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Criminalizing mental health in Sacramento County

The Sacramento County Board of Supervisors unanimously approved the implementation of Laura’s Law, an initiative that was signed into California state law in 2002 that provides community-based, assisted outpatient treatment (AOT) to a small population of individuals who meet strict legal criteria and who – as a result of their mental illness – are unable to voluntarily access community mental health services. Laura’s Law was adopted by the state Legislature after a man with mental illness fatally shot Laura Wilcox, a 19-year-old volunteer at a Nevada County mental health clinic.

Counties previously had the option to “opt in” to the program, which most larger counties did. Sacramento County has historically not opted in to providing AOT services. But this changed with the passage last year of AB 1976, which requires counties like Sacramento to hold public hearings at the Board of Supervisors about whether to “opt in” or “opt out,” and if a County chooses to “opt out,” they have to provide specific reasons. The deadline for Counties to have a hearing and formally decide is July 1, 2021.

Assisted outpatient treatment (AOT) laws sound good in theory, right? Sustained and intensive court-ordered treatment in the community for individuals with severe untreated mental illness and a history of violence or repeated hospitalization that is used until a person is well enough to maintain their own treatment regimen. Due to strict legal criteria, AOT participants typically represent far less than .05% of a state’s population but are described as people most at risk to be in a hospital, ER, on the streets, or behind bars. These laws purport to reduce hospitalization, arrest and incarceration, homelessness and violent acts associated with mental illness.

But don’t get it twisted, Laura’s Law is NOT a tool for assisting individuals most at risk for the negative consequences of not receiving treatment.

It’s another way to add to the criminalization and dehumanization of individuals experiencing mental illness - just because it’s in the community doesn’t mean it’s not criminalizing. It’s not surprising that the strongest supporters of AOT laws are the International Association of Chiefs of Police, National Sheriffs’ Association, and the Department of Justice.

AOT will adversely affect Black and Brown community members, as there is evidence in the research literature that racial bias plays a role in the over diagnosis of disorders like schizophrenia in Black people. There are also exponentially higher rates of Black individuals with severe mental illness in the criminal justice system.

Back in November, this Board declared racism a public health crisis in Sacramento County and as such pledged to promote racial equity while shaping policies, appropriating resources, implementing programs, and issuing directives. Opting-in to the Assisted Outpatient Treatment law directly goes against this declaration.

In Sacramento County, the program is estimated to cost $2.5 million annually. The Board of Supervisors and Sacramento County Behavioral Health Services will meet again in September to determine funding. Maybe County staff will have a plan by then to show how they actually plan to implement this ordinance.

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