BILL ANALYSIS                                                                                                                                                                                                    



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          Date of Hearing:  April 14, 2015


                            ASSEMBLY COMMITTEE ON HEALTH


                                  Rob Bonta, Chair


          AB 1193  
          (Eggman) - As Introduced February 27, 2015


          SUBJECT:  Mental health services:  assisted outpatient treatment


          SUMMARY:  Mandates county implementation of the Assisted  
          Outpatient Treatment (AOT) Demonstration Project, known as  
          Laura's Law, and authorizes a superior court judge to request a  
          petition to obtain AOT for a person who appears before the  
          judge. Specifically, this bill:  


          1)Mandates county implementation of Laura's Law unless the  
            county elects not to participate in the program by enacting a  
            resolution passed by the county board of supervisors;


          2)Authorizes a superior court judge to request a petition for  
            AOT for any person appearing before the judge; and


          3)Deletes the January 1, 2017 repeal date of Laura's Law and  
            extends the program until January 1, 2022.


          EXISTING LAW:  










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          1)Permits counties to provide AOT services for people with  
            serious mental illnesses when a court determines that a  
            person's recent history of hospitalizations or violent  
            behavior, and noncompliance with voluntary treatment,  
            indicates the person is likely to become dangerous or gravely  
            disabled without the court-ordered outpatient treatment.  

          2)Allows a court, after finding that an individual meets the  
            criteria for AOT, and there is no appropriate and feasible  
            less restrictive alternative, to order the individual to  
            receive AOT for an initial period not to exceed six months.   
            If the director of the assisted outpatient program determines  
            that the individual requires further assisted outpatient  
            services, requires that director, prior to expiration of the  
            time period of the treatment, to apply to the court for an  
            extension of the services, not to exceed 180 days. 

          3)Allows the following individuals to file a petition for an  
            order authorizing AOT for another individual:
             a)   A county mental health director or his/her designee;
             b)   The spouse, parent, sibling or child 18 years or older  
               of an individual that is the subject of a petition;
             c)   Any person over 18 residing with the individual;
             d)   The director of any public or private agency, treatment  
               facility, charitable organization, or licensed residential  
               care facility providing mental health services to the  
               individual;
             e)   The director of a hospital in which the individual is  
               hospitalized;
             f)   A licensed mental health treatment provider who is  
               either supervising the treatment of, or treating for a  
               mental illness for the individual;
             g)   A peace officer, parole office, or probation officer  
               assigned to supervise the individual.

          4)Sunsets the AOT Demonstration Project on January 1, 2017.  

          5)Grants any person subject to a petition for an order of AOT  
            the right to legal counsel at all steps of the hearing  








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            process. 

          6)Requires the Department of Health Care Services (DHCS) to  
            submit a report and evaluation to the Governor and the  
            Legislature of all counties implementing an AOT program by  
            July 1, 2015.  

          7)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.  

          8)Allows, under the LPS Act, a person who is gravely disabled to  
            be involuntarily detained for further inpatient mental health  
            treatment for an additional 14 days, as provided, which can be  
            extended for 14 days if the person presents an imminent threat  
            of taking his or her own life or 30 days if the county has  
            authorized the program and the person remains gravely  
            disabled.  

          9)Allows, under the LPS Act, a court to order an imminently  
            dangerous person to be confined for further inpatient  
            intensive health treatment for an additional 180 days, as  
            provided.  
          
          FISCAL EFFECT:  This bill has not yet been analyzed by a fiscal  
          committee.


          COMMENTS: 


          1)PURPOSE OF THIS BILL.  According to the author, only nine  
            counties have implemented AOT.  Laura's Law is a  
            community-based treatment program to assist individuals who,  








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            as a result of their severe mental illness, are unable to  
            access community mental health services voluntarily.  In fact,  
            AOT is a less restrictive alternative to involuntary  
            hospitalization, where an individual suffering from a severe  
            mental illness is contained for 72 hours if they have  
            presented a danger to themselves or others.  The current  
            process of opting in makes AOT implementation too difficult  
            for counties to participate, evidenced by the fact that only a  
            fraction of the counties have implemented AOT.  Implementing  
            AOT statewide will ensure that those at highest risks for  
            hospitalization can obtain the necessary treatment services to  
            keep them in the community.  The author writes that while this  
            bill implements Laura's Law statewide, this bill does allow  
            counties to retain control by allowing them to opt out if they  
            choose not to participate in Laura's Law. 
          
