Board approves assisted outpatient treatment ordinance after hours of debate and added oversight

San Francisco’s Board of Supervisors voted 9–2 on Tuesday to adopt an ordinance authorizing court-ordered assisted outpatient treatment (AOT), commonly called Laura’s Law, with new amendments intended to expand voluntary outreach and require an external evaluation three years after the law’s effective date.

Supporters said the policy will add a tool for families and the city to help people with severe mental illness who do not recognize their need for care. Opponents warned the program risks coercion, possible disproportionate impacts on people of color and that it must be paired with stronger, culturally competent community services.

The ordinance requires the Department of Public Health (DPH) to create an advocate team to try to engage individuals voluntarily at two stages — during the investigation of whether a person meets AOT criteria, and again after a petition is filed but before a court hearing. The board inserted an amendment from Supervisor Jane Kim requiring DPH to commission an external evaluation of the program three years after the ordinance takes effect; that evaluation must examine efficacy, demographics of referred individuals and program costs.

"Laura’s Law focuses on the most vulnerable individuals in our society who need the help the most," said Supervisor John Farrell, the ordinance’s author, arguing the measure was a narrowly targeted tool for people with clinically identified severe mental illness who are not adhering to treatment. Farrell also said jurisdictions with similar laws have reported lower rates of hospitalization, homelessness and arrests among participants.

Supervisor David Campos, who helped negotiate amendments with DPH, said the outreach and full-service partnership funding changes were designed to expand voluntary services before court action is pursued. "This infusion of resources into our mental health system together with a team-advocate approach to engaging individuals in voluntary treatment are extremely positive," Campos said.

Opponents, including Supervisor Eric Mar, said the city should not proceed without fully funding and expanding voluntary, culturally competent community services. Mar cited concerns that the law could further stigmatize people with mental illness and that the city must avoid violating civil rights. He voted no; Supervisor John Avalos also voted no.

Deputy City Attorney John Gibner advised the board during debate on the Kim amendment and clarified timing questions about the effective date and reporting. The board’s final roll call recorded nine ayes (Cohen, Farrell, Kim, Tang, Weiner, Yi, Breed, Campos, Chu) and two noes (Mar, Avalos).

What the ordinance will do and what it will not do

DPH told the board it will not use AOT to forcibly medicate people outside existing legal channels, and staff emphasized the ordinance was written to expand voluntary engagement and full-service partnerships for those eligible. The law’s local implementation will be contingent on DPH staffing and service capacity; supporters said the ordinance’s reporting and the three-year external evaluation make it possible to monitor outcomes and amend the program if needed.

Next steps

The ordinance passed on first reading and was adopted as amended. DPH must report annually to the board; the external evaluation is required at the three-year point. Supervisors said they expect ongoing oversight hearings to monitor civil-rights safeguards, language access and whether the program has disparate impacts by race or language.

By the numbers

Vote: 9–2 (Ayes: Cohen, Farrell, Kim, Tang, Weiner, Yi, Breed, Campos, Chu; Noes: Mar, Avalos)

Provenance: The board introduced the ordinance as Item 56 (item text and opening presentation) and completed the vote during the evening session; transcript evidence for the ordinance introduction and for the final roll call are available in the meeting record.