2009 California Welfare and Institutions Code - Section 5345-5349.5 :: Article 9. The Assisted Outpatient Treatment Demonstration Project Act Of 2002

WELFARE AND INSTITUTIONS CODE
SECTION 5345-5349.5

5345.  (a) This article shall be known, and may be cited, as Laura's
Law.
   (b) "Assisted outpatient treatment" shall be defined as categories
of outpatient services that have been ordered by a court pursuant to
Section 5346 or 5347.

5346.  (a) In any county in which services are available as provided
in Section 5348, a court may order a person who is the subject of a
petition filed pursuant to this section to obtain assisted outpatient
treatment if the court finds, by clear and convincing evidence, that
the facts stated in the verified petition filed in accordance with
this section are true and establish that all of the requisite
criteria set forth in this section are met, including, but not
limited to, each of the following:
   (1) The person is 18 years of age or older.
   (2) The person is suffering from a mental illness as defined in
paragraphs (2) and (3) of subdivision (b) of Section 5600.3.
   (3) There has been a clinical determination that the person is
unlikely to survive safely in the community without supervision.
   (4) The person has a history of lack of compliance with treatment
for his or her mental illness, in that at least one of the following
is true:
   (A) The person's mental illness has, at least twice within the
last 36 months, been a substantial factor in necessitating
hospitalization, or receipt of services in a forensic or other mental
health unit of a state correctional facility or local correctional
facility, not including any period during which the person was
hospitalized or incarcerated immediately preceding the filing of the
petition.
   (B) The person's mental illness has resulted in one or more acts
of serious and violent behavior toward himself or herself or another,
or threats, or attempts to cause serious physical harm to himself or
herself or another within the last 48 months, not including any
period in which the person was hospitalized or incarcerated
immediately preceding the filing of the petition.
   (5) The person has been offered an opportunity to participate in a
treatment plan by the director of the local mental health
department, or his or her designee, provided the treatment plan
includes all of the services described in Section 5348, and the
person continues to fail to engage in treatment.
   (6) The person's condition is substantially deteriorating.
   (7) Participation in the assisted outpatient treatment program
would be the least restrictive placement necessary to ensure the
person's recovery and stability.
   (8) In view of the person's treatment history and current
behavior, the person is in need of assisted outpatient treatment in
order to prevent a relapse or deterioration that would be likely to
result in grave disability or serious harm to himself or herself, or
to others, as defined in Section 5150.
   (9) It is likely that the person will benefit from assisted
outpatient treatment.
   (b) (1) A petition for an order authorizing assisted outpatient
treatment may be filed by the county mental health director, or his
or her designee, in the superior court in the county in which the
person who is the subject of the petition is present or reasonably
believed to be present.
   (2) A request may be made only by any of the following persons to
the county mental health department for the filing of a petition to
obtain an order authorizing assisted outpatient treatment:
   (A) Any person 18 years of age or older with whom the person who
is the subject of the petition resides.
   (B) Any person who is the parent, spouse, or sibling or child 18
years of age or older of the person who is the subject of the
petition.
   (C) The director of any public or private agency, treatment
facility, charitable organization, or licensed residential care
facility providing mental health services to the person who is the
subject of the petition in whose institution the subject of the
petition resides.
   (D) The director of a hospital in which the person who is the
subject of the petition is hospitalized.
   (E) A licensed mental health treatment provider who is either
supervising the treatment of, or treating for a mental illness, the
person who is the subject of the petition.
   (F) A peace officer, parole officer, or probation officer assigned
to supervise the person who is the subject of the petition.
   (3) Upon receiving a request pursuant to paragraph (2), the county
mental health director shall conduct an investigation into the
appropriateness of the filing of the petition. The director shall
file the petition only if he or she determines that there is a
reasonable likelihood that all the necessary elements to sustain the
petition can be proven in a court of law by clear and convincing
evidence.
   (4) The petition shall state all of the following:
   (A) Each of the criteria for assisted outpatient treatment as set
forth in subdivision (a).
