The Sacramento County Mental Health Board released a controversial report this week that endorses involuntary treatment for mentally ill patients in certain circumstances.
However, facing pressure from patient advocates, the board did not recommend involuntary care through Laura's Law, which gives judges greater authority to mandate services for the mentally ill and requires counties to provide the services they need.
The board's recommendation calls for an expansion of the county's Mental Health Court, a specialty court for criminal offenders with mental illnesses, where a judge would have the option of requiring defendants to receive treatment. A relatively small number of people would be eligible for the process.
The recommendations – approved by the board Wednesday night and forwarded to the county Board of Supervisors for consideration – are the result of a one-year study into alternative treatment options for mentally ill people not receiving care. Three board members interviewed a wide range of experts and officials to complete the 100-page report.
The recent massacre of children and adults at Sandy Hook Elementary School in Newtown, Conn., has revived a debate about providing mental health treatment to people who aren't receiving it and may not want it.
Under Laura's Law, approved by California lawmakers in 2002, judges can order treatment when someone has a history of violence, incarceration or hospitalization. However, counties have to adopt the law and provide service when they do.
The law was named after college sophomore Laura Wilcox, who was shot and killed by a mentally ill man 10 years ago in Nevada City. Scott Thorpe, under the care of Nevada County's mental health department at the time, killed Wilcox and two other people while she was working part-time for the department.
Nevada County agreed to implement the law as part of a settlement with Wilcox's family. However, of California's 58 counties, only Nevada and Los Angeles counties have adopted the law.
Patient groups have raised objections to forced treatment and threatened to sue counties that adopt the law.
More counties haven't opted into the program because they don't want to spend money on treatment, said D.J. Jaffe, executive director of Mental Illness Policy Org.
"It reduces suicide, hospitalization, incarceration and makes (patients) well," he said. "It also commits the mental health system to provide the service they need."
In the Sacramento board's report, Dorian Kittrell, who heads the county's Mental Health Treatment Center, said the county lacks the funding needed to implement the law.
The county has made widespread cuts to mental health services in recent years due to budget reductions.
Since 1988, Jaffe says there have been at least 21 incidents of serious violence in Sacramento that might have been prevented if Laura's Law had been in place.
The incidents were collected in a database maintained by the Treatment Advocacy Center, a nonprofit that promotes access to treatment. Most of them involve mentally ill people who were killed or killed someone else.
In the most recent case in September 2011, Sean Ogle was shot by Sacramento police after he went on a rampage with a baseball bat and reportedly threatened a police officer. Friends said he had schizophrenia and bipolar disorder and his symptoms had worsened.
The co-authors of the Mental Health Board report wanted to recommend that supervisors adopt Laura's Law if it could be implemented as it has in Nevada County, where a wide range of services are provided to people in the program.
But the full board decided Wednesday to exclude the proposal from the recommendations that will go to supervisors.
Delphine Brody of the California Mental Health Network told the board last year that the organization strongly opposed adoption of Laura's Law.
Members Frank Topping and Jane Fowler, who represent consumers on the board, expressed concern Wednesday about forcing treatment on people who don't want it.
Topping said the report's conclusions reflected a bias against users of mental health services and complained that not enough of them were included in the committee that completed the report. Two people with mentally ill family members and one consumer worked on the report.
Board Chairman Christopher Hunley said the report considered input from many stakeholders and was not biased.