BILL ANALYSIS
AB 2234
Page 1
Date of Hearing: April 6, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 2234 (Bonnie Lowenthal) - As Amended: March 15, 2010
SUBJECT : Mental health: target populations: older adults.
SUMMARY : Revises the existing list of priority target
populations eligible for mental health services provided by
counties and under the Mental Health Services Act (MHSA) to
establish a separate target category for older adults.
Specifically, this bill :
1)Creates a separate target population definition of adults who
are 60 years of age or older and eligible for mental health
services provided by counties and under the MHSA.
2)Requires members of the target population in 1) above to meet
specified criteria, including that the person is substantially
impaired as the result of a mental disorder in two of the
following areas on a continuing or intermittent basis: a)
independent living; b) social and family relationships; c)
vocational skills, employment, or leisure activities; d) basic
living skills, including instrumental activities of daily
living; e) money management; f) self-care capacities,
including activities of daily living; or, g) physical
condition.
EXISTING LAW :
1)Establishes the Bronzan-McCorquodale Act, also known as
"Realignment," which shifted responsibility for the provision
of mental health services from the state to counties.
Provides realignment funding for local programs with revenues
from increased vehicle licensing fees and sales taxes.
2)Requires public mental health services to be provided to
priority target populations in systems of care that are
client-centered, culturally competent, and fully accountable.
3)Establishes the following priority target populations that
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must be served by counties to the extent resources are
available: seriously emotionally disturbed children or
adolescents; adults and older adults who have a serious mental
disorder; adults or older adults who require or are at risk of
requiring acute psychiatric inpatient care, residential
treatment, or outpatient intervention, as specified; and,
persons who need brief treatment as a result of a natural
disaster or severe local emergency. Specifies the minimum
array of services that must be provided to target populations.
4)Requires members of the adults and older adults target
population to meet all of the following criteria:
a) The person has a mental disorder as identified in the
most recent edition of the Diagnostic and Statistical
Manual of Mental Disorders;
b) As a result of the mental disorder, the person has
substantial functional impairments or symptoms, defined as
substantially impaired as the result of a mental disorder
in independent living, social relationships, vocational
skills, or physical condition; and,
c) As a result of a mental functional impairment and
circumstances, the person is likely to become so disabled
as to require public assistance, services, or entitlements.
5)Establishes the MHSA, enacted by voters in 2004 as Proposition
63, to provide funds, through a 1% income tax on personal
income above $1 million, to counties to expand services and
develop innovative programs and integrated service plans for
mentally ill children, adults, and seniors who meet the
existing priority target population eligibility criteria.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, approximately
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20% of adults age 55 years or older experience some type of
mental health concern. Some of the most common conditions
include anxiety and mood disorders, such as depression or
bipolar disorder. The author argues that despite the
significant need for mental health treatment services, older
adults receive the least amount of services in California's
public mental health system and notes that in fiscal year
2008-09, older adults received only 5% of total Medi-Cal funds
expended, far lower than the estimated service need. The
author contends that older adults need to be a separately
defined target population because their service needs are far
more complex than those of adults. For example, they are more
likely to have co-morbid medical conditions that require their
mental health treatment to be coordinated with physical health
care. The author maintains that older adults have unique
treatment needs relevant to later life developmental needs,
such as grief, isolation, and generational differences, and
often have limitations in instrumental activities of daily
living that need to be taken into account. Lastly, the author
adds that, in times of shrinking resources, it is easy to
overlook the needs of specific populations, especially when
they are not emphasized as a separate target population in
statute. This bill is intended to recognize the dramatic
projected growth of the older adult population in the coming
years by creating a separate target population definition for
them to ensure that they receive their fair share of mental
health services.
