BILL NUMBER: AB 34 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 23, 1999
AMENDED IN ASSEMBLY JUNE 1, 1999
AMENDED IN ASSEMBLY APRIL 26, 1999
AMENDED IN ASSEMBLY APRIL 5, 1999
AMENDED IN ASSEMBLY MARCH 4, 1999
AMENDED IN ASSEMBLY FEBRUARY 4, 1999
INTRODUCED BY Assembly Members Steinberg and Baugh
(Principal coauthor: Senator Burton)
(Coauthors: Assembly Members Alquist, Calderon, Cedillo,
Gallegos, Hertzberg, Honda, Jackson, Keeley, Kuehl, Lowenthal,
Mazzoni, Romero, Strom-Martin, Thomson, and Washington)
(Coauthors: Senators Alpert, Baca, Chesbro, Johnston, Perata, and
Solis)
DECEMBER 7, 1998
An act to amend Sections 5802, 5806, and 5814 of the Welfare and
Institutions Code, relating to mental health, making an appropriation
therefor, and declaring the urgency thereof, to take effect
immediately.
LEGISLATIVE COUNSEL'S DIGEST
AB 34, as amended, Steinberg. Mental health funding: local
grants.
Existing law provides for the allocation of state funds to
counties for mental health programs.
This bill would make various statements of legislative findings
and intent regarding the need to provide sufficient funds to counties
for adult mental health and related services.
Existing law requires the State Department of Mental Health to
establish service standards relating to mental health services.
These standards are required to include, among other things, plans
for services and evaluation strategies.
This bill would also require these standards to include
coordination and access to related medications, substance abuse
services, housing assistance, vocational rehabilitation, and veterans'
services.
The bill would also provide for the award, by the department, of
planning grants, outreach grants, and service expansion grants to
counties for adult mental health programs.
The bill would appropriate funds to provide planning grants,
outreach grants, and expansion grants for counties with significant
populations of homeless mentally ill persons through the 2000-01
fiscal year.
This bill would declare that it is to take effect immediately as
an urgency statute.
Vote: 2/3. Appropriation: yes. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) Recent estimates indicate that there are 50,000 homeless
severely mentally ill Californians, including 10,000 to 20,000
homeless mentally ill veterans.
(b) Presently there are no financial incentives for counties to
provide outreach to homeless mentally ill adults to increase the
number of people they serve with severe mental illness.
(c) County dollars are generally fixed, so that treatment of a
higher than expected number of Medi-Cal recipients, who are entitled
to treatment by the county, reduces the amount of funds available to
serve other individuals.
(d) Counties should be provided an amount of funds to establish
systems of care for severely mentally ill adults, and provide mental
health services and related medications, substance abuse services,
housing assistance, vocational rehabilitation, and other nonmedical
programs necessary to stabilize homeless mentally ill persons, get
them into regular treatment or access to veterans' services, and off
the streets.
(e) When people who suffer from severe mental illness do not have
access to the services they require they frequently wind up in the
criminal justice system. However, those who receive extensive
community treatment are much less frequently incarcerated. The
Department of Corrections is expending $400 million annually for the
incarceration and treatment of people suffering from severe mental
illness. In addition, the Department of Corrections and the criminal
justice system are responsible for the placement of more than 3,000
of the total of approximately 4,500 persons in the state mental
hospitals, for an additional annual state cost of over $300 million.
(f) People suffering from severe mental illness receive sentences
that are frequently longer than those received by others convicted of
the same crimes.
(g) There are insufficient funds or programs to ensure that people
suffering from severe mental illness can receive the treatment they
need.
(h) Increasing funding for an adult mental health system of care
will result in significantly reduced Department of Corrections,
criminal justice system, and local law enforcement expenditures for
people with severe mental illness.
SEC. 2. Section 5802 of the Welfare and Institutions Code is
amended to read:
5802. (a) The Legislature finds that a mental health system of
care for adults and older adults with severe and persistent mental
illness is vital for successful management of mental health care in
California. Specifically:
(1) A comprehensive and coordinated system of care includes
community-based treatment, outreach services and other early
intervention strategies, case management, and interagency system
components required by adults and older adults with severe and
persistent mental illness.
