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On January 10, 2001, Scott Thorpe went on a shooting rampage in Nevada City, California, starting with the Nevada County Behavioral Health Department, where Laura Wilcox, age 19, was a volunteer. After being refused to see his psychiatrist, Thorpe shot and killed Wilcox and two other individuals. Thorpe, who had been diagnosed with schizophrenia, had resisted his family’s earlier attempts to convince him to seek psychiatric treatment.
The outpouring of pathos following Wilcox’s murder galvanized state legislators and then-Governor Gray Davis to pass “Laura’s Law,” less than a year later. Modeled after New York’s “Kendra’s Law,” Laura’s Law allows a family member, roommate, mental health provider, police or probation officer to petition the courts to compel a mentally ill individual into outpatient treatment, but does not allow for mandatory medication. In order to qualify for treatment under Laura’s Law, a person must have been hospitalized or jailed due to mental health reasons twice in the past three years and have attempted some form of self-harm within the past four years.
As an additional caveat, California permitted its counties to enact the law at their own discretion. In other words, the law was rendered virtually meaningless unless a county decided to enforce it by a majority vote from its board of supervisors or by ballot initiative. As of today, only three counties out of California’s 58 have gone ahead and implemented Laura’s Law. Strangely enough, Nevada County, where Wilcox was killed, delayed authorizing the law until eight years after Wilcox was murdered, although it was the first county to do so. The hesitancy on behalf of voters and county officials to enforce Laura’s Law reflects the civil liberty and public safety conundrum at the center of the mandate: if, and when, society is morally obligated to force psychiatric treatment on individuals who may pose a risk to themselves or others.
The answer may come in a matter of days. On July 8, San Francisco’s County Board of Supervisors will vote on whether to implement Laura’s Law. If four supervisors approve the measure it will be placed on the November ballot for voters to decide on. If six supervisors approve the measure it will automatically become law. At the moment the latter scenario is allbut assured, and come 2015 it will now be possible for San Francisco to force outpatient treatment on individuals with mental illness. In support of the measure are San Francisco May Ed Lee and the City Attorney; the District Attorney; the Public Health Department Chief; and local police and firefighter unions. In addition, Laura’s Law has earned the approbation of several national groups, including the Treatment Advocacy Center, the American Psychiatric Association, and the Mental Illness Policy Organization.
Advocates maintain that Laura’s Law could help stymie the revolving door that so many individuals with mental illness continually pass through on their way from either the hospital to the streets, or from the streets to jail and back again, as the existing healthcare system neglects those who cannot care for themselves and does little to encourage long-term, sustainable treatment. Laura’s Law, they argue, is fiscally prudent and will help stem the costs associated with mass incarceration and repeated hospitalizations while still allowing individuals a great degree of independence over their daily lives. In short, the law keeps individuals in the community and out of institutions, thus allowing them to lead productive, mostly autonomous lives that are mostly free of stigma. “We’re protecting civil liberties at the expense of health and safety,” said Doris A. Fuller, the executive director of the Treatment Advocacy Center, in 2012.
In contrast, critics deplore the irony of a state that is both lauded and scorned for its staunch progressivism trampling on the civil liberties of its own citizens. Opponents see the law as an atavistic turn towards a previous era, where individuals forcibly underwent treatment at the hands of the state, leaving the mentally ill liable to further abuse from law enforcement and even family members. Furthermore, the law will target minorities and individuals at the lower end of the socioeconomic spectrum who are more likely to suffer from homelessness and jail time, thus making the law a de facto form of social policing. By ignoring the rights of patients to choose which treatment model is best suited for their needs, the law in effect criminalizes individuals who have not committed any crime. As a direct result, Laura’s Law caters to the stereotypes of the mentally ill as dangerous, impulsive societal nuisances who require third-party control over their lives, thus doing very little to undermine the stigma associated with psychiatric illness.
Eduardo Vega, executive director of the Mental Health Association of San Francisco, says that the emphasis should instead be on expanding and improving voluntary treatment, such as the city’s pilot program where individuals with psychiatric illness can choose for themselves to receive treatment under the direction of a conservator, who is then granted permission to decide which care options are best for the patient. Moreover, Vega assets that the law “sets up a legal system for forcing people, or compelling people, into things that didn’t necessarily work for them before.” In other words, the law promotes a cookie-cutter style of treatment by only allowing for outpatient services, and not residential programs or medication monitoring. This concern was echoed in 2010 by Dr. Mitch Katz, then public health director of San Francisco, who insisted that the law could only be effective if it forced drug therapy on people, a move that mental health advocates see as anathema to the right of self-determination on behalf of individuals with psychiatric illness. Essentially, the law is a paradox: it aims to solve a multifaceted conflict by enacting measures that civil liberties advocates see as draconian, while actually creating more cracks in the system.
Caught in the crossfire between these two sides are the individuals who stand likely to be affected by the law’s passage and their loved ones, who simply want what is best for them. An uncomfortable fact about Laura’s Law is that it will force family members to testify against one another, leading to cries of betrayal and irrevocable household break-ups.
Alternatively, some caregivers see Laura’s Law and others like it as setting too high of a threshold and want the state to be able to directly intervene and take action against a loved one who they strongly suspect may harm themselves of others. Of course, lowering the bar for involuntary treatment would also make the system vulnerable to abuse and malfeasance.
Despite these possibilities, some patient advocates are vehemently in support of the mandate, as they argue that the individuals the law is likely to impact are so sick they don’t even recognize their own illness and shouldn’t continue to suffer. Candy DeWitt of Alameda County, whose son who was in and out of hospitals for five years, is one of those caregivers. Under the current system, mental health professionals must consider information supplied by family members during a commitment evaluation, yet some caseworkers will only judge a person’s competence based on their own personal interviews with the individual, tossing aside caregivers’ testimonials. Hence, when Mrs. DeWitt would try to offer her own narrative of her son’s behavior the caseworkers would merely ignore it and decide her son’s future care based on their own one-on-one sessions with him. In February, Mrs. DeWitt’s son, who had recently been let go by yet another short-term care facility despite his parents’ objections, killed a man. Deemed unfit to stand trial, Daniel DeWitt is presently being held at Napa State Hospital. His parents have joined the movement to make Laura’s Law enforceable statewide. Alameda County, where the DeWitts live, has not codified the law.
Can such laws prevent violence?
Laura’s Law isn’t solely intended for the well being of individuals with psychiatric illness, nor for the need to improve mental healthcare. Both of these rallying cries have been usurped by an argument for public safety, as large segments of the American population are aghast at recent mass shootings. As such, supporters of assisted outpatient treatment argue that preemptive action is necessary in order to curb mass killings, despite the fact that they are still rare events; in 2012, they accounted for only 0.15 percent of all the homicides in the United States. Yet because of the lurid media attention these events receive, the subsequent dialogue hyperbolizes the linkage between mental health and gun violence, generating knee-jerk legislative reactions that are unlikely to completely ameliorate the problem.
While it’s true that most mass killers have some form of a psychiatric illness, the vast majority of people with mental illness are not violent. Only about 4% of overall violence in the United States is associated with mental illness. This means that individuals who are not necessarily mentally ill, and may otherwise be considered perfectly sane on a psychological basis, commit 96% of violent crimes.
In May of this year, Dr. Richard Friedman wrote a particularly eye-opening piece in the New York Times on the expectation that beefing up our mental health system will somehow prevent future Aurora, Colorados and Newtown, Conneticuts. Laura’s Law, and others like it, are meditated on the premise that psychoanalytic treatment can occlude mass murders by forcing those liable to such behavior to seek care, which can ultimately help them to manage violent impulses. Moreover, the onus is placed on medical professionals to flag high-risk individuals and report them to local authorities.
However, two of the most recent mass killers, Elliot Rodgers and Adam Lanza, who combined murdered 33 people, were already receiving psychiatric treatment before going on their rampages. Furthermore, research has demonstrated that drug and alcohol abuse are far greater predictors of violence than mental illness. Friedman is concerned that making involuntary treatment more pervasive will only discourage patients from seeking help or being honest with their providers. “The sobering fact,” Friedman writes, “is that there is little we can do to predict or change human behavior, particularly violence; it is a lot easier to control its expression.” In the face of this evidence, Friedman argues, we must admit that asking doctors to identify killers creates no more than a guessing game, and our ability to label potential killers is no greater than chance.
Recently, government programs have delivered sideways solutions to help close the gap between the healthcare needs of the mentally ill and their ability to access treatment, such as the expansion of Medicaid under the Affordable Care Act, which has helped millions of Americans obtain quality, preventive healthcare including treatment for mental illness, which is now required to be covered like any other ailment, such as diabetes or asthma.
In spite of the fact that those with mental illness are more likely to be victims of violence rather than perpetrators the drumbeat that advocates for tougher procedures in mental healthcare carries on. Although well intentioned, Laura’s Law aims to solve the multifaceted problem of balancing civil liberties and public safety, but ultimately achieves neither. Violence crimes committed by individuals with mental illness garner a great deal of media attention, and have made it fashionable to call for reforms to our mental healthcare system. However, these atrocities are rare and serve as anecdotes that galvanize the passage of haphazard laws that usually do very little to eviscerate the roots of the problem, while simultaneously creating others. Laura’s Law is just one example.
Chaya Himelfarb resides in New Jersey and is a frequent contributor to Painted Brain News.