BILL ANALYSIS
Subject matter was not heard in Assembly policy committee this
legislative
Session, should be noted in the last paragraph of the background
section of the
CSA analysis. Language will vary depending on the circumstance.
AB 1421
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 1421 (Thomson)
As Amended August 22, 2002
Majority vote
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|ASSEMBLY: |65-1 |(June 25, 2002) |SENATE: |27-8 |(August 28, |
| | | | | |2002) |
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Original Committee Reference: HEALTH
SUMMARY : Permits counties to provide court-ordered outpatient
treatment services for people with serious mental illnesses when
a court finds that a person's recent history of hospitalizations
or violent behavior, coupled with noncompliance with voluntary
treatment, indicate the person is likely to become dangerous or
gravely disabled without the court-ordered outpatient treatment.
Sunsets this bill January 1, 2008. Specifically this bill :
1)Enacts "Laura's Law."
2)Defines "assisted outpatient treatment" (AOT) as categories of
outpatient services that have been ordered by a court under
this bill.
3)Permits, in any county in which the required services are
available, a court to order an individual to obtain AOT if the
court finds by clear and convincing evidence that the
individual meets all of the following criteria:
a) The person is 18 years or older;
b) The person is suffering from a serious mental illness,
as defined in existing law, and is unlikely to survive
safely in the community without supervision, based on a
clinical determination;
c) The person has a history of lack of compliance with
treatment for mental illness that has:
Subject matter was not heard in Assembly policy committee this
legislative
Session, should be noted in the last paragraph of the background
section of the
CSA analysis. Language will vary depending on the circumstance.
AB 1421
Page 2
i) At least twice within the last 36 months been a
substantial factor in necessitating hospitalization,
treatment in a mental health unit of a correctional
facility, or incarceration (not including any
hospitalization or incarceration immediately preceding
the filing of the petition); or
ii) Resulted in one or more acts, attempts, or threats
of serious violent behavior toward self or others, within
the last 48 months (not including any hospitalization or
incarceration immediately preceding the filing of the
petition).
d) The county mental health director or designee has
offered the person an opportunity to participate in a
treatment plan, the person continues to fail to engage in
treatment, and the person's condition is substantially
deteriorating;
e) In view of the person's treatment history and current
behavior, the person is in need of AOT in order to prevent
a relapse or deterioration which would be likely to result
in grave disability or serious harm to the person or others
as defined in Section 5150 (the state's existing
involuntary inpatient treatment law); and
f) AOT would be the least restrictive placement necessary
to ensure the person's recovery and stability, and the
person is likely to benefit from the treatment.
4)Permits a petition for an order authorizing AOT to be filed in
the superior court in the county in which the person who is
the subject of the petition is present or reasonably believed
to be present.
5)Permits a request for the filing of a petition for an AOT
order to be made to the county mental health department by:
a) An adult living with the person who is the subject of
the petition;
Subject matter was not heard in Assembly policy committee this
legislative
Session, should be noted in the last paragraph of the background
section of the
CSA analysis. Language will vary depending on the circumstance.
AB 1421
Page 3
b) The parent, spouse, sibling, or adult child of that
person; or
c) Specified mental health and law enforcement personnel.
6)Requires the county mental health director or his or her
designee to investigate the request, including conducting an
examination of the person who is the subject of the petition,
and to file the petition only upon a determination that there
is a reasonable likelihood that all the necessary elements to
sustain the petition can be proved by clear and convincing
evidence.
7)Requires the petition to state why the subject of the petition
meets the criteria for AOT services, and to include an
affidavit by the licensed mental health treatment provider who
was directed to examine the person by the mental health
director, stating that the provider either:
a) After personally examining the person, recommends AOT,
and is willing to testify at the hearing; or
b) Attempted but failed to persuade the person to submit to
an examination, but has "reason to believe" that the person
meets the criteria for AOT.
8)Requires the court to hold a hearing within five court days of
receipt of the petition (conducted in accordance with the
rules of evidence), and would permit the court to conduct the
hearing in the person's absence, if the person fails to appear
after appropriate notice.
9)Permits the court, if the person refused to be examined during
the petition examination, to request that the person consent
to such an examination, and if the person still refuses and
the court believes an examination is warranted, the court may
order the person to be taken into custody for up to 72 hours
for examination by a licensed mental heath provider.
