BILL ANALYSIS                                                                                                                                                                                                    ”



          SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:                    AB 745    
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          |AUTHOR:        |Chau                                           |
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          |VERSION:       |April 6, 2015                                  |
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          |HEARING DATE:  |June 10, 2015  |               |               |
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          |CONSULTANT:    |Reyes Diaz                                     |
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           SUBJECT  :  Mental Health Services Oversight and Accountability  
          Commission.

           SUMMARY  :  Requires the Governor to appoint an additional member to the  
          Mental Health Services Oversight and Accountability Commission  
          in existing law, who has experience providing supportive housing  
          to people with a severe mental illness. 

          Existing law:
          1)Establishes the Mental Health Services Oversight and  
            Accountability Commission (MHSOAC) to oversee the  
            implementation of the Mental Health Services Act (MHSA),  
            enacted by voters in 2004 as Proposition 63, which provides  
            funds to counties to expand services, and develop innovative  
            programs and integrated service plans, for mentally ill  
            children, adults, and seniors through a one percent income tax  
            on personal income above $1 million.

          2)Requires the MHSOAC to consist of 16 voting members as  
            follows:

                  a)        The Attorney General or his or her designee;
                  b)        The Superintendent of Public Instruction or  
                    his or her designee;
                  c)        The Chair of the Senate Health and Human  
                    Services Committee or another member of the Senate  
                    selected by the President pro Tempore of the Senate;
                  d)        The Chair of the Assembly Health Committee or  
                    another member of the Assembly selected by the Speaker  
                    of the Assembly; and,
                  e)        12 members appointed by the Governor that  
                    include:








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                        i.             Two people with a severe mental  
                         illness;
                        ii.            A family member of an adult or  
                         senior with a severe mental illness;
                        iii.           A family member of a child who has  
                         or has had a severe mental illness;
                        iv.            A physician specializing in alcohol  
                         and drug treatment;
                        v.             A mental health professional;
                        vi.            A county sheriff;
                        vii.           A superintendent of a school  
                         district;
                        viii.          A representative of a labor  
                         organization;
                        ix.            A representative of an employer  
                         with less than 500 employees;
                        x.             A representative of an employer  
                         with more than 500 employees; and,
                        xi.            A representative of a health care  
                         services plan or insurer.
          
          This bill:
          1)Adds an additional voting member to the MHSOAC, to be  
            appointed by the Governor, who has experience providing  
            supportive housing to people with severe mental illness.

           FISCAL  
          EFFECT  :  According to the Assembly Appropriations Committee,  
          this bill has minor and absorbable costs to reimburse for travel  
          and lodgings for MHSOAC meetings (from the MHSA administration  
          account).

           PRIOR  
          VOTES  :  
          
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          |Assembly Floor:                     |78 - 0                      |
          |------------------------------------+----------------------------|
          |Assembly Appropriations Committee:  |17 - 0                      |
          |------------------------------------+----------------------------|
          |Assembly Health Committee:          |18 - 0                      |
          |                                    |                            |
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          COMMENTS  :








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          1)Author's statement. According to the author, supportive  
            housing has proven to be an effective strategy for reducing  
            homelessness among people with mental illness. At any given  
            moment, more than 133,000 Californians are homeless. Of these  
            Californians, roughly 33,800 (25%) are considered chronically  
            homeless. According to researchers, at least one-third of  
            chronically homeless people are mentally ill. The MHSOAC  
            oversees the implementation of the MHSA and may advise the  
            Governor or the Legislature on mental health policy. However,  
            existing law does not require the MHSOAC to include any  
            members with experience providing supportive housing to  
            persons with severe mental illness. Adding a member with  
            supportive housing experience to the MHSOAC would further  
            encourage the proven method of using supportive housing as a  
            tool to reduce homelessness.
            
          2)Background. The MHSA requires each county mental health  
            department to prepare and submit a three-year plan to the  
            Department of Health Care Services (DHCS) that must be updated  
            each year and approved by DHCS after review and comment by the  
            MHSOAC.  DHCS is required to provide guidelines to counties  
            related to each component of the MHSA, including, among other  
            things, community services and support content to provide  
            integrated mental health and other support services to those  
            whose needs are not currently met through other funding  
            sources; prevention and early intervention content to provide  
            services to avert mental health crises; and innovative program  
            content to improve access to mental health services. 

