Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, Health System
David Young, Director, Behavioral Health and Recovery Services
Subject: Status Report on Laura’s Law Assisted Outpatient Treatment Implementation in San Mateo County
RECOMMENDATION:
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Adopt a resolution accepting the update on the progress of implementing Laura’s Law Assisted Outpatient Treatment.
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BACKGROUND:
In 2002, the California Legislature adopted Assembly Bill 1421, commonly known as Laura’s Law. On June 16, 2015, the San Mateo County Board of Supervisors voted unanimously to enact AB 1421 by establishing an Assisted Outpatient Treatment (AOT) program. The approved budget for this program was $3,766,973 through June 2018.
AOT is intended to address the mental health care needs of individuals who do not meet the requirements for “grave disability” in order to establish a conservatorship, or the “danger to self or others” requirement for involuntary confinement, but whose mental status appears to be nonetheless serious and deteriorating. By enacting AB 1421, the criteria to involuntarily detain an individual for a psychiatric evaluation for up to 72 hours is expanded. If an eligible individual does not accept services voluntarily, the court may order individuals to 180 days of AOT. The court, however, cannot force any individual to take medications or to participate in treatment; ultimately an individual can choose not to engage in treatment without any legal consequences.
DISCUSSION:
The AOT team staffing, as approved by your Board, consists of a Clinical Services Manager, a Psychiatric Social Worker, a Mental Health Counselor, a Peer Support Worker, a Deputy Public Guardian and a Psychologist. The BHRS AOT Team has been fully staffed since August 2016. The treatment is provided by Caminar’s Full Service Partnership (FSP), consisting of up to 50 slots. The first client was enrolled on August 4, 2016.
As of December 31, 2017, 244 referrals and 49 information calls were received. Twenty-five percent, or 53 individuals, have been enrolled in the Caminar AOT-FSP. The AOT-FSP enrollees have thus far shown a significant decrease in: hospitalization from 16 episodes prior to enrollment to 8 episodes since services began, with a subsequent reduction in hospital length of stay (252 days vs 96 days). Further initial outcomes include a reduction in Psychiatric Emergency Services (35 episodes vs 21 episodes); homelessness (26 vs 19); and jail (44 vs 9).
Since July 1st, 2016, three court petitions for court ordered enrollment have been filed for two unique clients who were not willing to engage otherwise. The first filing was dropped when the client refused to go to AOT court. The two clients were court ordered to receive FSP services; one client ultimately engaged in services voluntarily while the second client was able to be discharged to their family’s care.
This update contributes to the Shared Vision 2025 outcome of a Healthy Community by providing care for County residents whose mental status appears to be deteriorating and meet AOT criteria. It is anticipated that the total number of hospital days by enrolled clients will decrease by 60% (165 days).
PERFORMANCE MEASURE:
|
Measure |
FY 2017-18 Estimated |
FY 2018-19 Projected |
|
Percentage/number decrease in total hospital days by enrolled clients in comparison to total hospital days 6 months prior to enrollment |
62% 156 days |
60% 165 days |
FISCAL IMPACT:
There is no fiscal impact associated with this report.