(2) Mentally ill adults and older adults receive service from many
different state and county agencies, particularly criminal justice,
employment, housing, public welfare, health, and mental health. In a
system of care these agencies collaborate in order to deliver
integrated and cost-effective programs.
(3) The recovery of persons with severe mental illness and their
financial means are important for all levels of government, business,
and the community.
(4) System of care services which ensure culturally competent care
for persons with severe mental illness in the most appropriate,
least restrictive level of care are necessary to achieve the desired
performance outcomes.
(5) Mental health service providers need to increase
accountability and further develop methods to measure progress
towards client outcome goals and cost effectiveness as required by a
system of care.
(b) The Legislature further finds that the integrated service
agency model developed in Los Angeles and Stanislaus Counties and the
countywide systems model developed in Ventura County, beginning in
the 1989-90 fiscal year through the implementation of Chapter 982 of
the Statutes of 1988, provide models for managing care for adults and
older adults with severe mental illness , and have successfully met
the performance outcomes required by the Legislature.
(c) The Legislature also finds that the system components
established in adult systems of care are of value in providing
greater benefit to adults and older adults with severe and persistent
mental illness at a lower cost in California.
(d) Therefore, using the guidelines and principles developed under
the demonstration projects implemented under the adult system of
care legislation in 1989, it is the intent of the Legislature to
accomplish the following:
(1) Encourage each county to implement a system of care as
described in this legislation for the delivery of mental health
services to seriously mentally disordered adults and older adults.
(2) To promote system of care accountability for performance
outcomes which enable adults with severe mental illness to reduce
symptoms which impair their ability to live independently, work,
maintain community supports, care for their children, stay in good
health, not abuse drugs or alcohol, and not commit crimes.
(3) Maintain funding for the existing programs developed in Los
Angeles, Stanislaus, and Ventura Counties as models and technical
assistance resources for future expansion of system of care programs
to other counties as funding becomes available.
(4) Provide sufficient funds for counties to establish outreach
programs and to provide mental health services and related
medications, substance abuse services, supportive housing or other
housing assistance, vocational rehabilitation, and other nonmedical
programs necessary to stabilize homeless mentally ill persons or
mentally ill persons at risk of being homeless, get them off the
street, and into treatment and recovery, or to provide access to
veterans' services that will also provide for treatment and recovery.
SEC. 3. Section 5806 of the Welfare and Institutions Code is
amended to read:
5806. The State Department of Mental Health shall establish
service standards that ensure that members of the target population
are identified, and services provided to assist them to live
independently, work, and reach their potential as productive
citizens. The department shall provide annual oversight of grants
issued pursuant to this part for compliance with these standards.
These standards include but are not limited to:
(a) A service planning process that is target population based and
includes the following:
(1) Determination of the numbers of clients to be served and the
programs and services that will be provided to meet their needs. The
local director of mental health shall consult with the sheriff, the
police chief, the probation officer, the mental health board,
contract agencies, and family, client, ethnic and citizen
constituency groups as determined by the director.
(2) Plans for services including outreach, design of mental health
services, coordination and access to medications, substance abuse
services, housing assistance, supportive housing or other vocational
rehabilitation, and veterans' services. Plans shall also contain
evaluation strategies, which shall consider cultural, linguistic,
gender, age, and special needs of minorities in the target
populations. Provision shall be made for staff with the cultural
background and linguistic skills necessary to remove barriers to
mental health services due to limited English speaking ability and
cultural differences.
(3) Provisions for services to meet the needs of target population
clients who are physically disabled.
(4) Provision for services to meet the special needs of older
adults.
(5) Provision for family support and consultation services,
parenting support and consultation services, and peer support or
self-help group support, where appropriate.
(b) Each client shall have either a clearly designated mental
health case manager or a multidisciplinary treatment team who is
responsible for providing or assuring needed services.
Responsibilities include complete assessment of the client's needs,
development of the client's personal services plan, linkage with all
appropriate community services, monitoring of the quality and
followthrough of services, and necessary advocacy to ensure each
client receives those services which are agreed to in the personal
services plan. Each client shall participate in the development of
his or her personal services plan, and responsible staff shall
consult with the designated conservator and, with the consent of the
client, consult with the family and other significant persons as
appropriate.
(c) The individual personal services plan shall ensure that
members of the target population involved in the system of care
receive age, gender, and culturally appropriate services, to the
extent feasible, that are designed to enable recipients to:
(1) Live in the most independent, least restrictive housing
feasible in the local community.
