Laura's Law, Mental Health Services Act (MHSA) and Serious Mental Illness in California
California State Auditor, again, finds “significant issues with how people with serious mental illnesses are cared for.” Key findings for people on conservatorship include:
“[L]imited treatment options due to the level of care the require…”
“Counties cannot access state-managed data … that could better inform decisions about care.”
“[O]nly 19 counties [33%] have adopted assisted outpatient treatment [Laura’s Law], which allows individuals to continue to receive care in their communities.”
“Although the state invest billions of dollars each year in the county-based mental health system, stakeholders cannot assess the impact these funds make on people’s lives.”
Read the Auditor’s Fact Sheet and complete Report.
Introduction
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Laura’s Law (Assisted Outpatient Treatment/AOT) and the Mental Health Services Act (MHSA) were both enacted to help the most seriously mentally ill. MHSA funds may be used for individuals in Laura’s Law, but mental health commissioners divert MHSA funds to the highest-functioning, and tell their Boards of Supervisors that they need incremental funds for those in Laura’s Law. This is discrimination against the seriously ill that MHSA was intended for. It explains why the seriously mentally ill in California are sent to shelters, jails, prisons and morgues rather than treatment in spite of the over $1.5 billion raised annually by MHSA. This site details Laura’s Law and MHSA and provides county by county information.
Intro to Laura’s Law
“Laura’s Law” is California’s version of Assisted Outpatient Treatment (AOT). It allows courts–after extensive due process, to order a small subset of people with serious mental illness who have been noncompliant with treatment and meet very narrowly defined criteria to accept treatment as a condition of living in the community. It also allows courts to order the recalcitrant mental health system to provide treatment. National research shows AOT works. Research in California shows it works. For example, Nevada County found:
- Hospitalization was reduced 46%;
- Incarceration reduced 65%;
- Homelessness reduced 61%;
- Emergency Contacts reduced 44%;
- Saved of $1.81-$2.52 for every dollar spent as result of reducing incarceration, arrest, and hospitalization.
17 counties implemented Laura’s Law as of 2/2017: Alameda, Contra Costa, El Dorado, Kern, Los Angeles, Mendocino, Nevada, Orange, Placer, San Diego, San Francisco, San Luis Obispo, San Mateo, Shasta, Santa Barbara, Ventura, Yolo
Political summary (including eligibility numbers)
Intro to MHSA
In 2004, California voters altruistically passed Proposition 63 (Mental Health Services Act (MHSA), a 1% tax on millionaires to help people with “severe mental illness” and to “prevent mental illness from becoming severe and disabling.” It raises over $1.5 billion annually and is an important program that does a lot of good. But mental health commissioners, CalMHSA and the oversight commission (MHSOAC) encouraged social services programs that have little to do with serious mental illness to masquerade as mental illness programs to enable them to claim MHSA funds. This leads to programs that fail to serve the seriously ill being showered with funds while those that do serve the seriously ill go unfunded. Our report, MHSA: A Bait and Switch found this unmitigated mission-creep, insider dealing, and lack of oversight, found
- $1-2 Billion of Prevention and Early Intervention (PEI) Funds was intentionally diverted to social service programs masquerading as mental illness programs or falsely claim they prevent serious mental illness.
- $2.5 billion of the “Full Service Partnership (FSP) funds were spent without oversight of whether the recipients had schizophrenia, bipolar disorder, or the other serious mental illnesses that made them eligible for MHSA funds.
Why is public in dark about this? $11 million in MHSA funds went to hire a P.R. firm that works to convince the media that all is well. They continually issue press releases and call editorial boards to extol the virtues of the program. County mental health directors and recipients of the diverted funds benefit from the status quo and therefore defend it. Governor Brown, former state Senator Steinberg and his successors appointed recipients of MHSA funds to sit on the Oversight Commission. As a result of this conflict, MHSA is being overseen by beneficiaries of funds and cheerleaders for mission creep, rather than stewards of the public purse. This is not what voters wanted to happen or were told would happen. Money is not the issue. Leadership is.
