BILL ANALYSIS
AB 34
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CONCURRENCE IN SENATE AMENDMENTS
AB 34 (Steinberg)
As Amended September 3, 1999
2/3 vote. Urgency
ASSEMBLY: 79-1 (June 4, 1999) SENATE: 31-3 (September 7, 1999)
Original Committee Reference: HEALTH
SUMMARY : Revises county mental health service standards to
include access to integrated services, and establishes fiscal
incentives for counties to engage in outreach to mentally ill
persons. Specifically, this bill :
1)Revises county mental health service standards to be developed
by the Department of Mental Health (DMH), to include
coordination and access to medication, substance abuse
services, supportive housing, veterans' services and
vocational rehabilitation services.
2)Requires DMH, in the 1999-2000 fiscal year, and in years in
which General Fund dollars are provided, to select a small
group of counties or portions of counties who can provide
comprehensive services to a substantial number of adults who
meet specified criteria. Requires that eligible counties be
those that meet the criteria of the adult system of care as
set forth in existing law. Requires DMH to select counties
that demonstrate:
a) That the county's share of the $10 million will allow
the county to cost effectively increase the number of
severely mentally ill adults that the county will serve
from program inception through June 2001; and,
b) The county will serve a substantial percentage of the
unmet needs of the mentally ill that there is a clear
quantifiable impact on the need, and other criteria as
specified.
3)Requires the Department of Corrections and the county mental
health director for any area selected, to develop a
coordinated strategy to maximize the efficiency and cost
effectiveness of services to severely mentally ill parolees.
4)Provides that an eligible county that has not yet received a
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grant may participate in a demonstration grant by committing
new county general fund dollars comparable to the amount the
county would receive if it had been successful in receiving a
grant.
5)Permits DMH to 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 populated areas within
the county.
6)Requires counties to use grant funds to provide new services
rather than to supplant existing services.
7)Requires outreach grants to be sufficient to provide mental
health services, medications, alcohol and drug services,
housing assistance, vocational rehabilitation, financial
management assistance and stipends to attract and retain
professionals to provide services.
8)Permits subsequent funding to be limited, or for conditions
for improvement to be imposed upon a county that received a
grant, but did not reduce criminal justice expenditures or
meet other performance benchmarks as a result. Requires DMH to
provide annual oversight of grants for compliance with
contract standards.
9)Requires the DMH Director to establish an advisory committee
to provide advice regarding the development of grant award
criteria, and to identify performance measures for evaluating
the effectiveness of grants. The committee shall include, but
not be limited to, representatives from veterans' services
programs, law enforcement, county and private mental health
providers, the Board of Corrections, the Department of Alcohol
and Drug Programs, substance abuse service providers, the
Department of Rehabilitation, providers of 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
Clients, and Mental Health Planning Council. Requires
criteria for grant awards to include, but not be limited to:
a) A strategic plan for providing outreach,
prevention, intervention, and evaluation in a cost
appropriate manner; and,
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b) A description of the population to be served,
ability to administer an effective service program, and the
degree to which local agencies and advocates will support
program efforts.
10)Requires each selected county to provide data demonstrating
the success of the county's existing adult system of care
programs, to specify the numbers of person to whom the county
will provide services for each $1 million of additional
funding that may be awarded through a grant.
11)Permits grant amounts to be increased to reward counties that
are providing mental health services to significantly more
mentally ill adults with funds other than state
appropriations, relative to other comparable counties.
Permits grant amounts to be decreased to penalize counties
serving a number of severely mentally ill adults significantly
below that of comparable counties.
12)Requires, beginning on or before November 1, 2001, and
annually thereafter, the Director to report to the Legislature
about the impact of grants in reducing incarceration of
mentally ill persons, and to make recommendations regarding
improving county performance and state mental health policies.
The Senate amendments :
1)Add the number of mentally ill persons contacted in outreach
efforts, who have refused treatment, to the outcomes and
performance measurements of county performance.
2)Delete language that would have permitted DMH to renew a
county contract even if the county is not meeting standards
for reducing incarceration rates.
3)Remove language specifying which counties will receive pilot
project funding.
4)Require DMH to establish a methodology for awarding grants,
and select a small group of counties or portions of counties
for eligibility for demonstration grants.
5)Remove the appropriations previously contained in this bill.
Deletes specification of the duration of the grants.
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EXISTING LAW :
1) Requires counties to relieve and support poor, indigent and
incapacitated persons, when such persons are not supported
and relieved by relatives, friends, or other public or
private institutions.
2) Establishes three mental health care demonstration projects
in the Adult and Older Adult Mental Health System of Care
Act.
AS PASSED BY THE ASSEMBLY , this bill revised mental health
service standards to include access to integrated services, and
established incentives for counties to engage in outreach to
mentally ill persons.
FISCAL EFFECT : According to the Senate Appropriation Committee
analysis, $10 million in 1999-2000 from the General Fund, and
one-time costs of $500,000 required to be expended by DMH.
COMMENTS : The author is proposing this bill to reduce
homelessness of people with severe mental illnesses. The author
notes that the mentally ill frequently become disoriented and
unable to recognize the need for medical assistance. When
medical care is not sought, a cycle of hospitalization, return
to the streets, arrest, and return to homelessness ensues. This
bill is sponsored by the Mental Health Association in
California.
AB 3777 (Wright), Chapter 982, Statutes of 1988, authorized two
types of pilot programs for delivering mental health services to
seriously mentally ill adults: a system of care model, which has
been piloted in Ventura County, and the integrated service
agencies (ISA) model, piloted in Stanislaus and Los Angeles
Counties. These programs have helped clients become functional
through coordinated services to address multiple problems, such
as mental illness, substance abuse and homelessness. SB 659
(Wright), Chapter 153, Statutes of 1996, reauthorized the
demonstration projects, and required DMH to issue requests for
proposals for additional projects in any year in which the state
provides funds for that purpose.
The California Council of Community Mental Health Agencies
(CCCMHA) argues that the only way to stop the cycle of
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homelessness due to untreated illness is to provide incentive
funding for county programs. The Los Angeles County Sheriff's
Department believes this bill will provide resources to keep
mentally ill patients from weighing down our criminal justice
system. The California Mental Health Planning Council argues
that this bill will reverse a pattern of underfunding that has
continued since deinstitutionalization of the mentally ill in
the early 1970's.
Analysis Prepared by : Ann Blackwood / HEALTH / (916) 319-2097
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0003408