BILL ANALYSIS Ó
SENATE COMMITTEE ON PUBLIC SAFETY
Senator Loni Hancock, Chair A
2011-2012 Regular Session B
8
2
6
AB 826 (Atkins)
As Amended June 21, 2011
Hearing date: July 5, 2011
Penal Code
AA:mc
PAROLEES:
INTEGRATED SERVICES FOR
MENTALLY ILL PAROLEES (ISMIP) PROGRAM
HISTORY
Source: Housing California
Prior Legislation: AB 900 (Solorio) - Ch. 7, Stats. 2007
AB 2034 (Steinberg) - Ch. 518, Stats. 2000
AB 34 (Steinberg) - Ch. 617, Stats. 1994
Support: Unknown
Opposition:None known
Assembly Floor Vote: N/A
KEY ISSUE
SHOULD A NEW LAW BE ENACTED TO AUTHORIZE THE CALIFORNIA DEPARTMENT
OF CORRECTIONS AND REHABILITATION TO CREATE AN INTEGRATED SERVICES
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FOR MENTALLY ILL PAROLEES PROGRAM, AS SPECIFIED?
PURPOSE
The purpose of this bill is to enact detailed statutory
authority for CDCR to create an Integrated Services for Mentally
Ill Parolees (ISMIP) program, as specified.
Current law creates in state government the Department of
Corrections and Rehabilitation ("CDCR"), headed by a secretary
who is appointed by the Governor, subject to Senate
confirmation, and serves at the pleasure of the Governor. CDCR
consists of Adult Operations, Adult Programs, Juvenile Justice,
the Corrections Standards Authority, the Board of Parole
Hearings, the State Commission on Juvenile Justice, the Prison
Industry Authority, and the Prison Industry Board. (Government
Code § 12838 (a).)
Current law generally provides that inmates serving a
determinate term of imprisonment shall be released on parole for
a period of three years. (Penal Code § 3000.)
Current law generally requires that as a condition of parole,
prisoners who have a severe mental disorder, as specified, be
evaluated and treated by the State Department of Mental Health,
and further requires that the State Department of Mental Health
provide the necessary treatment. (Penal Code § 2962.)
Current law authorizes the Secretary of CDCR to enter into a
memorandum of understanding with the Administrative Offices of
the Courts for parolee reentry court programs which shall, with
the assistance of the parolee's parole agent, direct the
treatment and supervision of parolees who would benefit from
community drug treatment or mental health treatment. (Penal
Code § 3015.)
Current law authorizes CDCR to "obtain day treatment, and to
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contract for crisis care services, for parolees with mental
health problems. Day treatment and crisis care services should
be designed to reduce parolee recidivism and the chances that a
parolee will return to prison. The department shall work with
counties to obtain day treatment and crisis care services for
parolees with the goal of extending the services upon completion
of the offender's period of parole, if needed." (Penal Code §
3073.)
"Integrated Services for Mentally Ill Parolees" Program
This bill would enact detailed statutory authority for CDCR to
create, pursuant to section 3073, an Integrated Services for
Mentally Ill Parolees (ISMIP) program with the following
features and requirements:
This bill would state that the ISMIP "is a comprehensive model
that provides varied levels of care, supportive and transitional
housing, and an array of mental health rehabilitative services
that assist with the development of independent living in the
least restrictive environment possible."
This bill would provide that an "inmate is eligible for ISMIP
participation and shall qualify for the program if all of the
following are applicable:
A. He or she participates in the Enhanced Outpatient
Program, the Correctional Clinical Case Management System,
or receives a higher level of mental health care while in
prison.
B. The inmate voluntarily chooses to participate in the
ISMIP program.
C. He or she is assigned a date of release within 60 to 180
days."
This bill would require CDCR to "prioritize for participation in
ISMIP inmates designated as eligible for the Enhanced Outpatient
Program and who are likely to become homeless upon release," as
specified below. "Afterwards, the department shall give
priority to inmates participating in the Correctional Clinical
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Case Management System and who are likely to become homeless
upon release," as specified below. "Once participants likely to
become homeless are served, the department shall prioritize, for
ISMIP participation, all other Enhanced Outpatient Program then
Correctional Clinical Case Management System participants."
This bill would provide that for these purposes parolees who are
"likely to become homeless upon release" are individuals who
have a history of homelessness and who satisfy either of the
following:
(A) Lacking an identified fixed, regular, and adequate
nighttime residence for release.
