The problem with Laura's Law

When it comes to embracing laws such as AB 1421, California voters know better


OPINION Mental health conditions and mental illness are issues that bring passionate people to the table from all sides of the spectrum. Individuals who have lived with the experience of mental-health conditions, clinicians, family members, researchers, and advocates all have a lot to say.

But as a March 11 San Francisco Chronicle piece, "Laura's Law likely to save lives," suggests, people can be fueled by pain and emotion, rather than logic and information. It's in such a hot zone that AB 1421 emerged, after the tragic death of a young woman at the hands of a violent man who also happened to be dealing with mental health conditions.

The so-called Laura's Law passed the state Legislature in 2002, and counties have a choice whether to implement it locally. If enacted in San Francisco, AB 1421 would mandate outpatient treatment for some people with mental illness — and those out of compliance would get a 72-hour hold under lock and key at the hospital, and would be at risk of being thrown into the revolving door of the criminal justice system.

The public support for AB 1421 and similar involuntary measures outlines the pervasive misunderstanding that comes when emotion rules the fray over common sense and dignity. And more dangerously, it promotes the long-debunked myth that mental illness is related to violence. In fact, individuals with mental illness are one percent less likely to commit violence than other individuals.

Often, the very people whose voices are left out of the decision making process in legislation such as AB 1421, are the ones who are directly affected personally by mental illness and mental-health conditions. That's due in large part to the lasting impact of stigma, which deprives people of dignity, individual choice, and the empowerment to seek their own goals and paths in life.

What we know is this: voluntary treatment that is accessible in community settings and centered on individual strength is by far the best option for recovery from mental health conditions and the path for a rewarding, enriched life.

San Francisco typically leads the state in the number of involuntary commitments for people in acute psychiatric crisis. That's proven to be not only a colossal waste of resources but also the wrong approach. Many of those who are involuntarily detained are accessing the mental health system for the first time—in restraints. This leads to further mistrust and trauma for those dealing with mental health challenges.

When it comes to embracing laws such as AB 1421, California voters know better. After the passage of that measure, California voters passed the landmark Mental Health Services Act in 2004. It is the principles of MHSA—voluntary, community-driven treatment, and full inclusion of individuals with mental health conditions as decision-makers—that should guide our efforts in recovery from mental health conditions and eliminating the pervasive stigma and bias that are the true culprits in causing pain and trauma in our society. MHSA provides funding for innovative, alternative approaches to Treatment As Usual.

Michael Gause is deputy director of the Mental Health Association of San Francisco.



When this subject comes up, it is also vital to make sure that the public is clear on one key fact. The number one so-called mental health advocacy organization which most strongly supports Laura's Law is NAMI (the National Alliance On Mental Illness), which is a group that receives huge amounts of its funding from the pharmaceutical industry.

So the stealth agenda of draconian 19th century style approaches to forced treatment like Laura's Law, is to force huge swaths of the public to take unnecessary psychoactive medications, so that the pharmaceutical industry can vastly increase its already astronomical profits.

Posted by Eric Brooks on Apr. 11, 2012 @ 10:24 am

The author exhibits a good understanding of mental 'health', but a poor one of mental 'illness'. He says there is a long dubunked myth about the association between mental illness and violence. But Laura's Law is not for people with mental illness. Having a mental illness alone, would not make anyone eligible for Laura's Law. One must have a past history of dangerousness or violence, be unlikely to comply with treatment that could prevent the violence, be substantially deterioriating, be likely to become gravely disabled or dangerous without treatment, etc. By making it seem as if this law applies to all mentally ill, is disingenuous and doesn't contribute to the public good.
The author argues voluntary treatment is better. Agreed. But some people won't partake of it. They are too ill to recognize their need for treatment. Nothing in Laura's Law precludes the use of voluntary treatments. In fact, Laura's Law is only allowed after voluntary treatment is failed. Voluntary treatments are good for voluntary patients. Laura's Law is for others. They are mutually exclusive groups.
The author cites stigma, but the leading cause of 'stigma' is fear of violence. Violence by the minority is tarring the majority. Laura's Law reduces stigma by reducing violence.
The author should have disclosed that his org is a large recipient of MHSA funding and does not serve people who are not well enough to volunteer for treatment. Perhaps that colors his perspective

Posted by Mental Illness Policy ORg on Apr. 11, 2012 @ 12:07 pm

Well said "The author should have disclosed that his org is a large recipient of MHSA" is fundamental in understanding his opinion.

