Voluntary mental health services will deliver better outcomes
Eduardo Vega and Catherine Blakemore
Published 6:22 pm, Thursday, June 5, 2014
Crosses bear the names of the Newtown, Conn., shooting victims in Sandy Hook village. Photo: Seth Wenig, Associated Press
We all want to identify the reasons behind and prevent tragic senseless acts such as the horrifying violence that happened in Isla Vista last month. Our organizations, Disability Rights California and the Mental Health Association of San Francisco, and most mental health stakeholders across the nation agree that forcing treatment on people with mental health problems will not reduce these acts of violence.
Gun violence is an American problem unrelated to the prevalence of mental illness in this country. The prevalence of mental illness across the world varies somewhat, with prevalence in the United States being slightly higher than most others. But the prevalence of homicides by civilian gun violence is completely different. On that measure we stand, tragically, far and away above other developed nations.
San Franciscans recognize that we are not doing enough to provide effective services for people with mental health conditions. Proponents of AB1421 (often called Laura's Law), including The Chronicle, advocate for its forced outpatient provisions. Some have suggested that it's a cure for San Francisco's homelessness problem. Others also argue that it will prevent violence by people in dire need of mental health services, although there is no evidence to support this notion.
We agree with The Chronicle, the San Francisco Board of Supervisors and most people in San Francisco communities that we should radically improve mental health services and ensure they reach more people in need. Many of us are people living with mental health conditions or have family members with such conditions - we want better supports, better outcomes, and more compassionate communities to help reduce the despair, isolation and desperation that can accompany symptoms of mental illness.
Voluntary services are far more likely to deliver on these promises, especially new outstanding services developed in our state. This view was shared by Mayor Ed Lee's special CARE task force of community mental health experts, which recommended ways to better serve individuals with mental health conditions who are homeless and disengaged, but did not recommend implementing AB1421.
Simply put, that law does not create new or better services for people who are in need - it prescribes instead a bureaucratic, legally questionable process to compel these people, under threat of police force and involuntary hospitalization, to accept the same services that have failed them before.
The concept underlying involuntary outpatient commitment is that a court order will make the magic difference through the "black robe effect" of a judge's presence. A 2002 Rand Corp. meta-analysis of outcomes in eight states concluded: "[t]here is no evidence that a court order is necessary to achieve compliance and good outcomes, or that a court order, in and of itself, has any independent effect on outcomes."
Ironically, neither Adam Lanza (the Newtown, Conn., shooter), nor Elliot Rodger, the alleged attacker in Santa Barbara County, would qualify for the forced treatment authorized by this law - they had never been hospitalized, institutionalized or committed to an involuntary hold of any kind. Like Jared Lee Loughner, who shot Rep. Gabrielle Giffordsand others in Tucson, they managed to avoid official detection of their deteriorating mental health while they amassed weapons.
We need to back up compassion with new services, new supports and new monies to make a real difference. New legislative proposals to improve public safety include a "gun violence restraining order" that would give families an avenue to intervene when they see a rise in threatening behavior. Police training to help people in mental health crises and programs to reduce recidivism among prisoners with mental health disabilities are two funding priorities state Senate leader Darrell Steinberg has just put forward as well.
AB1421 is a marginal, ethically controversial program that has only been implemented in Yolo and Nevada counties, and which up to 2010 has been applied to six people. It is not a solution for racially diverse, urban and progressive communities like ours. An approach that is already working, the Full Service Partnerships possible through Mental Health Service Act (Prop. 63) funds, have been successful in reducing hospitalization days by 35 percent, homeless days by 66 percent and incarcerations by 48 percent. Associated peer support services increased the percentage of clients who successfully manage their mental health treatment from 30 percent to 80 percent.
And there is new state funding - more than $75 million already awarded to 28 counties - for critical services such as mobile crisis and community-based residential and stabilization beds. These services target people with the most serious needs and create "soft landing" spaces to help people through crisis without impacting our emergency rooms.
If we adopt programs like AB1421, which are fraught with bureaucratic, ethical and legal challenges, we will waste time and money. If we demand effective, evidence-based supports and treatment that are grounded in human dignity, we will soon see a positive difference in our communities and on our streets.
Based on our history of innovation, civil liberties and compassion for marginalized communities, San Francisco should lead the nation in mental health care that works. Rather than bureaucratic processes, we call for our supervisors and city leadership to implement the CARE task force recommendations for new psychiatric respite care, expanded homeless outreach teams, and mobile and site-based peer respite services.
Sorry, but undocumented or untreated mental illness has a direct relation with gun violence. According to the current laws, someone diagnosed or treated for mental illness would not be able to buy a firearm. So there is a whole subculture of the mentally ill that refuse contact or treatment. The only aspect of care which should be voluntary on the part of a patient, is their choice to take medication. Everything else should have an involuntary clause to treatment. The public's safety demands nothing less.« less
· 2 months ago
Santa Barbara is a college town with numerous colleges, including UCSB, that bring many young adults to that place for their education away from home. Young adults are often at the age of developing severe mental illness, as it evolves in this time of brain development. Locations such as Santa Barbara must have adequate mental health services for their residents. The Santa Barbara public health dept. advertises a mobile crisis intervention team, that is supposed to be available for in-home evaluations and interventions, upon solicitations by family members, or the public.This service is a sham. Parents call with very real concerns, and are dismissed. Family therapists call this service, and are dismissed. Instead of actually providing the mobile van with mental health providers, as is advertised, the police are summoned to go to the individual's home and make an assessment as to the person's status. The police are not qualified for this evaluation. In this case, Roger's parents and therapist called for help with assessing this young man, because of very worrisome video and written threats he made. The police did not check the California gun registry to determine he had purchased weapons, and they did not search his room or bring him in for further evaluation. This whole violent outcome could have been averted if the mobile crisis intervention team had been a real service.« less
· 2 months ago
The proposed introduction of Laura's law in San Francisco is very troubling for a number of reasons. First and foremost, mental illness should not be criminalized or brought into court supervision when no law has been broken. Being non compliant with a psychiatrist's medical recommendations or refusing to take prescribed medication should not result in a court intervention compelling treatment.
Many of these psych meds have long term and disabling side effects including severe weight gain and diabetes. I see it as a basic civil liberty to decide which medications one should take. The right of refusal should not be challenged with court orders.
Laura's Law or AB1421 will hurt more than it will help. It will also scare some of those in need from seeking treatment.
David Elliott Lewis, Ph.D.
Co-Chair, Mental Health Board of the City and County of San Francisco
· 2 months ago
Would any of this prevented the Isla Vista slaughter?
2 months ago