BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 1571
A
AUTHOR: Committee on Veterans Affairs
B
AMENDED: July 6, 2009
HEARING DATE: July 15, 2009
1
CONSULTANT:
5
Tadeo/
7
1
SUBJECT
Mental Health Services
SUMMARY
Revises the list of local stakeholders required to be
consulted in the development and update of each county's
Mental Health Services Act plan to include veterans and
representatives from a veterans organization. Requires the
Department of Mental Health, to inform the California
Department of Veterans Affairs of county plans that have
outreach programs or that provide services specifically for
veterans.
CHANGES TO EXISTING LAW
Existing federal law:
Establishes the Veterans Health Administration, within the
U.S. Department of Veterans Affairs (VA), to provide health
care and other benefits to veterans and their families and
administer VA medical centers and outpatient clinics.
Existing law:
Establishes the California Department of Veterans Affairs
(CVA) to administer state military affairs and, among other
things, provide veterans assistance with claims for
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 1571 (Committee on Veterans
Affairs) Page 2
veterans' benefits under federal laws, provide direct
low-cost loans; and provide rehabilitative, residential,
and medical care and services at California Veterans Homes.
Establishes the Department of Mental Health (DMH), which
directs and coordinates statewide efforts for the treatment
of mental health conditions and illnesses.
Requires counties to provide mental health services, to the
extent resources are available, to target populations
including seriously emotionally disturbed children; adults
and older adults who have a serious mental disorder,
including post-traumatic stress disorder (PTSD) and bipolar
disorder; adults or older adults who require or are at risk
of requiring acute psychiatric inpatient care, residential
treatment, or outpatient intervention because of a mental
disorder who have symptoms of psychosis, suicidality, or
violence; and persons who need brief treatment as a result
of a natural disaster or severe local emergency. Counties
must provide mental health services to veterans in need of
services who meet these existing eligibility requirements,
to the extent services are available to other adults.
Establishes the Mental Health Services Act, 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 one percent tax on personal
income above $1 million.
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 support; b) workforce
education and training; c) capital facilities and
technological needs; d) prevention and early intervention;
and, e) innovation. Requires DMH to establish guidelines
for the content of each of the five components and for
approval of county plans.
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.
STAFF ANALYSIS OF ASSEMBLY BILL 1571 (Committee on Veterans
Affairs) Page 3
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 adopted by majority vote of the
Legislature.
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 VA or other federal health care provider. Prohibits an
eligible veteran from being denied county mental health
services based solely on his or her status as a veteran.
Provides that if a member of the military forces of the
U.S., who served in combat, is convicted of a crime as a
result of PTSD, substance abuse, or psychological problems
stemming from service in a combat theater in the U.S.
military, who would otherwise be sentenced to county jail
or state prison, the court may order the defendant into a
local, state, federal, or private nonprofit treatment
program. The court is required to conclude that the
defendant suffers from post-traumatic stress disorder,
substance abuse, or psychological problems as a result of
that service; and the defendant must otherwise be eligible
for, and placed on, probation.
This bill:
Requires DMH, as part of its review and approval of
prevention and early intervention programs and innovations
programs of MHSA, to inform CVA of county mental health
plans that have outreach programs or that provide services
specifically for veterans.
Revises the list of local stakeholders required to be
consulted in the development and update of each county's
MHSA plan to include veterans and representatives from a
veterans organization.
FISCAL IMPACT
According to the Assembly Appropriations Committee analysis
of AB 1571 absorbable workload costs of less than $50,000
to DMH to add veteran review to the local plan review
process. The MHSA authorizes a transfer of up to five
STAFF ANALYSIS OF ASSEMBLY BILL 1571 (Committee on Veterans
Affairs) Page 4
percent of MHSA funding to offset state costs for
implementation of the measure.
Unknown special fund costs to county MHSA stakeholder
groups to increase the specificity of planning and
reporting regarding veterans' mental health. Up to 5
percent of MHSA funding is available for county planning
and other administrative activities.
