1. Outpatient Services Programs Workgroup: Laura’s Law May 29, 2014

2. Laura’s Law Laura’s Law was passed by the California legislature in 2002 and is the state law that allows for outpatient civil commitment. The statute can only be utilized in jurisdictions that choose to implement that law. Until recently, the law was only fully implemented in Nevada County. In May 2014, Orange County supervisors voted unanimously to implement the law. San Francisco is also considering implementing the law.

3. Components of Laura’s Law Investigations and the Petition Process Treatment Criteria Court Hearings Treatment Plan Renewals and Remedies for Non Adherence Rights of Individuals Subject to Petitions

4. Investigations and Petition Process Only the county mental health director may file a petition with the court in the county where the individual is present. The following persons may request that the county health department investigate whether to file a petition for the treatment of an individual: –Any adult with whom the person resides; –An adult parent, spouse, sibling, or adult child of the person; –If the person is receiving inpatient treatment, the director of a hospital; –The director of any public or private agency, treatment facility, charitable organization, or licensed residential care facility providing mental health services to the individual in whose institution the subject of the petition resides; –A treating or supervising licensed mental health treatment provider; or –A peace officer.

5. Investigations and Petition Process Upon receiving a request, the county mental health director is required to conduct an investigation. A petition is only filed if all the necessary elements for an outpatient civil commitment petition can be proven by clear and convincing evidence. The petition must state: that the person is present or believed to be present in the county where the petition was filed; –all the criteria necessary for placement in outpatient civil commitment; –the facts supporting the belief that the person meets all the criteria; and –that the subject of the petition has been represented by counsel. The petition must include an affidavit of a licensed mental health treatment provider designated by the county mental health director that the individual was examined in person or appropriate attempts were made to examine the individual.

6. Treatment Criteria 18 years of age or older; Has a mental illness; Is unlikely to survive safely in the community without supervision, based on a clinical determination; Has a history of lack of compliance with treatment and at least one of the following is true: The individual has been hospitalized, or received services in other specified settings (a mental health unit of a state or local correctional facility) at least twice in the past 36 months; or The individual has harmed, threated, or attempted to, harm to themselves or another individual in the past 48 months;

7. Treatment Criteria Has been offered an opportunity to participate in a treatment plan fails to engage in treatment; The person’s condition is substantially deteriorating; The outpatient civil commitment program would be the least restrictive placement; In view of the person’s treatment history and current behavior, the person is in need of outpatient civil commitment treatment in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to himself/herself or others; and Is likely that the person will benefit from outpatient civil commitment treatment.

8. Court Hearings The person who is subject to the petition has the right to be represented by counsel at all stages of an outpatient civil commitment hearing. The court will hear testimony and, if advisable, examine the person. If after hearing all relevant evidence, the court finds that the person does not meet the criteria for outpatient civil commitment, the court will dismiss the petition. If the court finds that the person meets the criteria for outpatient civil commitment, the court may order the person to receive outpatient services for up to six months. If outpatient civil commitment is ordered, the court shall specify the services that the person is to receive. The court may not require any treatment that is not included in the proposed treatment plan submitted by the examining mental health treatment provider.

9. Treatment Plans The court, in consultation with the county mental health director, must find the following: –That the ordered services are available for the duration of the court order; –That the ordered services have been offered on a voluntary basis and the person has refused or failed to engage in treatment; –That all the elements of the petition have been met; and –The treatment plan incorporated in the order will be delivered to the county director of mental health, or the appropriate designee.

10. Renewals and Remedies for Non Adherence Renewals: The procedures and requirements for obtaining a renewal order are the same as for obtaining an initial order. Remedy for Non adherence: A licensed mental health treatment provider and designated individuals may take a person under an outpatient civil commitment order to a hospital to be held for up to a 72-hour examination to determine if the subject of the order meets the criteria for inpatient hospitalization. The treatment provider may only make such a request after determining that: –The person has failed or refused or failed to comply with court- ordered treatment; –Efforts were made to solicit compliance; and –The person may need involuntary admission to a hospital for evaluation.

11. Rights of Individuals Subject to Petitions A person subject to a petition for outpatient civil commitment has the right to: –Retain counsel or utilize a court-appointed public defender; –Adequate notice of the hearings (parties designated by the subject of the petition also must receive adequate notice); –Receive a copy of the court-ordered evaluation; –Present evidence, call witnesses, and cross-examine adverse witnesses; –Be informed of his or her right to judicial review; and –Be present at the hearing, unless he or she waives this right; and –Appeal decisions, and to be informed of his or her right to appeal.

12. Sources California Welfare and Institution Code, Section 5345-5349.5 http://www.leginfo.ca.gov/cgi- bin/displaycode?section=wic&group=05001- 06000&file=5345-5349.5 http://www.leginfo.ca.gov/cgi- bin/displaycode?section=wic&group=05001- 06000&file=5345-5349.5 San Francisco Supervisors Get Behind Laura's Law Mental Health Program, http://www.latimes.com/local/lanow/la-me-ln- san-francisco-lauras-law-20140520-story.html http://www.latimes.com/local/lanow/la-me-ln- san-francisco-lauras-law-20140520-story.html O.C. First Large County in State to Adopt Laura’s Law, http://www.latimes.com/local/lanow/la-me-ln-oc-lauras- law-20140513-story.html http://www.latimes.com/local/lanow/la-me-ln-oc-lauras- law-20140513-story.html