228:
participate in a treatment plan by the local mental health department, yet fails to the point that, without a Laura's Law program, he or she will likely relapse or deteriorate to the point of being dangerous to self or others. "Participation in the assisted outpatient program is the least restrictive placement necessary to ensure the person's recovery and stability." While a specified group of individuals may request an investigation to determine if a person qualifies for a Laura's Law program, only the County mental health director, or his or her designee, may file a petition with the superior court for a hearing to determine if the person should be court ordered to receive the services specified under the law.
391:
to take away a person's freedom in order to help "treat" that person. Historically, the profession has suffered from abusing this right — so much so that reform laws in the 1970s and 1980s took the profession's right away from them to confine people against their will. Such forced treatment now requires a judge's signature. But over time, that judicial oversight — which is supposed to be the check in our checks-and-balance system — has largely become a rubber stamp to whatever the doctor thinks is best. The patient's voice once again threatens to become silenced, now under the guise of "assisted outpatient treatment" (just a modern, different term for forced treatment)."
415:
in the approach to mental health care between
America and Europe. European laws often state "danger to self or others," but danger in Europe is almost always interpreted very broadly — and you might think paternalistically — to include the patient's mental health. If I have a seriously ill schizophrenic patient who is neglecting himself, not taking his medicine, and I know he's going to get worse, I can say that's a "danger" to his health. My understanding is that in many states in America, it's got to be an imminent physical risk."
838:
coercion 1.36 CI 0.97 to 1.89). However, risk of victimisation may decrease with OPC (1 RCT, n = 264, RR 0.5 CI 0.31 to 0.8). In terms of numbers needed to treat (NNT), it would take 85 OPC orders to prevent one readmission, 27 to prevent one episode of homelessness and 238 to prevent one arrest. The NNT for the reduction of victimisation was lower at six (CI 6 to 6.5). A new search for trials in 2008 did not find any new trials that were relevant to this review.
848:
in the
Section 17 group). At 12 months, despite the fact that the length of initial compulsory outpatient treatment differed significantly between the two groups (median 183 days CTO group vs 8 days Section 17 group, p<0·001) the number of patients readmitted did not differ between groups (59 of 166 patients in the CTO group vs 60 of 167 patients in the Section 17 group; adjusted relative risk 1·0 ).
429:
204:, where the shootings took place, fully implemented the law. In 2010 the California State Association of Counties chose Nevada County to receive its Challenge Award for implementing Laura's Law. In 2011 a National Association of Counties Achievement Award in Health was awarded to Nevada County for the Assisted Outpatient Treatment Program.
285:
services, as specified, for persons with the most persistent and severe mental illness. The law specifies various rights of the person who is the subject of a Laura's Law petition as well as due process hearing rights. The bill also provides for voluntary settlement agreements as an alternative to the hearing process.
414:
Burns went on to highlight another critical difference between the two systems, and even mentioned that as a psychiatrist under a
European system he would be willing to order coercive treatment under circumstances similar to the ones described by Laura's Law: "There's a profound conceptual difference
847:
Of 442 patients assessed, 336 patients were randomly assigned to be discharged from hospital either on CTO (167 patients) or
Section 17 leave (169 patients). One patient withdrew directly after randomisation and two were ineligible, giving a total sample of 333 patients (166 in the CTO group and 167
842:
The results of this study also did not support the usefulness of compulsory outpatient treatment: Community treatment orders (CTOs) for patients with psychosis (OCTET): a randomised controlled trial done by
Professor Tom Burns DSc, Jorun Rugkåsa PhD, Andrew Molodynski MBChB, John Dawson LLD, Ksenija
484:
As a result of the opposition to Kendra's Law, similar in nature to Laura's Law, two studies were conducted on Kendra's Law and found favorable outcomes. One study of
Assisted Outpatient Treatment within the United States and another study done by a previous proponent of AOT type laws in the United
390:
John M. Grohol, Psy.D., in his article "The Double
Standard of Forced Treatment", says "Forced treatment for people with mental illness has had a long and abusive history, both here in the United States and throughout the world. No other medical specialty has the rights psychiatry and psychology do
406:
However, Burns' opinion was based heavily on his (very different) circumstances in the United
Kingdom. The study he conducted found that coerced treatment was no better than regular/competent un-coerced treatment (the standard in the United Kingdom, which has public healthcare). As a result, the
218:
In those counties that adopt outpatient commitment, the process will ensure individuals are provided the services, medical treatment and medication that will enable the person to have a good chance to recover. Nevada County
Director Michael Heggarty described it as part of the recovery movement.
