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"The conservator signs for their medication," she continued, "decides what medication will be taken in conjunction with treatment, makes sure they get routine medical treatment. ... The law says that the purpose of conservatorship is to make sure a person gets the treatment necessary to make them not gravely disabled."
Tenenbaum believes the county would need to set up a new court to hear cases under Laura's Law and that the county would have to demonstrate to the state that the mental health services it offers would meet the high standards called for by the law. To be subject to court-ordered outpatient treatment under the law, someone must have refused services and the criteria for such services under Laura's Law are extensive.
But Randall Hagar, the government affairs director for the California Psychiatric Association, which represents 3,300 psychiatrists statewide, disagrees with Tenenbaum's conclusions. "We see Laura's Law as an early intervention, not a panacea, to enable treatment for people who do not realize they are sick. ... We not only support the law, I helped draft the bill. It is counterintuitive and defies common-sense why people would oppose this opportunity for treatment."
According to Hagar, conservatorships are not the answer. "Conservatorships do not apply to people who are dangerous. They are only for people who are gravely disabled, not people who have intent to harm themselves or other people or could. Typically in a county, you're seeing people who are suicidal on a very regular basis. You also see people who have a history of lashing out; the danger of violence is focused outward: They get into altercations, domestic violence, assaults, and threats. That group who is not gravely disabled, who do all those other things, is excluded from the authority of the conservatorship. It is forbidden by law that conservatorship be used for the purposes of giving structure and treatment for those people."
Compared to Laura's Law, which places no burden on people other than to voluntarily comply with a judge's order to receive assistance as an outpatient, Hagar said that a "conservatorship can potentially be an absolute control over a person's life in every detail: finances, their health, medications, where they live. The conservator becomes the substitute decision-maker and those powers can be very, very broad."
Hagar believes that the real reason that counties have not adopted Laura's Law is a fear of accountability. "When the judge issues an order in the Laura's Law proceeding, the order is binding not only on the patient to adhere to a treatment plan, but also on the county to provide the services in the law and in the treatment plan for that particular person. In that respect, the mental health system is accountable to a judge, to a superior court judge, and I think that scares bureaucrats and the mental health departments."
Gloria Hill, a former adult family coordinator for the Mental Health Division of Contra Costa Health Services, sides with Hagar. Hill worked for ten years through 2010 with the families of adults who received psychiatric care. "Laura's Law has never been seriously considered in Contra Costa County," she said. "The problem as a result is we have the same people cycling in and out of the system all the time and people don't get the help they need. You basically have something like one hundred people cycling through jail and the psych emergency and being hospitalized, and bad things happen. People step in front of trains, kill themselves, get into psychotic states and kill family members and victims in the public.
"When your brain isn't working correctly, you don't know that; you can't possibly know your brain is not working correctly — just like someone with Alzheimer's," Hill continued. "They don't realize what's going on, they are not able to think, their cognition is gone: That is what happens to people who are severely mentally ill. Yet we let them make decisions, which are harmful, very harmful. We need to be thinking about how we can help people to stay in treatment and stay out of jail and stay out of the hospital and have some success in the community. That is what Laura's Law could do."
Correction: The original version of this story erroneously stated that police and sheriff's deputies transported nearly all of the 5150 patients to John George Psychiatric Pavilion of Alameda County Medical Center. They were transported by ambulance.
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