a civil court procedure wherein a legal process orders an individual diagnosed with a severe mental disorder to adhere to an o ...
programs based on the measure.


Background

Laura Wilcox was a 19-year-old college sophomore who had been valedictorian of her high school before going on to study at
Haverford College Haverford College ( ) is a private university, private Liberal arts colleges in the United States, liberal arts college in Haverford, Pennsylvania, United States. It was founded as a men's college in 1833 by members of the Religious Society of Fr ...
. While working at Nevada County'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 40-year-old man who resisted his family's and a social worker's attempt to have him hospitalized when he became increasingly delusional and paranoid. Thorpe was found incompetent to stand trial and was sent to Atascadero State Hospital and was later transferred to California's Napa State Hospital. After the killings, Laura's parents chose to advocate for assisted outpatient treatment of individuals considered to have mental illness.


Implementation at county discretion

The law is only operative in those counties in which the county board of supervisors, by resolution, authorizes its application and makes a finding that no voluntary mental health program serving adults, and no children's mental health program, was reduced in order to implement the law. In November 2004, California voters passed Proposition 63, the Mental Health Services Act (MHSA). The California Department of Mental Health (DMH) released its draft plan requirements for county mental health administrators on February 15, 2005 and included a provision that would allow MHSA funds to be used for "involuntary services" if certain criteria were met. In 2004,
Los Angeles County Los Angeles County, officially the County of Los Angeles and sometimes abbreviated as LA County, is the most populous county in the United States, with 9,663,345 residents estimated in 2023. Its population is greater than that of 40 individua ...
implemented Laura's Law on a limited basis. Since passage of MHSA, Laura's Law provisions have been implemented in
Kern County Kern County is a county (United States), county located in the U.S. state of California. As of the 2020 United States census, 2020 census, the population was 909,235. Its county seat is Bakersfield, California, Bakersfield. Kern County compris ...
,
Los Angeles County Los Angeles County, officially the County of Los Angeles and sometimes abbreviated as LA County, is the most populous county in the United States, with 9,663,345 residents estimated in 2023. Its population is greater than that of 40 individua ...
, Nevada County, Orange County, Placer County,
San Diego County San Diego County (), officially the County of San Diego, is a county in the southwest corner of the U.S. state of California, north to its border with Mexico. As of the 2020 census, the population was 3,298,634; it is the second-most populous ...
,
San Mateo County San Mateo County ( ), officially the County of San Mateo, is a county (United States), county located in the U.S. state of California. As of the 2020 United States census, the population was 764,442. Redwood City, California, Redwood City is th ...
, Yolo County,
Contra Costa County Contra Costa County (; ''Contra Costa'', Spanish language, Spanish for 'Opposite Coast') is a U.S. county, county located in the U.S. state of California, in the East Bay of the San Francisco Bay Area. As of the 2020 United States census, the ...
, the City and County of San Francisco,
Ventura County Ventura County () is a county located in the southern part of the U.S. state of California. As of the 2020 census, the population was 843,843. The largest city is Oxnard, and the county seat is the city of Ventura. Ventura County comprises ...
,
San Luis Obispo County San Luis Obispo County (), officially the County of San Luis Obispo, is a county on the Central Coast of California. As of the 2020 United States census, the population was 282,424. The county seat is San Luis Obispo. Junípero Serra fou ...
,
Alameda County Alameda County ( ) is a county located in the U.S. state of California. As of the 2020 census, the population was 1,682,353, making it the 7th-most populous county in the state and 21st most populous nationally. The county seat is Oakland. A ...
and
Mendocino County Mendocino County (; ''Mendocino'', Spanish language, Spanish for "of Antonio de Mendoza, Mendoza") is a County (United States), county located on the North Coast (California), North Coast of the U.S. state of California. As of the 2020 United S ...
By 2010, Nevada County, where the shootings took place, fully implemented the law. In 2010 the California State Association of Counties chose Nevada County to receive its Challenge Award for implementing Laura's Law. In 2011 a National Association of Counties Achievement Award in Health was awarded to Nevada County for the Assisted Outpatient Treatment Program.
Marin County Marin County ( ) is a county located in the northwestern part of the San Francisco Bay Area of the U.S. state of California. As of the 2020 census, the population was 262,231. Its county seat and largest city is San Rafael. Marin County is ac ...
launched a two-year pilot program for Laura's Law on September 4, 2018.
Santa Clara County Santa Clara County, officially the County of Santa Clara, is the sixth-most populous county in the U.S. state of California, with a population of 1,936,259 as of the 2020 census. Santa Clara County and neighboring San Benito County form the ...
adopted the provisions on May 25, 2021, at which time 21 out of 58 counties had opted in. Legislation in 2020 required counties to participate or explicitly opt out by July 1, 2021. Counties may choose to participate or opt-out of the program at the beginning of each fiscal year. In those counties that adopt outpatient commitment, the process will ensure individuals are provided the services, medical treatment and medication that will enable the person to have a good chance to recover. Nevada County Director Michael Heggarty described it as part of the recovery movement.


