CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1976

Author:(Eggman)

As Amended Ver:August 20, 2020

Majority vote

SUMMARY:

Requires a county or group of counties to implement an Assisted Outpatient Treatment (AOT) Program under what is known as Laura's Law, or to opt out of this requirement by a resolution passed by the governing body or bodies of the county or counties that includes a statement as to the reasons for opting out and any facts or circumstances relied on in making that decision. Allows a county, in combination with one or more counties, to implement an AOT program. Authorizes a judge of a superior court, before whom the person who is the subject of an AOT petition appears, to request a county mental health department to file a petition to obtain an order authorizing AOT. Repeals the January 1, 2022, sunset date of Laura's Law and makes the law permanent.

The Senate Amendments:

1. Delay the implementation date of the provisions of this bill to July 1, 2021.
2. Correct a cross-reference drafting error.

COMMENTS:

The Lanterman-Petri-Short (LPS) Act was signed into law in 1967 and provides for involuntary commitment of individuals with serious mental illness for varying lengths of time for the purpose of treatment and evaluation, provided certain requirements are met. Additionally, the LPS Act provides for LPS conservatorships, resulting in involuntary commitment for the purposes of treatment if an individual is found to meet the criteria of being a danger to themselves or others or is gravely disabled, as defined.

As an alternative to an LPS Act conservatorship, current law also provides for court-ordered outpatient treatment through AOT, established by AB 1421 (Thomson), Chapter, 1017, Statutes of 2002. In counties opting to implement an AOT program, the court may order a person into an AOT program if the court finds that the person either meets existing involuntary commitment requirements under the LPS Act or the person meets non-involuntary commitment requirements, 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. AOT is available only in those counties in which the county board of supervisors, by resolution, authorizes its application (opts in) and makes a finding that no voluntary mental health program serving adults and no children's mental health program may be reduced in order to implement the law. Laura's Law has been extended three times, most recently by AB 59 (Waldron), Chapter 251, Statutes of 2016, with a sunset date of January 1, 2022.

According to the Author:

According to the author, since AOT was approved by the Legislature in 2002, 24 counties have implemented it. This demonstration project is a community-based treatment program to assist individuals who, as a result of their severe mental illness (SMI), are unable to access community mental health services voluntarily. The author points out that AOT is a less restrictive alternative to involuntary hospitalization, where an individual suffering from a SMI is contained for 72 hours if they have presented a danger to themselves or others. The current AOT process of opting in is an unnecessary barrier, evidenced by the fact that the program has been available to counties for the last 18 years and less than half have implemented it. Easing and expanding AOT implementation will ensure that those at highest risk for hospitalization can obtain the necessary treatment services to keep them in the community. While this bill encourages implementation of Laura's Law statewide, it also allows counties to retain local control by allowing them to opt out through a resolution passed by the governing body that states the reasons for opting out and facts or circumstances used to make that decision.

Arguments in Support:

The California Psychiatric Association (CPA), sponsor of this bill, states that this bill encourages community dialogue between elected officials and their constituents about the potential utility of an AOT program for a community that does not now have it. Several counties have made decisions not to implement AOT without broad community input. For those and other counties that haven't implemented AOT, CPA states this bill would require a public process and a reasoned finding be put on the record as the endpoint of community engagement and input about the merits of an AOT program. CPA states the data shows that the law has been broadly effective and the 17 years that have elapsed underscore the rationale to remove the sunset. CPA also states that adding judges to the list of officials who can make referrals for an AOT investigation corrects an oversight in the original drafting of the law.

Arguments in Opposition:

The California Behavioral Health Planning Council (CBHPC) in opposition, states that it does not support changes to the law that require a county to justify not implementing AOT, as local governments would be required to explain and justify why they choose not to bypass an individual's right to make their own decisions. As this bill repeals the sunset date of the law, the CBHPC does not support efforts that expand taking civil liberties from individuals, as they believe involuntarily treatment is counterproductive to the wellness and recovery model that California embraces. Disability Rights California (DRC), also in opposition states that given the recent release by the State Auditor of the LPS Audit and recommendation and the fact that the audit examined the delivery of mental health services through LPS and AOT, any program modifications should only be considered within the context of an examination of these related mental health delivery systems for individuals with serious mental illnesses. DRC concludes by stating that such an effort is complicated by the fact there are only a few short weeks in the legislative session leaving little time for a thorough policy discussion.

FISCAL COMMENTS:

According to the Senate Appropriations Committee, the following fiscal impacts apply:

1. Courts. Unknown, potentially significant, ongoing cost pressures due to potential increased workload to the courts that will oversee additional AOT cases for counties that either join together to provide AOT, do not opt out of AOT, or otherwise would not pursue AOT (and the required court involvement) absent this bill. It is estimated that average court cost pressures would be $7,896 a day (or $987 an hour), to operate a courtroom, exclusive of the judge's salary, in fiscal year (FY) 2019-2020. Assuming an AOT hearing lasted an hour, there would only need to be at least seven additional cases statewide to meet the committee's suspense threshold.
2. Department of Health Care Services (DHCS). Short-term, workload pressures for DHCS staff to participate in, and provide technical assistance, to a county or group of counties that implements the bill, in developing a training and education program to improve AOT services. No significant workload related to legislative reporting requirements, as current law already requires DHCS to annually report to the Legislature on the effectiveness of AOT programs and includes similar specified metrics, such as housing and participation/contact with treatment; reduced use, or avoidance, of hospitalization; reduced involvement with local law enforcement, and the extent to which incarceration was reduced or avoided.

VOTES:

ASM HEALTH: 15-0-0

YES: Wood, Mayes, Aguiar-Curry, Bigelow, Bonta, Burke, Carrillo, Flora, Limón, McCarty, Nazarian, Ramos, Rodriguez, Santiago, Waldron

ASM APPROPRIATIONS: 18-0-0

YES: Gonzalez, Bigelow, Bauer-Kahan, Bloom, Bonta, Calderon, Carrillo, Chau, Megan Dahle, Diep, Eggman, Fong, Gabriel, Eduardo Garcia, Petrie-Norris, McCarty, Robert Rivas, Voepel

ASSEMBLY FLOOR: 77-0-2

YES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Megan Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kamlager, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Mullin, Muratsuchi, Nazarian, O'Donnell, Obernolte, Patterson, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

ABS, ABST OR NV: Kalra, Quirk

SENATE FLOOR: 30-0-10

YES: Allen, Archuleta, Atkins, Beall, Bradford, Caballero, Dodd, Durazo, Galgiani, Glazer, Lena Gonzalez, Hertzberg, Hill, Hueso, Hurtado, Jackson, Leyva, McGuire, Mitchell, Monning, Nielsen, Pan, Portantino, Roth, Rubio, Skinner, Stern, Umberg, Wieckowski, Wiener

ABS, ABST OR NV: Bates, Borgeas, Chang, Dahle, Grove, Jones, Melendez, Moorlach, Morrell, Wilk

UPDATED:

VERSION: August 20, 2020

CONSULTANT: Judith Babcock / HEALTH / (916) 319-2097 FN: 0003274

 THIRD READING  

Bill No: AB 1976

Author: Eggman (D), et al.

Amended: 8/20/20 in Senate

Vote: 21

SENATE HEALTH COMMITTEE: 8-0, 8/1/20

AYES: Pan, Lena Gonzalez, Grove, Hurtado, Leyva, Mitchell, Monning, Rubio

NO VOTE RECORDED: Melendez

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/20/20

AYES: Portantino, Bates, Bradford, Hill, Jones, Leyva, Wieckowski

ASSEMBLY FLOOR: 77-0, 6/10/20 - See last page for vote

SUBJECT: Mental health services: assisted outpatient treatment

SOURCE: California Psychiatric Association

DIGEST:

This bill (1) implements the Assisted Outpatient Treatment (AOT) Demonstration Project Act of 2002, or “Laura’s Law,” statewide and permits a county or a group of counties to opt-out of implementing Laura’s Law, rather than permitting a county to opt-in to provide AOT services; (2) permits a group of counties to implement Laura’s Law in combination under specified circumstances; and (3) repeals the sunset date for Laura’s Law.