(B) His or her only identified nighttime residence for
release includes a supervised publicly or privately
operated shelter designed to provide temporary living
accommodations, or a public or private place not designed
for, or is not ordinarily used as, a regular sleeping
accommodation for human beings.
This bill would require CDCR in implementing these provisions to
"contract with ISMIP service providers that have at least five
years of experience providing integrated services to homeless
people with mental illness. Selected providers shall offer
whatever services participants require to obtain and maintain
health and housing stability," as specified,<1> while
participants are on parole, including, but not limited to, all
of the following:
(1) Case management services.
(2) Coordination of mental health, medical, and
substance abuse services.
(3) Parole discharge planning.
(4) Housing location services.
-----------------------
<1> The cross-reference is to Section 5806 of the Welfare and
Institutions Code, which generally enumerates "service
standards" DMH must establish to "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."
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(5) Rental subsidies.
(6) Linkage to other services, as needed.
This bill would require that at "least 60 days prior to the
release of an ISMIP participant, a department-selected ISMIP
service provider shall do, or coordinate with a subcontractor to
do, all of the following:
(1) Draft a discharge plan with the participant that
includes transition into housing that serves the
participant's needs and is affordable, such as permanent
supportive housing or a transitional housing program that
includes support services and demonstrates a clear
transition pathway to permanent housing.
(2) Engage the participant to actively participate in
services upon release, including connecting the participant
with the participant's parole case manager.
(3) Assist the participant in obtaining identification, if
necessary.
(4) Assist the participant in applying for any benefits for
which the participant is eligible.
This bill would require that, to "facilitate the transition of
ISMIP participants into permanent supportive housing, ISMIP
service providers shall prioritize housing opportunities that
are supported by the Mental Health Services Act, the Mental
Health Services Act Housing Program, or other funding sources
that finance permanent supportive housing for persons with
mental illness."
This bill also would require ISMIP service providers to
"identify housing opportunities that satisfy both of the
following:
(A) Are located in apartments, single-room occupancy
buildings, townhouses, or single-family homes or provided
through rent-subsidized apartments leased in the open
market or set aside within privately-owned buildings.
(B) Are not subject to community care licensing requirements
or are exempt from licensing under Section 1504.5 of the
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Health and Safety Code.
This bill would require ISMIP service providers to report to
CDCR on the outcomes of services provided to ISMIP participants
within 12, 24, and 36 months of contract implementation.
Reported outcomes shall include, but not be limited to, all of
the following:
(A) The number of participants served.
(B) The types of services provided to program participants.
(C) The outcomes of participants, including the number of
participants who remain stably housed in permanent
supportive housing, the number of participants who ceased
to participate in the program and the reasons, and the
number of participants who have been arrested and dates of
arrest.
(D) The number of participants who successfully transitioned
to county mental health programs.
(E) The recidivism rate of program participants compared to
the recidivism rate for Enhanced Outpatient Program and
Correctional Clinical Case Management System parolees
living in the same county who did not participate in ISMIP.
This bill would require CDCR to report annually by February 1,
2013, and every February 1 thereafter, to the chairpersons of
the Joint Legislative Budget Committee, the Assembly Committee
on Budget, the Senate Committee on Budget and Fiscal Review, the
Assembly Committee on Public Safety, Senate Committee on Public
Safety, the Assembly Committee on Housing and Community
Development, and the Senate Committee on Transportation and
Housing all of the following information:
(A) The number of individuals who participated in the ISMIP
program during the previous fiscal year.
(B) The number of participants who remain housed.
(C) The number of participants who returned to prison or
jail.
This bill would provide that its provisions "shall only be
operative when the Legislature appropriates moneys for
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Integrated Services for Mentally Ill Parolees (ISMIP) in the
Budget Act for each fiscal year."
This bill further would provide that all "activities identified
in this act as the responsibility of ISMIP service provider
contractors shall be deemed appropriate expenditures of ISMIP
funds."
This bill contains uncodified legislative findings and
declarations concerning mentally ill parolees, as specified.
RECEIVERSHIP/OVERCROWDING CRISIS AGGRAVATION
For the last several years, severe overcrowding in California's
prisons has been the focus of evolving and expensive litigation.
As these cases have progressed, prison conditions have
continued to be assailed, and the scrutiny of the federal courts
over California's prisons has intensified.
