Research Shows Assisted Outpatient Treatment (AOT) Works

AOT allows courts to order six months of mandated and monitored treatment in the community for a very small group of people with very serious mental illness who have previously become arrested, incarcerated, violent, homeless or hospitalized multiple times as a result of their failure to comply with treatment, often because they are so ill they don't know they are ill ("anosognosia").

More than two decades of research and practice show it works. AOT reduced hospitalizations[i], arrests[ii], incarcerations, crime[iii], victimization[iv] and violence[v] and improved treatment adherence[vi] The Department of Justice deemed AOT to be an effective evidence-based program for reducing crime and violence[vii]; AOT also produces significant taxpayer/system cost savings. New York’s program achieved savings of 50% in the first year and an additional 13% in the second year. A study in North Carolina reported similar cost savings of 40%[viii]. These savings free up mental health funds to treat more people or provide better treatment.

Research showing AOT (Kendra's Law) in New York works

Research showing AOT (Laura's Law) in California works is here

Footnotes 

Biggest Police Group Endorses Greater Use of Assisted Outpatient Treatment (AOT)

“AOT helps prevent mental health officials from offloading 
the most seriously mentally ill to jails, shelters, prisons and morgues.” 

(Oct. 29, 2014) The International Association of Chiefs of Police (IACP) took steps to improve care for people with serious mental illness and protect the safety of officers by endorsing greater use of Assisted Outpatient Treatment (AOT) at their 2014 annual meeting in Orlando, FL. Research collected by Mental Illness Policy Org shows AOT reduces arrest, suicide, hospitalization and violence by people with the most serious mental illnesses over 70% each. By replacing more expensive and liberty-depriving inpatient commitment and incarceration with less expensive outpatient treatment, AOT cut taxpayers’ costs in half. DJ Jaffe, Executive Director of Mental Illness Policy Org. said “Police step in when one condition has been met: the mental health system failed. This resolution will encourage mental health departments to do the right thing. If implemented it will save the lives of patients and police.”

AOT allows judges to order a small group of the most seriously ill to stay in six months of mandated and monitored treatment while they live in the community. It is limited to those who have already accumulated multiple episodes of homelessness, hospitalization, violence, arrest or incarceration associated with going off treatment. Representative Tim Murphy (R. PA) included funding for AOT in the Helping Families in Mental Health Crisis Act (HR 3717). AOT is known as “Kendra’s Law” in New York and “Laura’s Law” in California after two women who were killed by persons with untreated serious mental illness. Families of the seriously ill in those states had been arguing for AOT to help their ill family members get treatment, but could not get mental health departments to listen to them until after the tragedies.

As the result of the mental health system’s refusal to deliver services to the most seriously ill, and preferring to treat the highest functioning, there are now ten times as many mentally ill incarcerated as hospitalized according to the Treatment Advocacy Center. New Windsor, NY Police Chief Michael Biasotti conducted a survey of 2400 senior law enforcement officers and recently told Congress “We have two mental health systems today, serving two mutually exclusive populations: Community programs serve those who seek and accept treatment. Those who refuse, or are too sick to seek treatment voluntarily, become a law enforcement responsibility.” “AOT will help return care and treatment of the seriously mentally ill back to the mental health system where it belongs” said Jaffe. The National Sheriff’s Association and Department of Justice previously endorsed AOT as has almost every major organization concerned about care and treatment of the most seriously ill. Chief Michael Biasotti and outgoing IACP President Yost Zakhary were responsible for obtaining the IACP endorsement. Mental Illness Policy Org urges local chiefs to encourage their mental health departments and legislatures to make greater use of it.

