BILL ANALYSIS
SENATE HEALTH AND HUMAN SERVICES
COMMITTEE ANALYSIS
Senator Martha M. Escutia, Chair
BILL NO: AB 2034
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AUTHOR: Steinberg
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AMENDED: June 22, 2000
HEARING DATE: June 28, 2000
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FISCAL: Appropriations / URGENCY
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CONSULTANT:
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McCarthy / ak
SUBJECT
Mental health funding: local grants
SUMMARY
This bill continues and expands a demonstration program
initiated in FY 99-00, in AB 34 (Steinberg), that provides
mental health outreach, case management, and other services
to persons with mental illness who are homeless or at-risk
of homelessness.
ABSTRACT
Existing law:
1.Requires counties to be the providers of last resort for
relief and support of incompetent, poor, indigent
persons, and those incapacitated by age, disease, or
accident, when such persons are not supported and
relieved by their own means, relatives, friends, or other
public or private institutions (WIC Section 17000);
2.Establishes in certain counties, an adult system of care
program, that provides county mental health services to
severely mentally ill adults and children with severe
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emotional disturbances, as defined;
3.Requires the Department of Mental Health (DMH) to
establish demonstration programs in three counties, as
specified in AB 34 (Ch. 617, Statutes of 1999), providing
mental health services to adults with severe mental
illness who are homeless, recently released from county
jail or who are at significant risk of incarceration or
homelessness, unless treatment is provided;
4.Provides $10 million in FY 1999-2000 for the three
demonstration projects in Los Angeles, Sacramento and
Stanislaus counties;
5.Specifies a number of service standards for the three
demonstration projects including, plans for mental health
services and housing assistance to the target population,
and plans for outreach to transition youth;
6.Requires that the demonstration projects be evaluated to
determine effectiveness and that a report be submitted to
the Legislature by May 1, 2000.
This bill:
1.Permits counties currently operating AB 34 demonstration
projects to be eligible for continued funding, if they
have demonstrated effectiveness, and also permits these
counties to expand the projects if they demonstrate
continued unmet need and the capacity to expand without
compromising effectiveness;
2.Makes any other counties, or portions of counties,
eligible for funding to establish an AB 34 program if the
county can develop an integrated adult systems of care
program that provides comprehensive services to a
substantial number adults who meet the target criteria
(i.e., severely mentally ill adults who are homeless,
recently released from county jail or who are at
significant risk of incarceration or homelessness, unless
treatment is provided);
3.Requires provision of AB 34 program services to youth 25
years and younger who are seriously mentally ill and
homeless or at significant risk of becoming homeless;
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4.Requires that program services reflect the special needs
of women with mental illness from diverse cultural
backgrounds, including supportive housing that accepts
children and substance treatment programs that address
gender-specific trauma and abuse;
5.Requires the AB 34 project's service and delivery process
to include provision of housing for clients, including
immediate, transitional and permanent housing;
6.Requires that services also include provision of
psychiatric and psychological services, integrated with
other services, and includes psychiatric and
psychological collaboration in overall service planning;
7.Requires certain entities--the California Department of
Social Services (CDSS), a service provider to transition
youth and specific advocacy groups, the United Advocates
for Children of California and the California Mental
Health Advocates for Children and Youth--to be
represented on the existing DMH advisory board which
recommends criteria for grant awards to counties;
8.Requires counties ensure any client hospitalizations are
coordinated with other services;
9.Requires DMH to submit a report with specified data to
the Legislature each year funding is provided for the
program, including data on the extent to which veterans
served in the program are receiving federally funded
veteran's services for which they are eligible;
10.Includes an urgency clause in order to maintain funding
for the existing demonstration programs without
disruption.
FISCAL IMPACT
According to the Assembly Appropriations Committee,
implementation of programs in this bill is contingent upon
the Budget Act. Unknown savings would accrue to the
California Department of Corrections, county mental health
programs and jails to the extent the AB 34 programs prevent
the need for more intensive mental health treatment and/or
incarceration. The Budget Act for FY 00-01, as passed by
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the Senate, contains funding to continue and expand these
programs.
BACKGROUND AND DISCUSSION
1.Background
Legislation enacted in 1999, AB 34 (Steinberg), Chapter
617 Statutes of 1999, established demonstration projects
in several counties to provide specified mental health
and related services to homeless mentally ill persons.
The legislation specified that only those counties with
an existing adult system of care program were eligible to
operate a demonstration project. The target population
under the existing AB 34 demonstration projects are
adults with severe mental illness who are homeless,
recently released from a county jail or state prison, or
others who are untreated, unstable and at significant
risk of incarceration or homelessness, unless treatment
is provided.
Through the demonstration projects, counties were
provided funds to establish outreach programs and to
provide mental health services, related medication,
substance abuse services, housing assistance, vocational
rehabilitation and other services to the target
population.