On June 30, 2005, in a class action lawsuit filed four years
earlier, the United States District Court for the Northern
District of California established a Receivership to take
control of the delivery of medical services to all California
state prisoners confined by the California Department of
Corrections and Rehabilitation ("CDCR"). In December of 2006,
plaintiffs in two federal lawsuits against CDCR sought a
court-ordered limit on the prison population pursuant to the
federal Prison Litigation Reform Act. On January 12, 2010, a
three-judge federal panel issued an order requiring California
to reduce its inmate population to 137.5 percent of design
capacity -- a reduction at that time of roughly 40,000 inmates
-- within two years. The court stayed implementation of its
ruling pending the state's appeal to the U.S. Supreme Court.
On May 23, 2011, the United States Supreme Court upheld the
decision of the three-judge panel in its entirety, giving
California two years from the date of its ruling to reduce its
prison population to 137.5 percent of design capacity, subject
to the right of the state to seek modifications in appropriate
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circumstances.
In response to the unresolved prison capacity crisis, in early
2007 the Senate Committee on Public Safety began holding
legislative proposals which could further exacerbate prison
overcrowding through new or expanded felony prosecutions.
This bill does not appear to aggravate the prison overcrowding
crisis described above.
COMMENTS
1. Stated Need for This Bill
The author states:
By not adequately targeting mentally ill parolees who
are homeless upon parole, the current ISMIP program
will not make a big enough impact on reducing
recidivism (and the fiscal burden that recidivism
creates). When Senators Steinberg and Lowenthal
helped advocate for these resources to be included in
the CDCR budget in 2007, their vision was that it
would target homeless persons, because homelessness
drastically increases the chances of recidivism (many
homeless persons recidivate within the first 72
hours). Furthermore, persons with mental illness are
far more likely to maintain stability in regards to
medication when stably housed.
I'm attaching information on how AB 2034 provided
evidence based outcomes for homeless mentally ill
adults. This legislation is modeled after that
program, which allowed for a "whatever it takes" array
of services that included housing to meet the needs of
participants. The key section of data I'm copying and
pasting here:
In 2000, California began implementing AB 2034, a bill
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known as "Systems of Care for Severely Mentally Ill
Homeless." This "whatever it takes" approach is
tailored to each individual and provides a home with
services, counseling, and whatever else is needed to
transition homeless people with mental illnesses from
a temporary shelter or the streets into a more stable,
sustainable living situation.
The program produced astounding results. Among the
4,900 participants there was a:
72% reduction in the number of days
incarcerated;
67% reduction in the number of days spent
homeless;
56% reduction in the number of days
hospitalized;
65% increase in the number of days of full-time
employment; and a
280% increase in the number of individuals
receiving wages.
The results provide clear evidence that this method of
combining a permanent, affordable home with readily
available supportive services works for people who
face the most complex challenges: those who are not
only homeless, but also have serious, persistent
mental illness conditions and very low incomes.
2. Background
This bill generally codifies a program already operated by CDCR,
with some added priorities and delineated requirements. The
Division of Adult Parole Operations issued a February 2011
report describing its services to mentally ill inmates.<2> The
report states the following with respect to parolees:
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<2> On file in the Committee offices. The report reflects
similar information from an earlier report available online at
http://cmhda.org/go/Portals/0/CMHDA%20Files/Committees/Forensics/
Handouts/2009_Handouts/0910_
Handouts/CDCR_MI_Parolee_Services_Description_(10-01-09).pdf.
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As of December 2010, the statewide mentally ill
parolee population was 22,156.
Mentally ill parolees account for approximately 20% of
the overall parolee
population. . . .
In California Fiscal Year (FY) 99/00, CDCR implemented
the Mental HealthServices Continuum Program (MHSCP),
which provides pre-release planning and post-release
treatment for mentally ill parolees. The MHSCP
consists of:
1. Transitional Case Management Program for the
Mentally Ill (TCMP-MI):
TCMP-MI consists of two contractors which provide
pre-release
assessments for all inmates identified as part of the
prison's Mental Health
Services Delivery System. The services begin 90 days
prior to parole and
conclude upon parole. TCMP-MI provides needed
information to the POC
staff for intake and treatment preparation.
2. POC: POC provides mental health assessments and
treatment upon and throughout parole. Treatment
consists of medication management, group therapy, and
individual therapy for parolees at high risk of
criminal behavior due to their mental illness. POC
conduct evaluations and provide services in CDCR
parole offices located throughout the State.
The MHSCP does not provide for supportive or
transitional housing, mental health board & care,
assisted living, crisis management beds, or in-patient
treatment. POC provides clinical services and
medication management solely on
an outpatient basis.
On February 5, 2007, the Division of Adult Parole
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Operations (DAPO)
implemented a new program to assist in recidivism
reduction by providing
increased frequency of clinical services to mentally
ill parolees upon parole from
prison. Upon parole, inmates designated as:
EOP are scheduled for 8 consecutive POC appointments
which occur within 120 days of release from
incarceration.