ANALYSIS:

Existing law:

1. Permits a county board of supervisors, by resolution, to authorize (opt-in to) Laura’s Law, whereby a county behavioral health director can petition for a court to order a person over the age of 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 a history of noncompliance with treatment for his or her mental illness; and the person's condition is substantially deteriorating, and participation in AOT would be the least restrictive placement necessary to ensure the person's recovery. [WIC §5346]
2. Permits specified individuals to make a request to the county health department for the filing of a petition to obtain an order authorizing AOT, including a parent, spouse, sibling, or adult child of the subject of the petition; licensed mental health treatment providers; and peace officer, parole officer, or probation officer, as specified. [WIC §5346]
3. Requires counties that implement Laura’s Law 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 of the implementation. [WIC §5349]
4. Requires a county that provides court-ordered AOT services to also offer the same services on a voluntary basis. [WIC §5348]
5. Requires the Department of Health Care Services (DHCS) to submit a report and evaluation of all counties implementing any component of Laura’s Law to the Governor and the Legislature annually. [WIC §5348]
6. Sunsets Laura’s Law on January 1, 2022. [WIC §5349.5]

This bill:

1. Implements Laura’s Law statewide, beginning July 1, 2021, and permits a county or group of counties that do not wish to implement Laura’s Law to opt-out of the requirements of AOT services through a specified process. Requires such counties to state the reason for opting out.
2. Permits a county to elect to implement Laura’s Law in combination with one or more counties. Requires a group of counties that provide AOT services in combination to execute a memorandum of understanding that requires designating a lead county for an individual receiving AOT services for such purposes as making a finding that the individual meets the AOT criteria, assuring services are provided and determining where they are provided, and ensuring that appropriate follow-up care is in place upon an individual’s release from the AOT treatment program.
3. Adds a judge of a superior court to the list of specified individuals permitted to make a request for the filing of a petition to obtain an order authorizing AOT, pursuant to 2) above, of existing law.
4. Deletes the requirement that DHCS submit a report to the Governor, pursuant to 5) above, of existing law.
5. Repeals the sunset date for Laura’s Law.
6. Makes other technical changes.

Comments

1. Author’s statement. According to the author, since AOT was approved by the legislature in 2002, 20 counties have implemented it. Also known as Laura’s Law, this demonstration project is a community-based treatment program to assist individuals who, 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 is an unnecessary barrier, evidenced by the fact that the program has been available to counties for the last 18 years and less than half have implemented it. Easing and expanding AOT implementation will ensure that those at highest risk for arrest, homelessness, hospitalization, and COVID-19 infection risk can obtain the necessary treatment services to keep them in the community. While this bill encourages implementation of Laura’s Law statewide, it also retains local control by allowing them to opt-out through a resolution passed by the governing body that states the reasons for opting out, and facts or circumstances used to make that decision.
2. Laura’s Law. Enacted pursuant to AB 1421 (Thompson, Chapter 1017, Statutes of 2002), Laura’s Law established a new court-ordered AOT demonstration program aimed at individuals with mental illness who meet specified criteria but who do not meet the criteria (danger to self or others, or gravely disabled) for involuntary commitment to an inpatient facility. The law is named 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. AOT provides counties with the option to implement intensive programs for individuals 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.

Laura’s Law requires a county’s 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. The law did not provide for any state or local funding, which has been perceived as one of the barriers to its statewide implementation. No county implemented Laura’s Law program until Nevada County in 2008. As a way to encourage counties to opt-in, SB 585 (Steinberg and Correa, Chapter 288, Statutes of 2013), clarified that Mental Health Services Act funds could be used for AOT services if the county had implemented the program. Since then, 18 other counties have received approval and adopted a program: Alameda, Contra Costa, El Dorado, Kern, Los Angeles, Marin, Mendocino, Orange, Placer, San Diego, San Francisco, San Luis Obispo, San Mateo, Santa Barbara, Shasta, Stanislaus, Ventura, and Yolo.

1. DHCS 2018-2019 Report on Laura’s Law. DHCS is required to evaluate the effectiveness of the programs’ strategies to reduce a client’s risk for homelessness, hospitalizations, and involvement with local law enforcement. All 19 counties that have Board of Supervisors approval to operate an AOT program submitted a report to DHCS. Six programs did not serve court-ordered individuals or are in the early stages of implementation. During the reporting period, 914 individuals were referred to AOT. Of those, 686 participants responded to the initial invitation to voluntary services and did not require a court petition or process. Counties with a high level of acceptance without court petition (686) cite a successful initial outreach and engagement. The remaining 228 individuals entered AOT as a result of court orders or settlements. The majority of participating individuals were Caucasian males between ages 26 and 49. In recent years, counties have reported serving more racial and gender diverse populations. This report reflects aggregate outcomes for 288 individuals from 13 counties (Alameda, Contra Costa, Los Angeles, Mendocino, Nevada, Orange, Placer, San Diego, San Francisco, San Mateo, Santa Barbara, Ventura, and Yolo) that reported court-involved client data to DHCS. Among the results highlighted for the 2018-2019 period over the previous year were (a) homelessness decreased by 30%; (b) hospitalization decreased by 33%; (c) contact with law enforcement decreased by 43%; (d) some individuals were able to secure employment or obtain volunteer positions; (e) victimization was reduced by 85%; (f) violent behavior decreased by 64%; (g) clients presenting with a co-occurring mental health and substance use disorder reduced substance use by 34%; (h) most counties reported improvements in client social functioning and independent living skills; and, (i) client and family satisfaction surveys indicated satisfaction with AOT services.

NOTE: For more background, please see the Senate Health Committee analysis dated July 31, 2020.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee:

• Courts. Unknown, potentially significant, ongoing cost pressures due to potential increased workload to the courts that will oversee additional AOT cases for counties that either join together to provide AOT, do not opt out of AOT, or otherwise would not pursue AOT (and the required court involvement) absent this bill. It is estimated that average court cost pressures would be $7,896 a day (or $987 an hour), to operate a courtroom, exclusive of the judge’s salary, in FY 2019-2020. Assuming an AOT hearing lasted an hour, there would only need to be at least seven additional cases statewide to meet the committee’s suspense threshold.
• DHCS. Short-term, workload pressures for DHCS staff to participate in, and provide technical assistance, to a county or group of counties that implements the bill, in developing a training and education program to improve AOT services. Staff does not anticipate significant workload related to legislative reporting requirements, as current law (WIC §5348) requires DHCS to annually report to the Legislature on the effectiveness of AOT programs and includes similar specified metrics, such as housing and participation/contact with treatment; reduced use, or avoidance, of hospitalization; reduced involvement with local law enforcement, and the extent to which incarceration was reduced or avoided.

SUPPORT: (Verified 8/20/20)

California Psychiatric Association (source)

California Downtown Association

California Hospital Association

California Judges Association

California Medical Association

California Psychological Association

California Treatment Advocacy Coalition

Dignity Health

District Attorney Jackie Lacey, Los Angeles County

Downtown Sacramento Partnership

NAMI Contra Costa County

Steinberg Institute

Sutter Health

Tenet Healthcare Corporation

OPPOSITION: (Verified 8/20/20)

Cal Voices

California Association of Mental Health Peer Run Organizations

California Behavioral Health Planning Council

California State Association of Counties

County Behavioral Health Directors Association of California

Disability Rights California

Mental Health America of Los Angeles

Peers Envisioning and Engaging in Recovery Services

Racial and Ethnic Mental Health Disparities Coalition

SEIU California

ARGUMENTS IN SUPPORT: The California Psychiatric Association (CPA), sponsor of this bill, states that this bill encourages community dialogue between elected officials and their constituents about the potential utility of an AOT program for a community that does not now have it. Several counties have made decisions not to implement AOT without broad community input. For those and other counties that haven’t implemented AOT, CPA states this bill would require a public process and a reasoned finding be put on the record as the endpoint of community engagement and input about the merits of an AOT program. CPA and other supporters of this bill, largely health care providers, argue the data shows that the law has been broadly effective and the 17 years that have elapsed underscore the rationale to remove the sunset. CPA also argues that adding judges to the list of officials who can make referrals for an AOT investigation corrects an oversight in the original drafting of the law. Supporters state that Laura’s Law is strictly tailored to help a small subset of individuals with behavioral health conditions who, as a result of their condition and after extensive due process protections, are unable to voluntarily access treatment. This legal mechanism stays in place until the individual is well enough to voluntarily maintain their own treatment regimen. In counties where Laura’s Law has been implemented, the program has yielded dramatic results. Now more than ever, California is looking for solutions to address the ever-growing behavioral health crisis.

ARGUMENTS IN OPPOSITION: Opponents of this bill, largely behavioral health advocates, argue that the purpose of the public mental health system dictates that coerced services, such as AOT, remain a county option. Individuals are compelled to receive AOT services through a lengthy and formal legal process. Currently, county Boards of Supervisors consider the needs and priorities (including fiscal ramifications) on their local communities and the impact on voluntary mental health services before opting into implementing AOT services. Opponents argue this bill upends the current opt-in process by requiring counties to undergo a formal county process to pass a county resolution opting out, otherwise a county is compelled to implement this service, which would place a virtual mandate on counties to participate; unnecessarily complicate the local decision of how, when, and whether to implement Laura’s Law; and increase staff workload at a time when counties are challenged to meet existing needs. Any increase in workload at a time of forecasted funding declines and a wave of COVID-19 related behavioral health issues is misguided. Opponents generally state that they support the elimination of the repeal date of the Laura’s Law demonstration and strongly support the voluntary local implementation of Laura’s Law.

The California Behavioral Health Planning Council (CBHPC) states that it does not support changes to the law that require a county to justify not implementing AOT, as local governments would be required to explain and justify why they choose not to bypass an individual’s right to make their own decisions. As this bill repeals the sunset date of the law, the CBHPC does not support efforts that expand taking civil liberties from individuals as they believe involuntarily treatment is counterproductive to the wellness and recovery model that California embraces.