          2)BACKGROUND.  The AOT Demonstration Project allows courts in  
            participating counties to order a person into an AOT program  
            if the court finds that the individual either meets existing  
            involuntary commitment requirements pursuant to Welfare and  
            Institutions Code Section 5150 (is gravely disabled or is a  
            danger to self or others), or the person meets non-5150  
            criteria including that the person has refused treatment,  
            their mental health condition is substantially deteriorating,  
            and AOT would be the least restrictive level of care necessary  
            to ensure the person's recovery and stability in the  
            community.  The law is only operative in those counties in  
            which the county board of supervisors, by resolution,  
            authorizes its application and makes a finding that no  
            voluntary mental health program serving adults, and no  
            children's mental health program, was reduced in order to  
            implement the law.

          3)COUNTY IMPLEMENTATION.  Currently, Nevada, Orange, Yolo, and  
            the City and County of San Francisco have approved full  
            implementation of Laura's Law; Los Angeles County implemented  
            the law on a limited basis. According to the treatment  
            provider that Nevada County contracts with for services,  
            Turning Point Community Programs, Initiating the AOT process  








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            begins with a referral submitted by family members, relatives,  
            cohabitants, treatment providers or their supervisors, or  
            peace officers.  If individuals meet AOT eligibility  
            requirements, a preliminary care plan is developed.  If the  
            individual voluntarily engages with the treatment after  
            initial contact, a petition is no longer necessary and the  
            patient no longer meets the criteria for AOT referral.   
            However if the client declines the preliminary care plan, the  
            AOT team proceeds with a petition and a public defender is  
            assigned to the client.  The court must be notified within 10  
            days of the intervention, and a hearing must be set within  
            five days of the filing of the petition and the judge either  
            grants or rejects the AOT petition.  If ordered, AOT is valid  
            for up to 180 days.

          According to Nevada County, in the seven years the county has  
            implemented Laura's Law, 37 AOT commitments have been ordered  
            by the court, and six individuals have failed to complete  
            their orders due to hospitalization, incarceration, or death.   
            Nevada County indicates that the number of hospitalization  
            days for program participants has been cut in half, and no  
            patient has encountered problems with law enforcement since  
            their commitment. In Orange County, two individuals have been  
            ordered to fulfill an AOT commitment.  The other county  
            programs have been recently implemented and do not yet have  
            any court ordered AOT commitments.

          4)SUPPORT.  Nick and Amanda Wilcox, in support of this bill and  
            of Laura's Law which is named after their daughter who was  
            shot and killed at the age of 19 by a man with untreated  
            severe mental illness.  The Wilcox's write that since  
            implementation in Nevada County in 2008, money and lives have  
            been saved and now over 40% of Californians have access to AOT  
            through Laura's Law.  With growing acceptance and visible  
            success, the family believes time has come to require further  
            implementation unless counties have specific reasons to opt  
            out.  The Wilcox's state that hurdles such as funding have  
            been handled by previous legislation and threats of litigation  
            from mental health advocacy groups have yet to manifest any  








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            legal challenges in the largest counties with implementation.

          The California Chapter of the American College of Emergency  
            Physicians, states in support this bill that Laura's Law was  
            signed into law in 2002 and allows for court ordered assisted  
            outpatient psychiatric treatment in counties that have  
            implemented the program.  Currently, there is no requirement  
            that counties implement Laura's Law.  The supporters state  
            that this bill is an important measure that will expand  
            implementation of Laura's Law by requiring that counties  
            implement the program, unless the county elects not to  
            participate by vote of the county board of supervisors.

