Laura’s Law, 5150 and Mental Health

VCBH Adult Division Chief John Schipper gives insight

By Lori Denman

Ventura County is using multiple tactics to help those with mental health issues. Laura’s Law assists persons with a severe mental illness. So does a 5150 hold. What are they and what’s the difference between the two?

Citizens Journal  met with Ventura County Behavioral Health Adult Division Chief John Schipper, PhD. The following interview provides insight.

Citizens Journal: Let’s discuss a 5150 and Laura’s Law. First, how does a 5150 work?

John Schipper: If the person is a danger to themselves or others, or is gravely disabled and meet the criteria for Welfare and Institutions Code 5150, the patient is placed on a 5150 hold, which is a form of involuntary treatment. This person requires hospitalization and they get taken into the hospital whether they want to go or not. They can only be treated against their will for a relatively short period of time, up to 72 hours. If needed, that hold can be extended by writing a different hold, a W&IC 5250 hold, which can last up to an additional 14 days and can be challenged in court. Involuntary treatment is always inpatient.

Can you please describe what Laura’s Law is and how that differs from the 5150.

Laura’s Law involves court-ordered or involuntary outpatienttreatment. It is designed and intended to address the mental health needs of persons who fall short of the 5150 criteria. They do not pose an immediate danger to others or themselves and are not gravely disabled. You can’t put them in the hospital or medicate them against their will.

What is the criteria for a person going under Laura’s Law?

To qualify for treatment under Laura’s Law, the patient has to meet nine criteria. Part of the criteria is that they do not need hospitalization now, but they have to have been hospitalized twice in the past three years. Or they have received mental health treatment in a forensic setting. So they got medicated when they were in jail.

Can a person be court ordered?

If the person meets the nine criteria for Laura’s Law and is also refusing services and decompensating and there is the Assist program in Ventura County, a court order can be pursued that would order the person into outpatient treatment whether they want it or not.

What are some common misunderstandings of Laura’s Law?

Laura’s Law is the name of the California’s assisted outpatient treatment (AOT) law because it was championed by the Wilcox family whose daughter, Laura, was killed by person who was suffering from an untreated mental illness. Other states have other names for their AOT laws, for example in New York it is called Kendra’s Law.

The two most common misunderstandings about AOT is that it does not authorize a person to be treated in a locked setting and it does not authorize the person to be medicated against their will. Those are two very dramatic differences from the 5150. With the 5150, the person is placed in inpatient care, they usually are taken against their will to a hospital and the door is locked and they may not leave until the hold is over or the psychiatrist and/or the court order their release. If the court finds that there is a legal basis for the person to be treated against their will it can involve forcing them to take medication by injection, if necessary. That is inpatient involuntary treatment under a 5150. Laura’s Law authorizes court-order or involuntary outpatient treatment. It cannot authorize medicating the person against their will. (End of interview)

Laura’s Law Information

The Company providing Laura’s Law in Ventura — the ASSIST program — can be referenced on the VCBH website with information on this website. It was established 2 1/2 years ago.

John Schipper told Citizens Journal, “The website itself provides a brief description, but probably more importantly links to the attached information sheet which provides more detail, including the nine criteria I mentioned.”

“It has been our goal to encourage family and friends to be familiar with the program, but to not feel obligated to try and make determinations with reference to the criteria.  We see that as our role and if a person in need of mental health services and treatment, but does not happen to meet ASSIST criteria, we can likely attempt to engage with other programming.”

Critics of Laura’s Law

Schipper said that there are critics who call Laura’s Law a “toothless court order.” They may say, “well, what if a person doesn’t comply or go along with outpatient treatment? What can the judge do?”

Schipper said that Laura’s Law has no punitive aspect to it. “Some people have said, and I do not entirely disagree with this, that the court order in some ways applies to the treatment provider as much if not more than to the client. The court order obligates the mental health provider to continue to vigorously outreaching and engaging the person. The effort of Laura’s Law is this.”

Schipper said that in some cases, the client eventually comes around to accept programs and services, due to finally wanting help or seeing the mere threat of a court order. Or the person continues to decompensate and then qualifies for inpatient involuntary treatment and even conservatorship, which is using a 5150 over the course of a year.”

There was a comment on NextDoor of Ventura last April regarding how the mentally ill has been treated in the city and also questioned the effectiveness of Laura’s Law. Schipper also responded to this comment.