Laura’s Law Fact Sheets
Political summary (including eligibility numbers)
Results in two sample California counties
Studies show AOT works throughout country (PDF)
Laura’s Law criminal justice fact sheet (PDF)
List of known supporters (PDF version here)
California Assoc of Psychiatric Technicians endorses
Myths about Laura’s Law (PDF version here)
Laura’s Law Funding Addressed
SB 585 Allows MHSA funds for Laura’s Law
2016 DCHS Letter OKs MHSA for Laura’s Law
CCR Reg. §3400 Counties can’t refuse services to Laura’s Law participants
DMH approves counties using MHSA funds for AOT
MHSA can be used for AOT – legal analysis – MIPO
MHSA funds can be used to fund AOT – legal analysis – TAC
MHSA funds can be used for Laura’s Law – legal analysis – MIPO (CA)
Ideas to clarify Laura’s Law’s interaction with MHSA
MHSA funds misused to stop Laura’s Law
Savings
Laura’s Law could save California $19 million
AOT saves Nevada County money – presentation
ER expensive way to treat mental illness – LA Times, 2011
Laura’s Law Source Documents
Presentations
Judge Tom Anderson encourages all counties to adopt AOT
Behavioral Health Dir.: Nevada County’s success with Laura’s Law
Laura’s Law presentation – Drs. Quanbeck & Tsai
Laura’s Law works says Judge Anderson
Laura’s Law helps recover – Tsai, Psych. Journal
Disability Advocates CA opposes Laura’s Law (also legal opinion)
Other California Issues
Goverment Reports
SAMHSA Report on California’s Behavioral Health System (2017)
LPS
State Auditor’s Report Shows Lanterman Act Reform is Badly Needed: Our laws aren’t working to help the sickest people on our streets (Bernard Op-Ed) – 09/28/2020
State Auditor’s report on LPS conservatorships – 07/28/2020
LPS Task Force Report (2012)
Linnea Lomax and the need to reform LPS Act
Hospital bed shortage & housing shortage
Two moms travel the state to find Housing That Heals. Their Report. – 05/2020
Severe psychiatric hospital bed shortage data
Stephen Seager on NAPA State Hospital – Video
Psychiatric beds empty. Prisoners wait for care – 5/15, LA Times
Future of psychiatric services in California – Torrey
Criminal Justice
MHSA Criminal Justice Report (12/2017)
Law enforcement interaction with persons suffering from a mental illness, “A legal perspective” – from the California Crisis Intervention Training Association (8/2016)
Untreated mentally ill drain CA law enforcement (Police Survey) (PDF version)
CA can comply with Brown v. Plata by treating mentally ill parolees
Involuntary medication of incompetent to stand trial (2011 bill)
Selected Laura’s Law op-eds and articles
Helen Thomas (Laura’s Law author) on renewal – 2016
San Don’t blame police for CA mental health system failures – 2015, SD UT
NBC on Teresa Pasquini’s fight for better care, 2015
Don’t delay Laura’s Law – SF Chron, 2013
Op-ed, editorial, article SF Chronicle – Jacobs, 2012
Seal Beach salon shooting shows need for Laura’s Law – 2011, HuffPo
Laura’s Law – 10 year anniversary of her death – 2011, HuffPo
Mentally ill Kelly Thomas dies in police encounter – 2011, HuffPo
Why California needs Laura’s Law – 2011, Daily Journal
Ignore mentally ill and court disaster – Tsai SF Chron, 2011
Will California Adopt Laura’s Law – Time Mag., 2011
Student video explains Laura’s Law
MHSA Fact Sheets
Breaking News: 2019 San Francisco report finds Laura’s Law a success.