   (B) Facts that support the petitioner's belief that the person who
is the subject of the petition meets each criterion, provided that
the hearing on the petition shall be limited to the stated facts in
the verified petition, and the petition contains all the grounds on
which the petition is based, in order to ensure adequate notice to
the person who is the subject of the petition and his or her counsel.
   (C) That the person who is the subject of the petition is present,
or is reasonably believed to be present, within the county where the
petition is filed.
   (D) That the person who is the subject of the petition has the
right to be represented by counsel in all stages of the proceeding
under the petition, in accordance with subdivision (c).
   (5) The petition shall be accompanied by an affidavit of a
licensed mental health treatment provider designated by the local
mental health director who shall state, if applicable, either of the
following:
   (A) That the licensed mental health treatment provider has
personally examined the person who is the subject of the petition no
more than 10 days prior to the submission of the petition, the facts
and reasons why the person who is the subject of the petition meets
the criteria in subdivision (a), that the licensed mental health
treatment provider recommends assisted outpatient treatment for the
person who is the subject of the petition, and that the licensed
mental health treatment provider is willing and able to testify at
the hearing on the petition.
   (B) That no more than 10 days prior to the filing of the petition,
the licensed mental health treatment provider, or his or her
designee, has made appropriate attempts to elicit the cooperation of
the person who is the subject of the petition, but has not been
successful in persuading that person to submit to an examination,
that the licensed mental health treatment provider has reason to
believe that the person who is the subject of the petition meets the
criteria for assisted outpatient treatment, and that the licensed
mental health treatment provider is willing and able to examine the
person who is the subject of the petition and testify at the hearing
on the petition.
   (c) The person who is the subject of the petition shall have the
right to be represented by counsel at all stages of a proceeding
commenced under this section. If the person so elects, the court
shall immediately appoint the public defender or other attorney to
assist the person in all stages of the proceedings. The person shall
pay the cost of the legal services if he or she is able.
   (d) (1) Upon receipt by the court of a petition submitted pursuant
to subdivision (b), the court shall fix the date for a hearing at a
time not later than five days from the date the petition is received
by the court, excluding Saturdays, Sundays, and holidays. The
petitioner shall promptly cause service of a copy of the petition,
together with written notice of the hearing date, to be made
personally on the person who is the subject of the petition, and
shall send a copy of the petition and notice to the county office of
patient rights, and to the current health care provider appointed for
the person who is the subject of the petition, if any such provider
is known to the petitioner. Continuances shall be permitted only for
good cause shown. In granting continuances, the court shall consider
the need for further examination by a physician or the potential need
to provide expeditiously assisted outpatient treatment. Upon the
hearing date, or upon any other date or dates to which the proceeding
may be continued, the court shall hear testimony. If it is deemed
advisable by the court, and if the person who is the subject of the
petition is available and has received notice pursuant to this
section, the court may examine in or out of court the person who is
the subject of the petition who is alleged to be in need of assisted
outpatient treatment. If the person who is the subject of the
petition does not appear at the hearing, and appropriate attempts to
elicit the attendance of the person have failed, the court may
conduct the hearing in the person's absence. If the hearing is
conducted without the person present, the court shall set forth the
factual basis for conducting the hearing without the person's
presence.
   (2) The court shall not order assisted outpatient treatment unless
an examining licensed mental health treatment provider, who has
personally examined, and has reviewed the available treatment history
of, the person who is the subject of the petition within the time
period commencing 10 days before the filing of the petition,
testifies in person at the hearing.
   (3) If the person who is the subject of the petition has refused
to be examined by a licensed mental health treatment provider, the
court may request that the person consent to an examination by a
licensed mental health treatment provider appointed by the court. If
the person who is the subject of the petition does not consent and
the court finds reasonable cause to believe that the allegations in
the petition are true, the court may order any person designated
under Section 5150 to take into custody the person who is the subject
of the petition and transport him or her, or cause him or her to be
transported, to a hospital for examination by a licensed mental
health treatment provider as soon as is practicable. Detention of the
person who is the subject of the petition under the order may not
exceed 72 hours. If the examination is performed by another licensed
mental health treatment provider, the examining licensed mental
health treatment provider may consult with the licensed mental health
treatment provider whose affirmation or affidavit accompanied the
petition regarding the issues of whether the allegations in the
petition are true and whether the person meets the criteria for
assisted outpatient treatment.
