THE HISTORY OF MENTAL HEALTH Colonial American’s referred to people suffering from mental illness as “lunatics” which was derived from the word lunar meaning moon. They believed insanity was caused by a full moon. Individuals suffering from mental illness were either classified as “manic” or “melancholy”. Colonists believed that to cure mental illness cathartic medical treatment was required to “expel crisis” from the individual. Treatment for various mental conditions consisted of barbaric procedures including ice baths, brain shocks, and blood letting. Few people experienced any real recovery from these treatment regiments. Mentally ill individuals were usually removed from society and locked away.
Whitaker, R. (2002). Mad in America: Bad science, bad medicine, and the enduring mistreatment of the mentally ill. Cambridge, MA: Perseus Pub.
THE HISTORY OF MENTAL HEALTHContinued -Turn of the Century-
New approach to treatment was introduced called, “Moral Management”. This approach focused on the importance of environment in the curative process. Artwork , beds, music, and culture replaced shackles, chains and cement cells as treatment methods. Servicemen experiencing postwar mental illness were funneled into hospitals and asylums for treatment. Due to overcrowding restraints and shock therapy were reintroduced. Opium was introduced as a drug treatment option.
THE HISTORY OF MENTAL HEALTHContinued 1930 and beyond…
In 1930 the lobotomy (a medical procedure that separates the neural passages that connect the front and back of the brain) was introduced. Common outcomes of the procedure were mental confusion, flat affect, weight gain, lack of motivation, and inhibition Thorazine, one of the first psychotropic medications for treatment of the mentally ill was introduced was introduced in 1954. In 1960 the mental health community began to de-institutionalize and there was a push towards out-patient and short term in-patient care. The movement towards community mental health facilities coupled with The Mental health bill in 1963 and the Medicade and Medicare acts in 1966 lead to a reduction of the use of existing mental health hospitals. The homeless population soared as the elderly, indigent, and mentally ill patients were released from asylums. Whitaker, R. (2002). Mad in America: Bad science, bad medicine, and the enduring mistreatment of the mentally ill. Cambridge, MA: Perseus Pub.
History of Laura’s Law Named after Laura Wilcox who was killed by a Scott Harlan Thorpe, a mentally ill person who refused treatment. Laura Wilcox was working in a public mental health clinic where Thorpe entered in a rage. Thorpe then shot and killed Laura Wilcox. Laura’s Law is based on New York’s Kendra’s law and makes assisted outpatient care available for severely mentally ill individuals in California. Laura’s Law was introduced in 2001, passed in 2002 and went into effect January 1st, 2003. The Treatment Advocacy Center, T. C. (n.d.). A guide to Laura's law. Retrieved from http://www.treatmentadvocacycenter.org
Laura’s Law Los Angeles County adopted a pilot program in 2004 2008 Nevada County was the only county which fully adopted Laura’s Law funded by Proposition 63, the Mental Health Services Act, which is designed to support those with mental health. Only 23 people have been referred to an Outpatient Treatment Program through Laura's Law 19 of the 23 clients voluntarily complied with the court order. The other 4 had to go to a hearing to be forced to treatment. San Francisco County, Marin County, San Mateo County, and San Diego County have considered implementing it, but have not due to funding and the feeling that it may impede the right to freedom.
The only case law that that is referenced when discussing Laura’s Law is the law that inspired it: Kendra’s Law. Carpinello, Sharon (March 2005), "Kendra's Law Final Report on the Status of Assisted Outpatient Treatment", Office of Mental Health NY, http://www.omh.state.ny.us/omhweb/kendra_web/finalreport/, retrieved 2010-10-27
Laura’s Law Timeline 2001- A social worker intern named Laura Wilcox, worked in a rural county in Nevada County, CA. Laura was killed by a severely disabled mental health patient, who previously refused mental treatment and medications. 2002- Governor Grey Davis (California), passed Laura’s Law. Modeled after Kendra’s Law (New York), law was passed to allow court ordered to mandate treatment for severely disabled mental health patients who refused medical treatment and medications. 2003-Laura’s Law also Assembly Bill 1421 (AB 1421), allows counties within the State of California, to administered medication to severely disabled mental health patients.
Laura’s Law Timeline (continued) AB 1421 ensures medications are administered to patients who are severely disabled. Patients are referred by law enforcement, family members, and community outpatient treatment programs. 2004- to provide funding for patients that meet the guidelines for Laura’s Law; Proposition 63 was passed by California voters. Prop. 63, was passed as the Mental Health Service Act (MHSA). It allows funding to meet the involuntary criteria.
