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HISTORIC COMPROMISE IN SAN FRANCISCO:
Pioneering Accord Balances MH Treatment and Patients Rights

Published Tuesday 15 of July, 2014


On July 8, 2014 the 11 member San Francisco Board of Supervisors (city council) voted 9-2 to implement a 2002 California state law, called Laura’s Law, which can compel certain individuals suffering from serious mental illness to undergo, under strict safeguards, outpatient treatment. The ordinance now goes to the Mayor Ed Lee who supports it. Los Angeles County is considering a similar ordinance next week.


In so doing, San Francisco reached a potentially historic compromise in the battle between treatment for serious mental illness versus patients right to decide their care. It may set an example for the rest of the country.


The setting for this landmark compromise is dramatic and telling. As the widely acknowledged most beautiful city in America, with its iconic Golden Gate Bridge and long history of incoming migrants, San Francisco has long been a magnet for people with mental illness, creating a large population of those with psychiatric disorders. The “City” (as locals call it) has also been dubbed “the most liberal city in America” going back to the UC Berkeley free speech movement of the 1960s. For years the issue of whether to implement Laura’s Law, which focuses strictly on persons with severe mental illness who due to the illness cannot ask for help themselves, has been a political hot potato. Families, mental health providers and law enforcement have pleaded for ways to be able to treat these individuals. Conversely, many patient advocates have strenuously argued that the individual’s right to determine their own care, should be paramount.


Laura’s Law is named for Laura Wilcox, a 19 year old college sophomore shot and killed, while working as a temporary receptionist in a government office, by a psychiatric patient with untreated mental illness. Laura’s parents had for years fought to create an option of seeking court-ordered mandatory treatment for patients unable to seek help themselves. In 2002 the State Legislature enacted Laura’s Law but requires each county in the State to opt-in before it is effective. Many in the patients’ rights field and some behavioral health advocates fought its implementation, believing that individuals should never be coerced to accept care.


With last week’s historic vote, San Francisco may be setting an example for Washington, D.C. in how to reach across aisles and find new solutions to complex health care policy debates.


The Compromise:



Another California county, Nevada County, where Laura Wilcox lived and died, has a record of Laura’s Law implementation with documented positive results: with just 41 cases in 10 years in that county, data show a decrease in patients’ rates of hospitalizations and incarcerations, and sufficient stabilization of formerly homeless people to secure housing. San Francisco County went even further in creating an innovative list of new ground rules for how Laura’s Law is implemented.


Washington pay attention! This is how compromise gets done when there is a will to find a way to help vulnerable citizens, while at the same time listening to all points of view. Out in the States, in municipalities across this country, leaders and activated citizens are finding creative negotiated solutions to balancing both the need for mental health treatment access, along with respect for patient rights and dignity and civil liberties. It’s time Washington’s elected representatives take note of what the States and cities can teach them In the art of compromise.


On July 15, 2014, the Los Angeles County Board of Supervisors voted to implement the State’s Laura’s Law. The three most populous California counties, San Francisco, Orange, and Los Angeles, have now implemented that State law which permits court-ordered outpatient treatment for a very few patients with serious mental disorders under strict safeguards and specified conditions, and with voluntary treatment always an option.


Florence C. Fee, J.D., M.A.

Executive Director

NHMH