The Racial and Ethnic Mental Health Disparities Coalition argues it is not unreasonable to assume and fear that African Americans (and perhaps Latinos) could be negatively affected by increased availability of AOT, which consumers consider to be involuntary or forced treatment. When African Americans access mental health services, they are more likely to experience bias, racism, and discrimination. African Americans are more often misdiagnosed (with more severe and disabling mental health diagnoses), more often administered higher doses of psychotropic medication, and receive involuntary treatment more often than whites.

Cal Voices argues they believe this bill was introduced to help mitigate the homelessness crisis, and homeless individuals are more likely to be the victims of public violence rather than the perpetrators. Cal Voices states that homelessness is an effect of the unaffordable housing crisis that puts extremely low-income individuals at risk, with only 1/4 of homeless people experiencing any mental illness or substance use disorder.

SEIU California argues that given the LPS Act audit and recommendations, this bill will move forward a piecemeal approach, resulting in and creating a system that remains disjointed, inefficient, and ineffective, and will not improve patient care.

Disability Rights California states that in light of the fact that the audit also examined the delivery of mental health services through LPS and AOT, any program modifications should only be considered within the context of an examination of these related mental health delivery systems for individuals with serious mental illnesses. Such an effort is complicated by the fact there are only a few short weeks in the legislative session leaving little time for a thorough policy discussion.

The California State Association of Counties (CSAC) states that this bill is seeking to ensure that AOT services are made available in all counties, despite locally developed treatment options, priorities, and funding needs. CSAC argues that this bill places a mandate on counties to participate, unnecessarily complicates the local decision of how, when, and whether to implement Laura’s Law, and increases staff workload by expanding the list of those authorized to request a petition, as the county mental or behavioral health director is required to conduct an investigation into the appropriateness of each petition. CSAC states that counties would support the elimination of the repeal date of Laura’s Law, as counties have utilized current law to decide whether implementing the law is a viable option, and continue to assess this based on the needs of their residents.

ASSEMBLY FLOOR: 77-0, 6/10/20

AYES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Megan Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kamlager, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

NO VOTE RECORDED: Kalra, Quirk

Prepared by: Reyes Diaz / HEALTH / (916) 651-4111

8/24/20 14:14:51

**** END ***

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2019 - 2020 Regular Session

AB 1976 (Eggman) - Mental health services: assisted outpatient treatment

Bill Summary:

Assembly Bill 1976 would repeal, effective January 1, 2022, existing Laura’s Law provisions, and would make the program permanent, effective July 1, 2021, by requiring a county or group of counties, unless it opts out by resolution, to offer assisted outpatient mental health treatment (AOT) programs. Would prohibit a county or group of counties from reducing existing voluntary mental health programs serving adults, or children’s mental health programs, as specified.

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on August 20, 2020

Fiscal Impact:

• Courts. Staff estimate unknown, potentially significant, ongoing cost pressures due to potential increased workload to the courts that will oversee additional AOT cases for counties that either join together to provide AOT, do not opt out of AOT, or otherwise would not pursue AOT (and the required court involvement) absent this bill. It is estimated that average court cost pressures would be $7,896 a day (or $987 an hour), to operate a courtroom, exclusive of the judge’s salary, in FY 2019-2020. Assuming an AOT hearing lasted an hour, there would only need to be at least seven additional cases statewide to meet the committee’s suspense threshold.
• Department of Health Care Services (DHCS). Staff notes short-term, workload pressures for DHCS staff to participate in, and provide technical assistance, to a county or group of counties that implements the bill, in developing a training and education program to improve AOT services. Staff does not anticipate significant workload related to legislative reporting requirements, as current law (WIC §5348) requires DHCS to annually report to the Legislature on the effectiveness of AOT programs and includes similar specified metrics, such as housing and participation/contact with treatment; reduced use, or avoidance, of hospitalization; reduced involvement with local law enforcement, and the extent to which incarceration was reduced or avoided.

Author Amendments:

The author’s amendment corrects a cross-reference.

-- END --

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2019 - 2020 Regular Session

AB 1976 (Eggman) - Mental health services: assisted outpatient treatment.

Bill Summary:

Assembly Bill 1976 would repeal, effective January 1, 2022, existing Laura’s Law provisions, and would make the program permanent, effective July 1, 2021, by requiring a county or group of counties, unless it opts out by resolution, to offer assisted outpatient mental health treatment (AOT) programs. Would prohibit a county or group of counties from reducing existing voluntary mental health programs serving adults, or children’s mental health programs, as specified.

Fiscal Impact:

Courts. Staff estimate unknown, potentially significant, ongoing cost pressures due to potential increased workload to the courts that will oversee additional AOT cases for counties that either join together to provide AOT, do not opt out of AOT, or otherwise would not pursue AOT (and the required court involvement) absent this bill. It is estimated that average court cost pressures would be $7,896 a day (or $987 an hour), to operate a courtroom, exclusive of the judge’s salary, in FY 2019-2020. Assuming an AOT hearing lasted an hour, there would only need to be at least seven additional cases statewide to meet the committee’s suspense threshold.

Department of Health Care Services (DHCS). Staff notes short-term, workload pressures for DHCS staff to participate in, and provide technical assistance, to a county or group of counties that implements the bill, in developing a training and education program to improve AOT services. Staff does not anticipate significant workload related to legislative reporting requirements, as current law (WIC §5348) requires DHCS to annually report to the Legislature on the effectiveness of AOT programs and includes similar specified metrics, such as housing and participation/contact with treatment; reduced use, or avoidance, of hospitalization; reduced involvement with local law enforcement, and the extent to which incarceration was reduced or avoided.

Background:

1. AB 1421 (Thompson, Chapter 1017, Statutes of 2002) established the Assisted Outpatient Treatment (AOT) Demonstration Project Act of 2002, known as “Laura’s Law”, which is a court-ordered AOT demonstration program aimed at individuals with mental illness who meet specified criteria but do not meet the criteria (danger to self or others, or gravely disabled) for involuntary commitment to an inpatient facility. AOT provides counties the option to implement intensive programs for individuals 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 1569 (Allen, Chapter 441, Statutes of 2012) extended the sunset date for the AOT statute from January 1, 2013, to January 1, 2017; and AB 59 (Waldron, Chapter 251, Statutes of 2016) extended the sunset date for the AOT statute until January 1, 2022.

Laura’s Law requires a county’s 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. No county implemented Laura’s Law program until Nevada County in 2008. As a way to encourage counties to opt-in, SB 585 (Steinberg and Correa, Chapter 288, Statutes of 2013), clarified that Mental Health Services Act funds could be used for AOT services if the county had implemented the program. Since then, 18 other counties have received approval and adopted a program: Alameda, Contra Costa, El Dorado, Kern, Los Angeles, Marin, Mendocino, Orange, Placer, San Diego, San Francisco, San Luis Obispo, San Mateo, Santa Barbara, Shasta, Stanislaus, Ventura, and Yolo.

The object of AOT under Laura’s Law is to prevent individuals with severe mental illnesses from deteriorating to a level that would require involuntary confinement. The person subject to a petition for AOT has a right to counsel at all stages; and, they may waive their right to a hearing and enter into a settlement agreement, which has the same force and effect as a court order. During an AOT hearing, the court considers testimony, including physician review of the person’s treatment history and in certain circumstances, also examines the person. Among other things, a court must find, by clear and convincing evidence, that the person is unlikely to survive safely in the community with supervision, that they have a history of failing to comply with a treatment program, that their condition is substantially deteriorating, and that the treatment will prevent the person from becoming gravely disabled or a danger to self or others. (Welf. & Inst. Code § 5346(a).) After this finding, and that there is no appropriate and less restrictive alternative, the court may order the person to receive AOT, and in its AOT order, specified types of services to be provided in the community.

According to the Senate Health Committee analysis, which included policy analysis by the Senate Judiciary Committee: “[D]ata indicates [assisted outpatient treatment] and program support are contributing factors in helping clients avoid or reduce hospitalization, homelessness, and incarceration.” In Nevada County, for instance, Laura’s Law reduced hospitalization by 46.7 percent; incarceration, 65.1 percent; homelessness, 61.9 percent; and emergency contacts 33.1%. As a result, Laura’s Law saved Nevada County $213,300 in incarceration costs and $75,000 in hospital costs. The available evidence indicate more positive outcomes from the provision of ongoing community-based mental health services on a voluntary basis, as well as AOT for people who are on the verge of decompensating. This bill focuses on expanding a treatment regime that enables the individual to remain in their community.