Remember -Forced medication is not needed for Laura’s Law to succeed.

Posted by Guest on Apr. 11, 2012 @ 12:28 pm

These last two responses are deceptive nonsense.

Laura's law in fact applies to vast spectra of people who are -not- and have never been shown to be dangerous or violent. If readers look carefully at the quote from the law you posted, they will notice that 'violent' and 'dangerous' are just the first two -options- of a whole list of possible reasons to trigger forced treatment, several of which have nothing to do with either violence, or the vague wiggle term 'dangerousness'. In all of these categories not involving violence, the law relies on utterly subjective third party judgements of when someone may or may not comprehend that they have a 'mental illness'.

Who makes the decision? You? A judge?

There is a damned good reason that people are allowed to refuse treatment, and any law which takes that freedom away is an extremely serious breach of constitutional civil rights.

Forced medication is -exactly- what Laura's law is about, and this is made patently obvious by its pharmaceutical industry backers.

And the comment that receiving MHSA funding (government health services funding) represents some sort of conflict of interest when it comes to Laura's Law is ludicrous.

Government funding of health care services doesn't present any identifiable conflict with either opposing, or even for that matter supporting, Laura's Law.

But the big Pharma backers of Laura's Law clearly have a whopping conflict of interest, because the law would directly increase their drug sales and therefore their profits.

Posted by Eric Brooks on Apr. 11, 2012 @ 5:46 pm

"Who makes the decision? You? A judge?"

A judge.

Posted by Guest on Apr. 13, 2012 @ 4:09 pm

A judge, gets to decide if someone must undergo forced treatment.

That is a road to political and hierarchical persecution by the state, of the sort that we had in the 19th century.

Posted by Eric Brooks on Apr. 14, 2012 @ 4:32 pm

You have obviously never dealt with the legal system.

-Past history of dangerousness or violence could mean
about anything. A minor scuffle for instance.
-Unlikely to comply with treatment that could prevent the
violence could mean saying one doesn't think that they
need treatment.
-Be substantially deteriorating could mean that that is
what the Psychiatrist thinks, or one just lost a job, or is
homeless, or got into a shouting match etc.
-Likely to become gravely disabled or dangerous without
treatment, again, the Psychiatrist thinks so.

Meaning, of course, that pretty much Anyone can have
have treatment forced upon them at pretty much any time
under "Laura's Law", unless the mental health system
alone proves to be a good guardian of our fundamental

Posted by Jon C. Stevens on Dec. 27, 2012 @ 2:57 pm

AB 1421 would and should be implemented and should mandate outpatient treatment for some people with mental illness — and those out of compliance would get a 72-hour hold under lock and key at the hospital,"which is much different then a mental institution and now are in our county hospitals which means better and more individual care and would be at risk of being thrown into the revolving door of the criminal justice system. they also would not be criminalized for there mental illness issues however there actions. However they would be treated civilly not criminally which would keep us with our rights and dignity which has for so many years been taken from us as soon as we are non-compliant. and another thing MHSA can fund such programs without this law people with mental illness whom cannot comply nor are they willing to listen are not being served and forcing them to go through our prisons and jails instead with no assistance or rights.

Posted by Guest on Apr. 11, 2012 @ 12:41 pm

I believe strongly that even mentally ill patients have the right to their own choices. In the case that they cannot make that decision over voting matters or matters that decide their own fate, a close family or friend should be around to make decisions affecting them. Involuntary restraint doesn't help the problems that patients with mental problems are already facing, such as a negative stigma and prejudice, so why make it worse?

Posted by Simon on May. 10, 2012 @ 8:02 pm