02/26/2013 11:41 am ET Updated Apr 28, 2013

New California Bills Could Improve Treatment for Mentally Ill

Bills Clarify MHSA Funds Can Be Used For Laura's Law and Make Other Improvements

California has two major laws that were specifically enacted to help persons with the most serious mental illnesses: Laura's Law and the Mental Health Services Act (MHSA). Neither has worked as promised and on February 22, 2013, four new bills were introduced to fix them.

Laura's Law Background

Before Laura's Law there was no way to help individuals with serious mental illness who refused treatment until after they became danger to self or others. Rather than preventing violence, the law required it. Laura's Law helps a subset of the most seriously ill who already have a history of violence or incarceration by allowing courts -- after substantial due process -- to order them to stay in treatment as a condition of living in the community. Laura's Law has reduced violence, dangerousness, incarceration, hospitalization and suicide in New York and the two California counties that use Laura's Law.

MHSA/Prop 63 Background

In 2004, Californians enacted Proposition 63, a 1 percent tax on millionaires to improve services for people with "serious" mental illness. It has generated about $8 billion and made California the only state with enough money to dramatically improve services for people with serious mental illness. But once MHSA was passed the mental 'health' industry that lobbied for it, immediately diverted MHSA funds to programs that don't serve the seriously mentally ill and more objectionably, sent millions to organizations working to prevent implementation of Laura's Law. $3 million went to Disability Rights California (DRC); $3 million went to a PR firm; and millions more go to other groups that are opposed to Laura's Law. As a result, Laura's Law, the most successful program for the most seriously ill remains largely unused.

That is the problem the four new bills address.

SB 585

SB 585 (Steinberg/Correa) clarifies that MHSA funds may be used for Laura's Law. This is needed because the MHSA-funded DRC has threatened to sue counties that use MHSA for Laura's Law. By clarifying the issue, SB 585 frees counties from their threat.

SB 664

SB 664 (Yee/ Wolk) states counties may implement Laura's Law without a special vote by county boards of supervisors. A formal vote is not needed to implement any other county mental health service because supervisors have other ways to oversee county behavioral health departments. It was an unneeded administrative burden.

SB 664 also removes a provision that DRC and MHSA Oversight Commissioners intentionally misinterpreted to allege that counties must treat everyone else in the county before they treat those who need Laura's Law. The effect of this misinterpretation was to send the most seriously ill to the end of the line for services, rather than the front. The exact opposite of what voters wanted when passing Prop 63.

Unfortunately, SB 664 also authorizes counties to limit the number of persons they will serve under Laura's Law. If a county must limit services, they should limit services to the least seriously ill, not the most seriously ill. That approach puts patients and public at risk and may violate Olmstead, which requires states to deliver services in the most integrated setting.


AB1265 (Conway along with Achadjian/Beth Gaines/Gorel/ Hagman/Harkey/ Morrell) allows individuals under Laura's Law to receive treatment for up to one year instead of the six month maximum previously allowed. research in New York found that the beneficial effect of being put under court order lasted after the order ended, as long as the patient was under the order for longer than six months.

AB1265 also require facilities discharging involuntarily committed patients first evaluate them to see if they could benefit from Laura's Law and if so, notify county officials. The most likely patients to needlessly deteriorate are those who were previously involuntarily committed (i.e, already danger to self or others). This is a very smart provision and was recently implemented in New York and should also apply to persons with mental illness being discharged from jails and prisons.

AB 1367

AB 1367 (Mansoor along with Achadjian/ Alle/ Conway/Beth Gaines/Gorel/ Hagma/ Harkey/ Morrell) also clarifies that MHSA funds may be used to implement Laura's Law but uses different language than AB 585.

AB 1367 also adds school districts, county offices of education, and charter schools as organizations that can receive certain MHSA funds and use them to identify students with mental health issues that may cause them to become danger to self or others.

It is a well intended amendment but contrary to those who argue otherwise, identification of those who need help has never been an issue. Anyone can see who needs help by walking down the streets and seeing who is psychotic and eating out of a dumpster; or standing outside a jail or hospital and see who is being released without treatment. Parents of those with mental illness who make headlines like Aaron Bassler (Fort Bragg) Ian Stawicki (Seattle Cafe), Kelly Thomas (Fullerton), Scott Dekraii (Seal Beach), Mathew Herrera (Sacramento) and Sunni Jackson (Paso Robles), were all identified by relatives as needing treatment, but were refused treatment by the mental health system. The police were there, the parents were there, but the California mental health system was MIA. They seem to be the only ones who can't see mentally ill who need help, even when they're standing in front of their face.

None of the bills remove the sunset in Laura's Law or address waste, fraud, and Insider Dealing in MHSA Funds. But all the bills contain good provisions and all the sponsors deserve our thanks. Whether they pass or not, could be a function of how much more MHSA funds are allocated to opposing these important initiatives.

Mental Illness Policy Org runs sites dedicated to Laura's Law and problems with the Mental Health Services Act.