Proposed Law:

The bill would repeal, effective January 1, 2022, existing Laura’s Law provisions, and would make the program permanent, effective July 1, 2021, by requiring a county or group of counties, unless it opts out by resolution, to offer assisted outpatient mental health treatment (AOT) programs. Specifically, the bill would:

• Require a county or group of counties that does not wish to implement Laura’s Law to opt out of the requirements by a resolution passed by the governing body that states the reasons for opting out and any facts or circumstances relied on in making that decision.
• Prohibit a county or group of counties from reducing existing voluntary mental health programs serving adults, or children’s mental health programs, as specified.
• Authorize a county to implement the bill’s provisions with one or more counties, In lieu of the resolution to opt out.
• Require, in the event a county chooses to provide services with one or more other counties, those counties to execute a memorandum of understanding that, among other provisions, will specify the process for designating the lead county, determining the county incurring financial responsibility, and ensuring appropriate follow-up care upon an individual’s release from the treatment program.
  • Require a county or group of counties that implements the bill, to consult with the DHCS, client and family advocacy organizations, and other stakeholders, develop a training and education program to improve service-delivery. Require the training be provided to mental health treatment providers contracting with participating counties and other individuals, such as law enforcement officials and certification hearing officers involved in making treatment and involuntary commitment decisions
  • Require, a county or group of counties that chooses to provide AOT services, to offer specified services, including, but not limited to, all of the following:
  • 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.
  • A specified service planning and delivery process.
  • Each client must have a designated mental health personal services coordinator, who may be part of a multidisciplinary treatment team.
  • The individual personal services plan must ensure that persons receive age-appropriate, gender-appropriate, and culturally appropriate services, to the extent feasible.
• Require, a county that provides AOT services under this bill, to offer the same services on a voluntary basis.
• Prohibit involuntary medication absent a separate order by the court, as specified.
• Require a county that operates an AOT program to provide data to the DHCS and, based on the data, require the DHCS to report to the Legislature on or before May 1 of each year an evaluation of the effectiveness of the strategies employed by each program in reducing homelessness and hospitalization of persons in the program and in reducing involvement with local law enforcement by persons in the program. The evaluation and report must also include any other measures identified by the department regarding persons in the program and all of the following, based on information that is available:
• Adds a superior court judge, as specified, the to the list of persons who may request the county mental health department for the filing of a petition to obtain an order authorizing assisted outpatient treatment:

Related Legislation:

AB 59 (Waldron, Chapter 251, Statutes of 2016) extends the operation of Laura’s Law until January 1, 2022.

AB 1193 (Eggman of 2015) would have required a county that has not held a specified public hearing to elect to initiate Laura’s Law by January 1, 2017, to hold a hearing by January 1, 2018, and would have required the Board of Supervisors to consider both whether specified programs may be reduced as a result of participation and options for providing services other than court-ordered outpatient treatment. AB 1193 was held on Assembly Appropriations suspense file.

Staff Comments:

On July 28, 2020, the State Auditor (CSA) released its audit, LPS Act: California Has Not Ensured That Individuals With Serious Mental Illnesses Receive Adequate Ongoing Care. The audit, which focuses on three counties’ (Los Angeles, San Francisco, and Shasta) definitions of the criteria for involuntary detention for those who are a danger to self or others or gravely disabled, due to a mental health condition, and criteria for conservatorship, found hat that counties in California have not widely adopted Laura’s Law, which could help prevent involuntary treatment in institutional settings. The CSA states that AOT is an effective approach to serving individuals in their communities, and makes recommendations for the Legislature to require AOT services in all counties, as well as expand access to AOT to people leaving conservatorship. The CSA’s recommendation differs from the provisions in this bill in that, under the CSA proposal, counties would have to apply to DHCS for a time-limited waiver if they seek not to provide AOT services, and would have to provide a plan for eventually offering AOT services. This bill similarly mandates AOT services in every county by making Laura’s Law a county opt-out program, rather than opt-in, and provides a less stringent opportunity for counties to opt-out of providing AOT services than the CSA proposal does. The CSA makes this recommendation in part because it found that many individuals were subjected to repeated instances of involuntary treatment without being connected to ongoing care that could help them live safely in their communities, as AOT services have shown to provide.

The author notes a technical drafting error to be corrected:

SEC. 8. Section 5349 is added to the Welfare and Institutions Code, to read:

5349. (b) In lieu of the resolution to opt out pursuant to subdivision (a), a county may elect to implement this article in combination with one or more counties pursuant to the implementation provisions of subdivision (a) (d).

-- END --

SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: AB 1976

Due to the COVID-19 Pandemic and the unprecedented nature of the 2020 Legislative Session, all Senate Policy Committees are working under a compressed timeline. This timeline does not allow this bill to be referred and heard by more than one committee as a typical timeline would allow. In order to fully vet the contents of this measure for the benefit of Senators and the public, this analysis includes information from the Senate Judiciary Committee.

SUBJECT: Mental health services: assisted outpatient treatment

SUMMARY:

Implements the Assisted Outpatient Treatment (AOT) Demonstration Project Act of 2002, or “Laura’s Law,” statewide and permits a county or a group of counties to opt-out of implementing Laura’s Law rather than permitting a county to opt-in to provide AOT services. Permits a group of counties to implement Laura’s Law in combination under specified circumstances. Repeals the sunset date for Laura’s Law.

Existing law:

1. Permits a county Boards of Supervisors, by resolution, to authorize (opt-in to) Laura’s Law, whereby a county behavioral health director can petition for a court to order a person over the age of 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 a history of noncompliance with treatment for his or her mental illness; and the person's condition is substantially deteriorating, and participation in AOT would be the least restrictive placement necessary to ensure the person's recovery. [WIC §5346]
2. Permits specified individuals to make a request to the county health department for the filing of a petition to obtain an order authorizing AOT, including a parent, spouse, sibling, or adult child of the subject of the petition; licensed mental health treatment providers; and peace officer, parole officer, or probation officer, as specified. [WIC §5346]
3. Requires counties that implement Laura’s Law 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 of the implementation. [WIC §5349]
4. Requires a county that provides court-ordered AOT services to also offer the same services on a voluntary basis. [WIC §5348]
5. Requires the Department of Health Care Services (DHCS) to submit a report and evaluation of all counties implementing any component of Laura’s Law to the Governor and the Legislature annually. [WIC §5348]
6. Sunsets Laura’s Law on January 1, 2022. [WIC §5349.5]

This bill:

1. Implements Laura’s Law statewide and permits a county or group of counties that do not wish to implement Laura’s Law to opt-out of the requirements of AOT services through a specified process. Requires such counties to state the reason for opting out.
2. Permits a county to elect to implement Laura’s Law in combination with one or more counties. Requires a group of counties that provide AOT services in combination to execute a memorandum of understanding that requires designating a lead county for an individual receiving AOT services for such purposes as making a finding that the individual meets the AOT criteria, assuring services are provided and determining where they are provided, and ensuring that appropriate follow-up care is in place upon an individual’s release from the AOT treatment program.
3. Adds a judge of a superior court to the list of specified individuals permitted to make a request for the filing of a petition to obtain an order authorizing AOT, pursuant to 2) above of existing law.
4. Deletes the requirement that DHCS submit a report to the Governor, pursuant to 5) above of existing law.
5. Repeals the sunset date for Laura’s Law.
6. Makes other technical changes.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, a county could incur significant unknown costs associated with implementation of Laura’s Law if they choose to do so, but these costs are not state reimbursable as it remains at the county's discretion.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, since AOT was approved by the legislature in 2002, 20 counties have implemented it. Also known as Laura’s Law, this demonstration project is a community-based treatment program to assist individuals who, 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 is an unnecessary barrier, evidenced by the fact that the program has been available to counties for the last 18 years and less than half have implemented it. Easing and expanding AOT implementation will ensure that those at highest risk for arrest, homelessness, hospitalization, and COVID-19 infection risk can obtain the necessary treatment services to keep them in the community. While this bill encourages implementation of Laura’s Law statewide, it also retains local control by allowing them to opt-out through a resolution passed by the governing body that states the reasons for opting out, and facts or circumstances used to make that decision.
2. Laura’s Law. Enacted pursuant to AB 1421 (Thompson, Chapter 1017, Statutes of 2002), Laura’s Law established a new court-ordered AOT demonstration program aimed at individuals with mental illness who meet specified criteria but who do not meet the criteria (danger to self or others, or gravely disabled) for involuntary commitment to an inpatient facility. The law is named 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. AOT provides counties with the option to implement intensive programs for individuals 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.

Laura’s Law requires a county’s 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. The law did not provide for any state or local funding, which has been perceived as one of the barriers to its statewide implementation. No county implemented Laura’s Law program until Nevada County in 2008. As a way to encourage counties to opt-in, SB 585 (Steinberg and Correa, Chapter 288, Statutes of 2013), clarified that Mental Health Services Act funds could be used for AOT services if the county had implemented the program. Since then, 18 other counties have received approval and adopted a program: Alameda, Contra Costa, El Dorado, Kern, Los Angeles, Marin, Mendocino, Orange, Placer, San Diego, San Francisco, San Luis Obispo, San Mateo, Santa Barbara, Shasta, Stanislaus, Ventura, and Yolo.

