Families ask this after the third hospitalization, when the person they love is released, stops the medication, and begins the slide again. California's answer is a court order with a narrow gate and, by design, fewer teeth than most people imagine: non-compliance can trigger a 72-hour hospital examination, but not jail and not forced medication.

The short answer: a family member can ask, but cannot file, and the order that results is not what "force" usually means. Under Laura's Law,¹ a petition for assisted outpatient treatment "may be filed by the county behavioral health director, or the director's designee," and an order is available only "in any county or group of counties where services are available as provided in Section 5348."² A request that the county file one "may be made only" by a listed person — an adult "with whom the person who is the subject of the petition resides"; "the parent, spouse, or sibling or child 18 years of age or older"; the director of a hospital where the person is hospitalized, or of an agency, treatment facility, charity or licensed residential care facility providing them mental health services in whose institution they reside; a licensed mental health treatment provider treating them; a peace, parole or probation officer supervising them; or a judge before whom they appear.² The court must find, "by clear and convincing evidence," every one of seven criteria, among them a history of non-compliance shown by two hospitalizations or custodial mental health stays in 36 months or serious violence or threats in 48 months, an offer of a treatment plan containing all the services the statute lists, after which the person "continues to fail to engage in treatment," and a clinical determination that the person "is unlikely to survive safely in the community without supervision and the person's condition is substantially deteriorating," or needs the treatment "to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm."² The initial order cannot exceed six months.² And two limits define it: "Involuntary medication shall not be allowed absent a separate order by the court,"³ and "Failure to comply with an order of assisted outpatient treatment alone may not be grounds for involuntary civil commitment or a finding that the person who is the subject of the petition is in contempt of court."²

Where it exists

The article applies in counties that provide the services. Since 1 July 2021 the section has been written as an opt-out: a county "that does not wish to implement this article may opt out of the requirements of this article by a resolution passed by the governing body that state the reasons for opting out and any facts or circumstances relied on in making that decision."⁴ A county that implements it "shall not reduce existing voluntary mental health programs serving adults or children's mental health programs as a result," and must "offer the same services on a voluntary basis" to people who are not under an order.⁴ ³ Ask the county behavioral health department whether it has an AOT programme or has opted out by resolution.

The seven findings

A court may order assisted outpatient treatment only if it finds, by clear and convincing evidence, that all of the following are true:²

  1. The person "is 18 years of age or older."
  2. The person "is experiencing a mental illness" as defined in section 5600.3(b)(2)–(3).
  3. There has been "a clinical determination that, in view of the person's treatment history and current behavior," either the person "is unlikely to survive safely in the community without supervision and the person's condition is substantially deteriorating," or the person "is in need of assisted outpatient treatment in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to the person or to others."
  4. A history of lack of compliance with treatment, shown in one of two ways: the mental illness "has, at least twice within the last 36 months, been a substantial factor in necessitating hospitalization, or receipt of services in a forensic or other mental health unit of a state correctional facility or local correctional facility"; or it "has resulted in one or more acts of serious and violent behavior toward themselves or another, or threats, or attempts to cause serious physical harm to themselves or another within the last 48 months." Time spent hospitalized or incarcerated immediately before the petition does not count toward either window.
  5. The person "has been offered an opportunity to participate in a treatment plan by the director of the local mental health department, or the director's designee," including all the services the statute requires, "and the person continues to fail to engage in treatment."
  6. The programme "would be the least restrictive placement necessary to ensure the person's recovery and stability."
  7. "It is likely that the person will benefit from assisted outpatient treatment."

Criterion 5 is the one families miss. The county must first have offered a plan containing all the services section 5348 lists, and the person must have continued to fail to engage; a person who has never been offered it does not qualify.²

The hearing

The person "shall have the right to be represented by counsel at all stages," and "If the person so elects, the court shall immediately appoint the public defender or other attorney."² The court sets the hearing "not later than five days from the date the petition is received," excluding weekends and holidays.² At the hearing the person has the right to notice, to a copy of the court-ordered evaluation, to counsel, to be present, "to present evidence," "to call witnesses," "to cross-examine witnesses," to be told of the right to habeas corpus review, and "to appeal decisions."² The examining professional's affidavit must address "whether the defendant has capacity to give informed consent regarding psychotropic medication."²

