BILL ANALYSIS
AB 1571
Page 1
Date of Hearing: April 28, 2009
ASSEMBLY COMMITTEE ON VETERANS AFFAIRS
Mary Salas, Chair
AB 1571 (Committee on Veterans Affairs) - As Introduced: March
16, 2009
SUBJECT : Veterans mental health: county plans.
SUMMARY : Prohibits the Department of Mental Health (DMH) from
approving a county's plan for the expenditure of funds from the
Mental Health Services Act (MHSA), 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.
Specifically, this bill :
1)Prohibits DMH from approving a county's plan for the
expenditure of MHSA funds for prevention and early
intervention and innovation programs unless it includes
verifiable representation from a legitimate veterans group in
the required stakeholder planning process and includes a
section that addresses the specific mental health issues of
veterans and how the plan will, or will not, address those
issues.
2)Requires each county's expenditure update report for MHSA
funds allocated to services for children, adults, and seniors
to include the number of veterans to be served.
3)Revises the list of local stakeholders required to be
consulted in the development and update of each county's MHSA
plan to include representatives from a legitimate veterans
organization.
4)Specifies that the reports of achievement outcomes that are
required to be included in each county's MHSA plan must
specifically include recognition of the mental health needs of
veterans and how those needs are, or are not, being met.
EXISTING LAW :
1)Establishes DMH to direct and coordinate statewide efforts for
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the treatment of mental disabilities.
2)Establishes the MHSA, enacted by voters in 2004 as Proposition
63, to provide funds to counties to expand services and
develop innovative programs and integrated service plans for
mentally ill children, adults, and seniors through a 1% tax on
personal income above $1 million.
3)Requires the State Controller to transfer specified amounts of
state funding into the Mental Health Services Fund,
administered by DMH. Requires revenues deposited into the
fund to be used to create new county mental health programs
and expand existing programs.
4)Requires each county mental health department to prepare and
submit to DMH a three-year program and expenditure plan for
MHSA funding that addresses the following five major
components: a) community services and supports; b) workforce
education and training; c) capital facilities and
technological needs; d) prevention and early intervention;
and, e) innovation.
5)Requires DMH to establish guidelines for the content of each
of the five components and approval of county plans.
6)Requires each county plan and update to be developed with
local stakeholders, including adults and seniors with severe
mental illness, families of children, adults, and seniors with
severe mental illness, providers of services, law enforcement
agencies, educators, social services agencies, and other
important interests.
7)Specifies that the MHSA may only be amended by a two-thirds
vote of both houses of the Legislature and only so long as the
amendment is consistent with and furthers the intent of the
MHSA. Permits provisions clarifying the procedures and terms
of the MHSA to be added by majority vote of the Legislature.
8)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
outpatient clinics.
9)Establishes the Bronzan-McCorquodale Act, also known as
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"Realignment," which shifted responsibility for the provision
of mental health services from the state to counties.
Provides funding for local programs with revenues from
increased vehicle licensing fees and sales taxes.
10) 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.
11) Includes within the definition of a serious mental disorder
post-traumatic stress disorder (PTSD) and bipolar disorder for
purposes of qualifying target populations for county mental
health services.
12) Clarifies that counties are required 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.
13) Requires counties to provide mental health services to
California veterans in need of services and who meet existing
eligibility requirements, to the extent resources are
available. Requires counties to advise veterans who may be
eligible for mental health services through USDVA of these
service
14) Requires counties to refer a veteran to the county veterans
service officer to determine the veteran's eligibility for,
and the availability of, mental health services provided by
the USDVA or other federal health care provider.
15) Prohibits an eligible veteran from being denied county
mental health services based solely on his or her status as a
veteran.
FISCAL EFFECT : Unknown
COMMENTS :
PURPOSE OF THIS BILL . The author states that this bill is
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needed to ensure that veterans receive their fair share of state
and county mental health resources. California is home to the
third largest population of veterans in the nation and is third
in the nation in residents who have been deployed in the Global
War on Terror. The author points out that there has been a
longstanding gap in mental health services for California's
veterans who have been referred to the VA for services without
regard to their actual eligibility for VA services and the VA's
actual capacity to deliver those services. The author notes
that veterans are disproportionately represented among the
homeless and mentally ill populations and the VA lacks the
capacity to meet the needs of all of California's veterans,
including the 45% of all forces deployed in Iraq and Afghanistan
from the Reserve and the State National Guard. The author
believes targeting veterans in the provision of county
mental health services will help to reduce the overall burden
mental health need places on our state and our communities.
