Audrey Vallen's 22-year-old daughter lives with Bipolar I disorder, experiences paranoia and was charged with a felony last year that she says could have been avoided if the county had opted into Laura’s Law.
The law, passed 18 years ago in the California Legislature, allows court-ordered treatment for people with a history of serious mental illness. But it’s optional for counties to enact and has been a contentious topic in Santa Clara County for years as regional leaders have so far chosen not to participate for a list of reasons, including a lack of funding for such a program and questions of whether it violates civil liberties.
But whatever the reasons, Vallen is pushing for the law that she thinks could have kept her daughter out of Elmwood women’s correctional facility in Milpitas, where she’s currently incarcerated.
“She never thought she was seriously ill,” Vallen says. “In the days leading up to the event that put her in jail, I reached out her psychiatrist and therapist to no avail.”
Even after reaching out to the sheriff’s office and mobile crisis response, Vallen says, no one would help bring her daughter into a psychiatric facility.
“Twenty four hours later, she attacked me with a pair of scissors and now she is in jail,” Vallen says. “If this program was in place I would hope that my beautiful college-educated daughter would get the help she needs… instead of having a felony and mental illness.”
It’s those kinds of emotional and personal testimonies paired with the hurdles to enact the law that county supervisors will weigh when they cast a final vote on whether or not to opt in to Laura’s Law at their May 25 regular meeting.
Laura’s Law was named for 19-year-old Laura Wilcox, who was killed in 2001 while working as a receptionist at the Nevada County Department of Behavioral Health. Her killer was a former patient of the county’s outpatient mental health clinic, who had been diagnosed with severe mental illness.
The AOT Demonstration Project Act—known colloquially as Laura’s Law, in honor of Wilcox—was signed into law in 2002 giving counties the option to pursue “Assisted Outpatient Treatment,” or AOT. The intensive court-ordered treatment is intended for those suffering from severe mental illness and meant to be temporary until patients are well enough to care for themselves.
Santa Clara County never opted in, though supervisors have considered it several times. County Supervisor Joe Simitian voted in favor of Laura’s Law when he was a state assemblyman in 2002.
But criticisms of the law have abounded since its passage, including fears that the law disproportionately affects people of color. Others say it denies individuals the right to due process, autonomy and other civil liberties. Some say that without dedicated funding, it won’t make a difference in the county.
But calls to implement the program are getting stronger. The Santa Clara County chapter of the National Alliance on Mental Illness (NAMI) recently endorsed the program.
“[AOT] is the only option for families having a loved one living with mental illness; these families are often desperate to get treatment for family members but are generally barred from helping, even to warn of potentially volatile behavior,” the NAMI Board of Directors wrote in a March 24 letter to the county’s Board of Supervisors.
When county supervisors took up the topic in 2019, they passed on adopting the program, but didn’t make a formal resolution to opt out. This year, supervisors will be forced to make a decision because of an Assembly bill that gives the county until June 30 to notify the state of a decision.
To date, only 19 of California’s 58 counties have opted in to the program, according to the California Association of Local Behavioral Health Boards & Commissions. San Jose’s City Council in 2019 considered endorsing Laura’s Law, after council member Raul Peralez and former councilman Johnny Khamis advocated for its implementation.
Khamis learned of Laura’s Law after the death of San Jose police officer Michael Johnson, who was killed by a suicidal man in March 2015. Khamis directed his staff to research ways to prevent a tragedy like Johnson’s death from happening again, and stumbled across AOT.
“I want to get some of the dangerous, mentally ill residents off the streets and into care,” Khamis says. “The county would have you think that this law is enforcement, but it’s not. This law is an involuntary conservatorship, and it’s meant to be temporary.”
Advocates for the law, including NAMI, argue mentally ill residents will remain ill and cause undue harm to themselves, their families and the community unless someone else steps in. “With AOT in place, we have an opportunity to help these individuals start along the road to recovery and to a more fulfilling life,” the NAMI letter to county officials states.
Some Bay Area counties have already opted into the program.
In San Mateo County, the program costs about $1.3 million per year for a caseload of about 50 people—or about $27,000 per client annually. Mark Cloutier, CEO of Caminar, a behavioral health services company, says that the program has had its successes, but there are still major barriers to overcome.
About 73% of San Mateo’s AOT clients are stable and housed, while another 23% are homeless. The remaining 4% are either incarcerated or in locked psychiatric facilities.
“We have an experience with the mandated clients that housing is a key motivator for people participating in the program,” Cloutier said during a recent Santa Clara County Health and Hospital Committee meeting. “When people graduate from AOT they lose their housing subsidy, which is a demotivator to go somewhere else and can lead to… regression of the client.”
Under Laura’s Law, people can only be placed in outpatient treatment if they meet a list of “exhaustive conditions,” such as being hospitalized or jailed twice within the last 36 months. “There’s a very high resistance to treatment in this cohort,” Cloutier admits.
Most clients remain in an AOT program for an average of two years, Cloutier says, and to avoid a backslide, clients need “stepping down” programs after their AOT program is over. Burnout among caseworkers is also high, Cloutier says, because of the verbal abuse and difficulty of working with clients who really don’t want treatment.
Khamis says one aspect that needs to be discussed more openly is the number of people an AOT program would assist—likely between 40 and 50 individuals at a time, based on San Mateo’s numbers.
“Some would say it’s a very small number of people to focus on,” Khamis says. “However if you ask police officers or firefighters, those people are the majority of their calls.”