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Wednesday, Jun 04 2014 02:00 PM

BRIK McDILL: Laura's Law: It might have helped

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    Brik McDill

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BY BRIK MCDILL Contributing columnist

One more angry young man, one more rampage. Seven dead, 13 wounded. Three from knife injuries, 17 from gunfire. His parents were screaming for help; he made no secret of his rage.

Police responded before the slaughter but found no evidence of his being "imminently of danger to self or others" nor was he showing signs of being "gravely disabled."

Thus, they could not detain him under the provisions of a 72-hour psychiatric hold. This goes back to 1972 and the Lanterman-Petris-Short Act when before patients suspected of being mentally ill could be quickly and easily checked into one of 10 California mental hospitals. I began my training to become a psychologist before the '70s, when once in, it was next to impossible for a patient to get out.

The LPS law reversed the easy-in-difficult-out pattern to difficult-in-easy-out. Once-locked mental hospital doors swung open and patients, with a few exceptions, were free to leave. For patients who resisted admission it took a judicial order to get them in. Yes, literally a judicial order.

Decades ago, with a mix of disbelief and shock, I sat in on mental health court hearings and saw clearly dangerous psychotics who scant hours before were yelling and running naked down the middle of La Cienega Boulevard who were pulled off the streets, rapidly dressed, and upon their demand placed before a WIC 5150 habeas corpus hearing judge.

If the person could give his name, recite his date of birth, give an address (never checked out), stand still for five minutes and not cuss out the judge, he was released as sane enough to not need forced inpatient treatment. These judges were not psychiatrically trained to recognize psychosis, yet were given the authority to declare a person in the midst of a florid psychotic episode perfectly sane. It was scary.

Now, some 40 years into the LPS era we struggle still with the problem of getting a known dangerous person desperately in need of help into that help. And still all it takes is for that person to refuse the help and when taken before a judge (if forced into treatment for 72 hours) simply say "I'm good..." for that person to be set free. Very little's changed.

But with all these killings actually something has changed. It's called Laura's Law. And it's equivalent on an outpatient basis to forced inpatient care. It applies to persons who seriously and recognizably need psychiatric care but refuse it.

If their mental illness is severe or dangerous enough a court order may be issued to force treatment. The patient is supervised closely by an appointed social worker who ensures they keep appointments and take their meds. If they should fail in either, the law then steps up treatment to forced inpatient care in a locked facility. A psychiatric team provides care and decides when release is appropriate. A judge, consulting with the treatment team, oversees the progress of the case, and decides when to lift his forced treatment order.

All very good in theory, but a booger to implement. It's unfunded, and expensive. And it's voluntary. That's why only two California counties have implemented it as enacted (Nevada and Orange). A few others have implemented modified forms of it. Kern County isn't one.

Why is that?

* As said above, it's unfunded and expensive.

* Too many complicated moving parts, too much new multi-layered bureaucracy, and too many affected and involved parties and county agencies who need to weigh in on and coordinate case progress and make other treatment related decisions. These agencies must be staffed above current levels to make complex and often conflicting -- even opposing -- clinical and administrative decisions.

* Reams of legal and clinical paperwork.

* Any number of parties can derail the process for complicated reasons. Who defines and sets what criteria for what kind of treatment and when and under what conditions to terminate and discharge the patient from care?

* Who bears ultimate responsibility for treatment outcomes and how are records kept and stored and statistics kept for program evaluation?

Nonetheless, something's got to be done, and start somewhere if we're going to make progress toward getting a handle on these mass murders.

Email contributing columnist Brik McDill, Ph.D., at bmcdill2@gmail.com. His work appears here every third Thursday; the views expressed are his own.

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