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SB-665 Mental Health Services Fund: county jails.(2019-2020)

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Date Published: 07/23/2020 09:00 PM
SB665:v95#DOCUMENT

Amended  IN  Assembly  July 27, 2020
Amended  IN  Senate  August 30, 2019
Amended  IN  Senate  April 23, 2019
Amended  IN  Senate  April 10, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill
No. 665


Introduced by Senator Umberg

February 22, 2019


An act to amend Section 5847 of, and to amend, repeal, and add Section 5813.5 of, add the heading of Chapter 1 (commencing with Section 5830) to, and to add Chapter 2 (commencing with Section 5832) to Part 3.2 of Division 5 of the Welfare and Institutions Code, relating to mental health, making an appropriation therefor, and declaring the urgency thereof, to take effect immediately. health, and making an appropriation therefor.


LEGISLATIVE COUNSEL'S DIGEST


SB 665, as amended, Umberg. Mental Health Services Fund: county jails.
Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, funds a system of county mental health plans for the provision of mental health services. The MHSA establishes the Mental Health Services Oversight and Accountability Commission to oversee these provisions. The MHSA requires county mental health programs to develop plans for innovative programs and specifies the funding for those programs. The MHSA also requires each county to prepare and submit a 3-year program and expenditure plan, and annual updates, to the commission. The MHSA establishes the continuously appropriated Mental Health Services Fund to fund various county mental health programs. Existing law prohibits MHSA funds from being used to pay for persons incarcerated in state prison or parolees from state prisons. The MHSA authorizes its provisions to be amended by the Legislature by a 2/3 vote of the Legislature if the amendment is consistent with and furthers the intent of the act, and authorizes the Legislature to clarify procedures and terms of the act by majority vote.
Existing law, the 2011 Realignment Legislation addressing public safety and related statutes, requires that certain specified felonies be punished by a term of imprisonment in a county jail, rather than the state prison, and provides for mandatory supervision, a period of suspended execution of a concluding portion of the sentence that is supervised by the county probation officer.
This bill would establish the Jail-Based Community Mental Health Innovation Program (JBCMHIP). The program would authorize up to 8 counties, including Orange County, with approval from the commission, to use MHSA funds to establish county JBCMHIPs to introduce innovative approaches to meet the mental health needs of persons in jail, including persons who have been convicted of a felony and sentenced to imprisonment in a county jail. The bill would prohibit a JBCMHIP from exceeding 5 years in duration. The bill would specify the duties of an approved county and would require an approved county to include the program in the county’s 3-year MHSA plan or periodic updates. The bill would require the commission to ensure that a proposal meets certain requirements and to ensure certain geographic and demographic representation, as described. The bill would require, at the conclusion of the JBCMHIP, the commission to report to the Legislature on the outcomes achieved, as specified. The bill would set forth legislative findings and declarations and state the intent of the Legislature in enacting these provisions.
By authorizing the use of continuously appropriated funds for new purposes, this bill would make an appropriation.
The bill would state the finding and declaration of the Legislature that this change is consistent with and furthers the intent of the act.

Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, funds a system of county mental health plans for the provision of mental health services. The MHSA establishes the continuously appropriated Mental Health Services Fund to fund various county mental health programs. Existing law prohibits MHSA funds from being used to pay for persons incarcerated in state prison or parolees from state prisons. The MHSA authorizes its provisions to be amended by the Legislature by a 23 vote of the Legislature if the amendment is consistent with and furthers the intent of the act, and authorizes the Legislature to clarify procedures and terms of the act by majority vote.

Existing law, the 2011 Realignment Legislation addressing public safety and related statutes, requires that certain specified felonies be punished by a term of imprisonment in a county jail, rather than the state prison, and provides for mandatory supervision, a period of suspended execution of a concluding portion of the sentence that is supervised by the county probation officer.

This bill would, until January 1, 2023, authorize a county to use MHSA funds, if that use is included in the county plan, to provide services to persons who are incarcerated in a county jail or subject to mandatory supervision, except persons who are incarcerated in a county jail for a conviction of a felony unless for purposes of facilitating discharge. By allocating moneys in the Mental Health Services Fund for a new purpose, this bill would make an appropriation. The bill would also declare that this change is consistent with and furthers the intent of the MHSA.

