Should Involuntary Treatment for the Mentally Ill Be the Law?

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Kelly Thomas, left, and his father Ron Thomas in 1997. Kelly, died July 10, 2011, after being beaten by six police officers.

For years, Ron Thomas struggled to convince his son Kelly to stay on medication and off the streets. That was a challenge, Ron says, because Kelly wasn't aware he had schizophrenia, and he would sometimes refuse treatment and wander the streets of Fullerton, Calif. He was doing just that in July when he was beaten and killed by six police officers at a bus depot. The officers' alleged brutality in the case has attracted national attention, especially after the local district attorney charged one of them with second-degree murder. But the incident has also triggered an emotional battle over one of the most divisive subjects in mental health: involuntary treatment for the ill.

In 2002, California passed legislation allowing judges to order involuntary outpatient treatment for people with severe mental illnesses if they have a history of being jailed, hospitalized or show violent behavior towards themselves or others. The law was dubbed "Laura's Law" after Laura Wilcox, a college student who was shot to death in 2001 by a man with an untreated mental illness. It was modeled after "Kendra's Law," similar legislation passed in New York state. Short-term involuntary hospitalization was already legal in California in cases where patients had already shown they were a danger to themselves or others. But Laura's Law was touted as a preventative measure allowing family members, mental health workers or parole officers to request treatment for the ill before they do anything harmful, especially in cases where a patient's condition inhibits them from making rational decisions about treatment. The law, however, left it up to counties to decide if they want to implement it, and they've been reluctant to do so not only because it's controversial in terms of civil rights but because of funding problems. Almost a decade later, only one of California's 58 counties has adopted it, Wilcox's Nevada County. A second is running a pilot program.

After years of failed attempts to expand the law to more counties, advocates are seizing on Thomas's tragic but well-publicized death to push for implementation in Orange County, the third most populous in the state after Los Angeles and San Diego. Indeed, the Orange County government recently asked its health care agency to study possibly adopting the law. Groups that support the legislation, such as the Treatment Advocacy Center, argue it would help keep mentally ill people like Thomas off the streets and out of danger by making it easier for others to get them treatment. That's sorely needed because an estimated one-third of the nation's homeless have untreated psychiatric illnesses, according to the Treatment Advocacy Center.

Supporters of the law often cite a study by the New York Office of Mental Health showing that Kendra's Law significantly reduced the number of days that mental patients spent in jail, in the hospital and on the streets. (Opponents of the law counter that another study shows patients who received voluntary treatment fared just as well.) Thomas Anderson, presiding judge of the Superior Court of California in Nevada County, says that despite the concerns about funding, Laura's Law has actually saved his county money. "This process has reduced the need for action by law enforcement, medical emergency personnel and the courts, and lessens the trauma and anguish of family and friends," Anderson wrote in a letter urging Orange County officials to adopt the law. Orange County's health care agency, however, appears to have sided with opponents, issuing a report critical of Laura's Law and skeptical about the viability of funding it. The county's board of supervisors has yet to set a date to discuss the report, and a spokesman said it was unclear when the board will take the matter up again.

There's no shortage of heartbreaking stories surrounding this issue. On a recent afternoon at a home in Orange County, Mary Palafox fought back tears to tell the story of her 27-year-old son Nathan's deterioration into schizo-affective disorder. Nathan, a jazz drummer, was studying music at a local university when he began hearing voices and telling people he thought he was dying, according to his mother. He stopped performing music, isolated himself from others, and trashed his apartment. But Palafox couldn't get Nathan treatment because he refused, believing he wasn't sick. County psychiatric health teams that evaluated him didn't help either, concluding he wasn't enough of a danger to himself or society. "They need you to actually start the fire or try to take their life. Once you do that, it's already too late," Palafox says. Indeed, Nathan got hold of a weapon, which Palafox says he intended to use to kill himself. Instead, he pulled it out when a police unit came to his house, ran outside, and was Tasered to the ground. He's now being charged with assault of an officer. Palafox says that under Laura's Law, she would have been able to get Nathan on medication, which could have improved his condition and prevented an altercation with the police. "It's been an extraordinarily horrific and painful process," Palafox said, her eyes welling up with tears. "He was allowed to disintegrate to the point where he wanted to take his own life."

While tragedies like Nathan's are compelling, the debate over Laura's Law is thorny. Some mental health patients, health care providers and disability rights attorneys bitterly oppose the law, calling it a violation of civil rights. They say Laura's Law is a throwback to an era when people were institutionalized against their will and traumatized to the point of distrusting health care. "When someone does something without your consent, including forcibly injecting you with medications, it can feel very dehumanizing. It feels like you have no control over your own being," says Ron Schraiber, who is recovering from mental illness and is director of client-peer relations for the Los Angeles County Department of Mental Health. Schraiber, who was expressing his personal opinion and not that of his department's, was diagnosed with paranoid schizophrenia and bipolar disorder when he was a college student in the 1970s, and underwent forced psychiatric treatment multiple times in state hospitals after he caused disturbances in public that police deemed dangerous. "To have them pull your pants down and inject you and then to have deleterious side effects, you feel objectified. You're not a person. You become a diagnosis."

Groups such as the California Network of Mental Health Clients, for whom Schraiber was a founding board member, have launched media campaigns and local rallies to oppose Laura's Law in counties that have considered it. "We consider the expansion of forced treatment to be an incursion on our civil liberties," says Delphine Brody, public policy director for the group. Brody and her allies say the law unfairly stereotypes the mentally ill by assuming they can't make rational decisions to seek treatment, and that such stigma negatively affects patients for the rest of their lives. They instead argue for more state investment in voluntary, community-based treatment and prevention programs, which they say have been hit too hard by the budget cuts of recent years.

Opponents also balk at the notion that the law could have saved Kelly Thomas, arguing that the tragedy was caused by police cruelty and not because of a lack of options for involuntary treatment. "Laura's Law does nothing to stem violence against those with psychiatric disabilities or the homeless nor does it provide police training in crisis intervention that might have saved Thomas's life," reads an op-ed published this month in the Los Angeles Daily News by a member of the California Network of Mental Health Clients and an attorney at a group that fights for disability rights.

The law's opponents don't have Kelly's father on their side. Ron Thomas believes that had the law been implemented and police officers trained on how to use it, law enforcement might have requested a medical evaluation for Kelly instead of beating him. And, after battling for 12 years to get his son care, he believes family members need more options to help mentally ill loved ones. "Many people say it violates rights," Thomas says. "But it's what's best for them to get them back on the right track."