Have laws to protect the severely mentally ill compromised our safety? To comment, please use our comments section at the end of the story or go our facebook page at www.facebook.com/sacramentobee. One in an occasional series

Aaron Bassler lived in a Depression-era cabin in the North Coast town of Fort Bragg and drew pictures of the invasion from outer space he believed was imminent. In August, he shot and killed two men. After a 36-day manhunt, he died in a fusillade of bullets fired by sheriff's sharpshooters.

In February, months before the horrible events, Jim Bassler, Aaron's father, wrote to Mendocino County authorities pleading with them to intervene. Now, he is a conscript to the cause of changing the mental health care system.

Kelly Thomas was a homeless man who suffered from schizophrenia. Suspecting that he had burgled cars, police confronted him outside a Fullerton bus depot. As bystanders captured the beating on video, Thomas is heard to cry out, "Dad, Dad, Dad." He died five days later.

"He needed to be forced to take his medication," Cathy Thomas, Kelly's mother, told me. Her son could hold rational conversations when he took his meds. When he didn't, he would converse with voices in his head. "He needed someone to step in."

In 2002, the Legislature approved a method for providing more aggressive treatment for mentally ill people, passing a bill named for Laura Wilcox, a college sophomore shot to death by a man under the care of the Nevada County Department of Behavioral Health. Scott Thorpe's rampage left three people dead on Jan. 10, 2001.

A decade later, Laura's Law is an orphan. The California Department of Mental Health, which should be a champion, neglects it. A patients rights organization that opposes involuntary treatment threatens to sue any county that dares adopt it.

Only Nevada County has embraced it. In a collective quest for absolution, leaders in this rural county have transformed their once frayed mental health care system, offering a lesson for the rest of the state.

The failure to replicate this success explains much about the troubled mental health care system and the abdication of responsibility to care for the most severely mentally ill. You don't need to be a shrink to understand why.

"No one wants to deal with them, because they're the hard cases," Jim Bassler, a commercial fisherman, told me. "The money goes to help people who want help and are easier. It's understandable. I don't look for the hardest fish to catch."

Law was a compromise

Then-Assemblywoman Helen Thomson patterned her 2002 legislation after a New York law, named for another woman, Kendra Webdale, killed when a mentally ill man shoved her into an oncoming subway train.

Thomson's supporters included psychiatrists and family members who witnessed mental illness consume their kin and how they received care only after they harmed themselves or committed crimes.

Laura's Law seeks to allow intervention before someone becomes so ill that they land on a psych ward or in jail. It is a success when people remain in their own homes, with the fewest restrictions possible.

To win passage, Thomson needed to compromise. She agreed to give counties a choice whether to implement the law, unlike New York, which mandates that counties provide such care.

She also had to agree to restrict counties' ability to fund the law's programs, accepting an amendment that says that "no voluntary mental health program serving adults … may be reduced as a result of the implementation."

Without those and other amendments, Thomson never could have pushed the bill past then-Sen. John Burton, the most powerful lawmaker in town at the time. The San Francisco Democrat embraces the view held by some psychologists and patients rights advocates who believe that people must voluntarily seek treatment for it to be effective and that they should be empowered to reject medication.

"It is a flat-out civil liberties issue," Burton said the other day.

California provides more money than ever for mental health care, thanks to Proposition 63, a 2004 initiative that earmarks upward of $1 billion a year for care.

"We should provide care before people end up on the streets or behind bars," proponents of the initiative said in the voter pamphlet urging its passage.

That line certainly sounded good. But it was vacuous. The California Department of Mental Health issued an ambiguous interpretation of Proposition 63 that effectively restricts use of money to services for which patients volunteer.

Because aspects of Laura's Law can be viewed as compulsory, the state's interpretation raises doubts about whether counties can spend any Proposition 63 money for its programs.

By limiting the use of Proposition 63 money, the state crippled the law and essentially required counties to fund it with general tax money, which is in short supply.

If lack of money weren't enough to kill the programs, a legal aid group, Disability Rights California, threatens to sue counties that might use Proposition 63 money to establish Laura's Law.

Chartered by federal and state laws in the 1970s, Disability Rights California represents people with disabilities, including mental illness and developmental disabilities, and often fights involuntary treatment. It's formidable, operating on an annual budget of $20.5 million, including $19 million in government grants.

Dan Brzovic, the group's associate managing lawyer, isn't aware of any individual who feels aggrieved by Laura's Law, but said, "From a civil rights point of view, it does cause damage by expanding the criteria (for involuntary treatment) to include people who are not gravely disabled or dangerous."

Even in its compromised form, Laura's Law expands the definition of who can be treated to include people who at some point may never "become gravely disabled in the future."

"You cannot predict future dangerousness," Brzovic said.

Settlement curbed L.A. effort

Disability Rights sued Los Angeles County when it tried to implement Laura's Law. The county settled in 2005 by agreeing to strictly limit the size of its program. Los Angeles County, with its 10 million people, offers assisted outpatient treatment to all of 10 low-level criminal offenders.

Even in this absurdly small program, there is success. Comparing individuals' lives in the six months preceding their participation and six months after, the county finds a 75 percent-plus reduction in the number of days they spend in forced hospitalization and jail.