“My frustration is with the city officials and whoever it is that is making decisions at the top about how to treat the mentally ill and dual diagnosed who are oftentimes homeless,” the author said. “I am self employed now but prior to that I worked at Hillmont Psychiatric Hospital as a Social Worker. We referred non-compliant mental health patients who were in and out of Hillmont to the Laura’s Law program which is called ASSIST.”

The author stated that the ASSIST staff is amazing. Yet, is wondering if the program (including Laura’s Law) has been altered in some way, creating a difference from its original form.

The comment read,“the original program out of Laura’s Law is to create a mandate for these non-compliant individuals to comply with treatment. If they do not, they would ultimately have to go in front of a judge and possibly face jail time. If you look up the success rate for this program when practiced in the way it was intended it shows wonderful results. However, Ventura County decided to have the program but take away the piece that mandates these individuals to take the treatmentwhich boggles my mind because I really cannot see be point of having the program if you are basically giving the chronically non-compliant a choice. You give them a choice and they will typically always choose to keep doing what they have been doing – which is nothing.”

Schipper responded to this critic of Laura’s Law implementation in Ventura. “The person, despite claiming to have worked in the mental health field, is confused or unaware of the actual limits in the law.  By no means does Laura’s Law (or any other AOT law in any other state) allow for putting people in jail.”

Schipper added that there is growing data that suggests that assisted outpatient treatment programs are receptive. He said that they do bring about change.

“Just like everything, this does not fix everybody,” he said. “But by in large, the data suggests that when people who are reluctant to engage in treatment and are given vigorous outreach, they come to see the benefit of it more often than not.”

Lori Denman has been a professional journalist since 1996. She has worked as associate editor for the Los Angeles Daily News TODAY Magazines and has freelanced for LA Weekly, Surfline.com and more. She is now the Ventura reporter for Citizens Journal.


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3 Responses to Laura’s Law, 5150 and Mental Health

  1. Kathy September 25, 2019 at 9:19 pm

    To C E Voigtsberger, bravo. That was so well articulated and such true and balanced. I wish I wish I had the command of language and the insight and clarity that you do.
    I have a mentally ill family member. He has been on the streets suffering from schizophrenia since he was a teen. He’s been in and out of jails, has racked up several felonies, has been beaten half to death and left for dead in the street, raped in prison, his teeth are rotting out of his head, he has chronic skin infections, steals to survive, lives in the river bottom, has no friends, is ashamed how how people look at him, ashamed that he’s dirty, is plagued by voices round the clock that take the form of his parents, and siblings verbally abusing him. He is living in absolute hell, but won’t get treatment. Instead he throws rocks at families windows, or at cars on the freeway (stands on over phases), breaks into coin operated laundry machines, shop-lifts, does drugs, threatens family, has hit us, spit in our faces, poured food and beverages on us, screams in our faces, demands money, and help and support but refuses to comply or even discuss anything that could help him. He sits on our porches and cries, and begs for help then turns on us like a rabid dog when we won’t just hand him $500 dollars. His family members—-without exception—-are either in hiding from him, have restraining orders against him or are in fear of his visits because we all know that he has the potential to seriously hurt or kill us. We can feel it. All our neighbors know it too. I hear from the psychiatric community that he is incapable of making the choice to get help because he is too sick. From the recovery community I hear that only he can make the decision to get help and nobody can help him until he chooses to clean up his act. From the court system I get judgment, as if we the family are partially to blame, and from NAMI, the leading support agency for families and friends of people with mental illness, I’m told stay hopeful and have compassion for him. But I ask this—-if a sick animal wandered onto your porch every few nights, suffering, hungry, howling in pain, unable to help itself——would you just stand there and have compassion for it? Week after week, year after year? I call that cruelty. Would you tell it, you have to help yourself? No, if you were humane you would call the authorities and get it immediate help. But there is no such help for a human being in this society. The person in need never quite qualifies. They don’t meet the rigorous criteria. Are they really trying to help people? I don’t really thing so.

    It is true that we treat animals better than humans. And it’s not just the mentally ill who are victims, but the families who are so often forced to watch the slow, agonizing deterioration of their loved ones, when they COULD be given help that would actually turn their life around, but instead because of the law their hands are tied. They are just told “I know it’s hard. You have to just have compassion for your loved one and yourself. there’s nothing else anyone can do.” Bullshit. That’s a lie. And if the lawmakers kids all had schizophrenia and we’re on the street, and non-compliant, the laws would change over night.

