Twenty years after California gave counties the option to create court-ordered psychiatric treatment programs, Santa Clara County supervisors have “opted in” to the legislation.
The Board of Supervisors voted unanimously Tuesday to opt in to Laura’s Law and begin creating an assisted outpatient treatment (AOT) program that legally requires individuals struggling with severe mental illness to comply with treatment.
New legislation requires counties to formally opt in or out by June 30.
“I have also been persuaded by those that have argued that while involuntary treatment raises some obvious concerns,” said Supervisor Joe Simitian Tuesday prior to casting his vote, “there’s nothing very voluntary about the incarceration or restraints or commitments that take place when we don’t have the kind of services available for folks that really need them.”
Supervisor Susan Ellenberg expressed reservations about whether the law deprived residents of their civil liberties, but ultimately voted in favor.
“We all have the same goal, we all want our residents to have access to the vital resources that they need to thrive and we want to erase any stigma and barriers around mental health that prevent our residents from thriving,” Ellenberg said.
Development of the countywide assisted outpatient treatment program will begin this fall.
To date, only 21 of California’s 58 counties have opted in to the program, according to the California Association of Local Behavioral Health Boards & Commissions.
Laura’s Law is named after Laura Wilcox, a 19-year-old woman killed in 2001 while working as a receptionist at the Nevada County Department of Behavioral Health. The man who killed Wilcox was a former patient of the county’s outpatient mental health clinic, and had a habit of resisting treatment.
The law allows a court to compel services to an individual struggling with mental health that refuses treatment, and only applies to a specific group of people who have formerly been hospitalized or incarcerated as a result of their mental illness.
“It’s not a cure all, it’s not a panacea—but for the people it will matter to, it will make all the difference in the world, in my view,” Simitian said.
During public comment Tuesday, Affordable Housing Network President Sandy Perry spoke out against the board’s approval and the people supporting it.
“Unfortunately, the debate about Laura’s Law is being politicized by people playing on the public’s frustration with our homelessness problem,” Perry said. “Laura’s Law will not solve homelessness… What’s most alarming about Laura’s Law debate is that it’s loudest advocates are the same people trying to make homeless people disappear from our streets.”
Another prominent opponent of the law is the Law Foundation of Silicon Valley. In a strongly-worded letter to supervisors, attorneys Abre’ Connor and Becky Moskowitz wrote that those in support of Laura’s Law wrongly conflate homelessness and mental illness.
“At a time when the county is grappling with ensuring that it creates culturally competent care and safety for individuals, AOT is a step in the wrong direction,” Connor and Moskowitz wrote. “AOT’s effectiveness is premised on individuals being more likely to engage in an outpatient program endorsed by a judge than a robust voluntary program like Assertive Community Treatment (ACT). However, communities such as Black, Latinx, Indigenous and other people of color are more likely to have negative experiences with or impressions of the judicial system and may find a judge’s involvement in their mental health treatment off-putting, and in some cases, re-traumatizing.”
Those compelled to get help under Laura’s Law must meet specific requirements that include recent hospitalizations within the last 36 months, demonstrated violent behavior towards themselves or others, repeatedly refused treatment, or being in a “substantially deteriorating” state. Concerned family members and caregivers can also request that an individual be referred to an assisted outpatient treatment program.
The Santa Clara County Behavioral Health Services Department estimates that the cost to implement the program, after MediCal reimbursements, will be a bit more than $10 million per year. The department also estimates the need for about 18 full-time employees dedicated to the program.
“The full cost of AOT is not anticipated to be fully expended in (the next fiscal year), but rather over time, as the program requires time to ramp up and hire staffing,” county health officials wrote in a report to supervisors. “Additional funding for increased program slots, expansions, or other adjustments to address existing service needs may also be required depending on actual number of AOT clients that qualify for services.”
Health officials estimate the program could serve between 20 to 50 people annually, based on an analysis of surrounding counties with similar programs, including San Mateo and San Francisco counties.
Under Laura’s Law, counties are prohibited from reducing existing voluntary mental health programs to enact assisted outpatient treatment, meaning implementation would expand, rather than shift, the county’s current services.
Elisa Koff-Ginsborg, executive director of the Behavioral Health Contractors Association of Santa Clara County, represents more than 30 contractors providing mental health services in the region. Koff-Ginsborg said some members support Laura’s Law while others are strongly opposed.
“For family members and friends, it’s grueling pain to watch your loved ones suffer… while they’re refusing to accept treatment,” Koff-Ginsborg said. “We have a crisis and we need to make sure we’re doing everything we can, and that goes beyond the limited potential of AOT.”
Those advocating for the program shouldn’t see it as a panacea, Koff-Ginsborg said.
Santa Clara County already has many resources that neighboring counties didn’t have before implementing AOT, she added, including a comprehensive program that offers a wide range of services from therapy to temporary housing and job support.
“So the question I would ask is, what’s preventing us from having more people engaged in those now?” Koff-Ginsborg said. “The mandatory aspect is only going to be a small portion, how are we going to engage everyone else? If AOT is passed and nothing else is changed, no one should be surprised that we don’t get the results that we’re looking for.”
Supervisors Otto Lee and Simitian supported implementing the program at a county Health and Hospital Committee meeting in March. Simitian voted in favor of Laura’s Law when he was a state assemblyman in 2002.
In a March 24 letter to supervisors, the Santa Clara County National Alliance on Mental Illness (NAMI) urged county leaders to finally implement Laura’s Law.
“(AOT) is the only option for families having a loved one living with mental illness; these families are often desperate to get treatment for family members but are generally barred from helping, even to warn of potentially volatile behavior,” the NAMI Board of Directors wrote.