Assisted outpatient treatment eligibility criteria

To be eligible under Laura's Law, a patient must have a serious mental illness plus a recent history of psychiatric hospitalizations, jailings or acts, threats or attempts of serious violent behavior towards self or others. The recipient must also have been offered an opportunity to voluntarily participate in a treatment plan by the local mental health department, yet fails to the point that, without a Laura's Law program, he or she will likely relapse or deteriorate to the point of being dangerous to self or others. "Participation in the assisted outpatient program is the least restrictive placement necessary to ensure the person's recovery and stability." While a specified group of individuals may request an investigation to determine if a person qualifies for a Laura's Law program, only the County mental health director, or his or her designee, may file a petition with the superior court for a hearing to determine if the person should be court ordered to receive the services specified under the law. A person may be placed in an assisted outpatient treatment if, after a hearing, a court finds that the following criteriaLaura's Law. AB 1421. September 28th, 2002. leginfo.ca.gov. http://leginfo.ca.gov/pub/01-02/bill/asm/ab_1401-1450/ab_1421_bill_20020928_chaptered.html 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 due to being 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. If the court finds that the individual meets the statutory criteria, the recipient will be provided intensive community treatment services and supervision by multidisciplinary teams of highly trained mental health professionals with staff-to-client ratios of not more than 1 to 10, and additional services, as specified, for persons with the most persistent and severe mental illness. The law specifies various rights of the person who is the subject of a Laura's Law petition as well as due process hearing rights. The bill also provides for voluntary settlement agreements as an alternative to the hearing process.


Debate over bill's efficacy and propriety


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 Chiefs Association, Mental Illness Policy Org. and the
National Alliance on Mental Illness The National Alliance on Mental Illness (NAMI) is a United States–based nonprofit organization originally founded as a grassroots group by family members of people diagnosed with mental illness. NAMI identifies its mission as "providing advoca ...
(NAMI). In an editorial endorsement of the law, the ''
Los Angeles Times The ''Los Angeles Times'' is an American Newspaper#Daily, daily newspaper that began publishing in Los Angeles, California, in 1881. Based in the Greater Los Angeles city of El Segundo, California, El Segundo since 2018, it is the List of new ...
'' touted then-Governor
Gray Davis Joseph Graham "Gray" Davis Jr. (born December 26, 1942) is an American attorney and former politician who served as the 37th governor of California from 1999 until he was recalled and removed from office in 2003. He is the second state governor ...
's support, while limiting its comments on opponents to mentioning that the
Citizens Commission on Human Rights Citizenship is a membership and allegiance to a sovereign state. Though citizenship is often conflated with nationality in today's English-speaking world, international law does not usually use the term ''citizenship'' to refer to nationality; ...
which opposes virtually all psychiatric treatments, sponsored a rally at the Capitol against Laura's law. The
San Francisco Chronicle The ''San Francisco Chronicle'' is a newspaper serving primarily the San Francisco Bay Area of Northern California. It was founded in 1865 as ''The Daily Dramatic Chronicle'' by teenage brothers Charles de Young and M. H. de Young, Michael H. ...
and The
San Francisco Examiner The ''San Francisco Examiner'' is a newspaper distributed in and around San Francisco, California, and has been published since 1863. Once self-dubbed the "Monarch of the Dailies" by then-owner William Randolph Hearst and the flagship of the He ...
have published positive articles on the topic. The
Los Angeles Times The ''Los Angeles Times'' is an American Newspaper#Daily, daily newspaper that began publishing in Los Angeles, California, in 1881. Based in the Greater Los Angeles city of El Segundo, California, El Segundo since 2018, it is the List of new ...
won a Pulitzer Prize, in part for its coverage of Laura's Law.