First Little Hoover Commission finds problems
Second Little Hoover Commission finds lack of oversight
California State Auditor finds lack of oversight
California Finance Department finds problems
MHSA “Bait and Switch” report – summary
MHSA “Bait and Switch” – entire report
$1-2 billion PEI funds diverted
$2.5 billion FSP funds spent without oversight
$23 million to MHSOAC insider dealing
$129 million to ineffective suicide and PR programs
$7 million to anti-treatment efforts
Social services masquerade as mental illness programs
County Directors uses stakeholder input to justify diverting funds
State Legislators raid MHSA fund
How to fix MHSA
How to fix Mental Health Services Act
Letter to Jerry Brown: Replace MHSOAC Commissioners
2015: Our fixes to MHSOAC regs designed to divert PEI MHSA funds
2014: Joy Torres fixes to regs designed to divert MHSA funds
2013: Our fixes to PEI regs designed to divert funds
Pre-2013 Oversight Commission used regulatory process to divert funds
MHSA Source Documents and Links to Agencies
Assemblymen Logue & Nestande ask for MHSA audit
California Mental Health Services Oversight and Accountability Commission -supposed to oversee MHSA spending
California Department of Health Care Services – has some MHSA oversight responsibilities
California Institute of Mental Health – provides policy direction
California Mental Health Services Authority – “Joint Authority” pools MHSA funds to run multi-county programs
3 year plan requirements for counties -2005
MHSOAC 2/09 minutes on 2 tier system
Rose King’s Whistleblower complaint
Two Tier mental health system (F.A.C.T.S)
MHSA Problems Rose King – 2012 memo to auditor
MHSA Media
Misspending on MHSA – Jaffe, SD Union Trib.
Little Hoover Commish fix wrong fix for MHSA – Day/Jaffe, SacBee
MHSA funds wasted – Jaffe/Bernard, collection
MHSA audit shows problems – Kazakoff, SF Chron.
Audit finds funds for mental health services misspent – Yanello SF Chron.
SF Chronicle: Mental “health” industry diverts MHSA – SF Chron.
Audit finds lack of MHSA oversight – LA Times
Prop 63 missing Goals – SacBee
Taxpayer money isn’t free money Chico-Enterprise Editorial
Prop 63 money is used unwisely – Contra Costa Times Editorial
MHSA spending lacks accountability – Press-Enterprise Editorial
Legislators call for Prop 63 audit
NAMI CA members say MHSA fails
MHSA creates haves and have-nots -Yannello Sac News
County by county info
California 24 hour crisis intervention lines by county
Names, phone, email addresses: California Behavioral Health Directors
List of 2012 MHSA funded programs by county (PDF)
Contacts: County PEI Coordinators
2012 MHSA fund payments to each county
Alameda County
Alameda Behavioral Health Home Page
Alameda adopts Laura’s Law pilot project – 11/2015
Supervisor Wilma Chan urges Alameda to adopt Laura’s Law – 1/2015
Supervisors delays Laura’s Law – 2014
Preventable mental Illness tragedies in Alameda
Supporter answers critic – Berkeley Planet
Forced treatment criticized – Berkeley Planet
Laura’s Law in a nutshell – Berkeley Planet
2013 – Mental Health Dept. refuses to implement Laura’s Law
Contra Costa County
11/2018: BOS Committee update on Laura’s Law 3 year pilot program – Agenda; Presentation; Report
Contra Costa Laura’s Law Savings/Cost Analysis – 2017
Contra Costa MH Crisis White Paper
11/2016 County evaluation of Laura’s Law
Summary: Families of Mentally Ill Report on Laura’s Law
Families of Mentally Ill Full Report
2/15: Contra Costa implements Laura’s Law
1/15: Board of Supervisors resolution on Laura’s Law
10/14 Work Group Recommendations on Laura’s Law
2012 ContraCosta County MHSA Plan
2014 Health Committee recommends pilot Laura’s Law program
Eldorado County
8/15: Board of Supervisors adopts Laura’s Law
Kern County
County by County Information (cont.)
