In California, many want to apply little-used state law to compel mentally ill people to take medications

From the San Francisco Chronicle:

From San Francisco to Los Angeles, groups of doctors, patients and police officers have been forming for the past year with one goal: Persuading every county in the state to take advantage of a little-used law to compel the mentally ill to take medications.

There are few hotter buttons in the field of mental health. But these groups say that with cuts looming in mental health funding and homelessness rising, it is time to reform the system.

"What we've got isn't working, and we want it fixed," said Carla Jacobs of Los Angeles, a mental health advocate who is helping lead the Lanterman-Petris-Short Act Reform Roundtable in its efforts to tighten California's defining mental health law.

"There is never enough money to do everything we want to do in this field, but there is also never enough money to waste money by not doing the right thing," Jacobs said.

The Lanterman-Petris-Short Act, passed in 1967, cut back drastically on institutionalization of the mentally ill in favor of letting them care for themselves at home or in housing with access to counselors. Medications had recently been developed that enabled the mentally ill to function without plunging them into a stupor, and the law gave patients the right to use or refuse them as they saw fit.

The trouble was that as many mental hospitals closed, funding for community psychiatric services intended to replace them was sharply curtailed. Many patients ended up on the street.

More than one-third of homeless people in California today are believed to be mentally ill, which means there are 50,000 people wandering the alleys in need of psychiatric help, according to the National Alliance to End Homelessness.

That number is bound to grow. The National Law Center on Homelessness and Poverty said last month that the U.S. homeless population has gone from 3 million before the recession to nearly 5 million today.

Jacobs' group, which has more than 50 mental health advocates and clients, judges, doctors and law-enforcement officials as members, is trying to craft legal refinements, including some to make it easier to get the mentally ill into programs. A major goal is pushing for statewide implementation of Laura's Law, enacted in 2003 to make it easier for authorities to force patients to take medications quickly.

Under Lanterman-Petris-Short rules, a patient must be determined by a judge to be a danger to himself or others before being ordered to undergo involuntary psychiatric treatment. Most stays, however, are only 72 hours, and it can take two years of legal maneuvering before a longer stay is ordered.

Laura's Law allows a judge to order a patient to take medication under supervised treatment much faster.

The trouble with Laura's Law, said Jacobs, is that it allows each of California's 58 counties to decide if it wants to use it. Only two are using it: Nevada County - where a demented man shot college student Laura Wilcox to death in 2001, inspiring the law - and Los Angeles.

Resistance to Laura's Law elsewhere comes from patients and community agency workers who say it would violate the civil rights of the mentally ill and be too expensive. The existing system works fine at its best, and the solution is to create more services, they say.

Roundtable members counter by pointing to examples such as the nonfatal stabbing last month of a man in the Tenderloin. Police say the suspect, Robert Lee Turner, had spent nearly a decade in state mental hospitals after killing a woman in San Francisco and had stopped taking his medication.

They say Laura's Law affects only a handful of mentally ill people - the 5 percent or fewer who are so troubled they don't know they need medication.

Ad hoc groups pushing for Laura's Law - with medical and law enforcement memberships similar to the roundtable's - have also formed in nearly a dozen counties including San Francisco, Contra Costa and Marin.

"Sometimes a patient just doesn't know he or she needs meds," said Dr. Cameron Quanbeck, a forensic psychiatrist in San Francisco and Oakland who is helping lead the Bay Area efforts. "And if you stabilize them, they aren't using emergency services, aren't abusing drugs, aren't doing any of a number of things that cost us all a lot of funding and heartache."

The effectiveness of giving mentally ill people a stable home and medication isn't hard to prove. A New York statute similar to Laura's Law has resulted in a 77 percent drop in hospitalizations since 1999 for those receiving court-ordered medication.

But opponents of forced medication point to successful models of voluntary treatment in San Francisco.

At 61, Paul Kerins has left homelessness behind and lived for four years at the Lyric Hotel run by Conard House, a supportive housing program for people with serious mental difficulties. He is studying at San Francisco City College to be a counselor and manages his own treatment.

"I don't recognize myself when I look back on my life before I came here," Kerins said. "Aristotle said, 'Love well, be loved and do something of value,' and that's what I am able to do now."

Conard House Executive Director Richard Heasley said programs like his - which has a 90 percent stabilization rate for residents - are the way to go, not coerced medication, because they are more compassionate.

"We're not against treatment," he said, "but making it mandatory as a matter of law creates the situation that existed many years ago with people warehoused in institutions. There are already laws that exist to mandate treatment. To redraw them opens a Pandora's box."

The trends of how California addresses mental illness, however, are sobering.

The state's prison population has increased more than 70 percent since 1990 to nearly 170,000, and the state Research Bureau estimates 15 percent of those inmates are mentally ill.

In the same period, the number of acute psychiatric care hospital beds declined by 30 percent to 6,500, the California Hospital Association says.

Community mental health funding in California shrank from $4.7 billion last year to $4.6 billion this year, and under cuts contemplated by the Legislature and governor, that may drop to $4.4 billion next year, says the California Psychiatric Association.

Given resistance from among San Francisco's galaxy of community services and patients-rights advocates, city leaders have been unable to implement Laura's Law - but Supervisor Michela Alioto-Pier is about to take another cut at it. She asked for and received a May 24 hearing before the supervisors' Operations Committee.

"This is my priority now," Alioto said. "Laura's Law is compassionate. It helps stabilize people when they need it most."