Newly formed Marin coalition calls for mandatory treatment of mentally ill in Marin

May 01--A group of Marin police officers and firefighters heard arguments this week about why Marin County should implement Laura's Law in a meeting in Larkspur sponsored by the Marin Organization to Reduce Homelessness Coalition.

About 30 people, including Supervisors Katie Rice and Damon Connolly, attended the meeting Wednesday night at the Central Marin Police Authority headquarters.

Laura's Law, AB 1421, signed into law by Gov. Gray Davis in 2002, gives local judges the authority to order severely mentally ill individuals to undergo outpatient treatment. The Legislature passed the law after a mentally ill man fatally shot Laura Wilcox, a 19-year-old volunteer at a Nevada County mental health clinic.

Nine California counties have implemented the law since the Legislature authorized use of Proposition 63 Mental Health Services Act funds for its enforcement.

Newly formed, the Marin Organization to Reduce Homelessness Coalition includes many members of the Marin chapter of the National Alliance on Mental Illness, or NAMI, some of whom are parents with mentally ill children. The Marin chapter of NAMI has been lobbying the county of Marin to adopt Laura's Law for some time now with little success.

On Wednesday, Adam Nelson, a Marin psychiatrist; Joel Fay, a retired San Rafael policeman who now works as a psychologist; and Marin County Public Defender Jose Varela outlined some of the reasons why they think Laura's Law is needed in Marin.

No funding

Fay said the realignment of California's mental health system by the Lanterman Petris Short Act in 1967 was supposed to substitute community health treatment for the warehousing of patients in mental hospitals.

"The problem is the system was underfunded from day one," Fay said.

As mental hospitals were closed, more of the mentally ill ended up homeless or in jail. Fay said that a year after passage of the act the number of mentally ill in jails had doubled.

Fay said that in 1960, California had a population of 15 million and 37,000 mental hospital beds; by 2010, the state's population had grown to 37 million and there were only 4,000 mental hospital beds. He noted that the Associated Press reported earlier this year that a quarter of California's prison population, 33,000 inmates, suffer from mental illness.

Under the Petris Short Act, a "qualified officer," such as a police officer or designated county clinician, can request that a person suspected to have a mental illness be involuntarily confined for at least 72 hours. They must be deemed to be a danger to themselves, a danger to others or "gravely disabled."

5150

In Marin this procedure, often referred to as a 5150 because that is the section of the state code that authorizes it, must be approved by workers at the county's psychological emergency services facility, which is adjacent to Marin General's 17-bed inpatient mental health facility on its campus.

"This is a law that is seriously outdated," Nelson said. "Sometimes individuals who want to be hospitalized can't be if they don't meet the criteria. Often times 5150 determinations are made not based on the clinical need of the individual but on the availability of resources like hospital beds."

Marin General's 17 beds are the only psychiatric beds in the county. Several members of Wednesday's audience complained that county mental health workers have refused to accept legitimate 5150 requests.

David Moss, a private mental health and addiction case manager, said county health workers rely more on the testimony of psychiatric patients than on that of family or case workers.

"To me the breakdown is at psychological emergency services over and over and over again," Moss said. "They don't do a good assessment."

Tom Forray, who recently retired from his job working with the county's Sustained Treatment after Release (STAR) program, said "I've seen first responders leave psychological emergency services saying, 'I did everything right and they turned our person away.'"

Forray said he also has had 5150 requests for severely ill patients rejected. Forray said the mental health workers told him, "'This person is psychotic, he isn't greatly disabled.'"

Penny Labourdette, who has a mentally ill grandson, said, "You need to be able to get a 5150 easier and not be turned away. It's not responsive to the mentally ill and their families."

Anosognosia

Nelson said many mentally ill individuals suffer from "anosognosia," a complete lack of awareness of their mental illness.

"It's virtually impossible to argue someone in that state into believing they are in need of treatment," Nelson said. "No matter how much they may be impaired by the problem."

Nelson said Laura's Law would provide clinicians with another tool to reach this type of patient.

Nevertheless, county mental health director, Suzanne Tavano, said Thursday she remains skeptical that Laura's Law would improve psychiatric services in Marin. In August, Tavano mentioned the creation of a new mobile response team, scheduled to debut in September, as one of the reasons Laura's Law is unneeded in Marin; but the team's creation has been delayed.

"We're working on the hiring process," Tavano said.

Tavano points out that patients can't be forced to take medication or accept treatment under Laura's Law -- although the law does allow patients to be held for up to 72 hours against their will if they refuse treatment.

Fay said results in New York, where a similar measure, Kendra's Law, has been enacted, have been good.

"The studies I've looked at show a significant reduction in all sorts of problematic behaviors with people who are under Kendra's Law," Fay said.

Nelson said people with mental illnesses often need choices presented in concrete terms and that is what Laura's Law does.

Varela said, "The black robe effect usually works; that is one of the take-aways."

By the end of the meeting, Supervisor Connolly said, "I'm very willing to consider adding Laura's Law in Marin County. We do need to look at strengthening the overall continuum of care."

Connolly's district includes the city of San Rafael, which has been bearing the brunt of caring for Marin's homeless population.

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