Laura’s Law & Kendra’s Law Bandages and Bondage

Laura’s Law and Kendra’s Law are, for anyone who has, has had, or appears to have a mental illness, scary legislations. These two laws inCalifornia and New York and copied by other states require a person to have psychiatric treatment when ordered by a judge after assessment by a mental health official. This is coercion and, I believe, an abridgement of fundamental human rights as established by the United States Constitution. Both these laws legislate treatment in an outpatient program and both purport not to require the taking of medication, but the underlying threat of non- compliance is involuntary treatment in a hospital and the imposition of unwanted medication.

I am extremely sensitive about this issue of coercion. I had my civil rights abused because I have a history of mental illness. I was in the hospital for another health issue and dressing discharged to go home.  A nurse apparently heard me make a threat. I do not remember the statement. Immediately I was surrounded by hospital police and escorted down to the psychiatric unit. I demanded they tell me why this was happening. No one would. I was now surrounded by more orderlies and hospital police. When I made a move to walk away, I was pounced upon, dragged into a room and strapped down to a slab. It took me eight hours to talk my way out of this incarceration. I felt dehumanized, violated psychically, and very angry at the power of institutions to abridge my civil rights based on a previous history of mental illness

Shackled in Hospital

I researched these laws after hearing a presentation by Brian Jacobs, a former president of NAMI California. When I asked him if these laws were coercive, he replied “yes, but coercion is a good thing.” He meant that Laura’s Law, which he was asking the NAMI San Gabriel chapter to support in the drive for it to be fully implemented inLos AngelesCounty, created a context that saves lives of the severely mentally ill by overruling their resistance to treatment.  InCaliforniathis law, first passed in 2002, has only been fully implemented in Nevada County, and inLos Angeles County it has only been partially implemented. Mr. Jacobs did not relate in what way the law has only been partly implemented. The law was made optional for eachCalifornia County to implement.

Laura’s Law is named after Laura Wilcox, who was shot and killed by a man with untreated mental illness at a mental health clinic in Nevada County,California. The law is based on a similar law, Kendra’s law, passed in New York State in 1999; this law is named after Kendra Webdale, who was pushed to her death from a subway platform by a schizophrenic man off his medications. Kendra’s law grants a judge the authority to issue orders requiring people who meet certain criteria to undergo Involuntary Outpatient Commitment (IOC). Failure to comply can result in commitment to a mental hospital. Laura’s law specifies a similar circumstance: a judge can order Assisted Outpatient Therapy (AOT), a change of words that Kendra Law also now utilizes to attempt to communicate a more positive intent to the law. Laura’s Law may differ in how the judge is authorized from Kendra’s Law. In California the county mental health director or his/her designee files the petition with the court. The county medical director is probably requested to do the petition by family members or mental health providers.

Both laws have a number of criteria associated with them that can trigger the court order including a history of mental illness, the substantial deterioration of the individual, their inability to survive on their own, a refusal to comply with treatment, and the risk to themselves and others. All of the criteria seem reasonable when viewed from the lenses of psychiatric practitioners and distressed family members. Family members who witness the suffering of loved ones and suffer themselves from the mental illness of a loved one see these laws as a life saver. My friend Marty, whose daughter is schizophrenic, sees this law as away to avoid forced commitment in mental hospitals. She writes:

“My daughter… She was living in a storage unit covered with ants, lice, and standing in a catatonic state for days, her feet swollen like melons, dehydrated and starving. When I called the police department, they refused to take her to the hospital. It took me over an hour to persuade them. The frightening experience of being placed in handcuffs, forced into a locked ward, kept there and forcibly medicated for five weeks, started her on a horrible odyssey to resist and flee from treatment. Over the course of six years, she was picked up by law enforcement and hospitalized in nearly every county in California only treated for a few days and released. She spent a year in a locked facility, and then ran away when she was out. I believe she cost the taxpayers over $300,000 in revolving door hospitalizations. I believe that if Laura’s Law had been in effect, she would have had a good chance to be treated before this sad saga began. She would have been made to feel like a participant in choosing her own treatment. I think the current situation, where people are free to die on the streets is inhumane and amounts to slow suicide. I am satisfied that Laura’s Law protects peoples rights and gets them help early enough to prevent tragedies such as the Gabrielle Gifford’s shooting and the Kelly Thomas killing.”

The Kelly Thomas killing inSan Diego, where a young man with mental illness was beaten to death by the police and the subsequent push by advocates of Laura’s Law in San Diego Countyto implement the legislation were covered in a story by Time Magazine. The author cited the compelling evidence that the law “would help mentally ill people like Thomas off the street and out of danger by making it easier for others to give them treatment. That is sorely needed because an estimated one-third of the nation’s homeless have untreated mental illness.”

