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Laura’s Law Can Help Decriminalize Mental Illness

San Francisco Public Defender Jeff Adachi receiving his Vanguard Justice Award last November in Davis.

San Francisco Public Defender Jeff Adachi receiving his Vanguard Justice Award last November in Davis.

By Jeff Adachi

Mental illness is not a crime. Assisted outpatient treatment, also known as Laura’s Law can stop us treating it like one. But the plan’s success rides entirely on its proper implementation.

As the public defender, my office represents more than 3,500 people with serious mental illnesses each year. We are mandated under city and state law to defend the interests of our clients and advocate on their behalf.

I support assisted outpatient treatment as long as its implementation is done legally, responsibly and thoughtfully.

Criminalization of people with organic brain diseases like schizophrenia is our national shame. Recent studies show approximately 1 in 5 people behind bars suffers from a severe mental illness.

I have seen it daily in my 30 years working in the justice system, people in desperate need of help shuffled from jail to prison to shelters to emergency rooms. And with each cycle, they lose their tenuous hold on health care and housing.

Laura’s Law holds the potential to strengthen San Francisco’s psychiatric health system while healing the lives of families struggling with mental health challenges.

I recently had the opportunity to learn firsthand about the practical aspects of Laura’s Law from Judge Thomas Anderson, the former Nevada County public defender.

Nevada County remains the only county in the state that has implemented the plan. Judge Anderson, who was placed in charge of the county’s assisted outpatient treatment court in 2008, reports that in more than 75 percent of their cases, the intervention of their outreach team resulted in a person in crisis receiving treatment. Most importantly, the outreach provided that person with the stability to remain free of forced commitment in the hospital or jail.

As a result, the incarceration rate of mentally ill people in Nevada County was reduced by 65 percent. The law also resulted in fewer criminal cases filed against the mentally ill in favor of civil proceedings and outcomes that took patients out of the criminal justice system.

The statistics are impressive. However, Laura’s Law is not a panacea for proper mental health care or a cure for homelessness.

According to Judge Anderson, it will likely only serve a small population of those who are most severely mentally ill.

In Nevada County, which has a population of 90,000, only 37 people were referred to assisted outpatient treatment in the first two years following implementation of Laura’s Law. Currently, more than 23,000 San Franciscans receive mental health treatment through The City’s Department of Public Health.

If the percentages of clients served in Nevada County hold true for San Francisco, only 1 percent of this group would be referred to treatment under Laura’s Law each year.

I believe it is absolutely necessary to form a strong oversight committee to ensure Laura’s Law is not abused and that only cases that meet the legal criteria are allowed.

Supervisor Mark Farrell, who has introduced the Laura’s Law legislation, has committed to work with my office and other agencies to enact additional legislation to ensure fair and responsible implementation of the law.

With these protections, and if all the participating agencies work together through the court process, we can begin making real change by addressing citizens’ mental health needs before a crisis occurs. We have experienced this success through our city’s Behavioral Health Court.

The collaborative court has become a national model in stabilizing the lives of people with mental illness through coordinated treatment and services, coupled with court supervision.

The criminal justice system has been described as society’s emergency room. But severe psychiatric disorders require a commitment to ongoing care.

Laura’s Law holds the promise of decriminalizing mental illness, but only if we do it right. The lives of vulnerable San Franciscans depend on it.

Jeff Adachi is the public defender for San Francisco.

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About David Greenwald

David Greenwald is the founder, editor, and executive director of the Davis Vanguard. He founded the Vanguard in 2006. David Greenwald moved to Davis in 1996 to attend Graduate School at UC Davis in Political Science. He lives in South Davis with his wife Cecilia Escamilla Greenwald and three children.

19 comments

  1. Dear Mr. Adachi,
    What is your opinion of the best way to handle this situation?
    A mentally ill woman falsely accuses an innocent man of sexual assault. He hires an expensive criminal defense team to defend himself, spending well over one hundred thousand dollras in legal fees.
    His name is mentioned in the newspaper, bringing embarrassment to his entire family.
    Who shoud have to pay for these legal fees, and what, if anything, should be done to the mentally ill false accuser?
    Thank You.

  2. Hi D.D.

    I am no lawyer, but for purposes of conversation, here are my thoughts on your questions.
    1) Legal fees should be covered by the “state”. Yes, that means our tax dollars if “the state” is in error.
    This would have the benefit of prosecutor’s being less willing to try cases on questionable evidence.
    2) The mentally ill woman should be shown empathy and treated appropriately for her illness. She should not
    be punished for her illness.