2)BACKGROUND . According to the California Commission on Aging's
Strategic Plan for an Aging California Population, California
is home to nearly four million people over age 65 - the
largest older adult population in the nation. This number is
expected to more than double over the next several decades as
baby boomers begin reaching this milestone. Moderate to
severe mental illness constitutes the third or fourth most
debilitating health problem affecting older adults, and as the
population continues to age, the number of older adults with
some form of mental illness will increase. Older adults
experience many types of moderate to severe forms of mental
illness, including anxiety, delirium, dementia, depression,
personality disorders, schizophrenia, and substance abuse.
Depression is strikingly prevalent among older people. Eight
percent to 20% of older adults in the community and up to 37%
in primary care settings experience symptoms of depression.
Between now and 2020, as baby boomers age, the number of older
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Californians with mental illness is likely to reach 1.8
million.
3)SURGEON GENERAL'S REPORT . According to the 1999 Surgeon
General's Report on Mental Health, assessment and diagnosis of
late-life mental disorders are especially challenging because
of several reasons that are unique to older adults. First,
the clinical presentation of older adults with mental
disorders may be different from that of other adults, making
detection of treatable illness more difficult. Additionally,
many older individuals present with somatic complaints and
experience symptoms of depression and anxiety that do not meet
the full criteria for depressive or anxiety disorders.
Detecting mental disorders in older adults is further
complicated by high co-morbidity with other medical disorders.
Lastly, older individuals are more likely to report somatic
symptoms than psychological ones, leading to further
underidentification of mental disorders. The Surgeon
General's report estimated that unmet need for mental health
services may be experienced by up to 63% of adults aged 65
years and older with a mental disorder, due to patient
barriers stemming from preferences for primary care or
reluctance to disclose psychological symptoms, provider
barriers relating to lack of awareness of the manifestations
of mental disorders, complexity of treatment, and reluctance
to inform patients of a diagnosis, and mental health delivery
system barriers relative to time pressures and reimbursement
policies.
4)MHSA . 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
existing programs. Adult, including older adult, systems of
care, children's services, preventive measures, workforce and
training, and technology improvements are all programs that
could receive Proposition 63 funds.
MHSA requires each county mental health program to prepare and
submit a three-year plan to the Department of Mental Health
(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,
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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.
5)PRIOR LEGISLATION .
a) 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 those services are not being delivered by another
entity, and revises the existing target population of
adults and older adults who have a serious mental disorder
to include adults and older adults who have post-traumatic
stress disorder.
b) SB 910 (Vasconellos), Chapter 948, Statutes of 1999,
requires the California Health and Human Services Agency to
develop a statewide strategic plan on aging for long term
planning purposes.
6)SUPPORT . The California Commission on Aging and the
California Mental Health Planning Council, co-sponsors of this
bill, state in support that currently older adults are
included in the broad target population definition of adults,
despite their significant differences in issues and treatment
needs. Supporters note that older adults are more likely to
have co-morbid medical conditions that require their mental
health treatment to be coordinated with physical health care,
have unique treatment needs relevant to later life
developmental needs, such as grief, isolation, and
generational differences, and often have limitations in
instrumental activities of daily living that need to be taken
into account. The California Mental Health Directors
Association adds that establishing older adults as a specific
target population for community mental health services will
not expand or limit eligibility for services beyond the scope
of current law, but will highlight in statute the unique and
complex service needs of older adults with serious mental
illness.
7)SUGGESTED TECHNICAL AMENDMENT . On page 14, line 17, delete
"instrument" and insert "instrumental".
REGISTERED SUPPORT / OPPOSITION :
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Support
California Commission on Aging (sponsor)
California Mental Health Planning Council (sponsor)
Aging Services of California
Area 4 Agency on Aging
California Association of Marriage and Family Therapists
California Mental Health Directors Association
Crestwood Behavioral Health, Inc.
Jewish Family Service
Mental Health America of Northern California
National Association of Social Workers, California Chapter
One individual
Opposition
None on file.
Analysis Prepared by : Cassie Rafanan / HEALTH / (916)
319-2097