Conflating homelessness with mental illness, the board of supervisors this week unanimously voted to enact the provisions of Assembly Bill 1976 and Senate Bill 507, commonly known as Laura’s Law, clearing the way for the San Bernardino County Department of Mental Health to track down homeless, take them into court and have them declared mentally ill, and force them to participate in involuntary “assisted outpatient treatment.” That assisted outpatient treatment is to consist of administering them anti-psychotic medication.
Laura’s Law grew out of the action of Scott Harlan Thorpe, a paranoiac who reportedly was not taking the anti-psychotic medication he had been prescribed when he murdered three people during a shooting spree in 2001, including Laura Wilcox, a 19-year-old high school valedictorian and college sophomore who was working at the Nevada County Department of Behavioral Health as a receptionist. The following year, Assembly Bill 1421, the Assisted Outpatient Treatment Demonstration Project Act of 2002 was passed, allowing, on a trial, the imposition of a requirement that mandated treatment – the use of medication – for individuals deemed to be mentally ill, even if those subject to the mandate had no criminal record and it was merely presumed they might prove violent. Once assisted outpatient treatment was demonstrated as workable and successful under the auspices of Assembly Bill 1421, the requirement was permanentized with Assembly Bill 1976. Subsequently Senate Bill 507 created a requirement that for the law to go into effect in any given county, the county’s board of supervisors must enact an ordinance permitting outpatient commitment programs under the provisions of the act to take place in that particular county.
According to the county, the board’s approval of that ordinance will result in providing “assistance” to those in the county suffering from mental illness, while simultaneously promoting public safety and quality of life and reducing the level of homelessness.As framed, Laura’s Law is supposed to require that those subjected to involuntary drugging have a serious mental illness in addition to a history of psychiatric care or hospitalizations, incarceration or acts of violence, threats of violence or attempted violence.
Based on the board of supervisor’s action on Tuesday, virtually anyone who is homeless in San Bernardino County will now be subject to being involuntarily medicated. Two of the supervisors equated homelessness with mental illness.
“Homelessness is, in large part, a mental health problem,” said Board of Supervisors Vice Chairman Paul Cook. “This action recognizes that reality and gives law enforcement and the courts new tools and resources to ensure that our chronically homeless get the mental health services they need.”
Supervisor Joe Baca Jr. said, “The implementation of Laura’s Law in San Bernardino County holds the promise of achieving measurable progress in addressing homelessness and two of its root causes – mental illness and substance abuse.”
“By taking this action, we are strengthening the partnership between [the] county [department of] behavioral health, the sheriff, and the county’s entire law and justice system to ensure the wellbeing and rights of all of our residents, including the mentally ill, are served and protected,” said Board of Supervisors Chairwoman Dawn Rowe.
“I appreciate the unanimous support of the Board of Supervisors to taking today’s meaningful step to address the human component of our current mental health crisis and its associated effects,” said Sheriff Shannon Dicus. “I look forward to working with all our county partners as we collaboratively develop and implement solutions.”
Dicus stated most of the mentally ill homeless individuals encountered by his Homeless Outreach and Proactive Enforcement Team, known by the acronym HOPE, don’t understand they are mentally ill and therefore resist help.
An issue in the sheriff’s department’s interaction with the county’s homeless population is the sometimes gratuitous violence deputies visit upon those they encounter in the field. The frequency of anabolic steroid use among San Bernardino County Sheriff’s deputies, particularly those under the age of 35, is significantly higher than in the population generally. A common cluster of side effects of anabolic steroid use is irritability, anger, both verbal aggression and physical aggression, as well as violence, collectively known as ’roid rage. Because deputies exhibiting ’roid rage are more prone to use excessive force, the department’s more mature and higher-ranking commanders tend toward assigning them to jails or details such as the Homeless Outreach and Proactive Enforcement Team, the latter in particular because the county’s homeless denizens are far less likely to have the wherewithal to hire an attorney when excessive force is used against them.
The four medications likely to be prescribed to the county’s homeless as a consequence of the advent of Laura’s Law in San Bernardino County are old school Thorazine; Serioquel, also known as Quetiapine; Risperidone, also known as Risperdol; and Haldol, also known as Haloperidol.