Kendra’s Law In 1999, Andrew Goldstein, a NY resident who suffered from schizophrenia and was not med compliant constantly requested supervised services. Three weeks after being discharged from a state hospital, he went to a subway station and pushed Kendra Webdale in front of a train. This tragedy and other similar events inspired the making of Kendra’s Law. Kendra’s Law is used to provide services to 747 participants per year. Carpinello, Sharon (March 2005), "Kendra's Law Final Report on the Status of Assisted Outpatient Treatment", Office of Mental Health NY, http://www.omh.state.ny.us/omhweb/kendra_web/finalreport/, retrieved 2010-10-27
Kendra’s Law Allows a person with mental health to be referred to assisted outpatient treatment (AOT) without having to meet the criteria of being hospitalized. Targets those who are decompensating and may cause a threat to public safety Targets those who have a history of noncompliance with treatment plan. Benefits those who have aosognosia (no insight of diagnosis), those who don’t want to address their illness, and those who slip through the cracks Designed to relapse prevention Not only commits the person to receive services, but also commits the mental health system to provide the service Swartz, Marvin (06-30-09), "New York State Assisted Outpatient Treatment Program Evaluation", Office of Mental Health NY, http://www.macarthur.virginia.edu/aot_finalreport.pdf, retrieved 2010-10-27
Studies Show… OMH study of clients during the first 6 months of treatment 74 % fewer experienced homelessness 77 % fewer experienced psychiatric hospitalization 83 % fewer experienced arrest OMH study of clients 6 months after treatment 55 % fewer recipients engaged in suicide attempts or physical harm to self 49 % fewer abused alcohol 48 % fewer abused drugs 47 % fewer physically harmed others 46 % fewer damaged or destroyed property 43 % fewer threatened physical harm to others New York State Psychiatric Institute and Columbia University 75 % said that AOT helped them gain control over their lives 81 % said that AOT helped them to get & stay well 90 % said AOT made them more likely to keep appointments and take medication Carpinello, Sharon (March 2005), "Kendra's Law Final Report on the Status of Assisted Outpatient Treatment", Office of Mental Health NY, http://www.omh.state.ny.us/omhweb/kendra_web/finalreport/, retrieved 2010-10-27 Swartz, Marvin (06-30-09), "New York State Assisted Outpatient Treatment Program Evaluation", Office of Mental Health NY, http://www.macarthur.virginia.edu/aot_finalreport.pdf, retrieved 2010-10-27
Groups Most Affected The populations most affected are the mentally ill over the age of 18 years of age with a history of violent behavior that resulted in incarceration. Laura’s Law is targeted against the population of mentally ill that have already been involved in acts of violence. If the patient failed to comply with the original order there may be challenges around getting the patient to comply with another restrictive order. If the patient does not adhere to the terms of an outpatient commitment order, they must be found negligent for failure to take medications separately.
Groups Most Affected Assisted medical treatment affects the mentally ill and incarcerated populations. Minorities are affected due to historical connections with involuntary treatment. Historically minority institutionalizations created a negative stigma around treatment therefore leaving the mentally ill wary of seeking treatment. Failure to comply with medication use cannot be used for grounds of involuntary hospitalization. As long as the patient is not of harm to themselves or others they will not be hospitalized for more than 72 hours. Individuals suffering from severe mental illnesses have a higher risk of criminal involvement.
Groups Most Affected Studies show that those involved in voluntary treatment have a lessor chance of being arrested than of those untreated. “The odds of arrest for participants currently receiving AOT were nearly two-thirds lower (OR=.39, p<.01) than for individuals who had not yet initiated AOT or signed a voluntary service agreement” (Gilbert et al., 2010). Applebaum, P. S. (2003). Law & Psychiatry: Ambivalence codified: California's new outpatient commitment statute. Psychiatric Services, 54, 26-28. Gilbert, A. R.., Moser, L. L. ., Van Dorn, R. A. ., Swanson, J. W.., Wilder, C. M., & Robbins, P. C., et al. (2010). Reductions in arrest under assisted outpatient treatment in New York. Psychiatric Services, 61(10), 1-4.
Pros vs. Cons of Laura’s Law Pros: Provides court-ordered intensive outpatient treatment for severely mentally ill people. Helps those who cannot help themselves. Makes patients and treatment team responsible for adherence to treatment protocol. Individuals overwhelmed by mental illness may have an increased quality of life as a result of mandated out-patient treatment. Will create a reduction in the number of mentally ill people living on the streets. Cons: Consumer input is vital in treatment and recovery. For the severely mentally ill AB 1421 takes away that choice. Involuntary commitment criteria changes from county to county. The Law is not uniformly applied. Reinforces the stereotype that all mentally ill people are violent. Minorities may be disproportionately overrepresented in the application of the law. No state funding. The Treatment Advocacy Center, T. C. (n.d.). A guide to Laura's law. Treatment Advocacy Center. Retrieved July 8, 2011, from http://www.treatmentadvocacycenter.org
Relevant Issues Surrounding Laura’s Law Laura’s Law could easily be viewed as sacrificing the rights of the mentally ill. There are holds that may be utilized should a mentally ill individual need treatment. For example, there is the 5150 hold, 72 hour hold, and if necessary a hold that can be extended up to 14-days. Many opponents of Laura’s Law feel that the law is too vague and patients are denied basic rights. Opponents feel that there is a need for more comprehensive wellness recovery programs and a broader array of programs. Many mentally ill populations have lost trust for service providers due to forced involuntary detention in hospitals with patients losing their rights regarding what goes into their bodies and where one is placed. Forced treatment would be detrimental to individuals whom do not feel the need for treatment. Forced treatment could be detrimental to individuals whom do not feel the need for treatment.
