No proof that Laura’s Law is helping the severely mentally ill, study says

A consulting firm’s report on Laura’s Law is a disappointment for residents who have urged Stanislaus County to adopt the law dealing with adults with severe mental illness who resist treatment.

Following a six-month study, The Results Group said it found inconclusive evidence that Laura’s Law has been successful in other counties. Legislation enacted in 2002 allows counties to use court-ordered outpatient treatment for adults who have refused mental health treatment and have a history of hospitalization or incarceration.

The Results Group recommends that Stanislaus County expand voluntary outreach programs for the mentally ill. “We believe that many of the benefits that are listed as reasons to implement Laura’s Law could be achieved by the county through other means,” the consultants concluded.

There’s no strong evidence backing claims of positive outcomes for patients or cost-savings for counties that implemented the law in California, the report said.

“I am not very pleased,” said Linda Mayo of the Stanislaus chapter of the National Alliance on Mental Illness, who believes the Laura’s Law program in Los Angeles County saved her daughter’s life.

A continued emphasis on voluntary treatment won’t reach people who are too sick to know they need treatment and will reinforce the status quo, Laura’s Law advocates said.

“It is like saying we are going to keep doing what we are doing, and that is not working,” said Rhonda Allen, a Modesto resident and advocate for Laura’s Law. “It is naïve to suggest that if we just had more people doing outreach, we will reach these individuals.”

Advocates are hoping the law will provide assistance for families in getting loved ones into treatment, and also help homeless people who suffer from severe mental disorders and reduce 5150 calls that are consuming the time of law enforcement.

Given the grassroots support for adopting Laura’s Law – 87 percent supported the law in an online survey – the county could consider adoption of the law under a 3-year pilot program. If the county chooses that option, the consultants recommend an evaluation of the results of court-ordered “assisted outpatient treatment” compared with voluntary services.

Stanislaus County supervisors are expected to consider the Results Group study Aug. 15.

According to the 55-page report, research literature is inconclusive on whether assisted outpatient treatment is more effective than the voluntary programs of mental health agencies.

While studies published in professional journals found that participants in court-ordered treatment have lower odds of arrest, fewer hospitalizations and emergency room visits, and better compliance with treatment, the Results Group said the methodologies of the research was flawed. One review looking at trials involving almost 750 subjects concluded that compulsory treatment was no more likely to produce good results than voluntary care, the report said.

During the fact-finding process, the consultants analyzed the results of Laura’s Law adoption in San Francisco and Kern counties and gleaned information from a conference call with 11 counties, from Alameda to Ventura, that implemented Laura’s Law. They also reviewed the documentation of programs in Nevada and Yolo counties and talked with key staff members of Behavioral Health and Recovery Services in Stanislaus County.

The law often was criticized for lacking “teeth”, or having no legal consequences for participants who ignore court-ordered treatment plans. The Results Group cited the 60 percent dropout rate among adults in Stanislaus County’s Mental Health Court.

In reaching out to adults who were eligible for Laura’s Law services, some counties allowed 60 to 90 days for voluntary compliance and few court orders were issued. Of 135 referrals in San Francisco, 23 were referred or were engaged in voluntary services and six court orders were issued.

The most court orders were done in Los Angeles and Orange counties (27 each) and Contra Costa County (21). Placer County reported two court orders and no court orders had been issued in half the counties in the conference call.

The outcomes for individuals in different counties were mixed or hard to assess, the report said. Nevada County, which is often cited as a Laura’s Law success story, dealt with 67 referrals under the law from 2008 to 2015, resulting in 30 court orders.

In 2015, the six participants in treatment in Nevada County reduced their days in the hospital by 68 percent and spent no time in jail or living on the streets. But the sample size was too small for drawing conclusions, the Results Group said.

No clear picture on the net cost-savings for counties emerged from the study.

The Results Group concluded that counties with Laura’s Law programs “experienced both cost savings and cost increases.” Counties may see cost savings from a reduction in hospitalization rates, emergency psychiatric services, emergency room visits, incarceration and law enforcement interventions, but they also have increased costs for mental health services, housing, legal staff services and court expenses.

Randall Hagar, director of governmental affairs for the California Psychiatric Association, said that counties reluctant to adopt Laura’s Law often cite studies that equivocate about the benefits of the law.

“In both the scientific literature and in California, the outcomes have been demonstrated,” Hagar said. “The outcomes are superior to voluntary treatment programs for those individuals. There is no doubt about it.”

Hagar suggested that Stanislaus follow the lead of San Diego County, which started with stepped-up voluntary services. Two years later, the county started using court orders for the 50 percent of clients that refused treatment.

The Results Group estimated that 21 adults in Stanislaus County are currently eligible for Laura’s Law services, based on an epidemiological formula that 1 in 25,000 are eligible for assisted outpatient treatment under the law’s criteria.

Another estimate puts the number at 36, based on county residents who were hospitalized or incarcerated six or more times in the past year.

County Supervisor Terry Withrow said the county needs to better serve people with mental illness, whether Laura’s Law is adopted or not. He said supervisors need more information on the costs of a Laura’s Law pilot program and whom it would serve.

He disagreed with comments that enhanced voluntary services would be ineffective.

Proponents of Laura’s Law said they are preparing a response to the consultants’ report and would voice their concerns to county supervisors next week.

This story was originally published July 31, 2017 at 6:19 PM with the headline "No proof that Laura’s Law is helping the severely mentally ill, study says."