BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2134
AUTHOR: Chesbro
AMENDED: May 3, 2012
HEARING DATE: June 20, 2012
CONSULTANT: Bain
SUBJECT : Community mental health services: assisted outpatient
treatment (AOT).
SUMMARY : Requires a county that elects to provide AOT services
under the Assisted Outpatient Treatment Demonstration Project
Act of 2002 (AOT Act, also known as Laura's Law) to develop best
practices for the purposes of responding to a mental health
crisis. Requires the best practices to include the utilization
of crisis intervention teams, mobile crisis teams, or
psychiatric emergency response teams, with an emphasis on peer
support.
Existing law:
1.Allows county boards of supervisors, by resolution, to
authorize AOT whereby a county mental health director can
petition for a court to order a person over age 18 with a
mental illness to receive AOT if the court finds the
individual meets specified criteria, including a clinical
determination that the person is unlikely to survive safely in
the community without supervision, the person has been offered
an opportunity to participate in a treatment plan by the
director of the local mental health department and the person
continues to fail to engage in treatment, the person has a
history of noncompliance with treatment for his or her mental
illness, the person's condition is substantially
deteriorating, and the least restrictive placement necessary
to ensure the person's recovery would be participation in the
AOT program.
2.Requires a county that chooses to provide AOT to offer AOT
services that meet specified requirements, including
community-based, mobile, multidisciplinary highly-trained
mental health teams.
3.Requires counties implementing the AOT Act to make a finding
that no voluntary mental health program serving adults and no
children's mental health program, may be reduced as a result
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AB 2134 | Page 2
of the implementation. The Department of Mental Health (DMH)
is required to monitor compliance with this requirement as
part of its review and approval of county Short-Doyle plans.
4.Requires a county that provides court-ordered AOT services to
also offer the same services on a voluntary basis.
5.Required DMH to submit a report and evaluation of all counties
implementing any component of the AOT Act to the Governor and
the Legislature by July 31, 2011, as specified.
6.Sunsets the AOT Act on January 1, 2013.
This bill:
1.Requires a county that elects to provide AOT services under
the AOT Act to develop best practices for the purposes of
responding to a mental health crisis.
2.Requires these best practices to include, but not be limited
to, the utilization of crisis intervention teams, mobile
crisis teams, or psychiatric emergency response teams, with an
emphasis on peer support.
3.Exempts a county that, as of January 1, 2012, is providing
services under the AOT Act.
4.Sunsets the provisions of this bill on January 1, 2013,
because this bill is contained within the existing AOT Act,
which sunsets on that date.
FISCAL EFFECT : This bill is keyed non-fiscal.
PRIOR VOTES :
Assembly Health:12- 5
Assembly Floor:48- 28
COMMENTS :
1.Author's statement. It is imperative that counties and
communities consider what "best practices" they wish to follow
during a mental health crisis. This will save money in
expensive emergency treatment, lower the risk or incident for
people who respond to crisis, reduce stigma, and reduce
discrimination among other benefits. The motive of this bill
is to help counties and those who wish to implement
involuntary treatment to discover though the process of
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developing best practices for crisis response that this way of
treating consumers of mental health care is not only
unnecessary but avoidable.
2.AOT required services. AB 1421 (Thomson), Chapter 1017,
Statutes of 2002, enacted the AOT Act or "Laura's Law," which
established a new court-ordered outpatient treatment statute
aimed at individuals with mental illness who meet specified
criteria but who do not meet the criteria (danger to
self/others or gravely disabled) for commitment to an
inpatient facility.
A county that chooses to provide AOT must offer AOT services
that meet specified requirements, and current law requires a
county that offers AOT services to offer the same services on
a voluntary basis. These services must include, but are not
limited to:
� 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;
� A clearly designated mental health personal services
coordinator who is responsible for providing or assuring
needed services for each client, which include complete
assessment of the client's needs, development of the
client's personal services plan, linkage with all
appropriate community services, monitoring of the quality
and follow-through of services, and necessary advocacy to
ensure each client receives those services that are agreed
to in the client's personal services plan;
� A service planning and delivery process that includes
specified components. These include the provision of staff
with the cultural background and linguistic skills
necessary to remove barriers to mental health services,
provision for family support and consultation services,
parenting support and consultation services, and peer
support or self-help group support, where appropriate, the
provision for services to be client-directed and to employ
psychosocial rehabilitation and recovery principles, and
the provision for psychiatric and psychological services
that are integrated with other services and for psychiatric
and psychological collaboration in overall service
planning; and
� An individual personal services plan that ensures that
persons subject to AOT programs receive age-appropriate,
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gender-appropriate, and culturally appropriate services, to
the extent feasible, that are designed to enable recipients
to live in the most independent, least restrictive housing,
to engage in the highest level of work or productive
activity appropriate to their abilities and experience, to
create and maintain a support system, to access an
appropriate level of academic education or vocational
training, to obtain an adequate income, to self-manage
their illnesses and exert as much control as possible over
both the day-to-day and long-term decisions that affect
their lives, to access necessary physical health care and
maintain the best possible physical health, to reduce or
eliminate serious antisocial or criminal behavior, and
thereby reduce or eliminate their contact with the criminal
justice system, to reduce or eliminate the distress caused
by the symptoms of mental illness, and to have freedom from
dangerous addictive substances.
