More than a year after its passage, a law intended to force severely mentally ill people into outpatient treatment has been stymied by a lack of funding and controversy over its implementation.
When it passed, supporters of the hard-won measure, known as Laura's Law, promised it would help get hundreds and possibly thousands of mentally ill people at risk of harming themselves or others off the streets and into treatment programs.
But under the law, counties must approve and fund the measure on their own, and many are far too short of cash to consider the idea.
Several counties, including San Francisco and San Diego, recently decided against such programs, citing costs and discomfort over the possibility of infringing on the rights of mentally ill people.
Late last month, Orange County began public hearings on the issue, but local mental health officials believe it doesn't have a strong chance of approval.
So far, only Los Angeles County has acted, starting a pilot program early last year that can treat just 15 patients at a time. To save money, the program is enlisting only patients who already have been arrested and are in the mental health system because they have been deemed unfit for trial.
Los Angeles mental health officials say they have yet to decide if they will extend the pilot project after it expires next year.
"We're taking a close, wait-and-see approach," said Marvin Southard, director of Los Angeles County's Department of Mental Health.
Laura's Law was named after 19-year-old Laura Wilcox, who was killed three years ago by a psychiatric patient while volunteering at a mental health clinic in Nevada City. The measure needs renewal by the state Legislature in four years and, without broader statewide participation, it could simply be phased out.
Unless more counties participate, "we won't have any proof to show the Legislature how much we need this law and how well it can work," said Helen Thomson, a Yolo County supervisor and former psychiatric nurse who sponsored Laura's Law in the state Assembly before she retired from the Legislature in late 2002.
Forced treatment has long been one of the most contentious debates in mental health. Some mental health and civil rights advocates insist that strong-arming people into treatment programs doesn't work and may in fact alienate patients.
"This was a mistake from the beginning.... It's clear that a coercive model doesn't work," said Sally Zinman, director of the California Network of Mental Health Clients.
Instead, Zinman and others suggest better funding for voluntary treatment and social service programs.
But supporters of the law, including relatives of mentally ill people, say involuntary outpatient treatment is a necessary last-ditch tool to help patients get treatment they clearly need. Many family members say that their loved ones lack the insight to realize they are ill.
For all the worry about patients' rights, they say, the reality is many untreated mentally ill people spend their lives on the margins of society, often cycling in and out of jails or hospitals.
The federal government estimates that as many as half of mentally ill people don't get any treatment. A third are homeless.
Linda Rigdon, of Laguna Hills, said she believes Laura's Law could give desperate families of mentally ill people a meaningful option. Rigdon's 35-year-old son, Todd, has been diagnosed as paranoid schizophrenic. Though he is taking medication now, a few years ago he walked around Laguna Hills with a claw hammer, and she feared he might use it against someone if he felt threatened.
"I love him and just want him to be well. Families like mine know what we are talking about, and this law can help us," she said.
More than 30 states around the country have some type of involuntary outpatient commitment law, but only about a dozen enforce them, experts say. New York passed such a law in 1999, and funding to go with it. The state has since treated more than 3,000 people.
In California, only a small percentage of patients have been involuntarily committed to hospitals because of stiff legal requirements and limited space.
The new law allows mental health officials to force patients to commit to a mix of outpatient services, including psychiatric care, group counseling and substance-abuse treatment. Someone who breaks the agreement can be forced back to court. No patient can be forced to take medication, however.
Before patients can be required to enter the program, they must be shown to be a danger to themselves or others, or indicate they are unable to meet basic needs for food, clothing or shelter. A family member, doctor or parole office must petition the local mental health department to pursue a court order for treatment.
"Sick people can't always make the right decisions on their own," said Linda Rigdon's son Todd, who said he has been well for two years now. "If this helps some people get back on track, I can't say it's a bad thing."