If the court finds the criteria met "and there is no appropriate and feasible less restrictive alternative," it "may order the person … to receive assisted outpatient treatment for an initial period not to exceed six months."² The order "shall state the categories of assisted outpatient treatment" the person is to receive, and "the court may not order treatment that has not been recommended by the examining licensed mental health treatment provider and included in the written treatment plan."² If the person has executed an advance health care directive under the Probate Code, "any directions included in the advance health care directive shall be considered in formulating the written treatment plan."² Psychiatric advance directives in California →

There is also a door out of the hearing. Before it concludes, the person "may waive the right to an assisted outpatient treatment hearing for the purpose of obtaining treatment under a settlement agreement, provided that an examining licensed mental health treatment provider states that the person can survive safely in the community"; the agreement "may not exceed 180 days," must be in writing, and must be approved by the court.⁵

What the order can and cannot do

  • Medication. "Involuntary medication shall not be allowed absent a separate order by the court pursuant to Section 5332 to 5336, inclusive."³ An AOT order is not a medication order. Can they medicate me against my will? →
  • Non-compliance. If a licensed provider judges that the person "has failed or has refused to comply with the treatment ordered by the court," that "efforts were made to solicit compliance," and that the person "may be in need of involuntary admission to a hospital for evaluation," the provider may ask that the person be taken to a hospital "to be held up to 72 hours for examination" — and anything beyond that "shall be pursuant to Section 5150." If during those 72 hours the person "is determined not to meet the criteria of Section 5150, and does not agree to stay in the hospital as a voluntary patient, the person shall be released."² Non-compliance alone is neither commitment nor contempt.² What is a 5150 hold? →
  • Duration and renewal. Six months at first; if the programme director judges that further treatment is needed, the director "shall apply to the court, prior to the expiration" of the order, for "continued assisted outpatient treatment for a period not to exceed 180 days," using the same procedure, and each later order "may not exceed 180 days."² At intervals of not less than 60 days the director must file an affidavit "affirming that the person … continues to meet the criteria" and "report to the court on adherence to prescribed medication"; at each such point the person has the right to a hearing on whether they still meet the criteria, with the burden of proof on the director.²

What to do

  • If you are the family member: write to the county behavioral health director with the facts under criterion 4 — dates of hospitalizations or custody stays, or dated incidents of violence or threats — and ask, in writing, whether the person has been offered the county's treatment plan.² If the county has opted out, ask for the resolution.⁴ The voluntary version of the same services must be on offer.³ CARE Court, the other route →
  • If you are the person named: ask for the public defender the moment you are served;² read the treatment plan for anything the examining provider did not recommend, because the court cannot order it;² and know that refusing medication is not contempt.² ³
  • Either way: an advance health care directive written while well must be considered in formulating the treatment plan.² Psychiatric advance directives →

Worked example

A mother's adult son has schizophrenia, has been hospitalized three times in two years, and stops his medication within a month of each discharge. She is his parent, so she may request that the county file;² the county behavioral health director's designee has offered him a treatment plan containing all the services section 5348 lists and he has not engaged, so criterion 5 is met;² his three hospitalizations in 24 months meet criterion 4.² A psychiatrist's affidavit finds him unlikely to survive safely without supervision and substantially deteriorating. He asks for counsel and the court appoints the public defender; the hearing is set for a date no more than five days, excluding weekends and holidays, after the petition is received; and the court orders six months of assisted outpatient treatment limited to the services in the plan.² When he misses a month of appointments, a licensed provider judges that he has not complied, that efforts to re-engage him have failed, and that he may need hospital evaluation, and asks staff designated under section 5150 to bring him in for up to 72 hours; he does not meet the 5150 criteria that day and is released.² The order did not, and could not, put him in jail or force an injection.² ³

Q&A

Q: Can I file the petition myself? A: No. Only the county behavioral health director or designee files; a parent, spouse, sibling or adult child may request that the county do so.²

Q: Does an order mean he has to take his medication? A: No. Involuntary medication requires a separate court order under sections 5332 to 5336.³

Q: What if the county says it has no programme? A: Since 1 July 2021 a county that does not wish to implement the article "may opt out" by a resolution stating its reasons.⁴ Ask whether such a resolution exists.

