BILL ANALYSIS                                                                                                                                                                                                    






                        SENATE HEALTH AND HUMAN SERVICES
                               COMMITTEE ANALYSIS
                        Senator Martha M. Escutia, Chair


          BILL NO:       SB 1464                                      
          S
          AUTHOR:        Johnson et al.                               
          B
          AMENDED:       As introduced
          HEARING DATE:  April 26, 2000                               
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          FISCAL:        Appropriations                               
          4
                                                                      
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          CONSULTANT:                                                 
          4
          Matosantos / ak
                                        

                                     SUBJECT
                                         
                        Mental health services:  funding

                                     SUMMARY  

          Appropriates $20 million from the General Fund to the  
          Department of Mental Health (DMH) to fund existing county  
          demonstration projects, to serve homeless and recently  
          released mentally ill adults, and expand this demonstration  
          project to serve an additional three counties.

                                     ABSTRACT 

          Existing law (the Adult and Older Adult Mental Health  
          System of Care Act, AB 34/Chapter 617, Statutes of 1999):
          
           Provides "system-of-care programs" for severely mentally  
            ill adults and older adults in California.

           Establishes three county mental health care demonstration  
            projects to provide community-based treatment, case  
            management and coordination of interagency services to  
            severely mentally ill homeless or recently incarcerated  
            adults. 
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          This bill:

           Appropriates funds to continue the existing mental health  
            demonstration projects serving severely ill homeless or  
            recently incarcerated adults and expands this  
            demonstration project to serve an additional three  
            counties. 
          
                                  FISCAL IMPACT  

          $20 million appropriation from the General Fund to DMH. 

                            BACKGROUND AND DISCUSSION

           During the 1970s, state policy changes transferred a number  
          of mentally ill patients from state mental hospitals to  
          community-based treatment programs.  Initially intended to  
          improve the quality of life and care of residents, these  
          policy changes have resulted in a lack of mental health  
          services for Californians.  Demand for mental health  
          services far exceeds capacity.  According to the County  
          Mental Health Directors Association, community-based  
          services are available to less than half those who need  
          them.  The Association argues that as a result of the  
          number of untreated serious mental illness, California has  
          witnessed an increase in homelessness, police interaction,  
          exacerbated symptoms and other personal and community  
          problems.

          According to the National Institute of Mental Health  
          (NIMH), over the course of a lifetime, approximately 20% of  
          Americans will experience a mental disorder or illness.   
          Although appropriate treatment and medication can often  
          mitigate the negative impact of mental illnesses, a Rand  
          Corporation study estimated a loss of $12 billion in missed  
          work days nationally each year due to depression alone.   
          Trends suggest that the managed care system also has  
          contributed to the decreased access to mental health  
          services.  According to a report prepared for Congress by  
          the National Advisory Mental Health Council, in 1981, 58%  
          of employees with any health insurance had coverage for  
          mental health inpatient care comparable to that for other  
          illnesses.  By 1993, only 16% of employees had such  
          coverage.  As a result, employees experience higher  
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          out-of-pocket expenses for mental heath care than for other  
          health care. 

          Through the years, several policy initiatives have sought  
          to increase access to mental health services in California.  
           Among these initiatives is AB 34 (Steinberg), which in  
          1999 established a three-county demonstration program  
          intended to show that comprehensive services provided to  
          homeless or recently incarcerated severely mentally ill  
          adults can prevent crime and decrease homelessness.   
          According to author, these pilot projects, operating in Los  
          Angeles, Sacramento and Stanislaus counties, have been  
          credited with helping move more than 1,000 people off the  
          streets. 

          SB 1464 seeks to continue the pilot programs created by AB  
          34 and expand these programs to serve an additional 3  
          counties.  This measure appropriates $20 million to DMH to  
          fund the pilot projects created by AB 34 in six counties.   
          The expanded program will target critical mental health  
          services to homeless mentally ill adults.  The author  
          believes that by providing services and getting mentally  
          ill homeless people off the streets, SB 1464 will enable  
          program beneficiaries to achieve better lives and become  
          productive and responsible citizens. 

          Related Legislation:


















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          SB 1464 conflicts with AB 2034 (Steinberg), which  
          appropriates an unspecified amount to continue and expand  
          community mental health services. AB 2034 adds transition  
          youth and families living with a severely mentally ill  
          adult to the target population for the AB 34 services.   
          This bill allocates new funds to counties with existing  
          pilot projects to expand available services.  AB 2034 also  
          makes additional funding available for other counties that  
          do not have an integrated services program but meet adult  
          system-of-care criteria.  In addition, AB 34 requires that  
          counties use grants to expand existing integrated service  
          programs that meet the adult system of care criteria to  
          provide new services. 

                                    POSITIONS  

          Support:  California Mental Health Directors Association  
          (if amended)
                    California Psychological Association
                    Jericho
                    Orange County Coalition for Mental Health

          Oppose:None registered






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