Laura’s Law a good plan, but timing’s wrong locally
By Victoria Metcalf
Members of the Plumas County Board of Supervisors, following Behavioral Health Director Tony Hobson’s recommendation, signed a resolution opting out of Assembly Bill 1976 (Laura’s Law) that would assist outpatient mental health treatment.
“Sometimes being in my position is (like) a punching bag,” Hobson told supervisors Tuesday, June 15, although he agreed with much of what Laura’s Law proponent Denise Pyper had said during public comment. “And I agree with most everything you said,” Hobson said as he turned to recognize Pyper at the rear of the supervisors’ meeting room.
Hobson’s stumbling block toward implementing Laura’s Law is that no funds are attached. While AB 1976 is mandated for California counties, there is a provision for supervisors to opt out of the program.
If funding comes available in another year, Hobson explained the county can decide to implement Laura’s Law.
Pyper spent her time during public comment explaining why Plumas County needs Laura’s Law. It covers Assisted Outpatient Treatment (AOT), a practice of delivering outpatient mental health treatment under court order to adults with severe mental illness. Individuals must meet specific criteria including a history of repeated hospitalizations or arrest for their illnesses.
In some respects, Hobson said Laura’s Law “is very similar to what we do presently.” However, the county doesn’t have a dedicated non-volunteer treatment program, and that is required.
“Denise (Pyper) is right on the money about increased needs,” for AOT outpatients, Hobson explained. But without additional funding to provide those specific services that are not now available at Behavioral Health, Hobson explained they can’t reduce the number of voluntary clients the programs now serve to accommodate non-voluntary clients. “We’re not allowed to do that,” Hobson said.
This is the first year Hobson has prepared a balanced Behavioral Health budget in his three years as director. And he’s looking at a 26 percent increase for next year’s programs.
AB 1976 background
Hobson presented supervisors with an overview of AB 1976. It “was chartered into law amending the current legislation associated with Assisted Outpatient Treatment (AOT), commonly known as Laura’s Law.”
“The implementation of AB 1976 by a county requires that current services are not allowed to be reduced in order to enact” it. And as Hobson indicated, he doesn’t have the funding to do AOT without cutting the other services.
Hobson said that Behavioral Health does offer programs that are similar or “mirror” programs within AOT, but cannot, without additional funding, implement the entire AOT program. Hobson was not specific on how much funding is required to offer AOT programs under the bill.
Supervisors voted to unanimously approve the resolution.
In support of AOT
In a prepared statement, Pyper explained her position in support of offering Laura’s Law within Plumas County.
Using information from the Treatment Advocacy Center, Pyper said there are only three states that do not offer opportunities similar to AOT. Connecticut, Maryland and Massachusetts do not have AOT programs.
AOT is designed to offer outpatient treatment under court orders to adults with severe mental illness who meet specific criteria. The criteria includes having a history of repeated hospitalizations and/or arrests. “It is a tool for assisting those individuals most at risk for the negative consequences of not receiving treatment,” according to Pyper’s information.
For those served by AOT programs, Pyper said statistics show there is a reduction in hospitalization and arrests to those court ordered to participate. This also shows fewer related causes of homelessness and violent acts associated with mental illness. “Due to strict legal criteria, AOT participants typically represent far less than .05 percent of a state’s population,” Pyper offered. The number eligible or served in California is not readily available. “Yet, on any given day, they are the people most at risk to be in a hospital, ER, on the streets or behind bars.”
Characteristics of the population eligible for AOT include those with schizophrenia or severe bipolar disorder; 97 percent have been hospitalized for related issues previously; 47 percent had co-occurring substance abuse disorder; and 47 percent didn’t adhere to needed medication directions before AOT.
And the costs of managing AOT-related clients add up. Each psychiatric admission into a hospital costs on the average of $7,500. “And non-adherence is the number one risk factor for it.”
According to the Treatment Advocacy Center, 30 percent of all MediCal (Medicaid) are re-admissions. These patients had more than 75,000 mental health related re-admissions in one year, and many of those were re-admitted within a month of their last discharge.
Through a partnership between the AOT individual, the courts, and the AOT-trained worker in the mental health system, statistics show that there is more compliance with medication use, less expense for hospitalizations because they decrease, and fewer incidents of arrest and incarceration.
Laura’s Law
AOT programs go by a variety of names. In California, it’s known as Laura’s Law for a receptionist named Laura Wilcox, who was killed by a man who refused psychiatric treatment.
The California legislature originally approved the bill in 2002. Nevada County is recognized as leading the way in its implementation and success of working with AOT-related clients.
