BILL NUMBER: AB 2034 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MAY 26, 2000
AMENDED IN ASSEMBLY APRIL 11, 2000
AMENDED IN ASSEMBLY MARCH 23, 2000
INTRODUCED BY Assembly Members Steinberg and Baugh
(Principal coauthors: Assembly Members Scott and Shelley)
(Principal coauthors: Senators Burton and Perata)
(Coauthors: Assembly Members Alquist, Aroner, Bock, Cardoza, Cox,
Hertzberg, Honda, Keeley, Knox, Kuehl, Longville, Lowenthal, Machado,
Mazzoni, Pescetti, Strom-Martin, Thomson, and Torlakson)
(Coauthors: Senators Alpert, Chesbro, Rainey, Solis, and
Vasconcellos)
FEBRUARY 18, 2000
An act to amend Sections 5806, 5814, and 5814.5 of the Welfare and
Institutions Code, relating to mental health , and making
an appropriation therefor .
LEGISLATIVE COUNSEL'S DIGEST
AB 2034, as amended, Steinberg. Mental health funding: local
grants.
Existing law requires the State Department of Mental Health to
establish service standards relating to mental health programs.
These standards include plans for services and evaluation strategies
to coordinate and provide access to housing assistance, vocational
rehabilitation, and veterans' services.
This bill would include transition youth, as defined, within the
target population and implement additional service standards relating
to outreach and diagnostic and assessment services.
Existing law requires the director to establish a methodology for
awarding grants and to establish a designated advisory committee.
The department is also required to select up to 3 counties for
eligibility for demonstration grants to be used to provide
comprehensive services to the severely mentally ill.
This bill would require the director to include additional
advisory committee members. This bill would also require additional
criteria to be used in awarding grants. The department would be
authorized to continue funding previously selected counties and to
select additional counties to provide comprehensive services to the
severely mentally ill. The 3-county limitation would be deleted.
Existing law requires counties receiving grants to provide the
department with program outcome data.
This bill would also require the counties receiving grants to
provide the department with information relating to funding for
housing.
Existing law reappropriates $10,000,000 to the department from a
specified item in the Budget Act of 1999 for the purpose of funding
grants. The provisions of this section are operative until
July 1, 2000, and would be repealed on January 1, 2001.
This bill would reappropriate an unspecified sum to the department
from the Budget Act of 2000 for the purpose of funding grants
provided under the bill. This bill would also delete the repeal of
these provisions and thus continue them indefinitely.
This bill would revise these provisions regarding the funding of
grants.
The bill would require the department to conduct a review of
published materials regarding certain early psychosis education
programs. The bill would require the department to report to the
Legislature on or before July 1, 2001, regarding the reviews and to
make recommendations.
Vote: 2/3 majority . Appropriation:
yes no . Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) The Legislature finds and declares as follows:
(1) In 1999, the Legislature recognized the longstanding problem
of the underfunded community mental health care system and the
consequences of severely mentally ill adults not getting treatment
resulting in these adults being homeless, incarcerated in jails, and
hospitalized.
(2) The Legislature began to address this problem by funding three
pilot programs in Los Angeles, Sacramento, and Stanislaus Counties
to provide extended community mental health services and outreach to
mentally ill adults who are homeless or at risk of homelessness.
(3) The legislation, Chapter 617 of the Statutes of 1999 (AB 34),
required the State Department of Mental Health to evaluate these
programs and determine if they were effective in reducing the risk of
continued homelessness, incarceration, or hospitalization.
(4) The response to the offer of outreach services to severely
mentally ill persons has been overwhelming, with more than 1,000
additional people now stabilized and in treatment with a greatly
reduced risk of further homelessness, incarcerations, or
hospitalizations.
(5) Based upon this success and the dramatic and unfortunate
consequences of two decades of not providing adequate community
mental health services, it is now time for the state to make a
significant effort to substantially increase these programs and
realize a measurable reduction in homelessness of people with mental
illness by dramatically expanding these programs.
(b) It is the intent of the Legislature to enact legislation that
will do all of the following:
(1) Provide funds in the 2000-01 fiscal year to allow the three
counties that currently conduct programs to continue successful
program expansions, based upon remaining unmet needs.
(2) Permit, in addition to the initial demonstration counties,
counties that have adult system of care programs to have an
opportunity to participate in these programs, based upon unmet needs,
successful existing programs, and each county's capacity to increase
services.
(3) Permit counties that do not yet have a system of care program
to increase community mental health services by establishing an
initial program that can be expanded upon in future years.
SEC. 2. 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 shall 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 to transition youth and
to families whose severely mentally ill adult is living with them,
design of mental health services, coordination and access to
medications , psychiatric and psychological services, substance abuse
services, supportive housing or other housing assistance, vocational
rehabilitation, and veterans' services. Plans shall also contain
evaluation strategies, that 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
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.
(7) Provision for psychiatric and psychological services that are
integrated with other services and for psychiatric and psychological
collaboration in overall service planning.
(8) Provision for transition youth diagnostic and assessment
processes and services designed specifically to meet the needs of 18
to 25 year olds, inclusive. These provisions may include
continuation of services that would still be received through other
funds had eligibility not been terminated due to age.
(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.