AB 34 provided funding for the demonstration projects in
Los Angeles ($4.8 million), Stanislaus ($2.8 million) and
Sacramento ($1.9 million) counties. In Sacramento
County, outreach teams go to parks, levees and other
places to find homeless persons to whom they can offer
services. Sacramento County has enrolled 196 people in
mental health services as a result of this program. In
Stanislaus, 88 people are being served by programs funded
through AB 34. According to the author, Stanislaus is
working to serve adults who are periodically homeless,
and young adults who are transitioning from foster care
and the juvenile justice system. Los Angeles County is
serving 790 people with demonstration project dollars.
2.AB 2034
In addition to the provisions described in the Abstract
above, AB 2034 contains the following provisions:
Requires participating counties to designate for each
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client a "personal services coordinator", who may be
part of an multidisciplinary team. Under current law,
clients may be provided a case manager or a
multidisciplinary team;
Requires DMH to conduct a literature review of mental
health public education programs on early psychosis,
and treatment thereof, and to make recommendations to
the Legislature as to whether such a program should be
implemented in California;
Adds to the criteria for grant awards, a description
of efforts to maximize utilization of other state,
federal and local funds, and a description of efforts
to obtain health foundation charitable funds.
The author is proposing this bill to continue and expand
upon the successful community mental health programs
established under AB 34 (Steinberg) Chapter 617, Statutes
of 1999.
3.Evaluation of AB 34
As required by AB 34, the demonstration projects were
evaluated by the DMH and a report submitted to the
Legislature ("Effectiveness of Integrated Services for
Homeless Adults with Serious Mental Illness", May, 2000).
The DMH's findings include the following:
fewer than 15% of eligible clients refused enrollment
in the program and less than 4% left the program;
approximately 2/3 of the clients were male;
most clients were between the ages of 22 and 59 years
(90%);
the ethnic distribution of the clients was 43%
Caucasian, 37% African American, 12% Hispanic, 1%
Asian and 7% unspecified;
the percent of enrollees hospitalized dropped 64%;
the number of days of incarceration dropped 74%;
the number of days of homelessness dropped 59%.
4.Arguments of proponents
Sacramento County supports this bill to extend the
1999-2000 demonstration program to other counties as well
as to youth in transition.
The California Psychiatric Association, writing in
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support of this bill, states that with AB 34, California
is "finally beginning to develop the community care
system" envisioned 30 years ago and that the program has
succeeded beyond expectations. The California Healthcare
Association states there is ample evidence that
"wraparound" (comprehensive) services for the seriously
mentally ill is cost effective and humane and that: "We
know how to effectively treat this population. What we
need now is additional funding to ensure that more
mentally ill individuals at risk of homelessness or
incarceration are given the chance to participate....".
PRIOR ACTIONS
Assembly Floor: 69-7Pass
Assembly Appropriations: 21-0Do Pass as Amended
Assembly Health: 13-0Do Pass as Amended
POSITIONS
Support: 50+ and Strong
ACCESS Campaign for Mental Healthcare
AFSCME, AFL-CIO
All Saints Parish
Calaveras County Mental Health Board
California Catholic Conference
California Child, Youth and Family Coalition
California Coalition for Ethical Mental
Health Care
California Council of Community Mental
Health Agencies
California Healthcare Association
California Medical Association
California Mental Health Directors Assoc.
California Mental Health Planning Council
California Psychological Assoc.
California Psychiatric Association
California Rural Legal Assistance Foundation
California Seniors Coalition
California Society for Clinical Social Work
California State Assoc. of Counties
Catholic Charities of California
Changing Lives Through Jobs
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Chief Probation Officers of California
City and County of San Francisco
CLARE Foundation, Inc.
Common Ground
Congress of California Seniors
County of Los Angeles
County of Sacramento
Didi Hirsch Community Mental Health Center
Gray Panthers
Homeless Action CenterJericho: A Voice for
Justice
Jesuit Volunteer Corps - San Jose
Los Angeles Youth Network
Mental Health Advocacy Project
Mental Health Assoc. in CA (Sponsor)
Mental Health Assoc. in Los Angeles County
Mental Health Assoc. in Santa Barbara
National Association of Social Workers
New Directions, Inc.
Ocean Park Community Center
Orange County Coalition for Mental Health
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Project Return: The Next Step
Protection and Advocacy, Inc.
Regional Psychological Society
Sacramento County Board of Supervisors
Support: San Diego County Board of Supervisors
(cont'd) Santa Clara County Board of Supervisors
Sacramento County Sheriff's Department
San Bernardino County Sheriff's Department
San Fernando Valley Community Mental Health
Center, Inc.
Union of American Physicians & Dentists
Upward Bound House
Urban Counties Caucus
Verdugo Mental Health Center
Westside Shelter and Hunger Coalition
Western Center on Law and Poverty
Oppose: None received
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