What Misty needed, Linda believed, was a program that would require her to take the medications that had been helping her in Modesto without having to be admitted to hospital. A bill in California could enforce this, but it had not been passed in Stanislaus County. Known as Laura’s Law, the bill allows courts to order what’s known as assisted outpatient treatment (AOT) to people with severe mental illness if they meet specific criteria, including previous hospitalizations or arrests, being noncompliant with outpatient treatment, and becoming dangerous to themselves or others.
The law, however, is not without its critics. Civil rights advocates argue that the state shouldn’t have the right to deprive someone of their liberties with forced treatment. Some psychiatrists say that AOT simply doesn’t work. Linda’s quest to get Laura’s Law passed in Modesto, together with Misty’s experiences in LA, highlight the high-stakes battle to find the best ways to help people with severe mental illness who, like Misty, may not recognize their own condition.
“It’s a politically charged word,” she says. “When someone uses it, by extension, it has come to mean that they are in favor of legislation to make it easier to treat patients against their will. Instead of being a medical treatment issue, it becomes a civil rights issue.”
But for Linda Mayo, the question of her daughter’s right to refuse treatment must be balanced against her right to have a roof over her head and food on the table. When she isn’t taking her medications, she ends up in jail, which also takes away her civil rights.
For the next 48 hours, having been strip-searched and forced to take medicine, Cutler stayed in the hospital under observation. Eventually, the psychiatrists agreed that she posed no risk to herself and discharged her. To Cutler, the experience of forced treatment was unbearably traumatic.
In the aftermath of her experience, Cutler started a group called Southern California Against Forced Treatment, which argues against Laura’s Law and any kind of forced psychiatric treatment. Her goal is to provide support for people traumatized by AOT and inpatient commitment, and she has closely followed the expansion of Laura’s Law into Stanislaus County. Cutler specifies that her group isn’t anti psychiatry; it opposes only involuntary treatment. She points to what she calls psychiatry’s double standard: “When I said I didn’t want to be locked up, when I said I didn’t want treatment, it was instantly, ‘Oh, wow, she’s so sick that she doesn’t even have insight into her own need for treatment,’” Cutler says.
“With any other issue that someone might have, if they don’t want a certain type of help for it, or they don’t want to take a certain type of action, we don’t use that, usually, to further justify, ‘Well look, they really need the treatment now, and we can really force it on them.’”
San Diego forensic psychiatrist Nicolas Badre agrees that this can lead to problems: “We have the sense that people don’t have insight sometimes like people seem to make claims or decisions that clearly seem against what we see as reality. It’s a different sort of path to go down because then you sort of assume that everything the patient says [that] doesn’t agree with you, that’s lack of insight or anosognosia. And it gives you free range to not listen to the patient. And that’s the real danger with it.”