   (4) The person who is the subject of the petition shall have all
of the following rights:
   (A) To adequate notice of the hearings to the person who is the
subject of the petition, as well as to parties designated by the
person who is the subject of the petition.
   (B) To receive a copy of the court-ordered evaluation.
   (C) To counsel. If the person has not retained counsel, the court
shall appoint a public defender.
   (D) To be informed of his or her right to judicial review by
habeas corpus.
   (E) To be present at the hearing unless he or she waives the right
to be present.
   (F) To present evidence.
   (G) To call witnesses on his or her behalf.
   (H) To cross-examine witnesses.
   (I) To appeal decisions, and to be informed of his or her right to
appeal.
   (5) (A) If after hearing all relevant evidence, the court finds
that the person who is the subject of the petition does not meet the
criteria for assisted outpatient treatment, the court shall dismiss
the petition.
   (B) If after hearing all relevant evidence, the court finds that
the person who is the subject of the petition meets the criteria for
assisted outpatient treatment, and there is no appropriate and
feasible less restrictive alternative, the court may order the person
who is the subject of the petition to receive assisted outpatient
treatment for an initial period not to exceed six months. In
fashioning the order, the court shall specify that the proposed
treatment is the least restrictive treatment appropriate and feasible
for the person who is the subject of the petition. The order shall
state the categories of assisted outpatient treatment, as set forth
in Section 5348, that the person who is the subject of the petition
is to receive, and the court may not order treatment that has not
been recommended by the examining licensed mental health treatment
provider and included in the written treatment plan for assisted
outpatient treatment as required by subdivision (e). If the person
has executed an advance health care directive pursuant to Chapter 2
(commencing with Section 4650) of Part 1 of Division 4.7 of the
Probate Code, any directions included in the advance health care
directive shall be considered in formulating the written treatment
plan.
   (6) If the person who is the subject of a petition for an order
for assisted outpatient treatment pursuant to subparagraph (B) of
paragraph (5) of subdivision (d) refuses to participate in the
assisted outpatient treatment program, the court may order the person
to meet with the assisted outpatient treatment team designated by
the director of the assisted outpatient treatment program. The
treatment team shall attempt to gain the person's cooperation with
treatment ordered by the court. The person may be subject to a
72-hour hold pursuant to subdivision (f) only after the treatment
team has attempted to gain the person's cooperation with treatment
ordered by the court, and has been unable to do so.
   (e) Assisted outpatient treatment shall not be ordered unless the
licensed mental health treatment provider recommending assisted
outpatient treatment to the court has submitted to the court a
written treatment plan that includes services as set forth in Section
5348, and the court finds, in consultation with the county mental
health director, or his or her designee, all of the following:
   (1) That the services are available from the county, or a provider
approved by the county, for the duration of the court order.
   (2) That the services have been offered to the person by the local
director of mental health, or his or her designee, and the person
has been given an opportunity to participate on a voluntary basis,
and the person has failed to engage in, or has refused, treatment.
   (3) That all of the elements of the petition required by this
article have been met.
   (4) That the treatment plan will be delivered to the county
director of mental health, or to his or her appropriate designee.
   (f) If, in the clinical judgment of a licensed mental health
treatment provider, the person who is the subject of the petition has
failed or has refused to comply with the treatment ordered by the
court, and, in the clinical judgment of the licensed mental health
treatment provider, efforts were made to solicit compliance, and, in
the clinical judgment of the licensed mental health treatment
provider, the person may be in need of involuntary admission to a
hospital for evaluation, the provider may request that persons
designated under Section 5150 take into custody the person who is the
subject of the petition and transport him or her, or cause him or
her to be transported, to a hospital, to be held up to 72 hours for
examination by a licensed mental health treatment provider to
determine if the person is in need of treatment pursuant to Section
5150. Any continued involuntary retention in a hospital beyond the
initial 72-hour period shall be pursuant to Section 5150. If at any
time during the 72-hour period the person is determined not to meet
the criteria of Section 5150, and does not agree to stay in the
hospital as a voluntary patient, he or she shall be released and any
subsequent involuntary detention in a hospital shall be pursuant to
Section 5150. Failure to comply with an order of assisted outpatient
treatment alone may not be grounds for involuntary civil commitment
or a finding that the person who is the subject of the petition is in
contempt of court.
