California's mentally ill people need early diagnosis, not forced treatment

Laura's Law, under which mentally ill people may be involuntarily committed, fails to deal with wider problems in the care system
California health
An paramedic van outside Cedars Sinai hospital in Los Angeles, California. Photograph: Dan Chung for the Guardian

In January, suicidal 18-year-old Christian Chavez was shot and killed by sheriff's deputies in Kern County, California, after a bystander contacted emergency services. Onlookers at the scene claim he was holding a knife but pointing it at his own chest, indicating a state of acute psychiatric crisis. Such situations are not uncommon, as police are trained to provide law enforcement services, not mental health care, but they're often the first line of defence when people call for help.

The Chavez case occurred hard on the heels of several high-profile cases of people with mental illness killed by police last year in California. Kelly Thomas was beaten to death in Fullerton in July, a case that resulted in a global outcry and criminal charges for the police officers involved. Aaron Bassler was shot in Fort Bragg in October after a manhunt that lasted for over a month, incurring a bill of over $600,000 (£377,000).

Officer-involved deaths of people with mental illness highlight the profound mental health crisis in California. Residents have difficulty accessing mental health services and obtaining steady and consistent care in the state, which cut its mental health budget by over 20% between fiscal year 2009 and 2012. As the state fails to address its funding shortfall, numerous social services are on the chopping block, including mental health programmes designed to cut costs in the long term, such as those administered under the Mental Health Services Act of 2004, which provides services funded by a millionaires' tax.

A taskforce recently claimed that Laura's Law, enacted in 2002, is the solution, advocating for an extension to prevent it from expiring in 2013. Under the law, based on New York's Kendra's Law, mentally ill people may be involuntarily committed and placed in conservatorships if they are deemed incapable of making their own decisions. They can be compelled to attend outpatient treatment and take antipsychotic medications. Thus far, only Nevada County, California has fully enacted Laura's Law, and the taskforce recommends widening its reach to all counties.

Disability advocates, including those represented by Disability Rights California, oppose Laura's Law, arguing that it is both ineffective and dehumanising. Writing for the San Francisco Chronicle, attorney Dan Brzovic noted that the law is costly and duplicative, and hasn't proved effective in Nevada county. He frames it as an example of bad, outdated policy for California, contradicting the taskforce recommendation.

A few issues stand out with Laura's Law; the first is that it reflects too little, too late. The law focuses on those with "severe mental illness" deemed most at risk of committing violence, ignoring the fact that mentally ill people are more likely to be victims of violence. By the time most people reach acute psychiatric crisis, numerous opportunities for intervention have come and gone.

Rather than enacting Laura's Law and extending state authority over mentally ill people, the state should strongly consider improving funding for early diagnosis, intervention and treatment. If mentally ill people are provided with evaluation and treatment before the onset of severe mental illness, they have a much higher likelihood of success in treatment, including adherence to treatment programmes. This is particularly important for mentally ill youth, who have few resources available to them, sometimes forcing parents to give children up to the foster care system in order to access treatment.

The legislation also deprives mentally ill people of autonomy by making them subject to conservatorship as adults, rolling back significant progress made over the past 50 years in California. The Lanterman-Petris-Short Act of 1967 promoted an end to involuntary commitment and a focus on community-based care delivered in communities rather than institutions. Laura's Law, with its forcible treatment clauses, threatens the civil rights hard-won by mentally ill Californians.

Providing people with early intervention and supporting them while they seek care on their own is both an economic and civil rights issue. It's less costly to offer early mental health services and enable community-based care than it is to compel treatment after the onset of severe mental illness. Families and caregivers claim that mentally ill people have too many civil rights in California when they advocate for Laura's Law, creating a chilling vision for some mental health advocates of a return to abuses in institutional settings.

The tensions inevitably created in the debate over Laura's Law can make it easy to forget that all sides want the same thing: better access to effective and comprehensive treatment for people with mental illness to ensure that they have consistent and stable access to care. This needs to be paired with stigma reduction to reduce the social costs of seeking and receiving care. Whether all parties can unite to promote the common interest of Californians with mental illness remains to be seen.

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