BILL ANALYSIS �
AB 2134
Page 1
Date of Hearing: May 8, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 2134 (Chesbro) - As Amended: May 3, 2012
SUBJECT : Community mental health services: assisted outpatient
treatment.
SUMMARY : Requires a county that elects to implement a
court-ordered assisted outpatient treatment (AOT) program for
mentally ill persons, pursuant to current law, to develop best
practices and provide services for mental health crisis
response, including, but not limited to, utilization of crisis
intervention teams, mobile crisis teams, or psychiatric
emergency response teams. Exempts a county providing AOT
services as of January 1, 2012, from the requirements of this
bill.
EXISTING LAW :
1)Establishes, pursuant to AB 1421 (Thomson), Chapter 1017,
Statutes of 2002, the AOT Demonstration Project Act of 2002
(Act) to permit counties to provide AOT services for people
with serious mental illnesses when a court finds 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)Requires a county that chooses to provide AOT services
pursuant to the Act to do so by a resolution of the county
Board of Supervisors that authorizes implementation and makes
a finding that no voluntary mental health program serving
adults, and no children's mental health program, may be
reduced as a result of implementation.
3)Requires a participating county to offer AOT services that
include all of the following, among other things:
a) Community-based, mobile, multidisciplinary, highly
trained mental health teams that use high staff-to-client
ratios of no more than 10 clients per team member for those
subject to court-ordered services; and,
b) A service planning and delivery process that includes
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the following, among other things:
i) Determination of the numbers of persons to be served
and the programs and services that will be provided to
meet their needs. Requires the local director of mental
health, in making this determination, to consult with the
sheriff, the police chief, the probation officer, the
mental health board, contract agencies, and family,
client, ethnic, and citizen constituency groups;
ii) Plans for services, including outreach to families
whose severely mentally ill adult is living with them,
design of mental health services, coordination and access
to medications, psychiatric and psychological services,
substance abuse services, supportive housing or other
housing assistance, vocational rehabilitation, and
veterans' services;
iii) Provision for family support and consultation
services, parenting support and consultation services,
and peer support or self-help group support, where
appropriate;
iv) Provision for services to be client-directed and
that employ psychosocial rehabilitation and recovery
principles;
v) Provision for psychiatric and psychological services
that are integrated with other services and for
psychiatric and psychological collaboration in overall
service planning; and,
vi) Provision for clients who have been suffering from
an untreated severe mental illness for less than one
year, and who do not require the full range of services,
but are at risk of becoming homeless unless a
comprehensive individual and family support services plan
is implemented. Requires these particular clients to be
served in a manner that is designed to meet their needs.
4)Requires a participating county that provides AOT services
pursuant to the Act to also offer the same services on a
voluntary basis.
5)Sunsets the Act on January 1, 2013, and requires the
Department of Mental Health (DMH) to submit a report and
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evaluation to the Legislature of all counties implementing an
AOT program by July 31, 2011.
6)Establishes the Lanterman-Petris Short (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.
7)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)Prescribes the conditions under which a mentally ill person
may be involuntarily detained.
FISCAL EFFECT : None
COMMENTS :
1)PURPOSE OF THIS BILL . The author asserts that, as counties
face increasing pressure to implement AB 1421 from newspaper
editorials across the state and self-appointed entities, such
as the LPS Reform Task Force, it is critical to require
counties to have appropriate best practices in place for
psychiatric crisis response as a condition of implementation.
The author states that a county that chooses to pursue
implementation of a court-ordered involuntary treatment
program should have policies and best practices, similar to
crisis intervention teams, mobile crisis teams, or psychiatric
emergency response teams, in place beforehand in order to
appropriately respond to a mentally ill person in crisis. The
author maintains that if a county that is considering an AOT
program has first responders experienced in cultural
competency, peer support, and other important de-escalation
techniques to diffuse dangerous and difficult situations and
provide mental health clients and consumers who are in crisis
with dignity and compassion, then it will not need to take,
what the author contends, is a drastic and unnecessary step of
implementing a forced involuntary treatment program.