            In the three-year plans, counties are required to include a  
            list of all programs for which MHSA funding is being requested  
            and that identifies how the funds will be spent and which  
            populations will be served. Counties also must submit their  
            plans for approval to the MHSOAC before they can spend certain  
            categories of funding. At the time it was created, the MHSOAC  
            acted as a division within the Department of Mental Health  
            (DMH); however, legislative changes effective March 2009  
            required the MHSOAC to administer its operations apart from  
            DMH.  

          3)MHSA Housing Program. Executive Order S-07-06, signed by  
            Governor Schwarzenegger on May 12, 2006, mandated the  
            establishment of the MHSA Housing Program, with the stated  
            goal of creating 10,000 additional units of permanent  
            supportive housing for individuals and their families who have  








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            a mental illness and are homeless or at risk of homelessness.  
            DHCS, the California Housing Finance Agency (CalHFA), and the  
            County Behavioral Health Directors Association implemented the  
            MHSA Housing Program, which provides funding for development,  
            acquisition, construction, and/or rehabilitation of permanent  
            supportive housing for this population. A total of $400  
            million was set aside for initial funding of the program to  
            fund both capital costs and capitalized operating subsidies.  
            Continued funding of the program is a locally driven decision,  
            as a county determines whether to assign additional MHSA  
            funding beyond the original $400 million. By including an  
            individual on the MHSOAC who has experience in providing  
            supportive housing to those with a severe mental illness,  
            housing advocates hope to leverage existing MHSA funds to  
            continue funding the MHSA Housing Program, as the initial $400  
            million is nearing depletion.  
          
            Funds provided under this program must serve the MHSA Housing  
            Program target population, which DHCS has defined as  
            low-income adults, or older adults with serious mental  
            illness, and children with severe emotional disorders and  
            their families who, at the time of assessment for housing  
            services, meet the criteria for MHSA services in their county  
            of residence. Counties may use MHSA funds for supportive  
            housing, but are not required to.  Supportive housing has  
            proven to be an effective strategy for reducing homelessness  
            among people with mental illness. Adding a member with  
            supportive housing experience to the MHSOAC may further  
            encourage the method of using supportive housing as a tool to  
            reduce homelessness of those with severe mental illness.
          
          4)National data on mental illness and homelessness. In the  
            "Current Statistics on the Prevalence and Characteristics of  
            People Experiencing Homelessness in the United States," last  
            updated in July 2011 by the federal Substance Abuse and Mental  
            Health Services Administration, data from 2010 shows that,  
            nationally, on a given night 407,966 individuals were homeless  
            in shelters, transitional housing programs, or on the streets  
            (not including those who were sleeping at the homes of family  
            or friends), and 109,812 individuals were chronically homeless  
            (a one percent decrease from the previous year). Of these  
            individuals, 26.2% had a severe mental illness, and 34.7% of  
            adults had chronic substance use disorders. Over the course of  
            that year, data shows that a total of 1,593,150 individuals  
            experienced homelessness.








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          5)Related legislation. AB 253 (Roger HernŠndez), makes specified  
            changes to the MHSA, the Veterans Housing and Homeless  
            Prevention Bond Act of 2014, and mental health plan  
            requirements. AB 253 is pending in the Senate.
            
          6)Prior legislation. AB 1929 (Chau, Chapter 674, Statutes of  
            2014), allows county mental health departments to deposit MHSA  
            funding with CalHFA, as specified, and allows CalHFA to use  
            those funds for special housing needs for those with mental  
            illness. Requires counties to dedicate funds to provide  
            housing assistance to those with serious mental illness who  
            are homeless or to the mentally ill at risk of being homeless.

            SB 82 (Committee on Budget and Fiscal Review, Chapter 34,  
            Statutes of 2013), established the Investment in Mental Health  
            Wellness Act of 2013 and authorizes the California Health  
            Facilities Financing Authority to administer a program to  
            increase capacity for mobile crisis support, crisis  
            intervention, crisis stabilization services, crisis  
            residential treatment, and specified personnel resources.

          7)Support. The California Primary Care Association writes in  
            support and states that research has demonstrated the positive  
            effects that supportive housing has on an individual's  
            employment, mental health, physical health, and school  
            attendance, leading to a decrease in the use of hospitals,  
            emergency rooms, and jails and prisons. The California Chapter  
            of the National Association of Social Workers writes that  
            including an additional individual on the MHSOAC that has  
            experience in supportive housing is consistent with improving  
            mental health services to those in need.



           SUPPORT AND OPPOSITION  :
          Support:  California Chapter of the National Association of  
                    Social Workers
                    California Primary Care Association

          
          Oppose:   None received.
                                      -- END --

          








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