BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 34|
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THIRD READING
Bill No: AB 34
Author: Steinberg (D), et al
Amended: 9/3/99 in Senate
Vote: 27 - Urgency
SENATE HEALTH & HUMAN SERV. COMMITTEE : 6-2, 8/18/99
AYES: Escutia, Hughes, Morrow, Polanco, Solis,
Vasconcellos
NOES: Haynes, Mountjoy
NOT VOTING: Figueroa
ASSEMBLY FLOOR : 79-1, 6/4/99 - See last page for vote
SUBJECT : Mental health funding: local grants
SOURCE : Mental Health Association in California
DIGEST : This bill establishes new county demonstration
programs, building upon existing county programs serving
adults who are severely mentally ill, homeless, or recently
released from a correctional institution.
ANALYSIS : Current law:
1.Requires counties, as providers of last resort, to
support and provide needed health services to indigent
and incapacitated persons not eligible to be served by
other institutions or programs.
2.Requires the state Department of Mental Health (DMH) to
establish three county mental health care demonstration
CONTINUED
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projects under the Adult and Older Adult Mental Health
System-of-Care Act (hereinafter referred to as the "Adult
System-of-Care Act"). The Adult System-of-Care programs
provide community-based treatment, case management and
coordination of interagency services.
This bill:
1.Reappropriates $10 million to DMH from Item 4440-101-0001
of the Budget Act of 1999 for a grant program for one
year in up to three counties to demonstrate that
comprehensive sources can be provided to severely
mentally ill adults who are homeless, recently released
from a county jail, or otherwise at risk of homelessness
or incarceration.
2.Provides that $500,000 shall be used for DMH
administrative costs and to work together with the
Department of Finance, the Department of Corrections, the
Board of Corrections, state associations representing law
enforcement and local government and the Legislative
Analyst to evaluate the program performance and cost
data.
3.Requires that, to be eligible for a grant, a county must
have an existing integrated adult source program that
meets the criteria for an adult system of care and that
can develop an integrated forensic program, as specified.
4.Requires the funds provided by the grants to be used for
new services and not to supplant existing services.
5.Requires the Department of Corrections and DMH to jointly
develop a coordinated strategy to maximize the efficiency
and cost-effectiveness of services to severely mentally
ill parolees. Authorizes the transfer of specified
Budget Act of 1999 funds to enhance services in reducing
the recidivism rate of mentally ill parolees at risk of
incarceration.
6.Requires DMH to establish an advisory committee to advise
on the development of criteria for the award of grants
and the identification of specific performance measures
for evaluating the effectiveness of the grants.
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7.Revises the Adult-System-of-Care Act statute to authorize
existing and expanded programs to add outreach and early
intervention as authorized program components as well as
authorizing other services.
8.Requires DMH to revise requirements for program
performance standards.
9.Requires DMH, in consultation with the advisory
committee, to report to the Legislature by May 1, 2000 on
the effectiveness of the strategies in providing
successful outreach and reducing homelessness,
involvement with local law enforcement, and other
measures identified by DMH
Background
Current law:
Under Welfare and Institutions Code (WIC) Section 17000,
counties are the providers of last resort of income support
and health care to indigent and incapacitated persons who
are not supported and relieved by relatives, friends, or
public or private institutions or programs. State policy
changes, commencing in the 1970s, transferred a number of
mentally ill patients from state mental hospitals to
community-based treatment programs. The policy of placing
patients in community-based programs was intended to
improve the quality of life and care of residents, and also
was expected to reduce state costs. In addition, as
reiterated in a recent U.S. Supreme Court Case ( Olmstead
vs. L.C. and E.W. ), the policy supported the right of
mentally ill persons to reside in the "least restrictive"
environment possible.
The transfer has resulted in state cost savings, according
to the Mental Health Association of California: "In the
early 1970's, before significant de-institutionalization,
institutional care and state mental hospitals represented
4% of the state general fund budget. Budget cuts over the
next 15 years, from 1975 to 1990, reduced the percentage to
about 1.5%." However, the transfer resulted in additional
fiscal pressure on local government to provide services to
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mentally ill residents.
