BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 585
AUTHOR: Steinberg and Correa
AMENDED: April 2, 2013
HEARING DATE: April 24, 2013
CONSULTANT: Robinson-Taylor
SUBJECT : Mental Health: Mental Health Services Fund.
SUMMARY : Clarifies that state funding sources for county mental
health programs, including funds generated under the Mental
Health Services Act (MHSA), can be expended to support mental
health treatment services provided under the Assisted Outpatient
Treatment Demonstration Project Act of 2002 (AOT Act, which is
also known as "Laura's Law").
Existing law:
1.Establishes MHSA which provides for local mental health services,
including prevention and early intervention, innovative projects,
Full Service Partnerships, peer support services, housing, and
other mental health treatment services.
2.Establishes the Mental Health Services Fund in the state Treasury,
continuously appropriated to and administered by the Department of
Health Care Services (DHCS), to fund specified county mental
health programs.
3.Establishes the Local Revenue Fund and the Local Revenue Fund
2011, which contain specified accounts and subaccounts used to
fund county mental health services.
4.Allows county Boards of Supervisors, by resolution, to authorize
the AOT Act whereby a county mental health director can petition
for a court to order a person over age 18 with a mental illness to
receive AOT if the court finds the individual meets specified
criteria, including: a clinical determination that the person is
unlikely to survive safely in the community without supervision;
the person has a history of noncompliance with treatment for his
or her mental illness; and the person's condition is substantially
deteriorating and participation in AOT would be the least
restrictive placement necessary to ensure the person's recovery.
5.Requires counties implementing the AOT Act to make a finding that
no voluntary mental health program serving adults, and no
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children's mental health program, may be reduced as a result of
the implementation.
6.Requires a county that provides court-ordered AOT services to also
offer the same services on a voluntary basis.
7.Requires DHCS to submit a report and evaluation of all
counties implementing any component of the AOT Act to the
Governor and the Legislature by July 1, 2015.
8.Sunsets the AOT Act on January 1, 2017.
9.Establishes the Lanterman-Petris Short Act (LPS Act), which
authorizes a person to be involuntarily detained for inpatient
mental health treatment when, as a result of a mental
disorder, the person is a danger to him or herself or to
others, or is gravely disabled. Defines "gravely disabled" to
mean a condition in which a person, as a result of a mental
disorder, is unable to provide for his or her basic personal
needs for food, clothing, or shelter.
10. Authorizes a peace officer, member of the attending
staff of an evaluation facility designated by the county,
designated members of a mobile crisis team, or other
professional person designated by the county, upon probable
cause, to take a person with a mental disorder who is a danger
to himself or herself, a danger to others, or who is gravely
disabled, into custody and place him or her in a facility
designated by the county and approved by Department of Social
Services as a facility for 72-hour treatment and evaluation
(referred to as a 72-hour hold).
This bill:
1.Clarifies that MHSA revenues distributed by the State
Controller to counties can be expended for mental health
treatment services provided under the AOT Act.
2.Requires a county to include provisions for the AOT Act in its
MHSA plan or annual update, if a county elects to implement
the AOT Act and use MHSA funds for implementation.
3.Specifies that, for mental health treatment services provided
under the AOT Act, counties may also use funds distributed to
them through various county realignment accounts, including:
the Mental Health Subaccount, the Mental Health Equity
Subaccount, and the Vehicle License Collection Account of the
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Local Revenue Fund; and, the Mental Health Account and the
Behavioral Health Subaccount within the Support Services
Account of the Local Revenue Fund 2011.
4.Specifies that mental health clients should be fully informed
and volunteer for all treatment provided under a court order
for the AOT Act and, prior to the filing of the petition for
the AOT Act, the client has been offered voluntary treatment
and has failed to engage in that treatment.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1. Author's statement. Approved by voters through
Proposition 63 of 2004, MHSA provides over $1 billion
annually for local mental health services, including
prevention and early intervention, innovative projects,
Full Service Partnerships, peer support services, housing,
and other mental health treatment services. The MHSA has
served as a catalyst for transforming California's mental
health system by emphasizing the philosophy, principles and
practices of recovery for mental health clients, including
personal empowerment, self-responsibility and
self-determination.
