BILL NUMBER: AB 34 AMENDED
BILL TEXT
AMENDED IN SENATE SEPTEMBER 3, 1999
AMENDED IN SENATE AUGUST 16, 1999
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, Pescetti, 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, and to
add Section 5809.5 to, and to add and repeal Section
5814.5 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.
This bill would require the department to select a small
group of up to 3 counties or portions of
counties for eligibility for demonstration grants to be used to
provide comprehensive services to certain adults who are severely
mentally ill. The bill would require the director to establish a
methodology for awarding these grants and to establish a designated
advisory committee.
The bill would reappropriate $10,000,000 to the State Department
of Mental Health from a specified item in the Budget Act of 1999 for
the purposes of grants provided for under the bill and would
authorize the Department of Finance to transfer certain Budget Act
funds for purposes of the bill, as provided.
This bill would declare that it is to take effect immediately as an
urgency statute.
Vote: 2/3. Appropriation: no. 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)
(b) When people who suffer from severe mental illness do not
have access to the services they require they frequently
wind up in enter 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)
(c) 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 adult system of care
model, beginning in the 1989-90 fiscal year through the
implementation of Chapter 982 of the Statutes of 1988, provides
models for managing care for adults and older
adults with severe mental illness , and has successfully met
that can meet 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 pilot adult system of care
programs that meet contractual goals 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, supportive housing or other housing assistance, 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.
(6) Provision for services to be client-directed and that employ
psychosocial rehabilitation and recovery principles.
(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 follow
through 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) Have freedom from dangerous addictive substances.
SEC. 4. Section 5809.5 is added to the Welfare and Institutions
Code, to read:
5809.5. (a) In 1999-00 fiscal year, the State Department of
Mental Health shall select a small group of counties or portions of
counties that demonstrate that they can provide comprehensive
services as set forth in this part to a substantial number of adults
who are severely mentally ill, who are homeless, recently released
from a county jail or the state prison, or others who are untreated,
unstable, and at significant risk of incarceration or homelessness
unless treatment is provided. In selecting counties, the department
shall look to those that are best able to maximize the number of
additional severely mentally ill adults that the county can serve
with both these funds and a mentally ill offender crime reduction
grant.
(b) (1) Eligible counties shall be those that have existing
programs that meet the criteria of the adult system of care as set
forth in Section 5806 that include one or more programs. Each
program shall provide all of the services specified in paragraph (2)
of subdivision (a) of Section 5806, and homeless outreach programs,
both of which can be expeditiously expanded to meet the needs of
those who are not currently being treated and may be homeless or
incarcerated, or untreated and unstable and at risk of homelessness
or incarceration.
(2) An eligible county that has not yet received the mentally ill
offender crime reduction grants may also participate in these
demonstration grants by committing an amount of new county general
fund dollars not currently expended for mental health care comparable
to the amount the county would receive if it had been successful in
receiving a mentally ill offender crime reduction grant.
(3) The department may provide a grant to only a portion of a
county's population and territory if the grant funds are clearly
allocated to a specific geographic area that is easily identifiable
and separated from other significantly populated areas within the
county.
(4) All counties, with or without mentally ill offender crime
reduction grants, shall also assure that funds provided by this grant
are used to provide new services and that none of these funds are
used to supplant existing services to seriously mentally ill adults.
The department shall develop methods and contractual requirements to
assure that no supplantation occurs with funds provided to counties
pursuant to this section.
(c) Each selected county shall do all of the following:
(1) Provide data demonstrating the success of the county's
existing adult system of care programs.
(2) Specify the additional numbers of severely mentally ill adults
to whom the county will provide comprehensive services for each one
million dollars ($1,000,000) of additional funding that may be
awarded through a grant.
(3) Agree to provide services in accordance with Section 5806.
(d) The department shall select counties or areas that best
demonstrate the following:
(1) That the county's share of the ten million dollars
($10,000,000) will allow the county to cost effectively increase the
number of severely mentally ill adults that the county is serving
from program inception to June 2001.
(2) The county will serve such a substantial percentage of the
unmet needs of severely mentally ill adults that there is a clear
quantifiable impact on the need.
