Yolo County supervisors on Tuesday will consider creating a pilot project that would allow for court-ordered involuntary outpatient treatment for certain individuals with serious mental illnesses.
The yearlong pilot project would implement Laura’s Law, a measure passed by the state in 2003 in the wake of a killing spree by a Nevada County man with a long history of mental illness who had resisted treatment.
The law allows a court to order involuntary outpatient treatment (also known as assisted outpatient treatment) for individuals with serious mental illnesses who have a recent history of hospitalization or violent behavior, as well as non-compliance with a voluntary treatment plan indicating that the person is likely to become dangerous or gravely disabled.
In the 10 years since Laura’s Law was passed, only Nevada County has fully implemented the law. However, former Yolo County Supervisor Helen Thomson, who authored the bill when she was in the state Assembly, urged county supervisors in March to embrace it locally, saying, “it is time to take care of those who need it so much.
“I think it’s really important that the mentally ill get the most appropriate care in the least restrictive setting,” Thomson said.
In order for an individual to be placed in involuntary treatment, a request would have to be made to the county’s mental health director by the person’s spouse, parent, sibling, adult child or roommate, or a treating doctor or peace officer. The county then would investigate and choose whether to file a petition with the court for assisted outpatient treatment.
Under the terms of the pilot project, up to four patient slots would be made available through the county’s existing assertive community treatment program (Turning Point Yolo ACT), which currently provides up to 50 seriously mentally ill individuals with medical and support services, housing assistance, recreational and employment opportunities and independent living skills. The four slots would be in addition to the 50 existing slots.
Mental health experts who spoke before the Board of Supervisors in March said a number of individuals suffering from severe mental illnesses, including one-third of those with schizophrenia, resist treatment because they don’t believe they need it. However, many end up hospitalized or in jail because of that lack of treatment.
Kim Suderman, director of alcohol, drug and mental health services for Yolo County, told supervisors the number of county residents who might fall in that category would be small.
“Definitely no more than 20, probably less,” she told supervisors in March.
And while treatment could be involuntary under Laura’s Law, Suderman said, medication would not be.
“This does not allow for literally strapping someone down and doing an injection against their will,” she said. “Forced medication is rarely done in any outpatient setting because it … is a civil rights issue.”
Cost is also an issue, because the state law did not provide additional funding for assisted outpatient treatment. But legislation pending in the state Assembly would clarify that revenue from Proposition 63 — the Mental Health Services Act — can be used for assisted outpatient services.
Additionally, Nevada County has shown an overall cost savings since implementing Laura’s Law.
According to the Nevada County Grand Jury, 17 individuals entered that county’s assisted outpatient treatment program for an extended period of time between April 2008 and December 2010. The total cost to the county for their treatment during that time was $482,443.
But in the one year preceding their entry into treatment, those 17 individuals had incurred a combined $425,100 in hospitalizations and incarcerations, the grand jury said. Had they not spent that time in assisted outpatient treatment, the projected cost of hospitalizations and incarcerations over that 2 1/2-year period would have topped $1 million, the grand jury reported.
In a report to Yolo County supervisors, Suderman said that while creating a program can be expensive, “there is also a cost for not operating such a program.
“Those eligible for (assisted outpatient treatment) are regularly using resources today through the criminal justice system and psychiatric inpatient services with a high cost,” she said. “(F)or example, Woodland Memorial Hospital’s psychiatric inpatient rate for fiscal year 2012-2013 (is) $1,447 a day. These same resources could be better spent on proactive treatment, rather than reactive intervention.”
The proposed pilot project would take place during the 2013-14 fiscal year, after which supervisors would have to decide whether to make the program permanent the following year.
Laura’s Law is not without its opponents, many of whom are troubled by the idea of forcing mentally ill individuals into treatment. That concern, in addition to concerns about costs, are cited as the reasons why Nevada County is the only county in the state to fully implement the law. However, Los Angeles, San Diego and Orange counties have all implemented pilot programs or alternatives to assisted outpatient treatment.
Supervisors are scheduled to take up the issue at 10:30 a.m. Tuesday in their chambers at the County Administration Building, 625 Court St., in Woodland.
— Reach Anne Ternus-Bellamy at firstname.lastname@example.org or 530-747-8051. Follow her on Twitter at @ATernusBellamy