Funding Laura's Law: Q&A
Can Mental Health Services Act Funds be used to fund Laura's Law?
Detailed answer as to why the myth persists. If you are a lawyer, and don't want to use Laura's Law, you could intentionally misread rules and regs to conclude whatever you want. There are two statements Mental Health Directors and Disability Advocates misread to make their point:
1. Stephen Mayberg Letter (05-05) http://www.dmh.ca.gov/dmhdocs/docs/letters05/05-05CSS.pdf
Programs funded under the Mental Health Services Act must be voluntary in nature. "
So mental health directors who don't want to implement Laura's Law use that sentence to justify the claim that MHSA funds can't be used. But the previous sentence in that same letter specifically said:
" Individuals accessing services funded by the Mental Health Services Act may have voluntary or involuntary legal status which shall not affect their ability to access the expanded services under this Act."
The directors who don't want to implement LL quote the second Mayberg sentence and ignore the first.
Taken together, the letter clearly meant to tell local mental health directors it is OK for the court to order someone into treatment and for that treatment to take place in the same programs where voluntary patients are also treated.
2. Laura's Law Legislation http://oceanpark.com/notes/ab1421.html
There was also language in the Laura's Law Legislation that said
Los Angeles County and Nevada county both use MHSA funds to implement Laura's Law.
Are there other references that support the use of MHSA funding for AB1421?
1. The DMH General Stakeholders Meetings #3 June 1, 2005 available at http://www.dmh.ca.gov/prop_63/mhsa/docs/meeting/05jun01/SummaryGenlStakeholdersJune13-3.pdf .
The relevant section starts on page 44 . They discuss in-depth the use of MHSA for AOT. Because it was explained in-depth, the document makes very clear that the intent and feedback was clearly that MHSA can be used to fund the treatment component (which can take place in programs that also serve voluntary patients).
2. MHSA Language
The repeatedly stated purpose of MHSA was to address "severe mental illness." Prevention funds were to target "programs effective in preventing mental illnesses from becoming severe" and "programs that have been successful in reducing the duration of untreated severe mental illness and assisting people in quickly regaining productive lives" in order to reduce "negative outcomes" like suicide, violence and incarceration. MHSA,Sec. 4 Pt.3.6(c),(d). Laura's Law does exactly that. It is clearly within the intent of MHSA.
More arguably, is MHSA Sections 3(d),5(a),7(b) which prohibits use of MHSA money even for "severe mental illness" where funding already exists. Since none exists for Laura's Law, it is within the perview of MHSA.
What other funding is available to implement Laura's Law?
Nevada and Los Angeles counties make use of numerous other sources to supplement Laura's Law. These include Medicaid, MediCal, Medicare, patient fees, private insurance and the savings from reduced hospitalization, arrest, trial, incarceration and homelessness. Other funding (for parolees) may be available via AB 118 which funds County Realignment Implementation Plans.
Do all voluntary consumers have to be given the same services those in Laura's Law receive?
Short Answer: No.
Detailed Answer: WIC 5348(b) says "A county that provides assisted outpatient treatment services pursuant to this article also shall offer the same services on a voluntary basis." But that does not mean anyone can demand AOT and automatically receive the service. It does mean you need to have non-court-ordered ACT services available However, you may still apply criteria, medical necessity, 'as resources are available', and all the other criteria regularly used to allocate resources to various patients (i.,e those who are conserved get different services from those who are not; those who have schizophrenia get different services from those who have learning disabilities, etc.). AB-1421 does not replace the concept of 'medical-necessity' and prohibit that from being applied using patient-by-patient individualized criteria.
Other funding issues concerning Laura's Law
Laura's Law does not 'entitle' anyone to services they shouldn't already be receiving. What it does do, is help prioritize the most severely ill. The only (small) incremental costs are the court costs.
Laura's Law saves counties money but does require Behavioral Health Departments to start prioritizing the most severely ill, rather than turning all those who refuse treatment over to police departments. For that reason, Behavioral Health officials often oppose Laura's Law while almost all criminal justice organizations support it. Nevada County found the law saves $1.81- $2.52 for every dollar spent via reduced homelessness, arrest, incarceration, and other costs. Enacting Laura's Law requires Supervisors to override the objections of the Behavioral Health Departments in order to save the county money (and help people with mental illness). Both the mental health director (Heggarty) and Judge (Anderson) in NV County (a rural county) have become huge supporters after initially being skeptics.
Behavioral Health departments and budgets should, but don't usually, prioritize the most seriously ill. County Behavioral Health Departments are engaged in unmitigated mission-creep that sends the most severely ill to the end of the line for services, while those with "issues" go to the front. They regularly expand programs that do not serve people with seriously mentally ill, but claim they don't have money to expand services to those who are seriously mentally ill. Instead of focusing on delivering services to the small group of most severely ill (their true mission), most counties have decided to "serve" the largest number of people. To do this they have defined poverty, bad grades, unhappy marriages, being gay, having too small a home, and other social and social service issues as factors that 'cause' mental illness and then divert funds meant for serious mental illness to these issues. There will never be enough money for Behavioral Health Departments to cure poverty, bad grades, unhappy marriages, poor housing etc., and it is ludicrous to say that these programs must be funded by mental health programs while the severely mentally ill have to wait.Conversely, they have defined anything that makes someone happier as "improving mental health" and therefore worthy of funding.
In almost every California county the issue is not lack of funding, it is the fact that those funds are being diverted elsewhere. County Behavioral Departments simply offload the most seriously ill to the police departments rather than enact programs to help those who are too sick to recognize their need for treatment. Laura's Law does not require additional funds. It simply requires Behavioral Health Departments (and to end mission-creep and start focusing on the sickest, those usually turned over to police.
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The information on Mental Illness Policy Org. is not legal advice or medical advice. Do not rely on it. Discuss with your lawyer or medical doctor. Mental Illness Policy Org was founded in February 2011 and in order to maintain independence does not accept any donations from companies in the health care industry or government. That makes us dependent on the generosity of people who care about these issues. If you can support our work, please send a tax-deductible donation to Mental Illness Policy Org., 50 East 129 St., Suite PH7, New York, NY 10035. Thank you. Contact firstname.lastname@example.org Contact Mary Ann Bernard, of counsel. Contact DJ Jaffe, founder http://mentalillnesspolicy.org.