  3. Thank you Tia. The mentally ill woman shared a cup of coffee with the man and somehow got it into her mind that the man slipped something in her coffee. A urine, saliva, and blood lab test revealed no date rape drug of any kind found. The samples were taken within 24 hours of her false accusation, so there would have been traces of a drug in her system. It took approximately six months for the state to release the lab results. The man was held in county without bail until a lawyer helped him.
    The man passed several lie detector tests. His case was mismanaged by the D.A. in the couty where this false accusation took place.
    It is not so much the money as the emotional toil this took on the man’s family. The D.A. barred him from his teenagers’ high school graduations, because they occurerd while this was all going on. The newspaper only printed half a story, too.
    The man does not want any further attention.
    I am a family member who is repulsed by the whole situation.

  4. D.D.

    Thank you for sharing the details. I agree with you that no amount of money would compensate for this kind of loss of life events of major importance.

    My issue about a financial compensation is that I think that it would have a significant deterrent effect on DAs if they realized that if their case was not strong, their actions would cause significant costs to their constituents. Unfortunately it tends to be true in our society that “money talks”. If a DA realized that he would likely be held accountable at the polls next election for wasting taxpayer money he/ she would be much more likely to prosecute only strong cases. From the falsely accused point of view, if they did not want the money, they could be allowed to donate it to charity of their choice, or a fund could be created to use these moneys for the defense of individuals accused in the future.

    Another point you raise is that when the accusation is spiking a drink, or similar non violent charge, it would be entirely reasonable to release on home ( and special event) monitoring rather than keeping this individual in jail. This is clearly punitive, not protective , and should be stopped immediately.

    • I agree with you that no amount of money would compensate for this kind of loss of life events of major importance.

      Before these events, the man’s daughter had a G.P.A. in the high 3.7-3.8 range. After these events, her grades suffered. During one of the home probation checks, later, a police officer made a derogatory remark to the young girl about her weight. I believe the officer was trying to incite her brother or her dad to take a swing at him, thus justfiying all the previous harrassment the wrongfully accused man had endured. Luckily, neither her older brother, her mom, or her the falsely accused man (her dad) took their bait.

    • “…a fund could be created to use these moneys for the defense of individuals accused in the future.”
      Tia, That’s a wonderful solution.

  5. For a while, the police decided to put an ankle bracelet on the man and track him at home. He was not allowed to walk anywhere near a school or playground (He was under tremendous emotional stress and the outdoor walks helped relieve the stress. )When law enforcement finally decided to remove the ankle bracelet, they made the man stand in the street in front of his home and they cut the bracelet off out in that street. I have no idea why they did that to him. I couldn’t make this crap up if ai tried.

  6. A friend who is an attorney once told me she and every attorney she knew would do anything to avoid having the courts make a decision about her life because they have first hand experience about how arbitrary court rulings can be. That’s a sad commentary on the state of our judicial system. Also, most of us want to believe the police behave in a civil manner while doing their jobs but those who attract the attention of the police know this isn’t the case–they are bullies and vindictive when they think they can get away with it. As in cutting the ankle bracelet off on a public street.

  7. South of Davis

    DB wrote:

    > they are bullies and vindictive when they think they can get away with it.

    I bet this CHP officer didn’t know he was on video last week:

    http://ktla.com/2014/07/08/video-of-violent-freeway-beating-prompts-chp-commissioners-meeting-with-community-groups/

    • Hi South of Davis,
      A similar incident occured in Davis wih he pepper spray and in Tucson with some drunk college students who were partying in the street.
      Apparently the officer in your cited URL was stressed out to the max and needed his own psychotherapy plan. Preventitive mandtory one on one time with a good therapist should be a requirement for all officers, to nip stress in the bud, before someone goes crazy hitting a defenseless woman.

  8. Der Mr. Adachi,
    I apologize for taking up so much space here. Your article is very important. I guess your first sentence is what struck a nerve with me.
    New topic:
    I worked for large government entities for 35 years. What worries me is, can your department get the resources to do its job properly?

