BILL ANALYSIS
AB 34
Page 1
ASSEMBLY THIRD READING
AB 34 (Steinberg)
As Amended June 1, 1999
2/3 vote. Urgency
HEALTH 14-0 APPROPRIATIONS 17-4
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|Ayes:|Gallegos, Baugh, |Ayes:|Migden, Cedillo, Davis, |
| |Aanestad, Bates, Corbett, | |Pescetti, Hertzberg, |
| |Firebaugh, Kuehl, | |Kuehl, Maldonado, Papan, |
| |Steinberg, Strickland, | |Romero, Shelley, |
| |Thomson, Vincent, Wayne, | |Steinberg, Thomson, |
| |Wildman, Zettel | |Wesson, Wiggins, Wright, |
| | | |Zettel, Aroner |
|-----+--------------------------+-----+--------------------------|
| | |Nays:|Brewer, Ashburn, Battin, |
| | | |Runner |
| | | | |
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SUMMARY : Revises county mental health service standards to
include access to integrated services, and establishes fiscal
incentives for counties to engage in outreach to mentally ill
persons. Specifically, this bill :
1)Revises county mental health service standards to be developed
by the Department of Mental Health (DMH), to include
coordination and access to medication, substance abuse
services, supportive housing, veterans' services and
vocational rehabilitation services.
2)Requires, as funds become available, the three demonstration
projects established in the Adult and Older Adult Mental
Health System of Care Act to be expanded to counties with
significant populations of homeless mentally ill persons.
3)Establishes four-year planning and outreach grants to
counties, provides for increased funding reflecting the number
of adults receiving mental health services for at least four
months in a six-month period.
4)Requires outreach grants to be sufficient to provide mental
health services, medications, alcohol and drug services,
housing assistance, vocational rehabilitation, financial
management assistance and stipends to attract and retain
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professionals to provide services.
5)Permits an outreach grant to be renewed if the county
demonstrates to DMH that the services are successfully
reducing mental health needs and reducing law enforcement,
criminal justice system, and state corrections expenditures on
severely mentally ill persons.
6)Permits grant reductions based upon benchmarks for a 20% or
larger reduction in incarceration rates over the four-year
grant. Permits DMH to approve grant renewal if the benchmark
is unmet and the county is stabilizing more mentally ill and
reducing homelessness, achieving the maximum feasible
reduction in incarceration, or meeting other performance
criteria specified in the county contract.
7)Permits subsequent funding to be limited, or for conditions
for improvement to be imposed upon a county that received a
grant, but did not reduce criminal justice expenditures or
meet other performance benchmarks as a result. Requires DMH to
provide annual oversight of grants for compliance with
contract standards.
8)Requires the DMH Director to establish an advisory committee
to provide advice regarding the development of grant award
criteria, and to identify performance measures for evaluating
the effectiveness of grants. The committee shall include, but
not be limited to, representatives from veterans' services
programs, law enforcement, county and private mental health
providers, the Board of Corrections, the Department of Alcohol
and Drug Programs, substance abuse service providers, the
Department of Rehabilitation, and providers of employment
services. Requires criteria for grant awards to include, but
not be limited to:
a) A strategic plan for providing outreach, prevention,
intervention, and evaluation in a cost appropriate manner;
b) A description of the population to be served, ability to
administer an effective service program, and the degree to
which local agencies and advocates will support program
efforts; and
c) Mechanisms to award grants in a manner that supports
better county performance, by restricting grants based on
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the extent to which the current number of people receiving
extensive mental health services with funds provided other
than through this part in the county are significantly
below those of other comparable counties, and by rewarding
counties that are able to provide mental health services to
more people with other resources.
9)Requires local strategy committees composed of, but not
limited to representatives of local government and providers
of housing assistance, mental health services, outreach for
mental health services, veterans' services, law enforcement,
substance abuse services and employment services.