1. DHCS 2018-2019 Report on Laura’s Law. DHCS is required to evaluate the effectiveness of the programs’ strategies to reduce a client’s risk for homelessness, hospitalizations, and involvement with local law enforcement. All 19 counties that have Board of Supervisors approval to operate an AOT program submitted a report to DHCS. Six programs did not serve court-ordered individuals or are in the early stages of implementation. During the reporting period, 914 individuals were referred to AOT. Of those, 686 participants responded to the initial invitation to voluntary services and did not require a court petition or process. Counties with a high level of acceptance without court petition (686) cite a successful initial outreach and engagement. The remaining 228 individuals entered AOT as a result of court orders or settlements. The majority of participating individuals were Caucasian males between ages 26 and 49. In recent years, counties have reported serving more racial and gender diverse populations. This report reflects aggregate outcomes for 288 individuals from 13 counties (Alameda, Contra Costa, Los Angeles, Mendocino, Nevada, Orange, Placer, San Diego, San Francisco, San Mateo, Santa Barbara, Ventura, and Yolo) that reported court-involved client data to DHCS. Among the results highlighted for the 2018-2019 period over the previous year were:
2. Homelessness decreased by 30%;
3. Hospitalization decreased by 33%;
4. Contact with law enforcement decreased by 43%;
5. Some individuals were able to secure employment or obtain volunteer positions;
6. Victimization was reduced by 85%;
7. Violent behavior decreased by 64%;
8. Clients presenting with a co-occurring mental health and substance use disorder (SUD) reduced substance use by 34%;
9. Most counties reported improvements in client social functioning and independent living skills; and,
10. Client and family satisfaction surveys indicated satisfaction with AOT services.
11. State audit on the Lanterman-Petris-Short (LPS) Act. The California State Auditor (CSA) released a report on its audit, LPS Act: California Has Not Ensured That Individuals With Serious Mental Illnesses Receive Adequate Ongoing Care, on July 28, 2020. The audit focuses generally on three counties’ (Los Angeles, San Francisco, and Shasta) definitions of the criteria for involuntary detention for those who are a danger to self or others or gravely disabled, due to a mental health condition, and criteria for conservatorship, and whether the counties have consistently followed those criteria; differences in approaches among the counties; funding sources and whether funding is a barrier to implementing the LPS Act; and the availability of treatment resources in each county. Relative to this bill, the CSA states that counties in California have not widely adopted Laura’s Law, which could help prevent involuntary treatment in institutional settings. The CSA states that AOT is an effective approach to serving individuals in their communities, and makes recommendations for the Legislature to require AOT services in all counties, as well as expand access to AOT to people leaving conservatorship. The CSA’s recommendation differs from the provisions in this bill in that, under the CSA proposal, counties would have to apply to DHCS for a time-limited waiver if they seek not to provide AOT services, and would have to provide a plan for eventually offering AOT services. This bill similarly mandates AOT services in every county by making Laura’s Law a county opt-out program, rather than opt-in, and provides a less stringent opportunity for counties to opt-out of providing AOT services than the CSA proposal does. The CSA makes this recommendation in part because it found that many individuals were subjected to repeated instances of involuntary treatment without being connected to ongoing care that could help them live safely in their communities, as AOT services have shown to provide. For example, almost 7,400 people in Los Angeles County experienced five or more short‑term involuntary holds from fiscal years 2015–16 through 2017–18, but only 9% were enrolled in the most intensive and comprehensive community‑based services available in fiscal year 2018–19.
12. Senate Judiciary Committee analysis. The following was provided by Senate Judiciary Committee staff who, in a typical legislative year, would have analyzed this bill:

Because Laura’s Law authorizes a court to order a person to participate in an AOT program for a serious mental health condition, this bill implicates civil rights and thus is in the Senate Judiciary Committee’s jurisdiction.

Over the last few years, as the state’s mental health and homelessness crises have intensified, several policy disagreements have played out in the Legislature with respect to the causes of, and solutions to, these crises. One prominent fault line centers on the state’s power to intervene on behalf of those who cannot act in their own best interests. Some argue that the conservatorship under the LPS Act should be expanded to provide counties additional discretion to assert legal control over people who are incapable of surviving safely on their own. Others argue that this focus is misguided because many counties currently do not provide adequate community-based services to help individuals avoid deteriorating into a condition that necessitates a conservatorship.

The CSA recently conducted an audit of the implementation of the LPS Act in Los Angeles, San Francisco, and Shasta Counties. The CSA concluded:

[…] the LPS Act’s criteria for involuntary treatment allows counties sufficient authority to provide short-term involuntary treatment to people. Expanding the LPS Act’s criteria to include additional situations in which individuals may be involuntarily treated could potentially infringe upon people’s liberties—and we found no evidence to justify such a change.

Perhaps most troublingly, many individuals were subjected to repeated instances of involuntary treatment without being connected to ongoing care that could help them live safely in their communities. […]^[1]

With respect to Laura’s Law, the CSA stated:

[…] counties in California have not widely adopted assisted outpatient treatment—a community-based approach to mental health treatment that could help prevent involuntary treatment in institutional settings. Assisted outpatient treatment is an effective approach to serving individuals in their communities, and we make recommendations to expand access to this treatment.^[2]

The object of AOT under Laura’s Law is to prevent individuals with severe mental illnesses from deteriorating to a level that would require involuntary confinement. Among other things, a court must find by clear and convincing evidence that the person is unlikely to survive safely in the community with supervision, that they have a history of failing to comply with a treatment program, that their condition is substantially deteriorating, and that the treatment will prevent the person from becoming gravely disabled or a danger to self or others. (Welf. & Inst. Code § 5346(a).)

Nineteen counties have opted into Laura’s Law. DHCS reports that “[d]ata indicates [assisted outpatient treatment] and program support are contributing factors in helping clients avoid or reduce hospitalization, homelessness, and incarceration.”^[3] In Nevada County, for instance, Laura’s Law reduced hospitalization, 46.7%; incarceration, 65.1%; homelessness, 61.9%; and emergency contacts 33.1% .^[4] As a result, Laura’s Law saved Nevada County $213,300 in incarceration costs and $75,000 in hospital costs.^[5]

Thus, the available evidence indicates that better outcomes will result from the provision of ongoing community-based mental health services on a voluntary basis, as well as AOT for people who are on the verge of decompensating. In lieu of more heavy-handed alternatives, this bill appropriately focuses on expanding a treatment regime that enables the individual to remain in their community.

1. Prior legislation. AB 59 (Waldron, Chapter 251, Statutes of 2016) extends the operation of Laura’s Law until January 1, 2022.

AB 1193 (Eggman of 2015) would have required a county that has not held a specified public hearing to elect to initiate Laura’s Law by January 1, 2017, to hold a hearing by January 1, 2018, and would have required the Board of Supervisors to consider both whether specified programs may be reduced as a result of participation and options for providing services other than court-ordered outpatient treatment. AB 1193 was held on Assembly Appropriations suspense file.

AB 1265 (Conway of 2014) would have permitted an initial court order for AOT services to be extended for up to 12 months (rather than six months), and required that each person discharged from a hospital be considered for AOT in the counties that have implemented Laura’s Law. AB 1265 failed passage in the Assembly Judiciary Committee.

AB 2266 (Waldron of 2013) would have authorized the court to order a person to receive AOT for an initial period not to exceed 12 months. AB 2266 would have, in a county that elects to implement Laura’s Law, upon the release of a person from intensive treatment or post certification treatment, authorized the professional staff of the agency or facility that provided the treatment to evaluate whether the person meets the criteria for AOT. AB 2266 would have authorized the professional staff to request the county mental health director to file a petition in the superior court for AOT if that person met the criteria. AB 2266 failed passage in the Assembly Judiciary Committee.

SB 585 (Steinberg and Correa) specified that counties that elect to implement Laura’s Law may, to the extent permissible under state and federal laws, pay for those services using funds distributed to counties from the Mental Health Subaccount, the Mental Health Equity Subaccount, and the Vehicle License Collection Account of the Local Revenue Fund, funds from the Mental Health Account and the Behavioral Health Subaccount, within the Support Services Account of the Local Revenue Fund 2011, funds from the Mental Health Services Fund, and any other funds from which the Controller makes distributions to the counties, for those purposes.

AB 1421 (Thompson) enacted Laura’s Law.

