Laura's Law
Encyclopedia
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. A complete functional outline of the legal procedures and safeguards within Laura’s Law has been prepared by NAMI San Mateo.
The law was named after Laura Wilcox, a young woman who was killed by a mental patient who had refused treatment. Modeled on Kendra's Law
, a similar statute
enacted in New York
, the bill was introduced as Assembly Bill 1421 by Assemblywoman
Helen Thomson, a Democrat
from Davis
. The measure passed the California Legislature in 2002 and was signed into law by Governor
Gray Davis
. The statute can only be utilized in counties that choose to enact outpatient commitment
programs based on the measure. As of 2010, Nevada County has fully implemented the law and Los Angeles County
has a pilot project. In 2010 the California
State Association of Counties chose Nevada County to receive its Challenge Award for implementing Laura’s Law.Subsequently in 2011, a National Association of Counties Achievement Award in Health was awarded to Nevada County for the Assisted Outpatient Treatment Program.
, was 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 41-year old mental patient who resisted his family's attempt to seek treatment. 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 incident Laura’s parents chose to advocate for treatment of individuals with mental illness.
In 2004, Los Angeles County
implemented Laura's Law on a limited basis. Since the passage of the MHSA [see below Prop. 63] Nevada County fully implemented Laura's Law in May 2008 and several other counties are discussing it, notably San Francisco County, San Mateo County, San Diego County, Marin County and others.
In those counties that adopt outpatient commitment, an AB 1421 program will ensure individuals are provided the services and medical treatment (including medication) that will enable the person to have a good chance to recover. Nevada County Director Michael Heggarty bests describes it as part of the recovery movement.
A person may be placed in an assisted outpatient treatment if, after a hearing, a court finds that the following criteria have been met. The patient must:
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.
), the California Psychiatric Association, the Police Chiefs Association, and the National Alliance on Mental Illness
(NAMI). In an editorial endorsement of the law, the Los Angeles Times
touted then-Governor Gray Davis
's support, while limiting its comments on opponents to mentioning that "a subgroup of the Church of Scientology
, which opposes virtually all psychiatric treatments, sponsored a rally at the Capitol against Laura's law." The San Francisco Chronicle
and The San Francisco Examiner have published positive articles on the topic. The Los Angeles Times
won a Pulitzer Prize, in part for its coverage of Laura’s Law.
and the California Network of Mental Health Clients (CNMHC), along with allies in the psychiatric survivors movement
, 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 also gained attention as an opponent of the new law.
(on which Laura's Law is based). Two notable studies were released in 2005 and in 2009.
A briefing of these and other studies was prepared by The Treatment Advocacy Center.
The 2005 study found:
Specifically, the OMH study found that for those in the AOT program:
Comparing the experience of AOT recipients over the first six months of AOT to the same period immediately prior to AOT, the OMH study found:
As a component of the OMH study, researchers with the New York State Psychiatric Institute and Columbia University conducted face-to-face interviews with 76 AOT recipients to assess their opinions about the program and its impact on their quality of life. The interviews showed that after receiving treatment, AOT recipients generally endorsed the program, with 62% reporting that being court-ordered into treatment had been overall a good thing:
Additionally, 87 percent said they were confident in their case manager's ability to help them—and 88 percent said that they and their case manager agreed on what is important for them to work on. AOT had a positive effect on the therapeutic alliance.
In 2009, an independent study by Duke University into alleged racism found "no evidence that the AOT Program is disproportionately selecting African Americans for court orders, nor is there evidence of a disproportionate effect on other minority populations. Our interviews with key stakeholders across the state corroborate these findings."
A 2010 study on Kendra's Law by Gilbert et al showed that "the odds of arrest for participants currently receiving assisted outpatient treatment (AOT) were nearly 2/3 lower (OR .39, p<.01) than for individuals who had not yet initiated AOT or signed a voluntary service agreement." Another 2010 study from Swartz et al tracked Medicaid claims and state reports for 3,576 AOT consumers from 1999-2007. They found that "the likelihood of psychiatric hospital admission was significantly reduced by ~25% during the initial six-month court order (odds ratio [OR]=.77, 95CI=.72-.82) and by over 1/3 during a subsequent six-month renewal of the order (OR=.59, CI=.54-.65) compared with the period before initiation of the court order. Similar significant reductions in days of hospitalization were evident during initial court orders and subsequent renewals (OR=.80, CI=.78-.82, & OR-.84, CI=.81-.86, respectively)."
