[Supervisor Antonovich] – The Board of Supervisors unanimously approved implementing Laura’s Law, a comprehensive, treatment-based approach for the mentally ill – many of whom are incapable of recognizing their illness, announced Supervisor Michael D. Antonovich.

“Laura’s Law has proven to significantly improve the lives of program of participants, decrease incarceration, reduce homelessness, and enhance public safety,” said Supervisor Antonovich. “It provides a humane alternative to the revolving door of mental hospitals, jails and the street.”

Supervisor Antonovich, who has worked tirelessly to support this effort, collaborated with former Assemblywoman Helen Thomson who authored the legislation that reformed the 1967 Lanterman-Petris-Short law.

Laura’s Law was named after Laura Wilcox who was killed by a delusional individual suffering with severe mental illness and patterned after New York State’s Kendra’s Law.  Initiated by Supervisor Antonovich, the County had previously adopted a successful pilot program which has resulted in a 78 percent reduction in incarcerations and a 77 percent reduction in hospitalizations among program participants.

Information presented to the Board of Supervisors in April 2014 by Marvin J. Southard, D.S.W., Director, Department of Mental Health:

Dr. Marvin Southard, Director of the County Department of Mental Health (DMH), appeared before CCJCC to provide an overview of plans for implementing Laura’s Law in Los Angeles County.

Assembly Bill (AB) 1421, passed and signed into law in 2002, established the Assisted Outpatient Treatment (AOT) Demonstration Project Act, which is known as Laura’s Law.

Laura’s Law allows Court-ordered mental health outpatient treatment under specific conditions. The purpose and intent of of the law is to identify certain adults with serious mental illness and treatment non-compliance who are at substantial risk for deterioration and/or detention under Welfare and Institutions Code (WIC) Section 5150, which could be mitigated by mandated acceptance of appropriate services.

Passage of the law, which was modeled on Kendra’s Law from New York State, involved substantial negotiations. Opponents of the law were concerned about civil liberties issues and didn’t want the law to be too aggressive in forcing unwilling people into treatment. Advocates of the law wished to ensure that unwilling individuals in need of treatment would receive it before reaching a WIC 5150 status or before a negative incident occurs. Family members of mentally ill individuals have been the among the strongest advocates.

Dr. Southard emphasized that Laura’s Law is meant to get mental health treatment to those individuals that are clearly in need of treatment, but are not currently a danger to themselves or others.

Counties may choose to implement the law if they enact outpatient commitment programs based on the measure. Los Angeles County was the first to partially implement the law. This was done through a pilot that was created to serve as a diversion program. The procedures allowed for an individual to choose to participate in lieu of facing the criminal charges against him or her.

While the pilot program was successful for a time, the incentive to participate began to wane as a result of decreases in the amount of time that inmates spent in jail for certain offenses. The program was then changed to an early release program for eligible individuals.

During the past four years, Nevada County in California implemented Laura’s Law as written. The Los Angeles County Board of Supervisors has requested that DMH determine the feasibility of similarly implementing the law in this county.

In response, DMH conducted a broad analysis of Laura’s Law and the legal, clinical, programmatic, and fiscal mechanisms required to proceed with full implementation.

A group of stakeholders formed by DMH has been meeting for the past year, and they are now close to finalizing a plan for implementation.

The analysis of Laura’s Law and the feasibility of full implementation was guided by DMH, expert consultation, and community feedback from a broad range of involved agencies. Both advocates and opponents of the law have provided input.

During the process of analysis and development of procedures, a team from Los Angeles County, including both advocates and opponents, as well as the DMH Medical Director, went to Nevada County to learn how the law is being implemented. Interviews were held with Judges and Court staff, as well as representatives from the District Attorney’s Office, Public Defender’s Office, County Counsel’s Office, and treatment specialists.

A notable finding from Nevada County is that 95% of the individuals participating in the program are doing so voluntarily. Only 5% of the participants have had a petition filed in Court to mandate their treatment.

Dr. Southard observed that this may lesson to some extent the concerns of civil liberties advocates as the program may be viewed less as a coercion treatment program and more as a very assertive engagement process.

This finding is also significant from a financing perspective in that the cost to the legal system is reduced with only 5% of the participating individuals requiring a petition being filed with the Court.

Dr. Southard reported that the Mental Health Services Act (MHSA) can fund treatment services under Laura’s Law, but it does not provide funding for legal or Court costs associated the law. He noted, however, that Nevada County officials have indicated that any additional judicial or legal costs resulting from the law are minimal. This is because the individuals being served would likely otherwise be in the system through conservatorships or criminal activity.

A programmatic component associated with DMH’s Laura’s Law implementation plan is the Assisted Outpatient Treatment (AOT) Team. This team will screen requests, conduct extensive outreach and engagement, develop petitions, and manage the Court processes to connect AOT enrollees with service providers.

DMH is proposing an initial pilot effort in which about 500 evaluations would be conducted per year, with 300 enrollees at any given time. There would also be 60 crisis residential beds.

In terms of treatment costs, DMH estimates that staffing for the AOT evaluation team will be about $2 milliion. The treatment slots would likely cost around $10 million. DMH’s proposal would fund the treatment components of this program as a pilot using one-time MHSA funding. If adopted at a public hearing of the Mental Health Commission in May, this funding proposal would ultimately be brought to the County Board of Supervisors for approval.

DMH’s operational process for implementing Laura’s Law as written is a 25-step procedural plan. The first ten steps entail engagement without involving the potential use of legal force. With Step 10, the AOT team meets with the individual and conducts an examination, which the person can consent to or not.

If after Step 10 the individual does not agree to voluntary treatment, the County Counsel’s Office is notified that a petition needs to be filed with the Court. Step 13 is the actual filing of the petition, and a hearing date is then set no later than five Court days after the filing.

Dr. Southard emphasized that Steps 13 through 19 (which is Court-ordered treatment) are only for those 5 percent of individuals who refuse voluntary treatment. And some of these individuals may chose to engage in voluntary treatment prior to Step 19.

Only specific individuals can issue a request for an individual to be placed in Court-ordered outpatient treatment under the terms of Laura’s Law. Persons with standing to request that this process take place include those who are living with the individual, a close family member, a hospital director, a peace officer, a probation officer, or a parole officer.

Los Angeles County Public Defender Ron Brown expressed concern that it may not be possible for the Public Defender’s Office to be prepared for a hearing in five Court days following the filing of the petition. Dr. Southard stated that this portion of the proposal, along with other procedures that raise issues of statutory compliance, have not been finalized and are still under discussion by the stakeholder workgroup.