Senate Bill No. 664

Introduced by Senator Yee

(Coauthor: Senator Wolk)

February 22, 2013

An act to amend Sections 5348, 5349, 5813.5, and 5892 of the Welfare and Institutions Code, relating to mental health, and making an appropriation therefor.

LEGISLATIVE COUNSEL’S DIGEST

SB 664, as introduced, Yee. Mental health: Laura’s Law: Mental Health Services Fund.

Existing law, known as Laura’s Law, until January 1, 2017, regulates designated assisted outpatient treatment services, which a county may choose to provide for its residents. To implement the program, the county board of supervisors is required to, by resolution, authorize the program and make a finding that no voluntary mental health program serving adults, and no children’s mental health program, may be reduced as a result of the program’s implementation. In a county where assisted outpatient treatment services are available, a person is authorized to receive specific mental health services pursuant to an order if requisite criteria are met, as specified. Under that law, a participating county is required to provide prescribed assisted outpatient services, including a service planning and delivery process that provides for services that are client-directed and employ psychosocial rehabilitation and recovery principles.

This bill would no longer require a county to authorize the program by resolution and make those findings to implement the program. This bill would authorize a county to limit the number of persons to whom it provides assisted outpatient treatment services.

Existing law contains provisions governing the operation and financing of community mental health services for the mentally disordered in every county through locally administered and locally controlled community mental health programs. Existing law, the Mental Health Services Act, an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, funds a system of county mental health plans for the provision of mental health services, as specified. The act establishes the Mental Health Services Fund, continuously appropriated to and administered by the State Department of Health Care Services, to fund specified county mental health programs, including programs funded under the Adult and Older Adult Mental Health System of Care Act. The Adult and Older Adult Mental Health System of Care Act establishes service standards that require, among other things, that a service planning and delivery process provides for services that are client-directed and employ psychosocial rehabilitation and recovery principles. The act authorizes the Legislature to clarify procedures and terms of the act by majority vote.

This bill would make an appropriation by clarifying that mental health services provided under Laura’s Law may be provided pursuant to the procedures established by the Mental Health Services Act. This bill would make other conforming changes and delete obsolete provisions.

Vote: majority. Appropriation: yes. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 5348 of the Welfare and Institutions Code
is amended to read:

5348.  

(a) For purposes of subdivision (e) of Section 5346, a
county that chooses to provide assisted outpatient treatment
services pursuant to this article begin insert may limit the number of persons
to whom it provides assisted outpatient treatment services, and end insert
shall offer assisted outpatient treatment services including, but not
limited to, all of the following:

(1) Community-based, mobile, multidisciplinary, highly trained
mental health teams that use high staff-to-client ratios of no more
than 10 clients per team member for those subject to court-ordered
services pursuant to Section 5346.

(2) A service planning and delivery process that includes the
following:

(A) Determination of the numbers of persons 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.

(B) 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,
which shall consider cultural, linguistic, gender, age, and special
needs of minorities and those based on any characteristic listed or
defined in Section 11135 of the Government Code 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 as a result of having
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.

(C) Provision for services to meet the needs of persons who are
physically disabled.

(D) Provision for services to meet the special needs of older
adults.

(E) Provision for family support and consultation services,
parenting support and consultation services, and peer support or
self-help group support, where appropriate.

(F) Provision for services to be client-directed and that employ
psychosocial rehabilitation and recovery principles.

(G) Provision for psychiatric and psychological services that
are integrated with other services and for psychiatric and
psychological collaboration in overall service planning.

(H) 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 still would
be received through other funds had eligibility not been terminated
as a result of age.

(I) 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.

(J) Provision for housing for clients that is immediate,
transitional, permanent, or all of these.

(K) 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.

(3) 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 follow begin insert - end insert through of services,
and necessary advocacy to ensure each client receives those
services that 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, shall consult with the family and other significant
persons as appropriate.

(4) The individual personal services plan shall ensure that
persons subject to assisted outpatient treatment programs receive
age-appropriate, gender-appropriate, and culturally appropriate
services, to the extent feasible, that are designed to enable
recipients to:

(A) 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.

(B) Engage in the highest level of work or productive activity
appropriate to their abilities and experience.

(C) Create and maintain a support system consisting of friends,
family, and participation in community activities.

(D) Access an appropriate level of academic education or
vocational training.

(E) Obtain an adequate income.

(F) Self-manage their illnesses and exert as much control as
possible over both the day-to-day and long-term decisions that
affect their lives.

(G) Access necessary physical health care and maintain the best
possible physical health.

