SUPES ADVANCE CALLS ON MENTAL HEALTH SERVICES
Laura’s Law allows for court-ordered treatment, but counties can opt out
After a lengthy discussion on mental health in Humboldt County, the Board of Supervisors voted unanimously to pursue the implementation of Laura’s Law or a similar assisted outpatient treatment program to alleviate violence associated with mental illness. Supervisors agreed to receive more information from staff before making a final decision.
Laura’s Law, or AB 1420, is a California state law passed in 2002 that allows for a court-ordered treatment program. It was implemented and named in memorial of Laura Wilcox and two others who were fatally shot by a person with mental health issues who refused treatment. The law provides a path for counties to implement the programs for people who have difficulty maintaining mental health stability and who experience frequent hospitalizations or contact with law enforcement related to their mental illness.
A legal adult can be placed in an assisted outpatient treatment program if a court finds they have a serious mental illness, are unlikely to survive safely in the community without supervision and has a history of noncompliance with treatment, according to the Humboldt County Department of Health and Human Services.
AB 1976, passed by the state legislature in September 2020, amended Laura’s Law to require counties to either implement an AOT program or to opt out through a resolution passed by the county Board of Supervisors. AB 1976 takes effect July 1.
During a presentation to supervisors, county Behavioral Health director Emi Botzler-Rodgers acknowledged the emotion surrounding the subject but urged the county to opt out of the program citing a redundancy in services, ongoing costs and increased staffing.
“We already have a number of voluntary services very similar to or the same as AOT with quite strong outcomes,” Botzler-Rogers said. “Without additional funding, it’s a fairly heavy lift for small counties that takes resources, funding and infrastructure and it is at a time that we’re impacted with ongoing deficit within behavioral health and COVID impacts and just really even trying to close out the books for this fiscal year to know what we have for next year.”
Botzler-Rogers said the county would benefit from strengthening existing resources rather than implementing a new program.
“Just to be clear in this recommendation, I’m not recommending that we opt out so that we don’t have to provide services to this population. I’m not recommending that we opt out to deny care for individuals who greatly need it,” she said. “My goal is for our community to care for those who are suffering in the best way that we can.”
DHHS said its existing behavioral health programs have “stronger performance outcome measures” when compared with successful assisted outpatient treatment programs throughout the state.
According to Department of Health Care Services AOT reports, the 13 counties that served 227 people in fiscal year 201819 reported a 33% decrease in inpatient psychiatric hospitalizations, a 30% decrease in homelessness and a 43% decrease in contact with law enforcement.
DHHS argued that its comprehensive community treatment program, which serves 300 people per year, has been more effective with a 46% decrease in the number of clients experiencing a stay at a psychiatric hospital, a 55% decrease in the number of clients experiencing an emergency shelter or homelessness and a 65% decrease in the number of clients experiencing incarceration, according to the staff report.
First District Supervisor Rex Bohn acknowledged that implementation of Laura’s Law would cost a pretty penny but said “we have a crisis on our hands.”
“When I see those numbers … out of 300 more than half of them are not suffering from homelessness, it just seems like, it doesn’t seem like we’re making any headway,” Bohn said. “I come into the office every Saturday and Sunday and about once a month I’m accosted out front and get threatened or screamed out for money and things like that. I take it in stride but if I was a 110-pound lady walking by, I don’t know if I would accept it as well.”
If it’s a financial issue, Bohn said he would like to see a breakdown of behavioral health’s spending.
DHHS Director Connie Beck noted that mental illness is “bigger than county behavioral health,” adding that many people living on the street are not eligible for services and the county cannot legally require them to seek treatment.
“We need Congress to change the laws and deal with the inequities in our nation, not just in the state,” Beck said. “We have serious issues and I don’t know that I or our staff at behavioral health are the ones that can take all of that on and all of that responsibility.”
“I think you hit it right on the head,” Bohn said to Beck. ” … I know it’s a huge problem and I don’t know how we address it but I appreciate what you guys are doing.”
Third District Supervisor Mike Wilson asked if the county would be able to opt in later if it were to opt out now.
“Is there a certain penalty that comes with not opting out if we chose to just be mute on the point? What would happen? Is there any sort of repercussion to that?” Wilson asked. ” … Without implementation, do we not have a path to put somebody in front of a (judge)?”
“We don’t utilize judges or the courts in any other part of our systems except, for instance, in our mental health diversion or other specific programs for that,” Botzler-Rogers said. “For our regular outpatient services for (comprehensive community treatment), we do not have a report component although those services, like I mentioned, are basically the same as an (assisted outpatient treatment), we just don’t have that robust outreach and engagement component which is what I really think we need to get people into those services.”
Even though Laura’s Law would only affect a small percentage of Humboldt County’s mentally ill, 2nd District Supervisor Michelle Bushnell said it only takes a couple of people to terrorize a community.
“In the very small communities of Garberville and Redway, you can have two individuals that are obviously mentally ill and there is no process now to get them to get help but those two individuals can affect an entire community,” Bushnell said. “I understand what you’re saying is maybe it’s only 10 to 15 people that Laura’s Law could touch, however, 10 to 15 people in a small community really affect a much larger population of people.”
Bushnell expressed concern that if the board failed to act immediately it would just be kicked down the road indefinitely.
Wilson called for “a more robust analysis” before voting to implement the program.
“Are we clear that this is going to be the most strategic way to spend General Fund dollars to alleviate the problem that we’re talking about today?” Wilson asked. “Laura’s Law is one element, it’s like one tool and there’s a huge spectrum of tools and programs that we have available.”
County Administrative Officer Amy Nilsen noted that staff would have to prepare a supplemental budget and seek additional funding for the $600,000 implementation of Laura’s Law would cost before supervisors make a final decision.
The board ultimately voted to direct staff to prepare a supplemental budget and position allocation to implement Laura’s Law, or a similar program, and to request an extension from the state to opt out. The board passed the motion 5-0.