This bill reflects a fine tuning of MHSA by clarifying that
MHSA funds can be utilized for mental health treatment
services provided to clients under a court order for AOT in
counties that have chosen to participate in the AOT Act. I
believe this fine tuning serves to recognize the continuum
of mental health treatment services available in California
while maintaining the integrity of MHSA by keeping a keen
focus on client recovery and the offering of voluntary
services to a client until a client fails to engage in
treatment.
2. Realignment. In 1991, a major change occurred in the
funding of human service programs in the State with the
enactment of AB 1288 (Bronzan), Chapter 89, Statutes of
1991, the Bronzan-McCorquodale Act, referred to as
"realignment." Realignment transferred financial
responsibility for most of the state's mental health and
public health programs, and some of the social services
programs from the state to local governments, and provided
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counties with a dedicated revenue source to pay for these
changes. In order to fund the program transfers and shifts
in cost-sharing ratios, the Legislature enacted two tax
increases in 1991, with the increased revenues deposited
into a State Local Revenue Fund dedicated to funding the
realigned programs. Each county created program accounts
and through a series of accounts and subaccounts at the
state level, counties receive deposits into their accounts
for spending on mental health programs. The basic formula,
which determines the amount to each county and each
sub-account is included in the statute. Additional
realignment occurred as a part of the FY 2011 - 2012 Budget
which created additional accounts and subaccounts in the
Local Revenue Fund 2011.
3. MHSA. As a funding source for mental health programs,
MHSA imposes a 1 percent income tax on personal income in
excess of $1 million. The purpose of MHSA is to expand
mental health services to children, youth, adults and older
adults who have severe mental illness or severe mental
health disorders and whose service needs are not being met
through other funding sources. The MHSA provides for a
continuous appropriation of funds for local assistance.
According to MHSA, funds are prohibited from being provided
to counties unless such spending is consistent with a plan
developed with significant local stakeholder input and
involvement. The local plans must be drafted every three
years and updated annually and are approved by county
Boards of Supervisors. The MHSA requires each plan to
cover the following five components: a) Community Services
and Supports for Adults and Children's System of Care; b)
Prevention and Early Intervention; c) Innovation; d)
Workforce Education and Training; and, e) Capital
Facilities and Technological Needs.
The MHSA emphasizes the philosophy, principles and practices
of recovery for mental health clients, including personal
empowerment, self-responsibility and self-determination.
While there is no specific language in MHSA that prohibits
the use of MHSA funds for mental health treatment for
clients participating in the AOT Act, historically, it has
been unclear whether MHSA funds could be used to treat
these clients. The AOT Act provides services on an
involuntary basis, which has been interpreted by some to be
in conflict with MHSA guiding principles. The author
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maintains that this bill will serve to mitigate these
misconceptions and that support for the AOT Act through
MHSA funding, in fact, ensures that the full continuum of
needs for mental health client recovery and wellness is
supported.
4. The AOT Act. AB 1421 (Thompson), Chapter 1017, Statutes
of 2002, the AOT Act, established a new court - ordered
outpatient treatment demonstration program in statute aimed
at individuals with mental illness who meet specified
criteria but who do not meet the criteria (danger to
self/others or gravely disabled) for commitment to an
inpatient facility. Also known as Laura's Law, the law is
named in memory of Laura Wilcox, a 19-yar-old college
student who was killed by a severely mentally ill man who
was not adhering to prescribed mental health treatment.
The AOT Act provides counties with the option to implement
intensive AOT programs for individuals who have difficulty
maintaining their mental health stability in the community
and have frequent hospitalizations and contact with law
enforcement related to untreated or undertreated mental
illness. The AOT Act requires county Board of Supervisors
to authorize implementation by resolution and to make a
finding that access to voluntary mental health programs
serving adults and children would not be reduced as a
result of implementation.