The case for these laws is compelling, and advocates of the law have many statistics to support their point of view. They cite a study made by the New York State Psychiatric Institute and Columbia University that says those in the AOT program have 74% fewer experiences of homelessness, 77% fewer psychiatric hospitalizations, 83% fewer arrests, 87% fewer incarcerations, 55% fewer suicides, and 47% fewer cases of harm to others. These are impressive numbers, and they support the assertion that Laura’s Law and Kendra’s Law save the taxpayer money. It is hard to speak against these figures, but I must.

Our mental health system is broken, but I do not believe Kendra’s Law and Laura’s Law are the answer. I have many reasons. First and primary is the civil rights issue. These laws violate the fundamental freedoms of all people with mental illness by forcing competent, non-dangerous persons with psychiatric disabilities into coerced programs of treatment. If we allow certain designated persons the right to abridge the rights of others, we are at the will of people who views and positions can be in arbitrary and falsely founded.  This is the path that can lead to laws like the Nazi-era laws incarcerating not only the Jews, but the mentally ill. The New York Civil Liberties Union in its dissent against the passage of Kendra’s Law cited court cases noted “that the modern trend in legal and psychiatric fields is to give even those inpatients suffering from psychological disabilities an increasing amount of control over their treatment decisions — including what medication regimes he or she follows, what therapy sessions he or she attends and what other mental health programs he or she participates in.”

This law may not work. Statistics can be manipulated. The success cited for the Kendra’s law program is based on the number of people who agreed to the program. How many disagreed? The statistics do not tell. A study done by Bellevue Hospital found that court ordered treatment did not lead to increased  compliance with treatment, fewer hospitalizations, or lower arrest rates and violence. What forced treatment does is remove patient trust. What patients distrust most is imposed medication. While neither program requires forced medication, most programs I know of supply medication and insist one take it. The view of many people with mental disorders is summed up in an email I received from a man named Doug. He says:

“I was on Lamictal and Ritalin. My life was falling apart and I didn’t even think it could be the drugs, until I researched some stuff online. I quit everything cold-turkey in November of 2009. It has now been 26 months and I am still recovering. My vision got miserable and my coordination got horrible and I didn’t have normal emotions anymore. One of my best friends weighs 375 and takes Adderall during the day to stay awake and Seroquel at night to sleep. He is ALREADY diabetic!!! His life is a nightmare because he feels like he can’t quit the Seroquel at all. Like millions of other people in the world, he hates psych drugs, knows they are shortening his life span and making him feel like a zombie, but the withdrawal symptoms are so horrible he stays on them. I hate all of them and think they are pretty much the old testament definition of sorcery.”

The imposition of drug treatment is the established way to treat mental illness. Laura’s law may say that drugs are not imposed, but the truth of most mental health programs is that they are. Kendra’s law is vague on the issue. To many the drugs are helpful – they were for me — but there is a large segment of the mental illness community who feel as Doug does. Should they be coerced to follow a program that they believe will impose this requirement on them? I think not. Are drugs the best ways to stabilize the mentally ill? Not necessarily. There are a significant number of mental health practitioners who do not believe in drug therapy and a large number of mental health care recipients opposed not only to drugs but to psychiatry. Some mental health practitioners are too close to the pharmaceutical companies that sell the drugs. This relationship distorts the mental health care system along with the budgetary constraints that limit alternative care.

Our distorted system looks for legalistic answers, since it appears to be the only way to wring value for mental health. Our country is starved for services and adequate monitoring. We need more programs more easily accessible to those in need. What is not needed is enforcement on a limited supply, which only overburdens the supply and makes it more dependent on quick fixes. Drugs are the quick fix and anyone who has to deal with publically funded programs knows this. The mentally ill know this.

One last point about violence, which is what the general population fears most about the mentally ill: Are we going to kill you or not? I think neither Kendra’s law nor Laura’s law will diminish the occurrence of insane violence.  I note the cited statistic that 47% were less violent after a Kendra’s Law compliance program. This means that 53% were still likely to be violent, if they are given to violence. Most mentally ill people are not violent. They more likely to be treated with violence than to be violent. Kelly Thomas might have been saved from state violence if police officers were better trained. Marty’s daughter might have not been so distrustful of help if her first contact had not been to be shackled by handcuffs and hauled off to an institution.

The answer to the problem of violently mentally ill, the homeless, the high suicide rate, the high rate of severe depression, does not lie in legislation, but rather it lies in a shift of our cultural priorities. Laura’s law and Kendra’s law are bandages on a system of mental health care, which is in critical condition. They represent bondage for people who may be ill, but have not committed a crime. In our society we don’t force people with cancer to take treatment. We should not force treatment on the mentally ill. They have to be freely willing to accept treatment. Force begets resistance. Resistance overpowered is slavery.