   (g) If the director of the assisted outpatient treatment program
determines that the condition of the patient requires further
assisted outpatient treatment, the director shall apply to the court,
prior to the expiration of the period of the initial assisted
outpatient treatment order, for an order authorizing continued
assisted outpatient treatment for a period not to exceed 180 days
from the date of the order. The procedures for obtaining any order
pursuant to this subdivision shall be in accordance with subdivisions
(a) to (f), inclusive. The period for further involuntary outpatient
treatment authorized by any subsequent order under this subdivision
may not exceed 180 days from the date of the order.
   (h) At intervals of not less than 60 days during an assisted
outpatient treatment order, the director of the outpatient treatment
program shall file an affidavit with the court that ordered the
outpatient treatment affirming that the person who is the subject of
the order continues to meet the criteria for assisted outpatient
treatment. At these times, the person who is the subject of the order
shall have the right to a hearing on whether or not he or she still
meets the criteria for assisted outpatient treatment if he or she
disagrees with the director's affidavit. The burden of proof shall be
on the director.
   (i) During each 60-day period specified in subdivision (h), if the
person who is the subject of the order believes that he or she is
being wrongfully retained in the assisted outpatient treatment
program against his or her wishes, he or she may file a petition for
a writ of habeas corpus, thus requiring the director of the assisted
outpatient treatment program to prove that the person who is the
subject of the order continues to meet the criteria for assisted
outpatient treatment.
   (j) Any person ordered to undergo assisted outpatient treatment
pursuant to this article, who was not present at the hearing at which
the order was issued, may immediately petition the court for a writ
of habeas corpus. Treatment under the order for assisted outpatient
treatment may not commence until the resolution of that petition.

5347.  (a) In any county in which services are available pursuant to
Section 5348, any person who is determined by the court to be
subject to subdivision (a) of Section 5346 may voluntarily enter into
an agreement for services under this section.
   (b) (1) After a petition for an order for assisted outpatient
treatment is filed, but before the conclusion of the hearing on the
petition, the person who is the subject of the petition, or the
person's legal counsel with the person's consent, may waive the right
to an assisted outpatient treatment hearing for the purpose of
obtaining treatment under a settlement agreement, provided that an
examining licensed mental health treatment provider states that the
person can survive safely in the community. The settlement agreement
may not exceed 180 days in duration and shall be agreed to by all
parties.
   (2) The settlement agreement shall be in writing, shall be
approved by the court, and shall include a treatment plan developed
by the community-based program that will provide services that
provide treatment in the least restrictive manner consistent with the
needs of the person who is the subject of the petition.
   (3) Either party may request that the court modify the treatment
plan at any time during the 180-day period.
   (4) The court shall designate the appropriate county department to
monitor the person's treatment under, and compliance with, the
settlement agreement. If the person fails to comply with the
treatment according to the agreement, the designated county
department shall notify the counsel designated by the county and the
person's counsel of the person's noncompliance.
   (5) A settlement agreement approved by the court pursuant to this
section shall have the same force and effect as an order for assisted
outpatient treatment pursuant to Section 5346.
   (6) At a hearing on the issue of noncompliance with the agreement,
the written statement of noncompliance submitted shall be prima
facie evidence that a violation of the conditions of the agreement
has occurred. If the person who is the subject of the petition denies
any of the facts as stated in the statement, he or she has the
burden of proving by a preponderance of the evidence that the alleged
facts are false.

5348.  (a) For purposes of subdivision (e) of Section 5346, a county
that chooses to provide assisted outpatient treatment services
pursuant to this article shall offer assisted outpatient treatment
services including, but not limited to, all of the following:
   (1) Community-based, mobile, multidisciplinary, highly trained
mental health teams that use high staff-to-client ratios of no more
than 10 clients per team member for those subject to court-ordered
services pursuant to Section 5346.
