Laura’s Law – Assisted Outpatient Treatment – Follow-Up

Well now, that was quite the number of impassioned comments. I did realize that by writing about Laura’s Law (Assisted Outpatient Treatment) there would be some contention, but I didn’t realize quite how much. Thanks to everyone who wrote in well clear, thoughtful comments. (For those whose comments weren’t of that ilk, please review the comment policy here at the Bipolar Burble.)

Due to the number of responses, I have been unable to address them each individually, but I would like to point a few things out in general.

Misperceptions of Laura’s Law (Assisted Outpatient Treatment)

To be clear, and this is something most people seemed to miss in the first article, Assisted Outpatient Treatment (AOT) in California and other states cannot force medication. While medication may be part of a treatment plan, medication cannot be given without consent without going through the normal court procedures already in place. I don’t know how frequently this is done but it seems infrequent.

“Laura’s Law,” “Kendra’s Law” vs. Assisted Outpatient Treatment

Assisted Outpatient Treatment Issues

As one person astutely pointed out, it is emotionally charged to give the law the name of a previous victim. I’m sorry to add to this as I know it’s political in nature but unfortunately people won’t necessarily know what I’m talking about if I don’t use those names.

Studies on Assisted Outpatient Treatment

Additionally, there was much disagreement on the numbers I cited regarding Assisted Outpatient Treatment. To be clear, some of those numbers come from New York where “Kendra’s Law” is in place and has been for longer (and thus has been more studied).

Numbers from California are based on a tiny population (as it turns out) and thus are of low quality.

Randomized Controlled Studies of Assisted Outpatient Treatment

A reader commented on how studies have rarely used randomized controlled samples when reviewing the Assisted Outpatient Treatment programs. This is a fair statement, but I have an issue with this concept of a randomized controlled sample in this group. How would this be possible? If a person qualifies for the AOT program, how could you include them in a study and not put them in a program? Does it not go against ethical standards to offer no treatment to a person who needs it? In short, I’m just not sure it’s possible. People who are selected for the AOT program are always going to be different than those who are not selected by very definition of the program.

An Example of One Such Study

One reader did point to a study that attempted to use randomized controlled samples to evaluate AOT-type programs in the US. While they did come up with some interesting conclusions, there are problems with their data.

What this review found is that there was no difference in those in an AOT vs. those who were not on the following measures:

  • Readmission to hospital by 11-12 months
  • Compliance with medications by 11-12 months
  • Arrest by 11-12 months

They did find that those in AOT significantly had fewer:

  • Arrests for violence by 11-12 months
  • Homelessness
  • Victimization by 11-12 months

Those look like pretty big wins to me.

However, there was a significant increase in those in AOT programs who perceived coercion in care.

However, as I said, there are issues with this data:

  • Data quality is considered “low” by study authors
  • Data does not include those with a history of violence (For some reason the studies excluded these people. I suspect their inclusion would change the numbers substantially.)

And by excluding those with a violent history, you’re actually excluding most of the people who would even be affected by Laura’s Law (Assisted Outpatient Treatment in California).

Check out more resources on Laura’s Law questions and answers.

Question for Those Who Are Anti-Assisted Outpatient Treatment

So, a question for all those who wrote in an said that Assisted Outpatient Treatment was horrible.

If I were to take a person who would fall under the qualifications for Laura’s Law:

  • The person has a serious mental illness
  • The person refuses treatment
  • The person has a history of violence
  • The person has been in jail twice in 3 years

What would you have the system do with this person? What is the right thing to do? Someone please suggest something other than outpatient/inpatient treatment or incarceration that would work. Because what I’m seeing is a person in desperate need of help and who are we if we do not offer any?

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