Report: Laura's Law Works for Mentally Ill Los Angelenos

A little noted Laura's Law Progress Report quietly filed by the Los Angeles County Department of Mental Health earlier this year shows Laura's Law has reduced the incarceration and hospitalization of people with severe mental illness and saved taxpayers money which can be used for other purposes.

Laura's Law allows courts to order certain historically violent, dangerous, or incarcerated individuals to accept treatment as a condition of living in the community. To be eligible individuals must have a serious mental illness that causes them to be unlikely to survive safely in the community without supervision, and been in a hospital, prison or jail at least twice within the last thirty-six months; or involved in acts, attempts or threats of serious violent behavior toward self or others within the last forty-eight months.

In addition to these stringent criteria meant to apply the program only to those who need it the most, L.A. also required them to meet extra criteria that theoretically would make these individuals even more difficult to treat.The results were outstanding:

Laura's Law reduced incarceration 78%
During the six months prior to enrollment in AOT, program participants were incarcerated for approximately 388 days. But during the six months after enrollment in AOT they were incarcerated for only 85 days, a reduction of 78%.

Laura's Law reduced hospitalization 86%
During the six months prior to Laura's Law participants were hospitalized for 345 days. While enrolled in Laura's Law only one person was hospitalized (for 49 days) for a reduction of 86%.

Laura's Law reduced hospitalization 77% even after discharge from Laura's Law
Since discharge from Laura's Law participants had 81 days of hospitalization, or a reduction of 77% in days of hospitalization.

These results are from a small pilot study, but are consistent with results in Nevada County, CA results in New York and other states that use laws like this to improve patient care, keep public and patients safer and save money. California counties are among the last in the nation to make use of this treatment modality. The services are funded with Mental Health Services Act funding.

Los Angeles Supervisor Michael Antonovich estimated Laura's Law cut taxpayer costs 40% and called for hearings which will be held on Tuesday, December 20.

 

 

 

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Comments

[Becky Murphy]

11:42 PM on 12/26/2011

Once again, the writer uses a personal bias and personal agenda instead of the best interests of "the seriously mentally ill" he advocates for; then he claims his agenda is supported by data he cites; in fact it is not.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004408.pub3/abstract Cochrane Library
We found little evidence that compulsory community treatment was effective in any of the main outcome indices: health service use (2 RCTs, n = 416, RR for readmission to hospital by 11-12 months 0.98 CI 0.79 to 1.2); social functioning (2 RCTs, n = 416, RR for arrested at least once by 11-12 months 0.97 CI 0.62 to 1.52); mental state; quality of life (2 RCTs, n = 416, RR for homelessness 0.67 CI 0.39 to 1.15) or satisfaction with care (2 RCTs, n = 416, RR for perceived coercion 1.36 CI 0.97 to 1.89). However, risk of victimisation may decrease with OPC (1 RCT, n = 264, RR 0.5 CI 0.31 to 0.8). In terms of numbers needed to treat (NNT), it would take 85 OPC orders to prevent one readmission, 27 to prevent one episode of homelessness and 238 to prevent one arrest. The NNT for the reduction of victimisation was lower at six (CI 6 to 6.5). A new search for trials in 2008 did not find any new trials that were relevant to this review.

[DJ Jaffe]

09:31 PM on 01/08/2012

The study found " People receiving compulsory community treatment were, however, less likely to be victims of violent or non-violent crime. "

[Fiachra Byrne]

06:33 AM on 12/22/2011

You cite several outcome statistics on the implementa­tion of Laura’s Law to the effect that it has reduced incarcerat­ion by 78% and hospitalis­ation by 86% during the time of the order and by 77% for the period following the lapse of the order.

These statistics appear to have been taken from an Assisted Outpatient Treatment outcomes report issued in February 2011 by the Los Angeles County Department of Mental Health, available here http://lau­ras-law.or­g/states/c­alifornia/­lalaurasla­wstudy.pdf

The report detailed the outcomes for all persons served with an AOT from April 2010 until December 2010. This total number of people so served with AOTs was ten.

The outcomes as of December 2010 for this group of ten individual­s were detailed as follows:
2 had been discharged to lower levels of care
2 were AWOL
2 were hospitalis­ed
1 was arrested
3 were still in the programme.
Aside from problems of selection bias, generalizi­ng on the success of Laura’s Law from the outcomes of such a small number of individual­s is deeply problemati­c and, I think, without validity.

[DJ Jaffe]

06:06 PM on 12/22/2011

2 discharged to lower levels of care is probably a good thing. It shows they were helped. Two AWOL (and there were also 2 who failed to sign voluntary agreements) is a bad thing and shows why the LA model (voluntary agreements only) should be replaced with a full-scale court order. 2 hospitals and 1 arrested was a decrease from the period pre-AOT. And since it is only a six month agreement, it is not surprising that few were in the program at the end. Again: it shows that getting people well is a good thing. Thanks for comments.

[Fiachra Byrne]

07:03 PM on 12/22/2011

The point is not whether any given individual on this AOT was helped or not - but that it is invalid to generalise outcomes from the operation of this law in statements such as "Laura's Law Works for Mentally Ill" on the basis of figures derived from 10 individuals. A change in outcome for any one of these individuals could have changed the figures you quote above considerably. To present the figures as you have above is misleading. These outcomes do not represent "evidence" in any scientific sense of the positive or negative impact of this legislation.

The operation of these types of programmes, as with forms of "treatment", should have been backed by proper RCTs before they are extended to other jurisdictions.

[DJ Jaffe]

07:32 PM on 12/20/2011

Excellent article in Orange County media about the need to enact Laura's Law and one supervisors thought process on it. http://taxdollars.ocregister.com/2011/12/19/lauras-law-can-o-c-create-something-even-better-for-mentally-ill/144761/

[DJ Jaffe]

04:13 PM on 12/18/2011

SacBee on changes needed for Laura's Law and Mental Health Services Act http://www.sacbee.com/2011/12/18/4128632/lauras-law-needs-help-from-prop.html

[dbrett480]

12:05 AM on 12/17/2011

A law that saves money and helps people. That means it definitely won't be implemented state wide.

[Louesa]

10:12 PM on 12/16/2011

It's just incredible to me how many stupid, dim-witted politicians and bureaucrats, and citizens there are in this country. Why don't they GET it? Study after study, enough to fill a library book shelf, have been done on Laura's Law, New York's AOT laws, and others. ALL of them demonstrate the benefits, human, social, and individual, of mandated outpatient treatment for the small percentage of people who need it. What a waste. What a tragedy!

[DJ Jaffe]

11:24 PM on 12/16/2011

I have to admit, that after studying the issue, I am surprised how little facts matter. I believe the reason is that there is a giant industry built up on helping people with 'mental health' issues who don't want the system to fund care for mental 'illness' because they fear it will put their own funding in danger. These programs, agencies, non-profits have convinced gov't that all is well and it is hard for politicians to understand it is not.

[Marsha Mann]

06:22 AM on 12/17/2011

AOT has been proven to work in NY and all states. The issue should not still be on the
back burner after all the studies and the improved lives. NY agencies put their money into
many "peer agencies" that should be funding themselves. The seriously ill people who need Laura's Law(different names, different states) are not sitting at laptops or using their
Iphones to read these blogs. Ask the not for profits to see their 990 tax returns and follow
the money. Marsha Mann/Buffalo, NY