(H) Reduce or eliminate serious antisocial or criminal behavior,
and thereby reduce or eliminate their contact with the criminal
justice system.

(I) Reduce or eliminate the distress caused by the symptoms of
mental illness.

(J) Have freedom from dangerous addictive substances.

(5) The individual personal services plan shall describe the
service array that meets the requirements of paragraph (4), and to
the extent applicable to the individual, the requirements of
paragraph (2).

(b) A county that provides assisted outpatient treatment services
pursuant to this article also shall offer the same services on a
voluntary basis.

(c) Involuntary medication shall not be allowed absent a separate
order by the court pursuant to Sections 5332 to 5336, inclusive.

(d) A county that operates an assisted outpatient treatment
program pursuant to this article shall provide data to the State
Department of Health Care Services and, based on the data, the
department shall report to the Legislature on or before May 1 of
each year in which the county provides services pursuant to this
article. The report shall include, at a minimum, an evaluation of
the effectiveness of the strategies employed by each program
operated pursuant to this article in reducing homelessness and
hospitalization of persons in the program and in reducing
involvement with local law enforcement by persons in the program.
The evaluation and report shall also include any other measures
identified by the department regarding persons in the program and
all of the following, based on information that is available:

(1) The number of persons served by the program and, of those,
the number who are able to maintain housing and the number who
maintain contact with the treatment system.

(2) The number of persons in the program with contacts with
local law enforcement, and the extent to which local and state
incarceration of persons in the program has been reduced or
avoided.

(3) The number of persons in the program participating in
employment services programs, including competitive employment.

(4) The days of hospitalization of persons in the program that
have been reduced or avoided.

(5) Adherence to prescribed treatment by persons in the program.

(6) Other indicators of successful engagement, if any, by persons
in the program.

(7) Victimization of persons in the program.

(8) Violent behavior of persons in the program.

(9) Substance abuse by persons in the program.

(10) Type, intensity, and frequency of treatment of persons in
the program.

(11) Extent to which enforcement mechanisms are used by the
program, when applicable.

(12) Social functioning of persons in the program.

(13) Skills in independent living of persons in the program.

(14) Satisfaction with program services both by those receiving
them and by their families, when relevant.

SEC. 2.  

Section 5349 of the Welfare and Institutions Code is
amended to read:

5349.  

begin delete This article shall be 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,
may be reduced as a result of the implementation of this article. end delete
Compliance with this section shall be monitored by the State
Department of Health Care Services as part of its review and
approval of county performance contracts.

SEC. 3.  

Section 5813.5 of the Welfare and Institutions Code
is amended to read:

5813.5.  

Subject to the availability of funds from the Mental
Health Services Fund, the state shall distribute funds for the
provision of services under Sections begin insert 5347, 5348, end insert 5801, 5802, and
5806 to county mental health programs. Services shall be available
to adults and seniors with severe illnesses who meet the eligibility
criteria in subdivisions (b) and (c) of Section 5600.3. For purposes
of begin delete this act end delete begin insert the Mental Health Services Act end insert , seniors means older
adult persons identified in begin delete Part 3 (commencing with Section 5800)
of end delete this begin delete division end delete begin insert part end insert .

(a) Funding shall be provided at sufficient levels to ensure that
counties can provide each adult and senior served pursuant to this
part with the medically necessary mental health services,
medications, and supportive services set forth in the applicable
treatment plan.

(b) The funding shall only cover the portions of those costs of
services that cannot be paid for with other funds including other
mental health funds, public and private insurance, and other local,
state, and federal funds.

(c) Each county mental health programs plan shall provide for
services in accordance with the system of care for adults and
seniors who meet the eligibility criteria in subdivisions (b) and (c)
of Section 5600.3.

(d) Planning for services shall be consistent with the philosophy,
principles, and practices of the Recovery Vision for mental health
consumers:

(1) To promote concepts key to the recovery for individuals
who have mental illness: hope, personal empowerment, respect,
social connections, self-responsibility, and self-determination.

(2) To promote consumer-operated services as a way to support
recovery.

(3) To reflect the cultural, ethnic, and racial diversity of mental
health consumers.

(4) To plan for each consumer’s individual needs.

(e) The plan for each county mental health program shall
indicate, subject to the availability of funds as determined by Part
4.5 (commencing with Section 5890) of this division, and other
funds available for mental health services, adults and seniors with
a severe mental illness being served by this program are either
receiving services from this program or have a mental illness that
is not sufficiently severe to require the level of services required
of this program.