Opposition

MindFreedom International MindFreedom International is an international coalition of over one hundred grassroots groups and thousands of individual members from fourteen nations. Based in the United States, it was founded in 1990 to advocate against forced medication, me ...
and the California Network of Mental Health Clients (CNMHC), along with allies in the
psychiatric survivors movement The psychiatric survivors movement (more broadly consumer/survivor/ex-patient movement) is a diverse association of individuals who either currently access mental health services (known as consumers or service users), or who have experienced inter ...
, also fought the measure and its earlier versions, accusing such legislation as a regressive and reprehensible scheme to enforce coerced drug treatment regimens against the will of patients. The
Church of Scientology The Church of Scientology is a group of interconnected corporate entities and other organizations devoted to the practice, administration and dissemination of Scientology, which is variously defined as a cult, a business, or a new religiou ...
and the
Citizens Commission on Human Rights Citizenship is a membership and allegiance to a sovereign state. Though citizenship is often conflated with nationality in today's English-speaking world, international law does not usually use the term ''citizenship'' to refer to nationality; ...
have also gained attention as an opponent of the new law. Outpatient commitment opponents make several varied arguments. Some dispute the positive effects of compulsory treatment, questioning the methodology of studies that show effectiveness. Others highlight negative effects of treatment. Still others point to disparities in the way these laws are applied. The
psychiatric survivors movement The psychiatric survivors movement (more broadly consumer/survivor/ex-patient movement) is a diverse association of individuals who either currently access mental health services (known as consumers or service users), or who have experienced inter ...
opposes compulsory treatment on the basis that the ordered drugs often have serious or unpleasant side-effects such as
anhedonia Anhedonia is a diverse array of deficits in hedonic function, including reduced motivation or ability to experience pleasure. While earlier definitions emphasized the inability to experience pleasure, anhedonia is currently used by researcher ...
,
tardive dyskinesia Tardive dyskinesia (TD) is an iatrogenic disorder that results in involuntary repetitive body movements, which may include grimacing, sticking out the tongue or smacking the lips, which occurs following treatment with medication. Additional mo ...
,
neuroleptic malignant syndrome Neuroleptic malignant syndrome (NMS) is a rare but life-threatening reaction that can occur in response to antipsychotics (neuroleptic) or other drugs that block the effects of dopamine. Symptoms include high fever, confusion, rigid muscles, va ...
, excessive weight gain leading to
diabetes Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...
, addiction, sexual side effects, and increased risk of suicide. John M. Grohol, Psy.D., in his article "The Double Standard of Forced Treatment", says "Forced treatment for people with mental illness has had a long and abusive history, both here in the United States and throughout the world. No other medical specialty has the rights psychiatry and psychology do to take away a person's freedom in order to help "treat" that person. Historically, the profession has suffered from abusing this right — so much so that reform laws in the 1970s and 1980s took the profession's right away from them to confine people against their will. Such forced treatment now requires a judge's signature. But over time, that judicial oversight — which is supposed to be the check in our checks-and-balance system — has largely become a rubber stamp to whatever the doctor thinks is best. The patient's voice once again threatens to become silenced, now under the guise of "assisted outpatient treatment" (just a modern, different term for forced treatment)." The New Mexico Court of Appeals declared an Albuquerque ordinance, modeled after Kendra's Law, requiring treatment for some mentally ill people conflicts with state law and can't be enforced.


Tom Burns

Tom Burns, the psychiatrist who originally advised the United Kingdom's government on laws that are similar to Laura's Law, has also come to the conclusion they are ineffective and unnecessary. Professor Burns, once a strong supporter of the new powers, said he has been forced to change his mind after a study he conducted proved the orders "don't work". However, Burns' opinion was based heavily on his (very different) circumstances in the United Kingdom. The study he conducted found that coerced treatment was no better than regular/competent un-coerced treatment (the standard in the United Kingdom, which has public healthcare). As a result, the bulk of his argument does not apply to California, where the alternative to coerced treatment in most cases is no treatment at all. Professor Burns himself admitted that: "We were careful in our Lancet article to say that ''in well-coordinated mental health services'', compulsory treatment has nothing to offer" (emphasis added). Burns went on to highlight another critical difference between the two systems, and even mentioned that as a psychiatrist under a European system he would be willing to order coercive treatment under circumstances similar to the ones described by Laura's Law: "There's a profound conceptual difference in the approach to mental health care between America and Europe. European laws often state "danger to self or others," but danger in Europe is almost always interpreted very broadly — and you might think paternalistically — to include the patient's mental health. If I have a seriously ill schizophrenic patient who is neglecting himself, not taking his medicine, and I know he's going to get worse, I can say that's a "danger" to his health. My understanding is that in many states in America, it's got to be an imminent physical risk."


