BILL ANALYSIS
AB 710
Page 1
Date of Hearing: April 28, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 710 (Yamada) - As Amended: April 22, 2009
SUBJECT : Veterans' Substance Abuse and Mental Health Services
Fund.
SUMMARY : Requires the California Department of Veterans
Affairs (CDVA) to apply to the federal Substance Abuse and
Mental Health Services Administration (SAMHSA) for funding to
award grants to community-based organizations (CBOs) to provide
substance abuse and mental health services to veterans.
Specifically, this bill :
1)Directs CDVA to submit a grant application to SAMHSA for the
purposes of funding CBOs, certified by CDVA, to provide
substance abuse and mental health services to veterans.
2)Requires all grant money from SAMHSA awarded to CDVA, and any
interest earned, to be deposited into the Veterans' Substance
Abuse and Mental Health Services Fund (Fund) established by
this bill.
3)Requires moneys in the Fund, upon appropriation by the
Legislature, to be used by CDVA for purposes of funding CBOs
that provide substance abuse and mental health programs that
the Secretary of CDVA deems would benefit California veterans
and to pay reasonable administrative expenses.
4)Directs CDVA to determine how to allocate and disburse moneys
from the Fund to CBOs and specifies that the moneys must only
be used for providing substance abuse and mental health
services to veterans, including, but not limited to the
treatment of post-traumatic stress disorder (PTSD) and
military sexual trauma (MST), as defined.
5)Requires CDVA to develop a process by which to certify CBOs
that receive funding and authorizes CDVA to adopt
certification standards or conditions that may be required by
SAMHSA.
6)Requires CBOs that receive funding pursuant to this bill to
prepare an annual report on the programs and services
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supported by the grant funds and submit it to CDVA. Requires
CVDA to use the report to determine renewal of funding to a
certified CBO, based on criteria of success established by
CDVA.
7)Clarifies that counties that do not have CBOs to serve
veterans may apply for a grant pursuant to this bill to be
used by the county to fund and provide substance abuse and
mental health services to veterans.
EXISTING LAW :
1)Establishes the CDVA to administer state military affairs and
oversee, among other things, veterans' welfare and homes.
2)Establishes the California Department of Mental Health (DMH)
to direct and coordinate statewide efforts for the treatment
of mental disabilities.
3)Establishes, under federal law, the Veterans Health
Administration (VA) within the U.S. Department of Veterans
Affairs, to provide health care and other benefits to veterans
and their families and administer VA medical centers and
community based-outpatient clinics.
4)Requires counties to provide mental health services to target
populations to the extent resources are available. Includes
in the target populations California veterans in need of
mental health services who are not eligible for care by the VA
or other federal health care provider. Specifies the minimum
array of services that must be provided to target populations.
5)Includes within the definition of a serious mental disorder
PTSD and bipolar disorder for purposes of qualifying target
populations for county mental health services.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . The author notes that while the VA is
mandated to maintain the capacity to provide specialized
treatment and rehabilitative services to disabled veterans,
including mental health services, not all veterans are
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eligible for VA benefits. The author asserts that VA health
care services are often prioritized into seven categories,
with those veterans evaluated to have the greatest need
identified as priority one. According to the author, veterans
suffering from PTSD or substance abuse receive low priority
and, consequently, report lengthy wait times for professional
care. The author states that this bill is needed to support
community programs that serve the substance abuse and mental
health needs of veterans and to provide additional funding for
these services.
2)STATISTICS FROM THE VA . According to an August 2007 research
brief by the VA's Office of Research and Development, from the
start of the conflicts in Iraq and Afghanistan in 2003 and
through 2006, more than 631,000 soldiers have been discharged.
Approximately 32.5% have sought VA healthcare and, of these,
35.7% have had a mental health condition or concern. In 2008,
VA expects to treat 5.8 million veterans, an increase of 2.4%
over 2007. Of these 5.8 million, VA expects to see 263,000
Iraq and Afghanistan war veterans, or 25.8% more than in 2007.
The VA notes that many of these veterans have experienced
multiple injuries including injuries to several organs, limb
loss, sensory loss, burns, and chronic pain. Moreover, combat
veterans of the Iraq and Afghanistan wars are at higher risk
for PTSD and other mental health disorders, such as adjustment
disorder, anxiety, depression, and substance abuse. The VA
notes that war veterans are eligible for two years of free
health care for any condition that may be related to combat,
and VA clinicians are informed to evaluate veterans for
war-related mental disorders.
3)COMMUNITY-BASED OUTPATIENT CLINICS . As part of its strategy
to transition from a hospital-based health care model
providing episodic specialized care to an ambulatory
care-based system providing coordinated continuity of care,
the VA initiated a system of community-based outpatient
clinics (CBOCs) beginning in 1995 to enhance delivery of
primary care to veterans. The VA defines a CBOC as a VA
operated clinic that is stationary or mobile or a VA funded or
reimbursed health care facility that is geographically
separate from the parent VA medical center. According to the
VA, CBOCs were established to more efficiently and effectively
serve eligible veterans in the most appropriate setting.
Currently, there are ten VA medical centers and 24 CBOCs
operating throughout California.