(2) Engage in the highest level of work or productive activity
appropriate to their abilities and experience.
(3) Create and maintain a support system consisting of friends,
family, and participation in community activities.
(4) Access an appropriate level of academic education or
vocational training.
(5) Obtain an adequate income.
(6) Self-manage their illness and exert as much control as
possible over both the day-to-day and long-term decisions which
affect their lives.
(7) Access necessary physical health care and maintain the best
possible physical health.
(8) Reduce or eliminate antisocial or criminal behavior and
thereby reduce or eliminate their contact with the criminal justice
system.
(9) Reduce or eliminate the distress caused by the symptoms of
mental illness.
(10) Reduce or eliminate the harmful effects of alcohol and
substance abuse.
SEC. 4. Section 5814 of the Welfare and Institutions Code is
amended to read:
5814. (a) (1) This part shall be implemented only to the extent
that funds are appropriated for purposes of this part. To the extent
that funds are made available, the first priority shall go to
maintain funding for the existing programs developed in Los Angeles,
Stanislaus, and Ventura Counties.
(2) The director shall establish a methodology for awarding grants
under this part consistent with the legislative intent expressed in
Section 5802, and in consultation with the advisory committee
established in this subdivision.
(3) The director shall establish an advisory committee for the
purpose of providing advice regarding the development of criteria for
the award of grants, and the identification of specific performance
measures for evaluating the effectiveness of grants. The committee
shall include, but not be limited to, representatives from state,
county, and community veterans' services and disabled veterans
outreach programs, supportive housing and other housing assistance
programs, law enforcement, county mental health and private providers
of local mental health services and mental health outreach services,
the Board of Corrections, the State Department of Alcohol and Drug
Programs, local substance abuse services providers, the Department of
Rehabilitation, and providers of local employment services. The
criteria for the award of grants shall include, but not be limited
to, all of the following:
(A) A description of a comprehensive strategic plan for providing
outreach, prevention, intervention, and evaluation in a cost
appropriate manner corresponding to the criteria specified in
subparagraph (C) of paragraph (1) of subdivision (b).
(B) A description of the local population to be served, ability to
administer an effective service program, and the degree to which
local agencies and advocates will support and collaborate with
program efforts.
(C) Memoranda of understanding for referral and coordination with
county probation program parolees and all severely mentally ill
individuals being released from custody of the sheriff, the
Department of the Youth Authority, or the Department of Corrections.
Memoranda of understanding with local housing and redevelopment
agencies and other programs to provide housing assistance and other
appropriate interagency coordination.
(D) Mechanisms to award grants in a manner that supports better
performance by counties by restricting the availability and level of
grants for counties based on the extent to which the current number
of people receiving extensive community mental health services with
funds provided other than through this part in the county are
significantly below those of other comparably sized counties with
comparable resources, and by rewarding counties who are able to
provide extensive community mental health services to more people
within other available resources.
(b) As funds become available, this program shall be expanded to
provide training and funding for counties with significant
populations of homeless mentally ill persons , which may include the
following types of grants:
(1) Strategic planning grants for new counties to create, and for
existing system of care counties to expand, an adult system of care
that meets the requirements of this part.
(A) Strategic planning grants shall require a strategy committee
composed of, but not limited to, representatives of the local
government and private providers of housing assistance, mental health
services, outreach for mental health services, veterans' services,
outreach to disabled veterans, law enforcement, substance abuse
services and employment services. An existing local committee may be
utilized to serve as this strategy committee if it includes or is
expanded to include the required representation.
(B) The strategy committee shall develop a comprehensive plan for
providing services pursuant to this part. The strategic plan shall
be suitable to form the basis for a performance-based contract with
the department.
(C) The strategic plan shall identify specific outcome and
performance measures and annual reporting that will allow the
department to evaluate, at a minimum, the effectiveness of the
strategies in providing successful outreach and reducing
homelessness, and involvement with local law enforcement, and other
measures identified by both the department and the strategy
committee. The outcome and performance measures shall include, but
not be limited to , all of the following:
(i) The number of persons served, and of those, the number who are
able to maintain housing, and the number who receive extensive
community mental health services for at least four months in a
six-month period.
