There is no simple solution for the complexities of severe and persistent mental illness.

But California policymakers have made one aspect of a knotty problem much too difficult, and in the process, inhibited counties' ability to try approaches that could help the most severely mentally ill among us.

The issue involves Laura's Law, which The Bee's Dan Morain has examined in columns last Sunday and today. Laura's Law is a little-used 2002 statute that permits counties to be more assertive in their care of mentally ill people by implementing a concept known as assisted outpatient treatment.

The law is set to expire on Jan. 1, 2013. Assemblyman Mike Allen, D-Santa Rosa, plans to introduce a bill to extend the sunset. He and legislative leaders ought to seize the opportunity to strengthen the law.

The only county that has embraced the law fully is rural Nevada County, the scene of a 2001 rampage by a mentally ill man that left three people dead, including the law's namesake, Laura Wilcox.

Like all legislation, the bill by then-Assemblywoman Helen Thomson was a compromise. But the California Department of Mental Health watered the bill down further by issuing an ambiguous interpretation about whether counties can pay for Laura's Law programs with money generated by Proposition 63, the 2004 initiative that raised income taxes on wealthy people to pay for mental health care, and generates $1 billion-plus a year.

Bending to well-organized advocates who oppose involuntary treatment, the department concluded that counties can use Proposition 63 money only for services that are "voluntary."

Aspects of the statute could be viewed as compulsory. In Nevada County, judges, after hearing evidence, can direct that individuals accept outpatient treatment, though owing to one compromise, the law doesn't give judges direct authority to compel people to comply with the orders.

Other counties assume they would be sued if they use Proposition 63 proceeds for Laura's Law programs, with good cause. Disability Rights California, a government-funded legal aid group, has sent them warning letters.

In Orange County, with a population of 3 million, behavioral health director Mark Refowitz issued a critique of the law in which he estimated that 120 severely mentally ill people would be affected, at an annual cost of as much as $6.1 million.

To pay for it, Refowitz wrote, the county would need to use general tax funds, which are in short supply, because "it is doubtful whether Mental Health Services Act (Proposition 63) funds could be utilized." He told The Bee it's a "foregone conclusion" that the county would be sued if it were to use Proposition 63 money.

Legislators need to make clear that Proposition 63 money can be used. They also should authorize judges to extend treatment orders for periods longer than the current six months, and give them authority over individuals who may defy their orders.

Assisted outpatient treatment has nothing to do with locked wards of old. Rather, the goal is to reach people before they must be hospitalized or jailed, and help them live with the fewest possible restrictions, in their own homes.

Senate President Pro Tem Darrell Steinberg intends to get involved in the issue, and should.

He authored Proposition 63. It undoubtedly has helped numerous people. But at least some of the money should be aimed at preventing seriously ill people from harming themselves or others, before they act, even if they must be ordered to accept care.

The issue is broader than one statute. Legislators should undertake a longer-term review of the Lanterman-Petris-Short Act, the 1967 law that governs mental health care in California.

It's a tough issue. But legislators who tackle it would leave their mark by helping people who, through no fault of their own, cannot help themselves.

The Bee's past stands

"Current law limits involuntary treatment to those who are 'gravely disabled or a danger to themselves or others.' The goal of Thomson's bill (Laura's Law) is to force extensive outpatient treatment on people before they become disabled or a danger and have to be hospitalized or jailed; they would get help before they kill or – and this is more likely – commit suicide."

– May 14, 2001

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