For those living with severe mental illnesses, access to treatment may make all the difference between whether they are able to survive within their communities or face challenges with time spent in jail, homelessness or psychiatric hospitalization.

Without treatment for conditions like schizophrenia or bipolar disorder, psychotic disorders left untreated can lead to estrangement from one’s family, substance abuse or time spent in jail, said Deanna Kolda, program director at the San Mateo nonprofit Caminar, which provides behavioral health services.

Having worked with individuals in the Assisted Outpatient Treatment, or AOT, program offered by County Health’s Behavioral Health and Recovery Services Division, Kolda has seen some of the challenges program clients have faced when they either didn’t know they had a mental illness or struggled to access treatment. Operated by Caminar, the program is aimed at meeting the needs of those whose conditions have worsened at home or jail or have made it difficult to function well in their communities, said Kolda.

“Unfortunately, mental health illness is complicated and people don’t always see the need to address it,” she said. “Bad stuff happens when people don’t address their mental illness.”

One of many Assisted Outpatient Treatment programs offered in counties throughout the state, the county’s program is the local implementation of Laura’s Law, a bill passed by the state Legislature in 2002, said Terry Rittgers, clinical services manager with County Health’s Behavioral Health and Recovery Services Division.

Drafted after the death of Laura Wilcox, a Nevada County mental health worker killed by a psychiatric patient, Assembly Bill 1421 is aimed at supplementing mental health services in counties to prevent similar tragedies, said Rittgers.

Approved by the Board of Supervisors in June of 2015, the program was designed so county staff receive referrals and screen potential program clients, and once they’re deemed eligible for the program, Caminar provides the treatment they need, he said. With a phone line, email address and website open to take calls from anyone who thinks they know someone in need of treatment, Rittgers said the program has received 340 referrals and 82 calls seeking information about mental health resources since it first started.

To be eligible, clients must be over 18 years of age, diagnosed with a serious mental illness, unable to safely survive in their community without supervision and either hospitalized or incarcerated at least twice within the last 36 months or been a threat to the safety of themselves or others in the last two years, said Rittgers. Though those deemed eligible for the program may have refused services in the past, Rittgers said members of the county’s AOT team meet with them and their families to figure out the best way to engage in services that may help, a process he said can take weeks or months to ensure they can see the benefit of getting involved in these services.

Rittgers said many of the some 70 clients have been enrolled in the program since it started were homeless, incarcerated or hospitalized just before they began treatment and a significant portion of those who have graduated have since found stable housing, developed a treatment plan and been able to get their lives together for the first time in years. Though the vast majority of AOT program clients participate in it voluntarily, Kolda said a small portion of clients are ordered into treatment through a court.

“That this is not only helped to get them into housing, but it’s helped to get them the behavioral health treatment they need,” he said. “It’s also helped them get a sense of hope.”

Kolda said the first step Caminar staff take with individuals who are entering the program is to understand what the clients feel their needs are and devise an individualized treatment plan, which could include medication education, individual and group therapy, case management and assistance with applying for benefits for which they are eligible.

She said many clients work with staff to apply for housing, which she said can be critical to the success of their treatment, and their case management team can help them make appointments and stay connected with resources that can help them.

Rittgers estimated more than $700,000 in costs were not incurred by county services, which include incarceration as well as psychiatric hospitalizations and emergency visits, because clients were served by the AOT program. Not every person who is evaluated for program eligibility is ultimately referred for AOT services but, in meeting with individuals with severe mental illness through the process, officials can more efficiently connect them with resources that can help them avoid trips to the emergency room or jail, he said. The approved budget for this program was $3,766,973 through June 2018, according to a staff report.

Kolda said the services clients access through the AOT program can be a step below a locked facility and often, unlike other experiences they’ve had in the past, offer them a way to work toward managing their conditions. Though she acknowledged the hospitals and jails offer an alternative, she noted they can be isolating experiences if they don’t meet the needs of someone who is struggling with managing a mental illness. She recalled a client who recently told her that in working with Caminar staff through the AOT program, she felt like she was seen for the first time, an account Kolda felt demonstrated the connection clients feel to those who are providing their treatment.

“They’re often met in our system with places that aren’t able to meet their needs and so they feel rejected,” she said. “People feel that sense of connection that they desperately need.”

Call (650) 372-6125 or email AOT@smcgov.org to contact the AOT team or make a referral. Visit smchealth.org/general-information/assisted-outpatient-treatment-san-mateo-county for more information.

(650) 344-5200 ext. 106

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