(ii) The number of persons with contacts with local law
enforcement and the extent to which local and state incarceration has
been reduced.
(iii) The number of persons able to demonstrate an increase in
stability of income including competitive employment.
(iv) The number of persons contacted in outreach efforts who
appear to be severely mentally ill, as described in Section 5600.3,
who have refused treatment after completion of all applicable
outreach measures set forth in the strategic plan.
(2) Four-year outreach service grants in accordance with a
contract between the state and approved counties that reflects the
number of anticipated contacts with people who are homeless or at
risk of homelessness, and the number of those who are severely
mentally ill and who are likely to be successfully referred for
treatment and will remain in treatment until successfully discharged.
(3) (A) Four-year service expansion grants in accordance with a
contract between the state and approved counties that provides a
formula for annual increased funding reflecting net increases in the
total annual number of severely mentally ill adults, as described in
Section 5600.3, who receive extensive community mental health
services in at least four months in a six-month period. As used in
this section, "receiving extensive community mental health services"
means having a case manager as described in subdivision (b) of
Section 5806, having an individual personal service plan as described
in subdivision (c) of Section 5806, and receiving service pursuant
to that plan in four months of a six-month period.
(B) The formula incentive funding provided pursuant to
subparagraph (A) shall be sufficient to provide mental health
services, medically necessary medications to treat severe mental
illnesses, alcohol and drug services, supportive housing and other
housing assistance, vocational rehabilitation, money management
assistance for accessing other health care and obtaining federal
income and housing support, accessing veterans' services, and
stipends to attract and retain sufficient numbers of qualified
professionals as necessary to provide the necessary levels of these
services. These grants shall, however, pay for only the portion of
the costs of those services not likely to be provided by federal
funds or other state funds. The amount of the grants may be
increased to reward counties that are providing extensive community
mental health services to significantly more severely mentally ill
adults, with funds other than those provided pursuant to this part,
relative to other comparable counties based on size, location, and
resources, and may be decreased to penalize counties, and in some
cases make them ineligible for participation in these grants, if the
numbers of severely mentally ill adults to whom a county is providing
extensive community mental health services relative to its size,
location, and resources is are
significantly below that of other comparable counties.
(C) Grants provided pursuant to subparagraph (A) shall include
provisions measuring the base level of the number of people suffering
from severe mental illness who are arrested and serve in jail,
prison, or a state hospital as a result of their arrest in the
applicable county, and measuring how the grant and increased mental
health services provided by the grant reduces the portion of criminal
justice system resources required to be expended on people with
severe mental illness. Grants shall also include a projection of the
number of persons to be served annually. Beginning in the 2002-03
fiscal year, funding shall be based upon each county's successful
demonstration that the county has served the number of adults
projected for the prior fiscal year.
(D) Four-year outreach grants, provided pursuant to paragraph (2),
may be renewed upon their expiration provided that the applicant
county demonstrates to the satisfaction of the department that the
outreach services are successfully reaching and bringing into
treatment the numbers of persons projected in the contract. The
contract may be modified as necessary based upon the results being
achieved, both in the outreach program and in the program expansion
grant.
(E) Four-year program expansion grants provided pursuant to
subparagraph (A) may be renewed upon their expiration, provided that
the applicant county demonstrates to the satisfaction of the
department that the services provided are successfully reducing the
unmet mental health need and providing for reduction in the amount of
law enforcement, criminal justice system, and state corrections
expenditures that would otherwise be expended upon persons with
severe mental illness from the applicable county in accordance with a
process included in the grant for measuring these reductions and
setting forth benchmarks for reducing the expenditures as mental
health expenditures increase, and for meeting other performance
objectives established in the contract. The benchmarks for reduction
in incarceration rates shall require each county to reduce
incarceration rates by 20 percent or more over the four-year period.
In reviewing a county program for renewal of a grant, the
department may approve the renewal even if the reduction in
incarceration rates does not meet the required performance, if the
department finds that the county program is meeting other performance
benchmarks established in the contract, and is successfully
stabilizing more people with severe mental illness, improving the
community by reducing homelessness, and achieving the maximum
feasible reduction in incarceration of people with severe mental
illness.
