BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 664
AUTHOR: Yee
AMENDED: April 11, 2013
HEARING DATE: April 24, 2013
CONSULTANT: Robinson-Taylor
SUBJECT : Mental Health: Laura's Law.
SUMMARY : Deletes the requirement under the Assisted Outpatient
Treatment Demonstration Project Act of 2002 (AOT Act, which is
also known as "Laura's Law") that county Board of Supervisors
must pass a resolution authorizing the AOT Act and make a
finding that no voluntary mental health programs may be reduced
as a result of the AOT Act's implementation. Allows counties to
place a cap on the number of persons to whom it provides AOT
services under the AOT Act.
Existing law:
1.Allows county Boards of Supervisors, by resolution, to authorize
the AOT Act whereby a county mental health director can petition
for a court to order a person over age 18 with a mental illness to
receive AOT if the court finds the individual meets specified
criteria, including: a clinical determination that the person is
unlikely to survive safely in the community without supervision;
the person has a history of noncompliance with treatment for his
or her mental illness; and the person's condition is substantially
deteriorating and participation in AOT would be the least
restrictive placement necessary to ensure the person's recovery.
2.Requires counties implementing the AOT Act to make a finding that
no voluntary mental health program serving adults, and no
children's mental health program, may be reduced as a result of
the implementation.
3.Requires a county that provides court-ordered AOT services to also
offer the same services on a voluntary basis.
4.Requires DHCS to submit a report and evaluation of all
counties implementing any component of the AOT Act to the
Governor and the Legislature by July 1, 2015.
5.Sunsets the AOT Act on January 1, 2017.
Continued---
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6.Establishes the Lanterman-Petris Short Act (LPS Act), which
authorizes a person to be involuntarily detained for inpatient
mental health treatment when, as a result of a mental
disorder, the person is a danger to him or herself or to
others, or is gravely disabled. Defines "gravely disabled" to
mean a condition in which a person, as a result of a mental
disorder, is unable to provide for his or her basic personal
needs for food, clothing, or shelter.
7.Authorizes a peace officer, member of the attending staff of
an evaluation facility designated by the county, designated
members of a mobile crisis team, or other professional person
designated by the county, upon probable cause, to take a
person with a mental disorder who is a danger to himself or
herself, a danger to others, or who is gravely disabled, into
custody and place him or her in a facility designated by the
county and approved by Department of Social Services as a
facility for 72-hour treatment and evaluation (referred to as
a 72-hour hold).
This bill:
1.Deletes the requirement under the AOT Act that county Board of
Supervisors must pass a resolution authorizing the program and
make a finding that no voluntary mental health programs may be
reduced as a result of the AOT Act's implementation; and,
2.Permits counties to place a cap on the number of persons to
whom it provides AOT services under the AOT Act.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. Anosognosia is a neurological syndrome
where an individual has a lack of awareness or a denial of a
neurologic defect or illness in general. According to the
author, anosognosia is the single largest reason why
individuals with schizophrenia and bipolar disorder do not
stay engaged in mental health treatment. The AOT Act, the
author maintains is primarily for those individuals who have
failed to engage in community treatment after hospital
discharges or incarceration because they suffer from this
condition. The author argues, just because an individual is
too sick to realize they need treatment is not a reason to
deny them treatment. Many of these individuals are the most
seriously mentally ill in our communities, are in most need of
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treatment and deserve treatment as much as someone seeking it
on a voluntary basis.
The author asserts this bill is attempting to remove an
unnecessary and politicized barrier to implementation of the
AOT Act for counties. By removing as a requirement that
county Board of Supervisors must pass a resolution authorizing
the program and making a finding that no voluntary mental
health programs may be reduced as a result of the AOT Act's
implementation, the decision to initiate a process for
implementation of the AOT Act would be in the hands of the
county mental health director who may be better equipped to
understand the needs of community and the impacts of such a
program. The author maintains, the mental health director
would still be required to submit a budget proposal to the
Board of Supervisors, which the Board of Supervisors would
have to approve, effectively making the current resolution
process unnecessary and duplicative. This bill also allows
counties to place a cap on the number of persons to whom it
provides AOT services to address concerns expressed by
counties that may not be able to meet the financial
obligations of serving the entire eligible population, but
want to implement the AOT Act to the extent resources are
available. The author maintains that this bill does not
remove local control or diminish the amount of mental health
services that a county may provide, but rather removes
unnecessary barriers to implementation for counties that deem
the AOT Act beneficial for their communities.
2.The AOT Act. AB 1421 (Thompson), Chapter 1017, Statutes of
2002, the AOT Act, established a new court-ordered outpatient
treatment statute aimed at individuals with mental illness who
meet specified criteria but who do not meet the criteria
(danger to self/others or gravely disabled) for commitment to
an inpatient facility. Also known as Laura's Law, the law is
named in memory of Laura Wilcox, a 19-yar-old college student
who was killed by a severely mentally ill man who was not
adhering to prescribed mental health treatment. The AOT Act
provides counties with the option to implement intensive AOT
programs for individuals who have difficulty maintaining their
mental health stability in the community and have frequent
hospitalizations and contact with law enforcement related to
untreated or undertreated mental illness.
