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Ideas like AB1421 (or Laura’s Law as it’s come to be known) always make me wish that I could just have a black or white response to something once in a while, but instead this concept leaves me in a quandary. The concept of a form of enforced treatment, repugnant as that feels to me, is not entirely beyond the pale in my opinion, but that it were so simple. The reason I am going to oppose this law at this time is described below, but first let me suggest an idea about how I could support such a law. Sometimes, even with the most compassionate and comprehensive care easily available, a person that has significant difficulty protecting and taking care of him (or her)self might benefit from some form of external enforcement of stability.
For myself, the parallel is from an experience I had at a very early stage in my social work career, working in a locked psychiatric unit for teenagers in Seattle. This facility had both a seclusion room and a “hands-on” policy, in that staff like myself would at times be called upon to conduct physical restraints and holds. This was a staff of passionate, serious and dedicated people who were, even under the most hair-raising situations, respectful and kind along with their firmness in setting limits and keeping kids safe. Every crisis response in which I was involved would contain steady, transparent statements to our client, such as, “We are controlling your body only until you can take control of it yourself and keep yourself and others safe.” I saw kids take back control over their weeks and months on the ward, choosing their behaviors instead of reacting to their impulses.
Sadly, this was a pretty isolated experience for me. In my 17 years in the mental health field, I have worked at only two agencies that, across the board, staffed only people that were “in it for the right reasons.” The other dozen jobs I have had in the field were staffed with some shining stars of ethics and intention, some decent if less involved workers, and some people I considered toxic to the environment and clients. On a macro scale, I know that implementing a law like Laura’s is entirely dependent on “the pointy end of the spear,” as they say. The one or two people who are actually enacting their interpretation of the law upon a single person with mental illness in our society. This alone makes me very nervous about a law like this. When done well, awesome, but enforced treatment is so ripe for abuse, toxicity, impatience, and intimidation, it makes me very worried indeed.
I have a second problem with the law as well. We have made strides to at least offer the semblance of systemic recognition for the rights and dignity of people living in our society with mental illness. This is most recently evidenced by the widespread adoption of terms such as “mental health consumer” to signify choice, autonomy and self-determination. Laura’s Law and similar policy are saying, in effect, “You don’t like what we’re selling? Well, we’re going to force you to buy it anyway.” Nobody seems to doubt that the mental health system could do a better job of engaging people in mental health treatment. According to LA County’s own statistics, only about 1/3 of adults living in LA with a severe and persistent mental illness are receiving any level of regular mental health care. It’s not a radical idea to suggest that mental health care is a pretty hard sell for most people, even in the best of situations. The public system ideally would find ways to make itself so available and enticing that people would be knocking down doors trying to get the help and support on offer. Instead there are gaps in the system everywhere, it takes work to get to and stay engaged in treatment, and many services that are available are simply not focused on customer satisfaction as a primary goal, and this is stating it mildly.
To me, policies like Laura’s Law seem like a cheat, an easy way out of focusing on the real needs of the mental health system. In America, we have the money (it really is there, just not as a priority) and knowledge to provide excellent public mental health care from cradle to grave for our own people, but we simply don’t do it. Mental health services are never a budgetary priority and we pay the price by incarcerating vast numbers of people who could be better engaged by an inviting, flexible, available voluntary system. While some of those who truly remain on the margins might ultimately benefit from a Laura’s Law-type of intervention, our mental health system remains deeply flawed. We should focus on overhauling it, rather than circumventing the problem by requiring participation in the broken system we already have.
Dave Leon is the Director of The Painted Brain.