Assisted Outpatient Treatment. Laura s Law

Transcription

1 Assisted Outpatient Treatment Laura s Law AB1421 Butte County, Department of Behavioral Health Presentation to the Board of Supervisors April 12, 2016

2 Background Assisted Outpatient Treatment, also known as Laura s Law was initiated following the 2001 killing of Laura Wilcox in Nevada County by an individual suffering from mental illness. In 2002 the State approved AB Assisted Outpatient Treatment (AOT) Demonstration Project Act of 2002 This law allows for Counties to implement Court-Ordered Outpatient Mental Health Treatment for certain individuals who have a serious mental disorder 2

3 California Welfare and Institutions Currently utilized or being implemented in 13 California Counties (degree of implementation varies depending on the County) Intended to serve individuals while allowing them to remain living in the community State law, but counties must choose to opt-in Strict eligibility criteria Code Civil court proceedings (not criminal) 3

4 AOT Requires Inter-Agency Collaboration Behavioral Health Courts County Counsel Public Defender / District Attorney Patients Rights Law Enforcement 4

5 AOT Criteria County resident 18 years or older suffering from severe mental illness Unlikely to survive safely in the community without supervision History of lack of participation in needed mental health treatment Person s condition is substantially deteriorating Participation in AOT would be least restrictive treatment option 5

6 Criteria (cont d) In addition, one of the following conditions must be met as a result of the person s mental illness: 2 psychiatric hospitalizations or incarcerations within the last 3 years Their behavior has resulted in acts of violence, or attempts of violence toward self or others within prior 4 years 6

7 AOT Process Request for Petition Investigation Evaluation Petition Filing and Superior Court Hearing Treatment 7

8 Request for Petition Adult with whom person resides Parent, spouse, sibling or child of person (18 or older) Director/designee of a Mental Health treatment facility or where person is/was receiving treatment Licensed mental health treatment provider Law enforcement, including parole/probation 8

9 Investigation/Evaluation Once a request to file a petition is made to the County Mental Health Director the following must occur: Locate and notify the individual of the filing and their rights, including the option to engage in AOT voluntarily. Evaluate the individual to determine if he or she meets AOT criteria Within 10 days of assessment, prepare written petition to Superior Court that includes a clinical assessment, treatment plan recommendation, and justification for participation in AOT If the Individual refuses evaluation, a Court may order up to 72 hours of psychiatric hospitalization for the purposes of evaluation. 9

10 Petition Filing and Superior Court Hearing Upon receipt of Petition, the Court must set hearing within 5 days Individual has right to counsel throughout the process If the petition is upheld the Court may order the individual into AOT AOT is ordered for up to 180 days at a time Mental Health Director must file affidavit at minimum every 60 days at which time the individual can contest the court order for AOT After 180 days a new petition must be filed if AOT is recommended to be continued 10

11 Treatment Community-based, mobile, multi-disciplinary treatment 24/7 on-call support Maximum of 1 staff to 10 clients ratio Implement the court approved treatment plan agreed to with individual Provide housing that is immediate, transitional, or permanent Provide incentives required to engage in treatment Provide family support and consultation, parenting support, and peer support Treatment provider may not force medication 11

12 Non-Compliance with Treatment Non-Compliance with medication or other court ordered treatment may result in a request of the treatment provider to the Court to order up to 72 hours of hospitalization for evaluation Further hospitalization beyond 72 hours would require the individual to meet criteria under 5150 (danger to self, others, or grave disability). Otherwise, the individual would have to be released Failure to comply with an order for AOT alone may not be grounds for involuntary civil commitment or a finding of contempt of court 12

13 Funding Mental Health Services Act (MHSA), Realignment and Medi-Cal reimbursement may be used for behavioral health treatment, administrative costs, quality management, flexible funds, and housing costs No other programming may be reduced or eliminated to fund AOT MHSA funds cannot be utilized to implement and operate Laura s Law for the cost to the other partner agencies (Courts, Public Defender, County Counsel, etc.) 13

14 Cost Research Reported Estimated Costs from other Counties for Behavioral Health Services only (excludes housing costs): San Luis Obispo (pop. 280,000) $23,000 per client Nevada (pop. 100,00) $21,000 per client Yolo (pop. 204,000) $23,000 per client Shasta (Pop. 180,000) $15,000 per client Estimated County Counsel costs from other Counties: San Luis Obispo $61K annually Nevada No Information Yolo No Information Shasta $72K annually Additional costs/resources: Public Defender, DA, Law Enforcement and Courts to be determined. 14

15 Benefits Limitations Allows family member and others to petition for treatment Improves engagement and compliance with treatment Provides housing options to homeless participants Reduce incarceration/hospitalization for participants Reduce emergency room visits for participants Lacks mechanism for enforcement Cannot compel medication compliance except in hospital setting with a separate court order Staff/Resource-intensive in area where health care resources are limited Requires significant interagency processes with time sensitive mandates Extensive reporting at State and local level 15

16 Final Considerations There is evidence from participating Counties that AOT has demonstrated a reduction in costs to community in terms of fewer incarcerations, hospital ER visits, and psychiatric hospitalizations for most individuals participating in the program. AOT law is set to sunset on January 1, Current, proposed legislation (AB 59) would extend programming to January 1, The California Department of Health Care Services has yet to issue its Legislative Report that was due in May, This report, when complete, should provide statewide, comprehensive outcome data regarding the success of this program in the Counties where it has been implemented. 16