Implementation of the AOT Act is at the discretion of the
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county. A county Board of Supervisors must authorize
implementation by resolution and make a finding that access to
voluntary mental health programs serving adults and children
would not be reduced as a result of implementation. The
implementing county must submit specified documentation to
DHCS prior to the AOT Act implementation that includes: a copy
of the county Board of Supervisor's resolution verifying that
voluntary services will not be reduced as a result of
implementation; documentation of the local mental health
board's review of the county's AOT Act implementation plan; a
detailed AOT program narrative; a proposed budget and budget
narrative for AOT program expenditures; a description of
methods for data collection; and, a plan for development of an
AOT training and education program.
3.Related legislation. SB 364 (Steinberg) broadens the types of
facilities that can be used for purposes of a 72-hour
treatment and evaluation under Section 5150 of the LPS Act for
individuals with a mental health disorder to include
facilities licensed or certified as mental health treatment
facilities by the DHCS or the Department of Public Health.
Permits county mental health directors to develop procedures
for the designation and training of professionals who will be
designated to perform functions under Section 5150. This bill
is scheduled to be heard by the Senate Health Committee on
April 24, 2013.
SB 585 (Steinberg) clarifies that state funding sources for
county mental health programs, including funds generated under
the Mental Health Services Act (MHSA), can be expended to
support mental health treatment services provided under the
AOT Act. This bill is scheduled to be heard by the Senate
Health Committee on April 24, 2013.
AB 1265 (Conway) permits an initial court order for AOT Act
services to be extended for up to 12 months (rather than the
current six months). Requires that each person discharged
from a hospital be "considered" for AOT in the counties that
have implemented the AOT Act. AB 1265 is currently in the
Assembly Judiciary Committee.
AB 1367 (Mansoor) clarifies that the Mental Health Services Act
(MHSA) funds can be used to support the AOT Act and provides
outreach to school children who may be a threat to themselves
or others. AB 1367 is currently in the Assembly Health
Committee.
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4.Prior legislation. AB 1569 (Allen), Chapter 441, Statutes of
2012, extends the sunset date of AOT Act from January 1, 2013
until January 1, 2017. Requires DHCS to submit a report and
evaluation of all counties implementing any component of the
AOT Act to the Governor and the Legislature by July 31, 2015.
AB 2134 (Chesbro) of 2012 would have required a county that
elects to provide AOT services to develop best practices for
the purposes of responding to a mental health crisis, and
would have required these best practices to include the
utilization of crisis intervention teams, mobile crisis teams,
or psychiatric emergency response teams, with an emphasis on
peer support. This bill failed passage in the Senate Health
Committee.
AB 2357 (Karnette and Yee), Chapter 774, Statutes of 2006
extended the AOT Act sunset date to January 1, 2013, and
required the former Department of Mental Health to submit a
progress report to the Governor and Legislature in 2011.
AB 1421 (Thompson), Chapter 1017, Statutes of 2002 enacted the
AOT Act with a January 1, 2008 sunset date.
5.Support. The California Psychiatric Association (CPA) writes
in support that this bill clarifies that counties which choose
to implement AOT have the flexibility to determine the size of
their AOT program. According to CPA, some county attorneys
have opined that if the program is adopted in their respective
county they must accept all individuals who may qualify for
AOT services into the program. This is not, and never has
been in accord with the AOT Act and this bill provides this
needed clarification. CPA also writes in support that this
bill removes a duplicative and unnecessary hearing by county
Board of Supervisors as a prior condition of implementation of
the AOT Act. CPA asserts that having a resolution hearing is
duplicative for the simple fact that Boards of Supervisors
possess and will continue to possess should this bill become
enacted, their powers granted to them by the California
Constitution for oversight and budget approval over any county
program, service or operation. Lastly, CPA writes in support
that by removing the duplicative Board of Supervisors hearing,
this bill also removes a finding required at the close of that
hearing that no voluntary mental health services will be
reduced by the implementation of the AOT Act. CPA maintains
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that this requirement has the effect of making the AOT Act
much more difficult to implement because it requires that a
county find a completely new source of funding for any
proposed AOT program and has the effect of restricting the
options and priorities that any particular county may wish to
set to meet local needs.
6.Opposition. The California Psychological Association writes
in opposition that local control is important in the public
mental health system and that counties are in the best
position to determine whether their region wants and can
successfully implement a program while keeping their current
programs and priorities funded. The Mental Health America of
California (MHA) writes in opposition the there are so many
people who need services and can't get them and for whom a
court order is not necessary that this program should be
appropriately targeted to only those whose needs are greater
than others. MHA maintains that provisions in current law
ensure that services will not be reduced.
7.Oppose Unless Amended. The California Mental Health Directors
Association (CMHDA) and the California State Association of
Counties (CSAC) both write that they are opposed unless
amended. CMHDA and CSAC both write in opposition to the
provisions of this bill that would remove the authority of
county Boards of Supervisors to determine whether the
implementation of the AOT Act is appropriate in their
communities. CMHDA and CSAC maintain that the AOT Act was
specifically constructed to allow county Boards of Supervisors
to consider the needs and priorities of their local
communities, as well as the fiscal ramifications, of
implementing AOT services. CMHDA is also opposed to the
provisions in this bill that make a finding that voluntary
mental health programs would not be reduced as a result of AOT
Act implementation.
SUPPORT AND OPPOSITION :
Support: California Psychiatric Association (sponsor)
California Association of Psychiatric Technicians
California Treatment Advocacy Coalition
National Alliance on Mental Illness, Orange County
Treatment Advocacy Center
22 individuals
Oppose: California Council of Community Mental Health Agencies
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California Psychological Association
Mental Health of America of California
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