Four New Bills Could Help Mentally Ill Gain Access To Laura’s Law (2/23/13. Updated 8/25/13)

Update 8/25/13 SB 585 below passed California Assembly and went to Governor Brown for signature
Update (6/25/13) In Feb. 2013 bills were introduced that would have removed the hurdles Senator Darrell Steinberg created to prevent use of Laura’s Law. One he introduced himself. However, subsequent to February, Steinberg killed SB 664 (below), added poison pill provisions to his own bill and introduced a new bill (SB 364) that make treating people with serious mental illness more difficult and puts families at risk. Following is what we wrote before this major backtracking:

They clarify MHSA funds can be used for Laura’s Law and make other improvements

Following is our preliminary analysis.

SB 585 (Steinberg/Correa) clarifies Mental Health Services Act (MHSA/ Prop 63) funds may be used by counties to implement Laura’s Law.

SB 664 (Yee/ Wolk) states counties may implement Laura’s Law without first forcing County Boards of Supervisors to undertake a special vote or represent that they they will treat everyone else in the county before they treat those who need Laura’s Law. (Unfortunately it allows counties to limit the number of individuals in Laura’s Law.)

AB1265 (Conway along with Achadjian/Beth Gaines/Gorel/ Hagman/Harkey/ Morrell) allows individuals under Laura’s Law to receive treatment for up to one year (instead of the six month max previously allowed). It would also, smartly, require facilities discharging involuntarily committed patients first evaluate them to see if they could benefit from Laura’s Law. They would then notify county officials so they can file a Laura’s Law petition.

AB 1367 (Mansoor along with Achadjian/ Alle/ Conway/Beth Gaines/Gorel/ Hagma/ Harkey/ Morrell). Like SB 585 (but using different language ) it clarifies that MHSA funds may be used to implement Laura’s Law. It also makes changes (not improvements) to Prevention and Early Intervention (PEI) funds.

Laura’s Law Background

Before Laura’s Law, there was no way to help individuals with serious mental illness who refused treatment until after they became danger to self or others. Rather than preventing violence, the law required it. Laura’s Law helps a subset who already have a history of violence or incarceration. After extensive due process, it allows courts to order them to stay in treatment as a condition of living in the community. It has reduced violence, dangerousness, incarceration, hospitalization and suicide in New York and the two California Counties that use it.

MHSA/Prop 63 Background

In 2004, Californians enacted Proposition 63, a 1% tax on millionaires to create to improve services for people with “serious” mental illness. It has generated about $8 billion. California suddenly became the only state in America with enough money to dramatically improve services for people with serious mental illness.

Problem: Once MHSA was passed the mental ‘health’ industry that lobbied for it, immediately abandoned their commitment to spend the money on the most seriously ill. They diverted MHSA funds to hip-hop car washes, wilderness adventure tours and massage chairs for government employees. The State Auditor is investigating. Millions are being used to prevent implementation of Laura’s Law. $3 million went to Disability Rights California (DRC); $3 million went to a PR firm; and millions more go to groups that are opposed to Laura’s Law..

As a result, Laura’s Law, the most successful program for the most seriously ill remains largely unused.

SB 585

SB 585 clarifies MHSA funds may be used for Laura’s Law. This would seem to be unnecessary as two counties already use MHSA funds for Laura’s Law and three separate legal analyses ( MIPO, MIPO/CA, and TAC) show MHSA funds can and should be used for Laura’s Law. But DRC has threatened to sue counties that use MHSA for Laura’s Law. By clarifying MHSA can be used for Laura’s Law, Senator Steinberg and Correa are freeing counties from this threat. Note that AB 1367 (below) also clarifies that MHSA can be used for Laura’s Law, but uses different language. There may be a problem with SB 585. It may only allow counties to use MHSA funds for Laura’s LAw if Laura’s Law was included in county mental health plans. Those plans are largely made up by representatives of mental ‘health’ programs that oppose Laura’s Law, so it is not likely they will include Laura’s Law in the plans. The County Behavioral Health Director can override the planning board and Board of Supervisors can override the Behavioral Health Director but we don’t know if that will happen. The insertion of that needless provision iis another example of Senator Steinberg siding with mental health industry, rather than those with serious mental illness.

