BILL ANALYSIS �
AB 1569
Page 1
Date of Hearing: April 10, 2012
ASSEMBLY COMMITTEE ON JUDICIARY
Mike Feuer, Chair
AB 1569 (Allen) - As Introduced: January 31, 2012
As Proposed to be Amended
SUBJECT : mental health services: COMPELLED assisted outpatient
treatment
KEY ISSUE : SHOULD THE AUTHORIZATION FOR COUNTIES TO IMPOSE
INVOLUNTARY OUTPATIENT MENTAL HEALTH TREATMENT PROGRAMS, WHICH
PROVIDE INTENSIVE TREATMENT TO INDIVIDUALS WHOSE MENTAL ILLNESS
IS BELIEVED TO PREVENT THEM FROM SEEKING OR ACCEPTING TREATMENT,
BE RENEWED FOR AN ADDITIONAL FOUR YEARS?
FISCAL EFFECT : As currently in print this bill is keyed fiscal.
SYNOPSIS
This bill seeks to reauthorize an involuntary mental health
treatment program that was initially adopted in 2001 and
previously reauthorized in 2006. The law permits any county
that wishes to do so to provide "assisted outpatient treatment
services," as defined. Both the initial measure and the prior
sunset extension received substantial bipartisan support.
According to the bill's sponsor, the California Psychiatric
Association, the law should be extended because it is a valuable
early intervention alternative for a small group of individuals
who meet certain stringent criteria and occupies a unique niche
in counties' continuum of care that supports recovery from
severe and persistent mental illness. However, this approach
continues to be controversial among disability rights advocates
because these services may be imposed on a person by court order
without their consent in specified conditions, including that
the 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. Despite the
important policy and ethical principles at issue, this debate
appears to be mostly theoretical. Over the 10 years in which
this authorization has been in place, only Nevada County has
chosen to make use of it, and only four persons have been
subject to this treatment. As a result, there appears to be no
reliable evidence to support either extending or eliminating the
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program.
SUMMARY : Extends the authorization of "Laura's Law," providing
for court ordered assisted outpatient treatment services.
Specifically, this bill :
1)Reauthorizes the provisions of "Laura's Law" that provide for
court ordered assisted outpatient treatment services for
persons suffering from mental disorders who have shown a
history of noncompliance with prior treatment.
2)Extends the sunset date of "Laura's Law" from January 1, 2013
to January 1, 2017.
3)Provides for a further report to the Legislature regarding
operation of the program in any county that chooses to adopt
it.
EXISTING LAW :
1)Permits counties to provide assisted outpatient treatment
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. (Welfare and Institutions Code Section 5346.)
2)Sunsets this authorization on January 1, 2013. (Welfare and
Institutions Code Section 5349.5(a).)
3)Grants any person subject to a petition for an order of
assisted outpatient treatment the right to legal counsel at
all steps of the hearing process. (Welfare and Institutions
Code Section 5346 (d)(4)(C).)
4)Requires the Department of Mental Health to submit a report
and evaluation to the Legislature of all counties implementing
an AOT program by July 31, 2011. (Welfare and Institutions
Code Section 5349.5(b).)
5)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". (Welfare and Institutions
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Code Section 5150.)
6)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. (Welfare and Institutions Code Section 5008
(h)(1)(A).)
COMMENTS : In support of the bill the author states:
AB 1569 would extend the sunset date of Laura's Law which
authorizes counties to implement assisted outpatient
treatment services to severely mentally disabled
individuals who have chronically refused mental health
treatment.
Enacted in 2002, Laura's Law was named for Laura Wilcox, a
19-year old college student who was gunned down by a man
suffering from serious delusional paranoia. Specifically,
Laura's Law permits counties to provide court-ordered
outpatient treatment services for people with serious
mental illness. To implement the order, a court must find
that a person's recent history of hospitalizations or
violent behavior, coupled with the noncompliance with
voluntary treatment, indicates the person is likely to
become dangerous or gravely disabled without treatment. The
petition requesting the court-ordered treatment must be
made to the county health department by an adult living
with the mentally disabled individual, the parent, spouse,
sibling, adult child of that person, mental health workers
or law enforcement personnel.
Laura's Law is simply another tool for treating the
severely mentally ill who chronically refuse voluntary
treatment and are a danger to themselves or others but are
not so gravely disabled that they qualify for
conservatorship. A model program for treatment, Laura's Law
provides the legal and clinical treatment structure
necessary to give certain severely mentally disabled people
the support they need to achieve stability and meaningful
recovery.
Statutory History. This act was first adopted in California in
2001, as a pilot program, permitting a special kind of
involuntary commitment designed to get intensive outpatient
treatment to individuals whose mental illness prevents them from
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seeking or accepting help. The 2001 bill, AB 1421 by
then-Assemblymember Helen Thomson, authorized, in participating
counties only a court or hearing officer to order a person into
an assisted outpatient treatment program if the court or hearing
officer finds that the individual either meets existing "5150"
involuntary commitment requirements (is gravely disabled or is a
danger to self or others), or the person meets new non-5150
criteria including that the person has refused treatment, their
mental health condition is substantially deteriorating, and
assisted outpatient treatment would be the least restrictive
level of care necessary to ensure the person's recovery and
stability in the community. AB 2357 then reauthorized the
provisions of AB 1421 in 2006. As a condition of authorization,
AB 2357 required the Department of Mental Health to file a
report on the success of the program in 2011. That report
entitled "Laura's Law Combined Annual Reports and One-Time
Evaluation Required by AB 2357" was filed in July of 2011.