A copy of the IACP Resolution follows or get PDF version to share with local law enforcement and mental health officials. Learn about AOT in New York (Kendra's Law) and about AOT in California (Laura's Law)

Mental Illness Policy Org. is an independent science based think tank on serious mental illness (not mental health) @MentalIllPolicy

IACP Endorses Assisted Outpatient Treatment 
Resolution adopted by IACP October 28, 2014
PDF VERSION

WHEREAS, law enforcement officers are often the first responders to individuals in mental health crisis; and

WHEREAS, law enforcement officers continue to experience an increase in interactions with people with severe mental illness[1]; and

WHEREAS, such interactions consume a disproportionate amount of limited law enforcement resources[2]; and

WHEREAS, approximately forty percent of individuals with severe mental illness are not receiving treatment, primarily because the illness affects their ability to voluntarily participate in needed care[3]; and

WHEREAS, noncompliance with treatment, specifically non-adherence to medication, is strongly associated with hospitalization,[4] suicide,[5] victimization,[6] violence[7] and relapse;[8] and

WHEREAS, noncompliance with treatment is also strongly associated with arrest and incarceration,[9] resulting in a disproportionate representation of individuals with severe mental illness in the criminal justice system; and

WHEREAS, a 2014 report found that 10 times more mentally ill persons are in prisons and jails than are receiving treatment in state psychiatric hospitals[10]; and

WHEREAS, Assisted Outpatient Treatment (AOT) provides court-ordered treatment in the community for high-risk individuals with severe mental illness and a history of treatment noncompliance, as a less restrictive alternative to inpatient hospitalization; and

WHEREAS, more than two decades of research and practice document AOT as an effective tool to improve outcomes for this focus population, including reduced hospitalizations[11], arrests[12], incarcerations, crime[13], victimization[14] and violence[15] while increasing treatment adherence[16] and substance abuse treatment outcomes; and

WHEREAS, numerous state and local law enforcement associations support and have championed the passage and implementation of AOT programs; and

WHEREAS, the Department of Justice deemed AOT to be an effective evidence-based program for reducing crime and violence[17]; and

WHEREAS, studies amply demonstrate AOT’s effectiveness in reducing arrests and incarcerations, e.g., a recent study of New York State’s signature AOT program (“Kendra’s Law”) concluded that the “odds of arrest in any given month for participants who were currently receiving AOT were nearly two-thirds lower” than those not receiving AOT[18]; and

WHEREAS, AOT also produces significant taxpayer/system cost savings, ultimately increasing overall service capacity and leading to greater access for both voluntary and involuntary recipients. A cost-impact study in New York City found net cost savings of 50% in the first year and an additional 13% in the second year; a study in North Carolina reported similar cost savings of 40%[19]; now, therefore be it

RESOLVED, that the International Association of Chiefs of Police (IACP) recommends the authorization, implementation, appropriate funding, and consistent use of Assisted Outpatient Treatment (AOT) laws to ensure treatment in the least restrictive setting possible for individuals whose illness prevents them from otherwise accessing such care voluntarily.

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[1] Biasotti, Michael C. Management of the severely mentally ill and its effects on homeland security. Naval Postgraduate School Monterey Ca. Dept. of National Security Affairs, 2011.

[2] Biasotti, Michael C. Management of the severely mentally ill and its effects on homeland security. Naval Postgraduate School Monterey Ca. Dept. of National Security Affairs, 2011.

[3] Substance Abuse and Mental Health Services Administration. (2013). Results from the 2012 National Survey on Drug Use and Health: Mental Health Findings. NSDUH Series H-47, HHS Publication No. (SMA) 13-4805.

[4] Valenstein, M., Copeland, L., Blow, F., et al. (2002). Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission. Med Care 40:630–639.

Weiden, P., Kozma, C., Grogg, A., et al. (2004). Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia. Psychiatric Services 55:886–891.

Gilmer, T., Dolder, C., Lacro, J., et al. (2004). Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia. American Journal of Psychiatry 161:692–699.

Ascher-Svanum, H., Faries, D., Zhu, B., et al. (2006). Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. Journal of Clinical Psychiatry 67:453–460.

Velligan, D., Weiden, P., Sajatovic, M., Scott, J., Carpenter, D., Ross, R., Docherty, J., (2009). The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness. Journal of Clinical Psychiatry. 70 Suppl 4:1-46; quiz 47-8.