(3) The ability to reasonably predict how much additional funding
would be required to serve all severely mentally ill adults in the
county or area.
(4) A quantifiable impact on all aspects of the criminal justice
system and law enforcement resources currently being expended on
severely mentally ill adults.
(e) The Department of Corrections and the county mental health
director for any area selected for this program shall develop a
coordinated strategy to maximize the efficiency and cost
effectiveness of services to severely mentally ill parolees and may
enter into agreements providing for the use of funds for parole
outpatient programs to be utilized to supplement funds for this
program in order to most effectively and efficiently provide mental
health care and related services that increase treatment compliance
and reduce recidivism.
(f) The department shall expend five hundred thousand dollars
($500,000) to consult with the committee specified in paragraph (3)
of subdivision (a) of Section 5814 and to work with the Department of
Finance, the Department of Corrections, the Board of Corrections,
state associations representing law enforcement and local government,
and the Legislative Analyst to measure the cost of comprehensive
community mental health care and the impact of increased community
mental health care on criminal justice system law enforcement
expenditures associated with people with mental illness.
(g) It is the intent of the Legislature that sufficient
appropriations be made in the 2000-01 fiscal year and subsequent
fiscal years to continue these demonstration programs and to
establish new programs so long as counties are demonstrating that
these programs are successful in treating severely mental ill adults
and cost effectively reducing their hospitalizations, homelessness,
and incarcerations.
(h) For purposes of this section, "severely mentally ill adults"
are those individuals described in subdivision (b) of Section 5600.3.
SEC. 5.
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 that meet adult system of
care contract goals.
(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
Mental Health Association of California, the California Alliance for
the Mentally Ill, the California Network of Mental Health Clients,
and the Mental Health Planning Council.
(4) 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
subdivision (c).
(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.
(b) In each year in which additional funding is provided by the
State Budget the department shall establish demonstration programs
that offer individual counties sufficient funds to comprehensively
serve severely mentally ill adults who are homeless, recently
released from a county jail or the state prison, or others who are
untreated, unstable, and at significant risk of incarceration or
homelessness unless treatment is provided to them and who are
severely mentally ill adults. For purposes of this subdivision,
"severely mentally ill adults" "severely
mentally ill adults" are those individuals described in
subdivision (b) of Section 5600.3.
(c) Each demonstration project shall identify specific outcome and
performance measures and annual reporting that will allow the
department to evaluate, at 5600.3. In consultation
with the advisory committee established pursuant to paragraph (3) of
subdivision (a), the department shall report to the Legislature on or
before May 1, 2000, and shall 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
department. The evaluation shall include, limited
to, all as much of the following as
available information permits :
(1) 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 .
(2) The number of persons with contacts with local law enforcement
and the extent to which local and state incarceration has been
reduced or avoided .
(3) The number of persons able to demonstrate an increase
in stability of income participating in employment
service programs including competitive employment.
(4) 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.
measures.
(5) The amount of hospitalization that has been reduced or
avoided.
(d)
(c) Each demonstration project shall include outreach and
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.
(e) 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.
(e) (1) As used in this part, "receiving extensive mental health
services" means having a case manager, as described in subdivision
(b) of Section 5806, and having an individual personal service plan,
as described in subdivision (c) of Section 5806.
(2) The funding provided pursuant to this part 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 that portion of the costs of those services not
otherwise provided by federal funds or other state funds.
(f) 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.
(g) 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.
SEC. 6.
SEC. 5. Section 5814.5 is added to the Welfare and Institutions
Code, to read:
5814.5. (a) Of the funds appropriated pursuant to Schedule (a) of
Item 4440-101-0001 of the Budget Act of 1999, the sum of ten million
dollars ($10,000,000) shall be allocated in accordance with the
following schedule:
(1) The sum of five hundred thousand dollars ($500,000) shall be
reappropriated in augmentation of Schedule (a) of Item 4440-001-0001
of the Budget Act of 1999 to provide for departmental support for the
additional administrative costs associated with the augmentation
contained in paragraph (2). Specifically, this amount shall be
utilized by the State Department of Mental Health to provide for its
administration of these programs, and to work together with the
Department of Finance, the Department of Corrections, the Board of
Corrections, state associations representing law enforcement and
local government, and the Legislative Analyst, in order to collect
and evaluate the program performance and cost data pertaining to
these programs.
