MYTHS ABOUT LAURA’S LAW (AB1421)
Prepared by Mental Illness Policy Org
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MYTH: If there were more voluntary services, Laura’s Law would not be needed.
REALITY: Voluntary programs and AOT currently serve two mutually exclusive populations. Voluntary programs serve those who ‘voluntarily’ accept services. Laura’s Law by definition is for those won’t accept voluntary services. Laura’s Law does not preclude anyone from accepting voluntary services.
MYTH: Laura's Law increases the use of force.
REALITY: Laura's Law reduces the use of force by reducing the need for inpatient commitment and incarceration. It is not a new way to use force, it is a new way to see maximum force does not have to be used.
MYTH: Assisted Treatment forces people to take medications.
REALITY: There is no provision for forced medication in Laura’s Law.
MYTH: Laura's Law does not work
REALITY:In Nevada County, Laura's Law reduced hospitalization, 46.7%; Incarceration, 65.1%; Homelessness, 61.9%; and Emergency Contacts 33.1%. In Los Angeles, Laura's Law reduced incarceration 78 %; reduced hospitalization 86%; and reduced hospitalization 77%. These results are consistent with NY and the other states.
MYTH: Laura's Law is expensive
REALITY: Laura's Law saved Nevada County $213,300 in incarceration costs and $75,000 in hospital costs.
MYTH: Existing community programs serve the same people who would be served by Laura’s Law
REALITY: Laura’s Law is the only community program that serves people who refuse treatment. AOT cut costs in NY 50% by reducing inpatient care and incarceration.
MYTH: Laura’s Law does not confer any benefits beyond those of LPS (5150)
REALITY: LPS only allows for inpatient commitment. Laura’s Law allows for court ordered outpatient treatment, a less restrictive, less expensive, more humane alternative.
MYTH: AOT will lead to a roundup of mentally ill individuals who will be forced into treatment.
REALITY: Laura’s Law’s narrowly-focused eligibility criteria, stringent multi-layer administrative requirements, independent judicial review and strong due process protections protect against misuse. Nevada County and Orange County estimate less than .003% of the population would be allowed into the program. This is consistent with NYS findings.
MYTH: AOT is unconstitutional and infringes on civil liberties.
REALITY: AOT has survived constitutional challenges in multiple states. A 2009 NYS study found:
“(I)t is now well settled that Kendra’s Law is in all respects a constitutional exercise of the states police power, and its parens patriae power. Further, the removal provisions of the law have withstood constitutional scrutiny.
AOT also cuts the need for incarceration, restraints, and involuntary inpatient commitment, allowing individuals to retain more liberties.
MYTH: Laura’s Law will frighten consumers away from seeking voluntary services
REALITY: A study in Psychiatric News of involuntarily treated discharged psychiatric patients found that 60 percent retrospectively favored having been treated against their will. A 2005 NYS study of consumers in their version of Laura’s Law found:
- 75% reported that AOT helped them gain control over their lives;
- 81% said that AOT helped them to get and stay well;
- 90% said AOT made them more likely to keep appointments and take medication.
The 2009 independent study found:
“On the whole, AOT recipients and non-AOT recipients report remarkably similar attitudes and treatment experiences. That is, despite being under a court order to participate in treatment, current AOT recipients feel neither more positive nor more negative about their mental health treatment experiences than comparable individuals who are not under AOT.”
MYTH: Assisted Outpatient Treatment is not racially neutral.
REALITY: A 2009 NYS study researched this issue and found:
“(N)o evidence that the AOT Program is disproportionately selecting African Americans for court orders, nor is there evidence of a disproportionate effect on other minority populations. Our interviews with key stakeholders across the state corroborate these findings.”
MYTH: There is wide opposition to Laura’s Law
REALITY: Laura’s Law has wide support from constituencies as diverse as the National Alliance on Mental Illness, National Sheriff’s Association, California Psychiatric Association, National Crime Prevention Council and consumers in AOT.
MYTH: Mental Health Commissioners support Laura’s Law
REALITY: Many (not all) mental health commissioners oppose Laura’s Law because they fear losing the ability to cherry-pick the easiest to treat for admission to their programs. Currently mental health policy is to send the most severely ill individuals to shelters and jails and use the ‘savings’ to fund services to a larger number of people (“mission-creep”)
MYTH: Prop 63/Mental Health Services Act money can not be used to fund Laura’s Law
REALITY: Both Los Angeles and Nevada County use MHSA money (plus Medicare, Medicaid, private insurance, and patient fees) to fund Laura’s Law.