402:
Tom Burns, the psychiatrist who originally advised the United
Kingdom's government on laws that are similar to Laura's Law, has also come to the conclusion they are ineffective and unnecessary. Professor Burns, once a strong supporter of the new powers, said he has been forced to change his mind
284:
If the court finds that the individual meets the statutory criteria, the recipient will be provided intensive community treatment services and supervision by multidisciplinary teams of highly trained mental health professionals with staff-to-client ratios of not more than 1 to 10, and additional
227:
To be eligible under Laura's Law, a patient must have a serious mental illness plus a recent history of psychiatric hospitalizations, jailings or acts, threats or attempts of serious violent behavior towards self or others. The recipient must also have been offered an opportunity to voluntarily
837:
by 11-12 months 0.98 CI 0.79 to 1.2); social functioning (2 RCTs, n = 416, RR for arrested at least once by 11-12 months 0.97 CI 0.62 to 1.52); mental state; quality of life (2 RCTs, n = 416, RR for homelessness 0.67 CI 0.39 to 1.15) or satisfaction with care (2 RCTs, n = 416, RR for perceived
366:
Outpatient commitment opponents make several varied arguments. Some dispute the positive effects of compulsory treatment, questioning the methodology of studies that show effectiveness. Others highlight negative effects of treatment. Still others point to disparities in the way these laws are
127:
The law is only operative in those counties in which the county board of supervisors, by resolution, authorizes its application and makes a finding that no voluntary mental health program serving adults, and no children's mental health program, was reduced in order to implement the law.
214:
adopted the provisions on May 25, 2021, at which time 21 out of 58 counties had opted in. Legislation in 2020 required counties to participate or explicitly opt out by July 1, 2021. Counties may choose to participate or opt-out of the program at the beginning of each fiscal year.
832:
We identified two randomised clinical trials (total n = 416) of court-ordered 'Outpatient Commitment' (OPC) from the USA. We found little evidence that compulsory community treatment was effective in any of the main outcome indices: health service use (2 RCTs, n = 416, RR for
135:(MHSA). The California Department of Mental Health (DMH) released its draft plan requirements for county mental health administrators on February 15, 2005 and included a provision that would allow MHSA funds to be used for "involuntary services" if certain criteria were met.
263:
Be, in view of his or her treatment history and current behavior, in need of assisted outpatient treatment in order to prevent a relapse or deterioration that would likely result in the person meeting California's inpatient commitment standard, which is
407:
bulk of his argument does not apply to California, where the alternative to coerced treatment in most cases is no treatment at all. Professor Burns himself admitted that: "We were careful in our Lancet article to say that
27:. To qualify for the program, the person must have a serious mental illness plus a recent history of psychiatric hospitalizations, jailings or acts, threats or attempts of serious violent behavior towards self or others.
1518:
827:
The study, Compulsory community and involuntary outpatient treatment for people with severe mental disorders by Steve R Kisely, Leslie Anne Campbell, Neil J Preston published at The Cochrane Library found:
355:, also fought the measure and its earlier versions, accusing such legislation as a regressive and reprehensible scheme to enforce coerced drug treatment regimens against the will of patients. The
394:
The New Mexico Court of Appeals declared an Albuquerque ordinance, modeled after Kendra's Law, requiring treatment for some mentally ill people conflicts with state law and can't be enforced.
