BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 59| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 59 Author: Waldron (R), et al. Amended: 3/28/16 in Senate Vote: 21 SENATE HEALTH COMMITTEE: 6-0, 6/8/16 AYES: Hernandez, Nguyen, Mitchell, Nielsen, Pan, Roth NO VOTE RECORDED: Hall, Monning, Wolk SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8 ASSEMBLY FLOOR: 77-0, 1/27/16 - See last page for vote SUBJECT: Mental health services: assisted outpatient treatment SOURCE: Author DIGEST: This bill 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 (DHCS) reporting requirement, as specified, regarding the AOT services a county provides. ANALYSIS: Existing law: AB 59 Page 2 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 DHCS to submit a report and evaluation of all counties implementing any component of Laura's Law to the Governor and the 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. Comments 1)Author's statement. According to the author, currently, Laura's Law is set to sunset on January 1, 2017. Without AB AB 59 Page 3 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. 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 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 AB 59 Page 4 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 (MHSA) funds could be used for AOT services if the county has implemented it. According to DHCS, 15 counties have approved and/or implemented Laura's Law: Alameda, Contra Costa, El Dorado, Kern, Los Angeles, Mendocino, Nevada, Orange, Placer, San Diego, San Francisco, San Luis Obispo, San Mateo, Ventura, and Yolo. Prior Legislation AB 1193 (Eggman, 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 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) See Comments. AB 1265 (Conway, 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, 2014) was similar to AB 1265. AB 2266 failed passage in the Assembly Judiciary Committee. AB 59 Page 5 SB 664 (Yee, 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 passage in the Senate Appropriations Committee without being heard. AB 1367 (Mansoor, 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, 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 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) See Comments. AB 59 Page 6 FISCAL EFFECT: Appropriation: Yes Fiscal Com.:YesLocal: No SUPPORT: (Verified6/28/16) 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 OPPOSITION: (Verified6/28/16) Disability Rights California ARGUMENTS IN 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 implemented Laura's Law have also seen a significant decrease in homelessness, as well as reduced spending on emergency room and jail costs. ARGUMENTS IN 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. AB 59 Page 7 ASSEMBLY FLOOR: 77-0, 1/27/16 AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Quirk, Rendon, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins NO VOTE RECORDED: Holden, Ridley-Thomas Prepared by:Reyes Diaz / HEALTH / (916) 651-4111 6/29/16 15:45:48 **** END ****