Health Commission weighs assisted outpatient treatment ("Laura's Law") after mixed public testimony

The San Francisco Health Commission on a June meeting heard an overview of assisted outpatient treatment, often called "Laura's Law," and took public testimony showing clear division in the community over whether the city should implement the court'ordered treatment program.

Jill Robinson, director for behavioral health services, told commissioners the state law sets strict criteria for who is eligible and requires court review and findings before treatment can be mandated. She said the county mental health director must investigate petitions and that the law does not permit forced medication, emphasizing the program'level limits and safeguards. Robinson said the department estimates program costs at about $40,000 per person per year and that the city would not likely be ready to implement a full program until late summer or early fall 2015.

Jess Montejano, legislative aide for Supervisor Mark Farrell, said Farrell introduced two identical ordinances to implement Laura's Law and is preparing a fallback ballot measure in case the Board of Supervisors does not approve the legislation. "We feel Laura's Law focuses on the most vulnerable individuals who really need the help the most," Montejano said, noting broad endorsements from local law enforcement, health professionals and several supervisors.

Public comment split sharply. Supporters, including physician volunteers and some mental health professionals, pointed to pilot results in smaller counties and argued AOT can reduce repeated hospitalizations, incarcerations and homelessness. One volunteer cited Nevada County's reported reductions in hospitalization and incarceration and said courts there have found cost savings over time.

Opponents urged caution. Michael Gause of the Mental Health Association of San Francisco said the organization opposed assisted outpatient treatment because of civil liberties concerns, potential racial disparities in how orders are applied, and the lack of new funding to increase actual services. "Most notably, the curtailing of civil liberties," Gause said, summarizing his group's objections. Jennifer Friedenbach of the Coalition on Homelessness told commissioners AB 1421 (the local implementing statute referenced in testimony) "does not add funding" and said the city should prioritize expanding voluntary full'service programs instead of creating new court processes.

Robinson and other DPH staff said the department has been working with the Mayor's CARES Task Force and stakeholders to identify supports that would accompany AOT, including full'service partnerships and case management, and that the legislation includes reporting requirements so outcomes are monitored. Commissioners asked for evidence of savings and outcome measures; presenters pointed to reduced emergency service use in pilot programs and said the ordinance includes annual reporting to allow evaluation.

No formal commission resolution was before the body at this meeting. Commissioners and staff said they would continue to gather data and engage community stakeholders while the proposal moves through the Board of Supervisors process or a potential ballot measure.