1004:
1490:
107:, a 40-year-old man who resisted his family's and a social worker's attempt to have him hospitalized when he became increasingly delusional and paranoid. Thorpe was found
1626:
1897:
1599:
257:
Have been offered an opportunity to voluntarily participate in a treatment plan by the local mental health department but continue to fail to engage in treatment
1902:
1777:
1776:
Burns, Thomas; Jorun Rugkåsa; Andrew Molodynski; John Dawson; Ksenija Yeeles; Maria Vazquez-Montes; Merryn Voysey; Julia Sinclair; Stefan Priebe (11 May 2013).
179:
231:
A person may be placed in an assisted outpatient treatment if, after a hearing, a court finds that the following criteria have been met. The patient must:
1076:
488:
A 2005 study, Kendra's Law A Final Report on the Status of Assisted Outpatient Treatment done by New York State's Office of Mental Health, found:
1876:
1519:"Housing, Homelessness, and Mental Illness - Recommendations for President Bush's New Freedom Initiative Commission on Mental Health Services"
1282:
132:
1844:
1498:
280:
Participation in the assisted outpatient program is the least restrictive placement necessary to ensure the person's recovery and stability.
119:. After the killings, Laura's parents chose to advocate for assisted outpatient treatment of individuals considered to have mental illness.
1442:
1418:
876:
360:
325:
311:
1001:
1554:
1394:
1322:
1020:
252:
Resulted in one or more acts, attempts or threats of serious violent behavior toward self or others within the last forty-eight months
103:
public mental health clinic during her winter break from college, on January 10, 2001, she and two other people were shot to death by
438:
1346:
471:
1838:
1834:
1555:"Los Angeles Times editorial supporting AB 1421, California bill for involuntary commitment: Governor, Sign Laura's Law 09 28 02"
55:
1102:
843:
Yeeles BSc, Maria Vazquez-Montes PhD, Merryn Voysey MBiostat, Julia Sinclair DPhil, and Professor Stefan Priebe FRCPsych found:
249:
Been a significant factor in his or her being in a hospital, prison or jail at least twice within the last thirty-six months; or
963:
175:
1308:
1233:
380:
368:
352:
299:
147:
139:
74:
1577:
95:
Laura Wilcox was a 19-year-old college sophomore who had been valedictorian of her high school before going on to study at
1907:
950:
870:
24:
1370:
1892:
858:
307:
163:
90:
31:
704:
371:
opposes compulsory treatment on the basis that the ordered drugs often have serious or unpleasant side-effects such as
272:
Gravely disabled (in immediate physical danger due to being unable to meet basic needs for food, clothing, or shelter);
1912:
108:
1178:
191:
142:
implemented Laura's Law on a limited basis. Since passage of MHSA, Laura's Law provisions have been implemented in
1050:
984:
1654:
1210:
882:
348:
303:
201:
159:
155:
151:
112:
51:
442:
494:
Reduced Incidence of Harmful Behaviors Percent of Persons with One or More Events Reported in the Past 90 Days
328:
which opposes virtually all psychiatric treatments, sponsored a rally at the Capitol against Laura's law. The
1466:
1917:
968:
329:
171:
100:
888:
699:
333:
187:
67:
63:
1331:
906:
894:
501:
356:
78:
1153:
927:
1080:
834:
241:
Be unlikely to survive safely in the community without supervision, based on a clinical determination
1871:
1002:
http://www.leginfo.ca.gov/cgi-bin/displaycode?section=wic&group=05001-06000&file=5345-5349.5
1721:"Compulsory community and involuntary outpatient treatment for people with severe mental disorders"
116:
104:
1808:
376:
211:
1778:"Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial"
1800:
1758:
1740:
337:
316:
96:
59:
1792:
1748:
1732:
1165:
195:
167:
43:
1562:
1319:
1028:
1326:
1309:
http://leginfo.ca.gov/pub/01-02/bill/asm/ab_1401-1450/ab_1421_bill_20020928_chaptered.html
1008:
988:
900:
695:
864:
35:
1837:- 'Bill for More Forced Psychiatry Passed by California Legislature, Goes to Governor',
1693:
1753:
1720:
1669:
1129:
183:
20:
1796:
351:
and the California Network of Mental Health Clients (CNMHC), along with allies in the
1886:
1110:
1812:
1655:"Can Laura's Law help the mentally ill? Researcher Tom Burns' surprising conclusion"
1736:
873:, a gun control to temporarily remove firearms from people who may present a danger
453:
207:
1541:
1206:
823:(Table taken directly from source and converted to Knowledge (XXG) Table Template)
690:(Table taken directly from source and converted to Knowledge (XXG) Table Template)
490:
1144:
Telecare Corp. has 17 of 30 slots in Alameda County. Retrieved 23 December 2017
143:
1186:
694:
A 2009 study, New York State Assisted Outpatient Treatment Evaluation done by
321:
70:
1744:
1141:
324:'s support, while limiting its comments on opponents to mentioning that the
372:
1804:
1762:
1719:
Kisely, Steve R.; Campbell, Leslie A.; O'Reilly, Richard (17 March 2017).
