BILL ANALYSIS Ó AB 1193 Page 1 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: AB 1193 Page 2 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 AB 1193 Page 3 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, AB 1193 Page 4 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 AB 1193 Page 5 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 AB 1193 Page 6 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 AB 1193 Page 7 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 AB 1193 Page 8 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 AB 1193 Page 9 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