In Opposition to "Assisted Outpatient Treatment" to "Laura's Law" (AB 1421) sign now

This petition is in opposition to "assisted outpatient treatment", "Laura's Law" (AB 1421)
An action item is expected on Supervisor Michela Aliot-Pier's proposed resolution authorizing the implementation of "assisted outpatient treatment" (that is, involuntary outpatient commitment) under "Laura's Law" (AB 1421). The meeting will be held at San Francisco City Hall on Monday, July 12th at 10:30; the agenda will be posted here.

California clients twelve-year battle over the expansion of involuntary treatment continues to the present day over local efforts to implement AB 1421 (Laura's Law), a law allowing assisted (forced) outpatient treatment (AOT) under very strict criteria. Since AB 1421 was introduced in 2001, the CNMHC has strongly opposed it, and we continue to oppose its implementation, working closely with our partners in the Coalition Advocating for Rights, Empowerment and Services (CARES).

AB 1421 was passed into law in 2002, going into effect January 1st, 2003 with a five-year sunset clause; a follow-up bill (AB 2357) was passed in 2006 to renew AB 1421 for another five years (to sunset January 1st, 2013), with the additional requirement of a report due in 2011. Since then, only one county (Nevada County) has implemented this regressive and arbitrary law, in accordance with a lawsuit settlement, and the scope of their pilot program appears to be very limited.

AB 1421 is an outdated, coercive, unproven and divisive law that codifies involuntary outpatient commitment, turning back the clock on transformation even as funding for voluntary, wellness and recovery-based services is now available through the Mental Health Services Act (MHSA).

Please feel free to cite and reproduce the following CNMHC talking points in your county if an effort to implement an AB 1421 pilot program appears to be underway.

Give voluntary community services (through the Mental Health Services Act) a chance.

Voluntary enhanced services are the answer to the mental suffering that surrounds us, not the expansion of forced treatment. In 1999, when legislation to expand forced treatment was introduced in California, the perception of the need for increased involuntary services was an incorrect response to the lack of accessible mental health services. Today, accessible voluntary community services are on the horizon with the passage of the Mental Health Services Act (MHSA). Before resorting to the extreme measure of denying the rights of a whole group of persons, give these voluntary community services a chance.

Deinstitutionalization did not fail; it was never completed. People with mental disabilities were never offered the full array of voluntary community mental health services they were promised, including medications, housing, job and benefits assistance, outreach teams and other alternative support for people in crisis, clientrun and self-help services, such as peer counseling. The Surgeon Generals Report, Mental Health: A Report of the Surgeon General (1999), states, One point is clear: the need for coercion should be reduced significantly when adequate services are readily accessible to individuals with severe mental disorders who pose a threat of danger to themselves or others. The Little Hoover Commission agrees, and urges an assessment of how improved access to voluntary treatment could diminish the need for involuntary treatment, before implementing options that would increase forced treatment. With the passage of the MHSA, California is moving in the direction of making adequate services readily accessible to Californians with mental disabilities, of improving access to voluntary services. California is fulfilling a promise made 30 plus years ago when it closed so many of its institutions. Give this initiative a chance.

The Surgeon Generals Report further states, Almost all agree that coercion should not be a substitute for effective care that is sought voluntarily. Implementing AB 1421 p

AB 1421 proponents have claimed that the MHSA provides funding opportunities for AOT pilot programs. In fact, MHSA funds cannot be used for AB 1421 programs.

The services that provided the model for the MHSA, AB 34 and 2034, were designed to be voluntary, and required providers to follow a client-directed, culturally competent and recovery-based standard of service. The California Council of Community Mental Health Agencies, one of the lead advocates of the MHSA, has written that the law [AB 34/2034] describes a process of developing an individual personal services plan in which each client participates. These are voluntary community services programs. There is no authority for using Proposition 63 funds for any other type of program. The imposition of involuntary treatment precludes such standards.

This is reiterated in the following passage from the State DMHs Requirements for Community Services and Supports Programs: Individuals accessing services funded by the Mental Health Services Act may have voluntary or involuntary legal status which shall not affect their ability to access the expanded services under this Act. Programs funded under the Mental Health Services Act must be voluntary in nature.

California is not New York State: Comparison with New York States Kendras Law

In her promotion of AB 1421, former Assemblywoman Betty Karnette, author of AB 2357, which extended AB 1421s sunset date by five years, cites findings of the New York State Office of Mental Health (OMH) touting positive outcomes for Kendras Law in New York. However, this data has been heavily criticized by advocates as heavily biased while lacking in scientific evidence. The New York Lawyers for the Public Interest (NYLPI) calls the OMH findings propaganda, not science, noting that the report is based almost entirely on opinions of case managers comparing their clients functioning prior to and during court orders. This is a very weak basis for conclusions. Departing from scientific protocols, the OMH report fails to compare these outcomes with a control group of people who received similar enhanced services on a voluntary basis.

In analyzing New Yorks outcomes, it is important to consider that New York State put millions of dollars into enhanced services for court ordered people, whereas California requires counties to foot the bill for AB 1421 pilot programs. A three-year controlled study in New York City that compared the efficacy of enhanced services with and without the use of involuntary outpatient commitment found no difference in rates of improved outcomes, showing that people do better when they are offered better services, not because they are forced to receive them. That study suggests that the OMHs reported positive outcomes came from the enhanced services, rather than from forced treatment, according to NYLPI. This explanation is also inferred in a 2001 Rand Study that was commissioned by the California Senate Rules Committee during the legislative course of AB 1421. Why deny a persons civil and human rights to achieve outcomes that have been proven to be achievable without this deprivation?

