San Diego County Launches Laura's Law

San Diego County law-enforcement has seen a number of 911 mental health calls increased steadily in recent years. Often those calls involve people who have a history of mental illness but refuse to stay on medications or don't Inc. they need any help. Between FMU members have been helpless to intervene but now there's a new upsurge -- option and pinnacle County Laura's law. Under the law concerned family member can ask a judge to order a loved one to undergo outpatient treatment. KPBS health reporter Kenny Goldberg spoke with Alfredo McCarry cynical County director of behavior health sciences and Dr. Michael Popper chief medical officer of short behavioral health services about how the county's recent adoption of Laura's law is working out. Here's the interview. Afraid of [ Indiscernible ] has been an option for California counties since 2003. Defended a County approved Laura's law only last year. What took so long? It's been a long process. We actually started a voluntary program designed to serve this population and outreach and engage program and in fact we have served a number of people currently it's our in-home outreach team. We actually served over close to 300 individuals are serving right now through the two providers. We have one asserts kind of the northern side of the county and other when the southern side of County kind of splits the mental aspect in particular fiscal considerations once we identified the dollars, once we had talked with public safety in the courts we knew we are ready to do this and then once the Board of Supervisors adopted it to take some time for start up. We had to do a procurement for the assistant outpatient team also nanus AOT which is tell a care Corporation and plus a lot of forms memorandums of understandings with the court everyone knows their role and implement an Laura's law. : Exactly? How will the loved ones of people who have a mental illness apply for the program Q Mac Will really be to take referrals from pretty much everyone 18 and over but typically it is family members is people that live with someone who has a serious mental element is coming treated and but also can come from hospitals and note Dr. Mike Popper is here with us he can make the referral or Coke we can get referrals from law enforcement other mental health providers, they'll come in different directions of nursing with in-home outreach team because in essence that team will feel the referrals and that's continuing as we speak so we are implementing Friday and we're ready to go. I understand that people to be eligible for this program they have to meet certain criteria. What are some of them, Alfredo? Creek, there's actually by criteria that they must meet. Number one is they must be 18 years old and that's real clear. By definition have to the mental illness that is defined by an institution code. They have to be clinically determined that are unlikely to survive safely in a community without supervision or go to demonstrate a history of noncompliance for example in the last 36 months a person has been resulted in a psychiatric position or in a jail's mental health unit or in the last 40 months of persons mental illness resulting monomer acts of serious violent behavior. Have an offer to purchase speaking treatment but they did engage, the condition is substantially curating AOT [ Indiscernible ] is least restrictive place necessary to ensure recovery and the really need this level of treatment to prevent a relapse or deterioration that would likely result in grave disability and the determination of the personal benefit from AOT so obviously we do the Laura's law evaluation which will be done by our in-home outreach team who actually will the client so they already have information and money to the formal evaluation they have to meet those nine criteria. And we know right now in the program we have in the queue ready to start in terms of getting the form of vibration we have somewhere around 20 individuals. So we are again, having done this work we know there are certain individuals that meet the critter will probably meet the criteria. Said Dr. Michael plop earthen pot does not allow the court to force a person with a severe mental illness to take medication. Can a person with severe mental illness be adequately cared for an out patient setting without taking medication? Will part of the treatment program recommended by the judge when it comes to that when a person actually is the court has been petitioned to actually review a person's case, part of the treatment program will be to take medication. That's not forced medication but it would be in most instances a component of the treatment recommendation. So while there's no provision to actually force anybody to take medication or somebody to fill that treatment program which may include medication case and they may have taken and maybe deteriorating and therefore risk the person can be upon court ordered place and 5150 to 2 psychiatric facility for up to 72 hours for an evaluation and during that time they would then in all likelihood the location's mother is no provision to actually impose taking medication upon individual ultimately the treatment plan had failed Is that's putting here's then or which you say in that regard? Helpings of. Think of their implementation of the law. I think me and there's a black robe affect the talk about whereby judge is telling an individual that I want you to follow all the treatment recommendations that would include medication and many people we believe will respond to that so-called black robe affect and comply. Alfredo very understanding about 11 counties in California including San Diego is implemented Laura's law about Orange County which is the close and experience to San Diego is been experience with floors on orange county? Yes, good question. Since October 2014 Orange County has adopted and actually implemented the program. They received hundreds of calls but they've actually received technically 750 referrals. As of today only basically 19 individuals were actually went to a court hearing. Of those only 19 had a contested meeting hearing the challenged and all the cases the county, the corporate health and services were provided. They have open and closed individuals. It's a six-month commitment. I don't have the data on renewals but that is allowable into the law. You can continue to petition for additional months and so again, orange county with what's really important and Dr. Popper alluded to this is the black robe affect your go with their finding is under the law once you receive referral to start to engage the client and you move -- you to the evaluation throughout the whole process you were to be offering services voluntarily so the majority of people that actually have received assisting out patient in Orange County are actually voluntary and as I said only 19 individuals have you know basically received -- and actually those court orders were settled so of the 19 I believe 16 or so were actually settled and so they agreed in the court took of the tobacco to a contested hearing so it kind of tells you again really reinforces Dr. Popper's point about the importance of the black robe. Dr. Parker the ACLU has argued that Laura's law sort of reinforces its stereotype that people with severe rental premises can't make their own decisions, they're not capable of it. Would make it a criticism? Well far and away, most people with mental analyst including severe mental must can continue to make their own decisions however there are group of people who are very severely mentally ill predominantly schizophrenia at some point bipolar user that don't recognize that they haven't illness. They despite all efforts to educate them just don't believe that they suffer in illness and therefore aren't seeking treatment themselves and could get into significant difficulty in terms of danger himself most often and sometimes danger to others. For that group of people the alternative is for if somebody is a danger to other the on the -- the only tool we have is that hundred and 80 day's PlayStation, that seems to me to be much more course of and prodding them of their civil liberties than engaging and assisted outpatient treatment at 20. Help crucial is housing Dr. Popper in this whole equation with floors law doesn't address really? Housing is a critical issue. In this community with one of the biggest homelessness issues in the country particularly including those with rental illness or car at least a third of Homer -- homeless have mental illness so housing is critical and one of the issues we face we discharge people from the hospital is a lack of reasonable place to live. And especially a reasonable place to live which would have wraparound mental health services which would enable them to stay well. When they get back in the committee's was a serious issue in San Diego terms adequate housing for the seriously mental health and treatment facilities and availability of the services after discharge adequately meet needs. Leslie Alfredo, what role do you Laura's law will play in the whole spectrum of mental health services in the county? I think to a large degree will really round out our options. We really don't have the quarter option right now and this will really provide for that leverage is Dr. Popper indicated for the most part I think her system works very well with people or call that the linkage but there is a subset of group that for reasons like they are not aware for months on this or they have had as spirits is medications or maybe cultural issues that give the way of receiving care, this will give us never tool and we're really looking forward to it. I mean, we look at other communities including other states including New York and they have been quite effective in Italy to mirror the outcomes as their voluntary sort of service programs which this program is actually being mirrored on which inch reinforced Dr. Popper's point, we are including housing needed in the overall AOT again sets mirrored after [ Indiscernible ] and that will be an additional resource for those individuals who need housing. Think very much I've been speaking with Alfredo [ Indiscernible ] director of Peter help for Senate will carry it Dr. Michael Popper the chief medical officer for sharp behavior health services and nine Kenny Goldberg.