Relevant Issues Surrounding Laura’s Law (continued) Many feel that involuntary treatment threatens liberty as well as an individual’s First Amendment right to his or her thoughts. Altering a person’s thoughts through drugs interferes with that person’s right to think freely. Liberty involves the ability to make decisions to either accept or reject treatment. The U.S. Supreme court ruled that the proscription against discrimination embodied in the Americans with Disabilities Act and the Attorney General regulations suggested the treatment of individuals with mental disabilities should be in the community rather than an institution.
Relevant Issues Surrounding Laura’s Law (continued) Laura’s Law is an intermediate intervention before imminent danger if services are offered before the individual is in crisis mode. Judge gets to talk to client regarding treatment plan and client can discuss treatment plan with attorney, caseworker, family, and friends. Laura’s Law is designed to prevent holds such as 5150, 72 hour, and up to 14-day holds. Laura’s Law encourages voluntary access to program.
Relevant Issues Surrounding Laura’s Law (continued) The right to community treatment depends upon the state’s treatment, professionals determining that community placement is appropriate that the client does not oppose a transfer from institutional care and that the placement can be fiscally accommodated without depriving other individuals with mental disabilities who are under the care of the state. Easier to compel individuals to take their medication therefore avoiding jail. Assisted outpatient treatment fills the gap for the Lanterman-Petris Act, which emptied institutions in favor of community half-way houses. Forum with Michael Krasny. (5/14/2010). Laura’s Law. Retrieved from www.kqed.org/epArchive/R201008030900. Forum with Michael Krasny. (8/3/2010). Laura’s Law. Retrieved from www.kqed.org/epArchive/R20100803900. Jr, Alexander, R. (2003). Understanding Legal Concepts That Influence Social Welfare Policy and Practice. Thomson-Brooks/Cole.
Social Work Implications of Laura’s Law There are two aspects of social work that support the client’s rights to refuse medications. Social workers provide support services and educate the clients on psychotropic medications. Social workers talk with clients about their feelings around using medications, make referrals to physicians, and discuss how medications may work with various psychosocial interventions.
Social Work Implications of Laura’s Law Social workers are obligated to respect the client’s privacy, religious beliefs, and acknowledge the clients competence. Winters v. Miller (1971), ruled that states do not have the right to override refusal of medication because of a patient’s religious beliefs. Social workers must respect religious boundaries and encourage client participation in treatment.
Social Work Implications of Laura’s Law Due to the social workers professional mandate, social workers are expected to support the client’s rights to refuse medications. Social workers must also respect the individual’s dignity, self -worth and right to self-determination. The social worker must be able to place their values aside to support client decisions for alternative treatments. Bentley, K.J., Walsh, J, & Farmer, R.L. (2005). Social work roles and activities regarding psychiatric medication: results of a national survey. Social Work, 37.
Bentley, K. (1993). The right of psychiatric patients to refuse medication: where should social workers stand? Social Work, 38. Retrieved from www.pubmed.gov
Recommendations It is proven through the results of Kendra’s Law that Laura’s Law would be effective. In the few cases where Laura’s Law have been implemented there were mostly favorable outcomes. Therefore education should be provided to the police and to mental health professional on the benefits of implementing the law and enforcing public safety. It would be beneficial to make the law mandatory and use MHSA funding, as Nevada County did, to fund the treatment.
Recommendations(Continued) It would be helpful to mandate treatment centers to provide services to clients so that they can’t be discharged because they are difficult to work with. Laura’s law should at least be piloted in California’s counties with a high population such as San Francisco County and Los Angeles County to observe its outcomes. Eventually it should be made mandatory for all counties, instead of at the discretion of the county as it is now. It is beneficial for helping people before they have to be hospitalized long term or end up in jail for harming others. Hogan, M., & Cuomo, A. (n.d.). Final report on the status of assisted outpatient treatment table of contents. New York State Office of Mental Health. Retrieved October 27, 2011, from http://www.omh.state.ny.us/omhwe