Friday, April 18, 2014
PLACERVILLE, CALIFORNIA
99 CENTS

Reply to John Bachman

EDITOR: John, your letter of 4-3-13 to the editor seemingly advocates for implementation of Laura’s Law, Assisted Outpatient Therapy, in El Dorado County.

I commend you for your change of viewpoint. I was a member of the El Dorado County Mental Health Commission in 2008, a time when you were the El Dorado County Mental Health director and attended all Mental Health Commission meetings.

Laura’s Law was discussed during the MHC’s 2008 meetings of April 23, July 23, and Nov. 19. Many commissioners saw the good that would come from Laura’s Law and wanted it. You spoke very clearly against Laura’s Law: it would violate individuals’ rights; court ordered medication would be meaningless to the clients; too much paperwork required; not enough mental health staff; better to advocate gun control. Several of us clearly recall your objections.

In 2008 your advocacy for Laura’s Law could have helped bring about its implementation; the Board of Supervisors gives much weight to department heads’ opinions. Instead, we do not have Laura’s Law.

Since you helped prevent it and dashed many hopes, it is only fair you explain to the mental health community why your position has changed.

CLAUDIA BALL

Rescue

 

Letters to the Editor

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  • John Bachman, PhDApril 09, 2013 - 11:59 am

    EDITOR: Claudia, thank you for the invitation to explain why my position on Laura’s Law has changed. Several factors converged: 1) effectiveness evidence; 2) financial, political and clinical feasibility; 3) inadequacy of current care and 4) national tragedies. At the time of my opposition, in 2008, none of us had the knowledge that subsequent scientific studies of Assisted Outpatient Therapy (AOT) have provided. The Psychiatric Services journal (in October 2010) published results of a 2009 evaluation of New York’s AOT program (commonly known as “Kendra’s Law”; upon which Laura’s Law is based). AOT significantly reduces hospitalization, homelessness, arrest and incarceration among people with severe psychiatric disorders, while increasing adherence to treatment and overall quality of life. If proposed legislation passes in California, implementing Laura’s Law will become financially, politically and clinically feasible. The pending bills include SB 585 and AB 1367, which allow MHSA funds to be used by counties to fund Laura's Law services; SB 664, which allows counties to implement Laura's Law without first requiring local Boards of Supervisors to approve; and AB1265, which allows Laura's Law individuals to receive treatment for up to one year instead of only six months. As I mentioned in my April 3rd letter, El Dorado County tax payers fund several multimillion dollar contracts to pay for expensive psychiatric hospitalization in several out-of-county hospitals. The vast majority of these (re)admissions result from 5150 detentions of gravely disabled, homicidal or suicidal individuals. These are many of the individuals for whom Laura’s Law would mandate less expensive, community treatment. If our County’s mental healthcare system reorganized away from its strict medical necessity model of care and moved toward a recovery-based model that emphasized assertive community treatment, I suspect all of us (tax payers, families, providers and clients) would receive a far better investment on our respective investments. Finally, no one can ignore the tragedies born of gun violence that have afflicted our County and the Nation. We have taken the necessary first steps in El Dorado County to curtail this violence by implementing crisis intervention training and teams for our law enforcement officers and by establishing behavioral health courts at both ends of the County (innovations, by the way, for which I take some credit). With these specialty courts in existence, the next step is to use them to order assertive community treatment for severely mentally ill people before they commit incomprehensible acts of violence; i.e., implement Laura’s Law. John Bachman, PhD Placerville

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