After years of debate over how to deal with the city’s large population of severely mentally ill people who refuse treatment, San Francisco officials have quietly implemented a version of the controversial Laura’s Law.
The Department of Public Health treats 23,000 mental health patients each year. Reaching a few dozen of the worst cases could help reduce the cost for care and emergency services and improve the quality of life on the streets where residents and tourists alike often complain about mentally ill homeless people creating havoc, city leaders said.
City leaders have never adopted Laura’s Law, but the Department of Public Health initiated a voluntary version of the law last year to treat a handful of people who were patients in the psychiatric ward of San Francisco General Hospital. The first set of results being evaluated now show promise, city officials said.
Laura’s Law allows counties to compel outpatient treatment in extreme cases, but it does not require patients to take medication.
Under San Francisco’s Community Independence Pilot Project, patients must voluntarily agree to participate once they’re already hospitalized. If they do, they’re assigned a public conservator who makes treatment decisions, including administering medication for the patient.
Edwin Batongbacal, director of the health department’s Adult Behavioral Health Services division, said San Francisco’s version is cheaper and less bureaucratic, raises fewer legal questions, and could be just as successful as Laura’s Law.
Streamlined version
“It’s more streamlined and more friendly to the clients,” he said. “It’s really about our ability to engage positively with clients rather than negatively through a court process where their rights are taken away.”
Under Laura’s Law, a concerned citizen like a family member or neighbor reports a mentally ill person to the county in hopes of compelling treatment. The mental health department then conducts an investigation, and patients qualify if they’re severely mentally ill and have been repeatedly arrested or hospitalized because they refuse treatment.
A judge ultimately decides whether the people qualify, and the patients can argue against the decision in court. If the patients qualify, law enforcement officers have the authority to pick up the participants for hospitalization.
“There was concern that people with mental illness get help before anything bad happens, but there are a lot of complications with Laura’s Law,” Batongbacal said of San Francisco’s decision to try an alternative approach.
So far, he said, doctors at S.F. General have referred eight patients to the program, but he had statistics only for the first six. Of those, one referral was withdrawn, one patient refused treatment, and four were admitted.
Those four were found to have a serious mental disorder, multiple hospitalizations and a failure to comply with treatment. While in the program – which hooks them up with a host of social services that already exist in city government – there were no more hospitalizations. One person was incarcerated, but wants to participate when released. None is homeless; it’s unclear whether they were homeless when they entered the program.
No further details about the patients were provided.
Asked how severely mentally ill patients can make informed decisions about participating in the program, Batongbacal said, “We make sure they know what they’re participating in. They’re free to decide other things later down the road.”
A little-used law
Laura’s Law was enacted in California in 2002 and named for Laura Wilcox, a 19-year-old college student in Grass Valley who had been shot and killed by a man with untreated schizophrenia the year before. His family had known of his violent tendencies and tried to get him into treatment, but he had refused.
Under the law, each county’s Board of Supervisors must pass a resolution authorizing participation.
So far, only Nevada County, the site of Wilcox’s killing, has fully opted in – doing so in 2008. The county has reported hospital days were reduced 61 percent among Laura’s Law patients, and jail days were reduced 97 percent. The county estimates it has saved $1.81 for every $1 it has spent on the program.
Whether to authorize the use of Laura’s Law in San Francisco has long been a point of contention among city officials. Former Mayor Gavin Newsom supported adopting Laura’s Law but wasn’t able to get it by the Board of Supervisors.
In 2010, then-Supervisor Michela Alioto-Pier wrote legislation to authorize Laura’s Law, but didn’t put it up for a vote after then-Public Health Chief Mitch Katz voiced his objections.
He argued that the law was not very effective because it doesn’t allow the county to compel medication. Proponents of the law say patients usually agree to prescribed medication once they’re in the program.
Overseen by a judge
San Francisco’s voluntary pilot program doesn’t need any particular authorization from the Board of Supervisors, and few City Hall insiders even know the program has been started. Barbara Garcia, the current public health chief, is supportive of the program.
The program does have participation from several social service and criminal justice agencies within the city and is being overseen by San Francisco Superior Court Judge Mary Wiss.
Mayor Ed Lee said it’s important for the city to give “sustained attention” to those individuals who are causing the most harm to themselves and others because of their mental illness. He said he wants to see the outcomes of the experiment before deciding whether to support the full-fledged adoption of Laura’s Law.
“It could be we don’t adopt the whole thing,” he said. “We just have to take a look at what’s working.”