CCCMS parolees are scheduled for 4 consecutive POC
appointments which occur within 90 days of release
from incarceration.
At completion of the initial POC appointments that
mentally ill parolees attend
upon parole, the frequency and duration of continued
outpatient mental health
treatment is determined by POC clinical staff.
This enhancement was approved as a result of
evidence-based research
conducted by the University of California, Los Angeles
(UCLA), Integrated
Substance Abuse Programs. The UCLA research revealed
a strong positive relationship between the number of
POC sessions attended and recidivism risk.
Specifically, the greater number of POC contacts a
mentally ill parolee has, the
less likely he or she is returned to prison, and that
enhancing retention in the
program would further reduce recidivism outcomes. . .
.
Enhanced Services for Mentally Ill Parolees
California Assembly Bill (AB) 900, Chapter 7, Statutes
of 2007, added California
Penal Code section (PC) 3073 that authorizes CDCR to
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contract with California
Counties for Day Treatment Programming and Mental
Health Crisis intervention
and services.
AB 900 also included 13 conditions outlined in
paragraphs (1) to (13) of section
PC 7021(a) that must be met prior to the release of
Phase II funding. Condition
(8) reads "At least 300 parolees are being served in
day treatment or crisis care
services, pursuant to Section 3073."
As a result of stakeholders informing CDCR that the
language in AB 900
pertaining to Day Treatment Programming is an outdated
model which does not
correspond with the current adult system of care
models that many counties are
conforming to, the AB 900 Definitions Committee,
defined Day Treatment
Programming as "Mental Health Rehabilitative Services
designed to target
individual needs of mentally ill parolee-clients."
CDCR developed the program description consistent with
the adult system of
care model, which began through the implementation of
Chapter 617 of the
Statutes of 1999 for adult mental health and related
items, and expanded by
Chapter 518 of the Statutes of 2000, to provide models
for parolees with serious
mental illness that can meet the performance outcomes
required by the
Legislature.
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The program has been named "Integrated Services for
Mentally Ill Parolees"
(ISMIP). ISMIP is a comprehensive model which
provides varied levels of care,
supportive/transitional housing, and an array of
mental health rehabilitative services that assist with
the development of independent living in the least
restrictive environment possible.
Each parolee-client shall have a clearly designated
mental health personal
services coordinator (Case Manager) who, as a part of
a multidisciplinary
treatment team, is responsible for providing or
assuring needed services. Case
Manager responsibilities include:
Complete assessment of the parolee-client's needs
and goals.
Development of the parolee-client-driven personal
services plan.
Linkage with all appropriate community services.
Housing referrals.
Monitoring the quality and follow through of
services.
Provide individualized coaching to achieve the goals
identified in the personal service plan.
Service plans are individualized to meet the needs of
each parolee-client as determined through goal
directed objectives, which can include but are not
limited to:
Live in the most independent, least restrictive
housing feasible in the local
community. Provision for housing for parolee-clients
that is immediate,
transitional, or permanent.
Engage in the highest level of work or productive
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activity appropriate to
their abilities and experience.
Obtain an income (including assistance with applying
for and denial appeals for benefit entitlements such
as Social Security, Medi-Cal, and Veterans).
Self-manage their serious mental illness and exert
as much control as possible over both the day-to-day
and long-term decisions that affect their lives.
Coordination and access to mental health services
such as: medications, psychiatric and psychological
services.
Provision for services to be parolee-client directed
and employs psychosocial rehabilitation and recovery
principles.
Substance abuse services.
Provision for family support and consultation
services, parenting support and consultation services,
and peer support or self-help group support.
Create and maintain a support system consisting of
friends, family, and participation in community
activities.
Access an appropriate level of academic education,
career-specific trade, or skill training as determined
necessary to meet the goal oriented objective.
Transitional planning and linkage for continuation
of services upon discharge from parole. Please Note:
Services provided after discharge from parole cannot
be at the expense of CDCR.
3. What This Bill Would Do
This bill generally would codify the ISMIP program described
above, which CDCR has been conducting for some mentally ill
parolees over the last few years. Key elements of the bill
include prioritization of inmates who are likely to become
homeless upon release; a requirement that service providers
offer whatever services participants require to obtain and
maintain health and housing stability, and draft a discharge
plan with the participant that includes transition into
appropriate and affordable housing; and including rental
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subsidies as part of what's permissible under the program.
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