[5] Muller-Oerlinghausen, B., Muser-Causemann, B. & Volk, J. (1992). Suicides and parasuicides in a high-risk patient group on and off lithium long-term medication. Journal of Affective Disorders, 25(4),261-269.

Leucht S., Heres S. (2006). Epidemiology, clinical consequences, and psychosocial treatment of nonadherence in schizophrenia. Journal of  Clinical Psychiatry, 67(Suppl. 5), 3–8.

Nordentoft, M. (2007). Prevention of suicide and attempted suicide in Denmark. Epidemiological studies of suicide and intervention studies in selected risk groups. Danish Medical Bulletin, 54(4),306-69.

Chapman, S.C., Horne, R. (2013). Medication nonadherence and psychiatry. Current Opinion in Psychiatry, 26(5),446-552.

[6] Hiday, V., et al. (1999). Criminal Victimization of Persons with Severe Mental Illness. Psychiatric Services, 50, 62-68.*

*Individuals with severe psychiatric disorders who were not taking medication were found to be 2.7 times more likely to be the victim of a violent crime (assault, rape, or mugging) than the general population.

[7] Swartz, M., Swanson, J., Hiday, V., Borum, R., Wagner, H., Burns, B. (1998). Violence and severe mental illness: The effects of substance abuse and nonadherence to medication. American Journal of Psychiatry, 155, 226-31.

Substance abuse, medication non-compliance and low insight into illness operate together to increase violence risk. Van Dorn, R., Volavka, J., Johnson, N. (2011). Mental disorder and violence: is there a relationship beyond substance use? Social Psychiatry and  Psychiatric Epidemiology.

Witt, K., Van Dorn, R., Fazel, S. (2013). Risk factors for violence in psychosis: Systematic review and metaregression analysis of 110 studies. PLOS  ONE, 8, e55942.

Belli, H., Ozcetin, A., Erteum, U., et al. (2010). Perpetrators of homicide with schizophrenia: sociodemographic characteristics and clinical factors in the eastern region of Turkey. Comprehensive Psychiatry, 51,135-41.

Alia-Klein, N., O’Rourke, T., Goldstein, R., et al. (2007). Insight into illness and adherence to psychotropic medications are separately associated with violence severity in a forensic sample. Aggressive Behavior, 33, 86–96.

Elbogen, E., Van Dorn, A., Swanson JW, et al. (2006). Treatment engagement and violence risk in mental disorders. British Journal of Psychiatry, 189,354–360.

Swanson, J., Swartz, M., Essock, S., et al. (2002). The social-environmental context of violent behavior in persons treated for severe mental illness. American Journal of Public Health, 92, 1523–1531.

Bartels, J., Drake, R., Wallach, M., et al. (1991). Characteristic hostility in schizophrenic outpatients.  Schizophrenia Bulletin, 17, 163–171.

[8] Robinson, D. (2010). First-episode schizophrenia. CNS Spectrum, 15 (Supplement 6), 4-7.

Ayuso-Gutierrez, J., Del Rio, V. (1997). Factors influencing relapse in the long-term course of schizophrenia. Schizophrenic Research, 28, 199-206.

Morken, G., Widen, J., Grawe, R. (2008). Non-adherence to antipsychotic medication, relapse and rehospitalisation in recent-onset schizophrenia. BMC Psychiatry, 8,32-8.

Suppes, T., Baldessarini, R., Faedda, G., Tohen, M. (1991). Risk of recurrence following discontinuation of lithium treatment in bipolar disorder.  Archives of General Psychology, 48(12),1082-1088.

Franks, M., Macritchie, K., Mahmood, T., Young, A. (2008) Bouncing back: is the bipolar rebound phenomenon peculiar to lithium? A retrospective naturalistic study. Journal of Psychopharmacology, 22(4), 452-456.

[9] Munetz, M.R., Grande, T.P., & Chambers, M.R. (2001). The incarceration of individuals with severe mental disorders. Community Mental Health, 34:361-71.* * Nearly 90 percent of a sample of individuals with severe mental illness in a local jail were partially or completely non-complaint with medication in the year before they were incarcerated.

Lattimore, P. K., Broner, N., Sherman, R., Frisman, L., & Shafer, M. S. (2003). A comparison of prebooking and postbooking diversion programs for mentally ill substance-using individuals with justice involvement. Journal of Contemporary Criminal Justice, 19(1), 30-64.* *Individuals with co-occurring mental illness and substance abuse who are noncompliant with medication have a threefold increase in risk for arrest and are significantly more likely to be at risk for violent behavior.

Ascher-Svanum, H., Nyhuis, A.W., Faries, D.E., Ball D.E., & Kinon B.J. (2010). Involvement in the US criminal justice system and cost implications for persons treated for schizophrenia. BMC Psychiatry, 10:11.

Shelton, D., Ehret, M. J., Wakai, S., Kapetanovic, T., & Moran, M. (2010). Psychotropic medication adherence in correctional facilities: A review of the literature. Journal of Psychiatric and Mental Health Nursing, 17(7), 603-613.

[10] Torrey, EF, Zdanowicz, MT, Kennard, AD, et al. The treatment of persons with mental illness in prisons and jails: a state survey. Treatment  Advocacy Center and National Sheriff’s Association, April 8, 2014.

[11] Swartz, M., Swanson, J., Wagner, H., Burns, B., Hiday, V., & Borum, R. (1999). Can involuntary outpatient commitment reduce hospital recidivism: Findings from a randomized trial with severely mentally ill individuals. American Journal of Psychiatry 156: 1968-1975.

Swartz, M., Swanson, J., Steadman, H., Robbins, P., & Monahan J. (2009).  New York state assisted outpatient treatment program evaluation. Duke University School of Medicine.

[12]Gilbert, A., Moser, L., Van Dorn, R., Swanson, J., Wilder, C., Robbins, P., Keator, K., Steadman, H., & Swartz, M. (2010). Reductions in arrest under assisted outpatient treatment in New York. Psychiatric Services 61: 996-999.

[13] New York State Office of Mental Health. 2005. Kendra’s Law: Final Report on the Status of Assisted Outpatient Treatment.

[14] Hiday, V., Swartz, M., Swanson, J., Borum, R., & Wagner, R. (2002). Impact of outpatient commitment on victimization of people with severe mental illness.  American Journal of Psychiatry, 159: 1403-1411.

[15] Phelan, J., Sinkewicz, M., Castille, D., Huz, St., & Link, B. (2010). Effectiveness and outcome of assisted outpatient treatment in New York state. Psychiatric Services 61: 137-143.

[16] New York State Office of Mental Health. 2005. Kendra’s Law: Final Report on the Status of Assisted Outpatient Treatment.

[17] National Institute of Justice, Program Profile Assisted Outpatient Treatment (AOT). Retrieved August 27, 2014, from  http://www.crimesolutions.gov/ProgramDetails.aspx?ID=228

[18] Gilbert, A., Moser, L., Van Dorn, R., Swanson, J., Wilder, C., Robbins, P., Keator, K., Steadman, H., & Swartz, M. (2010). Reductions in arrest under assisted outpatient treatment in New York. Psychiatric Services 61: 996-999.

[19] Swanson, J., Van Dorn, R.,  Swartz, M., Robbins, P., Steadman, H., McGuire, T., & Monahan, J. (2013). The cost of assisted outpatient treatment: Can it save states money? American Journal of Psychiatry 170:1423-1432.

NAMI/National less than honest with members

Call 202 224 3121 or go here and urge your U.S. Representative to co-sponsor HR 3717, the Helping Families in Mental Health Crisis Act.

NAMI State and local chapters do brilliant work trying to improve care for people with the most serious mental illnesses and provide comfort to them and their families. NAMI/National is ignoring the most seriously ill in order to be politically correct.

Representative Tim Murphy (R. PA) has proposed HR3717 the “Helping Families in Mental Health Crisis” that does much of what NAMI local and state members have been begging for.

SAMHSA FAILS SERIOUSLY MENTALLY ILL

A bill in Congress (HR3717, the Helping Families in Mental Health Crisis Act) would change SAMHSA and some wonder why change is needed. SAMHSA (Substance Abuse and Mental Health Services Administration) was created by Congress to “reduce the impact of…mental illness on America’s communities” and “target … mental health services to the people most in need”. SAMHSA has failed to do either. SAMHSA refuses to require its funds reach the most seriously ill and enacts policies to see they don't.

SAMHSA largely ignores the most significant impacts of mental illness on the communities, specifically violence, incarceration, hospitalization, homlessness and suicide. Instead, SAMHSA focuses on improving metrics like 'feeling of empowerment' 'hopefullness' and other softer outcomes.

Statement/Facts on Laura's Law vote in Los Angeles, CA

If You Don't Ask Your US Rep to Cosponsor Helping Families in Mental Health Crisis Act, You are Part of Problem.

Call your US Rep to ask them to co-sponsor HR-3717, the Helping Families in Mental Health Crisis Act for the 6 reasons below:
Background

Five percent of Americans have serious mental illness (i.e., schizophrenia, severe bipolar). Twenty percent have “any” mental illness (i.e., some form of depression, stress, anxiety, social phobia, etc.).  It is the 5% who are most likely to become homeless, suicidal, criminal, arrested, incarcerated and violent. Up to 40% of the most seriously ill are so ill they do not know they are ill (“anosognosia”). While most mentally ill are not violent, that does not hold true for the untreated seriously mentally ill with anosognosia. We can not ignore them. Following are provisions in HR3717 that most directly improve care for the seriously ill and reduce the chance of violence, homelessness, suicide:

Treatment of violent mentally ill lowers rates of reoffending. New Study

Important new study: Researchers followed violent offenders (sentenced to 2 years or more) for an average of 10 months following their release and ascertained the rate of violent re-offending. The study included 742 individuals without psychosis; 94 with schizophrenia; 29 with delusional disorder; and 102 with drug-induced psychosis. It also assessed whether the individual’s mental illness was treated in prison, after leaving prison, or not at all.

Is Assisted Outpatient Treatment (Laura's Law, Kendra's Law) "Forced Treatment"?

Someone suggested Assisted Outpatient Treatment (AOT) is "Forced" Treatment (and therefore presumably bad).

1. Describing AOT as "forced treatment" demonstrates a misunderstanding. AOT, by definition, is only used after voluntary treatment fails. They serve mutually exclusive populations. For those individuals who won't access voluntary treatment, perhaps because they are too psychotic or have anosognosia, AOT is a way to reduce forced treatment. It is the last off ramp before patients are put into locked into involuntary commitment wards or put behind locked cell doors. Involuntary commitment to a locked hospital ward or a jail cell is a genuine use of force. The AOT research clearly states AOT reduces the use of those forms of forced treatment.

Affordable Care Act/ACA Fails Seriously Mentally Ill

Many 'mental health' advocates claim that the Affordable Care Act (ACA, a/k/a "Obamacare") combined with "mental health parity" will ensure people with mental health issues get care. The ability to keep a child on your insurance until age 26 will likely help many, since serious mental illness affects people in their late teens, early twenties. Maybe other provisions will help the higher functioning. But as the analysis below shows, overall, it makes things worse for the most seriously ill: those who need long term hospitalization.  Unfortunately, the impact of ACA on the most seriously mentally ill has been largely ignored by 'mental health' advocates.

NYC Mental Health Dept. must Prioritize Serious Mental Illness Rather than Mental Health

Testimony by DJ Jaffe, to NYC Dept of Health and Mental HealthNov. 1, 2013

My name is DJ Jaffe. I am Executive Director of Mental Illness Policy Org.

NYC and State used to focus all their resources on people with serious mental illness, but both are engaged in massive mission-creep that now leaves the most seriously ill to fend for themselves. Bullying is the newest cause celebre used by NYC to justify ignoring serious mental illness[1]. The fact that bullying isn’t a mental illness matters not a whit when it comes to spending money. Peer support-in spite of lack of evidence that it reduces violence, arrest, homelessness, suicide and incarceration is flooded with money while Kendra’s Law proven to help the most seriously ill is largely ignored.

NYC has largely abandoned efforts at symptom amelioration for the most seriously ill and instead focuses on ‘recovery’ and ‘wellness’ services for those who are higher functioning. The mental health system, which used to be a mental illness system, has offloaded the most seriously ill to the shelters, prisons, jails and morgues. As a result Riker’s Island is now the primary provider of services to the seriously ill in NYC. There is no known way to prevent mental illness, but ‘prevention’ ranks high in the department’s activities. “Early Identification” is the  new buzz word, when those identified can’t get treatment. Mission-creep and ignoring the elephant in the room: untreated serious mental illness has become policy.

We would ask that NYC stop shunning the seriously mentally ill, end mission creep and return to making serious mental illnesses like schizophrenia and treatment resistant bipolar disorder a department priority.

Here is how NYC can help people with serious mental illness 

Mental Health First Aid Unproven & Should Not Be Funded

• Mental Health First Aid (MHFA) lacks sufficient proof it helps people with serious mental illness. 
• The venders of the program and those who want to purchase it, have convinced Congress to introduce a bill to have taxpayers pay for it. 
• Those funds would be better used on programs proven to help people with serious mental illness.

(Note: If anyone has research contrary to that which we discuss, please post it in comments section. Our goal is to make sure our information and conclusions are accurate. Thank you)

Background: Mental Health First Aid (MHFA) is a commercially available training program created in Australia and now sold by the National Council for Community Behavioral Healthcare, the Maryland Department of Health and Mental Hygiene, and the Missouri Department of Mental Health to non-profits in the United States. The training program purports to teach people to identify the symptoms of mental illness in others and connect them to help. They also license others to be trainers for a fee. Participants get a certificate saying they received the training.

As part of his “Now is the Time” initiative in response to the shootings at Newtown, President Obama announced support  for  Mental Health First Aid. The organizations above, plus NAMI, MHA and others are now lobbying Congress to spend $20 million dollars for passage of The Mental Health First Aid Act of 2013 (S. 153/H.R. 274). The program is shown to make those who receive and give the training feel better, but has not been shown to have an impact on those they are supposed to be helping: people with serious mental illness.

Congress should not fund MHFA, and instead use the funds for programs that work. (Read more)

Rep. Tim Murphy Announces Important Mental Health Legislation

This is big news.

Rep Tim Murphy (R. PA) is a former child psychologist, and head of the Mental "Health" Caucus. In spite of that,  he totally gets serious mental "illness" in adults and what the important versus tangential issues are.  He is as good as a Wellstone or a Domenici, and better than a Kennedy (who tended to focus on mental 'health' versus mental 'illness')

Rep. Tim Murphy has held extensive hearings where he listened to others focused on the most seriously ill including Dr. E. Fuller Torrey, Sally Satel, Joe Bruce , Ed Kelly. He also received extensive input from consumers around the country who contacted him. He  announced the results of his hearings today and the legislation he intends proposing.  It includes preserving hospitals, AOT (a/k/a Kendra's Law), revising HIPPA Handcuffs ( so families can get the info they need to help mentally ill loved ones), reigning in SAMHSA's anti-treatment activities , increasing police training, increasing NIMH budget for serious mental illness, and other key issues. I am very excited. 

 I am no Washington Insider, so I have no knowledge if it will fly or not. But at least someone is focused on right issues, not just PC tangential ones. Please support these efforts. He is totally on the right track. His press release and link to the floor speech follows: (Read more)

Tell Governor Brown to Sign SB 585 to allow MHSA Funds for Laura's Law

(Updated 9/3/13)

Urgent: Contact Governor Jerry Brown immediately (Sept. 2013) and URGE HIM TO SIGN SB 585 which will help clarify that Mental Health Services Act (Prop 63) funds may be used to fund Laura's Law.  Phone: (916) 445-2841.  Fax: (916) 558-3160 and use his online contact form.

Background:

Laura's Law allows courts to order a small group of people who have serious mental illness and a history of dangerousness to stay in treatment as a condition of living in the community. It has reduced arrest, incarceration, hospitalization and length of hospitalization in the two counties that use Laura's Law.

Two Reasons Counties Haven't Implemented Laura's Law:

There are two reasons more counties don't implement Laura's Law. Three million dollars in Mental Health Services Act (MHSA) funds are going to Disability Rights California and they are using those funds to threaten to sue counties that use any MHSA funds to implement Laura's Law even though such expenditure is clearly allowed. Laura's Law requires county boards of supervisors to vote to implement Laura's Law and simultaneously certify that no voluntary programs will be cut to do it.

Steinberg initially promised to help:

 In reaction to widespread outrage that people were being denied access to MHSA funded programs merely because they were so sick they were eligible for Laura's Law, Senator Steinberg introduced SB 585 in early April. The ostensible purpose was to clarify that MHSA funds could be used for people in Laura's Law.  But Steinberg  weakened his own bill. He added back a requirement that other bills by other legislators would have removed. Specifically, he added back a requirement that boards of supervisors vote (directly or through the budget process) to implement Laura's Law. And he added back a requirement that counties certify no voluntary programs will get cut to implement Laura's Law.

Unfortunately, SB 585 is the only bill Steinberg would let pass. And since it does somewhat clarify that MHSA funds can be used for Laura's Law, we are supporting it. Contact Governor Jerry Brown immediately (Sept. 2013) and urge him to sign SB 585 which will help clarify that Mental Health Services Act (Prop 63) funds may be used to fund Laura's Law. Phone: (916) 445-2841 Fax: (916) 558-3160 and use his  online contact form. 

Two new studies should lead to widespread use of Laura’s Law in California

Two new studies (including one reported in the New York Times) should lead to widespread adoption of Laura’s Law in California as a way to help some people with the most serious mental illnesses. Laura’s Law allows courts to order a narrowly defined group of individuals who have a history of violence to stay in treatment while living in the community. It has reduced violence, incarceration, hospitalization and homelessness wherever it has been used.

The first study was conducted in Australia and found 25% of individuals with schizophrenia were charged with a criminal offense during their lifetime. 6.4% of those with schizophrenia and 22.8% of those with schizophrenia plus substance abuse were charged with violent crimes compared to only 2.4% in the control group.

Unfortunately, California’s non-profit mental health industry continues to deny a relationship between violence and untreated serious mental illness and therefore oppose programs like Laura’s Law that can reduce the violence. They also claim it is too expensive.

A second study from Duke University studied New York’s version of Laura’s Law and found any increase in cost is dramatically offset by reduced hospitalization and incarceration costs.

Two Studies Should Lead to Radical Change in Mental Illness Treatment

The first study was conducted in Australia and found  individuals with schizophrenia – even those who do not have substance abuse problems – are significantly more violent than the general population.  The study found

·      25% of individuals with schizophrenia were charged with a criminal offense during their lifetime, compared with 10% of community controls.

·      6.4% of those with schizophrenia were found guilty of a violent offense, and 22.8% of those with schizophrenia plus substance abuse were found guilty of a violent offense compared to 2.4% of the general population

Assisted Outpatient Treatment for Seriously Mentally Ill Cuts Costs in Half

According to a just released study in the July 30, 2013, American Journal of Psychiatry, mandating Assisted Outpatient Treatment (AOT) for a narrowly defined group of persons with serious mental illness results in substantial savings. AOT allows courts to order individuals with serious mental illness and a history of treatment noncompliance to stay in treatment as a condition of staying in the community. It is only available for those who are so ill, they have a past history of going off the treatments that prevented them from becoming hospitalized, arrested, homeless or incarcerated. For this small group of the most seriously ill, AOT is a less expensive, less restrictive, more humane alternative to involuntary inpatient commitment and incarceration.

Researchers at Duke found that treatment costs declined 50 percent in New York City after the first year of AOT, and another 13 percent the second year. Even larger cost savings were reported in five other New York counties. Previous studies have proven AOT dramatically improves care for people with serious mental illness who have trouble staying in treatment voluntarily.