Proponent views
California law
California law consists of several levels, including constitutional, statutory, and regulatory law, as well as case law.-Constitutional 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. A complete functional outline of the legal procedures and safeguards within Laura’s Law has been prepared by NAMI San Mateo.
The law was named after Laura Wilcox, a young woman who was killed by a mental patient who had refused treatment. Modeled on Kendra's Law
Kendra's Law
Kendra's Law, effective since November 1999, is a New York State law concerning involuntary outpatient commitment. It grants judges the authority to issue orders that require people who meet certain criteria to regularly undergo psychiatric treatment. Failure to comply could result in commitment...
, a similar statute
Statute
A statute is a formal written enactment of a legislative authority that governs a state, city, or county. Typically, statutes command or prohibit something, or declare policy. The word is often used to distinguish law made by legislative bodies from case law, decided by courts, and regulations...
enacted in New York
New York
New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...
, the bill was introduced as Assembly Bill 1421 by Assemblywoman
California State Assembly
The California State Assembly is the lower house of the California State Legislature. There are 80 members in the Assembly, representing an approximately equal number of constituents, with each district having a population of at least 420,000...
Helen Thomson, a Democrat
Democratic Party (United States)
The Democratic Party is one of two major contemporary political parties in the United States, along with the Republican Party. The party's socially liberal and progressive platform is largely considered center-left in the U.S. political spectrum. The party has the lengthiest record of continuous...
from Davis
Davis, California
Davis is a city in Yolo County, California, United States. It is part of the Sacramento–Arden-Arcade–Roseville Metropolitan Statistical Area...
. The measure passed the California Legislature in 2002 and was signed into law by Governor
Governor of California
The Governor of California is the chief executive of the California state government, whose responsibilities include making annual State of the State addresses to the California State Legislature, submitting the budget, and ensuring that state laws are enforced...
Gray Davis
Gray Davis
Joseph Graham "Gray" Davis, Jr. is an American Democratic politician who served as California's 37th Governor from 1999 until being recalled in 2003...
. The statute can only be utilized in counties that choose to enact outpatient commitment
Outpatient commitment
Outpatient commitment refers to mental health law that allows the compulsory, community-based treatment of individuals with mental illness.In the United States the term "assisted outpatient treatment" or "AOT" is often used and refers to a process whereby a judge orders a qualifying person with...
programs based on the measure. As of 2010, Nevada County has fully implemented the law and Los Angeles County
Los Angeles County, California
Los Angeles County is a county in the U.S. state of California. As of 2010 U.S. Census, the county had a population of 9,818,605, making it the most populous county in the United States. Los Angeles County alone is more populous than 42 individual U.S. states...
has a pilot project. In 2010 the California
State Association of Counties chose Nevada County to receive its Challenge Award for implementing Laura’s Law.Subsequently in 2011, a National Association of Counties Achievement Award in Health was awarded to Nevada County for the Assisted Outpatient Treatment Program.
Background
Laura Wilcox, a 19-year old sophomore from Haverford CollegeHaverford College
Haverford College is a private, coeducational liberal arts college located in Haverford, Pennsylvania, United States, a suburb of Philadelphia...
, was working at Nevada County's
Nevada City, California
-2010:The 2010 United States Census reported that Nevada City had a population of 3,068. The population density was 1,399.7 people per square mile . The racial makeup of Nevada City was 2,837 White, 26 African American, 28 Native American, 46 Asian, 0 Pacific Islander, 40 from other races,...
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 41-year old mental patient who resisted his family's attempt to seek treatment. Thorpe was found incompetent to stand trial
Competency evaluation (law)
In the United States criminal justice system, a competency evaluation is an assessment of the ability of a defendant to understand and rationally participate in a court process....
and was sent to Atascadero State Hospital
Atascadero State Hospital
Atascadero State Hospital is located on the central coast of California, in San Luis Obispo County, half-way between Los Angeles and San Francisco. It is an all-male, maximum-security facility, that has patients from all over the state...
and was later transferred to California's Napa State Hospital. After the incident Laura’s parents chose to advocate for treatment of individuals with 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 2004, Los Angeles County
Los Angeles County, California
Los Angeles County is a county in the U.S. state of California. As of 2010 U.S. Census, the county had a population of 9,818,605, making it the most populous county in the United States. Los Angeles County alone is more populous than 42 individual U.S. states...
implemented Laura's Law on a limited basis. Since the passage of the MHSA [see below Prop. 63] Nevada County fully implemented Laura's Law in May 2008 and several other counties are discussing it, notably San Francisco County, San Mateo County, San Diego County, Marin County and others.
