Board hears extensive debate on "Laura's Law" pilot; supervisors continue item for staffing, cost and implementation questions

The San Francisco Board of Supervisors opened an extended debate on a resolution urging the city to implement assisted outpatient treatment (AOT), commonly known as "Laura's Law," as a pilot program but continued the item to allow further analysis and participation from the Department of Public Health.

Supervisor Christina Elliott (item sponsor) said Laura's Law establishes a civil court mechanism to order intensive community-based treatment for certain adults with severe mental illness who have repeatedly required hospitalization or have a history of recent violent behavior. "Laura's Law is a bridge to recovery from mental illness by providing structured treatment outside of acute care hospitals or jails," she said, citing studies from New York and California behavioral court data.

Supporters: Supervisors and advocates cited results from Kendra's Law in New York and the local behavioral court, noting reductions in hospital admissions, arrests and homelessness where AOT has been applied. Supervisor Bevan Dufty, a cosponsor, said "this is something that has been a concern, and I think there is a way to utilize this process and really do something meaningful."

Public health and clinical concerns: Officials from the Department of Public Health testified that AOT can include medication and a broad mix of services (medication support, case management, housing assistance and vocational help). Dr. James Dilley, representing San Francisco General's psychiatry service, disputed press accounts that medication could not be part of AOT plans, saying medication is often the single most important element of care for the individuals targeted by this statute.

Opposition and questions: Several supervisors and advocates urged caution. Questions focused on whether AOT would displace existing voluntary services, how the program would be funded (local general fund, Prop 63/mental health services funds or other sources), and whether there are enough inpatient beds and outpatient capacity to deliver the court-ordered services. Supervisor Mark Mercarimi moved to continue the item two weeks to allow fuller fiscal analysis and departmental testimony; Supervisor John Avalos and others requested the Department of Public Health bring additional staff, cost estimates and explanations of Prop 63 interactions.

Pilot structure and safeguards: The resolution as amended would make any local implementation a pilot to end no later than February 2013 and would require the Department of Public Health to file annual reports measuring effectiveness and to provide fiscal analysis.

Board action: After hours of testimony from clinical staff, advocates and supervisors the board voted to continue the item to allow the city to prepare further information on costs, how the pilot would interact with voluntary services and how to avoid displacing other programs.

Ending: Advocates and supervisors on both sides said they would return for additional hearings. "I truly believe that Laura's Law will help stop the revolving door that spins too many people in and out of hospitals and jails," Supervisor Elliott said. The matter was continued to a future meeting when the Department of Public Health and the controller can present requested follow-up materials.