A county that provides court-ordered AOT services must also
offer the same services on a voluntary basis. In addition, the
AOT Act 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 may be reduced as a result of AOT implementation.
1.Sonoma County program. The author held a hearing in February
2012 of his Select Committee on Disabilities entitled
"California's Mental Health System: Partners in Care." At that
hearing, the director of Sonoma County's Department of Health
Services Behavioral Health Division described the county's
psychiatric emergency services, crisis assessment, prevention
and education team (which provides mobile crisis response).
The director indicates its program has reduced law enforcement
calls for involuntary mental health commitments, improved
communication between law enforcement and individuals with a
mental illness, and provides an alternative to psychiatric
inpatient hospitalizations.
2.Judicial Council report. In April 2011, the Judicial Council's
Task Force for Criminal Justice Collaboration on Mental Health
Issues issued a report with recommendations to provide a
framework for improving practices and procedures in cases
involving both adult and juvenile offenders with mental
illness, for ensuring the fair and expeditious administration
of justice for offenders with mental illness, and for
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promoting improved access to treatment for litigants with
mental illness both in the community and in the criminal
justice system. One of the recommendations of the final report
was that law enforcement and local mental health organizations
should continue to expand the development and utilization of
crisis intervention teams, mobile crisis teams, and
psychiatric emergency response teams to effectively manage
incidents that require responses by law enforcement officers,
as such teams provide mental health expertise through
specially trained police officers or through mental health
professionals who accompany officers to the scene.
3.Requested amendments. Disability Rights California (DRC)
proposes amendments which it believes would strengthen the
provisions of this bill and further the goals and intent of
this bill. The DRC amendments would (a) require county AOT
policies and procedures to be designed to ensure inpatient
involuntary treatment is avoided to the extent possible, that
services avoid the use of seclusions and restraints and are
provided in the least restrictive environment, that there is
maximum coordination between law enforcement and mental health
service providers, and that there is a range of options
available for responding to mental health crises; (b) require
a county that offers AOT to demonstrate that the full array of
AOT services have been available for at least one year on a
voluntary basis; and (c) require a county deciding to
implement AOT to hold a hearing and make specific information
available prior to adopting a resolution finding that no AOT
services will be reduced as a result of the AOT program.
4.Related legislation. AB 1569 (Allen) extends the sunset date
of the AOT Act by four years, until January 1, 2017, and
requires the Department of Mental Health (DMH) to submit a
report and evaluation of all counties implementing any
component of the AOT Act to the Governor and the Legislature
by July 31, 2015.
5.Prior legislation. AB 2357 (Karnette and Yee), Chapter 774,
Statutes of 2006, extends the AOT Act sunset date to January
1, 2013, and required DMH to submit a progress report to the
Governor and Legislature in 2011.
AB 1421 enacted the AOT Act.
6.Support. The California Psychological Association (CPA) writes
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that this bill strikes a fair balance between providing mental
health services, protecting the public, and ordering people
into treatment when necessary. CPA states this bill is
sensitive to the civil rights and the efficacy of
court-ordered treatment and seeks to have counties establish a
wide variety of voluntary services to offer to an individual
before they decompensate and become a danger to themselves or
others. The California Association of Social Rehabilitation
Agencies, which is a statewide association of not-for-profit
entities that provide services to clients of the public mental
health system, writes that when someone is experiencing acute
psychiatric symptoms and assisted outpatient treatment
services are court ordered, it is clinically and ethically
imperative that they receive best treatment practices.
7.Opposition. The California Medical Association (CMA) writes in
opposition that it believes Laura's Law is essential in
protecting both mentally ill patients and their health care
providers from harm. CMA argues that, by requiring counties to
utilize additional resources, counties would be deterred from
fully implementing the AOT program and would be unable to
provide its public safety benefits. CMA states AOT should not
be taken lightly, but when the public safety is at risk,
counties should have the option to utilize it, and this bill
makes it financially infeasible, essentially taking that
option away.
The Citizens Commission on Human Rights (established by the
Church of Scientology) opposes this bill, arguing this bill
would include psychiatric emergency response teams as well as
forced psychiatric drugging of mental health outpatients.
8.Oppose unless amended. The California Psychiatric Association
writes that it opposes this bill as an unfunded county mandate
because it makes the implementation of Laura's Law more
difficult for any county wishing to participate. The
California Psychiatric Association writes it would remove its
opposition if the author accepts amendments to allow funds
from voter-approved Proposition 63 (the Mental Health Services
Act or MHSA) to be utilized for the mental health services
portion of crisis emergency response teams. In addition, the
proposed amendment would specify that services funded by the
MHSA cannot be denied to AOT program participants solely
because of their legal status, consistent with a specified DMH
regulation.
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9.Drafting issue. This bill amends the article of law which
establishes the AOT Act, which sunsets January 1, 2013. AB
1569 would extend the sunset date of the AOT Act by four
years, until January 1, 2017. If AB 1569 is not signed into
law, the change made by this bill would not take effect
because the article of law establishing the AOT Act will
sunset.
SUPPORT AND OPPOSITION :
Support: California Association of Social Rehabilitation
California Psychological Association
Oppose: California Psychiatric Association (unless amended)
California Medical Association
Citizens Commission on Human Rights
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