Saturday, June 9, 2007

More on the Los Angeles Sheriff's Department's Mental Health Programs


From a July 2000 Martin Kohl article in Psychiatric Times:

A 1999 report from the U.S. Department of Justice (DOJ) indicated that more than one-quarter million jail and prison inmates are mentally ill. This has spurred a broad spectrum of health care providers, legislators and advocacy groups into action....

Bills in both the U.S. House of Representatives and the U.S. Senate-with bipartisan support-are calling for funding of nationwide mental health courts to keep the nonviolent mentally ill who commit minor infractions of the law off the street and out of jail. Modeled on the mental health court in Broward County, Fla., the bills seek to create more than 100 pilot programs to fill in "something that's terribly missing in the system right now," Rep. Ted Strickland (D-Ohio), sponsor of the bill H.R. 2594, told Psychiatric Times.

Sen. Mike DeWine (R-Ohio) introduced the companion Senate bill S. 1865, by saying, "Essentially, the situation we have today in our prisons and jails is the result of over 30 years of cuts in the budgets of mental health institutions, as well as the outlawing of involuntary commitments." He went on to declare, "Far too many of our nation's mentally ill persons have ended up in our prisons and jails. In fact, today, the Los Angeles County Jail is the largest mental health care institution in our country. It treats 3,200 seriously mentally ill people every day."

Before we twist this into justification to release - reassign - Paris Hilton yet again, two things should be noted.

  • Senator DeWine was talking about the SERIOUSLY mentally ill. Despite what Lee Baca may be claiming, Hilton does not seem to fall into that category.

  • Even if Hilton truly is seriously mentally ill, the 2000 bill wasn't advocating that seriously ill people go to their mansions. On the contrary, it was advocating that they be placed under medical supervision.


Broward County's Mental Health Court operates using the triage method, Judge Ginger Lerner-Wren told PT.

"Our basic objectives [are] to help those who are in need of emergency treatment, because we know thatýmany people encountered on the streets should be brought to a hospital or a community unit" instead of being jailed, she said.

Individuals in crisis, she continued, should be placed in a treatment facility, independently evaluated and given treatment under the civil commitment statute....

The six- to eight-month treatment program that readies the mentally ill person for independent living is purely voluntary. "As a matter of fact, under the ADA [Americans With Disabilities Act] you can't really segregate and mandate somebody into a court because of a disability," Lerner-Wren concluded.

But California (at least for now) has Laura's Law:

The law...allow[s] California counties to involuntarily steer a mental patient at risk into outpatient treatment with a court order....

The original Laura's Law, AB1421, received no funding from the Legislature and only one county, Los Angeles, has used it. However, the pilot outpatient program in Los Angeles using Laura's Law is on a voluntary basis, and the official who administers it says the criteria excludes so many patients that it can't be effective on a wide scale.

Other detractors say that a bill calling for involuntary treatment is wrong for civil rights reasons....

The only place the ideas of Laura's Law have been used in California is in a pilot program in Los Angeles County. Alisa Dunn runs the program as director of the county's Mental Health Court Program.

Dunn said about nine people are enrolled in the all-volunteer program now. About 40 have gone through it, according to Kirsten Deichert of the county's mental health department.

They are misdemeanor court case defendants who are mentally incompetent to stand trial or at risk of becoming incompetent and who have agreed to the treatment program, which triggers a court order to give it to them. They also come from a program where patients are offered treatment instead of jail time.

Dunn is thrilled with the program's results, but not with the language in Laura's Law.

"The program is incredible and the clients are actually doing beautifully," Dunn said. But there is not enough of them because the criteria calls for a certain number of hospitalizations or jailings, which limits the number of possible participants.

"It's hard to find people to fit," Dunn said. "You have to ask yourself, 'Why did no other county do it?' It's hard to do involuntary and that's why no one went that route."


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