Four states plus the District of Columbia have enacted assisted outpatient treatment programs. In California, AOT is known as Laura’s Law and was passed by the State in 2002.
Laura’s Law is modeled on Kendra’s Law in New York State, which was enacted in 1999 and covered the entire state. Unfortunately, in California Laura’s Law requires passage and implementation on a county-by-county basis.
Assisted outpatient treatment targets the seriously mentally ill who otherwise are marginalized by most federal and state mental health programs. Under Laura’s Law, the court would be allowed to order this treatment as an alternative to hospitalization for the severely mentally ill when they are in crisis.
The severely mentally ill population is mostly folks with untreated schizophrenia. A smaller number have bipolar disorder or major depression disorder. Many of them are homeless.
The Mental Illness Policy Organization reported results from the largest study of homelessness in January. Almost 600,000 people are homeless on a given night in the United States. Approximately 25 percent of them are severely mentally ill while only 25 percent are homeless due to economic circumstances. Nearly half of those who are mentally ill are also involved with substance abuse or are veterans with post-traumatic stress syndrome. Beginning in the 1960s, states felt that releasing the severely mentally ill from mental institutions would be cost effective.
In fact, the cost to taxpayers is now $23,000 per homeless person per year.
That represents the costs for short-term hospitalizations (5,150 holds), arrests, incarcerations, suicides, 911 calls, violence and substance abuse.
Unfortunately, 50 percent of those with schizophrenia do not know they have a disease. Anosognosia is the term for this.
Some policy experts say America’s “prisons are the new asylums,” a phrase coined by the Treatment Advocacy Center.
The Washington Post reported in that in 2012 America’s prisons and jails housed almost 400,000 inmates with severe mental illness – 10 times the number in state psychiatric hospitals. Most are incarcerated for non-violent crimes.
The online magazine Slate reported in 2016 that, “America’s prisons have become warehouses for the severely mentally ill.”
That means correctional officers are the de facto mental health professionals. In truth, treatment is nil and recidivism is high. The literature and media are replete with stories of abuse, malnourishment and even death by dehydration of the mentally ill in prisons.
Regarding suicide, the American Foundation for Suicide Prevention reports there are more than 44,000 suicides a year. For comparison, there were 15,000 homicides in 2014 and 40,000 fatal car accidents in 2016. For every suicide there are 25 unsuccessful attempts. The highest rate was for ages 45 to 64 (20 per 100,000); among those ages 15 to 24, the rate is 13 per 100,000.
Some commit suicide by cop. Law enforcement are most likely to be called into situations involving untreated SMI, largely schizophrenia. To a smaller extent, police are involved with fatal shootings involving serious bipolar people in a psychotic crisis and suicidal people with major depression disorder. The SMI are 16 times more likely to be fatally shot than those without mental illness; 1 in 4 police encounters leading to death involve the severely mentally ill.
Last week, a pregnant woman in Seattle with a known history of schizophrenia was fatally shot in her apartment; her three small children were also there.
In D.J. Jaffe’s comprehensive book, Insane Consequences, he summarizes reductions in sentinel events following enactment of Kendra’s Law New York. Suicides or attempts were down by 55 percent. Harmful behavior to others or property was down 44 percent. Homelessness was reduced by 74 percent. Psychiatric hospitalizations were reduced by 77 percent and arrests were down 83 percent; obviously, incarcerations fell, too (87 percent). Substance abuse (alcohol and drugs) all fell by nearly 50 percent.
Compliance with medications increased by 51 percent and 75 percent said Kendra’s Law was responsible for allowing them to gain control of their lives. The net cost to the state was reduced by 50 percent or more, depending on how many years out from initiation of the program.
Paul Golden is a doctor in Modesto and author of “An Insider’s View of Bipolar Disease.” He wrote this for The Modesto Bee.