Monday, January 20, 2014

Laura's Law

I believe it’s been two months since I made an entry here. There are several reasons. One is that life happens: there was a vacation, followed immediately by Christmas and New Year’s and the flurry of starting resolutions. Another is that I’ve been writing this for four years: it’s not always easy to come up with something interesting and informative about mental health every two weeks. But the other is this: the silence from my audience is deafening. I frankly feel I am writing into the void. I can’t remember the last time anyone made a comment. And if no one is listening, what am I doing it for?

So if I don’t hear from any of you, this is my last blog entry.

Meanwhile, let me talk about a local California issue: “Laura’s Law.” It is the equivalent of “Kendra’s Law” in New York state. It essentially is built to guarantee that people with mental health issues that are not getting the treatment they need, and are scraping bottom in their lives,  will be given a chance at comprehensive state assistance - rather than circulate from jail to street to psych ward and back out again, over and over.

In the United States, this type of law is the majority - 45 states have adopted some program approximating “Laura’s Law.” So for once California is trailing at the rear end of a humane and liberal movement. Why is this?

It’s mostly bad press. Those who oppose it seem to have the idea that Laura’s Law will force medication, hospital stays, or even straight jackets and shock treatment, onto people who don’t want them. Nothing could be further from the truth. Let me tell you how it works in Nevada County, the only county in the state which has fully funded the program.

“Laura’s Law” is actually a nickname for Assisted Outpatient Treatment, or AOT. It begins with a request for AOT from any of the following: a family member, roommate, peace officer, agency or hospital director, or a licensed therapist. The next step is to determine if the possible patient meets all the criteria - if s/he doesn’t, the process goes no further.

Criteria include ALL of these:
a serious mental disorder, inability to survive safely in the community, not yet an emergency situation but the patient’s condition is deteriorating, treatment is necessary to prevent a 5150 (imminent danger to self or others), and the patient has not meaningfully engaged in treatment or has refused it. What does lack of meaningful engagement in treatment mean? For instance, in 2 of the last 3 years, they’ve been in hospital or prison, or at least 1 of the last 4 years has featured serious violent and threatening acts, and threats to oneself or others.

If the criteria are met, then a plan of treatment is put together, to include 24/7 on call support. That means help with housing (which must always be the least restrictive that is possible for this person) and basic services, help with entitlement programs like Social Security or Medicaid, Substance Use counseling, support groups or therapy, life skills training, whatever they need to stabilize their life. It does NOT include locks, restraints, seclusion, or forced medication.

What happens is that the person is approached by their local mental health community and  offered this array of services on a voluntary basis. Nevada County says that in their experience, 2/3 of the people they offer this to, simply agree.

If it gets to the length of a Court Order, it is usually in special cases, such as those on probation or parole, those who are Court Wards or Mental Health Court participants, and the like. Somebody visits them ahead of time and gives them a pre-hearing list of what the court is suggesting and discusses it with them. They are also given a Public Defender to argue their point of view. Basically, what happens at the hearing is that the Judge sits down with the patient and goes over the list of possible treatments, and they determine which of these things the patient is WILLING to participate in. Nobody is fined, forced, or jailed. After 60 days the plan gets reviewed to see how it’s going.

What Nevada County has found is that after someone’s life becomes more stable as a result of the help they are getting, they eventually become willing to take the medication.

There now. Does that sound coercive or scary?

Actually, AOT is the law of California right now - it is just left up to each county to activate it by funding it. Is it expensive? The interesting thing is that it’s not. This comprehensive treatment actually saves Nevada County an average of a dollar for every dollar spent. That’s a dollar in the mental heath system. It doesn’t even count the money saved by the jails or courts who don’t have to cycle these same patients out and in again, year after year.

So that’s what I found out, from the horses’ mouths, at a presentation by Nevada County administrators and judges. I hope you’ll support Laura’s Law if it comes up in your community. Emergency-only treatment has not worked for us. Let’s see what a little prevention and a voluntary helping hand can do.

Deborah is the author of Is There Room for Me, Too? 12 Steps & 12 Strategies for Coping with Mental Illness, available at Amazon and other major vendors. Visit her web page at or see her catalog at