1670:"Kendra's Law Final Report on the Status of Assisted Outpatient Treatment"
1262:
California Association of Local Behavioral Health Boards & Commissions
1257:
384:
210:
launched a two-year pilot program for Laura's Law on September 4, 2018.
981:
903:, a movement that opposes any form of involuntary psychiatric treatment
867:, assisted outpatient treatment law in NY on which Laura's law is based
39:
449:
1854:
310:, the Police Chiefs Association, Mental Illness Policy Org. and the
1207:"Marin debuts two-year Laura's Law pilot after years of resistance"
1142:
Alameda Assisted Outpatient Treatment and Community Conservatorship
1694:"New York State Assisted Outpatient Treatment Program Evaluation"
387:, addiction, sexual side effects, and increased risk of suicide.
244:
Have a history of non-compliance with treatment that has either:
1859:
411:, compulsory treatment has nothing to offer" (emphasis added).
340:
won a Pulitzer Prize, in part for its coverage of Laura's Law.
298:
Passage of the bill was supported by organizations such as the
131:
In November 2004, California voters passed Proposition 63, the
422:
1307:
Laura's Law. AB 1421. September 28th, 2002. leginfo.ca.gov.
30:
The law was named after Laura Wilcox, a receptionist who was
277:
Be likely to benefit from assisted outpatient treatment; and
861:, the shooting spree which led to the law being implemented
403:
after a study he conducted proved the orders "don't work".
1320:
Helping people off the streets: Governor, sign Laura's Law
363:
have also gained attention as an opponent of the new law.
269:
A serious risk of harm to himself or herself or others; or
1849:
1283:"Debate Continues Over Laura's Law, Mental Health Care"
1027:. Los Angeles Times. February 14, 2004. Archived from
1846:
Convention on the Rights of Persons with Disabilities
1627:"'Psychiatric Asbos' were an error says key advisor"
1000:
Welfare and Institutions Code 5349 leginfo.ca.gov.
928:"As county considers Laura's Law, a mother reflects"
314:(NAMI). In an editorial endorsement of the law, the
1600:"Court Nixes Albuquerque Ordinance On Mentally Ill"
1168:
Mental Illness Policy Org. Retrieved 9 August 2015.
336:have published positive articles on the topic. The
223:Assisted outpatient treatment eligibility criteria
34:who had refused psychiatric treatment. Modeled on
1443:"Laura's Law will save mentally ill, S.F. budget"
951:"Failed warnings arose as killer's paranoia grew"
1873:Mental Illness Policy Org. Laura's Law Home Page
1419:"Katz, supes need to give Laura's Law a chance"
1234:"UPDATE: Santa Clara County adopts Laura's Law"
1649:
1647:
879:, California's law for psychiatric emergencies
8:
1542:Community Fights the Psychiatric Steamroller
1179:"California Challenge Award Recipients 2010"
1130:Alameda County Assisted Outpatient Treatment
1839:California Network of Mental Health Clients
1725:The Cochrane Database of Systematic Reviews
1395:"Laura's Law faces battle with supervisors"
1371:"San Francisco chooses jail over treatment"
526:Physically Harm Self/Made Suicide Attempt
452:. Please do not remove this message until
409:in well-coordinated mental health services
115:and was later transferred to California's
1752:
1578:"The Double Standard of Forced Treatment"
1303:
1301:
472:Learn how and when to remove this message
289:Debate over bill's efficacy and propriety
1347:"Why Laura's Law has had limited impact"
1183:California State Association of Counties
448:Relevant discussion may be found on the
918:
719:Outcome events (past six months)
521:Percent Reduction in Harmful Behaviors
504:(AOT) Recipients with Harmful Behaviors
300:California Treatment Advocacy Coalition
1898:Mental health law in the United States
1467:"Correcting the record on Laura's Law"
1077:"County approves aid for mentally ill"
288:
1491:"Griffin: Laura's Law is sane choice"
713:
710:
7:
1903:United States disability legislation
885:, a Florida law of similar operation
711:No current or recent AOT (n=134)
877:5150 (Involuntary psychiatric hold)
383:, excessive weight gain leading to
361:Citizens Commission on Human Rights
326:Citizens Commission on Human Rights
312:National Alliance on Mental Illness
123:Implementation at county discretion
66:in 2002 and was signed into law by
1625:Manning, Sanchez (14 April 2013).