Subject matter was not heard in Assembly policy committee this
legislative
Session, should be noted in the last paragraph of the background
section of the
CSA analysis. Language will vary depending on the circumstance.
AB 1421
Page 4
10)Requires that the person who is the subject of an AOT
petition has the following rights:
a) Adequate notice of the hearing;
b) A copy of the court ordered evaluation;
c) Legal representation at all stages of the proceedings
(by the public defender, if the person has not retained
counsel); and
d) At the hearing, to be present, to call or cross-examine
witnesses, and to appeal decisions.
11)Permits the court, if it finds that the person meets the AOT
criteria, to order the person to receive AOT services, set
forth in a written treatment plan as specified, for an initial
period not to exceed six months.
12)Prohibits the court from ordering AOT services unless the
court finds, in consultation with the mental health director
or designee, all of the following:
a) The services are available from the county, or a
provider approved by the county, for the duration of the
court order.
b) That the services have been offered to the person by the
local director of mental health, or his or her designee,
and the person has been given an opportunity to participate
on a voluntary basis, and the person has failed to engage
in, or has refused, treatment.
c) That all of elements of the petition required by this
bill have been met.
d) That the treatment plan will be delivered to the county
director of mental health, or to his or her appropriate
designee.
Subject matter was not heard in Assembly policy committee this
legislative
Session, should be noted in the last paragraph of the background
section of the
CSA analysis. Language will vary depending on the circumstance.
AB 1421
Page 5
13)Requires that any directions included in an existing advance
health care directive for the person to be considered in
formulating the written treatment plan.
14)Requires the director of the AOT program, at 60-day
intervals, to file a declaration with the court confirming
that the person continues to meet the AOT criteria. States
that the person has the right to dispute the declaration at a
hearing with the burden of proof on the director. States that
the person has the right, during each 60-day period, to file
for a writ of habeas corpus requiring the director to prove
the person continues to meet the AOT criteria.
15)Requires that, if at any time during the 72-hour hold the
person is determined not to meet the criteria for involuntary
inpatient hospitalization pursuant to existing law (Section
5150), and does not agree to stay in the hospital as a
voluntary patient, the person shall be released, and any
subsequent involuntary retention in a hospital shall be
pursuant to existing law (Section 5150.)
16)Permits the court, if the person who is the subject of a
petition for an order for AOT pursuant to this bill refuses to
participate in the AOT program, to order the person to meet
with the AOT team designated by the director of the AOT
program. Requires the treatment team to attempt to gain the
person's cooperation with the AOT order. Permits the court to
subject the person to a 72-hour hold only if the treatment
team's efforts to gain cooperation failed.
17)States that failure to comply with an order of AOT alone
shall not be grounds for involuntary civil commitment or a
finding of contempt of court.
18)Requires the director, if the director of the AOT program
determines that the condition of the patient requires further
AOT, to apply to the court, prior to the expiration of the
period of the initial AOT order, for an order authorizing
continued AOT for a period not to exceed 180 days from the
date of the order. Requires the procedures for obtaining any
Subject matter was not heard in Assembly policy committee this
legislative
Session, should be noted in the last paragraph of the background
section of the
CSA analysis. Language will vary depending on the circumstance.
AB 1421
Page 6
order to be in accordance with specified provisions of this
bill. Prohibits the period for further involuntary outpatient
treatment authorized by any subsequent order from exceeding
180 days from the date of the order.
19)Permits any person ordered to undergo AOT who was not present
at the hearing at which the order was issued to immediately
petition the court for a writ of habeas corpus. Prohibits
treatment under the order for AOT from commencing until the
resolution of that petition.
20)Permits, in any county in which services are available as set
forth in 23) below, any person who is determined by the court
to be likely to be present, or subject to detention under
existing law, to voluntarily enter into an agreement for
services under this bill.
21) Permits the person who is the subject of the petition, after
a petition is filed but before the conclusion of the hearing,
to enter into a settlement agreement approved by the court
that shall have the same effect as an AOT order.
22)Permits either party to request that the court modify the
treatment plan at any time during the 180-day period.
23)Requires any county that chooses to provide AOT services, to
offer specified mental health outpatient services with an
enhancement of a 10-1 staff to client ratio and that services
for AOT clients be provided by specified trained mobile mental
health teams. Requires that participating counties also
provide these services on a voluntary basis.
24)Prohibits involuntary medication from being allowed absent a
separate order by the court under specified provisions of
existing law.
