New report finds Laura’s Law is helping the mentally ill

Outpatient treatment program shows signs of successs despite initial controversy

After three years, a San Francisco mental health program that can compel someone to receive outpatient treatment has shown success in reducing emergency care and jail stays.

More than half of those brought into the program, which requires a referral by a health care provider or family member, were recently homeless and nearly all had been treated recently by Zuckerberg San Francisco General Hospital’s Psychiatric Emergency Services.

A new evaluation of the assisted outpatient treatment (AOT) program, also known as Laura’s Law, shows that the 129 participants were costing a combined $485,000 monthly in city services before entering the program, but with the program, the cost dropped by 83 percent to $81,745 per month.

After years of debate and controversy, Laura’s Law was approved by the Board of Supervisors and launched in November 2015, 13 years after a state law passed allowing county boards to establish such programs.

Opponents at the time argued it was an infringement of patients’ civil liberties. Others said it would be ineffective because it doesn’t force a person to take medication.

The findings come as good news for a city in the midst of reforming its mental health services under Mayor London Breed, where a similar debate is underway over court-ordered conservatorships.

Breed wants the Board of Supervisors to expand The City’s ability to obtain conservatorships under Senate Bill 1045, which passed last year. The program would allow officials to force homeless people suffering from mental illness into treatment, including in locked facilities.

Currently, those eligible for conservatorships must first go through the outpatient program under Laura’s Law, but that restriction has narrowed the scope of SB 1045 so that as few as five people in The City could be eligible; supporters hoped it could cover between 50 and 100.

SB 1045’s author, state Sen. Scott Wiener, is working to pass legislation in Sacramento, Senate Bill 40, that would eliminate that provision.

The AOT program provides intensive case management to participants and helps them link up to long-term care. If a person refuses services, a court could compel them to receive treatment.

“On average we work with individuals for 138 days,” Dr. Angelica Almeida, director of assisted outpatient treatment program, told the Health Commission last week. “Given the needs of this population and the risk factors, it takes a significant amount of time to stabilize individuals in the community.”

The focused treatment is apparently paying off.

“There is substantial evidence that indicates that implementation to date can be considered a success,” said a three-year evaluation of the program by consultant Harder+Company Community Research. The report was presented to the Health Commission last week.

Among the stats of participants is that the number of individuals who experienced Psychiatric Emergency Services dropped from 105 in the three years prior to entry in AOT to 60, or 47 percent, since AOT.

Also, the number of individuals with a recent incarceration dropped from 81 to 51 since participating in AOT.

Most participants are white males between 36 and 45.

The success sounded so good to the Health Commission, that some members wanted to know how to boost enrollment. However, the program has strict eligibility requirements and only specific people, such as a family member or a health care provider, can refer a person for possible entry.

Health Commissioner Laurie Green asked if the city is “capturing all the people that could benefit from this program.”

“There are these various referrals. Do you feel like if you had the funding, you could expand this to many more people because the impact is so clear?” Green said.

Almeida said it wasn’t exactly clear how many people that aren’t being referred could qualify for AOT.

“We imagine that there are individuals who would qualify who don’t get referred to us for a number of different reasons,” Almeida said.

She said the strategy for increasing participation is to reach out to those who can refer to the program to educate them about it and who might qualify.

“We need those referrals to come in to be able to work with them,” she said.

Since launching in November 2015, the program, overseen by the Department of Public Health, has received 616 calls, 321 for information requests, 295 for referrals, of which 129 participated.

The report said that “89 of the 129 individuals served by the AOT program voluntarily engaged in services” and that “85 of the 129 individuals (66 percent) remained connected to a treatment provider at the time of this evaluation.”

Some contacted by AOT could end up being court ordered into a conservatorship.

“Sixteen individuals (12 percent) that AOT outreached and engaged with since the beginning of the program were determined to need a higher level of care than the AOT program provides,” the report said. “Of the 16 individuals conserved, 13 remain housed in the community, while three now reside in locked facilities which provide them with a higher level of care and personal safety appropriate for their needs.”

About 86 percent of participants surveyed in the report said they are feeling hopeful about their future and 82 percent said they were treated with respect.

Health Commissioner Dr. Edward Chow acknowledged the controversy when praising the program.

“When this topic was taken up it was extremely controversial,” Chow said. But, he said, based on the findings, the program is a “useful tool” and “all these individuals at this point have actually benefited from it.”

In the report, one unidentified AOT staff member described “the uniqueness of this program.” Pointing to its additional peer support, low caseloads and flexibility to do outreach, the staffer said, “I really think this program is changing and improving the lives of these individuals.”

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