BACKGROUND AND DISCUSSION
According to the author, AB 1571 is needed to ensure that
veterans receive appropriate state and county mental health
services. The author states that there has been a
longstanding gap in mental health services to California's
veterans, and that they are routinely referred to the VA by
county mental health providers in the belief that they will
receive the services they need. The author adds that this
practice does not take into consideration actual
eligibility for VA services, nor the VA's ability to
deliver those services. The author argues that, while
recognizing that it is the responsibility of the federal
government to provide these much needed services to our
returning veterans, the VA lacks the capacity to meet the
needs of all California's veterans.
The author argues that veterans are already
disproportionately represented among the homeless and
mentally ill populations and that many returning veterans
will be suffering from PTSD and other mental health
disorders. The author contends that targeting veterans in
the provision of county mental health services will help to
reduce the overall burden mental health needs place on our
state and our communities.
Veterans' mental health issues
The RAND Center for Military Health Policy reports that a
substantial percentage of the 1.7 million military service
members returning from the conflicts in Iraq and
Afghanistan may face mental health problems. A
comprehensive study conducted by RAND in 2008 found that an
estimated 18.5 percent of those back from deployment
reported symptoms consistent with a diagnosis of PTSD or
depression. The study concluded that the need for mental
health services for service members deployed to Afghanistan
and Iraq will increase over time, given the prevalence of
STAFF ANALYSIS OF ASSEMBLY BILL 1571 (Committee on Veterans
Affairs) Page 5
information available to date and prior experience with
Vietnam, creating additional burdens on the agencies that
will be called upon to care for them now and in the near
future.
The VA also reports that PTSD may also be accompanied by
other problems such as alcohol or substance abuse,
hopelessness, shame, despair, employment problems,
relationship problems including divorce and violence, and
physical symptoms.
Access to mental health services for veterans
All veterans are not eligible for VA services. Eligibility
is based on discharge status, length of active duty
(generally 24 months continuous active service), financial
need, and whether the veteran has a service connected
rating (having a condition which occurred or began during
active service).
According to the VA website, one of the more important VA
benefits is health care. It specifies that VA has about
1,300 care facilities, including 163 hospitals, 850
ambulatory care and community-based outpatient clinics, 206
counseling centers, 137 nursing homes, and 43 domiciliary
facilities. The website also indicates that the Veterans'
Health Care Eligibility Reform Act of 1996 created the
Medical Benefits Package, which is a standardized, enhanced
health benefits plan available to all enrolled veterans.
The Medical Benefits Package includes preventive services,
including: immunizations; screening tests; health education
and training classes; primary health care; diagnosis and
treatment; mental health and substance abuse treatment;
and, drugs and pharmaceuticals.
Most veterans must enroll to receive VA health care
benefits, and can apply for enrollment at any VA health
care facility or veterans' benefits office. According to
the website, more than six million veterans were enrolled
in the VA health care system as of October 2001, and a
quarter of the nation's population, approximately 70
million people, are potentially eligible for benefits and
services because they are veterans, or are family members
or survivors of veterans.
According to the California Association of Veteran Service
Agencies (CAVSA), California veterans number over 2.1
million, approximately 6 percent of the state's population.
California has more veterans than any other state in the
STAFF ANALYSIS OF ASSEMBLY BILL 1571 (Committee on Veterans
Affairs) Page 6
union and its number is expected to continue to grow.
CAVSA reports critical obstacles exist for veterans seeking
mental health care and states that veterans are often
denied services from both VA and county providers. CAVSA
reports that:
not all veterans are eligible for VA services;
there is a decline in mental health treatment and
substance abuse treatment capacity in the VA;
a variability in services and lack of continuum of
care exists in Veterans Integrated Services Networks;
there is an increased demand from newly separated
veterans; and,
there are institutional barriers to adequate mental
health care.