SB 664

As part of their efforts to prevent Laura’s Law from being used, DRC convinced the legislature to insert several administrative burdens that inhibit it’s use. One of these provisions was that county boards of supervisors must formally vote to implement Laura’s Law. A formal vote by the board of supervisors is not needed for any other mental health service. Boards of supervisors have other ways to oversee county behavioral health departments, for example, by hiring and firing directors. SB 664 removes the requirement of the board of supervisors to have a separate vote on Laura’s Law.

Another provision of Laura’s Law requires counties to offer services to individuals with mental illness on a voluntary basis before attempting to put them under court order. DRC, MHSOAC Commissioners and others in the mental health industry told counties (erroneously) that the provision requires behavioral health departments to offer all mental health services to everyone in the county before they can offer mental ‘illness’ services to those who need Laura’s Law. (See page 17) The effect of this interpretation was to send the most seriously ill to the end of the line for services, rather than the front. The exact opposite of what voters wanted. AB 664 removes the confusing provision, since other Laura’s Law provisions (ex. 5346(a)(5)) make it clear that Laura’s Law may only be offered if the individual refuses voluntary treatment.

Unfortunately, SB 664 also authorizes counties to limit the number of persons to whom it provides services under Laura’s Law. If a county must limit services, they should limit services to the least seriously ill, not the most seriously ill. That approach puts patients and public at risk. We also think it may violate Olmstead, which requires states to deliver services in the most integrated setting.

AB 1265

AB 1265 improves Laura’s Law to save taxpayers money and to improve it’s efficacy. One provision allows courts to issue treatment orders that last up to one-year, rather than just six months. This saves counties money because they don’t have to go back to court after six months to have a treatment order renewed. Research in New York, found that the beneficial effect of being put under court order lasted after the order ended, as long as the patient was under the order for at least seven months. AB 1265 allows counties to do that.

Many patients who are danger to self or others are released from involuntary treatment once stabilized and free to go off treatment again. Prior to release, AB 1265 requires facilities to evaluate people who have been involuntarily treated to see if they need Laura’s Law to stay healthy and safe. If they think Laura’s Law could help, the hospital lets the county know so they can take action if needed. This is a very smart provision and was recently implemented in New York. These provisions should also apply to persons with mental illness who are being discharged from jails and prisons.

There may be a small technical problem with AB 1265, as it is only effective in counties that elect to implement Laura’s Law. If SB 664 becomes law, counties will no longer need to ‘elect’ to implement Laura’s Law, so presumably this bill would need some tweaking.

AB 1367

Like SB 585, but using different language, it clarifies that MHSA funds may be used to serve those enrolled in Laura’s Law.

It also makes modifications to the Prevention and Early Intervention (PEI) provisions of MHSA. PEI programs represent 20% of total MHSA funds and are the ones most frequently diverted to programs that do not help people with serious mental illness.

AB 1367 makes changes, but not improvements. It adds school districts, county offices of education, and charter schools as organizations that can receive PEI funds and specifies they can use the funds to identify students with mental health issues that may cause them to become danger to self or others. While it sounds good, identification of who needs help, has never been an issue. Anyone can see who needs help by walking down the streets and seeing who is psychotic and eating out of a dumpster; or standing outside a jail or hospital and see who is being released without treatment. Parents of those with mental illness who make headlines like Aaron Bassler (Fort Bragg) Ian Stawicki (Seattle Cafe), Kelly Thomas (Fullerton), Scott Dekraii (Seal Beach) and Sunni Jackson (Paso Robles), were all identified by their parents as needing treatment, but refused treatment by the mental health system. The police were there, the parents were there, but the mental health system was MIA.

None of the bills remove the sunset in Laura’s Law or address waste, fraud, and Insider Dealing in MHSA Funds. But all the bills contain good provisions and all the sponsors deserve our thanks. Whether they pass or not, could be a function of how much more MHSA funds are allocated to opposing these important initiatives.