The recent incident in the Richmond District in which Peter Woo was suspected of stabbing his parents, killing his mother before ultimately being shot and killed by police ("Police kill man suspected of slaying mother," Oct. 4) reminded me of the multitude of other recent tragedies involving the mentally ill. While details of possible motives for this incident are lacking, his brother reported last week that Woo had a long history of schizophrenia. Similar to other recent events in Mendocino ("Rifle-wielding suspect killed," Oct. 2) and Orange County ("Suspect held after 8 killed in rampage at hair salon," Oct. 13) involving the untreated mentally ill, this incident ended in tragedy for all involved.
As a psychiatrist working in the public mental health system, and the son of a mother with schizophrenia, I know all too well the challenges of getting a loved one treatment in a system that seems designed to wait for catastrophe before providing necessary care.
After decades of trying to get my mother help for her relentless psychotic symptoms and being told by mental health professionals that she did not meet the legal criteria for involuntary hospitalization, my family was left feeling confused and abandoned. Eventually, we realized that she would never voluntarily agree to treatment for an illness she did not believe she had.
It was clear that my mother was suffering, believing that the TV was communicating with her and that North Korean spies were tracking her, but when interviewed at the hospital she would deny her symptoms, refuse treatment and inevitably be released.
Like millions of other families with severely mentally ill loved ones, we felt powerless as we watched our mother's gradual socioeconomic decline from a cancer research scientist with a Ph.D to an employee at a hardware store to unemployment and complete social isolation. We were locked out of the system that should have been there to help us.
After years of frustration and helplessness, my mother finally deteriorated to the point where she did meet the strict criteria for involuntary hospitalization. Several trips to the hospital, a series of failed follow-up appointments because she still did not believe she was ill or needed help, and being jailed for creating a disturbance due to her psychotic symptoms resulted in her involvement in an assisted outpatient treatment program in North Carolina. Similar to Laura's Law in California, this program involved court-mandated treatment in the community rather than in a locked psychiatric or forensic facility. The goal was to engage and provide intensive community services for the small subset of those who are most seriously ill and at risk for repeated hospitalization, incarceration and dangerous behavior.
While the process was long, complex and heart-wrenching, this approach worked for our family and finally connected my mother with the services she desperately needed to maintain stability in her life. Though her illness has forever changed her, it no longer controls her. Today she lives independently, enjoys gardening and has dinner with my brother every Sunday.
The issue of how to provide care for some of the most vulnerable members of society - the seriously mentally ill who suffer from schizophrenia or bipolar disorder - has plagued mental health systems everywhere. Recently, a slew of high-profile tragedies has shined a light on the potential benefits of Laura's Law. Both New York state and Nevada County have implemented such programs and obtained impressive results, achieving significant reductions in psychiatric hospitalizations, incarcerations, homelessness and violent behavior.
While critics cite concerns about protecting patients' rights, surveys of participants in assisted outpatient treatment programs in New York have found that these individuals actually reported more positive subjective experiences of their treatment than their non-program counterparts. Why? Because allowing a severely mentally ill individual, who often lacks the ability to make reasonable medical decisions, to suffer and succumb to homelessness, incarceration or placement in a locked psychiatric facility is more restrictive of rights than compelling them to receive treatment in the community. Individuals who are too ill to advocate for themselves need others to speak out for them to help them avoid these common pitfalls of their illness. I have no doubt that had my brother and I not continued to advocate for my mother's treatment and stayed by her side, that she would be institutionalized, homeless or in jail.
Ironically, critics also cite concerns that Laura's Law is too weak because it does not enable providers to force people to take their medications. Yet, research has clearly shown that assisted outpatient programs increase the degree to which participants take their medications. Thus, even if not mandated in the law, the program's effect on increasing medication adherence is the same.
Finally, mental health systems are also understandably concerned about funding. Nevada County saved $1.81 for every $1 invested in Laura's Law as a result of savings from decreased costly hospitalizations and incarcerations. I have no doubt that should Laura's Law be implemented in San Francisco, our upstream costs would be rewarded with downstream savings.
It is time for our leaders to stop reacting to tragedies and start preventing them. Laura's Law is good policy, is proactive and is a good first step toward the humane treatment of our severely mentally ill neighbors and loved ones.