In California, positive outcomes like those that AB 1421 proponents attribute to Kendra's Law have been achieved with voluntary community services alone, such as the AB 34/2034 programs upon which the MHSA is based. The expectation is that with the implementation of the MHSA, these positive outcomes will be repeated. For example, under the AB 34/2034 programs, the number of days hospitalized has decreased by 55.8\%, the number of days incarcerated has decreased by 72.1\%, the number of days homeless has decreased by 67.3\%, the number of days employed (full time) has increased by 65.4\%, and the number of days employed (part time) has increased by 53.1\%.

Furthermore, it must be noted that court-ordered treatment under Kendras Law in New York has very disproportionately targeted people of color, specifically African Americans and Latinos. NYLPIs analysis of state data shows that based on population, African American clients are nearly five times as likely as whites, and Latinos twice as likely as whites, to be the subject of court-ordered treatment under Kendras Law. For California to implement a similar involuntary outpatient commitment law would invite a comparably discriminatory application of court-ordered treatment, violating the civil rights of people of color and people with mental disabilities, along with the mental health systems legal mandates to uphold standards of cultural competence.

There is no justification to turn back the clocks on client-driven transformation.

No county has chosen to implement AB 1421. The Assembly Health Committees 2006 legislative analysis for AB 2357, which states that AB 1421 was implemented in Los Angeles, is incorrect. Los Angeles County has implemented a diversionary program for incarcerated persons with mental disabilities under the negotiated settlement section of AB 1421; it has ignored the rest of the law. Los Angeles County describes its program as a voluntary wraparound program, not an AB 1421 program. Only Nevada County has recently begun implementing an AB 1421 pilot program. They are doing so in accordance with the settlement of a lawsuit brought by the Wilcox family over their daughter Lauras death.

The Rand report commissioned by the Senate Rules Committee cites that one reason for the lack of implementation of outpatient commitment laws throughout the country is that mental health providers dont like it; they dont want to undermine their therapeutic relationship with coercion.

Involuntary outpatient commitment has no scientific evidence supporting its efficacy. To effectively measure the efficacy of an involuntary outpatient commitment pilot program independent of the enhanced services role, the evaluation study should be a double-blind study with a control group that receives the same type of enhanced services voluntarily. New Yorks legislature, in fact, mandated this kind of comparative study when it extended the sunset deadline for Kendras Law. This gold standard of scientific research is very expensive. But in California, there is no new funding stream that can support AB 1421; the MHSA cannot support involuntary programs.

AB 1421 should be allowed to quietly sunset as we instead dedicate our efforts to the task of transforming the mental health system. In a state that avows to support client empowerment, a client-driven system, and client inclusion in decision making, the fact that clients of the state overwhelmingly oppose increasing forced treatment is in itself a powerful reason to oppose AB 1421 implementation locally. The very people whom this approach purports to help, who the state says should drive the system, oppose it.


◊ U.S. Department of Health and Human Services, Mental Health: A Report of the Surgeon General. MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999.

◊ Little Hoover Commission, Being There: Making a Commitment to Mental Health, November, 2000.

◊ Final report. Research Study of the New York City Involuntary Outpatient Commitment Pilot Project. Policy Research Associates, Inc. December 4, 1998.

◊ Achieving the Promise: Transforming Mental Health Care in America, Final Report, The Presidents New Freedom Commission on Mental Health, July 3002.

◊ The Well-Being Project: Mental Health Clients Speak for Themselves, Campbell, Jean; Schraiber, Ron. California Network of Mental Heath Clients, California Department of Mental Health, 1989.

◊ Mental Health Services Act Community Services and Supports Three Year Program and Expenditure Plan Requirements, Fiscal Years 2005-06, 2006-07, 2007-08. California Department of Mental Health, August 1, 2005.

◊ New York Lawyers for The Public Interest, Inc., Implementation of Kendras Law Is Severely Biased, April 7, 2005.\%20-\%20Report\%20on\%20Kendra's\%20Law.pdf

◊ Henry Steadman, Kostas Gounis, Deborah Dennis, et al., Assessing the New York City Involuntary
Outpatient Commitment Pilot Program, 52 Psychiatric Services 330 (2001), cited in Ibid.

◊ The Effectiveness of Involuntary Outpatient Treatment: Empirical Evidence and the Experience of Eight States, Rand Corporation, 2001.

◊ Effectiveness of Integrated Services for Homeless Adults with Serious Mental Illness: A Report to the Legislature, Grantland Johnson, Secretary California Health and Human Services Agency and Stephen W. Mayberg, PhD., Director of California Department of Mental Health, May 2003.

◊ Racial Disproportion Seen in Applying Kendras Law, Michael Cooper, The New York Times, April 7, 2005; Kendras Law Hearing Reopens Coercion Controversy, April 11, 2005

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Bridgette BarnettBy:
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San Francisco Board of Supervisors City Operations and Neighborhood Services Committee


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