Los Angeles County
LA Dept. of Mental Health tells Supervisors how to help seriously mentally ill in LA – 9/2017
2017 Memo to Board on improving care in LA
2017 Laura’s Law Numbers (not results)
Los Angeles adopts Laura’s Law – 7/2014
How to make a Laura’s Law referral
Results in Nevada and Los Angeles (PDF Version)
Board of Supervisors votes for statewide Laura’s Law
Treat, don’t jail, mentally ill – Jaffe, LA Times letter
2012 LA County favors renewing Laura’s Law
2011 Mental Health Dept. says Laura’s Law pilot works
2011 Supervisor Antonovich endorses
2011 Press -Telegram endorses AOT
LA MHSA Stakeholder Process fatally flawed
Marin County
2/2017: Novato supports Laura’s Law
1/17: Marin County Supervisors support Laura’s Law
10/16: Behavioral Health Dept. pretends Laura’s Law not needed
4/15: Marin County police and firefighters endorse
9/14 Marin County mulls Laura’s Law
Mendocino County
Mendocino sheriff helps mentally ill – 2/2017
Mendocino adopts, but refuses to use Laura’s Law – 3/16
Mendocino delays implementing Laura’s Law – 6/15
Mendocino supervisors reconsider Laura’s Law – 11/14
Mental Health Dept convinces Sups to not implement – 7/12
James Bassler: AOT could have stopped son from Ft. Bragg killing
James Bassler: the logic of Laura’s Law
Manhunt for Aaron Bassler due to mental health failure – LA Times
Letter to Editor: Mendocino needs Laura’s Law – Jaffe
Laura’s Law might save county money – Ft. Bragg Advocate
Mendocino County Proposition 63/MHSA Home Page
Mental Health Dept convinces Supervisors to not use Laura’s Law – 7/12
Ft. Bragg Advocate on Laura’s Law
Nevada County
2014-2015 Results in Nevada County
Results in Nevada and Los Angeles Counties (PDF Version)
Grand Jury Report on Laura’s Law – 2012
Judge Anderson encourages all counties to adopt Laura’s Law
County Behavioral Health Dir. on Laura’s Law
Q&A: Laura’s Law by Nevada County officials
Laura’s Law success in Nevada County – Video
DMH to NV County: OK to use MHSA for LL
Orange County
2015 OC Grand Jury Mental Health Report
Misspending Plagues Orange County MHSA programs
9/2015 OC stashing, not using MHSA funds
2/15 OC refusing to use Laura’s Law
5/14 OC Register, LA Times, NBC, NPR, Voice of OC on OC adopting Laura’s Law
Preventable Tragedies in Orange County (PDF Version)
OC should adopt Laura’s Law (Voice of OC)
2011 OC Health Care report to supervisors is wrong – MIPO
2011 OC Health Care Agency report to supervisors is wrong – NAMI OC & TAC
Health Care Agency misleads supes on Laura’s Law – OC Register
2011 Health Care Agency Report to Supervisors on LL
Ending Homelessness in OC – testimony
Seal Beach Salon shooting shows need for Laura’s Law
Letter in OC Register – Jaffe
Seal Beach Salon shooting and Laura’s Law
Mentally ill Kelly Thomas shooting shows need for Laura’s Law
Placer
9/2014 Placer County adopts Laura’s Law
Could Laura’s Law come to Placer County
Sacramento
Mental illness tragedies in Sacramento
Grand Jury finds “shameful neglect of mentally ill” – 7/15
7/15: editorial on Grand Jury Report – SacBee, 7/15
Laura’s Law languishes – Sac. News/Review
San Diego County
Mental illness tragedies in San Diego
Problems in San Diego, Jaffe, Union Trib
Video explaining Laura’s Law in San Diego – 2016
Laura’s Law might have prevented this horror – NBC, 4/16
San Diego Supervisors adopt Laura’s Law – 4/15
County stashing, not using mental health funds – 2015
San Diego moves closer to adopting – NBC, 2015
San Diego approves LL planning – 1/15
SD rubber stamps misspending MHSA funds – Jaffe/Bish (PDF) 2013
County report says ‘implement LL’ – 2013
2013 Supervisors authorize Laura’s Law study
Laura’s Law: pro and con – SD City Beat
Available in all formats at Amazon and Barnes and Noble
County by County (cont.)