Under current state law, counties operate local government
mental health programs; however, funding limitations result
in few counties providing comprehensive, integrated
services to severely mentally ill adults or significant
outreach to homeless mentally ill adults. According to the
County Mental Health Directors Association, despite the
development of community based system-of-care programs,
"capacity remains inadequate. Community based services are
available to less than half those who need them. The
consequences of untreated, serious mental illness are
homelessness, police interaction, exacerbated symptoms and
other personal and community problems."
The Adult Systems-of-Care Act, AB 3777 (Wright), Chapter
982, Statutes of 1988, authorized demonstration programs in
three counties for delivering mental health services to
seriously mentally ill adults. Two types of demonstration
programs were authorized: a "system of care" model, which
has been piloted in Ventura County, and an "integrated
service agencies (ISA)" model, piloted in Stanislaus and
Los Angeles Counties. 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 funding was made
available (WIC Section 5814). The Adult Systems-of-Care
Act programs support coordinated services from county and
state agencies, including criminal justice, mental health,
employment, housing, welfare, and health agencies. The act
also requires DMH to establish standards for
systems-of-care programs, requiring: a county services
plan; consultation with specified local entities and
families; assignment of a case manager or multidisciplinary
team for each client; and an individual service plan for
each client.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to Senate Appropriations Committee:
Fiscal Impact (in thousands)
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Major Provisions 19999-2000
2000-01 2001-02 Fund
Grants and DMH 10,000* General
administration
*Included in the 1999 State Budget Act
SUPPORT : (Unable to verify at time of this writing)
Mental Health Association in California (source)
Alta California Regional Center
American Federation of State, County and Municipal
Employees
American Nurses Association/California
Association for Los Angeles Deputy Sheriffs, Inc.
Association of Regional Center Agencies
Board of Supervisors, counties of Contra Costa, Sacramento,
San Francisco, San Mateo, Santa Clara, Ventura
Butte County Behavioral Health Board
California Association of Social Rehabilitation Agencies
California Association of Veteran Services Agencies
California Catholic Conference
California Church Impact
California Coalition for Mental Health
California Council of Community Mental Health Agencies
California Correctional Peace Officers Association
California Democratic Council
California Healthcare Association
California Independent Public Employees Legislative Council
California Mental Health Planning Council
California Network of Mental Health Clients
California Nurses Association
California Probation, Parole and Correctional Association
California Psychiatric Association
California Psychological Association
California State Association of Counties
California State Sheriff's Association
City of Sacramento
City of San Francisco
Congress of California Seniors
County Alcohol and Drug Program Administrators Association
of California
County of San Joaquin Veterans Service Office
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County of Santa Clara Board of Supervisors
Department of Health and Human Services, County of Marin
Department of Mental Health, County of Los Angeles
Eli Lilly and Company
Engineers and Scientists of California
Families First
Family Service Council of California
Fresh Cut Florist and Gifts
Friends Committee on Legislation of California
Governmental Advocates, Inc.
Jericho
Jewish Public Affairs Committee of California
Jewish Community Relations Committee
Joann's Elegant Gifts
Johnson and Johnson
Kern Regional Center
League of California Cities
League of Women Voters of California
Little Hoover Commission
Loaves and Fishes
Lutheran Office of Public Policy
Mental Health Association, Counties of Los Angeles, Orange
Mental Health Division of Contra Costa County Health
Services
National Alliance for the Mentally Ill, chapters of Los
Angeles,
Marin, Ponoma Valley, San Bernardino, Sacramento, San
Diego, San Gabriel, San Mateo, Tuolumne, Ventura,
Whittier
National Association of Social Workers, California Chapter
Office of the Sheriff, Counties of Amador, Butte,
Calaveras, Contra Costa, Glenn, Humboldt, Kern, Kings,
Los Angeles, Marin, Mendocino, Modoc, Monterey, Napa,
Nevada, Orange, Placer, San Benito, San Bernardino, Santa
Cruz, San Diego, San Mateo, Santa Clara, Shasta, Solano,
Sonoma, Stanislaus, Tehama, Tuolumne, Yolo, Yuba
Older Womens League of California
Orange County Coalition for Mental Health
Orange County Multi-Ethnic Behavioral Health Service Task
Force
Police Department, Cities of Monrovia, Sacramento, Santa
Barbara
Protection and Advocacy, Inc.