Serioquel was described to the Sentinel as a mild antipsychotic; Risperidone as a mid-range anti-psychotic; and both Thorazine and Haldol as powerful anti-spychotics.
Thorazine leaves most of those who take it in an uncommunicative, nearly vegetative state, rendering even the most violent-prone individual docile. Because of the degree to which it incapacitates its users, many American psychiatric professionals have migrated away from using it in recent years.
A side effect of Serioquel is seizures.
Risperidone’s side effects may include users developing potentially permanent involuntary body movement; death resulting from an increase in body temperature, heart rate and blood pressure; and an increased risk of suicide.
Likewise, Haldol’s side effects include potentially permanent involuntary body movement and death resulting from an increase in body temperature, heart rate and blood pressure.
A medical professional the Sentinel consulted with said that most of the anti-psychotics given in sensible doses would remain effective for roughly six hours. An alternative dosing methodology to oral ingestion with Haldol, particularly those resistant to taking it on a daily basis, would be to intermuscle inject a time-released formulation every four to five weeks.
The judicious and limited use of anti-psychotics for patients who are truly psychotic can “do good,” the consultant told the Sentinel. “If you have someone who is in a paranoid state, delusional and not dealing realistically or logically, these are treatments which will help him or her make better decisions,” he said.  He emphasized, however, that for each individual patient, dosages had to be “calibrated precisely. It’s very easy to get it wrong.”
Even more importantly, he said, it has to be taken into consideration that these are only temporary fixes.
“None of those are permanent solutions,” he said, as even short-term use can subject the patient to undesirable side effects, and longer-term use means the side effects are assured and will be even more pronounced. Six months, he said, is the longest duration that anyone should be taking anti-psychotics. With all four of the substances considered, the onset of Parkinson’s disease would be very likely if their use extended to a year-and-a-half, he said.
Part of the county’s calculation in adopting Laura’s Law is that the county’s homeless do not have and are unlikely to develop the means and sophistication to legally challenge what they are to be subjected to.
As demonstrated by Cook’s and Baca’s statements, anyone who is homeless in San Bernardino County is considered mentally ill. By demonstrating to a judge that just one of the other four set of criteria – previous psychiatric care or hospitalizations; incarceration; an act or acts of violence; or threats or attempts at violence – applies, the burden of proving that an individual needs to be provided assisted outpatient treatment will have been met.
San Bernardino County has been rolling the dice on drugging people against their will for nearly two decades. Since the turn of the Third Millennium, the San Bernardino County Sheriff’s Department, in conjunction with the San Bernardino County Department of Behavioral Health, has been managing the male inmate population in its jails with the administration of anti-psychotic medication, a primary one being Thorazine. If an inmate gets into a fight – even if he is not the aggressor – or if he involves himself in a verbal altercation with another inmate, he will be sent to an interview with the jail psychologist/psychiatrist. Based upon the psychologist/psychiatrist’s subjective determination, an inmate can, and likely will, be prescribed medication. Most inmates, faced with interminable days in custody and only limited venues for activity or amusement within the confines of the jail or detention center, freely take the medication, which renders them into docility, making it far less challenging for their jailers to deal with them. Occasionally, an inmate will resist taking his “prescription.” The jailers will then inform the other inmates in his dormitory that their collective privileges – television, exercise, access to the commissary, telephone – are being revoked because of the inmate’s intransigence in taking his medicine. In virtually every case, after the inmate’s fellow prisoner’s go to work on him, he will relent and take his medication. The sheriff’s department’s practice in this regard is kept on the down low and has gone virtually unchallenged.
In 2016, the Sentinel made a California Public Records Request with San Bernardino County, The San Bernardino County Sheriff’s Department and the San Bernardino County Department of Behavioral Services for information and documents pertaining to the policy of drugging inmates in the custody of the sheriff’s department. None of the three parties responded to that request.
The untoward health consequences of prolonged anti-psychotic use are so onerous that the county board of supervisors’ adoption of Laura’s Law has created a risk that some enterprising attorney will one day take up the cause of an indigent victim who in the future develops a neurological disorder such as Parkinson’s Disease from having been forcefully and involuntarily medicated, opening the way for an onslaught of similar lawsuits that will perhaps create a revenue stream by which a good number of the county’s homeless might at last be able to afford to purchase houses.
–Mark Gutglueck