BILL NUMBER: AB 3083 CHAPTERED 09/30/08 CHAPTER 591 FILED WITH SECRETARY OF STATE SEPTEMBER 30, 2008 APPROVED BY GOVERNOR SEPTEMBER 30, 2008 PASSED THE SENATE AUGUST 14, 2008 PASSED THE ASSEMBLY AUGUST 18, 2008 AMENDED IN SENATE JULY 2, 2008 AMENDED IN ASSEMBLY MAY 23, 2008 AMENDED IN ASSEMBLY APRIL 22, 2008 AMENDED IN ASSEMBLY APRIL 10, 2008 INTRODUCED BY Committee on Veterans Affairs (Salas (Chair), Beall, Carter, Lieu, and Wolk) (Coauthors: Assembly Members Cook, DeVore, and Sharon Runner) MARCH 13, 2008 An act to amend Sections 5600.3, 5806, 5807, and 5808 of, and to add Section 5815 to, the Welfare and Institutions Code, relating to mental health. LEGISLATIVE COUNSEL'S DIGEST AB 3083, Committee on Veterans Affairs. Mental health: veterans. Existing law, the Adult and Older Adult Mental Health System of Care Act, sets out a system of mental health care services, provided by participating counties and administered by the State Department of Mental Health, for adults and seniors with serious mental disorders. Existing law states that California veterans who meet the existing eligibility requirements for participation be provided services to the extent resources are available. Existing law provides that counties should advise veterans of the services available through the federal government and requires counties to refer the veteran to a county veterans' service officer to determine their eligibility for federal services. This bill would make services available to the extent that services are available to other adults. This bill would require counties to assist veterans in accessing federal services. The bill would also specifically include bipolar disorder and post-traumatic stress disorder in the definition of "serious mental disorder." This bill would also require the State Department of Health Care Services, in conjunction with the State Department of Mental Health, to seek all available federal funding for mental health services of veterans. By imposing new duties upon each county, this bill would create a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 5600.3 of the Welfare and Institutions Code is amended to read: 5600.3. To the extent resources are available, the primary goal of the use of funds deposited in the mental health account of the local health and welfare trust fund should be to serve the target populations identified in the following categories, which shall not be construed as establishing an order of priority: (a) (1) Seriously emotionally disturbed children or adolescents. (2) For the purposes of this part, "seriously emotionally disturbed children or adolescents" means minors under the age of 18 years who have a mental disorder as identified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, other than a primary substance use disorder or developmental disorder, which results in behavior inappropriate to the child's age according to expected developmental norms. Members of this target population shall meet one or more of the following criteria: (A) As a result of the mental disorder, the child has substantial impairment in at least two of the following areas: self-care, school functioning, family relationships, or ability to function in the community; and either of the following occur: (i) The child is at risk of removal from home or has already been removed from the home. (ii) The mental disorder and impairments have been present for more than six months or are likely to continue for more than one year without treatment. (B) The child displays one of the following: psychotic features, risk of suicide or risk of violence due to a mental disorder. (C) The child meets special education eligibility requirements under Chapter 26.5 (commencing with Section 7570) of Division 7 of Title 1 of the Government Code. (b) (1) Adults and older adults who have a serious mental disorder. (2) For the purposes of this part, "serious mental disorder" means a mental disorder that is severe in degree and persistent in duration, which may cause behavioral functioning which interferes substantially with the primary activities of daily living, and which may result in an inability to maintain stable adjustment and independent functioning without treatment, support, and rehabilitation for a long or indefinite period of time. Serious mental disorders include, but are not limited to, schizophrenia, bipolar disorder, post-traumatic stress disorder, as well as major affective disorders or other severely disabling mental disorders. This section shall not be construed to exclude persons with a serious mental disorder and a diagnosis of substance abuse, developmental disability, or other physical or mental disorder. (3) Members of this target population shall meet all of the following criteria: (A) The person has a mental disorder as identified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, other than a substance use disorder or developmental disorder or acquired traumatic brain injury pursuant to subdivision (a) of Section 4354 unless that person also has a serious mental disorder as defined in paragraph (2). (B) (i) As a result of the mental disorder, the person has substantial functional impairments or symptoms, or a psychiatric history demonstrating that without treatment there is an imminent risk of decompensation to having substantial impairments or symptoms. (ii) For the purposes of this part, "functional impairment" means being substantially impaired as the result of a mental disorder in independent