Mental illness, like other diseases, does not discriminate. Within the scope of the Los Angeles County Sheriff’s Department, its presence can be noted in the field, as well as in custody facilities. Some of the most unsettling aspects of severe mental illness, such as schizophrenia and bipolar disorder, occur when individuals do not recognize they are ill and/or refuse psychiatric treatment. In many cases involving such severe mental illness, the symptoms of the untreated psychiatric condition can grow to become very disruptive, especially as the affected person becomes psychotic and less rational. Such deterioration can, unfortunately, become fertile ground for potential acts of belligerence or violence.
In 2001, 19-year-old Laura Wilcox was a college student working as a receptionist at a community mental health clinic in northern California. A severely mentally ill individual, who had discontinued treatment and become psychotic, visited the clinic and murdered Laura as well as patrons at a nearby restaurant. Her parents consequently lobbied for state law that addressed the issue of mentally unstable individuals who refuse psychiatric treatment.
Laura’s Law was adopted by Los Angeles County in 2014 and is operated by the Los Angeles County Department of Mental Health. The name of the program was altered to Assisted Outpatient Treatment Los Angeles (AOT-LA). Simply put, AOT assists individuals who have been diagnosed with severe mental illness, are treatment non-compliant and are demonstrating psychiatric deterioration. However, because it is state law, there are specific requirements or conditions that must be met for acceptance into the program. The following is a summary of the requirements:
1. 18 years or older
2. Has a mental illness
3. Unlikely to survive safely in community without supervision due to difficulty with providing for food, clothing or shelter
4. Two involuntary hospitalizations (i.e., 5150) or two jail mental health housings within the last 36 months
5. During the past four years, has committed a verbal or physical act of aggression toward self or others
6. Refuses mental health treatment
7. Condition is deteriorating
8. AOT is the least restrictive setting to assist this person
Once an individual is accepted into AOT, a team of mental health professionals visits the person and attempts to persuade them into accepting treatment. Such frequent contact is often successful in connecting the person to psychiatric treatment. In instances where the repeated visits are met with refusal, AOT has the option of submitting a declaration to civil court that requests a judge to mandate outpatient mental health treatment. If the judge mandates treatment and the person still refuses, Welfare and Institutions Code (WIC), 5346d (which is a new Welfare and Institutions Code and part of Laura’s Law), may be utilized to involuntarily psychiatrically hospitalize the individual. WIC 5346d only requires demonstration of psychiatric deterioration. Conditions for Welfare and Institution Code 5150 are not necessary. Think of it as the ability to psychiatrically hospitalize at 5148 versus 5150.
Peace officers are permitted by law to refer individuals to AOT-LA. Patrol personnel may consider referring someone to AOT in instances involving mentally ill individuals who typically are not in treatment and:
• Generate a high volume of calls for service
• Live at a residence that has been “flagged” due to ongoing concerns
• Have been psychiatrically hospitalized many times
• Pose a risk of serious injury or death due to suicide by cop or provide a constant threat to community/their family (e.g., property destruction, family leaving the home due to fear)
• Are homeless and disorganized (dirty, barefoot, walking while dragging their blanket, etc.)
It is assumed that, once in treatment, the individual will experience fewer symptoms and demonstrate greater stability. Consequently, concerning behavior and contacts with law enforcement will also decrease. AOT-LA is not crisis response, so if a referral is made to the program, it may take two to three weeks for the application to be processed and for a response to be made to the referring party (the referring patrol personnel). If a person is experiencing a psychiatric crisis, patrol personnel are encouraged to proceed with immediate action (WIC 5150, if appropriate). In some non-emergent situations, referring concerned persons (such as family members) to the Los Angeles County Department of Mental Health Access Center by calling (800) 854-7771 may also be appropriate. One of the services provided at this number is the dispatch of clinician teams that conduct crisis psychiatric (WIC 5150) evaluations in the community.
Patrol personnel may access Assisted Outpatient Treatment for Los Angeles candidate criteria online by visiting http://file.lacounty.gov/SDSInter/dmh/227733_AOT-LACriteria.pdf.
Patrol personnel may access the AOT-LA online application at http://file.lacounty.gov/sdsinter/dmh/1017016_updated_aot_referral_form.pdf.
For further information, you may also contact Psychological Services Bureau at (213) 738-3500.