          The California Medical Association (CMA) states in support that  
            this bill would delete the provisions in current law that  
            authorize a county to voluntarily elect to implement the  
            provisions of Laura's Law thereby making it a mandatory  
            program.  By making this important law mandatory, this bill  
            will ensure that each county in the state has the ability and  
            resources to provide AOT and will result in better health  
            outcomes for the patients that are treated while at the same  
            time provide cost savings to the locality by avoiding costly  
            hospitalizations and incarcerations. 

          5)OPPOSITION.  Disability Rights California (DRC) writes in  
            opposition that this bill removes many provisions in current  
            law that protects the rights of individuals subject to AOT.   
            DRC states that this bill removes the requirement that a  
            county board of supervisors approve an AOT program and the  
            county prohibition to reduce voluntary mental health services  
            when implementing AOT programs.  According to DRC, this bill  
            increases in the maximum duration of an AOT order from six to  
            twelve months; broadens the group of people who can request an  
            AOT petition; and removes the program's sunset provision.  DRC  
            states that to the extent it continues to be authorized in  
            California, counties should retain local control and AOT  
            should be at their election and not imposed on them by the  
            state.  DRC notes that existing law provides that certain  
            people who are involved in providing mental health treatment  








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            to an individual, including a licensed mental health treatment  
            provider and the director of a hospital, public or private  
            agency, treatment facility, charitable organization or  
            licensed residential care facility, any request that the  
            county mental health department file an AOT petition on behalf  
            of that individual.  This bill would add "the professional  
            staff" of an agency or facility that provided involuntary  
            treatment to an individual to that list."  DRC argues that  
            this increases the possibility that the petitions may be filed  
            without adequate basis, therefore further limiting individual  
            rights.

          6)RELATED LEGISLATION.  AB 59 (Waldron) authorizes county  
            participation in the AOT Demonstration Project without  
            requiring counties to make findings that no existing mental  
            health programs will be reduced as a result of AOT  
            implementation, and increases the maximum period of imposed  
            outpatient treatment under the AOT Demonstration Project from  
            six months to one year.  AB 59 is pending in this Assembly  
            Health Committee.

          7)PREVIOUS LEGISLATION.  
          
             a)   AB 2266 (Waldron) of 2014, would have increased the  
               maximum period of imposed outpatient treatment under the  
               AOT Demonstration Project from six months to one year. AB  
               2266 failed passage in the Assembly Judiciary Committee.

             b)   AB 1265 (Conway) of 2013 increased the maximum period of  
               imposed outpatient treatment under the AOT Demonstration  
               Project from six months to one year.  AB 1265 also failed  
               passage in the Assembly Judiciary Committee.

             c)   AB 1569 (Allen), Chapter 441, Statutes of 2012, extends  
               authorization for "Laura's Law" to January 1, 2017, and  
               require the DHCS to submit the report by July 1, 2015.

             d)   SB 1606 (Yee) of 2008 would have required the Department  
               of Mental Health to conduct a study of individuals whose  








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               mental health needs are not currently being met, because  
               they do not meet existing eligibility criteria for AOT, but  
               have mental health needs that may not be met through  
               voluntary services.  This bill died in the Assembly  
               Appropriations Committee.

             e)   AB 1421 (Thomson), Chapter 1017, Statutes of 2002,  
               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.
             
          8)DOUBLE REFERRAL.  This bill is double referred, upon passage  
            of this Committee, it will be referred to the Assembly  
            Committee on Judiciary.  


          REGISTERED SUPPORT / OPPOSITION: 


          Support




          California Psychiatric Association (sponsor)
          California Chapter of the American College of Emergency  
          Physicians
          California Hospital Association
          California Medical Association
          California Treatment Advocacy Coalition 
          Dignity Health
          Nick and Amanda Wilcox (parents of Laura for whom Laura's Law  
          was named)
          The ARC California
          United Cerebral Palsy Collaboration








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          Opposition


          California Association of Mental Health Peer Run Organizations
          California Association of Social Rehabilitation Agencies
          California Council of Community Mental Health Agencies
          California Psychological Association
          Disability Rights California
          Mental Health America of California
          Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097