BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
SB 60 (Evans)
Hearing Date: 5/23/2011 Amended: 5/10/2011
Consultant: Katie Johnson Policy Vote: Public Safety 7-0
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BILL SUMMARY: SB 60 would require the Department of Mental
Health (DMH) to conduct a security and violence risk evaluation
of each patient, upon admission to a state hospital, prior to
any transfer, annually, and after any serious security incident.
The bill would require the California Department of Corrections
and Rehabilitation (CDCR) to conduct regular assessments on
specified individuals transferred back to CDCR from DMH.
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Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
DMH conduct new likely in the hundreds of General
or augment existing thousands of dollars annually
assessments
DMH increased or altered unknown, potentially
significant, General
state hospital capacityas needed
CDCR conduct new unknown, potentially minor,
dependsGeneral
assessments on the number of individuals transferred
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STAFF COMMENTS: This bill meets the criteria for referral to the
Suspense File.
This bill would require the Department of Mental Health (DMH) to
conduct a security and violence risk assessment utilizing both
security and clinical personnel of each patient upon admission
to a state hospital, prior to any transfer, annually, or after
any serious security incident. This bill would require the
department to place a patient determined to be a high security
or violence risk in a treatment unit within a state hospital,
correctional facility, state prison psychiatric facility, or
other secure facility with sufficient enhanced security and
SB 60 (Evans)
Page 1
treatment options to ensure the security of the patient, other
patients, and staff, and to address the underlying causes of
risk.
DMH Impact
DMH currently conducts several evaluations upon a patient's
arrival at a state hospital, including a psychological
evaluation that includes a propensity to violence assessment, as
well as annually on any patient remaining in the hospital for
that amount of time. This bill would likely necessitate an
augmentation of the current intake and annual assessments and
additional assessments upon transfer or after any serious
security incident. There were approximately 600 serious security
incidents system-wide on average over the last few years, some
of which were committed by repeat offenders. Costs to augment
existing and conduct additional assessments would likely be at
least in the hundreds of thousands of dollars annually General
Fund. 6,352 individuals currently reside in state hospitals and
psychiatric programs.
Although existing law requires that prior to a patient's
admission to Napa or Metropolitan State Hospitals the department
must evaluate each patient and those that are determined to be a
high security risk should be treated in DMH's most secure
facilities, there could be an increase in the necessary transfer
of many individuals from lower security facilities to higher
security facilities and vice versa because this bill would
extend that requirement system-wide. If there is a bed capacity
issue, there could be significant capital costs to the General
Fund to rearrange facilities' ability to appropriately care for
and secure patients.
Actual costs to the state would depend on DMH's interpretation
and subsequent implementation of these provisions. If DMH
determines that many of the requirements of this bill are
currently within its normal scope of activities, then costs
would be substantially less than noted above.
CDCR Impact
Existing law permits DMH to transfer individuals to CDCR if they
would be better served by a custody placement rather than in a
state hospital. This bill would require CDCR to conduct regular
assessments on and determine when and if an individual who was
transferred to CDCR to DMH under this authority because he/she
committed an act that resulted in the death, rape, or
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Page 2
life-threatening injury of another patient or a staff member may
return to a state hospital. In calendar year 2010, 4 individuals
were sent to CDCR to DMH under this authority. Even if one were
to assume that this authority is underutilized, it is unlikely
that there would be more than relatively minor costs to CDCR to
conduct assessments on these individuals.
However, staff notes that the state is currently working to
comply with the Coleman court order requirements that require
the state to increase CDCR's capacity to appropriately treat
inmates with mental illnesses. To the extent that this bill
results in more individuals being transferred from state
hospitals to CDCR, it would put pressure on already limited
treatment bed space and could affect the state's ability to
effectively comply with Coleman.
Budget-May Revision DMH Proposals
On May 16, 2011, Governor Brown released the May Revision of the
state budget. There were several proposals that would impact
DMH:
1) Eliminate the department;
2) Transfer state-level functions associated with Medi-Cal
programs that serve individuals with severe mental illness
to the Department of Health Care Services (DHCS); this
proposal follows the realignment of the Early and Periodic
Screening, Diagnosis and Treatment Program and Mental
Health Managed Care to County Mental Health Plans.
3) Propose $9.5 million to fund increased safety and
security staffing with 78 positions to support increased
safety and security measures including patient transfer,
ground presence/safety teams, and personal alarms.
4) Create a Department of State Hospitals; more details on
this proposal are pending, but it is anticipated to be
completed by July 1, 2012.
Since details are pending on all of the above proposals, it is
unknown how they would interact with this bill.