Meeting of the Minds, 2013: Laura’s Law: What is Assisted Outpatient Treatment (AOT)?

Posted by Sappho on May 22nd, 2014 filed in Bipolar Disorder, Classes, Lectures, and Conferences

This workshop was another panel discussion, with panelists from a variety of county agencies, including the Orange County Health Care Agency, the Orange County Counsel, the Orange County Public Defender’s Office, and OC Arts for Wellness.

The workshop, like the other workshops I’ve been blogging about from the Meeting of the Minds, took place on Tuesday, May 13, 2014, and we began with an announcement. On this very morning, the Orange County Board of Supervisors had unanimously passed a resolution implementing Laura’s Law.

AB 1421, also known as Laura’s Law, became effective on January 2, 2003, and was set to sunset unless extended. AB 1569 extended the sunset to 1/1/2017. The law creates an Assisted Outpatient Treatment (AOT) program that provides court-ordered treatment for persons with severe mental illness who meet certain criteria.

Currently only Nevada County has implemented Laura’s Law (though Los Angeles County has a pilot program). We can now add Orange County.

In order to implement Laura’s Law, counties must “opt in.” The Board of Supervisors must pass a resolution. The legislators didn’t provide funding for the law, and existing mental health programs couldn’t be decreased to fund AOT, so funding has proved an obstacle. SB 585, passed in September 2013, allowed Mental Health Services Act funding to be used to fund Laura’s Law. It also allowed some other funds to be used. Counties still must opt in and still must not reduce other mental health services.

Next, we had a woman who herself lived with mental illness speak about the benefits of Assisted Outpatient Treatment and barriers for consumers. I didn’t take many notes on this part, because I had trouble figuring out what she was saying. I did learn about at this point about the sudden death of a well known local psychiatrist. And I have a few different notes that I think were her attempts to summarize the views expressed to her by different people. These are: Allowing people with severe mental illness to direct their own treatment empowers them to care for themselves, but those most in need are too disorganized. “Coercive treatment is not an answer to treatment non-compliance.” “Why should people who are doing all the wrong things get preference?” Bring back the biosocial model, not just meds. The most important requirement is sleep. Do these things with kindness. “Everyone needs something to do, something to love, and something to hope for.”

Assisted Outpatient Treatment is for county residents, aged 18 and older, with a history of lack of engagement in mental health treatment. To qualify for a court order, a patient must have two psychiatric hospitalizations within the last 36 months or incidents of violence to self or others within the last 48 months, be unable to survive safely in the community, and be deteriorating. People who can file a petition for AOT include immediate family, people living with the patient, professionals, and cops. You will be able to file a petition request, and the mental health director will conduct an investigation to see whether the patient meets the criteria. A licensed mental health professional must examine the patient within 10 days of the petition, and there must be a treatment plan. The petition must show that they meet the criteria. It can only be filed if the case can be proved according to a legal standard of clear and convincing evidence.

If the person refuses examination, the court can order them to the hospital for up to 72 hours, for evaluation. The subject of an AOT petition has a right to legal counsel.

Ms. Beaseley, the Public Defender, spoke: If you find yourself the subject of an AOT proceeding, you have a right to counsel. Hopefully your voice will be heard. As a lawyer, she will explain the process and make sure that your rights are protected. Failure to comply alone may not be grounds for forced hospitalization, but it may get to that point. There are no civil or criminal penalties. Assisted Outpatient Treatment doesn’t include a medication order, but the hospital could medicate you if they determine that you’re a danger to yourself or others.

The subject of an AOT can file a writ of habeus corpus.

Another panelist discussed treatment. It involves a 1 to 10 staff to client ratio, a multidisciplinary team, a continuum of services, a carefully tailored treatment plan, and medications but no involuntary medication.

They will need time to train stakeholders and set up an 800 number. This is the timeline: First they put this into the three year mental health plan. Then a resolution was approved today (“today” being the day of the workshop, May 13). From June to September, they will come up with a plan, and they will start the implementation of AOT in October.

Someone asked about Nevada County’s experience implementing the law. Many cases in Nevada County end up settled out of court, with a settlement agreement.

Another questioner talked about the Los Angeles County pilot program, and asked whether AOT would apply to people who already are already under a conservatorship. In LA County the answer is no. One of the panelists said that a conservatorship already provides more ability to put someone in treatment than does an AOT court order.

A cop asked the public defender what relations she expected with the police force in these cases.

Someone on the panel told us that they anticipate a reduction in hospitalizations.

And here my notes on the workshop (and on the conference itself) end.

There was also a key note talk at lunch time, of which I posted some remarks to my Facebook page, but I didn’t take detailed notes on that one, so I’m not going to blog it. It was basically an inspirational talk by a woman who lived with mental illness, and it was good.

2 Responses to “Meeting of the Minds, 2013: Laura’s Law: What is Assisted Outpatient Treatment (AOT)?”

  1. Marian Neudel Says:

    Is there some kind of psychoactive medication that can be administered by a long-term shot or implant, as some kinds of contraceptive are? Is anybody working on this?

  2. Sappho Says:

    No implants, but yes, there are injectable anti-psychotics that last longer than taking the meds in pill form. Not for every drug, but for some: