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Despite Pleas from Families, County Supervisors Opt Against Vote on Laura’s Law

Despite the pleas of a dozen public speakers, several of whom have had family members die while struggling with mental illness, the Santa Barbara County Board of Supervisors backed away Tuesday from a vote on a program that county staff say would save money and provide treatment for the most severely mentally ill.

One family member called the board's decision "profoundly sad."

The supervisors heard from county staff Tuesday about Laura's Law, a bill that has been adopted by several California counties and calls for mentally ill people who refuse treatment and meet specific criteria to enter a court-ordered treatment program.

On the table was a pilot program that would take 10 of the patients in the Alcohol, Drug & Mental Health Services department who are resistant to treatment and begin a system of outreach in order to get them to choose to treat their illness voluntarily. 

If, after repeated tries, a person still refused treatment and met the criteria, which include repeated mental health crises, a judge could order him or her to begin treatment in an outpatient setting.

County staff estimated that most likely only one person would reach that point out of the 10 who entered the program.

Although Supervisors Doreen Farr and Salud Carbajal said they felt it was time to embrace the law, the other three supervisors said they could not support it after hearing from ADMHS Director Alice Gleghorn that the department was overtaxed already, and could not take on another program as it works to make changes that were highlighted by an outside report.

The supervisors ultimately voted to come back after the upcoming budget process is complete to hear about the changes to the system that are being made, but punted on a Laura's Law vote.  

Lynne Gibbs, who Noozhawk profiled last year during a story on Laura's Law, was one family member who said she was "profoundly sad and disappointed" by the decision.

"I feel we have let down the families, some of whom have advocated for Laura's Law for years," she said.

In the meantime, she said, many have seen their family members suffer or die as a result of untreated mental illness. She added that the time for the law's passage in Santa Barbara "was a decade ago."

Gibbs, who serves on two of the ADMHS systems change committees, said that no degree of changes to the system "will help persons who are able to reject treatment for their mental illness when they don't know they are ill."

During Tuesday's presentation, Assistant County Executive Officer Terri Maus-Nisich gave an encyclopedic presentation, stating that the law has been significantly debated across the state and the country.

Proponents say the law reaches out to people who are so severely mentally ill that they don't recognize they have symptoms, and who are "unlikely to survive in the community," she said. "Frankly, they don't recognize they have a need."

Opponents often say that adults should be able to choose treatment for themselves and that civil liberties are at stake.

Forty-five states have legislation authorizing assisted outpatient treatment, or AOT, and New York is the only state with widespread implementation, she said.

Twelve counties in California are currently considering AOT, including Santa Barbara, she said, and six are in the process of implementing the law.

More counties are looking into the law at this time thanks to a 2013 clarification that stated Mental Health Service Act monies could be used for court-ordered treatment services, Nisich said.

MHSA monies may be used for components of the law, like housing that might be needed while a person is in treatment, but the county's general fund would have to fund court costs and costs to county counsel and public defender as the person is moving through the court process.

If the program were to be fully implemented, about 75 people would qualify, and by the time the extensive outreach was conducted, only about three three would received a court order, since most will chose treatment voluntarily before then, she said.

The cost to operate a full program would be $2.2 million, and would include the costs of a full-time psychologist, a psych tech, court costs for a public defender, county counsel and all associated housing for about half of the clients.

Perhaps most astounding were the cost figures given.

Under the full program, each client moving through AOT would cost about a third of what those clients cost to the system now. The cost of each would be about $30,000 under AOT, as opposed to about $89,000 now.

Maus-Nisich later clarified those costs only include treatment, and do not include the amount the county spends for incarceration for those clients.

A "small yet meaningful 10-person program" was also considered, and would have cost $630,000 for a half-time psychologist and all the accompanying court expenses. 

With a smaller program, economies of scale would be lost, Maus-Nisich said, but the cost savings would still be significant, from $165,000 per client under the current system to $63,000 a person under AOT. The program could save over $4 million in hospitalization costs, according to the county estimates.

Supervisor Farr reminded the board that she and District Attorney Joyce Dudley gave direction to staff to look into the law because "we were asked by the public to bring it."

"We've heard so many heartbreaking stories about people in our community," she said.  

The department's system changes are going well, but Farr said she felt the law would complement the work being done. Dudley was also on hand at Tuesday's meeting to support the law.

When Supervisor Janet Wolf asked about success rates for the law, Maus-Nisich responded that L.A. County's program reported an 80-percent decrease in incarceration and a decrease of 70 percent in hospitalizations of patients in the program.

Nisich said it was more difficult to tell whether that success came from expanded services or the court-order itself.

Gleghorn said positive changes in the department are ongoing, but that "moving forward on so many fronts at once is proving very difficult."  

"It's probably too great a strain on the system at this time," she said, adding that the county could come back in a year and revisit.

Supervisor Peter Adam sympathized with Gleghorn, who began the position in December 2014.

"We hired you to fix a troubled department," he told her, adding that it is a "bit much" to ask somebody who has been there four months to take on another project.

About a dozen people spoke during public comment, many of whom were parents of adult children with mental illness who stated that many families are in crisis and urged county supervisors to approve the law. Some parents who spoke have children in the Incompetent to Stand Trial Program that is currently a cost burden to the county.

Ann Eldridge said she's been hearing the same arguments for a decade against the program, and "I am horrified that they still exist." 

Eldridge said the county should not wait until changes to the system are complete.

"It's a bit of magical thinking that if we have all this stuff done, then they will come," she said. "We have waited too long. ... It's time to do it."

On the dais, Adam said he didn't believe Laura's Law would fix the department.

"Fundamentally, we just have not been doing a good job," he said. "Better management is the only thing that is going to solve this problem."

Supervisor Steve Lavagnino said the board is more committed to mental health than ever before, but that he had to defer to Gleghorn's observations.

"Until I get the ADMHS department head to say she's ready for it and her department is ready for it, I can't move forward," he said.

Farr said that not only does she look to staff for recommendations, but "I'm looking to the public we serve. Sometimes it's our job to push and ask for more," she said, adding that she supported the pilot project. Supervisor Carbajal agreed.

Ultimately, Wolf served as the deciding voice on the issue, and said she felt things were moving in the right direction and didn't feel good about taking on another program.

"In all good conscience, I can't vote for it, it's not working for me," she said.

The board approved coming back in several months to review the systems change process, with Carbajal saying he was voting yes, but "with discontent that we're not looking at Laura's Law."

"I think we all have the same thought," Lavagnino replied.

Noozhawk staff writer Lara Cooper can be reached at .(JavaScript must be enabled to view this email address). Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.

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