25)Requires each participating county to provide to the
Department of Mental Health (DMH) specified data. Requires
DMH to report on that data to the Legislature on or before May
1 of each year in which the participating county provides AOT
Subject matter was not heard in Assembly policy committee this
legislative
Session, should be noted in the last paragraph of the background
section of the
CSA analysis. Language will vary depending on the circumstance.
AB 1421
Page 7
services. Requires, among other things, that reporting
requirements include, at a minimum, an evaluation of the
effectiveness of the strategies employed by any program
operated pursuant to this bill in reducing homelessness and
hospitalization of persons in the program and in reducing
involvement with local law enforcement by persons in the
program and other specified information that is available.
26) Requires that AOT orders may only be issued in counties
where the board of supervisors has authorized its application,
and has made a finding that implementation of an AOT program
will not result in reductions in the county's current
voluntary outpatient mental health programs.
27)Requires participating counties, in consultation with DMH and
other specified interested parties, to develop a training and
education program for those delivering mental health services.
Requires the training to include both of the following:
a) Information relative to legal requirements for detaining
a person for involuntary inpatient and outpatient
treatment, including criteria to be considered with respect
to determining if a person is considered to be gravely
disabled;
b) Methods for ensuring that decisions regarding AOT
services direct patients toward the most effective
treatment. Training shall include an emphasis on each
patient's right to provide informed consent to assistance.
28)Sunsets the provisions of this bill January 1, 2008.
The Senate amendments:
1.Make the implementation of this act permissive to counties,
and delete the state grant-funding requirement for AOT
programs in participating counties.
2.Revise the qualifying criteria for AOT orders to match
criteria in New York's AOT statute by specifying a required
level of past dangerousness or hospitalizations for those
Subject matter was not heard in Assembly policy committee this
legislative
Session, should be noted in the last paragraph of the background
section of the
CSA analysis. Language will vary depending on the circumstance.
AB 1421
Page 8
subject to an AOT order, and by deleting criteria related to
"psychotic disorders" and existing involuntary inpatient
criteria (Section 5150).
3.Limit those individuals who can file an AOT petition in the
court to only the local director of mental health of
participating counties. Requires the director, prior to
filing an AOT petition with the courts, to investigate and
screen all AOT petition requests and to make a determination
that all elements of the petition are likely to be proved by
clear and convincing evidence and delete the ability of family
members and other individuals to file a petition for an AOT
order directly with the courts.
4.Extend from three to five days the time between the filing of
the petition and the court hearing on the petition.
5.Add to the specified rights of a person, who is the subject of
an AOT order, the right to a public defender if he or she has
not retained counsel.
6.Conform enforcement procedures for noncompliance with
settlement agreements to those specified for noncompliance
with AOT orders.
7.Add a requirement that any existing advance directives for the
person be considered in formulating the written treatment plan
required under the AOT order.
8.Require the local mental health director, at 60-day intervals,
to file a declaration with the court confirming that the
person continues to meet AOT criteria, and adds the right of
the person to dispute the director's declaration and to file a
writ of habeas corpus with the burden of proof on the
director.
9.Require the court, if the person is noncompliant with the
order, to order the person to meet with the treatment team and
then, only if the team's efforts to gain compliance fail, to
order the person be held for 72 hours to be evaluated for an
Subject matter was not heard in Assembly policy committee this
legislative
Session, should be noted in the last paragraph of the background
section of the
CSA analysis. Language will vary depending on the circumstance.
AB 1421
Page 9
inpatient commitment pursuant to existing law; adds that any
subsequent involuntary detention shall be pursuant to existing
law.
10.Delete the infraction penalty for noncompliance with an AOT
order.
11.Conform data reporting requirements to those required for AB
2034 (Steinberg) programs for homeless mentally ill persons.
12.Conform outpatient services requirements to those required
under AB 2034 statutes with an added enhancement that the
services be provided by a multidisciplinary team with a 10-1
staff to client ratio for those persons under AOT orders.
13.Require that AOT orders may only be issued in counties where
the board of supervisors has authorized its application, and
has made a finding that implementation of an AOT program will
not result in reductions in the county's current voluntary
outpatient mental health programs.
14.Require participating counties, in consultation with DMH and
other interested parties, to develop training requirements as
specified for those delivering mental health services.
15.Extend the sunset by two years to January 1, 2008.