living, social relationships, vocational skills, or physical condition. (C) As a result of a mental functional impairment and circumstances, the person is likely to become so disabled as to require public assistance, services, or entitlements. (4) For the purpose of organizing outreach and treatment options, to the extent resources are available, this target population includes, but is not limited to, persons who are any of the following: (A) Homeless persons who are mentally ill. (B) Persons evaluated by appropriately licensed persons as requiring care in acute treatment facilities including state hospitals, acute inpatient facilities, institutes for mental disease, and crisis residential programs. (C) Persons arrested or convicted of crimes. (D) Persons who require acute treatment as a result of a first episode of mental illness with psychotic features. (5) California veterans in need of mental health services and who meet the existing eligibility requirements of this section, shall be provided services to the extent services are available to other adults pursuant to this section. Veterans who may be eligible for mental health services through the United States Department of Veterans Affairs should be advised of these services by the county and assisted in linking to those services. (A) No eligible veteran shall be denied county mental health services based solely on his or her status as a veteran. (B) Counties shall refer a veteran to the county veterans service officer, if any, to determine the veteran's eligibility for, and the availability of, mental health services provided by the United States Department of Veterans Affairs or other federal health care provider. (C) Counties should consider contracting with community-based veterans' services agencies, where possible, to provide high-quality, veteran specific mental health services. (c) Adults or older adults who require or are at risk of requiring acute psychiatric inpatient care, residential treatment, or outpatient crisis intervention because of a mental disorder with symptoms of psychosis, suicidality, or violence. (d) Persons who need brief treatment as a result of a natural disaster or severe local emergency. SEC. 2. Section 5806 of the Welfare and Institutions Code is amended to read: 5806. The State Department of Mental Health shall establish service standards that ensure that members of the target population are identified, and services provided to assist them to live independently, work, and reach their potential as productive citizens. The department shall provide annual oversight of grants issued pursuant to this part for compliance with these standards. These standards shall include, but are not limited to, all of the following: (a) A service planning and delivery process that is target population based and includes the following: (1) Determination of the numbers of clients to be served and the programs and services that will be provided to meet their needs. The local director of mental health shall consult with the sheriff, the police chief, the probation officer, the mental health board, contract agencies, and family, client, ethnic, and citizen constituency groups as determined by the director. (2) Plans for services, including outreach to families whose severely mentally ill adult is living with them, design of mental health services, coordination and access to medications, psychiatric and psychological services, substance abuse services, supportive housing or other housing assistance, vocational rehabilitation, and veterans' services. Plans shall also contain evaluation strategies, that shall consider cultural, linguistic, gender, age, and special needs of minorities in the target populations. Provision shall be made for staff with the cultural background and linguistic skills necessary to remove barriers to mental health services due to limited-English-speaking ability and cultural differences. Recipients of outreach services may include families, the public, primary care physicians, and others who are likely to come into contact with individuals who may be suffering from an untreated severe mental illness who would be likely to become homeless if the illness continued to be untreated for a substantial period of time. Outreach to adults may include adults voluntarily or involuntarily hospitalized as a result of a severe mental illness. (3) Provisions for services to meet the needs of target population clients who are physically disabled. (4) Provision for services to meet the special needs of older adults. (5) Provision for family support and consultation services, parenting support and consultation services, and peer support or self-help group support, where appropriate for the individual. (6) Provision for services to be client-directed and that employ psychosocial rehabilitation and recovery principles. (7) Provision for psychiatric and psychological services that are integrated with other services and for psychiatric and psychological collaboration in overall service planning. (8) Provision for services specifically directed to seriously mentally ill young adults 25 years of age or younger who are homeless or at significant risk of becoming homeless. These provisions may include continuation of services that would still be received through other funds had eligibility not been terminated due to age. (9) Services reflecting special needs of women from diverse cultural backgrounds, including supportive housing that accepts children, personal