MEASURE :  A.B. No. 334
AUTHOR(S) :  Steinberg (Principal coauthor: Cox) (Coauthors: Aroner,
 Chan, Keeley, Koretz, Liu, and Strom-Martin) (Coauthors:
 Senators Chesbro, Kuehl, Machado, Scott, and Soto).
TOPIC :  Mental health funding:  local grants.
HOUSE LOCATION :  SEN
+LAST AMENDED DATE  :  08/27/2001
 

TYPE OF BILL :
                Active
                Non-Urgency
                Non-Appropriations
                Majority Vote Required
                Non-State-Mandated Local Program
                Fiscal
                Non-Tax Levy

LAST HIST. ACT. DATE:  09/06/2001
LAST HIST. ACTION   :  From committee:  Do pass.  (Ayes 10. Noes  0.).   Read
 second time.  To third reading.
FILE :  SEN THIRD READING
FILE DATE :  09/07/2001
ITEM : 190
 

TITLE :  An act to amend Sections 5806, 5811, 5814, and 5814.5 of
 the Welfare and Institutions Code, relating to mental
 health.

 AMENDED IN SENATE  AUGUST 27, 2001
 AMENDED IN SENATE  JUNE 25, 2001
 AMENDED IN ASSEMBLY  MAY 31, 2001

INTRODUCED BY   Assembly Member Steinberg
   (Principal coauthor:  Assembly Member Cox)
   (Coauthors:  Assembly Members Aroner, Chan, Keeley, Koretz, Liu,
and Strom-Martin)
   (Coauthors:  Senators Chesbro, Kuehl, Machado, Scott, and Soto)

                        FEBRUARY 16, 2001

   An act to amend Sections 5806, 5811, 5814, and 5814.5 of the
Welfare and Institutions Code, relating to mental health.
 

 LEGISLATIVE COUNSEL'S DIGEST
 

   AB 334, as amended, Steinberg.  Mental health funding:  local
grants.
   Existing law provides for the allocation of state funds to
counties for mental health programs.  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, evaluation strategies,
coordination, and access to related medications, substance abuse
services, housing assistance, vocational rehabilitation, and veterans'
services.  Existing law requires the department to select 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.  Existing law also requires the
director to establish a methodology for awarding these grants and to
establish a designated advisory committee.
   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.  This bill would
define the outreach services  to families of persons with
mental illness  that are part of the service planning
and delivery process under the bill  .  This bill would provide
that the outreach to adults required as part of the service standards
may include adults voluntarily or involuntarily hospitalized as a
result of a severe mental illness.  This bill would also require that
the service standards include provision for persons who have been
suffering from an untreated severe mental illness for less than one
year, and who do not require the full range of services but are at
risk of becoming homeless unless a comprehensive individual and
family support services plan is implemented.  The bill would require
that these persons be served in a manner that is designed to meet
their needs.  This bill would also make various changes in and
additions to reporting requirements.  This bill would also add
certain training, consultation, and technical assistance requirements
to existing law.  This bill would also provide for services for
persons who have been suffering from an untreated severe mental
illness for less than one year.  This bill would also provide for
training for various professionals likely to come into contact with
persons who may be suffering from an untreated severe mental illness.
  This bill would also require that proposals to be submitted to the
state by a city or county be reviewed by a local advisory committee,
including clients, family members, private providers of services, and
other relevant stakeholders.  This bill would require the advisory
committee to provide to the director written comment on each of the
county programs.
   Vote:  majority.  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) 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
prisons, and hospitalized.
   (b) 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.
   (c) 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.
   (d) A May 2000 report showed that the legislation has been a great
success, and the programs are having excellent results.  Days of
hospitalization were reduced by 60 percent, days of homelessness were
reduced by 65 percent, and days in jail were reduced by 80 percent.