   (2) A service planning and delivery process that includes the
following:
   (A) Determination of the numbers of persons to be served and the
programs and services that will be provided to meet their needs. The
local director of mental health shall consult with the sheriff, the
police chief, the probation officer, the mental health board,
contract agencies, and family, client, ethnic, and citizen
constituency groups as determined by the director.
   (B) Plans for services, including outreach to families whose
severely mentally ill adult is living with them, design of mental
health services, coordination and access to medications, psychiatric
and psychological services, substance abuse services, supportive
housing or other housing assistance, vocational rehabilitation, and
veterans' services. Plans shall also contain evaluation strategies,
which shall consider cultural, linguistic, gender, age, and special
needs of minorities and those based on any characteristic listed or
defined in Section 11135 of the Government Code in the target
populations. Provision shall be made for staff with the cultural
background and linguistic skills necessary to remove barriers to
mental health services as a result of having limited-English-speaking
ability and cultural differences. Recipients of outreach services
may include families, the public, primary care physicians, and others
who are likely to come into contact with individuals who may be
suffering from an untreated severe mental illness who would be likely
to become homeless if the illness continued to be untreated for a
substantial period of time. Outreach to adults may include adults
voluntarily or involuntarily hospitalized as a result of a severe
mental illness.
   (C) Provision for services to meet the needs of persons who are
physically disabled.
   (D) Provision for services to meet the special needs of older
adults.
   (E) Provision for family support and consultation services,
parenting support and consultation services, and peer support or
self-help group support, where appropriate.
   (F) Provision for services to be client-directed and that employ
psychosocial rehabilitation and recovery principles.
   (G) Provision for psychiatric and psychological services that are
integrated with other services and for psychiatric and psychological
collaboration in overall service planning.
   (H) Provision for services specifically directed to seriously
mentally ill young adults 25 years of age or younger who are homeless
or at significant risk of becoming homeless. These provisions may
include continuation of services that still would be received through
other funds had eligibility not been terminated as a result of age.
   (I) Services reflecting special needs of women from diverse
cultural backgrounds, including supportive housing that accepts
children, personal services coordinator therapeutic treatment, and
substance treatment programs that address gender-specific trauma and
abuse in the lives of persons with mental illness, and vocational
rehabilitation programs that offer job training programs free of
gender bias and sensitive to the needs of women.
   (J) Provision for housing for clients that is immediate,
transitional, permanent, or all of these.
   (K) Provision for clients who have been suffering from an
untreated severe mental illness for less than one year, and who do
not require the full range of services, but are at risk of becoming
homeless unless a comprehensive individual and family support
services plan is implemented. These clients shall be served in a
manner that is designed to meet their needs.
   (3) Each client shall have a clearly designated mental health
personal services coordinator who may be part of a multidisciplinary
treatment team who is responsible for providing or assuring needed
services. Responsibilities include complete assessment of the client'
s needs, development of the client's personal services plan, linkage
with all appropriate community services, monitoring of the quality
and followthrough of services, and necessary advocacy to ensure each
client receives those services that are agreed to in the personal
services plan. Each client shall participate in the development of
his or her personal services plan, and responsible staff shall
consult with the designated conservator, if one has been appointed,
and, with the consent of the client, shall consult with the family
and other significant persons as appropriate.
   (4) The individual personal services plan shall ensure that
persons subject to assisted outpatient treatment programs receive
age-appropriate, gender-appropriate, and culturally appropriate
services, to the extent feasible, that are designed to enable
recipients to:
   (A) Live in the most independent, least restrictive housing
feasible in the local community, and, for clients with children, to
live in a supportive housing environment that strives for
reunification with their children or assists clients in maintaining
custody of their children as is appropriate.
   (B) Engage in the highest level of work or productive activity
appropriate to their abilities and experience.
   (C) Create and maintain a support system consisting of friends,
family, and participation in community activities.
   (D) Access an appropriate level of academic education or
vocational training.
   (E) Obtain an adequate income.
