Thursday, March 14, 2013

Improving Mental Health Access for the Desperate with Laura's Law


Laura’s Law – Time to
Bring it to Your County?
 
By Adam Dougherty, MPH, MS III

MENTAL ILLNESS HAS TOUCHED most of us
in some way − be it a personal struggle, a loved
one’s troubles, a news story of mass murder, or
simply witnessing a disturbed soul on the street
corner. Fortunately, there is growing recognition
of the importance of mental health services as a
mainstay of comprehensive medical care.

But what if an individual is too ill and
disorganized to even seek out care? Tragically,
people with the greatest need are the same ones
with the most trouble navigating the system.
If these people are lucky enough to find some
mental health services, it is usually limited to
acute short-term hospitalization or care within
the criminal justice system after a crime has
been committed.

Our patients with mental illness are forever
in a revolving door between the emergency
department, county mental health clinics,
and jail psychiatric services. With no ability to
provide sufficient follow up, doctors are forced
to discharge these patients back to the streets
until they fall into the cycle again.

This was the case in 2001 when Scott Thorpe,
an untreated schizophrenic, made headlines for
gunning down 19-year-old Laura Wilcox and
two other employees in a Nevada City clinic.
Following the tragedy, the California Legislature
passed Laura’s Law. It expands services to
severely ill, often-untreated individuals. The law
allows counties to require Assisted Outpatient
Treatment (AOT) for needy people who have a
history of violence and repeated hospitalization
and have failed voluntary treatment.

More specifically, AOT is court-ordered
therapy that is designed to intervene before an
individual further deteriorates into the vicious
cycle. Unlike high-cost acute hospitalization,
AOT includes a menu of options tailored to an
individual’s unique needs and circumstances.
It focuses on outpatient services such as
psychotherapy, medication management, crisis
intervention, in-home nursing and social
services.

Counties have the prerogative to decide
whether to implement the law or not; and
unfortunately for most of California’s severely
mentally ill, only one county − Nevada County
− has done so. Local government has been
hesitant to implement the law, given a sense that
it limits people’s autonomy. However, many of
us would argue for a greater good to promote
public safety and a moral responsibility to help
those who truly can’t help themselves.

AOT shouldn’t be construed as “forced
treatment,” but rather it is an opportunity to
bring relief to a vulnerable, high-risk and costly
group, providing services to those who have
been unable to benefit from the medical system
other than re-hospitalization or incarceration.
For every Scott Thorpe, there are hundreds more
who don’t make headlines, but continue to suffer
in the community − many with malnutrition,
medical illness and treatable mental health
conditions that severely limit their ability to
become a functioning member of society.

Governor Jerry Brown recently signed
legislation extending Laura’s Law to 2017, and
it is time for Sacramento and surrounding
counties to take a closer look at the benefits of
implementation. Not only would it save lives,
but AOT also makes fiscal sense. In a recent
study of the law’s implementation, the Nevada
County Behavioral Health Department found 
that AOT significantly reduced hospitalization
and incarcerations rates, resulting in savings of
$1.81 for every $1.00 invested in the program.
For these efforts, Nevada County was bestowed
the 2011 National Association of Counties
Achievement Award.

Laura’s Law would be a promising patch to
help mend our fragmented local mental health
system, reduce disparities for the neediest among
us, provide rehabilitation and prevent tragedy.
Sacramento and its neighboring counties could
lead the way by enabling funding streams
available through the Medi-Cal program, the
Prop. 63 Mental Health Services Act, and the
recently unveiled bipartisan federal legislation,
The Excellence in Mental Health Act, introduced
by our very own Congresswoman Doris Matsui.

Local law enforcement, county health
services and their affiliates, and patient
advocates also all have a part to play in making
this program a reality. 

Adam Dougherty is a third year medical student
at the UC Davis School of Medicine and sits on the
Sacramento County Public Health Advisory Board
(PHAB).

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