BILL NUMBER: SB 291 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 28, 2015
AMENDED IN SENATE APRIL 6, 2015
INTRODUCED BY Senator Lara
FEBRUARY 23, 2015
An act to amend Section Sections 127750
and 131019.5 of, and to add Article 2 (commencing with
Section 127810) to Chapter 1 of Part 3 of Division 107 of,
of the Health and Safety Code, and to amend Section 4060
of the Welfare and Institutions Code, relating to mental health.
LEGISLATIVE COUNSEL'S DIGEST
SB 291, as amended, Lara. Mental health: vulnerable communities.
(1) Existing law establishes the Office of Statewide Health
Planning and Development and requires the office to prepare a Health
Manpower Plan for California to establish standards for, and
determine the adequacy of, policies relating to health care
practitioners, including physicians, nurses, and dentists, to serve
the needs of the state.
This bill would require the office to prepare a Mental
Health Manpower Plan to assess include the
needs and services available to serve the mental
health needs of Californians, especially those in
vulnerable communities, as defined , in the Health Manpower Plan
.
(2) Existing law establishes the Office of Health Equity within
the State Department of Public Health for the purposes of aligning
state resources, decisionmaking, and programs to accomplish various
goals relating to health, and requires the office to perform various
duties specifically relating to vulnerable communities, as defined.
This bill would include individuals who have experienced trauma
related to genocide in the definition of vulnerable communities.
(3) Existing law requires the State Department of Health Care
Services to provide, to the extent resources are available, technical
assistance, through its own staff, or by contract, to county mental
health programs and other local mental health agencies in the areas
of program operations, research, evaluation, demonstration, or
quality assurance projects. Existing law requires the department, to
this end, to utilize a meaningful decisionmaking process that
includes, among others, stakeholders as determined by the department.
This bill would require the department to include specified
stakeholders from vulnerable communities in this process, including
diverse racial, ethnic, cultural, and LGBTQQ communities, communities
that experience trauma related to genocide, women's health
advocates, mental health advocates, health and mental health
providers, community-based organizations and advocates, academic
institutions, local public health departments, local government
entities, and low-income and vulnerable consumers.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 127750 of the Health
and Safety Code is amended to read:
127750. The office shall prepare a Health Manpower Plan for
California. The plan shall consist of at least the following
elements:
(a) The establishment of appropriate standards for determining
the adequacy of supply in California of at least each of the
following categories of health personnel: physicians, midlevel
medical practitioners (physician's assistants and nurse
practitioners); nurses; dentists; midlevel dental practitioners
(dental nurses and dental hygienists); optometrists; optometry
assistants; pharmacists; and pharmacy technicians.
(b) A determination of appropriate standards for the adequacy of
supply of the categories in subdivision (a) shall be made by taking
into account all of the following: current levels of demand for
health services in California; the capacity of each category of
personnel in subdivision (a) to provide health services; the extent
to which midlevel practitioners and assistants can substitute their
services for those of other personnel; the likely impact of the
implementation of a national health insurance program on the demand
for health services in California; professionally developed standards
for the adequacy of the supply of health personnel; and assumptions
concerning the future organization of health care services in
California.
(c) A determination of the adequacy of the current and future
supply of health personnel by category in subdivision (a) taking into
account the sources of supply for such personnel in California, the
magnitude of immigration of personnel to California, and the
likelihood of the immigration continuing.
(d) A determination of the adequacy of the supply of specialties
within each category of health personnel in subdivision (a). The
determination shall be made, based upon standards of appropriate
supply to speciality developed, in accordance with subdivision (b).
(e) Recommendations concerning changes in health manpower
policies, licensing statutes, and programs needed to meet the state's
need for health personnel.
(f) All of the elements in subdivisions (a) to (e), inclusive, as
appropriate, when addressing workforce education and training
programs and activities and workforce shortages and deficits
identified in the Workforce Needs Assessment for the purposes of
meeting the mental health needs of vulnerable communities, as defined
in subdivision (a) of Section 131019.5.
(g) The Legislature finds and declares that the needs of
vulnerable communities for mental health services are often unique
because of the cultural, linguistic, and experiential circumstances
of these communities and that unique solutions need to be considered
for outreach, removal of the stigma for seeking assistance, and
treatment of individuals in these vulnerable communities.
