+California: Separate outpatient standard only available in counties that have adopted provisions established by Assembly Bill 1421 (2002) (a.k.a. Laura’s Law); otherwise mandated outpatient treatment only permitted via conservatorship process
*Duty to Warn: Discretionary: States that require law enforcement notification.
Court Ordered Assisted Outpatient Treatment
Statutes providing for Court Ordered Assisted Outpatient Treatment (AOT) may also be known as Kendra's Law, Kevin's Law, Laura's Law, etc. After several incidents that resulted in the death or serious harm of an individual by a mentally ill subject, many states established a procedure for obtaining court ordered assisted outpatient treatment for the severely mentally ill. The criterion for court ordered AOT are specific and comprehensive related to a mentally ill individual who presents as a substantial and ongoing risk to the safety of themselves or others and has a history of treatment noncompliance. 42 states and D.C. have implemented laws for court ordered assisted outpatient treatment. California allows for AOT by county; only Los Angeles has bought into it at this time. There are obvious advantages to court ordered assisted outpatient treatment. Specially, AOT criteria does not require a person to be an "imminent danger" to themselves or others, as does a petition for an involuntary inpatient commitment. It also allows for a person to be ordered to treatment to prevent a relapse that could result in the serious harm of the individual or others. Outpatient treatment is certainly less restrictive than inpatient for the individual. It also frees up frequently limited bed availability for individuals who present as a more imminent risk. However, AOT is only effective in preventing harm to self/others if there is consistent follow-up by the court and the mental health system.
Duty to Warn Laws
Background: In Berkeley, California in 1969, Prosenjit Poddar confided to Dr. Lawrence Moore his intent to kill Tatiana Tarasoff. Several months later, Poddar carried out his threat and killed Tarasoff. Neither Tatiana nor her parents received any warning of the threat. Tarasoff's parents then sued Moore.
Statutes based on the Tarasoff incident create exceptions to therapist-patient confidentiality. The "duty to warn" relates to a patient telling his/her therapist that he/she has plans to harm another. 13 states have laws addressing a mental health clinician's responsibility to warn the intended victim or law enforcement. The laws related to other states are frequently ambivalent. 27 states impose a "duty to warn" potential violence to a third party. 12 of these states make this duty nondiscretionary (not subject to the judgment of the therapist). 15 "duty to warn" states explicitly incorporate the therapist's judgment. Nine states and D.C. permit, but do not require, a therapist to breach confidentiality and warn the third party. 14 states require law enforcement notification. However, most prudent clinicians in duty states will contact the sheriff's or police department, largely to transfer some if not all of any civil liability in the worst case scenario situations (local governments tend to have deeper pockets). State laws certainly differ, but may require law enforcement officers to confiscate the individual's firearms and report to the DOJ.
Mental Health Systems
Perhaps the most important component to this whole mess is that the state mental health systems' ability to treat the most severely mentally ill is often dismal. The National Alliance for the Mentally Ill (NAMI) analyzed 48 states' adequacy related to mental health infrastructure, information access, services, and recovery support. For an overview of your state's grade related to the ability to treat the most seriously mentally ill and a discussion about the urgent needs of your state's system, see the link below. New York and Colorado did not respond to NAMI's request for information
This ultimately does become a law enforcement problem when an officer or deputy is trying to secure treatment for their jurisdiction's most seriously mentally citizens. It becomes a personal problem if you, a loved one, a friend or a peer is in need of mental health care.