(f) Each county plan and annual update pursuant to Section
5847 shall consider ways to provide services similar to those
established pursuant to the Mentally Ill Offender Crime Reduction
Grant Program. Funds shall not be used to pay for persons
incarcerated in state prison or parolees from state prisons. begin insert Funds
may be used to provide persons with assisted outpatient treatment
services, as defined in Section 5345. end insert

(g) The department shall contract for services with county
mental health programs pursuant to Section 5897. After begin delete the
effective date of this section end delete begin insert January 1, 2005, end insert the term begin delete grants
referred to end delete begin insert “grant” as used end insert in Sections 5814 and 5814.5 begin delete shall refer
to such contracts end delete begin insert means a contract described in this subdivision end insert .

SEC. 4.  

Section 5892 of the Welfare and Institutions Code is
amended to read:

5892.  

(a) In order to promote efficient implementation of begin delete this
act end delete begin insert the Mental Health Services Act end insert , the county shall use funds
distributed from the Mental Health Services Fund as follows:

(1) In 2005-06, 2006-07, and in 2007-08 10 percent shall be
placed in a trust fund to be expended for education and training
programs pursuant to Part 3.1 begin insert (commencing with Section 5820) of
this division end insert .

(2) In 2005-06, 2006-07 and in 2007-08 10 percent for capital
facilities and technological needs distributed to counties in
accordance with a formula developed in consultation with the
California Mental Health Directors Association to implement plans
developed pursuant to Section 5847.

(3) Twenty percent of funds distributed to the counties pursuant
to subdivision (c) of Section 5891 shall be used for prevention and
early intervention programs in accordance with Part 3.6
(commencing with Section 5840) of this division.

(4) The expenditure for prevention and early intervention may
be increased in any county in which the department determines
that the increase will decrease the need and cost for additional
services to severely mentally ill persons in that county by an
amount at least commensurate with the proposed increase.

(5) The balance of funds shall be distributed to county mental
health programs for services to persons with severe mental illnesses
pursuant to Part 4 (commencing with Section 5850), for the
children’s system of begin delete care and end delete begin insert care, end insert Part 3 (commencing with
Section 5800), for the adult and older adult system of begin delete care end delete begin insert care,
and Sections 5347 and 5348 end insert .

(6) Five percent of the total funding for each county mental
health program for Part 3 (commencing with Section 5800), Part
3.6 (commencing with Section 5840), and Part 4 (commencing
with Section 5850) of this division, shall be utilized for innovative
programs in accordance with Sections 5830, 5847, and 5848.

(b) In any year after 2007-08, programs for services pursuant
to Part 3 (commencing with Section 5800), and Part 4
(commencing with Section 5850) of this division may include
funds for technological needs and capital facilities, human resource
needs, and a prudent reserve to ensure services do not have to be
significantly reduced in years in which revenues are below the
average of previous years. The total allocation for purposes
authorized by this subdivision shall not exceed 20 percent of the
average amount of funds allocated to that county for the previous
five years pursuant to this section.

(c) The allocations pursuant to subdivisions (a) and (b) shall
include funding for annual planning costs pursuant to Section 5848.
The total of these costs shall not exceed 5 percent of the total of
annual revenues received for the fund. The planning costs shall
include funds for county mental health programs to pay for the
costs of consumers, family members, and other stakeholders to
participate in the planning process and for the planning and
implementation required for private provider contracts to be
significantly expanded to provide additional services pursuant to
Part 3 (commencing with Section 5800), and Part 4 (commencing
with Section 5850) of this division.

(d) Prior to making the allocations pursuant to subdivisions (a),
(b), and (c), funds shall be reserved for the costs for the State
Department of Health Care Services, the California Mental Health
Planning Council, the Office of Statewide Health Planning and
Development, the Mental Health Services Oversight and
Accountability Commission, the State Department of Public Health,
and any other state agency to implement all duties pursuant to the
programs set forth in this section. These costs shall not exceed 3.5
percent of the total of annual revenues received for the fund. The
administrative costs shall include funds to assist consumers and
family members to ensure the appropriate state and county agencies
give full consideration to concerns about quality, structure of
service delivery, or access to services. The amounts allocated for
administration shall include amounts sufficient to ensure adequate
research and evaluation regarding the effectiveness of services
being provided and achievement of the outcome measures set forth
in Part 3 (commencing with Section 5800), Part 3.6 (commencing
with Section 5840), and Part 4 (commencing with Section 5850)
of this division. The amount of funds available for the purposes
of this subdivision in any fiscal year shall be subject to
appropriation in the annual Budget Act.

(e) In 2004-05 funds shall be allocated as follows:

(1) Forty-five percent for education and training pursuant to
Part 3.1 (commencing with Section 5820) of this division.