SECTION 1. Article 2 (commencing with Section
127810) is added to Chapter 1 of Part 3 of Division 107 of the Health
and Safety Code, to read:
Article 2. Mental Health Planning for Vulnerable Communities
127810. (a) The office shall prepare a Mental Health Manpower
Plan for California to assess the needs and services available to
serve the mental health needs of Californians, especially those in
vulnerable communities. The plan shall consist of at least the
following elements:
(1) The establishment of appropriate standards for determining the
adequacy of supply in California of psychologists, psychiatrists,
counselors, and other mental health personnel who may be able to
treat groups in vulnerable communities.
(2) A determination of appropriate standards for the adequacy of
supply of the categories in subdivision (a).
(3) A determination of the adequacy of the current and future
supply of personnel in subdivision (a), taking into account the
sources of supply for that personnel in California, the magnitude of
immigration of personnel to California, and the likelihood of the
immigration continuing.
(4) A determination of the adequacy of the supply of specialties
within each category of health personnel in subdivision (a).
(5) Recommendations concerning changes in programs, mental health
manpower policies, and licensing statutes needed to meet the state's
need for mental health personnel to serve vulnerable communities.
(b) For purposes of this section, "vulnerable communities" has the
same meaning as in Section 131019.5.
(c) The Legislature finds and declares that the needs of
vulnerable communities for mental health services are often unique
because of the cultural, linguistic, and experiential circumstances
of these communities and that unique solutions need to be considered
for outreach, removal of the stigma for seeking assistance, and
treatment of individuals in these vulnerable communities.
SEC. 2. Section 131019.5 of the Health and Safety Code is amended
to read:
131019.5. (a) For purposes of this section, the following
definitions shall apply:
(1) "Determinants of equity" means social, economic, geographic,
political, and physical environmental conditions that lead to the
creation of a fair and just society.
(2) "Health equity" means efforts to ensure that all people have
full and equal access to opportunities that enable them to lead
healthy lives.
(3) "Health and mental health disparities" means differences in
health and mental health status among distinct segments of the
population, including differences that occur by gender, age, race or
ethnicity, sexual orientation, gender identity, education or income,
disability or functional impairment, or geographic location, or the
combination of any of these factors.
(4) "Health and mental health inequities" means disparities in
health or mental health, or the factors that shape health, that are
systemic and avoidable and, therefore, considered unjust or unfair.
(5) "Vulnerable communities" include, but are not limited to,
women, racial or ethnic groups, low-income individuals and families,
individuals who are incarcerated and those who have been
incarcerated, individuals with disabilities, individuals with mental
health conditions, children, youth and young adults, seniors,
immigrants and refugees, individuals who have experienced trauma
related to genocide, individuals who are limited English proficient
(LEP), and lesbian, gay, bisexual, transgender, queer, and
questioning (LGBTQQ) communities, or combinations of these
populations.
(6) "Vulnerable places" means places or communities with
inequities in the social, economic, educational, or physical
environment or environmental health and that have insufficient
resources or capacity to protect and promote the health and
well-being of their residents.
(b) The State Department of Public Health shall establish an
Office of Health Equity for the purposes of aligning state resources,
decisionmaking, and programs to accomplish all of the following:
(1) Achieve the highest level of health and mental health for all
people, with special attention focused on those who have experienced
socioeconomic disadvantage and historical injustice, including, but
not limited to, vulnerable communities; culturally, linguistically,
and geographically isolated communities; and communities that have
experienced trauma related to genocide.
(2) Work collaboratively with the Health in All Policies Task
Force to promote work to prevent injury and illness through improved
social and environmental factors that promote health and mental
health.
(3) Advise and assist other state departments in their mission to
increase access to, and the quality of, culturally and linguistically
competent health and mental health care and services.
(4) Improve the health status of all populations and places, with
a priority on eliminating health and mental health disparities and
inequities.
(c) The duties of the Office of Health Equity shall include all of
the following:
(1) Conducting policy analysis and developing strategic policies
and plans regarding specific issues affecting vulnerable communities
and vulnerable places to increase positive health and mental health
outcomes for vulnerable communities and decrease health and mental
health disparities and inequities. The policies and plans shall also
include strategies to address social and environmental inequities and
improve health and mental health. The office shall assist other
departments in their missions to increase access to services and
supports and improve quality of care for vulnerable communities.