(d) For purposes of this section and Section 5814, "transition
youth" are individuals 18 to 25 years old, inclusive, with the
conditions described in paragraph (2) of subdivision (a) of Section
5600.3.
SEC. 2.
SEC. 3. 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. The next priority for funding shall be
given to counties with highly urbanized areas, significant numbers of
persons who are homeless or severely mentally ill, or both, and at
high risk of losing federally funded Section 8 low-income housing.
(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, providers of local employment services, the State
Department of Social Services, a service provider to transition
youth, the United Advocates for Children of California, the
California Mental Health Advocates for Children and Youth, 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.
(C) A description of efforts to maximize the utilization of other
state, federal, and local funds that can support and enhance the cost
effectiveness of these programs.
(D) A description of efforts to obtain health foundation
charitable funds to expand and support these programs.
(5) In addition to the criteria specified in paragraph (4),
counties seeking grants for expansion of programs that were funded
pursuant to this part prior to January 1, 2001, shall provide:
(A) Data on the total number of adults and the total number of
transition youth receiving extensive community mental health services
including programs funded pursuant to this part and other programs.
This information shall identify the number of persons served in
programs that meet the criteria for adults system of care and the
number in other structured programs.
(B) Data for each type of program on the amount of funding
expended per person.
(C) To the extent available, outcome measures for other programs
that serve populations similar to those served with funds provided
pursuant to this part.
(D) An analysis that compares the cost and outcomes for services
provided under the adults system of care programs with services
provided under other programs for adults with similar needs.
(E) The policy reasons or other explanations for those receiving
services outside of the adults system of care programs and, to the
extent possible, the county's plan for expansion of system of care
services to include persons not currently receiving services under
this type of system of care program.
(b) In each year in which additional funding is provided by the
State Budget the department shall establish 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" are those individuals described in subdivision (b) of
Section 5600.3 or transition youth. 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, involvement with local law enforcement, and
other measures identified by the department. The evaluation shall
include, 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.
(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 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.
(5) The amount of hospitalization that has been reduced or
avoided.
(c) Each 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.
(d) If sufficient funds have been made available to provide
funding to all counties that are eligible as set forth in this
section, additional funding may be made available for other counties,
or groups of counties, that do not currently have an existing
program of integrated services that meet adults system of care
criteria. To the extent funds are available, those counties may
apply for a start up program to serve approximately 100 people in
accordance with specific terms and conditions of oversight and
training which shall be developed by the department, in consultation
with the advisory committee.
(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. 3.
SEC. 4. Section 5814.5 of the Welfare and Institutions Code
is amended to read:
5814.5. (a) Of the funds appropriated pursuant to Schedule (a) of
Item 4440-101-0001 of the Budget Act of 2000, the sum of ____
dollars ($__) shall be allocated in accordance with the following
schedule:
(1) The sum of five hundred thousand dollars ($500,000) shall be
reappropriated in augmentation of Schedule (a) of Item 4440-001-0001
of the Budget Act of 2000 to provide for departmental support for the
additional administrative costs associated with the augmentation
contained in paragraph (2). Specifically, this amount shall be
utilized by the State Department of Mental Health to provide for its
administration of these programs, and to work together with the
Department of Finance, the Department of Corrections, the Board of
Corrections, state associations representing law enforcement and
local government, and the Legislative Analyst, in order to collect
and evaluate the program performance and cost data pertaining to
these programs.
(2) The sum of ____ dollars ($__) shall be allocated for
continuation and expansion of counties funded in 1999-2000 that have
successfully demonstrated the cost effectiveness
5814.5. (a) (1) Counties funded under this part in the 1999-2000
fiscal year are eligible for funding to continue and expand their
programs if they have successfully demonstrated the
cost-effectiveness of their grants received in that year and
demonstrate significant continued unmet need and capacity for
expansion without compromising quality or cost effectiveness
of care and to other counties or portions of counties, that
demonstrate that the county can provide
cost-effectiveness of care.
(2) Other counties or portions of counties are eligible for
funding to establish programs if a county demonstrates that it 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 expand existing integrated service programs that meet the
criteria of adults system of care 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 a manner that protects 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.
Each county shall identify, as the department may require, the amount
of funding required for housing market conditions, the estimated
number of people who will be eligible for income from Social
Security, and types of housing and support services that will be
required.
SEC. 4.
SEC. 5. (a) The State Department of Mental Health shall
conduct a review of published materials regarding early psychosis
education programs such as those operating in Melbourne, Australia,
London, England, Canada, Rogaland, Norway that utilize schools,
primary care physicians, and a general public education campaign to
ensure that people suffering from schizophrenia-related illnesses
receive treatment within months of the onset of the symptoms as
compared to several years in similar communities without these
programs.
(b) The State Department of Mental Health, on or before July 1,
2001, shall report to the Legislature regarding the findings of the
literature review and make recommendations as to whether such a
program should be implemented in California. The report shall
include, but not be limited to, information related to the costs and
benefits to mentally ill persons and the society in which they live.
The report shall also include an overview of the actions and
resources necessary to implement such a program in California.
(c) The State Department of Mental Health shall report to the
Legislature regarding the study and recommendations required under
this section on or before July 1, 2001.