1544:, article on a Scientology website
1103:"Laura's Law A Functional Outline"
308:California Psychiatric Association
238:Be suffering from a mental illness
73:. The statute can only be used in
14:
1668:Carpinello, Sharon (March 2005),
897:, which is independent of setting
804:Mental health pick-up/removal
753:Suicidal thoughts or attempts
235:Be eighteen years of age or older
1441:Cummings, Stephen (2010-08-01),
1051:"Kern County Adopts Laura's Law"
427:
180:City and County of San Francisco
81:programs based on the measure.
1489:Griffin, Melissa (2010-05-27),
1737:10.1002/14651858.CD004408.pub5
871:Gun Violence Restraining Order
698:, Policy Research Associates,
381:neuroleptic malignant syndrome
369:psychiatric survivors movement
353:psychiatric survivors movement
260:Be substantially deteriorating
23:that allows for court-ordered
1:
1877:The Treatment Advocacy Center
1797:10.1016/S0140-6736(13)60107-5
1692:Swartz, Marvin (2009-06-30),
1465:Stettin, Brian (2010-08-17),
1281:McConahay, Pat (2010-08-19),
1232:Reese, Madelyn (2021-05-25).
1021:"True help on mental illness"
926:Jenkins, Logan (2013-03-08).
502:Assisted Outpatient Treatment
46:, the bill was introduced as
25:assisted outpatient treatment
1856:Disability Rights California
859:2001 Nevada County shootings
515:At Onset of AOT Court Order
91:2001 Nevada County shootings
1576:Grohol, John (2012-11-26).
1417:Nevius, C.W. (2010-07-31),
1393:Nevius, C.W. (2010-07-20),
1369:Martin, Fred (2010-03-22),
1345:Fagan, Kevin (2010-05-12),
624:Create Public Disturbances
596:Damage or Destroy Property
454:conditions to do so are met
1934:
1701:Office of Mental Health NY
1674:Office of Mental Health NY
1132:Retrieved 23 December 2017
133:Mental Health Services Act
109:incompetent to stand trial
88:
1211:Marin Independent Journal
982:In memoriam: Laura Wilcox
891:, which is hospital-based
803:
786:
769:
752:
735:
730:
727:
724:
721:
718:
667:Average Percent Reduction
520:
517:
514:
498:
493:
349:MindFreedom International
304:Treatment Advocacy Center
113:Atascadero State Hospital
62:. The measure passed the
638:Verbally Assault Others
1471:San Francisco Chronicle
1447:San Francisco Chronicle
1423:San Francisco Chronicle
1399:San Francisco Chronicle
1375:San Francisco Chronicle
1351:San Francisco Chronicle
1166:"Laura's Law Home Page"
1156:Retrieved 14 July 2016.