   (e) The State Budget for the 2000-01 fiscal year added 26
additional counties and cities to participate in the program.  These
counties have developed new programs in efforts to replicate the
success of the three pilot programs in order to take this program
statewide.
   (f) While the program has been successful in helping those that it
has served, there is still the need to expand the program to service
a sufficient number of people so as to make a difference noticeable
to law enforcement officers and the public as to the number of
homeless and mentally ill people on our streets; a difference
noticeable to sheriffs as to the population in their jails of people
who are suffering from mental illnesses; and a noticeable difference
in the number of hospitalizations of people with mental illness who
did not receive timely assistance.
   (g) The counties receiving funding for this program should
continue to be required to demonstrate the effectiveness of the
program, including those who will have received funds on a countywide
basis for at least three years. Those counties should be required to
quantify the benefits and the impact the program is making on the
streets, in the jails, and in hospitals.
   (h) One of the greatest values of integrated treatment services is
that it can lead to recovery by dealing with all of the aspects of a
person's mental illness.  For those counties that were funded both
in the 1999-2000 and 2000-01 fiscal years, there are now nearly 1,000
individuals who will have received services for more than a year.
Those programs are evaluated on the extent to which they are
succeeding in enabling the individual served to significantly recover
and reduce their overall public dependence due to their mental
illness.
   (i) The outreach services of the AB 34 program provide
opportunities for earlier intervention so that a person's mental
illness can be treated before it is as severe as it might otherwise
become if left untreated for a considerable period of time.  Chapter
617 of the Statutes of 1999 specifically expanded outreach to serve
individuals who were not homeless and were living with their family
members.  Many of these individuals are likely to be experiencing the
early phases of severe mental illness.  Studies from pilot programs
in Australia, Canada, and Norway show that when outreach is expanded
to include families,  high school or  primary care
physicians, and  general community education
the general community  , treatment is sought and received within
six months of the onset of a severe mental illness as compared to
more than two years of untreated mental illness without this special
outreach  educational  effort.  These same studies
also show that when treatment is provided within the first six months
of the onset of symptoms of mental illness, the majority of
individuals are back in full-time work or education within one year
of treatment.  Less than 20 percent of individuals with untreated
illnesses of more than two years achieve such full recovery even
following several years of treatment.
   (j) Outreach efforts should include  educational
outreach to family members of persons with mental illness,
schools,  employment centers, and other places where young
adults are likely to be found in order to enhance the likelihood that
symptoms will be more readily recognized and treatment sought before
the illness has progressed to a level that results in homelessness.