    Reply
  2. C E Voigtsberger August 24, 2018 at 8:36 pm

    California apparently led the way with the case of Hop Louie vs. (I think, as it was many years ago) The Director of Mental Health, a case originating here in Ventura County. Public Defender Richard Erwin considered it the crown jewel of his career as a public defender. I often wonder when I read about some mentally ill person attacking an innocent bystander or causing an horrific fire that causes the death of a firefighter what he would think of his “victory” now.

    The shorthand for the criteria of a 5150 hold is homicidal, suicidal or catatonic. After 72 hours the detainee must appear before a superior court judge for a hearing to determine if they should be held further. They are represented by both a public defender and a lawyer advocate separate and apart from the public defender. All this at taxpayer expense, of course. By this time the detainee has been on psychotropic drugs for 72 hours and is somewhat stabilized and unless really sick, is able to pass the three tests. The judge then orders them released and they are turned loose to continue their former lifestyle which includes self-treatment with street drugs and/or alcohol.

    So following two 5150s within the prescribed period, assuming the patient meets all nine, count ’em – nine criteria, the judge can order the patient to attend outpatient treatment but there is no downside if the patient decides he/she prefers his self-prescribed lifestyle.

    I am afraid that Mr. Schipper is somewhat pollyannish in his view that eventually the patient succumbs to entreaties by the county employees and follows the medically prescribed program for treatment of the patient’s mental disorder.

    A most interesting statistic would be independently developed figures of how many patients decide to abide by the medically prescribed treatment program viz a viz how many patients are ordered by the courts of this county to enroll in the program and fail to complete the program and revert back to their former lifestyle.

    Articles I have read indicate that the U.S. today has significantly fewer beds for the mentally ill in publicly supported mental health facilities than the U.S. had in the 1880s. This is in actual numbers, not some magically adjusted figure. When one considers that the population of the U.S. is much larger now than it was in the 1880s, that is a shocking statement.

    The LPS Act, a bi-partisan bit of legerdemain was sold to various constituents on different bases. To the liberals, it was sold as freeing the poor unfortunate inmates of snake-pit mental health prisons so that they would be free to seek their own treatment on their own terms. To the conservative side of the political spectrum the LPS act was sold as saving the state vast sums of money by closing the mental health hospitals and the blood sucking freeloaders would have to seek their own mental health treatment.

    For the liberals, how much better are the mentally ill today, living under freeway overpasses or in the various river bottoms in unsanitary, unhealthful conditions, self-treating on illegal drugs and alcohol, going unbathed, and generally, with a unhealthful diet?

    For the conservative side of the aisle, how much money did we really save? It is estimated that 30% of our overcrowded prison population is the severely mentally ill. It costs a whole lot more to keep a prisoner in state prison than it ever did to house them at Cam State Hospital. With what the taxpayers are on the hook for with the recent Elsinor fire and the San Bernardino fire both of which were “allegedly” started by mentally ill folks, how much did we save? Tell me! How much did we save! With 30% of our state prison population severely mentally ill, how much are we saving?

    If it is your daughter or son slaughtered in a restaurant in front of their babe-in-arms child, HOW MUCH ARE WE SAVING?

    Sorry to ramble on so long, but this is a really sore subject with me. I, fortunately, haven’t had any family members involved in the tragedy that is our mental health “system” nor have I had any personal loss caused by a mentally ill person in a psychotic breakdown, but, my God, we treat stray animals better than we treat the mentally ill. We treat our garbage with more care than we treat our mentally ill. They did not choose to be sick any more than someone chooses to be ill with cancer or some other disease entity. A truly compassionate society would see that they received proper treatment in a safe environment. Part of their illness is that they don’t recognize that they really need treatment. To offer them a choice to live the lifestyle they have adopted isn’t helping them at all and it certainly isn’t saving any money.

    Reply
  3. William Hicks August 22, 2018 at 8:58 am

    Just an old saying…….”What you are willing to pay for, expect more of it.”

    So if you are willing to pay for housing homeless mental cases, expect it to be a magnet for more of them.

    Reply

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