(2) Establishing a comprehensive, cross-sectoral strategic plan to
eliminate health and mental health disparities and inequities. The
strategies and recommendations developed shall take into account the
needs of vulnerable communities to ensure strategies are developed
throughout the state to eliminate health and mental health
disparities and inequities. This plan shall be developed in
collaboration with the Health in All Policies Task Force. This plan
shall establish goals and benchmarks for specific strategies in order
to measure and track disparities and the effectiveness of these
strategies. This plan shall be updated periodically, but not less
than every two years, to keep abreast of data trends, best practices,
promising practices, and to more effectively focus and direct
necessary resources to mitigate and eliminate disparities and
inequities. This plan shall be included in the report required under
paragraph (1) of subdivision (d). The Office of Health Equity shall
seek input from the public on the plan through an inclusive public
stakeholder process.
(3) Building upon and informing the work of the Health in All
Policies Task Force in working with state agencies and departments to
consider health in appropriate and relevant aspects of public policy
development to ensure the implementation of goals and objectives
that close the gap in health status. The Office of Health Equity
shall work collaboratively with the Health in All Policies Task Force
to assist state agencies and departments in developing policies,
systems, programs, and environmental change strategies that have
population health impacts in all of the following ways, within the
resources made available:
(A) Develop intervention programs with targeted approaches to
address health and mental health inequities and disparities.
(B) Prioritize building cross-sectoral partnerships within and
across departments and agencies to change policies and practices to
advance health equity.
(C) Work with the advisory committee established pursuant to
subdivision (f) and through stakeholder meetings to provide a forum
to identify and address the complexities of health and mental health
inequities and disparities and the need for multiple, interrelated,
and multisectoral strategies.
(D) Provide technical assistance to state and local agencies and
departments with regard to building organizational capacity, staff
training, and facilitating communication to facilitate strategies to
reduce health and mental health disparities.
(E) Highlight and share evidence-based, evidence-informed, and
community-based practices for reducing health and mental health
disparities and inequities.
(F) Work with local public health departments, county mental
health or behavioral health departments, local social services, and
mental health agencies, and other local agencies that address key
health determinants, including, but not limited to, housing,
transportation, planning, education, parks, and economic development.
The Office of Health Equity shall seek to link local efforts with
statewide efforts.
(4) Consult with community-based organizations and local
governmental agencies to ensure that community perspectives and input
are included in policies and any strategic plans, recommendations,
and implementation activities.
(5) Assist in coordinating projects funded by the state that
pertain to increasing the health and mental health status of
vulnerable communities.
(6) Provide consultation and technical assistance to state
departments and other state and local agencies charged with providing
or purchasing state-funded health and mental health care, in their
respective missions to identify, analyze, and report disparities and
to identify strategies to address health and mental health
disparities.
(7) Provide information and assistance to state and local
departments in coordinating projects within and across state
departments that improve the effectiveness of public health and
mental health services to vulnerable communities and that address
community environments to promote health. This information shall
identify unnecessary duplication of services.
(8) Communicate and disseminate information within the department
and with other state departments to assist in developing strategies
to improve the health and mental health status of persons in
vulnerable communities and to share strategies that address the
social and environmental determinants of health.
(9) Provide consultation and assistance to public and private
entities that are attempting to create innovative responses to
improve the health and mental health status of vulnerable
communities.
(10) Seek additional resources, including in-kind assistance,
federal funding, and foundation support.
(d) In identifying and developing recommendations for strategic
plans, the Office of Health Equity shall, at a minimum, do all of the
following:
(1) Conduct demographic analyses on health and mental health
disparities and inequities. The report shall include, to the extent
feasible, an analysis of the underlying conditions that contribute to
health and well-being. The first report shall be due July 1, 2014.
This information shall be updated periodically, but not less than
every two years, and made available through public dissemination,
including posting on the department's Internet Web site. The report
shall be developed using primary and secondary sources of demographic
information available to the office, including the work and data
collected by the Health in All Policies Task Force. Primary sources
of demographic information shall be collected contingent on the
receipt of state, federal, or private funds for this purpose.
(2) Based on the availability of data, including valid data made
available from secondary sources, the report described in paragraph
(1) shall address the following key factors as they relate to health
and mental health disparities and inequities:
(A) Income security such as living wage, earned income tax credit,
and paid leave.