2)AB 1421 . AB 1421 is also known as Laura's Law, 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. Laura's Law provides counties with
the option to implement intensive AOT programs for individuals
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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. AB 1421 requires a county 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.
Although implementation of an AOT program is a local option,
counties that choose to implement one are required to submit
specified documentation to DMH prior to implementation that
includes a copy of the Board of Supervisors' resolution
verifying that voluntary services will not be reduced as a
result of implementation; documentation of the local mental
health board's review of the county's implementation plan; a
detailed AOT program narrative; a proposed budget and budget
narrative for AOT program expenditures; a description of
methods for data collection; and, a plan for development of an
AOT training and education program.
3)PSYCHIATRIC CRISIS RESPONSE MODELS . According to an April
2005 manual issued by Technical Assistance Collaborative,
Inc., a non-profit organization that provides technical
assistance to public agencies that oversee public sector human
services for low-income and vulnerable populations, a
competent community-based psychiatric crisis response model
should be able to do the following for persons experiencing
psychiatric distress:
a) Provide timely and accessible aid;
b) Provide access to a wide range of crisis stabilization
options;
c) Stabilize them as quickly as possible and assist them to
return to their pre-crisis level of functioning;
d) Increase and maintain their community tenure;
e) Increase their ability to recognize and deal with
situations that may otherwise result in crises; and,
f) Increase or improve their network of community and
natural supports, as well as their use of these supports
for crisis prevention.
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Generally, mental health crisis response teams are composed of
mental health practitioners, law enforcement officers, social
services personnel, and other professionals who can
effectively and appropriately intervene in a mental health
crisis. These professionals can meet face-to-face with the
person in crisis at home, school, work, or wherever a crisis
occurs, to assess and de-escalate the situation. Additional
services can include stabilization for a certain period of
time, rapid access to psychiatrists, health care navigators,
mental health crisis beds, and referrals to community mental
health providers. Teams can also contact emergency services
when necessary. Additionally, teams can provide longer-term
support by helping loved ones and caregivers develop "crisis
plans" to better prepare for future crises.
According to the California Mental Health Directors
Association (CMHDA), which represents county mental health
departments, all counties in California are required to have
24/7 access lines and to respond to crises and psychiatric
emergencies, regardless of whether they are considering
adopting an AOT program. However, CMHDA notes that not all
counties have mobile support teams and some, but not all,
provide training to law enforcement on crisis intervention
with individuals with mental illness.
4)SUPPORT . The California Psychological Association (CPA)
writes in support that this bill strikes a fair balance
between providing mental health services, protecting the
public, and ordering people into treatment, when necessary.
CPA adds that this bill is sensitive to the civil rights and
efficacy of court-ordered treatment and seeks to ensure
counties establish a wide variety of voluntary services,
including crisis response teams, to offer to individuals
before they decompensate and become a danger to themselves or
others. Disability Rights California supports this bill as a
positive first step to protect client rights.
5)OPPOSITION . The California Psychiatric Association (CPA)
objects to this bill, stating that there is no policy reason
to bring this bill forward because there is no identified
problem that it would solve in relation to AB 1421. CPA
contends that all counties have suffered funding cuts to their
mental health budgets in recent years and this bill would
place another impediment relating to crisis response in the
way of counties that have expressed interest in implementing
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an AOT program.
6)RELATED LEGISLATION . AB 1569 (Allen), pending on the Assembly
floor, extends the sunset date of AB 1421 from January 1,
2013, to January 1, 2017, and requires a related evaluation
report to be submitted to the Legislature by July 1, 2015.
7)PREVIOUS LEGISLATION . AB 2357 (Karnette), Chapter 774,
Statutes of 2006, extends the sunset date of AB 1421 from
January 1, 2008, to January 1, 2013.
8)POLICY COMMENT . The effect of this bill is unclear since, to
date, only Nevada County has opted to implement an AOT program
and counties have cited as barriers to implementation the lack
of an identified funding source and controversy surrounding
the effectiveness of court ordered treatment.
REGISTERED SUPPORT / OPPOSITION :
Support
California Psychological Association
Disability Rights California
Opposition
California Psychiatric Association
Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097