services coordinator therapeutic treatment, and substance treatment programs that address gender specific trauma and abuse in the lives of persons with mental illness, and vocational rehabilitation programs that offer job training programs free of gender bias and sensitive to the needs of women. (10) Provision for housing for clients that is immediate, transitional, permanent, or all of these. (11) Provision for clients who have been suffering from an untreated severe mental illness for less than one year, and who do not require the full range of services but are at risk of becoming homeless unless a comprehensive individual and family support services plan is implemented. These clients shall be served in a manner that is designed to meet their needs. (12) Provision for services for veterans. (b) Each client shall have a clearly designated mental health personal services coordinator who may be part of a multidisciplinary treatment team who is responsible for providing or assuring needed services. Responsibilities include complete assessment of the client' s needs, development of the client's personal services plan, linkage with all appropriate community services, monitoring of the quality and followthrough of services, and necessary advocacy to ensure each client receives those services which are agreed to in the personal services plan. Each client shall participate in the development of his or her personal services plan, and responsible staff shall consult with the designated conservator, if one has been appointed, and, with the consent of the client, consult with the family and other significant persons as appropriate. (c) The individual personal services plan shall ensure that members of the target population involved in the system of care receive age, gender, and culturally appropriate services or appropriate services based on any characteristic listed or defined in Section 11135 of the Government Code, to the extent feasible, that are designed to enable recipients to: (1) Live in the most independent, least restrictive housing feasible in the local community, and for clients with children, to live in a supportive housing environment that strives for reunification with their children or assists clients in maintaining custody of their children as is appropriate. (2) Engage in the highest level of work or productive activity appropriate to their abilities and experience. (3) Create and maintain a support system consisting of friends, family, and participation in community activities. (4) Access an appropriate level of academic education or vocational training. (5) Obtain an adequate income. (6) Self-manage their illness and exert as much control as possible over both the day-to-day and long-term decisions which affect their lives. (7) Access necessary physical health care and maintain the best possible physical health. (8) Reduce or eliminate serious antisocial or criminal behavior and thereby reduce or eliminate their contact with the criminal justice system. (9) Reduce or eliminate the distress caused by the symptoms of mental illness. (10) Have freedom from dangerous addictive substances. (d) The individual personal services plan shall describe the service array that meets the requirements of subdivision (c), and to the extent applicable to the individual, the requirements of subdivision (a). SEC. 3. Section 5807 of the Welfare and Institutions Code is amended to read: 5807. (a) The State Department of Mental Health shall require counties which receive funding to develop interagency collaboration with shared responsibilities for services under this part and achievement of the client and cost outcome goals and interagency collaboration goals specified. (b) Collaborative activities shall include: (1) Identification of those agencies that have a significant joint responsibility for the target population and ensuring collaboration on planning for services to that population. (2) Identification of gaps in services to members of the target population, development of policies to assure service effectiveness and continuity, and setting priorities for interagency services. (3) Implementation of public and private collaborative programs whenever possible to better serve the target population. (4) Provision of interagency case management services to coordinate resources to target population members who are using the services of more than one agency. (5) Coordination with federal agencies responsible for providing veterans' services, as well as national, state, and local nonprofit organizations that provide veterans' services, to maximize the integration of services and to eliminate duplicative efforts. SEC. 4. Section 5808 of the Welfare and Institutions Code is amended to read: 5808. In order to reduce the state and county cost of a mental health system of care, participating counties shall collect reimbursement for services from clients which shall be the same as patient fees established pursuant to Section 5710, fees paid by private or public third-party payers, federal financial participation for Medicaid or Medicare services or veterans' services, and other financial sources when available. SEC. 5. Section 5815 is added to the Welfare and Institutions Code, to read: 5815. The State Department of Health Care Services, in conjunction with the State Department of Mental Health, shall seek all available federal funding for mental health services for veterans. SEC. 6. If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.