10)Requires the local strategy committee to develop a
comprehensive plan to from the basis for a performance-based
contract with DMH. Requires the plan to identify specified
outcome and performance measures identified by DMH and the
local committee.
11)Permits grant amounts to be increased to reward counties that
are providing mental health services to significantly more
mentally ill adults with funds other than state
appropriations, relative to other comparable counties.
Permits grant amounts to be decreased to penalize counties
serving a number of severely mentally ill adults significantly
below that of comparable counties.
12)Permits outreach grants to be renewed, if the county
demonstrates to DMH that the outreach services are
successfully bringing into treatment the number of persons
projected in the contract. Permits contracts to be modified
as necessary.
13)Requires, beginning on or before November 1, 2001, and
annually thereafter, the Director to report to the Legislature
about the impact of grants in reducing incarceration of
mentally ill persons, and to make recommendations regarding
improving county performance and state mental health policies.
14)Appropriates $12 million from the General Fund during the
current (1999-2000) fiscal year to DMH. Requires $500,000 to
be allocated for training, $500,000 to be allocated for
homeless outreach training for counties, to be offered through
an organization with significant success with homeless
outreach programs. Requires $9 million to be allocated for
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county planning grants.
15)Appropriates $41 million to DMH from the General Fund for the
2000-2001 fiscal year. Requires, of the amounts appropriated
each year, $500,000 to be allocated to DMH for administrative
purposes.
16)Expresses legislative intent that the future funding be
allocated to counties based on the amount due under the
applicable county's contract, according to net increases in
the number of persons served in the prior fiscal year,
adjusted by the amount the county's prior fiscal year
allocation was greater or less than the amount required to
fund the county's actual increase in number of persons served.
If the total amount of allocations due to all counties would
exceed the previous year's appropriation by more than $50
million, each county shall receive a percentage of a $50
million increase over the previous year's appropriation.
EXISTING LAW :
1) Requires counties to relieve and support poor, indigent and
incapacitated persons, when such persons are not supported
and relieved by relatives, friends, or other public or
private institutions.
2) Establishes three mental health care demonstration projects
in the Adult and Older Adult Mental Health System of Care
Act.
FISCAL EFFECT : According to the Assembly Appropriations
Committee analysis, the bill appropriates $12 million General
Fund in 1999-2000, and $41 million in 2000-2001. In addition,
this bill expresses intent to provide state funding, with annual
increases not to exceed $50 million annually.
COMMENTS : The author is proposing this bill to reduce
homelessness of people with severe mental illnesses. The author
notes that the mentally ill frequently become disoriented and
unable to recognize the need for medical assistance. When
medical care is not sought, a cycle of hospitalization, return
to the streets, arrest, and return to homelessness ensues. This
bill is sponsored by the Mental Health Association in
California.
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AB 3777 (Wright), Chapter 982, Statutes of 1988, authorized two
types of pilot programs for delivering mental health services to
seriously mentally ill adults: a system of care model, which has
been piloted in Ventura County, and the integrated service
agencies (ISA) model, piloted in Stanislaus and Los Angeles
Counties. These programs have helped clients become functional
through coordinated services to address multiple problems, such
as mental illness, substance abuse and homelessness. SB 659
(Wright), Chapter 153, Statutes of 1996, reauthorized the
demonstration projects, and required DMH to issue requests for
proposals for additional projects in any year in which the state
provides funds for that purpose.
The California Council of Community Mental Health Agencies
(CCCMHA) argues that the only way to stop the cycle of
homelessness due to untreated illness is to provide incentive
funding for county programs. The Los Angeles County Sheriff's
Department believes this bill will provide resources to keep
mentally ill patients from weighing down our criminal justice
system. The California Mental Health Planning Council argues
that this bill will reverse a pattern of underfunding that has
continued since deinstitutionalization of the mentally ill in
the early 1970's.
Analysis Prepared by : Ann Blackwood / HEALTH / (916) 319-2097
FN:
0001584