969:San Francisco Chronicle
964:Carry out 'Laura's Law'
835:readmission to hospital
787:Involuntary commitment
610:Threaten Physical Harm
582:Physically Harm Others
330:San Francisco Chronicle
1495:San Francisco Examiner
1185:, 2010, archived from
1055:California County News
889:involuntary commitment
700:University of Virginia
334:San Francisco Examiner
188:San Luis Obispo County
64:California Legislature
1332:The Los Angeles Times
1287:California Healthline
1154:"Ukiah Daily Journal"
907:Outpatient commitment
895:Involuntary treatment
357:Church of Scientology
320:touted then-Governor
302:(an affiliate of the
79:outpatient commitment
77:that choose to enact
1908:2002 in American law
1335:, September 28, 2002
1081:Half Moon Bay Review
714:Current AOT (n=115)
21:California state law
1893:California statutes
1841:(September 3, 2002)
1791:(9878): 1627–1633.
1213:. 19 September 2018
441:of this section is
176:Contra Costa County
117:Napa State Hospital
105:Scott Harlan Thorpe
99:. While working at
1913:2002 in California
1325:2005-03-05 at the
1238:San José Spotlight
1007:2010-11-23 at the
987:2008-03-19 at the
377:tardive dyskinesia
212:Santa Clara County
148:Los Angeles County
140:Los Angeles County
48:Assembly Bill 1421
1565:on March 5, 2005.
1559:www.psychlaws.org
972:, March 21, 2006.
824:
820:
819:
736:Violent behavior
691:
687:
686:
568:Threaten Suicide
485:Kingdom did not.
482:
481:
474:
338:Los Angeles Times
317:Los Angeles Times
97:Haverford College
54:Helen Thomson, a
1925:
1817:
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1604:Associated Press
1596:
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1573:
1567:
1566:
1561:. Archived from
1551:
1545:
1539:
1533:
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1530:
1515:
1509:
1508:
1507:
1506:
1501:on July 16, 2011
1497:, archived from
1486:
1480:
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1109:, archived from
1099:
1093:
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1090:
1088:
1073:
1067:
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1064:
1062:
1047:
1041:
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1038:
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1031:on April 4, 2004
1017:
1011:
998:
992:
979:
973:
961:
955:
954:
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705:
689:
491:
477:
470:
466:
463:
457:
431:
430:
423:
196:Mendocino County
168:San Mateo County
164:San Diego County
111:and was sent to
1933:
1932:
1928:
1927:
1926:
1924:
1923:
1922:
1883:
1882:
1879:- 'Laura's Law'
1866:Proponent views
1835:MindFreedom.org
1826:
1821:
1820:
1780:
1775:
1774:
1770:
1731:(6): CD004408.
1718:
1717:
1713:
1705:
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1696:
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1676:
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1635:
1633:
1631:The Independent
1624:
1623:
1619:
1609:
1607:
1606:. 5 August 2008
1598:
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1353:
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1339:
1327:Wayback Machine
1318:
1314:
1306:
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36:Kendra's Law
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500:Percent of
172:Yolo County
144:Kern County
42:enacted in
17:Laura's Law
1887:Categories
1785:The Lancet
1706:2010-10-27
1679:2010-10-27
1529:2010-10-27
1505:2010-10-27
1476:2010-10-27
1452:2010-10-27
1428:2010-10-27
1404:2010-10-27
1380:2010-10-27
1356:2010-10-27
1292:2010-10-27
1267:2021-06-03
1243:2021-06-03
1217:5 December
1193:2010-10-27
1117:2010-10-27
1087:12 January
1061:12 January
913:References
439:neutrality
344:Opposition
322:Gray Davis
294:Supporters
85:Background
71:Gray Davis
1745:1469-493X
883:Baker Act
702:, found:
450:talk page
398:Tom Burns
373:anhedonia
200:By 2010,
138:In 2004,
1813:16949843
1805:23537605
1763:28303578
1323:Archived
1005:Archived
985:Archived
853:See also
462:May 2013
443:disputed
385:diabetes
359:and the
332:and The
75:counties
68:Governor
56:Democrat
44:New York
1754:6464695
934:9 March
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1781:(PDF)
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60:Davis
58:from
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1759:PMID
1741:ISSN
1638:2013
1612:2013
1586:2013
1523:NAMI
1219:2018
1089:2017
1063:2017
1037:2024
936:2013
661:29%
647:36%
644:21%
641:33%
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