San Francisco County
SF annual AOT report -3/2017
How to access Laura’s Law – 2/2017
Laura’s Law working in SF – 1/2017
San Francisco Annual AOT report – 2017
San Francisco Adopts Laura’s Law – 7/14
NBC News on Teresa Pasquini’s fight for better care – 7/15
San Francisco Examiner says implement LL (PDF) – 12/20/13
Preventable Mental Illness Tragedies in San Francisco (PDF)
Op-ed, editorial, article SF Chronicle
SF Mayoral candidates misunderstand Laura’s Law
SF Chronicle op-ed: Support Laura’s Law (DJ Jaffe)
Why Laura’s Law has such limited impact (SF Chronicle)
Ignore mentally ill and court disaster (SF Chronicle)
Where the Mayoral Candidates stand
San Luis Obispo
NIMBY groups defeat housing for mentally ill 11/2016
Board of Sups tells MH Dept. to plan to implement Laura’s Law – 11/2015
Untreated mentally Ill woman kills mom due to lack of LL
SLO Tribune report on mental illness
San Mateo County
San Mateo County MHSA Home Page
Preventable Tragedies in San Mateo (PDF here)
San Mateo approves Laura’s Law – 6/24
San Mateo Mental Health Dept. recommends Laura’s Law – 2015
San Mateo Health System Chief Jean S. Fraser, misleads on LL 2013
2011 Analysis of San Mateo Officials Claims About Laura’s Law
San Mateo Health Dept and NAMI Presentations to Board of Supervisors Committee
Presentation on Laura’s Law by local mental health officials
Preventable Tragedies in San Mateo (PDF Version here)
Santa Barbara County
09/2017 Report: 58% AOT of referrals unserved
02/2017: Diverting incarcerated mentally ill to treatment
02/2017: Status of Laura’s Law in Santa Barbara
Santa Barbara MH Dept presentation to MH Commission (PDF)
03/20/15 Status of Laura’s Law in Santa Barbara
Santa Barbara prison mental health services questioned
Shasta County
MHSA Funded Suicide Prevention Activities Fail
Siskiyou County
Sonoma County
12/2016: Shifting mentally ill from jail to treatment
2011 Health Care Director defends status quo (and read our response)
Stanislaus
8/2017 Analysis: Results Group Report Inaccurate
7/2017 Results Group Report
2/2017: Forum to consider Laura’s Law
2/2017: Advocates push for Laura’s Law
1/2017: Stanislaus to study Laura’s Law
1/2017 Supervisor Olson favors Laura’s Law
11/2016: Doug Dunn leads push for Laura’s Law
11/2016: Stanislaus considers Laura’s Law
Ventura County
Guest column: Discrimination a major issue in the Ventura County mental healthcare system (Haffner Op-Ed) – 09/08/2020
Behavioral Health Director “Berates” Behavioral Health Board Member for advocating for the seriously mentally ill (VC Reporter) – 07/29/2020
A failure of care: One family’s harrowing journey reveals inadequacy of mental health services (VC Reporter) – 07/08/2020
Leadership is key to dealing with Ventura County’s mental health crisis (Hayden Op-Ed) – 01/2020
Ventura County has a mental health crisis (Haffner Op-Ed) – 11/2019
The need for more in-patient psychiatric beds (Haffner Op-Ed) – 02/2019
Legislators add to broken mental health system (Haffner Op-Ed) – 07/2018
Mental illness laws must be changed (Hayden, Haffner Op-Ed) – 05/2018
Treatment before tragedy (Hayden Op-Ed) – 10/2017
Laura’s Law set to start (VC Star Editorial) – 01/2017
Close revolving door for mentally ill (Hayden Op-Ed) – 07/2017
Laura’s Law starts (VC Star) – 01/2017
Ventura jails mentally ill (Padilla Op-Ed) – 10/2016
Mental health funds are being misspent (Hayden Op-Ed) – 09/2016
Yolo County
Yolo gets great results – 10/2017
Yolo county gets good results -6/2015
6/14/14 Yolo Supervisors approve full implementation – 6/2014
Yolo supervisors approve Laura’s Law Pilot – 6/2013
Yolo residents want Laura’s Law – 6/2013 Sups Meeting