    I know several people who have attended state mandated therapy. (At the county level.) It seems like they do not get enough one on one with a truly wonderful therapist. It seems like there is a shortage of extremely high quality therapists. Much of a care plan is group therapy sessions. One man told me, “I love it when that one jerk takes up all our time in group. Then I don’t have to say anything.” He was referring to a patient who hogged the conversations in group. I wish everyone could have quality, one on one time with a good therapist. A few years ago a private practice therapist, I’ll call him “Dr. T”, helped me tremendously. Our talk therapy was priceless. No prescription drug could ever replace that. We need more therapists like him in our state run system, so more patients can get one on one time.
    But where is the funding? Does each county get their own?

  9. It’s fair to say that the jury is still out on the effectiveness of assisted outpatient treatment, more accurately referred to as involuntary outpatient commitment. Most outcome studies suffer from methodological shortcomings. For example, involuntary outpatient commitment typically comes with enhanced treatment services. So, it’s not possible to determine if positive outcomes, when found, are due to the involuntary nature of these programs or the provision of enhanced treatment itself. Comparisons of groups receiving similarly enhanced treatment—with and without court-mandated participation—do not show that mandatory participation produces significantly better outcomes.

    What of those presumably too delusional to know they need treatment? That’s not a criterion for court-ordered treatment under San Francisco’s new law. And the criteria that do apply are vague and capable of overbroad application. Projections of likely utilization of involuntary outpatient commitment in San Francisco from the experience in Nevada County are highly questionable. There are few similarities between these communities.

    Yes—criminalization of mental illness is a disgrace. But the focus should be on expanding the availability of enhanced treatment, not forced treatment.

    • Mr. Gelber: It is true that the research is equivocal on the outcomes. A Cochrane review of two randomized controlled trials found no differences between groups on a variety of clinical outcomes but did find significantly less crime victimization for those in the IOT group.

      Generally I don’t believe that we should throw the baby out with the bath water and I believe that maintaining Laura’s law has some significant benefit while we are moving in the direction of more services and better access to those services. In essence, Laura’s law is a tool to help us move forward. We should be expanding services while we also have Laura’s law programs in place. Your fear that the criteria are too vague and could be applied overbroadly is a good one. But just as there is no current evidence of the program’s efficacy (there might be some in the future), so too there is no evidence that the counties that have applied Laura’s law (Yolo, Nevada, and Orange) have done so.

      Working in the correctional system has suggested to me that we need all the tools we can get to keep mentally ill people safe and out of prison/jail.

    • From the album: Timeline Photos
      By Humans of New York
      “They sent me to the psych ward 20 times. They said I had bipolar, schizophrenia, dyslexia, mad stupid shit. The only one that made sense was schizophrenia, because my mom has schizophrenia. I didn’t have any of that though. I was just angry. What I was angry about, anyone would be angry about.”

    • Hello Mr. Gelber,

      Your reply is fascinating but a tad difficult to comprehend. I just put it though the Flesch readability app and the grade level for your words is fairly high.
      You need everyone, at all different reading levels, to read your words because they are very important. Maybe you could use simpler words so everyone has a chance to be educated about your opinion.

  10. The man who killed the woman named Laura was reaching out for help from Nevada Co. Apparently, the man went into Nevada Co. in person, begging for psycho therapy?
    So he knew he had a severe illness, and he was turned away. And a beautiful young woman was killed.
    Obviously something needs to be fixed.
    Maybe some older folks still remember Jack Nicholson’s character in One Flew Over the Cuckoo’s Nest. Or they remember the Native American Indian, or the nurse. I think her name was Nurse Ratchett?
    Laura’s Law was born of good intentions, like Megan’s Law and cash for convictions and other laws. Just not sure the benefits of Laura’s Law outweigh the risks of abuse of Americans’ civil rights.
    No disrespect ntended for Laura’s family and friends. God rest her soul.

    • Was Ted Danson in that?

      • Ted Danson was not in this movie but I do advise you watch it, or read the novel. The blogger iduncan00 explains the book/movie, mentioned above, this way:
        The strongest commentary comes in Kesey’s themes about conformity. This novel is about the suppression of the individual spirit and the pressure of “the system” that demands everyone to conform to the same standards and values. You see it in minor details like Chief’s musings about trains dispensing people that all look the same who go home to houses that all look the same, to major events like a rebel like McMurphy being literally crucified and sacrificed by the “Combine” because he’s gotten dangerous in his inspiration to the other men who, up until this point, have allowed themselves to be manipulated by the system.
        Other major comments deal with the treatment of Native Americans and the destruction of the natural landscape in favor of sterile industrialization.

  11. If seriously ill people refuse voluntary treatment, they need to be treated involuntarily. They’re a danger to themselves and others if they aren’t treated.

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