Judge Anderson on how Laura's Law works in Nevada County California to help mentally ill
Lynne Gibbs notes from Judge Anderson's recent presentation to the Ventura County Laura's Law workgroup.
It was enlightening, and I learned a lot. (Ask Judge Anderson to present to your county)
VCBH Health Workgroup on Laura's Law, January 2015. Judge Anderson (Nevada County "NC") Presentation.
-Brief history of Laura's Law (LL).
-Fidelity to the process is essential – treating the client with respect and soliciting his/her participation.
-Nevada County (NC) was a good "beta site" for LL, as funding is so scarce. A return of $1.81 for every $1 spent.
-Catching the person before they're 5150d or arrested.
-Families have a voice.
-ACT is essential, as persons under LL have the same wraparound services ACT provides. In NC, the only difference is that some clients are court ordered into ACT, and others are not. No one knows the difference.
-Almost all under LL take medications voluntarily.
-Court-ordered treatment under LL is not unique. It is common in other areas, such as conservatorship and probation, etc.
-Anderson focused on the process:
1) Once a petition is filed, a mental health professional repeatedly seekout the person where he/she is. Over half accept services at this intervention stage. This alone justifies the cost of the program.
2) A mental health evaluation takes place.
3) County counsel files a petition to the court. It includes a proposed treatment plan.
4) Clients are represented by counsel, and are served notice. Etc. All rights protected.
5) The LL petition is heard. Each hearing takes approx. 45 minutes. In NC, T-F, 4 pm-
6) -If LL is approved, a status hearing takes place within 60 days – approx. 5 mins. The judge has usually already had one or more "check-ins" with the client, where the proposed treatment plan is reviewed. It is negotiated with the client, and only those elements the client agrees with are included. (In one case, the client insisted on living in her car, but agreed to stay in a shelter 3 times a week). Clients feel empowered. Judge makes it clear the client should report to the court if the treatment professional is not discharging the plan as defined. The case manager is called a "Personal Services Coordinator." Judge Anderson said "I didn't understand the black robe effect, until I did this."
7) If there is no agreement, a contested hearing takes place, and the PD (public defender) advocates for the client. If successful, treatment is ordered. If the client does not comply with treatment, he/she can be taken to the hospital for an assessment. The client cannot be taken to jail. Pending criminal cases are still honored, however LL clients have not been criminalized, as there is no benefit. In one case, a client served his previously ordered jail term, but only because the judge didn't know he was doing it.
-Who is in the courtroom? A bailiff. A recorder for the first session only.
-Case managers are key to the success of LL. In all but 1-2 cases, clients have continued treatment voluntarily after the 6 mo. LL term expires.
-How are such cost savings achieved when clients previously didn't receive treatment, and now are? Because institutionalization, at huge cost, is avoided.
-How were barriers broken down in NC? The new mental health director came on board, and MHSA began funding.
-This is another instance in which the collaborative court model works. The atmosphere is the same. With continuing exposure to the success of the collaborative court model, it is more and more accepted.
-Many clients have been conserved in the past. Rather than file again, a LL petition can be filed instead. Someone under conservatorship can file for LL instead as a less restrictive option, and if he/she meets the criteria, he/she is moved to LL.
-Someone recently released from jail can have a LL petition filed, instead of being re-incarcerated.
-"Honesty is the best tool in working with these persons."
-Consistent with other experience, there are approx. 5 cases for every 100,000 in population.
-Staff to client ratio of 1 to 10.
-Why have other counties been so slow to adopt LL, if it's so successful? "It boggles my mind." "It's saved so much money everyplace it's been implemented." Judge Anderson ascribed this to bureaucratic resistance. As an example, the court tends to resist new collaborative court programs, only because it's yet one more program to implement. But, "implementing AOT is so simple." And, it saves court time, as more time is required for criminal hearings and conservatorship hearings.
-Are some clients able to move home and live with their families under LL? "Yes. This is a hallmark of the program."