Nevada County calls its program voluntary and uses Proposition 63 money to pay for part of it, $2.7 million since 2008. Disability Rights has contemplated suing the county.

"It is something we're looking at, but haven't made a decision," Brzovic said.

A suit would disrupt important work. On a recent Monday, nine mental health caseworkers gathered in a conference room in their Grass Valley office to review weekend incidents: One woman talked of suicide. A man worried his family by using a machete to chop down bushes on his property where he thought people might be hiding.

A Nevada County psychiatrist made a house call at the jail to make sure a young man had the proper antipsychotic drug. A woman who is a recluse, because she fears the Mexican Mafia is after her, went bowling, a minor miracle and major victory.

The caseworkers' clients have tried to kill themselves and hurt others. They've been hospitalized against their will and jailed. They have been homeless and have refused treatment, generally because they are too sick to know they are ill. Caseworkers say they're privileged to carry out this work, and they mean it.

The caseworkers are from Turning Point Providence Center, a nonprofit that has a $1.8 million a year contract with the Nevada County Department of Behavioral Health.

"Whatever it takes," said Carol Stanchfield, the Turning Point executive who supervises the effort. She has her own caseload and keeps a framed portrait of Laura Wilcox on her office shelf.

35 in Nevada County program

Under Laura's Law, a family member, a cop or a social worker who is worried about an individual's state of mind can contact the behavioral health department. A caseworker will visit the person, offer food, shelter, something, to induce them into assisted outpatient treatment.

Assisted outpatient treatment may sound nebulous, but it's not. Recipients are assigned to a "personal services coordinator," a caseworker who arranges drug counselors, group therapy, psychiatric visits, whatever. Someone is at the other end of the phone at all hours.

Nevada County expected 50 assisted outpatient treatment cases a year. That was an overestimate. Since 2008, when the county started its program, 35 individuals have been referred.

Nine people didn't meet the criteria. Sixteen others agreed to participate. For the people who refuse, Nevada County Behavioral Health Director Michael Heggarty files a Superior Court petition seeking an order directing compliance.

Nevada County Superior Court Judge Thomas Anderson has granted 10 petitions directing compliance. Anderson knows how dreadful the system was on the day Thorpe killed three people. He was the Nevada County public defender at the time and defended Thorpe.

"Why anyone opposes this is beyond me," Anderson told me.

Anderson let me sit in on a Laura's Law hearing earlier this month so long as I didn't identify the subject. I'll call him John, the 11th person to undergo such a hearing. Like all subjects of such hearings, John had an attorney. Two Turning Point caseworkers and a psychiatrist were there representing the county.

The man wore a tie, was lucid and wanted no part of what they offered. Far from heavy-handed, Anderson sought a middle ground: Would John attend therapy? Meet with a psychiatrist? Agree to a new type of medication?

"I don't have psychotic experiences," the man replied. "I don't hear voices, Your Honor."

Anderson was getting nowhere and put off a decision whether to order treatment. So long as John maintains, there is unlikely to be an order. I don't know John's history. His file is sealed, as are all such cases. But the bar to qualify is high, so much so that Thorpe might not have met the criteria.

Adults must have refused treatment and be unlikely to survive without intervention. They must have been hospitalized or jailed twice in a three-year period, or have committed or threatened to commit violence.

They are people like a man I'll call Jack, who had his first break with reality in 2003 when he was a UC Santa Cruz student. His parents brought him home to Nevada County, not knowing what was in store for him and for them.

In the years since, Jack has broken doors, walls, furniture, and his father's sternum. Police have picked him up, and he has been hospitalized against his will. He was homeless when his mother called the mental health department. Jack refused help, prompting the county to request an order from Anderson to compel treatment, which he granted.

For six months, Jack complied with the order, participated in therapy, saw a psychiatrist and took antipsychotic meds. In November, he moved into an apartment. Without the help, Jack would have been on the streets, or worse.

"I would be worried about his safety," his mother told me. "Not much sleep."

Anderson's six-month order expired two weeks ago. Laura's Law has no provision by which Anderson could extend it, another of the compromises made to win passage. That's a problem.

Jack has stopped taking his meds and started drinking. His mother and caseworker must wait until he spirals down before petitioning the court once more. But at least there will be a net to catch him.

Nevada County Deputy Public Defender Keri Klein represents most people in Laura's Law cases, including Jack. The civil libertarian in her questions why government inserts itself into the lives of people who have committed no crime. But she also cares for her clients and sees the benefits: "a decrease in crime, people get back on their feet, they get apartments."

The 35 people who have been referred are a subset of 100 severely mentally ill people under the care of the county and Turning Point. In the year before entering the program, they spent 1,404 days in hospitals because of their mental illness and 1,824 days in jail, at a cost of $1.2 million.

In the year after being in treatment, the recipients spent 748 days in hospitals and 637 days in jail. Nevada County spent $500,000 less on their care than if it had conducted business the old way.

Laura's Law will sunset Jan. 1, 2013. Assemblyman Mike Allen plans to introduce a bill to extend it. It probably will pass, though some critics would dismantle it.

They contend the success in Nevada County could never be exported to a big city. But what of New York, which has tougher law that has been in place for 11 years? Judges there have ordered treatment for 9,700 people. The concept works in Manhattan and in Nevada County. Surely, it's worth a try in Los Angeles, Fort Bragg and Fullerton.

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