BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                            



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                                    THIRD READING


          Bill No:  SB 664
          Author:   Yee (D)
          Amended:  4/11/13
          Vote:     21


           SENATE HEALTH COMMITTEE  :  7-2, 4/24/13
          AYES:  Hernandez, Beall, De León, DeSaulnier, Monning, Pavley,  
            Wolk
          NOES:  Anderson, Nielsen


           SUBJECT  :    Mental health:  Laura's Law

           SOURCE  :     California Psychiatric Association


           DIGEST  :    This bill 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 Boards 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.

           ANALYSIS  :    

          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  
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            mental illness to receive AOT if the court finds the  
            individual meets specified criteria.

          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 the Department of Health Care Services (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.

          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 himself/herself or to  
            others, or is gravely disabled.

          7.Specifies who is authorized upon probable cause, to take a  
            person with a mental disorder who is a danger to  
            himself/herself, a danger to others, or who is gravely  
            disabled, into custody and place him/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.

           Background
           







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          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-year-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  
          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.

           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, 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  







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          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.
          
           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  No   Local:  
           No

           SUPPORT  :   (Verified  4/26/13)

          California Psychiatric Association (source)
          California Association of Psychiatric Technicians
          California Treatment Advocacy Coalition
          National Alliance on Mental Illness, Orange County
          Treatment Advocacy Center

           OPPOSITION  :    (Verified  4/26/13)

          California Council of Community Mental Health Agencies
          California Psychological Association
          Mental Health of America of California
          The California Mental Health Directors Association
          The California State Association of Counties

           ARGUMENTS IN SUPPORT  :    The author's office 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's office 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  







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          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's  
          office 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.

           ARGUMENTS IN 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 that 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.

          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.


          JL:ej  4/30/13   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE








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