1. Support. The California Psychiatric Association (CPA), sponsor of this bill, states that this bill encourages community dialogue between elected officials and their constituents about the potential utility of an AOT program for a community that does not now have it. Several counties have made decisions not to implement AOT without broad community input. For those and other counties that haven’t implemented AOT, CPA states this bill would require a public process and a reasoned finding be put on the record as the endpoint of community engagement and input about the merits of an AOT program. CPA and other supporters of this bill, largely health care providers, argue the data shows that the law has been broadly effective and the 17 years that have elapsed underscore the rationale to remove the sunset. CPA also argues that adding judges to the list of officials who can make referrals for an AOT investigation corrects an oversight in the original drafting of the law. Supporters state that Laura’s Law is strictly tailored to help a small subset of individuals with behavioral health conditions who, as a result of their condition and after extensive due process protections, are unable to voluntarily access treatment. This legal mechanism stays in place until the individual is well enough to voluntarily maintain their own treatment regimen. In counties where Laura’s Law has been implemented, the program has yielded dramatic results. Now more than ever, California is looking for solutions to address the ever-growing behavioral health crisis.
2. Opposition. Opponents of this bill, largely behavioral health advocates, argue that the purpose of the public mental health system dictates that coerced services, such as AOT, remain a county option. Individuals are compelled to receive AOT services through a lengthy and formal legal process. Currently, county Boards of Supervisors consider the needs and priorities (including fiscal ramifications) on their local communities and the impact on voluntary mental health services before opting into implementing AOT services. Opponents argue this bill upends the current opt-in process by requiring counties to undergo a formal county process to pass a county resolution opting out, otherwise a county is compelled to implement this service, which would place a virtual mandate on counties to participate; unnecessarily complicate the local decision of how, when, and whether to implement Laura’s Law; and increase staff workload at a time when counties are challenged to meet existing needs. Any increase in workload at a time of forecasted funding declines and a wave of COVID-19 related behavioral health issues is misguided. Opponents generally state that they support the elimination of the repeal date of the Laura’s Law demonstration and strongly support the voluntary local implementation of Laura’s Law. The California Behavioral Health Planning Council (CBHPC) states that it does not support changes to the law that require a county to justify not implementing AOT, as local governments would be required to explain and justify why they choose not to bypass an individual’s right to make their own decisions. As this bill repeals the sunset date of the law, the CBHPC does not support efforts that expand taking civil liberties from individuals as they believe involuntarily treatment is counterproductive to the wellness and recovery model that California embraces. The Racial and Ethnic Mental Health Disparities Coalition argues it is not unreasonable to assume and fear that African Americans (and perhaps Latinos) could be negatively affected by increased availability of AOT, which consumers consider to be involuntary or forced treatment. When African Americans access mental health services, they are more likely to experience bias, racism, and discrimination. African Americans are more often misdiagnosed (with more severe and disabling mental health diagnoses), more often administered higher doses of psychotropic medication, and receive involuntary treatment more often than whites. Cal Voices argues they believe this bill was introduced to help mitigate the homelessness crisis, and homeless individuals are more likely to be the victims of public violence rather than the perpetrators. Cal Voices states that homelessness is an effect of the unaffordable housing crisis that puts extremely low-income individuals at risk, with only ¼ of homeless people experiencing any mental illness or SUD. SEIU California argues that given the LPS Act audit and recommendations, this bill would move forward a piecemeal approach, resulting in and creating a system that remains disjointed, inefficient, and ineffective, and will not improve patient care. Disability Rights California states that in light of the fact that the audit also examined the delivery of mental health services through LPS and AOT, any program modifications should only be considered within the context of an examination of these related mental health delivery systems for individuals with serious mental illnesses. Such an effort is complicated by the fact there are only a few short weeks in the legislative session leaving little time for a thorough policy discussion.
3. Oppose unless amended. The California State Association of Counties (CSAC) states that this bill is seeking to ensure that AOT services are made available in all counties, despite locally developed treatment options, priorities, and funding needs. CSAC argues that this bill places a mandate on counties to participate, unnecessarily complicates the local decision of how, when, and whether to implement Laura’s Law, and increases staff workload by expanding the list of those authorized to request a petition, as the county mental or behavioral health director is required to conduct an investigation into the appropriateness of each petition. CSAC states that counties would support the elimination of the repeal date of Laura’s Law, as counties have utilized current law to decide whether implementing the law is a viable option, and continue to assess this based on the needs of their residents.
4. Policy comment. While the CSA audit makes a similar recommendation that this bill does, the timing of the release of the audit does not provide ample opportunity for all of the CSA recommendations to be fully vetted and considered by the Legislature. The Committee may wish to consider whether this bill is premature.
5. Amendments. To address some of the concerns expressed about the timing of the implementation of this bill, the author has agreed to amend this bill to include a delayed implementation date of July 1, 2021.

SUPPORT AND OPPOSITION:

Support: California Psychiatric Association (sponsor)

California Downtown Association

California Hospital Association

California Judges Association

California Medical Association

California Psychological Association

California Treatment Advocacy Coalition

Dignity Health

District Attorney Jackie Lacey, Los Angeles County

Downtown Sacramento Partnership

Steinberg Institute

Sutter Health

Tenet Healthcare Corporation

Oppose: Cal Voices

California Association of Mental Health Peer Run Organizations

California Behavioral Health Planning Council

California State Association of Counties (unless amended)

County Behavioral Health Directors Association of California

Disability Rights California

Mental Health America of Los Angeles

Peers Envisioning and Engaging in Recovery Services

Racial and Ethnic Mental Health Disparities Coalition

SEIU California

-- END --

1. Lanterman-Petris-Short Act: California Has Not Ensured That Individuals With Serious Mental Illnesses Receive Adequate Ongoing Care (July 28, 2020) Report 2019-119, Public Letter, available at https://www.auditor.ca.gov/reports/2019-119/index.html (as of Jul. 28, 2020). ↑

2. Id. ↑

3. Laura’s Law: Assisted Outpatient Treatment Demonstration Project Act of 2002, Department of Health Care Services (March, 2020), available at https://www.dhcs.ca.gov/formsandpubs/Documents/Legislative%20Reports/Lauras_Law_May2016-April2017.pdf (as of Jul. 28, 2020). ↑

4. Myths About Laura’s Law (AB 1421) Mental Illness Policy Org, available at https://mentalillnesspolicy.org/states/california/lauraslawmyths.html (as of Jul. 28, 2020). ↑

5. Id. AB 1976 (Eggman of 2020) would require a county to offer AOT programs under Laura’s Law unless the county opts out, as provided. The bill would also eliminate the current January 1, 2022 sunset date, thereby extending it indefinitely. ↑

ASSEMBLY THIRD READING

ATR Bill Id:AB 1976

Author:(Eggman)

As Amended Ver:May 4, 2020

Majority vote

SUMMARY:

Allows a county, in combination with one or more counties, to implement an Assisted Outpatient Treatment (AOT) Program under what is known as Laura's Law. Requires a county or group of counties to implement an AOT program, or to opt out of this requirement by a resolution passed by the governing body or bodies of the county or counties that states the reasons for opting out and any facts or circumstances relied on in making that decision. Authorizes a judge in a superior court to request a petition for that order to be filed for a person who appears before the judge. Repeals the January 1, 2022 sunset date of Laura's Law and makes the law permanent.

Major Provisions

COMMENTS:

The Lanterman-etris-Short (LPS) Act was signed into law in 1967 and provides for involuntary commitment of individuals with serious mental illness (SMI) for varying lengths of time for the purpose of treatment and evaluation, provided certain requirements are met. As an alternative to an LPS Act conservatorship, current law provides for court-ordered outpatient treatment through Laura's Law. In counties opting to implement an AOT program, the court may order a person into an AOT program if the court finds that the person either meets existing involuntary commitment requirements under the LPS Act or the person meets non-involuntary commitment requirements, 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. AOT is available only in those counties in which the county board of supervisors, by resolution, authorizes its application (opts in) and makes a finding that no voluntary mental health program serving adults and no children's mental health program may be reduced in order to implement the law. Laura's Law has been extended three times, with a current sunset date of January 1, 2022.

Laura's Law is designed to provide participating counties with tools for early intervention. It allows for family members, relatives, cohabitants, treatment providers, or peace officers to initiate the AOT process with a petition to the county behavioral health director or designee. The health director must then determine how to proceed. If the individual is found to meet the AOT eligibility requirements, an individual preliminary care plan is developed to meet that person's needs. If this process results in the person voluntarily engaging with treatment, then the patient is deemed to no longer meet the criteria and the petition is no longer available. However, if the client declines their preliminary plan, then a public defender is assigned and the petition proceeds. It is then up to the judge to either grant or reject the AOT petition. If an AOT petition is approved by the court, any treatment ordered is valid for up to 180 days.

The most recent AOT report reflects aggregate outcomes for 288 individuals from 13 counties that reported court-involved client data to the Department of Health Care Services and among the results highlighted for the 2018-2019 period over the previous year were: 1) Homelessness decreased by a 30% change; 2) Hospitalization decreased by a 33% change; 3 )Contact with law enforcement decreased by a 43% change; 4) Some individuals were able to secure employment or obtain volunteer positions; 5) Victimization was reduced by an 85% change; and, 6) Violent behavior decreased by a 64% change;

According to the Author:

According to the author, since AOT was approved by the Legislature in 2002, 24 counties have implemented it. This demonstration project is a community-based treatment program to assist individuals who, as a result of their SMI, are unable to access community mental health services voluntarily. The current AOT process of "opting in" is an unnecessary barrier, evidenced by the fact that the program has been available to counties for the last 18 years and less than half have implemented it. Easing and expanding AOT implementation will ensure that those at highest risk for hospitalization can obtain the necessary treatment services to keep them in the community. While this bill encourages implementation of Laura's Law statewide, it also allows counties to retain local control by allowing them to "opt out" through a resolution passed by the governing body that states the reasons for opting out and facts or circumstances used to make that decision.