The existing MHSA requires each county mental health program to prepare and submit a 3-year program and expenditure plan, and annual updates, as specified, to the Mental Health Services Oversight and Accountability Commission and the State Department of Health Care Services within 30 days after adoption.

This bill would, until January 1, 2024, require a county to include in its 3-year program and expenditure plan, and in the annual updates, a report on expenditures made pursuant to the provisions of this bill. By increasing the reporting duties of counties, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

This bill would declare that it is to take effect immediately as an urgency statute.

Vote: 2/3   Appropriation: YES   Fiscal Committee: YES   Local Program: YESNO  

The people of the State of California do enact as follows:


SECTION 1.

 The heading of Chapter 1 (commencing with Section 5830) is added to Part 3.2 of Division 5 of the Welfare and Institutions Code, to read:
CHAPTER  1. Innovative Programs: General Provisions

SEC. 2.

 Chapter 2 (commencing with Section 5832) is added to Part 3.2 of Division 5 of the Welfare and Institutions Code, to read:
CHAPTER  2. Jail-Based Community Mental Health Programs

5832.
 (a) The Legislature finds and declares both of the following:
(1) The innovation component of the Mental Health Services Act mandates efforts to improve existing mental health services, programs, and strategies.
(2) Innovation is premised upon the recognition that existing programs can result in better outcomes, more effective care, care integration, or coordination, and reduced costs.
(b) It is the intent of the Legislature in enacting this chapter to support innovative approaches to responding to persons who are involved with the county criminal justice system, including persons who are in jail, and who have mental health needs. It is the further intent of the Legislature to improve care planning, service delivery, and the coordination of community-based care and jail-based care, upon entry into jail or upon release, in order to reduce costs and improve outcomes, including improving criminal justice diversion strategies and reducing recidivism.

5832.1.
 For purposes of this chapter, the following definitions apply:
(a) “Commission” means the Mental Health Services Oversight and Accountability Commission.
(b) “Jail-Based Community Mental Health Innovation Program,” or “JBCMHIP” refers to the programs established by approved counties pursuant to this chapter.
(c) “MHSA” means the Mental Health Services Act.

5832.2.
 (a) With approval from the commission, each county that is accepted into the program established pursuant to this chapter may use MHSA Innovation Funds for the establishment of a JBCMHIP. Funds may be used to support all of the following activities:
(1) Providing mental health services to inmates in county jails.
(2) Care planning and coordination.
(3) Coordinating and integrating services and supports between community-based and jail-based programs.
(4) Staffing.
(5) Research and evaluation.
(6) Training, technical assistance, and capacity building.
(7) Other needs as determined and approved by the commission.
(b) Funding allocated for the purposes described in subdivision (a) shall not be used to supplant existing county expenditures.

5832.3.
 (a) Each county electing to establish a JBCMHIP shall do all of the following:
(1) Require approval of the program from the county board of supervisors, or other appropriate governing body, and ensure inclusion of the JBCMHIP in the county’s three-year MHSA plan or periodic update.
(2) Establish a robust community planning process that involves, at a minimum, county mental health and criminal justice agencies, the local county mental health or behavioral health board or commission, mental health peers and family members, and the general public.
(3) Establish an ongoing workgroup of representatives from, at a minimum, the county office of health, the county office of mental or behavioral health, the county jail system, community-based stakeholders, mental health peers, and the county probation department for the purpose of developing, monitoring, implementing, and assessing the program.
(b) The commission may approve up to eight counties, which shall include Orange County, to establish a JBCMHIP provided the proposed program meets both of the following requirements:
(1) Introduces an innovative approach to meeting the mental health needs of persons in jail, including persons who have been convicted of a felony and sentenced to imprisonment in a county jail. That innovation may be related to the services that are delivered, the method of delivery, staffing and service integration or coordination with community-based care, or related opportunities to improve care, support, delivery, and outcomes.
(2) At a minimum, ensures both of the following:
(A) A transfer of care between jail mental health personnel and services and community-based mental health services, if possible, in the presence of the individual receiving the care, including the individual’s family or their guardian, if the individual has been receiving community-based mental health services prior to incarceration.
(B) A transfer of care to community-based mental health services, if possible, in the presence of the individual receiving the care, including the individual’s family or their guardian, upon the individual’s release from jail and the involvement of the probation department, the county mental health office, and other appropriate social service agencies to ensure continuity of care between the jail environment and the community.