Regional Center of Orange County
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Sacramento County and Cities Board on Homelessness
SmithKline Beecham
Solano County Mental Health Board
Stanislaus Department of Aging and Veterans Services
State Coalition of Probation Organizations
TACC Triple-A Council of California
Union of American Physicians and Dentists
Verdugo Mental Health Center
Veterans Service Office, County of San Joaquin
Westside Regional Center
California Mental Health Directors Association (if amended)
numerous individuals
ARGUMENTS IN SUPPORT : This bill is sponsored by the
Mental Health Association in California. The author's
purpose in proposing this bill is to reduce homelessness of
people with severe mental illnesses. The author notes
that, as such persons frequently are unable to recognize
the need for medical assistance, a cycle of
hospitalization, return to the streets, arrest, and return
to homelessness ensues.
The California Mental Health Planning Council argues this
bill will help reverse a pattern of underfunding that has
continued since deinstitutionalization of the mentally ill
in the early 1970's. The California Council of Community
Mental Health Agencies (CCCMHA) argues the only way to stop
the cycle of homelessness, due to untreated illness, is to
provide incentive funding for county programs. The
California Healthcare Association, representing hospitals,
argues: "Hospital providers are acutely aware of the lack
of appropriate treatment and housing resources for the
seriously mentally ill in the community. It is often
difficult, if not impossible, to find appropriate aftercare
services or residential placement for a patient once he/she
has been stabilized in the hospital. With nowhere to go,
patients often relapse and either end up back in the
hospital, or, too often, in the criminal justice system".
In addition, the Little Hoover Commission, in support of AB
34, states that in its 1998 report, Beyond Bars:
Correctional Reforms to Lower Prison Costs and Reduce
Crime, it found "?community based programs were a viable
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alternative to prison for nonviolent offenders?" The
Commission states, "County services for the mentally ill,
such as AB 34, would constitute such a program." The
Commission argues counties bear all the cost of handling
offenders at the local level, but none of the cost when
judges send offenders to state prison and this "provides a
fiscal disincentive for counties to independently develop
alternatives, including expanded services to the mentally
ill."
The California State Sheriff's Association states, in
support of AB 34, "?from a law enforcement perspective, the
need for adult mental health and related services is clear.
The unfortunate reality is that our local jails have
become the last resort for many of our mentally ill. This
is a disservice to them and to us". The Los Angeles County
Sheriff's Department asserts AB 34 will add resources to
keep mentally ill patients out of the criminal justice
system.
ASSEMBLY FLOOR :
AYES: Aanestad, Ackerman, Alquist, Aroner, Ashburn,
Baldwin, Bates, Battin, Baugh, Bock, Brewer, Briggs,
Calderon, Campbell, Cardenas, Cardoza, Cedillo, Corbett,
Correa, Cox, Cunneen, Davis, Dickerson, Ducheny, Dutra,
Firebaugh, Florez, Floyd, Frusetta, Gallegos, Granlund,
Havice, Hertzberg, Honda, House, Jackson, Kaloogian,
Keeley, Knox, Kuehl, Leach, Lempert, Leonard, Longville,
Lowenthal, Machado, Maddox, Maldonado, Margett, Mazzoni,
McClintock, Migden, Nakano, Olberg, Oller, Robert
Pacheco, Rod Pacheco, Papan, Pescetti, Reyes, Romero,
Runner, Scott, Shelley, Soto, Steinberg, Strickland,
Strom-Martin, Thomson, Torlakson, Vincent, Washington,
Wayne, Wesson, Wiggins, Wildman, Wright, Zettel,
Villaraigosa
NOES: Thompson
CP:sl 9/4/99 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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