Studies

As a result of the opposition to Kendra's Law, similar in nature to Laura's Law, two studies were conducted on Kendra's Law and found favorable outcomes. One study of Assisted Outpatient Treatment within the United States and another study done by a previous proponent of AOT type laws in the United Kingdom did not. A 2005 study, Kendra's Law A Final Report on the Status of Assisted Outpatient Treatment done by New York State's Office of Mental Health, found: (Table taken directly from source and converted to Wikipedia Table Template) A 2009 study, New York State Assisted Outpatient Treatment Evaluation done by
Duke University Duke University is a Private university, private research university in Durham, North Carolina, United States. Founded by Methodists and Quakers in the present-day city of Trinity, North Carolina, Trinity in 1838, the school moved to Durham in 1 ...
, Policy Research Associates,
University of Virginia The University of Virginia (UVA) is a Public university#United States, public research university in Charlottesville, Virginia, United States. It was founded in 1819 by Thomas Jefferson and contains his The Lawn, Academical Village, a World H ...
, found: (Table taken directly from source and converted to Wikipedia Table Template) The study, Compulsory community and involuntary outpatient treatment for people with severe mental disorders by Steve R Kisely, Leslie Anne Campbell, Neil J Preston published at The Cochrane Library found: :We identified two randomised clinical trials (total n = 416) of court-ordered 'Outpatient Commitment' (OPC) from the USA. We found little evidence that compulsory community treatment was effective in any of the main outcome indices: health service use (2 RCTs, n = 416, RR for readmission to hospital by 11-12 months 0.98 CI 0.79 to 1.2); social functioning (2 RCTs, n = 416, RR for arrested at least once by 11-12 months 0.97 CI 0.62 to 1.52); mental state; quality of life (2 RCTs, n = 416, RR for homelessness 0.67 CI 0.39 to 1.15) or satisfaction with care (2 RCTs, n = 416, RR for perceived coercion 1.36 CI 0.97 to 1.89). However, risk of victimisation may decrease with OPC (1 RCT, n = 264, RR 0.5 CI 0.31 to 0.8). In terms of numbers needed to treat (NNT), it would take 85 OPC orders to prevent one readmission, 27 to prevent one episode of homelessness and 238 to prevent one arrest. The NNT for the reduction of victimisation was lower at six (CI 6 to 6.5). A new search for trials in 2008 did not find any new trials that were relevant to this review. The results of this study also did not support the usefulness of compulsory outpatient treatment: Community treatment orders (CTOs) for patients with psychosis (OCTET): a randomised controlled trial done by Professor Tom Burns DSc, Jorun Rugkåsa PhD, Andrew Molodynski MBChB, John Dawson LLD, Ksenija Yeeles BSc, Maria Vazquez-Montes PhD, Merryn Voysey MBiostat, Julia Sinclair DPhil, and Professor Stefan Priebe FRCPsych found: :Of 442 patients assessed, 336 patients were randomly assigned to be discharged from hospital either on CTO (167 patients) or Section 17 leave (169 patients). One patient withdrew directly after randomisation and two were ineligible, giving a total sample of 333 patients (166 in the CTO group and 167 in the Section 17 group). At 12 months, despite the fact that the length of initial compulsory outpatient treatment differed significantly between the two groups (median 183 days CTO group vs 8 days Section 17 group, p<0·001) the number of patients readmitted did not differ between groups (59 6%of 166 patients in the CTO group vs 60 6%of 167 patients in the Section 17 group; adjusted relative risk 1·0 5% CI 0·75—1·33.


See also

* 2001 Nevada County shootings, the shooting spree which led to the law being implemented *
Kendra's Law Kendra's Law, effective since November 1999, is a New York State law concerning involuntary outpatient commitment also known as assisted outpatient treatment. It grants judges the authority to issue orders that require people who meet certain cr ...
, assisted outpatient treatment law in NY on which Laura's law is based * Gun Violence Restraining Order, a gun control to temporarily remove firearms from people who may present a danger * 5150 (Involuntary psychiatric hold), California's law for psychiatric emergencies * Baker Act, a Florida law of similar operation *
involuntary commitment Involuntary commitment, civil commitment, or involuntary hospitalization/hospitalisation, or informally in Britain sectioning, being sectioned, commitment, or being committed, is a legal process through which an individual who is deemed by a qual ...
, which is hospital-based *
Involuntary treatment Involuntary treatment or mandatory treatment refers to medical treatment undertaken without the consent of the person being treated. Involuntary treatment is permitted by law in some countries when overseen by the judiciary through court orders; ...
, which is independent of setting *
anti-psychiatry Anti-psychiatry, sometimes spelled antipsychiatry, is a movement based on the view that psychiatric treatment can often be more damaging than helpful to patients. The term anti-psychiatry was coined in 1912, and the movement emerged in the 1960s, ...
, a movement that opposes any form of involuntary psychiatric treatment *
Outpatient commitment Outpatient commitment—also called assisted outpatient treatment (AOT) or community treatment orders (CTO)—refers to a civil court procedure wherein a legal process orders an individual diagnosed with a severe mental disorder to adhere to an o ...


References

{{reflist


External links

;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)

Convention on the Rights of Persons with Disabilities

Bazelon Center

Disability Rights California

Mad in America ;Proponent views

Mental Illness Policy Org. Laura's Law Home Page
The Treatment Advocacy Center
- 'Laura's Law' California statutes Mental health law in the United States United States disability legislation Disability in California 2002 in American law 2002 in California 2002 in health