CAVSA cites the VA mental task force findings that a newly
returning veteran will find the availability of appropriate
evidence-based care is haphazard and spotty. CAVSA also
cites findings from a study published in the National
Journal of Medicine that found that, 4 months after
deployment, 15 to 17 percent of troops met the criteria for
PTSD, 12 months out, the same troops' rates had jumped to
21 percent.
The Mental Health Services Act (MHSA)
In November 2004, voters passed the Mental Health Services
Act (MHSA), or Proposition 63, which imposes a one percent
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 existing
programs. Adult systems of care, children's services,
preventive measures, workforce and training, and technology
improvements are all programs that may receive MHSA.
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 by the Mental
Health Services Oversight and Accountability Commission.
Each county plan and update must 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,
STAFF ANALYSIS OF ASSEMBLY BILL 1571 (Committee on Veterans
Affairs) Page 7
and other important interests.
In their three-year plan, 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.
Related bills
AB 710 (Assembly Veterans Affairs Committee) would require
CVA to apply to the federal Substance Abuse and Mental
Health Services Administration for funding to award grants
to community-based organizations to provide substance abuse
and mental health services to veterans. This bill is set
to be heard in the Senate Health Committee on July 8, 2009.
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 VA or other federal health
care providers, and who meet existing eligibility
requirements, to the existing target populations that
counties are required to serve, to the extent resources are
available.
AB 2828 (Salas, 2008) would have required CVA to apply for
federal Substance Abuse and Mental Health Services
Administration funding to provide grants to community based
organizations for substance abuse and mental health
services for veterans. This bill was vetoed by the
STAFF ANALYSIS OF ASSEMBLY BILL 1571 (Committee on Veterans
Affairs) Page 8
governor, who stated in his veto message that it was not
identified as a high priority for the state.
Arguments in support
Proponents argue that AB 1571 would help address mental
health issues which
predominately effect veterans such as PTSD, by specifically
including veterans in county stakeholders groups that
participate in county mental health planning.
Concerns
The California Mental Health Directors Association (CMHDA)
and the California State Association of Counties (CSAC)
state that they would be in full support of AB 1571 if the
bill were amended to delete the following provisions:
require county expenditure plans and annual updates to
indicate the number of veterans to be served, the cost per
person; and, require DMH to determine the extent to which
the county has the capacity to serve the proposed number of
veterans and the extent to which there is an unmet need to
serve that number of veterans. CMHDA and CSAC further
state that they support the intent of these provisions,
which is to identify the extent to which counties are
serving veterans in county mental health programs and
service. CMHDA and CSAC have also provided alternative
provisions and technical assistance in drafting appropriate
amendments to the bill.
COMMENTS
1)The author may wish to consider the alternatives provided
by CMHDA and CSAC. While the bill has already been
amended in a way that addresses the concerns stated by
CMHDA and CSAC, the author may wish to consider the
alternatives that were offered, to identify the extent to
which counties are serving veterans in county mental
health programs and services. The two alternatives that
were provided are as follows:
Require DMH and CVA, in consultation with an organization
representing county mental health directors and an
organization representing county veteran service
officers, to identify an effective method for collecting
the veteran status of all county mental health consumers;
or
STAFF ANALYSIS OF ASSEMBLY BILL 1571 (Committee on Veterans
Affairs) Page 9
Require DMH to use its MHSA State Administrative funds to
contract out for a study of existing county MHSA programs
and services provided to veterans to identify the number
of veterans currently being served.
PRIOR ACTIONS
Senate Veterans Affairs: 6-0
Assembly Floor: 73-2
Assembly Appropriations:15-0
Assembly Veterans Affairs: 8-1
Assembly Health: 14-2
POSITIONS
Support: American Legion, Department of California
AMVETS, Department of California
California Association of County Veterans
Service Officers
California Mental Health Directors
Association
California State Association of Counties
Oppose: None received
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