MOORLACH UPDATE — SB 689 – Needle Exchange — March 1, 2019

This morning we introduced SB 689, addressing needle and syringe exchange programs, at a news conference in front of the Orange City Hall.

Presenters included Orange County District Attorney Todd Spitzer, Orange Mayor Mark Murphy, Anaheim City Councilman Trevor O’Neil, Costa Mesa City Councilwoman Sandra Genis, and Tamara Jimenez of the Anaheim Lighthouse Treatment Center. Orange City Councilman Chip Monaco was also present in support.

The bill is simple. The State Department of Public Health can allow a nonprofit to come into a city that has adopted a resolution or ordinance authorizing needle exchanges.

We’re simply asking for a protocol for collaboration and an appropriate etiquette between Sacramento and California’s 482 cities. Hopefully, this will reduce the need for future litigation, which is costly.

For those requiring needles, they are currently being dispensed by local pharmacies. So, this effort is not stifling a strategy. It just allows for local control in implementing it. KNX AM 1070 covers the details in the first piece below. My editorial submission to the OC Register is provided in the second piece below.

The third piece below mentions another effort of mine, SB 585 (Steinberg), that has recently been judged as a helpful tool in adopting Laura’s Law in 19 other counties (see MOORLACH UPDATE — Joint Author Details — July 7, 2018).

This OC Register in-depth piece provides a contrast to SB 689. One amazing sentence explains it all: “Yet many counties with the highest drug overdose death rates in California do not yet have Laura’s Law on the books.”

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CA Lawmaker Wants to Give Cities More Authority Over State-Run Needle Exchange Programs

https://knx1070.radio.com/blogs/ca-lawmaker-wants-give-cities-more-authority-over-state-run-needle-exchange-programs

A state lawmaker is looking to give cities more authority over state-run needle exchange programs.

After the state Department of Public Health authorized the ability to operate the programs, mobile needle exchanges began popping in local communities.

“They were concerned about the unintended consequences of now more needles being in parks and libraries,” said State Senator John Moorlach.

His Bill 689 comes on the heels of a judge’s ruling temporarily blocking a non-profit from operating a needle exchange in Santa Ana after Orange County officials filed suit over it.

“They found needles in library books and janitors were getting poked,” he said.

Under his bill, should it be approved, non-profits would not be allowed to operate needle exchanges in city’s unless there is a city resolution or ordinance authorizing the program.

Local control is key to making needle exchange programs work

By JOHN MOORLACH

https://www.ocregister.com/2019/02/28/local-control-is-key-to-making-needle-exchange-programs-work/

A sad development that has exploded across the country in recent years has become known as “the Opioid Epidemic,” especially among young people. That’s why I have introduced Senate Bill 689, which establishes guidelines and increases local control for needle and syringe exchange programs.

Such programs do not condone drug abuse but recognize the reality that some people are going to inject themselves with harmful substances. Almost inevitably, these people are poor. They “only had a dollar to live on till next Monday,” to quote the old Hoyt Axton anti-drug song, “Snowblind Friend.”

Experts will tell you people are tempted to use old needles that may be contaminated with HIV, hepatitis or other diseases, perpetuating the contagion. Which is why needle-exchange programs hand them new, sterile needles. This idea, while well-intentioned, presents a whole new set of challenges.

When addicts receive the needles, they also make contact with the public health system, possibly for the first time. Doing so gives them the opportunity to receive information on health, recovery and other programs that can help them break the addiction, or at least to live another day.

Crucial to such programs is local control. That’s because local city councils, police and health officials are the ones on the ground trying to help the addicts. Also important to consider is increased risk to public safety.

The California Department of Public Health, Office of AIDS, has cautioned that some existing needle-exchange programs have not made matters better, but worse through threatening non-drug-using residents. These concerns are real.

The Register reported last November when Orange County’s only needle-exchange program was shut down, Superior Court Judge Joel R. Wohlfeil “agreed with concerns raised by Orange County officials and the cities of Anaheim, Costa Mesa and Orange about the potential for used syringes to litter the community and stick people.”

The judge called the program a “noble goal” and lauded volunteers’ “selfish devotion.” Then he cited “the estimated 250,000 syringes that were unaccounted for during Civic Center operations,” according to the Register.

“The seriousness of the harm outweighs the social utility,” Wohlfeil ruled.

Discarded needles have pricked city employees. Heather Folmar, operations manager at the nearby Santa Ana Public Library, said needles rarely were found in the library before the exchange opened, but 40 to 50 a month afterward. “We found them on shelves, near planters, window sills, in books,” she said. “A cleaning lady was pricked by one.”

Helping some people shouldn’t hurt other people.

SB 689 specifically states its intent is to “reduce the spread of HIV infection and bloodborne hepatitis among the intravenous drug user population within California.” Therefore, “the Legislature hereby authorizes a clean needle and syringe exchange project.”

