TOPICS > Health

California Law That Aspires to Improve Mental Health Raises Coercion Concerns

December 26, 2012 at 12:00 AM EDT
In the wake of several recent shootings, politicians and commentators have called for improved mental health screening and treatment. Spencer Michels reports on a program in California called "Laura's Law," an unfunded mandate that has proven difficult to implement and has drawn concern about involuntary treatment for patients.
LISTEN SEE PODCASTS

TRANSCRIPT

MARGARET WARNER: We turn to the difficulties of getting mental health care to those who need it. It’s a subject getting more attention in the wake of the several recent shootings.

It’s not known if the gunman in Newtown, Conn., suffered from mental illness. But the man who shot four firefighters in Webster, New York, this week, killing two of them, who were remembered at a procession yesterday, left a disturbing note in which he pledged to burn down the neighborhood and — quote — “do what I like doing best, killing people.”

Politicians and commentators have used these and prior attacks to call for improved mental health screening and treatment.

But one such program in California has proven hard to implement, as NewsHour correspondent Spencer Michels reports.

AMANDA WILCOX, Mother of murder victim: I wanted the world to know what a wonderful, incredible person she was.

SPENCER MICHELS: For more than a decade, Nick and Amanda Wilcox have been advocating timely treatment and early intervention for the severely mentally ill, in the hopes they won’t become violent. Twelve years ago, their 19-year old-daughter, Laura Wilcox, a college sophomore, was murdered while she was working over Christmas break at a mental health clinic in Nevada County, Calif.

AMANDA WILCOX: At about 11:30, a client at the clinic came in and shot Laura four times at point-black range through the glass.

NICK WILCOX, father of murder victim: What we know now after the fact is he had late-onset paranoid schizophrenia.

SPENCER MICHELS: Laura’s murderer, Scott Thorpe, killed two others, and then went home and took a nap. He was eventually sentenced to a locked mental hospital for life.

NICK WILCOX: We felt that Laura’s death was a result of a failed mental health system.

AMANDA WILCOX: We wanted to help prevent people from being so mentally ill that they would commit a violent act.

SPENCER MICHELS: Helen Thomson, a former psychiatric nurse, was a California legislator at the time working on a new law to get treatment and social services like housing for reluctant and sometimes dangerous mentally ill individuals, people who were not covered by existing laws.

HELEN THOMSON, former California legislator: They were resistant. They didn’t want to go to the clinic, or they didn’t want to take their medicine or they just simply weren’t willing to participate.

We were answering the frustrations of families who were told they didn’t need help. They would call the police. The police would take them to the hospital or the jail. They’d be released and back on the street, and it became a rotating, circular activity.

SPENCER MICHELS: Thomson named her law for Laura Wilcox. After much contentious debate, it passed in 2002. A major aim is to provide aggressive treatment for those existing laws miss, people who may not have committed a crime, yet have a history of prior hospitalization and appear to be on a downward spiral.

Laura’s Law provides court-ordered outpatient treatment for the seriously mentally ill for up to six months. The court must find the patient is likely to become dangerous to himself or others. The patient must have a history of not complying with treatment. The process can be requested by parents, roommates, siblings, a spouse, as well as mental health workers and the police.

HELEN THOMSON: I think this is a perfectly good way to go. It beats doing nothing.

SPENCER MICHELS: For patients who don’t comply, the court has the power to send them to the hospital for an assessment, which is a threat designed to convince them to comply. Legislators never funded the law.

They said that supervisors in each of California’s 58 counties had to implement and pay for it. Only one county, Nevada County, where Laura lived, has opted in. It sits in the foothills of the Sierra Nevada Mountains and has fewer than 100,000 residents.

Nationwide, 43 states other than California have laws permitting some form of involuntary outpatient commitment. Though no one knows the diagnosis of the perpetrator of the shootings in Newtown, the killings have raised once again the issue of forcing the mentally ill into treatment.

It was raised when Laura’s Law was passed and remains a point of contention.

EDUARDO VEGA, Mental Health Association of San Francisco: Coercive programs, fears of things like involuntary treatment, fears of having your dignity and your rights taken away, drive a lot of people away from things that would help.

SPENCER MICHELS: Eduardo Vega suffered from mental illness when in his 20s. He is the executive director of San Francisco’s Mental Health Association and took part in a news conference with legislators to boost support for mental health programs in California and across the country following the Newtown shootings.

But Vega is opposed to the involuntary treatment programs in Laura’s Law.