(2) Forty-five percent for capital facilities and technology needs
in the manner specified by paragraph (2) of subdivision (a).

(3) Five percent for local planning in the manner specified in
subdivision (c).

(4) Five percent for state implementation in the manner specified
in subdivision (d).

(f) Each county shall place all funds received from the State
Mental Health Services Fund in a local Mental Health Services
Fund. The Local Mental Health Services Fund balance shall be
invested consistent with other county funds and the interest earned
on the investments shall be transferred into the fund. The earnings
on investment of these funds shall be available for distribution
from the fund in future years.

(g) All expenditures for county mental health programs shall
be consistent with a currently approved plan or update pursuant
to Section 5847.

(h) Other than funds placed in a reserve in accordance with an
approved plan, any funds allocated to a county which have not
been spent for their authorized purpose within three years shall
revert to the state to be deposited into the fund and available for
other counties in future years, provided however, that funds for
capital facilities, technological needs, or education and training
may be retained for up to 10 years before reverting to the fund.

(i) If there are still additional revenues available in the fund
after the Mental Health Services Oversight and Accountability
Commission has determined there are prudent reserves and no
unmet needs for any of the programs funded pursuant to this
section, including all purposes of the Prevention and Early
Intervention Program, the commission shall develop a plan for
expenditures of these revenues to further the purposes of this act
and the Legislature may appropriate these funds for any purpose
consistent with the commission’s adopted plan which furthers the
purposes of this act.

begin delete

(j) For the 2011-12 fiscal year, General Fund revenues will be
insufficient to fully fund many existing mental health programs,
including Early and Periodic Screening, Diagnosis, and Treatment
(EPSDT), Medi-Cal Specialty Mental Health Managed Care, and
mental health services provided for special education pupils. In
order to adequately fund those programs for the 2011-12 fiscal
year and avoid deeper reductions in programs that serve individuals
with severe mental illness and the most vulnerable, medically
needy citizens of the state, prior to distribution of funds under
paragraphs (1) to (6), inclusive, of subdivision (a), effective July
1, 2011, moneys shall be allocated from the Mental Health Services
Fund to the counties as follows:

(1) Commencing July 1, 2011, one hundred eighty-three million
six hundred thousand dollars ($183,600,000) of the funds available
as of July 1, 2011, in the Mental Health Services Fund, shall be
allocated in a manner consistent with subdivision (c) of Section
5778 and based on a formula determined by the state in
consultation with the California Mental Health Directors
Association to meet the fiscal year 2011-12 General Fund
obligation for Medi-Cal Specialty Mental Health Managed Care.

(2) Upon completion of the allocation in paragraph (1), the
Controller shall distribute to counties ninety-eight million five
hundred eighty-six thousand dollars ($98,586,000) from the Mental
Health Services Fund for mental health services for special
education pupils based on a formula determined by the state in
consultation with the California Mental Health Directors
Association.

(3) Upon completion of the allocation in paragraph (2), the
Controller shall distribute to counties 50 percent of their 2011-12
Mental Health Services Act component allocations consistent with
Sections 5847 and 5891, not to exceed four hundred eighty-eight
million dollars ($488,000,000). This allocation shall commence
beginning August 1, 2011.

(4) Upon completion of the allocation in paragraph (3), and as
revenues are deposited into the Mental Health Services Fund, the
Controller shall distribute five hundred seventy-nine million dollars
($579,000,000) from the Mental Health Services Fund to counties
to meet the General Fund obligation for EPSDT for fiscal year
2011-12. These revenues shall be distributed to counties on a
quarterly basis and based on a formula determined by the state in
consultation with the California Mental Health Directors
Association. These funds shall not be subject to reconciliation or
cost settlement.

(5) The Controller shall distribute to counties the remaining
2011-12 Mental Health Services Act component allocations
consistent with Sections 5847 and 5891, beginning no later than
April 30, 2012. These remaining allocations shall be made on a
monthly basis.

(6) The total one-time allocation from the Mental Health
Services Fund for EPSDT, Medi-Cal Specialty Mental Health
Managed Care, and mental health services provided to special
education pupils as referenced shall not exceed eight hundred
sixty-two million dollars ($862,000,000). Any revenues deposited
in the Mental Health Services Fund in fiscal year 2011-12 that
exceed this obligation shall be distributed to counties for remaining
fiscal year 2011-12 Mental Health Services Act component
allocations, consistent with Sections 5847 and 5891.

(k) Subdivision (j) shall not be subject to repayment.

(l) Subdivision (j) shall become inoperative on July 1, 2012.

end delete