It allows the California Department of Public Health to authorize needle-exchange programs only if the city or county in which the exchange will be “operating has adopted an ordinance or resolution approving that authorization or reauthorization.”

The bill provides a crucial element to make needle exchanges work: local control.

Please join me March 1 at 10 a.m. as I introduce SB 689 to the public.

Address: City Hall, 300 E Chapman Ave, Orange, CA 92866.

John M. W. Moorlach, R-Costa Mesa, represents the 37th District in the California Senate

A piecemeal, but promising

start for Laura’s Law to help

severely mentally ill in

California

Beating death of schizophrenic Kelly Thomas in Fullerton sparked wider use of law compelling treatment statewide

By TERI SFORZA

https://www.ocregister.com/2019/03/01/a-piecemeal-but-promising-start-for-lauras-law-to-help-severely-mentally-ill-in-california/

Lauren Rettagliata’s son was homeless for years, refusing to take medication for schizophrenia, rejecting the very notion that anything was amiss.

Fawn Kennedy Dessy’s daughter was hospitalized more than 100 times on so-called 5150 holds, meaning she was a danger to herself or others due to severe mental illness.

Mark Gale’s son had a temporary conservatorship and 10 hospitalizations before doctors finally found medication that could stabilize his frenetic mind.

It’s a parent’s worst torment, not being able to help a struggling child because he’s legally an adult and can make his own decisions — even if he’s profoundly mentally ill and those decisions can be dangerous.

“That’s a fear as a parent you have,” Rettagliata said. “That they could harm someone else, as well as harming themselves.”

Rettagliata, Kennedy Dessy and Gale are among a fierce army of California parents who have beseeched their counties to adopt Laura’s Law — requiring treatment for the most seriously mentally ill — and who help guide its ever-evolving, uneven rollout.

A county-by-county analysis of Laura’s Law in California found that the Golden State is off to a promising start, with much-improved outcomes for people with severe mental illness. But only 20 of California’s 58 counties have adopted it, and the state’s version differs greatly from what works elsewhere, leaving some powerful tools on the table, according to the Virginia-based Treatment Advocacy Center.

“The current partial implementation of Laura’s Law continues to under-serve — and in some cases fail outright — the population it was created to help,” said the report from the center, which was a strong proponent of the law.

More than 1 million people in California suffer with dire mental illness, and as many as half are untreated on any given day, cycling between homeless shelters and emergency rooms, tent encampments and jails, the report said.

What does Laura’s Law do?

Laura’s Law compels county mental health workers to persuade the severely ill to voluntarily accept treatment. It also empowers courts to order recalcitrant people into outpatient treatment, even if it’s against their wishes.

Civil libertarians vehemently oppose Laura’s Law, saying forced treatment has a long and abusive history and the decision to enter or refuse treatment should always rest with the individual, not the state.

The law is named in honor of Laura Wilcox, who was working at a public mental health clinic in Nevada County during winter break in 2001. A man who had refused psychiatric treatment stormed the clinic, killing Wilcox and two others. She was 19.

The Legislature approved Laura’s Law in 2003, but, rather than requiring it statewide, let each individual county decide to embrace it or not.

Los Angeles County started a small pilot program soon after passage, but for years, Nevada was the only county to fully implement the law. After the beating death of homeless schizophrenic Kelly Thomas by Fullerton police in 2011, Orange became California’s first large county to fully adopt Laura’s Law three years later.

Riverside and San Bernardino are among the largest that still do not have Laura’s Law on the books.

Reluctance to adopt the law was largely due to its cost — estimated to be some $40,000 a year per client. The Legislature didn’t approve specific funding for Laura’s Law, and counties felt they just couldn’t afford it.

After Kelly’s death, then-Orange County Supervisor John Moorlach — a fiscal conservative who found himself playing against type to get Laura’s Law adopted — worked with Democratic state Sen. Darrell Steinberg to pass a bill explicitly allowing counties to use “millionaires’ tax” dollars to fund Laura’s Law programs.

That tax — enacted through Proposition 63, approved in 2004 — hits personal income in excess of $1 million, specifically to fund mental health programs. It’s expected to generate more than $2.2 billion this fiscal year.

Counties have found that, despite its costs, Laura’s Law saves millions on jail and psychiatric hospitalization costs each year. The state, however, does not track costs or savings.

Law yields progress

In the 10 counties providing outcome data, the Treatment Advocacy Center found that the most seriously ill had fewer psychiatric hospitalizations, crisis contacts, incarcerations and homelessness.

It’s hard to pinpoint how many people have been treated because of uneven data collection and late reporting. But at least 3,400 have received services via Laura’s Law through 2017, counties reported.

Los Angeles and Orange are among the most experienced with the law, and are making good progress, the nonprofit said.

