As a community psychiatrist practicing in Orange County for 37 years I have observed the expanding need for the implementation of appropriate assisted outpatient treatment [AOT] during this time. The main reasons for this type of treatment, which will be introduced with the implementation of Laura’s Law this October, are the shrinking availability of state hospital beds and lack of community outpatient funds and facilities. These problems have resulted in the transfer of the mentally ill to our jails, prisons, homeless shelters and streets.
Laura’s Law as discussed in “Opening a Safety Net for the Mentally Ill,” in the May 23 edition, stated that only 120 people countywide would be treated annually. Established formulas for the number of individuals needing AOT in Orange County would estimate at least 500. My clinical experience locally and in California jails and prisons suggests that individuals in need of such a program here would exceed 1,000. I hope that services for 120 are considered only a feasibility study to meet the greater need that exists.
Mary Hale, county mental health director, is also quoted as stating “emphatically” that “involuntary medications are not allowed.” There are many ways this statement can be interpreted as involuntary can have several meanings. However, the ability to medicate mentally ill patients has been essential to the success of similar programs in other states. This may be through a direct judicial hearing as currently exists in California psychiatric inpatient facilities or medication compliance as a condition for being in an AOT program. The majority of the mentally ill who are incarcerated or homeless would not be so treated if mandated medication were available to them in outpatient programs. I must also emphasize that medication must only be a part of a compassionate complete treatment program as it alone will always fail.
Ed Kaufman, Laguna Beach