County implementation of the AOT Act is at the discretion of
each county and the AOT Act did not provide for any state
or local funding for the program's implementation. This
lack of funding has been perceived as one of the barriers
to the AOT Act implementation. According to the former
Department of Mental Health (DMH) in 2011, no county
implemented a court-ordered AOT program until 2008, and
only Nevada County currently operates such a program. Los
Angeles County has also implemented a pilot similar to the
AOT Act. The AOT Act was reauthorized in 2006 and in 2012
and is due to sunset on January 1, 2017.
5. Related legislation. SB 364 (Steinberg) broadens the
types of facilities that can be used for purposes of a
72-hour treatment and evaluation under Section 5150 of the
LPS Act for individuals with a mental health disorder to
include facilities licensed or certified as mental health
treatment facilities by the DHCS or the Department of
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Public Health. Permits county mental health directors to
develop procedures for the designation and training of
professionals who will be designated to perform functions
under Section 5150. This bill is scheduled to be heard by
the Senate Health Committee on April 24, 2013.
SB 664 (Yee) removes the requirement that each county board
of supervisors pass a resolution prior to implementing AOT
and acknowledges that counties can cap the number of people
under the program. SB 664 is scheduled to be heard by the
Senate Health Committee on April 24, 2013.
AB 1367 (Mansoor) clarifies that MHSA funds can be used to
support the AOT Act and provides outreach to school
children who may be a threat to themselves or others. AB
1367 is currently in the Assembly Health Committee.
AB 1265 (Conway) permits an initial court order for AOT Act
services to be extended for up to 12 months (rather than
the current six months). Requires that each person
discharged from a hospital be "considered" for AOT in the
counties that have implemented the AOT Act. AB 1265 is
currently in the Assembly Judiciary Committee.
6. Prior legislation. AB 1569 (Allen), Chapter 441,
Statutes of 2012, extends the sunset date of AOT Act from
January 1, 2013 until January 1, 2017. Requires DHCS to
submit a report and evaluation of all counties implementing
any component of the AOT Act to the Governor and the
Legislature by July 1, 2015.
AB 2134 (Chesbro) of 2012 would have required a county that
elects to provide AOT services to develop best practices
for the purposes of responding to a mental health crisis,
and would have required these best practices to include the
utilization of crisis intervention teams, mobile crisis
teams, or psychiatric emergency response teams, with an
emphasis on peer support. This bill failed passage in the
Senate Health Committee.
AB 2357 (Karnette and Yee), Chapter 774, Statutes of 2006
extended the AOT Act sunset date to January 1, 2013, and
required the former DMH to submit a progress report to the
Governor and Legislature in 2011.
AB 1421 (Thompson), Chapter 1017, Statutes of 2002 enacted
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the AOT Act with a January 1, 2008 sunset date.
7. Support. The California Mental Health Directors
Association and the California Psychiatric Association
(CPA) write in support that they applaud the author for
taking a stand to settle this issue so that counties may
act with assurance that they can use all available mental
health funds to support an AOT program, including services
provided under the AOT Act. The CPA maintains that
counties will benefit from wider implementation of the AOT
Act by having a tool in their continuum of care with
services to prevent crises before they happen. The Urban
Counties Caucus (UCC) writes that since the creation of the
AOT Act, many counties have considered adopting this law in
order to address the mental health needs of their
constituents, however, one of the major barriers to the
adoption has been the funding of this program. According
to UCC, this bill makes it clear that counties may use MHSA
and other funding to address these critical needs. The
Treatment Advocacy Center (TAC) writes in support that the
weight of evidence both in California and throughout the
country demonstrates that when implemented, AOT laws reduce
crime, violence, homelessness, suicide and other
consequences of non-treatment. TAC asserts that this bill
will increase the likelihood that more counties will
implement and benefit from this critical law.
SUPPORT AND OPPOSITION :
Support: California Association of Psychiatric Technicians
California Mental Health Directors Association
California Psychiatric Association
Mental Illness Policy Org.
National Alliance on Mental Illness
Nick and Amanda Wilcox
Treatment Advocacy Center
Urban Counties Caucus
22 individuals
Oppose: None on file.
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