   (F) Self-manage their illnesses and exert as much control as
possible over both the day-to-day and long-term decisions that affect
their lives.
   (G) Access necessary physical health care and maintain the best
possible physical health.
   (H) Reduce or eliminate serious antisocial or criminal behavior,
and thereby reduce or eliminate their contact with the criminal
justice system.
   (I) Reduce or eliminate the distress caused by the symptoms of
mental illness.
   (J) Have freedom from dangerous addictive substances.
   (5) The individual personal services plan shall describe the
service array that meets the requirements of paragraph (4), and to
the extent applicable to the individual, the requirements of
paragraph (2).
   (b) A county that provides assisted outpatient treatment services
pursuant to this article also shall offer the same services on a
voluntary basis.
   (c) Involuntary medication shall not be allowed absent a separate
order by the court pursuant to Sections 5332 to 5336, inclusive.
   (d) A county that operates an assisted outpatient treatment
program pursuant to this article shall provide data to the State
Department of Mental Health and, based on the data, the department
shall report to the Legislature on or before May 1 of each year in
which the county provides services pursuant to this article. The
report shall include, at a minimum, an evaluation of the
effectiveness of the strategies employed by each program operated
pursuant to this article in reducing homelessness and hospitalization
of persons in the program and in reducing involvement with local law
enforcement by persons in the program. The evaluation and report
shall also include any other measures identified by the department
regarding persons in the program and all of the following, based on
information that is available:
   (1) The number of persons served by the program and, of those, the
number who are able to maintain housing and the number who maintain
contact with the treatment system.
   (2) The number of persons in the program with contacts with local
law enforcement, and the extent to which local and state
incarceration of persons in the program has been reduced or avoided.
   (3) The number of persons in the program participating in
employment services programs, including competitive employment.
   (4) The days of hospitalization of persons in the program that
have been reduced or avoided.
   (5) Adherence to prescribed treatment by persons in the program.
   (6) Other indicators of successful engagement, if any, by persons
in the program.
   (7) Victimization of persons in the program.
   (8) Violent behavior of persons in the program.
   (9) Substance abuse by persons in the program.
   (10) Type, intensity, and frequency of treatment of persons in the
program.
   (11) Extent to which enforcement mechanisms are used by the
program, when applicable.
   (12) Social functioning of persons in the program.
   (13) Skills in independent living of persons in the program.
   (14) Satisfaction with program services both by those receiving
them and by their families, when relevant.

5349.  This article shall be operative in those counties in which
the county board of supervisors, by resolution, authorizes its
application and makes a finding that no voluntary mental health
program serving adults, and no children's mental health program, may
be reduced as a result of the implementation of this article.
Compliance with this section shall be monitored by the State
Department of Mental Health as part of its review and approval of
county Short-Doyle plans.

5349.1.  (a) Counties that elect to implement this article, shall,
in consultation with the department, client and family advocacy
organizations, and other stakeholders, develop a training and
education program for purposes of improving the delivery of services
to mentally ill individuals who are, or who are at risk of being,
involuntarily committed under this part. This training shall be
provided to mental health treatment providers contracting with
participating counties and to other individuals, including, but not
limited to, mental health professionals, law enforcement officials,
and certification hearing officers involved in making treatment and
involuntary commitment decisions.
   (b) The training shall include both of the following:
   (1) Information relative to legal requirements for detaining a
person for involuntary inpatient and outpatient treatment, including
criteria to be considered with respect to determining if a person is
considered to be gravely disabled.
   (2) Methods for ensuring that decisions regarding involuntary
treatment as provided for in this part direct patients toward the
most effective treatment. Training shall include an emphasis on each
patient's right to provide informed consent to assistance.

5349.5.  (a) This article shall remain in effect only until January
1, 2013, and as of that date is repealed, unless a later enacted
statute that is enacted on or before January 1, 2013, deletes or
extends that date.
   (b) The State Department of Mental Health shall submit a report
and evaluation of all counties implementing any component of this
article to the Governor and to the Legislature by July 31, 2011. The
evaluation shall include data described in subdivision (d) of Section
5348.


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