AS PASSED BY THE ASSEMBLY , enacted "Laura's Law," which
authorized a new type of involuntary commitment order to get
intensive outpatient treatment to adults whose mental illness
currently prevents them from seeking or accepting help.
Authorized, in participating counties, a court to order a person
into an assisted outpatient treatment program (AOT) if the court
finds that the individual either meets existing "5150"
involuntary commitment requirements (is gravely disabled or is a
danger to self or others), or the person meets other criteria
including that the person has a psychotic disorder or other
severe mental illness and has been offered but failed to engage
in treatment, is substantially deteriorating, and AOT would be
the least restrictive placement necessary to ensure the person's
Subject matter was not heard in Assembly policy committee this
legislative
Session, should be noted in the last paragraph of the background
section of the
CSA analysis. Language will vary depending on the circumstance.
AB 1421
Page 10
recovery and stability. Required DMH to award grants to
counties that can provide specified services for persons with
the most persistent and severe mental illness. Made funding for
AOT grants subject to appropriation in the budget. Sunset the
bill January 1, 2006.
FISCAL EFFECT : According to the Senate Appropriations
Committee, the Judicial Council's estimates for additional state
General Fund court costs range from $1.2 million to $3.8 million
per year, assuming that Los Angeles, Sacramento and Stanislaus
Counties would choose to participate. The costs of additional
mental health services provided as part of the assisted
outpatient treatment are indeterminate until the counties are
able to determine how much funding could be made available for
that purpose. Furthermore, the DMH estimates that its costs
would be minor and absorbable.
The author's office estimates significantly less in potential
court costs ($60,000 to $90,000 per year) for those three
counties based on AOT court cost experience in other states and
service capacity estimates from Los Angeles and Sacramento
County mental health officials.
COMMENTS :
1)According to the author, the bill will implement key findings
in the 2001 RAND report by funding a limited AOT program in
California to test its success when applied to the same
eligibility criteria and service standards used in existing
successful programs. RAND findings provide a scientific basis
for pursuing an outpatient treatment option for those
high-risk patients whom for various reasons, even when
treatment is made available, do not voluntarily comply.
2)Supporters generally argue that:
a) This bill provides both the legal and clinical treatment
structure necessary to give severely disabled people, who
have failed to engage in treatment after repeated offers of
the best and most intensive services available, the support
Subject matter was not heard in Assembly policy committee this
legislative
Session, should be noted in the last paragraph of the background
section of the
CSA analysis. Language will vary depending on the circumstance.
AB 1421
Page 11
they need to achieve stability and meaningful recovery;
b) AOT services has been proven as an evidence-based,
comprehensive, community treatment program for individuals
with the most severe and persistent mental illnesses who
are chronically resistant to treatment;
c) Scientific research demonstrates that sustained
outpatient commitment can be highly successful for persons
with serious mental illness if the following conditions are
met: a) they have at least 180 days of service; and, b)
they receive an intensive array of services needed to
address their very serious problems;
d) This bill will give hope to Californians with mental
illnesses that they will be going from a fractured system
of care to one that provides continuity of care, support
and an understanding of the multiple needs of those with
serious and persistent mental illnesses.
3)Opposition from statewide mental health client organizations
base their arguments generally on a "fundamental philosophical
difference," asserting that this bill:
a) Substitutes coercion for establishing a system of
effective care that is sought voluntarily; and contains an
enforcement mechanism and the authority to hold the AOT
hearing without the person present if the person does not
appear and appropriate attempts to elicit the attendance of
the person have failed;
b) Creates additional layers of bureaucracy in a mental
health system that already lacks accountability and would
throw money in a direction that upsets the balance of civil
liberties and social stability;
c) Allows persons in some counties to be subject to
involuntary detention and psychiatric treatment under a
standard less stringent than that required for persons in
other counties in violation of the Equal Protection clause;
Subject matter was not heard in Assembly policy committee this
legislative
Session, should be noted in the last paragraph of the background
section of the
CSA analysis. Language will vary depending on the circumstance.
AB 1421
Page 12
and
d) Provides services that would be very similar to those in
other legislation, and that where system resources are
sufficient, the vast majority of individuals that need
treatment can be treated voluntarily.
Analysis Prepared by : Nancy Westergaard / HEALTH / (916)
319-2097
FN:
0007658
0007392
0001493
FN: 0007658 0007392