BILL ANALYSIS Ó
AB 1193
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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