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How California can prevent violence by mentally ill, save money, and improve care: Laura's Law

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Ten years ago, January 10, 2001, California was stunned when mentally ill Scott Harlan Thorpe killed Perlie Mae Feldman, Michael Markle and 19-year-old Laura Wilcox in Nevada County. That horrific event drove California to pass its eponymously named Laura's Law that was supposed to help end violence both by and to people with serious mental illness.

Yet the killings continue.

  • Two weeks ago, mentally ill Vinh Bui was shot while acting out by San Francisco police who felt threatened by a knife he was carrying.
  • In June, Sacramento Police shot mentally ill Anthony Alvarez, while he was holding a 16-month-old baby hostage after locking himself for days in a Sacramento apartment.
  • On August 29, 2010, 47-year-old Kenneth James Ward, suffering from bipolar disorder killed a 40-year-old Mormon Bishop at church in Visalia in San Joaquin Valley.

Don't blame the police or people with mental illness. Blame Sacramento and the counties. They caused the problem.

The reason Laura's Law isn't working is that the state legislature passed the law but refused to see it gets used. Rather than fixing the system, they created another CYA crack in it. And county supervisors are all-too-complacent while their mental health officials drive people with serious mental illness straight through it.

Laura's Law is California's version of Assisted Outpatient Treatment (AOT). These laws allow judges to order--after full hearings and considering all the evidence--certain potentially violent seriously mentally ill individuals to stay in treatment as a condition for living in the community. The vast majority of individuals with mental illness will never become dangerous. Laura's Law is for the others. But until there's another murder, the law will continue to be ignored. And even then, it will only get short-term media attention versus action. (My own attempts to get the media to focus on this, absent an act of violence, have been abysmal).

When used, AOT saves lives, and improves care for the seriously ill. In New York studies of individuals in AOT:

  • 47% fewer physically harmed others;
  • 55% fewer engaged in suicide attempts
  • 74% fewer experienced homelessness

California may not have enough money to save lives and improve care, but using Laura's Law would also save money, something California is very interested in. Nevada County, the only California county to fully implement Laura's Law, just received the California State Association of Counties 2010 Challenge Award for innovative projects. While honoring Nevada county, California commissioners are ignoring their own by failing to implement the law locally. Nevada County estimates that for for every dollar they spent on Laura's Law they saved $2.54 in decreased hospitalizations and jailings.

That's not surprising. New York has the largest collection of data on AOT (known there as Kendra's Law) and the savings have been even greater than expected. Among people with mental illness enrolled in AOT in New York:

  • 87% fewer experienced incarceration. Money saved.
  • 83% fewer were arrested. Money saved.
  • 77% fewer experienced psychiatric hospitalization. Money saved.
  • And length of hospitalizations was reduced 56%. Money saved.

Rather than saving money, California sends the mentally ill to jail. According to a report co-authored by the National Sheriff's Association, mentally ill individuals in California are over three times more likely to be in jail or prison compared to a hospital. As Dr. E. Fuller Torrey, author of The Insanity Offense, observed "In California, the prison system treats the most seriously ill and the mental health system 'all others.'"

It's almost become a clichà to point out that the LA County Jail is the state's largest treatment system. But it's not treatment and it's not a clichà . It's a horror.

Carla Jacobs, California's leading behind-the-scenes advocate for the seriously mentally ill, explains that 10 years after the death of Laura Wilcox, county supervisors have enrolled fewer than 30 participants in AOT. Compare that to New York's 1,800, which is also not enough. Ms. Jacobs points to advocates in Orange County, in Sacramento, in Marin , in Santa Barbara, and elsewhere, many of who are parents of the mentally ill desperate to help their loved ones. She thinks there is hope for progress in her own San Diego County with San Mateo and Contra Costa not far behind. "We try and we try, but officials seem oblivious to the problem and oblivious to fixing it." She hopes Jerry Brown will have more compassion for people with serious mental illness than his predecessor.

If compassion isn't enough, then perhaps prison guards and police chiefs -California's de facto mental health system--will be able to convince Brown (who they supported for Governor) and the counties to force California's mental health system to do what it is supposed to: provide services for the most seriously ill, if for no other reason, than to keep their officers and the public safer.

Ten years ago Laura Wilcox was murdered. The law named after her could protect others from the same fate.

DJ Jaffe covers the intersection of mental illness and violence and how to improve care for people with mental illness

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DJ Jaffe is a long-time advocate for people with very serious mental illness. He has written for NY Times, WSJ, Wash Post and others. He blogs on mental illness on Huffington Post
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