Some mentally ill folks can’t help themselves. Why Sacramento took a tough step to help

July 25, 2021

The Sacramento Bee

By Phil Serna

June 05, 2021

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A man enjoys brief respite from the heat on a shaded park bench in Sacramento’s Cesar E. Chavez Plaza in May 2021. It’s a common sight across the Sacramento region; people in need – many with mental health concerns – relying on the solitude of a vacant public space. PHIL SERNA

By a unanimous vote, the Sacramento County Board of Supervisors recently approved a controversial assisted outpatient treatment program for those suffering from severe mental illness in our community.

Sacramento County enacted“Laura’s Law.” Named after Laura Wilcox, a Nevada County woman who was only 19 when she was shot and killed in 2001 by an individual with untreated severe mental illness, Laura’s Law was adopted by the California legislature nearly 20 years ago.

Laura’s Law was first introduced by a legislator from our region, former Assemblywoman Helen Thompson of Davis. It was signed into law by former Gov. Gray Davis in 2002.

The law gives counties like ours the ability to obtain court orders to help people suffering from severe mental illness — some of the most vulnerable people in our community and in our state. These are people who have been recently treated with psychiatric hospitalizations, who have been incarcerated or who have been threatening to others. These are people who can’t help themselves.

Some counties have chosen not to implement “Laura’s Law” because they are concerned about the civil liberties of the mentally ill. We’re concerned about civil liberties as well, but we think we can help people without trampling on their civil liberties.

The board’s approval of an assisted outpatient treatment program (AOT) signals the seriousness with which Sacramento County intends to compassionately care for those in the most desperate need of assistance. It also demonstrates our interest in empowering and enlisting the community’s help in doing so.

Unlike the county’s long-standing conservator-based program CARES+, AOT broadens the ability of treatment providers, family members, roommates, peace officers and others, along with the county’s mental health director, treatment practitioners and the county’s collaborative court system, to function as a team dedicated to the stabilization and long-term mental health of an individual who would otherwise have relatively limited resources and advocates.

With AOT, the aforementioned parties may formally request that the county mental health director investigate whether or not someone experiencing significant mental illness satisfies specific statutory criteria, such as a history of failed compliance with past treatment that resulted in one or more acts of serious and violent behavior toward themselves or others.

The mental health director or their designee can then petition the court for enlistment in AOT .

However, as a check to ensure civil liberties are genuinely preserved, the person for whom the petition is filed is entitled to legal defense before court-ordered treatment can begin.

Should the court find that the person suffering from mental illness satisfies all legal criteria, a judge can then order treatment for the individual not to exceed 180 days in duration. If the individual is not compliant with court-ordered treatment, they can be hospitalized for up to 72 hours after which the same inpatient hospitalization criteria (i.e., harm to self or others) would apply to determine their release.

The law’s team approach has influenced my consideration of AOT’s merits, especially as I continue witnessing more of my constituents suffering on our streets, in our neighborhoods, in the Parkway and in our jails. It is demoralizing to see someone who is clearly in distress without anyone around to offer support or deescalate a mental health crisis.

Perhaps no other inquiry regularly populates my inbox as much as the frustrations expressed by residents concerned about a loved one, family member or even a complete stranger who clearly needs mental health care and attention, but who, for various reasons, isn’t receiving it. The stories are heartbreaking to read. Some even involve the eventual loss of life due to suicide.

These profound testimonials have become so frequent that legislation (AB 1976) was recently signed into law making AOT the default practice for all counties not already offering it. That means California counties not currently implementing Laura’s Law have until July 1 of this year to provide findings that support opting out of AOT. Sacramento County did not opt out — instead, it passed by resolution our affirmation for Laura’s Law, marking a significant shift in how we help those most in need.

Unfortunately, during our deliberations, we heard from some who continue to believe that implementing AOT amounts to the “criminalization” of mental illness because it is perceived as excessively involuntary.

While I appreciate the concern from critics of Laura’s Law, I respectfully disagree. In many instances, the people we all want to help have such acute and chronic mental health needs that they often don’t even understand that they require help or that the people who love and care for them are willing to assist.

Assisted outpatient treatment expands our means to address the complexities of mental health care access, and the too-often simultaneous circumstance of homelessness in Sacramento County. It is this intent to “leave no stone unturned” when addressing social and public health challenges that will remain my focus on balancing the needs of mental healthcare consumers, family members, loved ones and our community at large.


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