(B) Food security and nutrition such as food stamp eligibility and
enrollment, assessments of food access, and rates of access to
unhealthy food and beverages.
(C) Child development, education, and literacy rates, including
opportunities for early childhood development and parenting support,
rates of graduation compared to dropout rates, college attainment,
and adult literacy.
(D) Housing, including access to affordable, safe, and healthy
housing, housing near parks and with access to healthy foods, and
housing that incorporates universal design and visitability features.
(E) Environmental quality, including exposure to toxins in the
air, water, and soil.
(F) Accessible built environments that promote health and safety,
including mixed-used land, active transportation such as improved
pedestrian, bicycle, and automobile safety, parks and green space,
and healthy school siting.
(G) Health care, including accessible disease management programs,
access to affordable, quality health and behavioral health care,
assessment of the health care workforce, and workforce diversity.
(H) Prevention efforts, including community-based education and
availability of preventive services.
(I) Assessing ongoing discrimination and minority stressors
against individuals and groups in vulnerable communities based upon
race, gender, gender identity, gender expression, ethnicity, marital
status, language, sexual orientation, disability, and other factors,
such as discrimination that is based upon bias and negative attitudes
of health professionals and providers.
(J) Neighborhood safety and collective efficacy, including rates
of violence, increases or decreases in community cohesion, and
collaborative efforts to improve the health and well-being of the
community.
(K) The efforts of the Health in All Policies Task Force,
including monitoring and identifying efforts to include health and
equity in all sectors.
(L) Culturally appropriate and competent services and training in
all sectors, including training to eliminate bias, discrimination,
and mistreatment of persons in vulnerable communities.
(M) Linguistically appropriate and competent services and training
in all sectors, including the availability of information in
alternative formats such as large font, braille, and American Sign
Language.
(N) Accessible, affordable, and appropriate mental health
services.
(3) Consult regularly with representatives of vulnerable
communities, including diverse racial, ethnic, cultural, and LGBTQQ
communities, women's health advocates, mental health advocates,
health and mental health providers, community-based organizations and
advocates, academic institutions, local public health departments,
local government entities, and low-income and vulnerable consumers.
(4) Consult regularly with the advisory committee established by
subdivision (f) for input and updates on the policy recommendations,
strategic plans, and status of cross-sectoral work.
(e) The Office of Health Equity shall be organized as follows:
(1) A Deputy Director shall be appointed by the Governor or the
State Public Health Officer, and is subject to confirmation by the
Senate. The salary for the Deputy Director shall be fixed in
accordance with state law.
(2) The Deputy Director of the Office of Health Equity shall
report to the State Public Health Officer and shall work closely with
the Director of Health Care Services to ensure compliance with the
requirements of the office's strategic plans, policies, and
implementation activities.
(f) The Office of Health Equity shall establish an advisory
committee to advance the goals of the office and to actively
participate in decisionmaking. The advisory committee shall be
composed of representatives from applicable state agencies and
departments, local health departments, community-based organizations
working to advance health and mental health equity, vulnerable
communities, and stakeholder communities that represent the diverse
demographics of the state. The chair of the advisory committee shall
be a representative from a nonstate entity. The advisory committee
shall be established by no later than October 1, 2013, and shall
meet, at a minimum, on a quarterly basis. Subcommittees of this
advisory committee may be formed as determined by the chair.
(g) An interagency agreement shall be established between the
State Department of Public Health and the State Department of Health
Care Services to outline the process by which the departments will
jointly work to advance the mission of the Office of Health Equity,
including responsibilities, scope of work, and necessary resources.
SEC. 3. Section 4060 of the Welfare and Institutions Code is
amended to read:
4060. The State Department of Health Care Services shall, in
order to implement Section 4050, utilize a meaningful decisionmaking
process that includes local mental health directors and
representatives of local mental health boards as well as other
stakeholders in vulnerable communities, including diverse racial,
ethnic, cultural, and LGBTQQ communities, communities that experience
trauma related to genocide, women's health advocates, mental health
advocates, health and mental health providers, community-based
organizations and advocates, academic institutions, local public
health departments, local government entities, and low-income and
vulnerable consumers. The purpose of this collaboration shall be to
promote effective and efficient quality mental health services to the
residents of the state under the realigned mental health system.