BILL ANALYSIS
AB 2661
Page 1
Date of Hearing: April 20, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 2661 (Salas) - As Introduced: February 19, 2010
SUBJECT : California National Guard: mental health assessments:
combat troops.
SUMMARY : Requires the California National Guard (CNG) to
develop a comprehensive and ongoing mental health assessment
program for every CNG soldier that has been deployed to a combat
zone.
EXISTING LAW :
1)Establishes, under federal law, the Veterans Health
Administration (VA) within the U.S. Department of Veterans
Affairs (USDVA), to provide health care and other benefits to
veterans and their families and administer VA medical centers
and outpatient clinics.
2)Requires the Secretary of the California Department of
Veterans Affairs (CDVA), or a designee, and the Adjutant
General, or a designee, to develop an outreach plan for
traumatic brain injury (TBI) and posttraumatic stress disorder
(PTSD) health screenings for California's returning veterans,
including CNG members.
3)Establishes the Mental Health Services Act (MHSA),
administered by DMH, to provide funds to counties to expand
services and develop innovative programs and integrated
service plans for seriously mentally ill children, adults, and
seniors.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, the California
Military Department (CMD) has few mental health personnel that
provide emergency crisis counseling, referral and personal
support, combat stress evaluations, and mental health support
for an increasingly tasked state military force. The author
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argues that a comprehensive and mandatory mental health
program would enable the CMD to step up its support structure
for deploying and returning service members to enhance morale,
retention, and mental health. The author believes that the
state needs to assume responsibility for making these soldier
services defined and uniformly implemented. According to the
author, the federal government does not provide for the needs
of current service members in the CNG and that there have been
no increases in federal or state funding aimed at improving
the assessment and treatment of the mental health needs of
returning veterans to California.
2)BACKGROUND . The CMD is a dual status agency, with both
federal and state responsibilities. The federal
responsibility includes organizing, training, equipping, and
deploying National Guard units in support of the federal
mission. Since September 11, 2001, there have been continued
deployments of National Guard personnel within California, to
other states, and overseas, including the combat zones of Iraq
and Afghanistan. The growing reliance on the CMD has resulted
in more than 32,000 deployments as of January 2010.
3)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 the 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, sleep
disturbances, depression, anxiety, irritability, outbursts of
anger, and feelings of intense guilt. Physical symptoms
include headaches, gastrointestinal distress, immune system
problems, dizziness, chest pain, or discomfort in other parts
of the body. The onset of these symptoms often does not occur
until months after the traumatic events that trigger it.
According to the USDVA website, in 2003, more than 185,000
veterans were listed as having PTSD as a service-connected
disability. Between 2003 and 2007 there were 40,000 more
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veterans diagnosed with PTSD.
4)COSTS FOR RETURNING SOLDIERS . A 2008 RAND Corporation Center
for Military Health Policy Research Report, "Invisible Wounds:
Mental Health and Cognitive Care Needs of America's Returning
Veterans" (RAND) estimated that, for two years
post-deployment, medical treatment for PTSD and depression can
total between $5,900 and $27,650 per case; estimates for
mild-TBI range from $27,260 to $32,760 and can go as high as
$268,900 to $408,520 for severe TBI. RAND estimates societal
costs are between $4.5 billion and $7.1 billion nationally for
these conditions and include lost productivity, reduced
quality of life, homelessness, domestic violence, strain on
families and suicide. RAND reports that there are
evidence-based, effective treatments that exist for depression
and PTSD and providing treatment to veterans suffering from
one or more of these conditions can reduce costs by
approximately $1.7 billion or $1,063 per returning veteran.
5)CURRENT HEALTH AND MENTAL HEALTH PROGRAMS . The Department of
Defense has implemented the voluntary Yellow Ribbon Program,
made available to all National Guard and Reserve Service
members and their families, activated to participate in, or
deployed in support of, an operational mission for 90 days or
more. The Yellow Ribbon Program provides National Guard and
Reserve members and their families with information, services,
referrals, and proactive outreach opportunities throughout the
deployment cycle. The program can provide health and mental
health assessments pre-deployment and post-deployment at 30-,
60-, and 90-day intervals on a voluntary basis and relies
solely on self-referral and self-disclosure. Through MHSA
(Proposition 63), the CNG maintains two full time outreach
clinicians to provide crisis intervention services, referrals
to county programs, and support services to soldiers and their
family members. However, statewide Proposition 63 funding is
steadily declining. According to the Director of the CNG
Behavioral Health Service office, currently there is no
comprehensive tool to get all returning soldiers mandatory
mental health screenings or assessments. Additionally,
National Guard members who are deployed for more than 30 days
are eligible to continue their health insurance coverage
through TRICARE, the health maintenance organization (HMO) of
the CMD for up to a maximum of 180 days.
