Marin mulls mandated remedy for mental illness

09/10/2015

Marin may soon join a small but growing number of counties to adopt a state law allowing courts to order some who suffer from mental illness into outpatient treatment. 

Currently treatment for mental illness can only be mandated for individuals found to be an immediate danger to themselves or others. However, an opt-in law passed in 2002, known as Laura’s Law, permits courts to order outpatient treatment for adults who meet other criteria—including being hospitalized twice in the past three years or committing a significant act of violence. It cannot require medications. 

To date, only three counties have implemented the law. Nine others—including San Francisco and Los Angeles Counties—are in the process of opting in. 

Marin supervisors are planning to consider the measure this fall. The county held a community meeting in San Rafael on Tuesday to solicit input.

Many with mental illness don’t seek help, said Roberta Chambers, a trained psychologist who is working as a consultant with the county as they consider adopting the law. Some people don’t recognize their own illness, some had traumatic experiences with past treatment and others cannot figure out how to access services, she said.

One primary goal of permitting court-ordered outpatient treatment is to encourage people to pursue voluntary treatment instead.

Under Laura’s Law, a parent, spouse, sibling, adult child or housemate can request court-ordered treatment. A county investigation determines eligibility; if the person qualifies, a petition is filed in civil court and a hearing is scheduled. But if the person accepts voluntarily treatment at any point, the court process stops. 

The pressure of a looming court order to compel voluntary compliance—sometimes known as the “black robe effect”—is key, because the law has no real enforcement mechanism. If a person disobeys the order, a health care provider can request a 72-hour hold. But the person must meet the stringent requirement of immediate danger to qualify. 

Still, many people whose family members had a mental illness spoke in favor of the law, saying that often their relatives do not know they need help or just miss the current threshold for mandated services. Sometimes caregivers are unclear about what services are available.

“Assisted outpatient treatment is so much more humane,” said one woman. Her son is now taking medication for his illness after treatment, but the “trauma” of involving law enforcement could have been avoided with Laura’s Law, she said. 

Yet a few people who had themselves been in treatment opposed the idea of court orders, arguing that the mentally ill have the right to make their own choice. “What about what your child wants for him or herself?” one man said.

Peer-reviewed data on the effectiveness of mandatory outpatient treatment, known as “assisted outpatient treatment,” is hard to come by. Many other states have programs, but they are difficult to compare since the details of the laws vary. Even research within states is inconclusive, Ms. Chambers said.

Yet officials in Nevada County, which was the first to opt in to Laura’s Law, find it useful and believe it saves money, Ms. Chambers said. That county, of roughly 100,000, has about five people under a court order at a time.