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 health care 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 from the USDVA for any condition that may be related
to combat, and USDVA clinicians are informed to evaluate
veterans for war-related mental disorders.
PROPOSITION 63 . In November 2004, voters passed Proposition
63 or MHSA. MHSA imposes a 1% state income surtax on incomes
exceeding $1 million. MHSA requires the State Controller to
transfer specified amounts of state funding into the Mental
Health Services Fund. Revenues deposited into the fund must be
used to create new county mental health programs and to expand
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existing programs. Adult systems of care, children's services,
preventive measures, workforce and training, and technology
improvements are all programs that may receive Proposition 63
funds.
MHSA requires each county mental health program to prepare and
submit a three-year plan to DMH that must be updated each year
and approved by DMH after review and comment by the Mental
Health Services Oversight and Accountability Commission. In
their three-year plans, counties are required to submit a
listing of all work plans for which MHSA funding is being
requested that identifies how the funds will be spent and which
populations will be served. This bill requires counties to
include in their revenue and expenditure reports the number of
veterans being served.
SUPPORTERS. According supporters of this legislation and the
U.S. Department of Veteran Affairs, at least of one third of men
and women returning from the wars in Iraq and Afghanistan will
suffer from Post Traumatic Stress and/or Traumatic Brain Injury.
Supporters say that from past experience they know that the VA
will not be able to help all the veterans who need mental health
care. Some will get missed by an overwhelmed VA system. Some,
because of their discharge status, will be ineligible for VA
care. Some, particularly women suffering from Military Sexual
Trauma, will not seek help in male dominated VA facilities. And
some simply will not seek help until they are on the county's
doorstep.
Assembly Bill 1571 will require counties to recognize and plan
for a problem too many would like to label just a federal issue.
OPPOSITION . The California Mental Health Directors Association
(CMHDA) and the California State Association of Counties (CSAC)
object to this bill. They note that veterans are and should
remain an identified part of the target population for MHSA
programs but they point out that veterans should qualify for
enrollment based on community-identified priority and need, not
solely on their status as a veteran.
Additionally, they are concerned that the provision in this bill
that includes veterans among the groups of local stakeholders
that counties must consult when developing and updating their
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MHSA plans will set a precedent that will open the floodgates to
other populations seeking similar status.
CMHDA and CSAC also take issue with the provision in this bill
that requires the updates on MHSA expenditures that counties
must provide to DMH to include the number of veterans served.
They argue that counties do not have a way to accurately
identify the number and costs of veterans served and this
requirement singles out veterans over other segments of the
population. Furthermore, they add that, in many cases, veterans
come to county mental health departments and choose not to
self-identify as a veteran or as having been in the military.
They point out that many veterans are in fact being served
through adult mental health service programs, but are not
specifically identified as veterans, and may not want to be.
PRIOR LEGISLATION . 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.
AB 2844 (Nation), Chapter 618, Statutes of 2006, requires
counties to provide mental health services to California
veterans in need of services and who meet existing eligibility
requirements to the extent resources are available, and
prohibits eligible veterans from being denied county mental
health services based solely on their status as a veteran.
AB 599 (Gordon), Chapter 221, Statutes of 2005, adds California
veterans in need of mental health services who are not eligible
for care by the USDVA or other federal health care provider and
who meet existing eligibility requirements, to the existing
target populations that counties are required to serve, to the
extent resources are available.
SUGGESTED TECHNICAL AMENDMENTS . On page 2, lines 19 and 22,
delete "Include," and insert "Includes".
9)POLICY COMMENT . This bill prohibits DMH from approving a
county's plan for the prevention and early intervention and
innovation components of MHSA funding unless certain criteria
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have been met, including that the plan involves verifiable
representation from a legitimate veterans group in the
stakeholder planning process. Given that this bill does not
specify how the verification of representation would be
determined and there are many veterans' organizations at the
local level with various priorities, the author may wish to
clarify this provision.
REGISTERED SUPPORT / OPPOSITION :
Support
California Association of Veteran Service Agencies
Opposition
California Mental Health Directors Association
California State Association of Counties
Analysis Prepared by : Eric Worthen / V. A. / (916) 319-3550