Operation of the Program. According to the DMH report, as of
July 2011 only Nevada County has implemented an assisted
outpatient treatment program. Since adopting the program in
2008, Nevada County has committed four patients to involuntary
assisted outpatient programs. Based on information apparently
provided by Nevada County, the DMH reports that Nevada County's
program has been a success because the number of hospitalization
days for program participants in Nevada County has been cut in
half, no patient has encountered problems with law enforcement
since their commitment and all patients in the programs have
seen their medical symptoms improve. Half of the individuals in
the program were stabilized to the point of maintaining their
own home without assistance. The report also states that all of
the family members of the patients reported positive impressions
of the program and reported appreciation for the assistance the
Nevada County treatment program provides to family members of
those in treatment. In addition to the small program operated
in Nevada County, the County of Los Angeles also reports it has
implemented a small pilot program that has been an initial
success.
Apart from the very small sample size, the DMH report does not
appear to provide information sufficient to determine whether
the AOT approach is scientifically valid because it appears to
omit any control group or other reliable comparators who did not
receive AOT.
ARGUMENTS IN SUPPORT : The sponsor of this bill, the California
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Psychiatric Association, states that the law should be extended
because it is a valuable early intervention alternative to
revolving door hospitalization and incarceration for a small
group of individuals who meet certain stringent criteria and
occupies a unique niche in counties' continuum of care that
supports recovery from severe and persistent mental illness.
The California Treatment Advocacy Coalition notes in support
that in Nevada County the AOT program saved $1.81 in
hospitalization and incarceration costs for every $1.00 invested
and it has had a positive fiscal impact on decreasing costs to
other county systems, such as emergency departments, ambulance,
law enforcement, and the courts. L.A. County supports this bill
and argues that it should be accompanied by State implementation
funds. The California Association of Psychiatric Technicians
adds that as trained, licensed, and regulated mental health and
developmental services nursing professionals, they are strongly
compelled to support AOT services, which could save lives,
families, and funds if the law is allowed to continue and
encouraged to be implemented.
ARGUMENTS IN OPPOSITION : Disability Rights California (DRC)
objects to this bill, arguing that involuntary treatment is
unnecessary because there are good alternatives to ensure access
to needed mental health services; assisted outpatient treatment
has not been widely implemented and does not work; and the
current LPS Act law allows for involuntary mental health
treatment under statutorily defined criteria. DRC argues that
the voluntary programs supported by Prop. 63 of 2004 have
demonstrated success in saving lives and money. Some counties
already have in place proven voluntary treatment programs that
have comparable results to AOT without the expense and coercion
of court-ordered treatment, DRC argues. By comparison, the
outcome data on involuntary outpatient treatment shows forced
treatment is often counterproductive DRC contends - renewing
trauma and steering people away from the mental health system
altogether. Scarce public dollars are better spent expanding
voluntary treatment programs that provide the surest path to
recovery. DRC argues that counties should track people who have
applied for services and are not currently receiving them due to
funding limitations, and should improve coordination between
county personal service coordinators and Lanterman Petris Short
Act conservators to ensure that services are provided
effectively in the community. DRC concludes based on the DMHC
report and a 2009 study of a similar New York law that the AOT
approach does not work.
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In opposing this bill both Mental Health America of Los Angeles
and the California Association of Social Rehabilitation Agencies
argue that this bill represents a "massive curtailment of
liberty." Additionally, the California Association of Social
Rehabilitation Agencies contends that the statutory criteria to
be used by judicial officers in determining the order for
outpatient assistance cannot be accurately assessed on an
individual basis sufficiently to satisfy constitutional
standards established by the United States Supreme Court.
Author's Proposed Amendments. In light of the still largely
untested nature of this program, the author has agreed to limit
the sunset extension to four years, and to reinstate the report
to the Legislature in the year prior to the expiration of the
sunset so that there is better information on which to evaluate
the results of the program at that time.
Prior Legislation : AB 1421 (Thomson, Ch. 1017, Stats. of 2002)
first enacted Laura's Law and granted counties the authority to
enact pilot programs to determine the effectiveness of
involuntary commitment assisted outpatient programs.
AB 2357 (Karnette and Yee, Ch. 774, Stats. of 2006) extended the
pilot program established by AB 1421 through January 1, 2013 and
mandated that the Department of Mental Health submit a progress
report to the Governor and Legislature in 2011.
REGISTERED SUPPORT / OPPOSITION :
Support
California Psychiatric Association (sponsor)
California Hospital Association
California State Sheriffs' Association
California Treatment Advocacy Coalition
County of Los Angeles
Friends Committee on Legislation of California
National Alliance for the Mentally Ill
Nevada County Suicide Prevention Task Force
Treatment Advocacy Center (Arlington VA)
California Probation, Parole and Correctional Association
Several Individuals
Opposition
ACLU
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Bazelon Center for Mental Health Law
California Association of Mental Health Patients' Rights
Advocates
California Association of Social Rehabilitation Agencies
California Network of Mental Health Clients
Disability Rights California
Mental Health Advocacy Services
Mental Health America of Los Angeles
Mental Health Association of San Francisco
MindFreedom International
National Association for Rights Protection and Advocacy
San Diego Disability Action Coalition
United States Psychiatric Rehabilitation Association
Voices of the Heart, Inc.
Several individuals
Analysis Prepared by : Kevin Baker and Nicholas Liedtke / JUD. /
(916) 319-2334