Arguments in Support:

The California Psychiatric Association (CPA), sponsor of this bill, states that data derived from the AOT program demonstrates that a small subset of people with psychotic disorders - who have a history of revolving-door arrests and incarceration, revolving-door hospitalization or who have made threats of or carried out acts leading to grave bodily harm - benefit from intensive services under court supervision if the duration of those services is at least six months. The most obvious benefits lie in reduced arrests, hospitalization and incidents of violence. Of particular interest in this environment where policy makers and the public are focused on homelessness, AOT programs help patients maintain stable housing and increase adherence to medications which provide stability in the community that supports recovery.

Arguments in Opposition:

The California Behavioral Health Planning Council states in opposition that this bill would eliminate the requirement for a county Board of Supervisors to engage in a public deliberation to authorize the implementation of AOT, thus resulting in automatic acceptance. Further, this bill would require a county to justify not implementing AOT. This means a local government would be required to explain and justify why they choose not to bypass an individual's right to make their own decisions.

Arguments in Opposition Unless Amended

The California State Association of Counties and the County Behavioral Health Directors Association have an oppose unless amended position and state that counties are concerned that allowing a judge to request a petition for an AOT order will increase workload and that expanding the list of those authorized to request a petition increases the workload of the county department as the county mental or behavioral health director is required to conduct an investigation into the appropriateness of each petition

FISCAL COMMENTS:

According to the Appropriations Committee, a county could incur significant unknown costs associated with implementation of AOT if they choose to do so, but these costs are not state- reimbursable as it remains at the county's discretion.

VOTES:

ASM HEALTH: 15-0-0

YES: Wood, Mayes, Aguiar-Curry, Bigelow, Bonta, Burke, Carrillo, Flora, Limón, McCarty, Nazarian, Ramos, Rodriguez, Santiago, Waldron

ASM APPROPRIATIONS: 18-0-0

YES: Gonzalez, Bigelow, Bauer-Kahan, Bloom, Bonta, Calderon, Carrillo, Chau, Megan Dahle, Diep, Eggman, Fong, Gabriel, Eduardo Garcia, Petrie-Norris, McCarty, Robert Rivas, Voepel

UPDATED:

VERSION: May 4, 2020

CONSULTANT: Judith Babcock / HEALTH / (916) 319-2097 FN: 0003038

Date of Hearing: June 2, 2020

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 1976

Author:(Eggman) – As Amended Ver:May 4, 2020

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill addresses local implementation of Assisted Outpatient Treatment (AOT, or Laura's Law). Specifically, this bill:

1. Requires counties to implement AOT or opt out via a resolution of the county board of supervisors.
2. Allows specified judges to file a petition to obtain an order authorizing assisted outpatient treatment.
3. Removes the current requirement that a county make a finding that "no voluntary mental health program serving adults, and no children’s mental health program, may be reduced as a result of the implementation" of AOT.
4. Deletes the sunset date on statutes authorizing AOT (current law repeals the statutes authorizing AOT, effective January 1, 2022).
5. Allows a county to implement an AOT program in combination with one or more counties.

FISCAL EFFECT:

A county could incur significant unknown costs associated with implementation of AOT if they choose to do so, but these costs are not state- reimbursable as it remains at the county's discretion.

COMMENTS:

1. Purpose. The author believes this bill will encourage counties to implement AOT, which will provide them another option to assist people with community-based treatment. The author notes it also allows counties to retain control by opting out if they choose not to participate.
2. Background. Enacted in 2002, Laura’s Law was named for Laura Wilcox, a 19-year-old college student in Nevada County who was killed by a severely mentally ill man who was not adhering to prescribed mental health treatment. Laura’s Law permits counties to provide AOT, or 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 noncompliance with voluntary treatment, indicates the person is likely to become dangerous or gravely disabled without treatment. Unlike “5150 holds” and the related body of law that describes involuntary holds for mental health reasons, AOT is involuntary intensive community-based, not inpatient, mental health treatment.

The intent of Laura's Law is to prevent a small number of individuals who meet narrow eligibility criteria from becoming gravely disabled or threatening. A county board of supervisors must pass a resolution to implement AOT. According to a 2018-19 report by the Department of Health Care Services, 19 counties had implemented AOT in some form. The report found generally positive outcomes for individuals who participated through court order. The majority of individuals who might have been subject to a court order through AOT instead complied with voluntary treatment.

1. Support. This bill is sponsored by the California Psychiatric Association and supported by hospitals. They cite success of implemented AOT programs, and desire to increase the reach of what they describe as an important option for outpatient treatment.
2. Opposition. Disability Rights California opposes this bill unless amended to reinstate a key protection, namely, the prohibition on reducing voluntary mental health services when implementing AOT programs. CA Behavioral Health Planning Council, Cal Voices (formerly NorCal MHA), and the California Association of Mental Health Peer Run Organizations oppose this bill for similar reasons and because it would not require counties to publicly discuss and adopt AOT.
3. Prior Legislation.
4. AB 1193 (Eggman), of the 2015-16 Legislative Session, was similar to this bill except it included a requirement for a public hearing before a county could choose to opt out. It was held on the Suspense File of this committee.
5. AB 59 (Waldron), Chapter 251, Statutes of 2016, extended the sunset of Laura’s Law to January 1, 2022.
6. AB 193 (Maienschein) of the 2015-16 Legislative Session, AB 2266 (Waldron) and AB 1265 (Conway), both of the 2013-14 Legislative Session, also attempted to change various aspects of the AOT program. None were signed into law.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: May 18, 2020

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 1976

Author:(Eggman) – As Amended Ver:May 4, 2020

SUBJECT: Mental health services: assisted outpatient treatment.

SUMMARY: Allows a county, in combination with one or more counties, to implement an Assisted Outpatient Treatment (AOT) Program under what is known as Laura’s Law. Requires a county or group of counties to implement an AOT program, or to opt out of this requirement by a resolution passed by the governing body or bodies of the county or counties that states the reasons for opting out and any facts or circumstances relied on in making that decision. Authorizes a judge of a superior court, before whom the person who is the subject of an AOT petition appears, to request a county mental health department to file a petition to obtain an order authorizing AOT. Repeals the January 1, 2022 sunset date of Laura’s Law and makes the law permanent. Specifically, this bill:

1. Allows a county to implement an AOT program in combination with one or more counties.
2. Requires a county or a group of counties to implement an AOT program unless they elect to opt out of the requirement by a resolution passed by the governing body or bodies of the county or counties that states the reasons for opting out and any facts or circumstances relied on in making that decision.
3. Requires, that in the event multiple counties choose to provide services, those counties must execute a memorandum of understanding to include, but not be limited to, a process for designating the lead county for an individual receiving services pursuant to the memorandum of understanding for the following purposes:
   1. Making the findings for recommending an individual to participate in AOT;
   2. Assuring the services are provided and determining where they are provided.
   3. Determining the county incurring financial responsibility, as applicable, for an individual receiving services; and,
   4. Ensuring that appropriate follow-up care is in place upon an individual’s release from the treatment program.
4. Eliminates the requirement that the Department of Health Care Services (DHCS) provide an annual report on the status of Laura’s Law implementation to both the Governor and the Legislature and instead requires the report be submitted only to the Legislature.
5. Authorizes a judge of a superior court, before whom the person who is the subject of an AOT petition appears, to request a county mental health department to file a petition to obtain an order authorizing AOT.
6. Repeals the January 1, 2022 sunset date of Laura’s Law and makes it permanent.
7. Makes other non-substantive changes.

EXISTING LAW:

1. Establishes the Lanterman-Petris-Short Act (LPS) to end the inappropriate, indefinite, and involuntary commitment of persons with mental health disorders, developmental disabilities, and chronic alcoholism, as well as to safeguard a person’s rights, provide prompt evaluation and treatment, and provide services in the least restrictive setting appropriate to the needs of each person.
2. Defines “gravely disabled” as a condition in which a person, as a result of a mental disorder or impairment by chronic alcoholism, is unable to provide for their basic personal needs for food, clothing, or shelter, or a condition in which a person has been found mentally incompetent, as specified.
3. Defines “a danger to himself or herself or others, or gravely disabled” to also refer to the condition of being a danger to self or others, or gravely disabled, as a result of the use of controlled substances rather than by mental disorder.
4. Authorizes, a superior court under Laura’s Law (in participating counties) to order a person age 18 or older into AOT if the court finds by clear and convincing evidence that the person is suffering from a serious mental illness (SMI) and is unlikely to survive safely in the community without supervision.
5. Grants the person who is the subject of the AOT petition the right to be represented by counsel at all stages of an AOT proceeding.
6. Grants the person subject to an AOT petition the rights to:
   1. Adequate notice of the hearing;
   2. A copy of the court-ordered evaluation;
   3. Legal representation at all stages of the proceedings (by the public defender, if the person has not retained counsel); and,
   4. Be present at the hearing, to call or cross examine witnesses, and to appeal decisions.
7. Requires the court to dismiss the petition if the court finds that the person who is the subject of the petition does not meet the criteria for AOT.
8. Authorizes the court to order the person to receive AOT services, set forth in a written treatment plan as specified, for an initial period not to exceed six months.
9. Allows a county to use AOT if the board of supervisors has authorized its application, and has made a finding that any additional costs incurred by the AOT program will not result in reductions in the county’s current voluntary mental health programs.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, since AOT was approved by the Legislature in 2002, 24 counties have implemented it. This demonstration project is a community-based treatment program to assist individuals who, as a result of their SMI, are unable to access community mental health services voluntarily. The author points out that AOT is a less restrictive alternative to involuntary hospitalization, where an individual suffering from a SMI is contained for 72 hours if they have presented a danger to themselves or others. The current AOT process of opting in is an unnecessary barrier, evidenced by the fact that the program has been available to counties for the last 18 years and less than half have implemented it. Easing and expanding AOT implementation will ensure that those at highest risk for hospitalization can obtain the necessary treatment services to keep them in the community. While this bill encourages implementation of Laura’s Law statewide, it also allows counties to retain local control by allowing them to opt out through a resolution passed by the governing body that states the reasons for opting out and facts or circumstances used to make that decision.
2. BACKGROUND.
   1. LPS Act. The LPS Act was signed into law in 1967 and provides for involuntary commitment of individuals with SMI for varying lengths of time for the purpose of treatment and evaluation, provided certain requirements are met. Additionally, the LPS Act provides for LPS conservatorships, resulting in involuntary commitment for the purposes of treatment if an individual is found to meet the criteria of being a danger to themselves or others or is gravely disabled, as defined. The LPS Act provides for a conservator of the person, of the estate, or of both the person and the estate for a person who is gravely disabled as a result of a mental health disorder or impairment by chronic alcoholism or use of controlled substances. The person for whom such a conservatorship is sought has the right to demand a court or jury trial on the issue of whether they meet the gravely disabled requirement. The purpose of an LPS conservatorship is to provide individualized treatment, supervision, and placement for the gravely disabled person. Current law also deems a person as not being gravely disabled for purposes of a conservatorship if they can survive safely without involuntary detention with the help of responsible family, friends, or others who indicate they are both willing and able to help.
   2. AOT. As an alternative to an LPS Act conservatorship, current law provides for court-ordered outpatient treatment through Laura’s Law, or AOT, established by AB 1421 (Thomson), Chapter, 1017, Statutes of 2002. In counties opting to implement an AOT program, the court may order a person into an AOT program if the court finds that the person either meets existing involuntary commitment requirements under the LPS Act or the person meets non-involuntary commitment requirements, 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. AOT is available only in those counties in which the county board of supervisors, by resolution, authorizes its application (opts in) and makes a finding that no voluntary mental health program serving adults and no children’s mental health program may be reduced in order to implement the law. Laura’s Law has been extended three times, most recently by AB 59 (Waldron), Chapter 251, Statutes of 2016, with a sunset date of January 1, 2022.

Laura’s Law is designed to provide participating counties with tools for early intervention. It allows for family members, relatives, cohabitants, treatment providers, or peace officers to initiate the AOT process with a petition to the county behavioral health director or designee. The health director must then determine how to proceed. If the individual is found to meet the AOT eligibility requirements, an individual preliminary care plan is developed to meet that person’s needs. If this process results in the person voluntarily engaging with treatment, then the patient is deemed to no longer meet the criteria and the petition is no longer available. However, if the client declines their preliminary plan, then a public defender is assigned and the petition proceeds. It is then up to the judge to either grant or reject the AOT petition. If an AOT petition is approved by the court, any treatment ordered is valid for up to 180 days.

• 1. DHCS 2018-2019 Report on Laura’s Law: AOT Demonstration Project Act of 2002. Under Laura’s Law, DHCS is required to evaluate the effectiveness of the programs’ strategies to reduce a client’s risk for homelessness, hospitalizations and involvement with local law enforcement. All 19 counties that have Board of Supervisors approval to operate an AOT program submitted a report to DHCS. Six programs did not serve court-ordered individuals or are in the early stages of implementation. During the reporting period 914 individuals were referred to AOT. Of those, 686 participants responded to the initial invitation to voluntary services, and did not require a court petition or process. Counties report that the high level of acceptance without court petition (686) is due to a successful initial outreach and engagement. The remaining 228 individuals entered AOT as a result of court orders or settlements. The majority of participating individuals were Caucasian males between ages 26 and 49. In recent years, counties have reported serving more racial and gender diverse populations.

The most recent report reflects aggregate outcomes for 288 individuals from 13 counties that reported court-involved client data to DHCS. Among the results highlighted for the 2018-2019 period over the previous year were:

• • 1. Homelessness decreased by a 30% change;
    2. Hospitalization decreased by a 33% change;
    3. Contact with law enforcement decreased by a 43% change;
    4. Some individuals were able to secure employment or obtain volunteer positions;
    5. Victimization was reduced by an 85% change;
    6. Violent behavior decreased by a 64% change;
    7. Clients presenting with a co-occurring mental health and substance use disorder reduced substance use by a 34 percent change;
    8. Most counties reported improvements in clients social functioning and independent living skills; and,
    9. Client and family satisfaction surveys indicated satisfaction with AOT services.

1. SUPPORT. The California Psychiatric Association (CPA), sponsor of this bill, states that data derived from the AOT program demonstrates that a small subset of people with psychotic disorders - who have a history of revolving-door arrests and incarceration, revolving-door hospitalization or who have made threats of or carried out acts leading to grave bodily harm - benefit from intensive services under court supervision if the duration of those services is at least six months. The most obvious benefits lie in reduced arrests, hospitalization and incidents of violence. Of particular interest in this environment where policy makers and the public are focused on homelessness, AOT programs help patients maintain stable housing and increase adherence to medications which provide stability in the community that supports recovery. CPA states adding judges to the list of officials who can make referrals for an AOT investigation corrects an oversight in the original drafting of Laura’s Law. Given the significant extent to which individuals with psychotic disorders find themselves in court, judges - like law enforcement, treatment professionals, family, friends, and roommates - would be in a position to conclude that the person may be able to benefit from supervised, intensive treatment and should be able to refer those individuals for evaluation.
2. OPPOSE UNLESS AMENDED. Disability Rights California (DRC) has an oppose unless amended position and states that the bill should be amended to ensure that critical protections for participants remain. It points out that the bill is not clear when a group of counties choses to provide AOT, which county has the direct responsibility to assure the AOT services are provided and where they are provided. The bill should be amended to specify that there is a lead county that is responsible for the actual delivery of the services and making the statutory finding required by AOT..
3. OPPOSITION. The California Behavioral Health Planning Council (CBHPC) states in opposition that this bill would eliminate the requirement for a county Board of Supervisors to engage in a public deliberation to authorize the implementation of AOT, thus resulting in automatic acceptance. CBHPC points out that this bill also eliminates the requirement to ensure that the implementation of AOT will not result in the reduction of programs serving adults and children. Further, this bill would require a county to justify not implementing AOT. This means a local government would be required to explain and justify why they choose not to bypass an individual’s right to make their own decisions.
4. PREVIOUS LEGISLATION.
   1. AB 1193 (Eggman) of 2015, would have required a county that has not held a specified public hearing to elect to initiate Laura’s Law by January 1, 2017, to hold a hearing by January 1, 2018, and would have required the board of supervisors to consider both whether specified programs may be reduced as a result of participation and options for providing services other than court-ordered outpatient treatment. Would have extended the January 1, 2017, repeal date until January 1, 2022 and authorize a judge in a superior court’s mental health court, reentry court, or other collaborative justice court available for improving the mental health of the defendant, or a probate court, as specified, to request a petition for that order to be filed for a person who appears before the judge. AB 1193 was held in Assembly Appropriations.
   2. AB 59 extended the operation of the AOT program until January 1, 2022. Required the DHCS to submit its annual report to the Governor.
   3. AB 2266 (Waldron) of 2013, would have authorized the court to order a person to receive AOT for an initial period not to exceed 12 months. Would have required, in a county that elects to implement Laura’s Law, upon the release of a person from intensive treatment or post certification treatment, authorized the professional staff of the agency or facility that provided the treatment to evaluate whether the person meets the criteria for AOT. Would have authorized the professional staff to request the county mental health director to file a petition in the superior court for AOT if that person met the criteria. AB 2266 was held in the Assembly Judiciary Committee.
   4. SB 585 (Steinberg) Chapter 288, Statutes of 2013, specified that counties that elect to implement Laura’s Law may, to the extent permissible under state and federal laws, pay for those services using funds distributed to counties from the Mental Health Subaccount, the Mental Health Equity Subaccount, and the Vehicle License Collection Account of the Local Revenue Fund, funds from the Mental Health Account and the Behavioral Health Subaccount, within the Support Services Account of the Local Revenue Fund 2011, funds from the Mental Health Services Fund, and any other funds from which the Controller makes distributions to the counties, for those purposes.

REGISTERED SUPPORT / OPPOSITION:

Support

California Psychiatric Association (sponsor)

California Hospital Association

California Psychological Association

California Treatment Advocacy Coalition

Sutter Health

Tenet Healthcare Corporation

Opposition

Analysis Prepared by: Judith Babcock / HEALTH / (916) 319-2097