BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 59
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|AUTHOR: |Waldron |
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|VERSION: |March 28, 2016 |
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|HEARING DATE: |June 8, 2016 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : Mental health services: assisted outpatient treatment
SUMMARY : Extends the repeal date of the Assisted Outpatient Treatment
(AOT) Demonstration Project Act of 2002, or "Laura's Law," by
five years, to January 1, 2022, and deletes and recasts in
existing law the Department of Health Care Service's reporting
requirement, as specified, regarding the AOT services a county
provides.
Existing law:
1)Allows a county Boards of Supervisors, by resolution, to authorize
Laura's Law, whereby a county behavioral health director can
petition for a court to order a person over the age of 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 that implement Laura's Law 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 Laura's Law to the Governor and the
AB 59 (Waldron) Page 2 of ?
Legislature by July 1, 2015.
5)Sunsets Laura's Law on January 1, 2017, unless a later enacted
statute extends or repeals that date.
This bill: Extends the sunset of Laura's Law by five years, to
January 1, 2022, and deletes and recasts in existing law DHCS's
reporting requirement to the Governor and Legislature, on or
before May 1 of each year, regarding the AOT services the county
provides pursuant to Laura's Law.
FISCAL
EFFECT : According to the Assembly Appropriations Committee, this
bill has negligible state fiscal effect.
PRIOR
VOTES :
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|Assembly Floor: |77 - 0 |
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|Assembly Appropriations Committee: |17 - 0 |
|Assembly Judiciary Committee: | 7 - 0 |
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|Assembly Health Committee: |16 - 0 |
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COMMENTS :
1)Author's statement. According to the author, currently,
Laura's Law is set to sunset on January 1, 2017. Without AB
59, Laura's Law will expire and leave those who are mentally
ill without the necessary treatment they need. AOT is a
program that helps assist family members to initiate
outpatient treatment for severe mentally ill adults who are
incapable of seeking help on their own and have a history of
incarceration, hospitalization, or have threatened to hurt
themselves or others. AOT is an evidence-based, well-studied
modality of treatment that has been effective in helping and
stabilizing mentally ill individuals. The program has
increased stable housing, medication adherence, and social
skills building. AB 59 will ensure Laura's Law is available to
the families of those who are mentally ill in order to provide
proper care and support.
AB 59 (Waldron) Page 3 of ?
2)Laura's Law. Enacted pursuant to AB 1421 (Thompson, Chapter
1017, Statutes of 2002), Laura's Law established a new
court-ordered AOT demonstration program aimed at individuals
with mental illness who meet specified criteria but who do not
meet the criteria (danger to self or others, or gravely
disabled) for involuntary commitment to an inpatient facility.
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.
AOT provides counties with the option to implement intensive
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.
Laura's Law requires a county's board of supervisors to
authorize implementation by resolution and to make a finding
that access to voluntary mental health programs serving adults
and children would not be reduced as a result of
implementation. Implementation of Laura's Law is at the
discretion of each county. The law did not provide for any
state or local funding for the program's implementation. This
lack of funding has been perceived as one of the barriers to
its implementation. According to the former Department of
Mental Health (DMH) in 2011, no county implemented a
court-ordered Laura's Law program until Nevada County
implemented it in 2008. Since implementation, Nevada County
has found that Laura's Law has resulted in: 46% reduction in
hospitalizations, 65% reduction in incarcerations, 61%
reduction in homelessness, 44% reduction in emergency
contacts, and $1.81-$2.52 in savings for every dollar spent as
a result of reducing incarceration, arrest, and
hospitalization.
SB 585 (Steinberg and Correa, Chapter 288, Statutes of 2013),
clarified that Mental Health Services Act funds could be used
for AOT services if the county has implemented it. Currently,
fourteen counties have approved and/or implemented Laura's
Law: Nevada, Yolo, Placer, Mendocino, San Francisco, Contra
Costa, San Mateo, Kern, Orange, Los Angeles, San Diego, El
Dorado, Alameda, and Ventura.
3)Prior legislation. AB 1193 (Eggman, of 2015), would have,
among other things, required a county that has not held a
specified public hearing by January 1, 2017, to hold a hearing
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by January 1, 2018, and would have required the county board
of supervisors to consider both whether mental health programs
may be reduced as a result of participation in Laura's Law and
options for providing services other than court-ordered
outpatient treatment. AB 1193 was held on suspense in the
Assembly Appropriations Committee.
SB 585 (Steinberg and Correa, Chapter 288, Statutes of 2013).
AB 1265 (Conway, of 2014), would have permitted an initial
court order for AOT services to be extended for up to 12
months (rather than the current six months), and required that
each person discharged from a hospital be considered for AOT
in the counties that have implemented Laura's Law. AB 1265
failed passage in the Assembly Judiciary Committee.
AB 2266 (Waldron, of 2014), was similar to AB 1265. AB 2266
failed passage in the Assembly Judiciary Committee.
SB 664 (Yee, of 2013), would have removed the requirement that
each county board of supervisors pass a resolution prior to
implementing Laura's Law, and acknowledged that counties could
cap the number of people under the program. SB 664 failed in
the Senate Appropriations Committee without being heard.
AB 1367 (Mansoor, of 2013), would have clarified that MHSA
funds could be used to support Laura's Law and provided
outreach to school children who may be a threat to themselves
or others. AB 1367 failed passage in the Assembly Health
Committee without being heard.
AB 1569 (Allen, Chapter 441, Statutes of 2012), extends the
sunset date of Laura's Law from January 1, 2013, until January
1, 2017, and requires DHCS to submit a report and evaluation
of all counties implementing any component of the law to the
Governor and the Legislature by July 1, 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. AB 2134 failed passage in the Senate Health
AB 59 (Waldron) Page 5 of ?
Committee.
AB 2357 (Karnette and Yee, Chapter 774, Statutes of 2006),
extended the Laura's Law 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).
4)Support. Supporters of this bill argue that extending Laura's
Law allows local governments to assess the needs of their
communities on an ongoing basis, and that it is an important
part of the mental health continuum of care, focusing on
prevention, saving lives, and improving the quality of life
for individuals and communities. Supporters state that
counties that have implements Laura's Law have also seen a
significant decrease in homelessness, as well as reduced
spending on emergency room and jail costs.
5)Opposition. Disability Rights California (DRC) argues that it
has concerns about AOT programs and believes that voluntary
services are more effective and should be expanded. DRC states
that the sunset provision is important to protect the rights
of people with mental health disabilities in California.
SUPPORT AND OPPOSITION :
Support: California Chapter of the American College of
Emergency Physicians
California State Association of Counties
NAMI-Contra Costa
San Diego Regional Chamber of Commerce
Tenet Healthcare
Urban Counties of California
One individual
Oppose: Disability Rights California
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