MYTH: Voluntary programs have to be cut to fund Laura’s Law
REALITY: Per California Department of Mental Health, voluntary programs that provide services (ex., medication, case management, housing, CSS, etc.) may also serve individuals under court orders. There is no need to close these programs, merely open them up to people under court orders.
Myth: Laura’s Law is expensive.
REALITY: Nevada County found they saved $1.81 for every $1.00 invested. The Mental Health Director found it decreases hospitalizations, length of hospitalizations, and use of 911, arrest, trial, incarceration and parole; and can be funded with existing sources
CALIFORNIA NEEDS LAURA'S LAW TO SAVE LIVES, PROTECT THE PUBLIC, AND BETTER USE LIMITED RESOURCES
Misunderstandings about Laura’s Law
Some people argue that because Laura’s Law does not forcibly medicate people it is not useful.
• One of the goals of Laura’s Law is to eliminate the need for forced medication. q Laura’s Law offers “coordination and access to medications,” as a component of the treatment plan. CALIF. WELF.& INST. CODE § 5348(2)(B).
o The treatment plan is included in the assisted outpatient treatment (AOT) order issued by the judge. However, AOT orders cannot authorize forced medication. There are other laws and procedures (Riese hearings) already on the books that dictate how and when there can be medication over objection. If someone does not follow their AOT treatment plan, those procedures could be invoked.
* Forcible medication is not needed for Laura’s Law to succeed.
o Under Kendra’s Law, New York’s law for assisted outpatient treatment, medication adherence among participants increased by 103%.
o Laura’s Law mirrors New York’s Kendra’s Law with respect to medication. Medication can be included in the treatment plan, but there is a separate law and hearing for forced medication if it is needed.
o Although Laura’s Law does not allow for medication over objection, it has not proved to be a hindrance to the effectiveness of New York’s law or other similar laws.
* Laura’s Law is not about the physical act of forcibly medicating. Forced medication can---and should---only happen in a licensed hospital. It is about prioritizing highest-need patients and the monitoring and case management that accompanies those patients under the law so that they have the support to stay on their treatment plan, which may include medication.
TREATMENT PLAN PARTICIPATION
Some argue that individuals who meet the criteria under Laura’s Law have no opportunity to participate in their treatment plan.
* First and foremost, Laura’s Law only applies to those individuals who a court has determined are unable to access community treatment voluntarily. CALIF. WELF. & INST. CODE § 5345 (A) (8).
o One of the requirements under the law is that the individual has been offered an opportunity to voluntarily “participate in a treatment plan ... and the person continues to fail to engage in treatment.” CALIF. WELF.& INST. CODE § 5346(a)(5)
o Where someone does meet the criteria under the law, Laura’s Law provides that individuals “participate in the development” of the treatment plan. CALIF. WELF.& INST. CODE § 5348(3)
VOLUNTARY SERVICES ARE INSUFFICIENT
Some claim that if we better utilized existing voluntary community treatment, we wouldn’t need Laura’s Law.
* Laura’s Law is not an alternative to community treatment; it is a way to see that community treatment is available to help those who lack insight into their illness (anosognosia) and have been unable to utilize other community services.
o It is often claimed that "if you make the psychiatric services attractive enough and culturally relevant, then individuals with serious mental illnesses will utilize them." This ignores individuals suffering from lack of awareness of their illness, which is roughly the case in about 40-50% of people with bipolar disorder or schizophrenia.
o Recent studies have shown that lack of insight is the single most significant reason why individuals with schizophrenia and bipolar disorder fail to take their medication.
o Individuals lacking insight will not voluntarily utilize psychiatric services, no matter how attractive those services are, because they do not believe that they have an illness.
o Laura’s Law allows individuals who would otherwise be unable to utilize community services another avenue to get help before a crisis (i.e., re-hospitalized or jail).
Some mistakenly argue that Laura’s Law can only be used in a county that has fully funded voluntary services.
* In no place does Laura’s Law require a system have “fully funded voluntary services.” What the law requires is that:
o “Any county that provides assisted outpatient treatment services pursuant to [Laura’s Law] also shall offer the same services on a voluntary basis.” CALIF. WELF.& INST. CODE § 5348(5)(b)
o Laura’s Law is “operative in those counties in which the county board of supervisors, by resolution, authorizes its application and makes a finding that no voluntary mental health program serving adults, and no children's mental health program, may be reduced as a result of the implementation of [Laura’s Law].”CALIF. WELF.& INST. CODE § 5349.