(2) The sum of nine million five hundred thousand dollars
($9,500,000) is hereby allocated in augmentation of Item
4440-101-0001 of the Budget Act of 1999, to be awarded by the
department in the 1999-2000 fiscal year, for up to three counties or
portions of counties, that demonstrate that the county can provide
comprehensive services, as set forth in this part, to a substantial
number of adults who are severely mentally ill, as defined in Section
5600.3, and are homeless or recently released from the county jail
or who are untreated, unstable, and at significant risk of
incarceration or homelessness unless treatment is provided.
(b) (1) Counties eligible for funding pursuant to paragraph (2) of
subdivision (a) shall be those that have existing integrated adult
service programs that meet the criteria for an adult system of care,
as set forth in Section 5806, and that have, or can develop,
integrated forensic programs with similar characteristics for
parolees and those recently released from county jail who meet the
target population requirements of Section 5600.3 and are at risk of
incarceration unless the services are provided. Local enrollment for
integrated adult service programs and for integrated forensic
programs funded pursuant to paragraph (2) of subdivision (a) shall
adhere to all conditions set forth by the department, including the
total number of clients to be enrolled, the providers to which
clients are enrolled and the maximum cost for each provider, the
maximum number of clients to be served at any one time, the outreach
and screening process used to identify enrollees, and the total cost
of the program. Local enrollment of each individual for integrated
forensic programs shall be
subject to the approval of the county mental health director or his
or her designee.
(2) Each county shall ensure that funds provided by these grants
are used to provide new services in accordance with the purpose for
which they were appropriated and allocated, and that none of these
funds shall be used to supplant existing services to severely
mentally ill adults. In order to ensure that this requirement is
met, the department shall develop methods and contractual
requirements, as it determines necessary. At a minimum, these
assurances shall include that state and federal requirements
regarding tracking of funds are met and that patient records are
maintained in such a manner as to protect privacy and
confidentiality, as required under federal and state law.
(c) Each county selected to receive a grant pursuant to this
section shall provide data as the department may require, that
demonstrates the outcomes of these adult system of care programs,
shall specify the additional numbers of severely mentally ill adults
to whom they will provide comprehensive services for each million
dollars of additional funding that may be awarded through either an
integrated adult service grant or an integrated forensic grant, and
shall agree to provide services in accordance with Section 5806.
(d) This section shall become inoperative on July 1, 2000, and, as
of January 1, 2001, is repealed, unless a later enacted statute, that
becomes operative on or before January 1, 2001, deletes or extends
the dates on which it becomes inoperative and is repealed.
SEC. 6. The Department of Corrections and the State Department of
Mental Health may jointly develop a coordinated strategy, including
written protocols, to maximize the efficiency and cost-effectiveness
of services to severely mentally ill parolees. Upon request by the
Director of Corrections, the Director of Finance, upon legislative
notification, may transfer funds from Provisions 15, 17, 19, and 20
of Item 5240-001-0001 of the Budget Act of 1999 to Provisions 13 to
20, inclusive, of Item 5240-001-0001 of the Budget Act of 1999 or to
Schedule (a) of Item 4440-101-0001 of the Budget Act of 1999 in an
agreed upon amount to enhance services that reduce the recidivism
rate of mentally ill parolees, who, without the services and support
provided pursuant to Part 3 (commencing with Section 5800) of
Division 5 of the Welfare and Institutions Code, are at significant
risk of incarceration.
SEC. 7. In consultation with the committee specified in paragraph
(3) of subdivision (a) of Section 5814 of the Welfare and
Institutions Code, the State Department of Mental Health shall
establish the selection criteria and reporting requirements for
future integrated adult service programs and integrated forensic
programs under Section 5814.5 of the Welfare and Institutions Code,
if additional funding becomes available.
SEC. 8. 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.