Orange County Supervisors Misled by Health Care Agency on Laura's Law

In light of the increasing incidence of homelessness, arrest, incarceration, suicide and dangerous behavior by (and to) people with untreated serious mental illness who refuse voluntary treatment, and the impending release of incarcerated mentally ill to Orange County as a result of Brown v. Plata, on August 9th the Orange County Board of Supervisors asked the Health Care Agency (HCA) to submit a "recommendation to implement" Laura's Law (also known as "Assisted Outpatient Treatment" or "AOT") as a way to keep patients and public safer. The report submitted by Mark Refowitz, Deputy Director of the Behavioral Health Services division is exceedingly misleading and uninformed.

Laura's Law is aimed to help a very small but important segment of the mentally ill. It is only for those who have severe mental illness and a past history of violence, arrest, incarceration, or multiple hospitalizations due to a failure to stay in treatment. Laura's Law allows courts, after extensive due process, to order certain individuals to stay in treatment as a condition for living in the community. It provides the patient with a case manager and access to treatment. It has proven very successful and cost-effective in other states that use it, and surprisingly, even those who are court ordered into treatment express gratitude about it.

The Board of Supervisors first expressed interest in implementing Laura's Law in 2004.The Orange County Health Care Agency never took any action. Since then, many have died or been incarcerated.

On October 13, 2011, in response to the most recent request from the Board of Supervisors, Health Care Agency Deputy Director, Mark Refowitz
that gave them three options:
  1. Provide $5.7-6.1 million to implement Laura's Law
  2. Don't implement Laura's Law
  3. Implement more voluntary programs

Option one is the only option that meets the supervisor's goal of delivering services to seriously mentally ill people who have a past history of violence, incarceration, dangerous behavior or multiple rehospitalizations who refuse voluntary treatment. It is also the only one likely to be of benefit to mentally ill inmates released to Orange County as a result of Brown v. Plata who refuse voluntary treatment. Options two and three fail to deliver services to seriously mentally ill individuals who refuse voluntary treatment and therefore fail to meet the goals of the supervisors.

While option one ostensibly presents a path to implementation, according to the
and a
prepared by the California Treatment Advocacy Coalition in conjunction with National Alliance on Mental Illness of Orange County (
), Mr. Refowitz
  1. failed to inform the supervisors about the advantages of that plan;
  2. overstated alleged disadvantages;
  3. grossly inflated the costs;
  4. failed to offset the costs with the savings; and
  5. misled the supervisors about the multiple funding streams available to implement the program.
Mr. Refowitz's Health Care Agency report indicated that implementing Laura's Law in Orange County would cost $5.7 million to $6.1 million annually,
funding can be used and the only programs that can be cut to pay for it are programs serving involuntarily committed patients. None of these statements are true. MHSA funds can be used. The non-MHSA costs of implementing Laura's Law would not exceed $676,000. Involuntary programs would not have to be cut. (

Misinforming the Board of Supervisors could be deadly for two groups of Orange County residents: those with severe mental illness and those without. Current Orange County Health Care Agency policy is to not provide services to mentally ill people who refuse treatment until after they become "danger to self or others" or "gravely disabled." After that, HCA will offer inpatient commitment when requested by police. Orange County does not have a single program that will serve people who are mentally ill and refuse treatment, other than waiting until after violence and involuntarily committing them. Laws should prevent violence, not require it. Laura's Law does that. It provides a less restrictive, less expensive alternative to these LPS/5150 inpatient commitments. But due to the Health Care Agency's misleading report, the Board of Supervisors may be swayed into maintaining the status quo.

1. Based on a review of Mr. Refowitz's report, regulations issued by the California Department of Mental Health, literature in peer-reviewed publications; plus actual implementation in New York, Nevada County, Los Angeles and elsewhere, Mental Illness Policy Org suggests the board of supervisors implement Laura's Law.
2. We suggest funding Laura's Law in Orange County by using Mental Health Services Act funds, Medicaid, Medicare, private insurance and patient fees. Nevada County has successfully used these funding streams to implement Laura's Law and found it resulted in a net savings of $500,000 or $2.52 for every $1.00 invested. The savings come from reduced hospitalizations, shorter length of hospitalizations, reduced involuntary commitments, reduced 911 calls, reduced arrests, reduced trials, reduced incarcerations, and reduced parole costs.
3. The Orange County Health Care Agency Behavioral Health Services Department should make narrowly defined serious mental "illness" rather than "all other" their top priority.
4. Because Health Care Agency leadership is critical to implementing a successful Laura's Law program (one that keeps patients and public safer), we recommend the supervisors consider replacing Mr. Refowitz with a Behavioral Health Services Director who will work with the board to implement and champion the program. People with severe mental illness, their families and Orange County residents shouldn't have to wait for more to die.

Read the complete report.