Los Angeles had enrolled 1,242 people through October 2017 — or 1.3 people per 100,000 residents. They logged a 30 percent reduction in the use of emergency services, a 17 percent drop in psychiatric hospitalizations, and a 13 percent reduction in use of law enforcement services, according to the data.

Orange County — praised for the thoroughness of its record-keeping — had 692 people in the program in 2017, or 1.7 people per 100,000 residents. It logged a 34 percent reduction in incarcerations, a 48 percent decrease in hospitalization episodes and a 75 percent reduction in number of days spent homeless.

Counties collecting data on “co-occurring disorders” showed that most patients — up to 80 percent — also had substance use problems. Yet many counties with the highest drug overdose death rates in California do not yet have Laura’s Law on the books.

Court oversight needed?

There’s a significant lack of standardization in how Laura’s Law works from county to county, the nonprofit found.

Some appeared reluctant to use Laura’s Law, with a low of 0.5 enrollments per 100,000 people in El Dorado, and a high of 11 enrollments per 100,000 people in sparsely populated Nevada — Laura Wilcox’s home, with what’s considered the gold standard program.

And while courts play a starring role in other states — with the “black robe effect” credited for prodding recalcitrant people into treatment and nudging the system into providing more comprehensive services — the court’s role is markedly diminished in California.

Four counties, for example, had no one enrolled in Laura’s Law programs with court oversight, the study found.

It’s the combination of court supervision and robust services that most effectively reverses “the tragic downward spiral too often experienced by individuals with severe mental illness,” the nonprofit said.

So to make full use of Laura’s Law, California should make court oversight a fundamental part of the process, not just an avenue of last resort, the nonprofit said.

The law should be implemented in every county, and all counties should increase enrollment and shorten outreach and engagement times to ensure more timely treatment.

Counties also should include psychiatric medication in settlement agreements and court orders when that medication is called for in treatment plans — which some counties are reluctant to do for fear of being perceived as forcing medication.

“I have my fingers into multiple states, and California is by far the worst,” said DJ Jaffe, executive director of Mental Illness Policy Org and author of “Insane Consequences: How the Mental Health Industry Fails the Mentally Ill.”

“Laura’s Law is on the books, it works, but it is rarely used,” Jaffe said. “That is because the county mental health directors shun the most seriously ill. They send the highest functioning to the head of the line, and the seriously ill to jails, shelters, prisons and morgues. Laura’s Law could fix the mental-illness-to-jail-and-homelessness pipeline, but only if it is used.”

‘Saving a lot of lives’

Folks are learning that passing Laura’s Law is not the end of the journey, but the beginning.

After finally convincing Kern to come on board in 2015, Kennedy Dessy requested intervention for her daughter, who has a psychotic disorder and was hospitalized scores of times. She got no help from the new Laura’s Law team, she said.

So Kennedy Dessy and her colleagues at the Mental Health Collaborative of Kern County kept pushing. The program has been revamped, relaunched, and has finally referred one person for court intervention. She’s hopeful more people will now get help.

In Los Angeles, Gale sits on the county’s Laura’s Law oversight committee, and is criminal justice chair for the local chapter of the National Alliance on Mental Illness. He doesn’t see California’s light use of court intervention as a negative.

“I’ve been proud of the fact we haven’t had to do compulsory court orders,” Gale said. “Look at how many people we’re helping without doing that. We’re saving a lot of lives.”

The “secret sauce,” Gale said, is that the program remains voluntary for the ill — but not for mental health workers. Before, workers could walk away from recalcitrant people and move on to those who are more amenable to treatment. But Laura’s Law requires them to engage, repeatedly, over a period of months, with the most severely ill.

“It binds the mental health system to the client. That’s one of the reasons it works,” Gale said.

Rettagliata has served on Contra Costa’s Mental Health Commission. Her son has lived in Orange and Contra Costa counties, and Laura’s Law has brought him into court to face a judge.

She’s a believer in the court’s power here — “Sometimes it takes a third party who can listen and say, ‘Maybe they’re back on street homeless again because you’re not providing adequate housing’ ” — but her son felt intimidated by the process. It should be gentler, perhaps one on one, she said.

She agrees that the law is greatly underutilized. Those in regular contact with the mentally ill — shelter staff, law enforcement and the like — are often unaware that they can recommend people to Laura’s Law teams directly, she said.

For his part, former Orange County Supervisor Moorlach — now a state senator — was heartened to hear that the nonprofit concluded Laura’s Law is off to a promising start, and stands ready to push legislation to make it better.

He and Senate President Pro Tem Kevin de Leon co-authored the bill that led to November’s Proposition 2, taps “millionaires’ tax” revenue for supportive housing for the mentally ill homeless. Another, with Sen. Scott Wiener, allows funds to be used for early intervention for young people with mental illness.

“Who would have thought that the death of Kelly Thomas would start this snowball rolling?” he said.

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