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A 2002 study using performance measures related to primary
prevention, early disease detection, and chronic disease
management compared quality of care provided at CBOCs with
quality of care provided at traditional VA medical centers.
The study found that CBOCs overall provide a similar level of
quality of care as VA medical centers and suggested that
community-based settings are a valid approach to providing
quality primary care services to veterans. However, a 2004
provider survey conducted by the VA concluded that while
primary care providers performed some screening for substance
abuse disorders, no substantial psychosocial or
pharmacological treatment was regularly available through VA
medical centers or CBOCs.
4)PTSD . According to the National Institute of Mental Health
(NIMH), PTSD is an anxiety disorder that can develop after
exposure to a terrifying event or ordeal in which grave
physical harm occurred or was threatened. Traumatic events
that may trigger PTSD include violent personal assaults,
natural or human-caused disasters, accidents, or military
combat. According to NIMH, individuals who may experience
PTSD include military troops who served in the Vietnam and
Gulf Wars and other wars. Many people with PTSD repeatedly
re-experience the ordeal in the form of flashback episodes,
memories, nightmares, or frightening thoughts, especially when
they are exposed to events or objects reminiscent of the
trauma. Anniversaries of the event can also trigger symptoms.
People with PTSD also experience emotional numbness and sleep
disturbances, depression, anxiety, and irritability, or
outbursts of anger. Feelings of intense guilt are also
common. PTSD is diagnosed when symptoms last more than one
month. Physical symptoms such as headaches, gastrointestinal
distress, immune system problems, dizziness, chest pain, or
discomfort in other parts of the body are common in people
with PTSD. According to the VA Web site, more than 185,000
veterans were identified in 2003 as having PTSD as a
service-connected disability.
5)MILITARY SEXUAL TRAUMA . According to the VA's National Center
for PTSD, MST refers to both sexual harassment and sexual
assault that occurs in military settings. Both men and women
can experience military sexual trauma and the perpetrator can
be of the same or opposite gender. The VA estimates that 27%
of men and 60% of women in the armed forces have experienced
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MST. MST most often occurs in a setting where the victim
lives and works. In most cases, this means that victims must
continue to live and work closely with their perpetrators,
often leading to an increased sense of feeling helpless,
powerless, and at risk for additional victimization. Victims
are often forced to choose between continuing military careers
during which they are forced to have frequent contact with
their perpetrators or sacrificing their career goals in order
to protect themselves from future victimization.
Among both men and women in the active duty military, sexual
trauma is associated with poorer psychological well-being,
more physical problems, and lower satisfaction with health and
work. Female veterans who access VA health care and report a
history of sexual trauma while in the military also report a
range of negative outcomes, including poorer psychological and
physical health, more readjustment problems following
discharge, such as difficulty finding work and abuse of
alcohol and drugs, and a greater incidence of unemployment due
to mental health problems. Victims of MST also identify PTSD
as a frequent outcome. According to the 2008 Department of
Defense report on MST, from the period of October 1, 2007,
through September 30, 2008, there were 2,908 incidents of
sexual trauma involving military service members reported, of
which 2,389 criminal investigations were completed.
6)SUPPORT . Supporters, representing veterans groups, service
providers, counties, and mental health and disability
advocates, state that many veterans are returning home from
the wars in Afghanistan and Iraq with mental health disorders
and substance abuse problems and this bill takes advantage of
available federal funding to ensure that veterans receive the
services they need in their communities.
7)RELATED LEGISLATION . AB 1571 prohibits DMH from approving a
county's plan for the expenditure of funds from the Mental
Health Services Act, as specified, unless it includes
verifiable representation from a legitimate veterans group in
the stakeholder planning process and includes a separate
section that specifically addresses how the mental health
needs of veterans are, or are not, being met. AB 1571 is
pending in the Assembly Veterans Affairs Committee.
8)PRIOR LEGISLATION .
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a) AB 2828 (Salas) of 2008, which was nearly identical to
this bill, would have required CDVA to apply for SAMHSA
funding to provide grants to CBOs for substance abuse and
mental health services for veterans. AB 2828 was vetoed by
Governor Schwarzenegger because it was not identified as a
high priority for the state.
b) AB 3083 (Committee on Veterans Affairs), Chapter 591,
Statutes of 2008, requires counties to provide mental
health services to California veterans in need of services
and who meet existing eligibility requirements, to the
extent services are available to other adults, and expands
the definition of a serious mental disorder to include PTSD
and bipolar disorder for purposes of qualifying target
populations for county mental health services.
9)SECOND COMMITTEE OF REFERENCE . This bill was previously heard
in the Assembly Veterans Affairs Committee and was approved on
an 8-0 vote.
REGISTERED SUPPORT / OPPOSITION :
Support
American Association for Marriage and Family Therapy
American Legion
California Association of County Veterans Service Officers
California Mental Health Directors Association
California Psychological Association
California Public Defenders Association
California Society for Clinical Social Work
California State Association of Counties
California Therapeutic Communities
County Veterans Service Officers
Disability Rights California
Mental Health Association in California
Vietnam Veterans of America
Opposition
None on file.
Analysis Prepared by : Cassie Rafanan / HEALTH / (916)
319-2097