6)JOINT LEGISLATIVE VETERAN WORKGROUP . In December 2009 the
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California Research Bureau (CRB) released a report titled
"Joint Legislative Veteran Workgroup: Health and Mental Health
Site Visit Roundtable" (CRB Report). According to the CRB
Report, California has the largest population of veterans with
more frequent and intense deployments. In the general
population, one in five people experience a mental health
disorder as compared to the veteran population where the
proportion is three in four people. At least one-third of all
new veterans have a diagnosed mental health condition,
including TBI. According to CRB, California veterans have
trouble finding, accessing, and maintaining adequate mental
health services; and, the federal-state-county continuum of
care makes this task even more difficult, especially when
veterans are experiencing health and mental health problems.
The CRB Report noted that veterans of the wars in Iraq and
Afghanistan are more likely to experience mental health issues
than veterans of previous wars and attributed this to lower
death rates due to advances in body armor that are
contributing to veterans returning with a higher incidence of
TBI and physical disabilities.
The CRB Report found some of the following barriers for veterans
to find and keep needed mental health services: access is
limited to VA clinics, especially in rural areas of
California; the number of licensed psychologists has dropped
20% in recent years and only 10% are trained in treatments for
military service-related PTSD; soldiers and veterans often
worry about the stigma associated with mental health issues;
and, the "warrior mentality" or a hyper-vigilance is useful
training for active soldiers, but problematic when trying to
adjust to civilian life. The CRB Report concluded that less
than 40% of troops with psychological wounds are being treated
and estimated that even though 20% of returning veterans
screen positive for TBI symptoms, only 6% receive a TBI
diagnosis. According to the CRB Report, women veterans face a
unique set of challenges associated with their military
service. Women who use the VA are twice as likely as men to
have serious psychological distress. Women have complex
mental health needs including depression, PTSD, TBI, parenting
and family issues, and military sexual trauma.
7)CALIFORNIA MENTAL HEALTH PLANNING COUNCIL REPORT . In January
2008 the California Mental Health Planning Council within the
Department of Mental Health (DMH) released a report,
"Recommendations to Strengthen Mental Health Services for
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Military Service Members, Veterans, and Their Families" (DMH
Report). The DMH Report found that a large number of soldiers
returning from Iraq and Afghanistan have significant mental
health issues, but the capacity of CDVA to meet the mental
health needs of all veterans has been stretched significantly.
The DMH Report included the following recommendations: each
service member should undergo an annual psychological needs
assessment addressing cognition, psychological functioning,
and overall psychological readiness; the assessment should be
conducted in a setting that allows interpretation by a trained
professional and prompt referral to a credentialed mental
health provider, with a person-to-person handoff; there should
be clear policy and procedure to ensure that these assessments
remain private; and, the coordination of the items on the pre-
and post-deployment assessments and re-assessments are
coordinated.
8)PREVIOUS LEGISLATION .
a) SB 1401 (Simitian), Chapter 593, Statutes of 2008,
requires the Secretary of CDVA, or a designee, and the
Adjutant General, or a designee, to develop an outreach
plan for TBI and PTSD health screenings for California's
returning veterans.
AB 3083 (Cook), Chapter 591, Statutes of 2008, requires
counties to provide mental health services to California
veterans, including CNG members 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.
b) AB 581 (Salas) of 2007 would have required the Military
Department to create a Combat Stress Support Team Program
to provide emergency crisis counseling, referral and
personal support, combat stress evaluations, and mental
health support for state military personnel and their
families. AB 581 died on the Senate Appropriations
Suspense File.
c) AB 599 (Gordon), Chapter 221, Statutes of 2005, adds a
requirement to the existing target populations of the
mental health account of a local health and welfare trust
fund that California veterans in need of mental health
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services who are not eligible for care by USDVA or other
federal health care who meet existing eligibility
requirements, should be provided services to the extent
resources are available. Requires counties to refer a
veteran to the county veterans service officer, if any, to
determine the veteran's eligibility for, and the
availability of, mental health services provided by USDVA
or other federal health care provider.
9)DOUBLE REFERRAL . This bill is double referred. It was heard
in the Assembly Committee on Veterans Affairs on April 13,
2010, and passed with a vote of 8-0.
REGISTERED SUPPORT / OPPOSITION :
Support
None of file.
Opposition
None on file.
Analysis Prepared by : Patty Rodgers / HEALTH / (916) 319-2097