  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, all of the
following:
   (a) A service planning and delivery 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 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 ability and cultural differences.
Outreach to families may include education and training of families,
students in school   Recipients of outreach services may
include families  , the public, primary care physicians, and
others who are likely to come into contact with individuals who may
be suffering from an untreated severe mental illness who would be
likely to become homeless if the illness continued to be untreated
for a substantial period of time.  Outreach to adults may include
adults voluntarily or involuntarily hospitalized  as a result of a
severe mental illness.
   (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 services specifically directed to seriously
mentally ill young adults 25 years of age or younger who are homeless
or at significant risk of becoming homeless.  These provisions may
include continuation of services that would still be received through
other funds had eligibility not been terminated due to age.
   (9) Services reflecting special needs of women from diverse
cultural backgrounds, including supportive housing that accepts
children, personal services coordinator therapeutic treatment, and
substance treatment programs that address gender specific trauma and
abuse in the lives of persons with mental illness, and vocational
rehabilitation programs that offer job training programs free of
gender bias and sensitive to the needs of women.
   (10) Provision for housing for clients that is immediate,
transitional, permanent, or all of these.
   (11) Provision for clients who have been suffering from an
untreated severe mental illness for less than one year, and who do
not require the full range of services but are at risk of becoming
homeless unless a comprehensive individual and family support
services plan is implemented.  These clients shall be served in a
manner that is designed to meet their needs.
   (b) Each client shall have a clearly designated mental health
personal services coordinator who may be part of 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, if one has been appointed,
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, and for clients with children, to
live in a supportive housing environment that strives for
reunification with their children or assists clients in maintaining
custody of their children as is appropriate.
   (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 serious 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) The individual personal services plan shall describe the
service array that meets the requirements of subdivision (c), and to
the extent applicable to the individual, the requirements of
subdivision (a).
  SEC. 3.  Section 5811 of the Welfare and Institutions Code is
amended to read:
   5811.  The State Department of Mental Health shall provide
participating counties all of the following:
   (a) Request for proposals, application guidelines, and format, and
coordination and oversight of the selection process as described in
Article 2 (commencing with Section 5803).
   (b) Contracts with each state funded county stipulating the
approved budget, performance outcomes, and scope of work.
   (c) Training, consultation, and technical assistance for county
applicants.  This training, consultation, and technical assistance
shall include:
   (1) Efforts to ensure that all of the different programs are
operating as well as they can.
   (2) Information on which programs are having particular success in
particular areas so that they can be replicated in other counties.
   (3) Technical assistance to counties in their first two years of
participation to ensure quality and cost-effective service.
  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.  The next priority for funding shall be given to
counties with a high incidence of persons who are severely mentally
ill and homeless or at risk of homelessness, and meet the criteria
developed pursuant to paragraphs (3) and (4).
   (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) (A) 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 review evaluation reports and make findings on
evidence-based best practices and recommendations for grant
conditions.  At not less than one meeting annually, the advisory
committee shall provide to the director written comments on the
performance of each of the county programs.  Upon request by the
department, each participating county that is the subject of a
comment shall provide a written response to the comment.  The
department shall comment on each of these responses at a subsequent
meeting.
   (B) 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,
the Department of Housing and Community Development, 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, the Mental Health Planning Council, and other
appropriate entities.
   (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 use of other state,
federal, and local funds or services that can support and enhance the
effectiveness of these programs.
   (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.  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 of each
year in which additional funding is provided, 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 for each program funded in the current
fiscal year 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.
   (6) The extent to which veterans identified through these programs'
outreach are receiving federally funded veterans' services for which
they are eligible.
   (7) The extent to which programs funded for three or more years
are making a measurable and significant difference on the street, in
hospitals, and in jails, as compared to other counties or as compared
to those counties in previous years.
   (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 as necessary.
   (d) All counties that receive funding shall be subject to 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 personal services coordinator, 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,
transportation, supportive housing and other housing assistance,
vocational rehabilitation and supported employment services, money
management assistance for accessing other health care and obtaining
federal income and housing support, accessing veterans' services,
stipends, and other incentives 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.
   (3) Methods used by counties to contract for services pursuant to
paragraph (2) shall promote prompt and flexible use of funds,
consistent with the scope of services for which the county has
contracted with each provider.
   (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. 5.  Section 5814.5 of the Welfare and Institutions Code is
amended to read:
   5814.5.  (a) (1) In any year in which funds are appropriated for
this purpose through the annual Budget Act, counties funded under
this part in the 1999-2000 fiscal year are eligible for funding to
continue their programs if they have successfully demonstrated the
effectiveness of their grants received in that year and to expand
their programs if they also demonstrate significant continued unmet
need and capacity for expansion without compromising quality or
effectiveness of care.
   (2) In any year in which funds are appropriated for this purpose
through the annual Budget Act, other counties or portions of
counties, or cities that operate independent public mental health
programs pursuant to Section 5615 of the Welfare and Institutions
Code, are eligible for funding to establish programs if a county or
eligible city 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 subdivision (a)
shall be those that have or can develop 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.  Before a city or county submits a
proposal to the state to establish or expand a program, the proposal
shall be reviewed by a local advisory committee or mental health
board, which may be an existing body, that includes clients, family
members, private providers of services, and other relevant
stakeholders.  Local enrollment for integrated adult service programs
and for integrated forensic programs funded pursuant to 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   the adult  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   the
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's plan shall identify
and include sufficient funding to provide housing for the individuals
to be served, and shall ensure that any hospitalization of
individuals participating in the program are coordinated with the
provision of other mental health services provided under the program.