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Upon the completion of a 14-day period of intensive treatment as authorized under California Welfare & Institutions § 5250 et seq., the subject individual may be certified for an additional period of not more than 30 days of intensive treatment as authorized under Welfare and Institutions Code §§ 5270.10-5270.65, subject to the requirements and procedures of those sections, or any successor provisions.
(a) The City and County of San Francisco (the “City”) designates all employees of the San Francisco Fire Department (the “Fire Department”) who (1) are certified by the state of California as EMT-Ps or paramedics under Division 2.5 of the California Health and Safety Code, (2) are accredited by the City’s Local Emergency Medical Services Agency (LEMSA) as paramedics, and (3) meet all applicable procedural requirements adopted by the county behavioral health director under Section 5121 of the California Welfare and Institutions Code, to initiate temporary psychiatric holds under Section 5150 of the California Welfare and Institutions Code upon a finding of probable cause to initiate such holds under the criteria set forth in that section, and subject to all other requirements of that section for initiating such holds.
(b) The Fire Department and the Department of Public Health shall ensure that all individuals designated to initiate temporary psychiatric holds under subsection (a) receive all appropriate training, consistent with state and City law, regarding proper procedures in the initiation of temporary psychiatric holds under Section 5150 of the California Welfare and Institutions Code.
(Added by Ord. 115-21, File No. 210539, App. 8/4/2021, Eff. 9/4/2021)
DIVISION II: ASSISTED OUTPATIENT TREATMENT
(a) California Welfare and Institutions Code §§ 5345-5349.5, also known as "Laura's Law," authorizes counties to implement Assisted Outpatient Treatment ("AOT") to obtain court-ordered mental health treatment for individuals with mental illness for whom other methods of entering and maintaining treatment have been unsuccessful.
(b) AOT provides treatment through community-based, mobile, recovery-oriented, multidisciplinary, highly trained mental health teams with a staff-to-client ratio of no more than 10 clients per team member.
(c) Several independent studies of similar programs in other states cited in a background paper prepared by the Treatment Advocacy Center show that AOT promotes long-term treatment compliance, and reduces the incidence and duration of hospitalizations, homelessness, arrests, incarcerations, violent episodes, and the victimization of individuals with mental illness by others, while also relieving caregiver stress.
(d) These same studies show that states and municipalities that have successfully implemented AOT realized cost savings in their respective mental health, criminal justice, and emergency care systems.
(e) According to research cited in The Resident's Journal, a publication of The American Journal of Psychiatry, almost half of the individuals with a severe mental illness in the United States are untreated, and almost half of those individuals suffer from anosognosia (the inability to recognize one's own mental illness) and possess significant deficits in self-awareness.
(f) This same research also finds a clear link between lack of insight regarding one's own mental illness and the inability to adhere to treatment, which results in poorer clinical outcomes, illness relapse, hospitalization, and suicide attempts.
(g) For severely mentally ill individuals who are unable to maintain a consistent voluntary treatment regime, AOT provides a means to assist and support them through a structured treatment program.
(h) Before an AOT program may be implemented in a county under California Welfare and Institutions Code §§ 5345-5349.5, the county must authorize the application of the program in the county by appropriate legislation and make a finding that no voluntary mental health program serving adults, and no children's mental health program will be reduced as a result of implementing AOT.
(Added by Ord. 154-14, File No. 140557, App. 7/22/2014, Eff. 8/21/2014)
(a) The City and County of San Francisco ("City") authorizes the implementation of California Welfare and Institutions Code §§ 5345-5349.5 through court-ordered Assisted Outpatient Treatment ("AOT") within the City as provided in this Division II. The City finds that no voluntary mental health program serving adults, and no children's mental health program within the City will be reduced as a result of implementing AOT.
(b) As part of AOT, the City shall provide services that will conform to the requirements of California Welfare and Institutions Code § 5348, or any successor provisions. These services shall include, but are not limited to, community-based comprehensive individual service and delivery plans, which plans shall be gender, age, disability, linguistically and culturally appropriate. The plans shall provide access to housing, and be designed to allow the individual referred to AOT ("Referred Individual") to live in the most independent, least restrictive setting possible. The City shall provide AOT services in each case through a community-based multidisciplinary and highly trained mental health team ("AOT Team") with a staff-to-client ratio of no more than 10 clients per team member.
(c) The County Mental Health Director ("Director") shall create a Care Team. The Care Team shall work closely with the Referred Individual and the individual requesting the AOT petition to maximize all opportunities within AOT to engage individuals who meet AOT criteria into voluntary treatment.
(Added by Ord. 154-14, File No. 140557, App. 7/22/2014, Eff. 8/21/2014)
For the purposes of this Division II, the following words or phrases shall mean:
"Care Team" means a group of program staff charged with implementing AOT and shall consist of: 1) A forensic psychologist, who shall be the designated licensed mental health treatment provider responsible for clinical evaluation of the Referred Individual; 2) A peer specialist, who shall be a person who has lived experience with mental health recovery and has been trained to provide peer support to help the Referred Individual engage into treatment; and 3) A family liaison, who shall be a person who has had a family member with mental illness, and has been trained to provide lived experience to educate the referring source on the eligibility, benefits, limitations, and opportunities that AOT provides.
"City" means the City and County of San Francisco.
"Full Service Partnership ("FSP")" means the collaborative relationship between the City and the Referred Individual and, when appropriate, the Referred Individual's family, through which the City plans for, and provides, the full spectrum of community services so that the Referred Individual can achieve the identified goals. The City shall provide FSP services that conform to the requirements of California Code of Regulations Title 9, Section 3200.13c, defining FSP, or any successor provisions.
"Referred Individual" means the person on whose behalf an AOT petition is requested.
(Added by Ord. 154-14, File No. 140557, App. 7/22/2014, Eff. 8/21/2014)
(a) Referral to AOT provides two key opportunities for voluntary engagement of individuals meeting AOT criteria prior to a court hearing:
(1) Immediately after the request for petition and before the filing of a petition with the court; and
(2) After the filing of a petition and before the conclusion of the court hearing on the petition.
(b) At each of the two opportunity points listed in Subsection 4114(a), the Care Team shall make every attempt to engage the Referred Individual into voluntary treatment.
(c) The Referred Individual shall at all times have the opportunity to voluntarily participate in a FSP. The Care Team shall work closely with the Referred Individual and the individual initiating the petition in an effort to engage the Referred Individual into a FSP as a preferred alternative to court-ordered treatment.
(d) All evaluations of the Referred Individual shall be conducted in the least restrictive setting.
(e) The Referred Individual may not be transported for evaluation by a peace, probation or parole officer, unless there is probable cause to believe that the individual meets the criteria required by California Welfare and Institutions Code § 5150, or there is no other means to safely transport the Referred Individual.
(f) The AOT Team shall also ensure that individuals referred for AOT who do not meet AOT criteria are evaluated for, and connected to, the appropriate level of mental health treatment.
(Added by Ord. 154-14, File No. 140557, App. 7/22/2014, Eff. 8/21/2014)
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