(F) In any county in which the director determines the program has
not resulted in a reduction of criminal justice expenditures or is
not meeting other performance benchmarks in accordance with the
previous four-year grant, the director may limit the funds available
for a continuation of the grant, or an expansion of the grant, or
impose other conditions upon the grant in order to improve the
performance of the county in reducing the incarceration of people
suffering from severe mental illness.
(G) On or before November 1, 2001, and annually thereafter, the
director shall report to the Legislature regarding the impact of
grants funded pursuant to this section in reducing the incarceration
of people suffering from severe mental illness, and make
recommendations to the Legislature regarding how counties can improve
their performance and whether state policies regarding severe mental
illness should be changed. The director may establish standards and
a reporting format for county reports to the director on annual
progress toward attaining expansion grant goals.
(c) Contracts awarded pursuant to this part shall be exempt from
the Public Contract Code and the state administrative manual and
shall not be subject to the approval of the Department of General
Services.
(d) Notwithstanding any other provision of law, funds awarded to
counties pursuant to this part and Part 4 (commencing with Section
5850) shall not require a local match in funds. However, counties
shall demonstrate a maintenance of effort in adult and
childrens childrens' mental health services.
(e) No county shall reduce existing system-of-care or
Bronzan-McCorquodale service funds provided under this part and Part
4 (commencing with Section 5850) if adult or childrens
childrens' system-of-care funds are accepted by
the county.
SEC. 5. (a) The sum of twelve million dollars ($12,000,000) is
hereby appropriated from the General Fund to the State Department of
Mental Health. Five hundred thousand dollars ($500,000) shall be
allocated for training, by or through the programs established
pursuant to subdivision (a) of Section 5814 of the Welfare and
Institutions Code. Five hundred thousand dollars ($500,000) shall be
allocated for training to counties in homeless outreach to be
offered through an organization with significant success with
homeless outreach programs, and two million dollars ($2,000,000)
shall be allocated for grants to counties for implementation of
paragraph (1) of subdivision (b) of Section 5814 of the Welfare and
Institutions Code during the 1999-2000 fiscal year. Nine million
dollars ($9,000,000) shall be allocated for implementation of
paragraphs (2) and (3) of subdivision (b) of Section 5814 of the
Welfare and Institutions Code for grants to counties that enter into
contracts to establish or expand their programs on or before April 1,
2000.
(b) The sum of forty one million dollars ($41,000,000) is hereby
appropriated from the General Fund for the 2000-01 fiscal year to the
State Department of Mental Health for implementation of paragraph
(2) of subdivision (b) of Section 5814 of the Welfare and
Institutions Code.
(c) The State Department of Mental Health shall allocate to
counties, from the amount appropriated pursuant to subdivision (a),
for the first year of initial grants to counties, the amount
projected by each county that would be required to fund first-year
costs pursuant to paragraph (2) of subdivision (b) of Section 5814 of
the Welfare and Institutions Code. If the total of the projected
first-year costs of all counties exceeds the maximum appropriation,
each county shall receive a percentage of the maximum appropriation
equal to that county's percentage of the total projected costs for
all counties.
(d) It is the intent of the Legislature that the amounts
appropriated to the State Department of Mental Health for the second
and all subsequent fiscal years of funding for expansion of the
county mental health programs pursuant to Section 5814 of the Welfare
and Institutions Code, shall be allocated to counties based on the
actual amounts due under the contract with the applicable county for
the actual net increases in the number of persons served during the
prior fiscal year, adjusted by the amount that the allocation to the
county in the prior fiscal year was greater or less than the amount
required to fund the county for the actual increase in number of
persons served. If the total amount of the allocations due to all
counties would exceed the previous year's appropriation by more than
fifty million dollars ($50,000,000) for that year, each county shall
receive a percentage of a fifty million dollar ($50,000,000) increase
over the previous year's appropriation equal to that county's
percentage of the total costs for all counties for that year. The
balance of each county's costs shall be paid to that county in the
following fiscal year to the extent funds are available.
(e) Of the amounts appropriated each year, five hundred thousand
dollars ($500,000) shall be allocated to departmental support for
administrative costs associated with the programs described in this
section.
SEC. 6. This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect. The facts constituting the necessity are:
In order for the State Department of Mental Health to have the
program established and grants awarded within the time frames set
forth in this act, and to ensure that the state is able to begin
promptly achieving reductions in incarceration and homelessness in
accordance with this measure, it is essential that this act take
effect immediately.