5832.4.
 (a) If applicable, the commission shall ensure that a county innovation proposal includes all of the following:
(1) Appropriate ongoing training of jail personnel in order to provide a supportive and therapeutic environment for individuals with mental illness.
(2) Collaborative treatment planning between the jails and county or community mental health personnel for incarcerated individuals to ensure the appropriateness, quality, and continuity of care.
(3) Regular patient status meetings between the jails and county or community mental health personnel for all incarcerated individuals who are receiving mental health services in order to ensure easy transition of care and case management upon release.
(4) A commitment to provide data as required by the commission in a manner, form, and schedule determined by the commission to support program evaluation or outcome reporting.
(b) The commission is encouraged to create a learning collaborative for the purpose of facilitating information exchange and education for all counties approved for a JBCMHIP and other counties that can benefit from the work of participating counties.
(c) To the extent practical, the commission shall ensure geographic and demographic representation when approving counties to establish a JBCMHIP in order to ensure that both urban and rural counties are included and that there is diversity in the population of individuals by the JBCMHIP programs. The commission may impose additional geographic and demographic requirements as determined by the commission.
(d) A JBCMHIP shall not exceed five years in duration.

5832.5.
 (a) In order to assess the appropriateness and effectiveness of the JBCMHIPs in achieving the desired outcomes, the commission shall require the approved counties to provide data in a manner, form, and schedule determined by the commission. The commission shall use the desired outcomes described in subdivision (b) as initial goals and may establish additional outcomes as determined to be appropriate by the commission.
(b) Desired program outcomes include, but are not limited to, all of the following:
(1) Ensuring that individuals identified with mental health needs who were previously untreated through community mental health offerings receive mental health services while incarcerated.
(2) Reducing recidivism that results in individuals being returned to jail.
(3) Increasing the successful transition of individuals from jail-based mental health care to community-based care.
(4) Reducing the numbers of individuals who have been incarcerated requiring ongoing community-based mental health services.
(5) Improving the ability to track the quality of community-based care and outcomes.
(c) At the conclusion of the JBCMHIP, the commission shall report to the Legislature on the outcomes achieved through the innovation permitted by this chapter and provide guidance to the Legislature on whether jail-based care is an appropriate use of MHSA funds and, if so, under what circumstances.

SEC. 3.

 The Legislature finds and declares that this act is consistent with and furthers the intent of the Mental Health Services Act within the meaning of Section 18 of the Mental Health Services Act.
SECTION 1.Section 5813.5 of the Welfare and Institutions Code is amended to read:
5813.5.

Subject to the availability of funds from the Mental Health Services Fund, the state shall distribute funds for the provision of services under Sections 5801, 5802, and 5806 to county mental health programs. Services shall be available to adults and seniors with severe illnesses who meet the eligibility criteria in subdivisions (b) and (c) of Section 5600.3. For purposes of this act, “seniors” means older adult persons identified in Part 3 (commencing with Section 5800) of this division.

(a)Funding shall be provided at sufficient levels to ensure that counties can provide each adult and senior served pursuant to this part with the medically necessary mental health services, medications, and supportive services set forth in the applicable treatment plan.

(b)The funding shall only cover the portions of those costs of services that cannot be paid for with other funds, including other mental health funds, public and private insurance, and other local, state, and federal funds.

(c)Each county mental health program’s plan shall provide for services in accordance with the system of care for adults and seniors who meet the eligibility criteria in subdivisions (b) and (c) of Section 5600.3.

(d)Planning for services shall be consistent with the philosophy, principles, and practices of the recovery vision for mental health consumers:

(1)To promote concepts key to the recovery for individuals who have mental illness: hope, personal empowerment, respect, social connections, self-responsibility, and self-determination.

(2)To promote consumer-operated services as a way to support recovery.

(3)To reflect the cultural, ethnic, and racial diversity of mental health consumers.

(4)To plan for each consumer’s individual needs.

(e)The plan for each county mental health program shall indicate, subject to the availability of funds as determined by Part 4.5 (commencing with Section 5890) of this division, and other funds available for mental health services, adults and seniors with a severe mental illness being served by this program are either receiving services from this program or have a mental illness that is not sufficiently severe to require the level of services required of this program.

