Assisted Outpatient Treatment, “Laura’s Law,” in Los Angeles County
What is Assisted Outpatient Treatment?
Assisted Outpatient Treatment (AOT) provides court ordered intensive community-based mental health treatment for people with serious mental health disabilities who do not meet the Lanterman-Petris-Short Act (LPS) criteria for involuntary hospitalization but whose condition is currently deteriorating and who are unwilling to accept treatment.
In addition, AOT is only ordered if the individual has a history of not complying with treatment that has resulted in past hospitalizations, incarceration or dangerous behaviors.
Who qualifies for AOT?
The person must meet all of the following criteria for AOT to be ordered:
• be eighteen years of age or older;
• have a qualifying mental illness;
• be unlikely to survive safely in the community without supervision;
• have a condition that is substantially deteriorating; and
• have a history of not complying with treatment that includes at least two hospitalizations or incarcerations in the last 36 months, or at least one act, threat, or attempt of harm to self or others within the last 48 months, or both.
In addition, for AOT to be ordered the following must be shown:
• AOT is the least restrictive placement necessary to ensure recovery and stability.
• AOT is necessary to prevent relapse or deterioration likely to result in grave disability or serious harm to self or others.
• The person continues to fail to engage in psychiatric treatment.
• The person is likely to benefit from AOT.
What is a qualifying mental illness that could allow a person to receive AOT?
For an individual to receive AOT, he or she must have a serious mental illness that:
• is severe in degree and persistent in duration;
• may cause behaviors that substantially interfere with daily living; and
• may result in an inability to maintain independent functioning without treatment, support, and rehabilitation for a long or indefinite period of time.
Qualifying mental illnesses include, but are not limited to schizophrenia, bipolar disorder, post-traumatic stress disorder, major affective disorders, and other severely disabling mental disorders.
Who is qualified to refer an individual for AOT?
The following people can request that an individual be considered for AOT:
• an adult who lives with the person;
• a parent, spouse, sibling or adult child of the person;
• a director of a residential care facility in which the person lives;
• the director of a hospital in which the person is hospitalized;
• a licensed mental health treatment provider who is either supervising the treatment of, or treating, the individual for mental disability; or
• a peace officer, parole officer, or probation officer assigned to supervise the person.
How does a qualified person make a referral for AOT?
The Los Angeles County Department of Mental Health (DMH) has a referral form on its website at http://file.lacounty.gov/dmh/cms1_228375.pdf. To make a referral, a qualified person must fill out this form and fax it to (213) 380-3680 or email it to AOTLAOE@dmh.lacounty.gov. Los Angeles’ AOT Program can be reached at (213) 738-2440.
What happens after a referral is made?
At DMH, an AOT Outreach and Engagement Team (Outreach Team) has been established to process referrals. Once a referral is made, the Outreach Team reviews the referral and performs an investigation to determine whether the candidate meets the AOT criteria. If the candidate meets the criteria, the Outreach Team will make an initial treatment offer. The team will contact the candidate repeatedly for at least 30 days to attempt to gain voluntary acceptance for treatment. If the candidate refuses after this time, the Outreach Team will develop documents to support a court petition for treatment, including a proposed treatment plan. Note that the treatment plan does not include involuntary administration of psychotropic medications.
The Medical Director of DMH, through County Counsel, reviews the evidence the Outreach Team has gathered to make sure that all of the necessary criteria for receiving AOT can be proven by clear and convincing evidence. If so, County Counsel drafts and files a petition with the Los Angeles County Superior Court. When a petition is filed the proposed AOT recipient will be assigned a Public Defender to provide representation. Within five days (excluding weekdays and holidays) of the filing of a petition, a hearing is held before the court to determine whether treatment should be ordered. Once the court orders AOT, the mental health consumer is required to participate in an individualized treatment program. The individual receives intensive support to stay on his or her treatment plan while remaining in the community.
If the individual consistently refuses AOT, and attempts have been made by the providers to obtain compliance, he or she may be involuntarily hospitalized for up to 72 hours to determine if the criteria for involuntary commitment are met.
What types of treatment services are available through AOT?
AOT is a community-based treatment program. Los Angeles County’s AOT program provides two treatment services: Full Service Partnership Programs and Alternative Crisis Services. Full Service Partnership Programs are intensive outpatient programs that provide targeted case management, mental health services, and voluntary medication support services. Alternative Crisis Services are services carried out at unlocked residential facilities where a patient is given a bed, 24-hour supervision, and intensive mental health services.
How long will the court-ordered treatment provided by Laura’s Law last?
The court determines how long treatment will be. It may order treatment for a period of up to six months. If the director of the AOT program determines that the patient requires further AOT, he or she may apply to the court prior to the initial order’s expiration for an additional period of treatment of up to 180 days.