In those counties that adopt outpatient commitment, an AB 1421 program will ensure individuals are provided the services and medical treatment (including medication) that will enable the person to have a good chance to recover. Nevada County Director Michael Heggarty bests describes it as part of the recovery movement.
Proposition 63 impact
In November 2004, California voters passed Proposition 63. When the California Department of Mental Health (DMH) released its draft plan requirements for county mental health administrators on February 15, 2005, they contained a provision that would allow MHSA funds to be used for "involuntary services" if certain criteria were met. Nevada County's Laura's law program and Los Angeles County's AOT pilot project are utilizing MHSA funding for services.Assisted outpatient treatment eligibility criteria
As stated above the 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 is 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 criteria 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.
Supporters
Passage of the bill was supported by organizations such as the California Treatment Advocacy Coalition (an affiliate of the Treatment Advocacy CenterTreatment Advocacy Center
The Treatment Advocacy Center is national U.S. nonprofit organization dedicated to eliminating legal and other barriers to the timely and effective treatment of severe mental illness...
), the California Psychiatric Association, the Police Chiefs Association, and the National Alliance on Mental Illness
National Alliance on Mental Illness
The National Alliance on Mental Illness was founded in 1979 as the National Alliance for the Mentally Ill. NAMI is a nation-wide American advocacy group, representing families and people affected by mental illness as a non-profit grass roots organization and has affiliates in every American state...
(NAMI). In an editorial endorsement of the law, the Los Angeles Times
Los Angeles Times
The Los Angeles Times is a daily newspaper published in Los Angeles, California, since 1881. It was the second-largest metropolitan newspaper in circulation in the United States in 2008 and the fourth most widely distributed newspaper in the country....
touted then-Governor Gray Davis
Gray Davis
Joseph Graham "Gray" Davis, Jr. is an American Democratic politician who served as California's 37th Governor from 1999 until being recalled in 2003...
's support, while limiting its comments on opponents to mentioning that "a subgroup of the Church of Scientology
Church of Scientology
The Church of Scientology is an organization devoted to the practice and the promotion of the Scientology belief system. The Church of Scientology International is the Church of Scientology's parent organization, and is responsible for the overall ecclesiastical management, dissemination and...
, which opposes virtually all psychiatric treatments, sponsored a rally at the Capitol against Laura's law." The San Francisco Chronicle
San Francisco Chronicle
thumb|right|upright|The Chronicle Building following the [[1906 San Francisco earthquake|1906 earthquake]] and fireThe San Francisco Chronicle is a newspaper serving primarily the San Francisco Bay Area of the U.S. state of California, but distributed throughout Northern and Central California,...
and The San Francisco Examiner have published positive articles on the topic. The Los Angeles Times
Los Angeles Times
The Los Angeles Times is a daily newspaper published in Los Angeles, California, since 1881. It was the second-largest metropolitan newspaper in circulation in the United States in 2008 and the fourth most widely distributed newspaper in the country....
won a Pulitzer Prize, in part for its coverage of Laura’s Law.
Opposition
MindFreedom InternationalMindFreedom International
MindFreedom International is an international coalition of over one hundred grassroots groups and thousands of individual members from fourteen nations. It was founded in 1990 to advocate against forced medication, medical restraints, and involuntary electroconvulsive therapy. Its stated mission is...
and the California Network of Mental Health Clients (CNMHC), along with allies in the psychiatric survivors movement
Psychiatric survivors movement
The psychiatric survivors movement is a diverse association of individuals who are either currently clients of mental health services , or who consider themselves survivors of interventions by psychiatry, or who identify themselves as ex-patients of mental health services...
, 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 also gained attention as an opponent of the new law.
Studies on Kendra's Law
Many of the studies on the efficacy of assisted outpatient treatment (AOT) are done on Kendra's LawKendra's Law
Kendra's Law, effective since November 1999, is a New York State law concerning involuntary outpatient commitment. It grants judges the authority to issue orders that require people who meet certain criteria to regularly undergo psychiatric treatment. Failure to comply could result in commitment...
(on which Laura's Law is based). Two notable studies were released in 2005 and in 2009.
A briefing of these and other studies was prepared by The Treatment Advocacy Center.
The 2005 study found:
Specifically, the OMH study found that for those in the AOT program:
- 74 percent fewer experienced homelessness;
- 77 percent fewer experienced psychiatric hospitalization;
- 83 percent fewer experienced arrest; and
- 87 percent fewer experienced incarceration.
