People with serious mental illness such as schizophrenia and bipolar disorder often refuse treatment because they don't know they're sick.
Anita Fisher is the education director for the San Diego chapter of the National Alliance on Mental Illness. She became a mental health advocate when her son, Pharoh Degree, was diagnosed with schizophrenia.
Before Degree was diagnosed, he was a medic in the United States Army and was stationed at Walter Reed Hospital.
“I have noticed over these 14 years that when he is untreated he is very, very ill but when he is accepting his treatment regime, he also does extremely well,” Fisher said.
In a video Fisher recorded in 2010, Degree said he had gotten a lot of help in his recovery.
“I am now certified to be a peer support specialist, I am a peer mentor and I now work for NAMI as a peer helpline specialist. I just wanted to share my story with you all and tell you that with hope, God and support, recovery is possible,” he said.
“Because my son has an added feature to his diagnosis, schizophrenia and addictive illness, he often time ends up on the streets homeless and he ends up being arrested, goes to jail or prison,” Fisher said.
Fisher said if she’d been able to get her son involuntary treatment, he would not have gone back to prison this last time.
Degree was released from Donovan State Prison on July 10 and he’s been missing ever since.
San Diego County is in the process of reviewing the mental health services available to thousands of people living in the county who are resistant to treatment.
One option the County has considered is an Assisted Outpatient Treatment, or AOT program, called Laura's Law.
Right now Laura's Law is only fully implemented in rural Nevada County, north of Sacramento.
The path to Laura's Law in Nevada County began in January 2001. A man with serious mental illness who was not receiving mental health treatment shot and killed three people and injured several others. One of the people killed was 19-year-old Laura Wilcox, a college student. Lawmakers drafted the Laura's Law program and it passed the California Legislature in 2002.
Nevada County began it's Laura's Law program in May 2008.
Nevada County Behavioral Health Director Michael Heggarty says Laura's Law is designed to help people who have serious mental illness and refuse treatment.
"Even though there isn’t an immediate emergency condition, Laura’s law offers a method and a procedure and due process to help people who are seriously mentally ill and refusing treatment to get the help that they need," he said.
Some patient advocates argue that because Laura's Law is involuntary, it violates a patients civil rights.
Heggarty hasn't always been a supporter of Laura's Law.
He said, "Prior to moving to Nevada county, I really didn’t know very much about Laura's Law so I was operating from impressions and also from personal values. I strongly value personal freedom and I think that voluntary treatment is always preferable over involuntary treatment so I really didn’t see a need for it at the time."
"What I really lacked in my own understanding was that there are some people with mental illnesses that in spite of the difficulty in their lives, in spite of being arrested, in spite of being hospitalized, repeatedly, they don’t believe they have a mental illness, they don’t believe they need treatment and they won’t participate in treatment no matter what the outcomes are."
He said without a Laura's Law program Nevada County would not be able to reach the small segment of the population.
Laura's Law treatment services are available seven days a week and 24 hours a day using a one to 10 staff to client ratio. They include help with housing, employment, substance abuse, psychiatry services, nursing and physical health. People mandated to participate in a Laura's Law program in Nevada County are in the same program as those in voluntary treatment.
Heggarty says, "If you were to view the program and sit in the waiting room, you can’t really tell who’s court ordered and who isn’t because everybody is receiving the same type of intensive treatment."
Some counties, including San Diego County have cited high program costs as one reason they have not adopted Laura's Law. In rural Nevada County, the program costs $15,700 per year, per patient.
But Heggarty said, "When we look at that cost which does at first pass sound like a large number, we’ve been able to document and realize a net savings in our mental health budget so simply by reducing the amount of psychiatric involuntary hospitalizations, we’re able to realize a savings."
"So we look at it really that even though it is an up front expense, in the long run and even in the short run it actually saves or avoids additional expenses in psychiatric in-patient treatment," he said.
Another barrier to implementing Laura's Law is access to funding. San Diego County administrators say clarification is needed on whether the County can use Proposition 63, the Mental Health Services Act (MHSA), funding to implement Laura's Law. Nevada county has been paying for Laura's Law using MHSA funding since it adopted the program in 2008.
California State Senator pro Tem Darrell Steinberg introduced legislation, Senate Bill 585, which would clarify that MHSA funds can be used to administer Laura’s Law.
Steinberg said, "Because the law isn’t as clear as it could be, and the regulations passed after Prop 63 passed are not as clear as they could be, that they would be subject to a lawsuit if they went ahead and implemented Laura’s Law using Prop 63 dollars. And so my bill is to clear up any ambiguity to make sure that counties know that if they choose to fund Laura’s Law with prop 63 dollars that can do so."
Heggarty said if SB585 passes, "I think counties would be much more confident that if they were to use MHSA funds that they would be more protected from possible litigation."
The State Assembly is expected to vote on SB 585 in September.
But Steinberg said the conversation shouldn't only focus on Laura's Law.
"What we really need to be talking about is Laura's Law as part of, and in fact at the end of, a continuum of care for people. Because what’s really happening in California is that for most people, counties and program providers, don’t even get to a point of having to determine if somebody should be under a court order or be involuntarily committed."
"There aren’t enough voluntary services to offer and then determine whether or not the individual who is suffering can take advantage of the voluntary service," he said.
San Diego County does not have Laura’s Law at the end of the continuum of care.
Heggarty agreed that there aren't enough voluntary programs in California.
"We do need more funding for voluntary services."
"This is not the main thrust of any of our programming, it serves a small subset of people who are mentally ill and refuse treatment but they’re still dangerous to the community," he said.
In Fisher's case, Heggarty said, "It’s horrible that we have to wait until somebody commits a crime, or attempts to hurt themselves or someone else, before we can get them into treatment. Laura’s Law in many ways is a prevention response before an emergency situation is happening."
Other California counties are still considering Laura’s Law as an option.
Most recently, Yolo County's Board of Supervisors unanimously approved a Laura's Law pilot program. The program will be paid for out of the County's general fund.
This story was produced with support from the USC Annenberg/California Endowment Health Journalism fellowship.