* While a county implementing Laura’s Law cannot specifically close a voluntary program to implement Laura’s Law, it can make use of existing services for Laura’s Law recipients.
o Laura’s Law will make more effective use of existing resources.
o One such source is California’s Mental Health Services Act (MHSA, or Prop. 63).
o Laura’s Law requires the same types of services that MHSA was designed to fund. In fact, Nevada County uses MHSA funds for Laura’s Law implementation.
o Additionally, most people who qualify for Laura’s Law will also qualify for medi-cal and federal support such as SSI as well as realignment mental health services.
Laura’s Law recipients are to receive services that would help them make appropriate use of those benefits, including applying for them. CALIF. WELF.& INST. CODE §5348 (3)
* Prop. 63, MHSA, approved by California voters after passage of Laura’s Law, requires that its funds be used in a nondiscriminatory manner. MHSA programs must not discriminate against AOT recipients. MHSA funds can pay for mental health services provided by Laura’s Law.
Some argue that if any cuts are made to the mental health system, Laura’s Law cannot be implemented.
* In no place does AB 1421, Laura’s Law, state that the law cannot be implemented if cuts are made to the mental health system. CALIF. WELF.& INST. CODE § 5349
Some argue that Laura’s Law will take voluntary services away from clients. q Laura’s Law will not reduce voluntary services available for those able to access them.
o Provisions of the authorizing legislation, AB 1421, require that any county providing assisted outpatient treatment must make a finding that no voluntary mental health program will be reduced as a result of implementing Laura’s Law. CALIF. WELF.& INST. CODE § 5349.
o Laura’s Law is a less restrictive alternative to hospitalization and provides individuals opportunity to participate in his or her own treatment planning. CALIF. WELF.& INST. CODE § 5346(a)(5)
Some argue that it is too expensive to implement Laura’s Law.
In fact, we cannot afford not to implement Laura’s Law. We are inefficiently using our mental health system resources right now. We are paying for individuals to be repeatedly hospitalized and/or sent to emergency rooms. These are the most costly types of services and do not provide long term community stabilization or allow the individual to receive the support and services they need to be in the least restrictive environment as is required by Laura’s Law. CALIF. WELF.& INST. CODE §5346 (B).
* AOT is designed to reduce incidents of hospitalization and crises, while providing long-term engagement and stabilization in the community. It costs approximately $1200 per day to treat an individual in a California psychiatric hospital. By contrast, a comprehensive package of the most intensive community services for the same individual costs on average $43.84 per day.
Some claim that Laura’s Law is unnecessary because the county already uses conservatorships.
* Laura’s Law and conservatorships are two very different tools that can each be used to help those with severe mental illnesses. A mental health (LPS) conservatorship makes one adult (called the conservator) responsible for a seriously mentally ill adult (called the conservatee). Laura’s Law is a court order directing a severely mentally ill person who meets strict criteria to adhere to a treatment plan as a condition of remaining in the community.
* AOT is a less restrictive option than conservatorship. Assisted outpatient treatment is designed to create a partnership and collaboration between the mental health professionals and the client in determining the treatment plan and service engagement. However, conservatorships appoint a substitute decision-maker, the conservator, who is legally entitled and responsible to make decisions about all treatment and any aspects of daily living as authorized by the court order.
* Additionally, there is a difference in who qualifies for a conservatorship versus AOT because the legal standards are different.
o For conservatorship: the Court will not let you establish an LPS conservatorship unless it finds beyond a reasonable doubt, that the mentally ill person is gravely disabled. Gravely disabled means that, because of a mental disorder, the person cannot take care of his/her basic, personal needs for food, clothing, or shelter. If the system or another adult can pay or provide for the person’s basic needs, the Court cannot find the person to be gravely disabled. A person who has been dangerous to self or others does not qualify for a conservatorship under California Law. CALIF. WELF.& INST. CODE §5350.
o For assisted outpatient treatment: A person may be placed in assisted outpatient treatment only if, after a hearing, a court finds that their condition is likely to substantially deteriorate, unlikely to survive safely in community without supervision, history of noncompliance which includes two hospitalizations in past 36 months or act/threat/attempt of violence to self/others in 48 months immediately preceding petition filing, likely needs to prevent meeting inpatient standard, and likely to benefit from assisted outpatient treatment. CALIF. WELF.& INST. CODE § 5346(a)
FORENSIC BEHAVIORAL HEALTH COURT
Some argue that Laura’s Law is not needed because counties already have forensic behavioral health court
* Unlike the behavioral health court, Laura’s Law does not require criminal action before an individual can be helped.