Three of five county supervisors have indicated their support for implementing a pilot program of a state bill commonly known as Laura’s Law, which governs mandatory outpatient treatment for the mentally ill. Under Assembly Bill 1421, which gives counties the discretion to adopt the provision, a judge can order a person with severe and untreated mental illness to adhere to a mental health treatment plan. The law cannot mandate the use of medication. 

Laura’s Law is named after teenager Laura Wilcox who was murdered by a man with untreated severe mental illness in 2001. The following year, then-governor Gray Davis signed the bill into law. So far 11 counties have adopted the provision, including San Francisco, Contra Costa, Mendocino, Los Angeles and Nevada Counties. 

Last February, Marin supervisors decided against adopting A.B. 1421 following a recommendation from Health and Human Services. At the time, Dr. Grant Colfax, the department’s director, and Dr. Suzanne Tavano, director of Mental Health and Substance Use Services, told supervisors there was insufficient evidence of any benefit, and noted that only a few Marin residents would be eligible. 

In lieu of a pilot program, the board approved an expansion of Health and Human Services through an approach called the Crisis Services Continuum. This includes three community response teams—an outreach and engagement team, a transitions team and a mobile crisis response team–that coordinate with a crisis stabilization unit. 

People either voluntarily come to the stabilization unit or are brought there on a psychiatric hold.

In February, Supervisor Damon Connolly was the sole supervisor in favor of adopting Laura’s Law. Earlier this month, in remarks at the first board meeting of the year—a time when supervisors outline their goals and visions for the upcoming year—he echoed that support. 

“We do know that Laura’s Law is not a panacea on its own, but I will continue to push for implementation in 2017 as another tool at our disposal when it comes to addressing serious mental illness in our community,” he said.

But his opinion is no longer a minority one on the board. During her remarks, Supervisor Judy Arnold also spoke in favor of supporting A.B. 1421. She told the Light that she changed her position following conversations she had with constituents during her open office hours, and said she would direct staff to draft a recommendation to pilot A.B. 1421 for one year. That recommendation could be presented during the next update on expanded mental health services later this year.

Supervisor Dennis Rodoni was an outspoken supporter of A.B. 1421 during his campaign for supervisor last year. He told the Light in March that he had “a hard time thinking we are one of the wealthiest counties in the country and we can’t spend some money just to help one
person.”

Speaking to the Light this month, he said, “It’s important to me to provide services to stop that one person. I don’t know how you put a value on a life. If you look at Laura’s Law, it makes sense. For the most part, where [the law] has been implemented, there isn’t a huge cost and it keeps people out of hospitals and jails. The success from other counties has been impressive and that’s what caught my eye.”

Barbara Alexander, a former president of the Marin chapter of the National Alliance on Mental Illness, has been advocating for the implementation of Laura’s Law for years. She met the new majority support with unexpected glee. 

“Everything had fallen on deaf ears until Damon Connolly [joined the board],” she told the Light this month. “He said he saw signs of increased homelessness and mental illnesses every day in San Rafael.” She added, “It was very much of a surprise to hear that Judy Arnold [changed her position],” she said. “We had no idea.” 

Ms. Alexander said A.B. 1421 would help people who aren’t even aware they’re in need of assistance. “Some people don’t understand a person with mental illness can’t make informed consent,” she said.

As it stands now, treatment for the mentally ill can be mandated only when an individual is found to be an immediate danger to themselves or others. A.B. 1421 permits courts to order outpatient treatment for adults who meet looser criteria, such as being hospitalized twice in the past three years or committing a significant act of violence. 

Under the law, a parent, spouse, sibling, adult child or housemate can request court-ordered treatment. If a county investigation determines eligibility, a petition is filed in civil court and a hearing is scheduled. But if the person accepts voluntary treatment at any point, the court process stops. 

Ms. Alexander spoke about the various methods in which A.B. 1421 works efficiently. She mentioned what is often referred to as the “black robe effect,” in which the fear of having to stand before a judge helps to persuade a person to seek assistance, and highlighted the law’s focus on early intervention. “When you see someone clearly deteriorating, a referral [by a parent or guardian] leads to an assessment,” she said.

But critics say A.B. 1421 can be a threat to civil rights. And for Maya Gladstern, a Woodacre resident and a member of the Marin Advocates for Mental Health, the law presents other problems, too.

“The government has to bend over backwards to ensure due process. It also stigmatizes mental illness even more. It puts vulnerable individuals through a very difficult process,” she told the Light last week.

Ms. Gladstern explained that when she was 18 years old, she had a “psychotic break and was put in a locked mental facility for six months.” Following her release, she relocated to Marin, where she joined the county mental health board in 1976. She believes Laura’s Law would be relatively ineffective. 

“There’s nothing to stop the [health care] consumer from saying they don’t want to do it,” she said. “They can just walk away.”

Dr. Tavano said her department is compiling information and data for a report she expects to present to supervisors in either late February or March.