(f)Each county plan and annual update pursuant to Section 5847 shall consider ways to provide services similar to those established pursuant to the Mentally Ill Offender Crime Reduction Grant Program. Notwithstanding any other law and consistent with subdivision (a) of Section 5891, funds may be used, if that use is included in the county plan pursuant to Section 5847, to provide services to persons who are incarcerated in a county jail or subject to mandatory supervision, except as otherwise provided in this subdivision. Funds shall not be used to pay for persons who are incarcerated in a county jail for a conviction of a felony, except for purposes of facilitating discharge, or for persons incarcerated in the state prison or on parole from the state prison. If included in county plans pursuant to Section 5847, funds may be used for the provision of mental health services under Sections 5347 and 5348 in counties that elect to participate in the Assisted Outpatient Treatment Demonstration Project Act of 2002 (Article 9 (commencing with Section 5345) of Chapter 2 of Part 1).

(g)The department shall contract for services with county mental health programs pursuant to Section 5897. After November 2, 2004, the term “grants,” as used in Sections 5814 and 5814.5 refers to those contracts.

(h)This section shall become inoperative on January 1, 2023, and, as of January 1, 2024, is repealed.

SEC. 2.Section 5813.5 is added to the Welfare and Institutions Code, to read:
5813.5.

Subject to the availability of funds from the Mental Health Services Fund, the state shall distribute funds for the provision of services under Sections 5801, 5802, and 5806 to county mental health programs. Services shall be available to adults and seniors with severe illnesses who meet the eligibility criteria in subdivisions (b) and (c) of Section 5600.3. For purposes of this act, seniors means older adult persons identified in Part 3 (commencing with Section 5800) of this division.

(a)Funding shall be provided at sufficient levels to ensure that counties can provide each adult and senior served pursuant to this part with the medically necessary mental health services, medications, and supportive services set forth in the applicable treatment plan.

(b)The funding shall only cover the portions of those costs of services that cannot be paid for with other funds including other mental health funds, public and private insurance, and other local, state, and federal funds.

(c)Each county mental health program’s plan shall provide for services in accordance with the system of care for adults and seniors who meet the eligibility criteria in subdivisions (b) and (c) of Section 5600.3.

(d)Planning for services shall be consistent with the philosophy, principles, and practices of the recovery vision for mental health consumers:

(1)To promote concepts key to the recovery for individuals who have mental illness: hope, personal empowerment, respect, social connections, self-responsibility, and self-determination.

(2)To promote consumer-operated services as a way to support recovery.

(3)To reflect the cultural, ethnic, and racial diversity of mental health consumers.

(4)To plan for each consumer’s individual needs.

(e)The plan for each county mental health program shall indicate, subject to the availability of funds as determined by Part 4.5 (commencing with Section 5890) of this division, and other funds available for mental health services, adults and seniors with a severe mental illness being served by this program are either receiving services from this program or have a mental illness that is not sufficiently severe to require the level of services required of this program.

(f)Each county plan and annual update pursuant to Section 5847 shall consider ways to provide services similar to those established pursuant to the Mentally Ill Offender Crime Reduction Grant Program. Funds shall not be used to pay for persons incarcerated in state prison or parolees from state prisons. When included in county plans pursuant to Section 5847, funds may be used for the provision of mental health services under Sections 5347 and 5348 in counties that elect to participate in the Assisted Outpatient Treatment Demonstration Project Act of 2002 (Article 9 (commencing with Section 5345) of Chapter 2 of Part 1).

(g)The department shall contract for services with county mental health programs pursuant to Section 5897. After the effective date of this section, the term grants referred to in Sections 5814 and 5814.5 shall refer to such contracts.

(h)This section shall become operative on January 1, 2023.

SEC. 3.Section 5847 of the Welfare and Institutions Code is amended to read:
5847.

Integrated Plans for Prevention, Innovation, and System of Care Services.

(a)Each county mental health program shall prepare and submit a three-year program and expenditure plan, and annual updates, adopted by the county board of supervisors, to the Mental Health Services Oversight and Accountability Commission and the State Department of Health Care Services within 30 days after adoption.