Comparing the experience of AOT recipients over the first six months of AOT to the same period immediately prior to AOT, the OMH study found:
- 55 percent fewer recipients engaged in suicide attempts or physical harm to self;
- 49 percent fewer abused alcohol;
- 48 percent fewer abused drugs;
- 47 percent fewer physically harmed others;
- 46 percent fewer damaged or destroyed property; and
- 43 percent fewer threatened physical harm to others.
As a component of the OMH study, researchers with the New York State Psychiatric Institute and Columbia University conducted face-to-face interviews with 76 AOT recipients to assess their opinions about the program and its impact on their quality of life. The interviews showed that after receiving treatment, AOT recipients generally endorsed the program, with 62% reporting that being court-ordered into treatment had been overall a good thing:
- 75 percent reported that AOT helped them gain control over their lives;
- 81 percent said that AOT helped them to get and stay well; and
- 90 percent said AOT made them more likely to keep appointments and take medication.
Additionally, 87 percent said they were confident in their case manager's ability to help them—and 88 percent said that they and their case manager agreed on what is important for them to work on. AOT had a positive effect on the therapeutic alliance.
In 2009, an independent study by Duke University into alleged racism found "no evidence that the AOT Program is disproportionately selecting African Americans for court orders, nor is there evidence of a disproportionate effect on other minority populations. Our interviews with key stakeholders across the state corroborate these findings."
A 2010 study on Kendra's Law by Gilbert et al showed that "the odds of arrest for participants currently receiving assisted outpatient treatment (AOT) were nearly 2/3 lower (OR .39, p<.01) than for individuals who had not yet initiated AOT or signed a voluntary service agreement." Another 2010 study from Swartz et al tracked Medicaid claims and state reports for 3,576 AOT consumers from 1999-2007. They found that "the likelihood of psychiatric hospital admission was significantly reduced by ~25% during the initial six-month court order (odds ratio [OR]=.77, 95CI=.72-.82) and by over 1/3 during a subsequent six-month renewal of the order (OR=.59, CI=.54-.65) compared with the period before initiation of the court order. Similar significant reductions in days of hospitalization were evident during initial court orders and subsequent renewals (OR=.80, CI=.78-.82, & OR-.84, CI=.81-.86, respectively)."
See also
- Kendra's LawKendra's LawKendra's Law, effective since November 1999, is a New York State law concerning involuntary outpatient commitment. It grants judges the authority to issue orders that require people who meet certain criteria to regularly undergo psychiatric treatment. Failure to comply could result in commitment...
, assisted outpatient treatment law in NY on which Laura's law is based - 5150 (Involuntary psychiatric hold)5150 (Involuntary psychiatric hold)Section 5150 is a section of the California Welfare and Institutions Code which allows a qualified officer or clinician to involuntarily confine a person deemed to have a mental disorder that makes them a danger to him or her self, and/or others and/or gravely disabled...
, California's law for psychiatric emergencies - involuntary commitmentInvoluntary commitmentInvoluntary commitment or civil commitment is a legal process through which an individual with symptoms of severe mental illness is court-ordered into treatment in a hospital or in the community ....
, which is hospital-based - Involuntary treatmentInvoluntary treatmentInvoluntary treatment refers to medical treatment undertaken without a person's consent. In almost all circumstances, involuntary treatment refers to psychiatric treatment administered despite an individual's objections...
, which is independent of setting - anti-psychiatryAnti-psychiatryAnti-psychiatry is a configuration of groups and theoretical constructs that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing,...
, a movement that opposes any form of involuntary psychiatric treatment
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)
Proponent views
- Psychlaws.org - 'A Guide to Laura’s Law: California's New Law for Assisted Outpatient Treatment', The California Treatment Advocacy Coalition and the Treatment Advocacy CenterTreatment Advocacy CenterThe Treatment Advocacy Center is national U.S. nonprofit organization dedicated to eliminating legal and other barriers to the timely and effective treatment of severe mental illness...
(January, 2003) - PsychLaws.org - 'Landmark Legislation, Laura's Law, Brings Much-Needed Reform to California: AB 1421 will help those with severe mental illnesses who are too sick to help themselves' (opinion), Mary T. Zdanowicz, Treatment Advocacy Center (September 30, 2002)
- PsychLaws.org - 'Gov. Davis Signs Laura's Law: AB 1421 will help those with severe mental illnesses who are too sick to help themselves' (November 22, 2002)
- The Treatment Advocacy Center - 'Laura's Law'