Sacramento County, CA (MPG) - The Sacramento County Board of Supervisors voted unanimously on May 18 to implement “Laura’s Law” - state legislation authorizing the courts to order outpatient treatment for individuals with a mental illness who may be a danger to themselves or others.

“Laura’s Law” was named after 19-year-old Laura Wilcox, who was killed in 2001 while working as a receptionist at the Nevada County Department of Behavioral Health. Her killer was a former patient of the county’s outpatient mental health clinic, who had been diagnosed with severe mental illness. After the incident, Laura's parents chose to advocate for assisted outpatient treatment (AOT) for individuals who meet strict legal criteria.

AOT permits courts to order treatment for those 18 years or older who suffer from a serious mental illness, are unable to survive safely in the community without supervision and meet at least one of the following criteria: Been hospitalized two or more times in the last 36 months due to mental illness; Demonstrated violent behavior toward themselves or others in the last 48 months; Has been offered treatment on a voluntary basis and refused it; Or, is deteriorating.

“We acknowledge that this is a complex issue with proponents on each side of this decision,” said Ryan Quist, Behavioral Health Director. “We are committed to engaging with all of our stakeholders in a community planning process to minimize concerns and design the best program for Sacramento County.”

California counties previously had the option to “opt in” to the program and that has been done in most of the larger counties. Sacramento County has historically not opted in to providing AOT services.

The process changed, however, with the passage last year of AB 1976, which requires counties like Sacramento to hold public hearings at the Board of Supervisors about whether to “opt in” or “opt out,” and if a County chooses to “opt out,” they have to provide specific reasons. The deadline for Counties to have a hearing and formally decide is July 1, 2021.

In Sacramento County, the program is estimated to cost $2.5 million annually. The Board of Supervisors and Sacramento County Behavioral Health Services will meet again in September to determine funding. 

Community Input

In March, Sacramento County Behavioral Health Services virtually hosted informational sessions and solicited community input via a brief survey for community members to hear input on whether to implement or opt out of Laura’s Law/AOT. 280 individuals participated in the survey. Nearly three-quarters of participants indicated that they think Sacramento County should implement Assisted Outpatient Treatment (AOT) (73 percent), 15 percent of participants indicated that they think Sacramento County should opt-out of AOT, and 12 percent of participants indicated that they were neutral or unsure about the decision.

Court Requirements of AOT

AOT is a court-ordered outpatient treatment service for adults, ages 18 years and older, who have a serious mental illness and a history of (a) psychiatric hospitalizations, (b) incarcerations, or (c) acts, threats or attempts of serious violent behavior towards themselves or others. Consumers must first be offered voluntary treatment within the past 10 days. The court cannot order involuntary administration of medications.

Family members, roommates, treatment providers and law enforcement may request an investigation to determine whether the consumer meets criteria. Only the County mental health director or his or her designee may file a petition with the court. The person named in the petition has a right to a defender appointed by the court.

If a judge finds that the individual meets the criteria, the AOT order would be for a 180-day treatment period, not to exceed 180 days. After 180 days, the director of the AOT program can apply for an additional 180 days of treatment. If the consumer is not compliant with treatment, the consumer can be transported to a hospital and held up to 72 hours. After 72 hours, the same hospitalization inpatient criteria such as being a danger to self, others, or gravely disabled.

Sacramento County Behavioral Health Services provides a full array of culturally competent and linguistically proficient mental health services to individuals of all ages.  Services include prevention and early intervention, outpatient services, case management services, crisis intervention and stabilization services, and inpatient psychiatric hospitalizations.