Earlier this year, Charity Voth, Behavioral Health Program coordinator with San Diego County Behavioral Health Services, said no person has been forced into treatment in the three years since Laura’s Law has been in effect locally, but 24 people had gone into treatment voluntarily because of its threat.
Linda Mimms, a National Alliance on Mental Illness-trained mental health advocate from San Diego, said that’s far short of what is needed.
“The criteria under Laura’s Law needs to be changed,” she said. “There’s no teeth to it. There needs to be some way to get forced medication.”
Participants in Sheffres’ support group say Laura’s Law hasn’t been much help, and in fact has left them in the uncomfortable position of waiting for their children to do something that will trigger the law.
Several of the women said officers in the Police Emergency Response Team, commonly known as PERT, have even told them that the best thing they can do for their children at home is to evict them and wait for something to happen so they can be picked up and hospitalized.
“Nobody wants to do that to their kid,” Mimms said.
Some of the women in the group said their experiences with PERT officers have been very positive, but too infrequent. Several said PERT officers have arrived only one in five times when calls were made to police about an incident at home.
Dr. Mark Marvin, PERT director in San Diego County, said it is true that officers’ hands are tied to an extent when they answer a call about a disturbance because they can’t arrest the person unless he or she is a threat.
He also said the 50 PERT officers in the county is about double what it used to be a few years ago, but agreed there could be more.
“There’s always talk about having more teams,” he said. “Police Chief (David) Nisleit has said he’d like to have more teams, and I think that’s going to happen.”
Marvin said only about half of the calls a PERT officer responds to result in someone being hospitalized, but the officers may take other actions that are helpful, such as connecting someone to services.
People displaying behavior that puts themselves or others at risk may be taken into custody under state law — California Welfare and Institutions Code 5150 — and held for 72 hours for evaluation.
If further evaluation is needed, the person can be held for 14 days and then another 30 days. Finally, the person may go before a Lanterman–Petris–Short court, which could order mandatory medication and a year-long conservatorship, meaning the patient’s care and protection will be the duty of someone else, such as a family member.
Mimms criticized the long process in a commentary published in The San Diego Union-Tribune last August, where she argued that family members should have more say early on about the care of their loved ones.
“We can take our elderly parents to the doctor and get them on meds for dementia,” she wrote. “Severe mental illness is like dementia. Why can’t we do this for our loved ones who don’t realize how sick they are?”
She also wrote that laws put in place decades ago eliminated past unjust institutionalizations, but are outdated because of more effective medications and therapies today.
Some lawmakers also believe protecting the mentally ill from forced institutionalization and medication does a disservice to them.
Assembly Bill 1971 would broaden the criteria for someone to be placed in a conservatorship, giving someone else authority over their decisions and medication.
“It is our duty as a clinical service, as a department that must embrace humane and least-restrictive approaches to do everything possible to engage individuals with serious mental illness without the use of conservatorship,” said Dr. Jonathan Sherin, director of the LA County Department of Mental Health. “However, in some cases, we are unable to engage individuals in need of care due to their mental illness and must rely upon conservatorship as an engagement tool.”
AB 1971 grew out of a motion by the LA County Board of Supervisors, which worked with Sherin to pursue legislation addressing conservatorships of mentally ill people.
One crucial piece of the bill would clarify the definition of “gravely disabled” as a requirement for conservatorship. Sherin, Mimms and many others have said the definition often is open for interpretation when conservatorship cases go before judges.
More specific, Sherin said the definition of “gravely disabled” under current law applies to people unable to feed, shelter or clothe themselves. Some homeless people are able to survive on the street well enough that they don’t meet the definition of “gravely disabled,” he said, although in reality their health is rapidly deteriorating because of their mental condition.
“What ends up happening in many scenarios is, someone’s ability to get food, clothing and shelter is quite subjective and not easily demonstrated,” Sherin said.
AB 1971 would expand the definition of “gravely disabled” to include people who also can’t provide for their own mental health treatment.
The bill passed the Assembly on May 30 and is headed to the state Senate.
A similar proposed law, Senate Bill 1045, would create a pilot program in Los Angeles and San Francisco counties that would establish a procedure to appoint a conservator for a person who is chronically homeless and incapable of caring for his or her health and well-being because of a serious mental illness and substance use disorder.