(b)The three-year program and expenditure plan shall be based on available unspent funds and estimated revenue allocations provided by the state and in accordance with established stakeholder engagement and planning requirements as required in Section 5848. The three-year program and expenditure plan and annual updates shall include all of the following:

(1)A program for prevention and early intervention in accordance with Part 3.6 (commencing with Section 5840).

(2)A program for services to children in accordance with Part 4 (commencing with Section 5850), to include a program pursuant to Chapter 4 (commencing with Section 18250) of Part 6 of Division 9 or provide substantial evidence that it is not feasible to establish a wraparound program in that county.

(3)A program for services to adults and seniors in accordance with Part 3 (commencing with Section 5800).

(4)A program for innovations in accordance with Part 3.2 (commencing with Section 5830).

(5)A program for technological needs and capital facilities needed to provide services pursuant to Part 3 (commencing with Section 5800), Part 3.6 (commencing with Section 5840), and Part 4 (commencing with Section 5850). All plans for proposed facilities with restrictive settings shall demonstrate that the needs of the people to be served cannot be met in a less restrictive or more integrated setting, such as permanent supportive housing.

(6)Identification of shortages in personnel to provide services pursuant to the above programs and the additional assistance needed from the education and training programs established pursuant to Part 3.1 (commencing with Section 5820).

(7)Establishment and maintenance of a prudent reserve to ensure the county program will continue to be able to serve children, adults, and seniors that it is currently serving pursuant to Part 3 (commencing with Section 5800), the Adult and Older Adult Mental Health System of Care Act, Part 3.6 (commencing with Section 5840), Prevention and Early Intervention Programs, and Part 4 (commencing with Section 5850), the Children’s Mental Health Services Act, during years in which revenues for the Mental Health Services Fund are below recent averages adjusted by changes in the state population and the California Consumer Price Index.

(8)Certification by the county behavioral health director, which ensures that the county has complied with all pertinent regulations, laws, and statutes of the Mental Health Services Act, including stakeholder participation and nonsupplantation requirements.

(9)Certification by the county behavioral health director and by the county auditor-controller that the county has complied with any fiscal accountability requirements as directed by the State Department of Health Care Services, and that all expenditures are consistent with the requirements of the Mental Health Services Act.

(10)Until January 1, 2024, a report on expenditures made pursuant to subdivision (f) of Section 5813.5, as that section read on January 1, 2020, to provide services to persons who are incarcerated in a county jail or subject to mandatory supervision.

(c)The programs established pursuant to paragraphs (2) and (3) of subdivision (b) shall include services to address the needs of transition age youth 16 to 25 years of age. In implementing this subdivision, county mental health programs shall consider the needs of transition age foster youth.

(d)Each year, the State Department of Health Care Services shall inform the County Behavioral Health Directors Association of California and the Mental Health Services Oversight and Accountability Commission of the methodology used for revenue allocation to the counties.

(e)Each county mental health program shall prepare expenditure plans pursuant to Part 3 (commencing with Section 5800) for adults and seniors, Part 3.2 (commencing with Section 5830) for innovative programs, Part 3.6 (commencing with Section 5840) for prevention and early intervention programs, and Part 4 (commencing with Section 5850) for services for children, and updates to the plans developed pursuant to this section. Each expenditure update shall indicate the number of children, adults, and seniors to be served pursuant to Part 3 (commencing with Section 5800), and Part 4 (commencing with Section 5850), and the cost per person. The expenditure update shall include utilization of unspent funds allocated in the previous year and the proposed expenditure for the same purpose.

(f)A county mental health program shall include an allocation of funds from a reserve established pursuant to paragraph (7) of subdivision (b) for services pursuant to paragraphs (2) and (3) of subdivision (b) in years in which the allocation of funds for services pursuant to subdivision (e) are not adequate to continue to serve the same number of individuals as the county had been serving in the previous fiscal year.

(g)The department shall post on its website the three-year program and expenditure plans submitted by every county pursuant to subdivision (a) in a timely manner.

SEC. 4.

If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.

SEC. 5.

The Legislature finds and declares that this act is consistent with and furthers the intent of the Mental Health Services Act within the meaning of Section 18 of the Mental Health Services Act.

SEC. 6.

This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:

In order to address the ongoing health issues inside of county jails and to further the alignment of state funding with new policies being proposed by county governments throughout California as soon as possible, it is necessary that this act take effect immediately.