EDUARDO VEGA: I have had some bad experiences in mental health services. There’s so many people who, precisely because they’re afraid of things like coercion, things like being locked up, being labeled, they don’t receive any services, they don’t talk to anybody. They become more isolated.

SPENCER MICHELS: Vega says that, in the wake of a tragedy, politicians often rush to pass unhelpful legislation.

EDUARDO VEGA: The Laura’s Law project was driven by this example of a tragedy and spoke to people’s need to want to try to do something different. And in this case, it wasn’t the right thing. But, yes, it can be that we rush to create a solution before really thinking about what the implications are of it.

SPENCER MICHELS: The debate over involuntary treatment is familiar ground at the nonprofit Turning Point community programs in Nevada City, which provides services for the county’s mentally ill, including those who fall under Laura’s Law and many who don’t.

Some of the patients, like 36- year-old Jonathan Maurer, here for a long-acting injection for his paranoid schizophrenia, and to meet with a psychiatrist, resent being ordered to receive treatment. Today, Maurer accepts voluntary treatment for his paranoia, though he claims to have been mistreated previously.

JONATHAN MAURER, patient: They gave me a catheter and strapped me down naked to the hospital bed and then sedated me. They strip you of all your rights. I just don’t see how they expect to logically assume that treating people with violence is going to cure violence.

 

SPENCER MICHELS: But Debra Simmons, mother of a very disturbed son who gets treatment here, praises Laura’s Law and involuntary treatment for essentially saving his life. She didn’t want his name used.

DEBRA SIMMONS, mother of patient: He gets angry and agitated, doesn’t sleep, doesn’t eat, just goes through a whole cycle of events that just kind of spiral downward, until he’s become a concern to the society if he’s out in public.

We had to call the police, and he struck my husband physically. We have had to lock ourselves in our room. He’s torn our house apart.

SPENCER MICHELS: Her son, she says, refused treatment until he was ordered under Laura’s Law.

DEBRA SIMMONS: He doesn’t think he’s ill. He doesn’t recognize — even when he’s at his worst, he doesn’t recognize that he has an illness and that he’s missed — he thinks everyone else in the room or in the community has a problem, not him.

SPENCER MICHELS: For Simmons, Laura’s law has been a game-changer.

DEBRA SIMMONS: Without that, I believe he would have either been — have injured someone else or himself, and I don’t believe we would have him today.

SPENCER MICHELS: Still, many in the mental health community, like Rusty Selix, say the law builds up false expectations. Selix, executive director of the Mental Health Association of California, says it applies to very few people.

RUSTY SELIX, executive director, Mental Health Association of California: The belief that every single person out there who has a mental illness and doesn’t, you know, seek treatment for it is going to be helped by Laura’s Law is just nonsense. They’re not a danger to anybody.

The irony, of course, is it wouldn’t have applied to any of these mass shooters. None of them were in that situation, or if they were, they were very good at hiding it from everyone around them.

SPENCER MICHELS: Selix says Nevada County, where the law is in effect but has been used in just 54 cases, is too small to be a model for big cities with vast mental health populations. Besides, he argues, much of what it does is covered by other laws; it’s the funding that’s missing.

RUSTY SELIX: It’s a very expensive and cumbersome process. Maybe in a small rural county like Nevada, it’s not that expensive and cumbersome, but in all the larger counties, to go through this enormous court process to get people into an outpatient program that we already have, and that we have hundreds of people on the street that are desiring of it, and we don’t need a court order to get, what do we get out of it? And the feeling is that it doesn’t really add that much.

SPENCER MICHELS: But at the Nevada County Courthouse, presiding Judge Thomas Anderson says the law has been very effective in two-thirds of the cases, avoiding time-consuming court hearings.

JUDGE THOMAS ANDERSON, Nevada County Superior Court: It’s saving tons of time, getting people into treatment when they need it, and the results have been very, very good. In the first couple of years, we saved a half-a-million dollars in our small county, which is a huge factor. This is a tool that’s been missing forever from our mental health-providing statutes.

SPENCER MICHELS: Anderson says the law tries to prevent psychotic patients from acting out and getting worse.

JUDGE THOMAS ANDERSON: The purpose of Laura’s Law and the goal here is to catch them before that happens, engage them in treatment, hopefully voluntary, and allow them to get some stability and then build on that stability to get back into a more normal lifestyle.

SPENCER MICHELS: The California legislature recently extended Laura’s Law, but still hasn’t funded it. Outside Nevada County, Los Angeles has started a very small pilot program to implement Laura’s Law, and several other counties have debated it. But with budgets tight, implementation by cash-strapped counties appears problematic.