Q: Is this the same as CARE Court? A: No. CARE Court is governed by a different part of the Welfare and Institutions Code, with its own criteria. CARE Court and conservatorship →

Q: My relative is 17. A: The first criterion is age 18 or older.² For a minor, the routes are different. Can my teen see a therapist? →

Our therapist directory: See its current status →

The next step up: Can I petition for an LPS conservatorship? →

In crisis? Call or text 988 — free, 24/7.

Sources

  1. Cal. Welfare & Institutions Code §5345 — (a) "This article shall be known, and may be cited, as Laura's Law"; (b) "assisted outpatient treatment" defined as "categories of outpatient services that have been ordered by a court pursuant to Section 5346 or 5347" — california.public.law. The article's sunset, former §5349.5, was repealed, and §§5346–5349.1 amended, repealed and re-added, by AB 1976 (Stats. 2020, Ch. 140) — legiscan.com.
  2. Cal. Welfare & Institutions Code §5346 — (a) "In any county or group of counties where services are available as provided in Section 5348, a court may order a person … to obtain assisted outpatient treatment if the court finds, by clear and convincing evidence, that the facts stated in the verified petition … are true and establish that all of the requisite criteria set forth in this section are met," (a)(1)–(7) as quoted, including (a)(3)(A)–(B), (a)(4)(A)–(B) with "not including any period during which the person was hospitalized or incarcerated immediately preceding the filing of the petition," and (a)(5) "the person continues to fail to engage in treatment"; (b)(1) "A petition for an order authorizing assisted outpatient treatment may be filed by the county behavioral health director, or the director's designee, in the superior court in the county in which the person who is the subject of the petition is present or reasonably believed to be present"; (b)(2) "A request may be made only by any of the following persons to the county mental health department," (A)–(G) as quoted; (b)(5)(B) the affidavit on "capacity to give informed consent regarding psychotropic medication"; (c) counsel and "the court shall immediately appoint the public defender or other attorney"; (d)(1) the hearing "not later than five days from the date the petition is received by the court, excluding Saturdays, Sundays, and holidays"; (d)(4)(A)–(I) the rights as quoted; (d)(5)(B) "an initial period not to exceed six months," "the court may not order treatment that has not been recommended by the examining licensed mental health treatment provider and included in the written treatment plan," and the advance health care directive "shall be considered in formulating the written treatment plan"; (f) the 72-hour examination on non-compliance as quoted, and "Failure to comply with an order of assisted outpatient treatment alone may not be grounds for involuntary civil commitment or a finding that the person who is the subject of the petition is in contempt of court"; (g) renewal "for a period not to exceed 180 days"; (h)(1)–(2) the 60-day affidavit and the report "on adherence to prescribed medication" — california.public.law.
  3. Cal. Welfare & Institutions Code §5348 — (a) the services a participating county "shall offer"; (b) "A county that provides assisted outpatient treatment services pursuant to this article also shall offer the same services on a voluntary basis"; (c) "Involuntary medication shall not be allowed absent a separate order by the court pursuant to Section 5332 to 5336, inclusive" — california.public.law.
  4. Cal. Welfare & Institutions Code §5349 — (a) "A county or group of counties that does not wish to implement this article may opt out of the requirements of this article by a resolution passed by the governing body that state the reasons for opting out and any facts or circumstances relied on in making that decision"; (c) "shall not reduce existing voluntary mental health programs serving adults or children's mental health programs as a result of implementation"; (e) "This section shall become operative on July 1, 2021" — california.public.law.
  5. Cal. Welfare & Institutions Code §5347(b)(1) — the waiver "for the purpose of obtaining treatment under a settlement agreement, provided that an examining licensed mental health treatment provider states that the person can survive safely in the community," and "The settlement agreement may not exceed 180 days in duration and shall be agreed to by all parties"; (b)(2) "in writing, be approved by the court, and include a treatment plan" — california.public.law.

Paid for by participating therapists. Inclusion is computed from availability data — never purchased. No ads, no data sold.