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SB-1004 Mental Health Services Act: prevention and early intervention.(2017-2018)

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Date Published: 04/16/2018 12:39 PM
SB1004:v97#DOCUMENT

Amended  IN  Senate  April 16, 2018
Amended  IN  Senate  March 22, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill No. 1004


Introduced by Senators Wiener and Moorlach
(Principal coauthor: Assembly Member Mullin)
(Coauthor: Senator Portantino)
(Coauthors: Assembly Members Arambula, Chiu, Eggman, Kiley, Maienschein, Mayes, and Waldron)

February 06, 2018


An act to add a heading to Chapter 1 (commencing with Section 5840) of, and to add Chapter 2 (commencing with Section 5840.5) to, Part 3.6 of Division 5 of the Welfare and Institutions Code, relating to mental health.


LEGISLATIVE COUNSEL'S DIGEST


SB 1004, as amended, Wiener. Mental Health Services Act: prevention and early intervention.
Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters by Proposition 63 at the November 2, 2004, statewide general election, establishes the continuously appropriated Mental Health Services Fund to fund various county mental health programs by imposing a tax of 1% on annual incomes above $1,000,000. The MHSA establishes the Mental Health Services Oversight and Accountability Commission to oversee various parts of the act, as specified. Under the MHSA, funds are distributed to counties to be expended pursuant to a local plan for specified purposes, including, but not limited to, prevention and early intervention. Existing law specifies that prevention and early intervention services include outreach, access, and linkage to medically necessary care, reduction in stigma, and reduction in discrimination. The MHSA permits amendment by the Legislature by a 2/3 vote of each house if the amendment is consistent with, and furthers the intent of, the MHSA.
This bill would require the commission, on or before January 1, 2020, to establish priorities for the use of prevention and early intervention funds and to develop a statewide strategy for monitoring implementation of prevention and early intervention services, including enhancing public understanding of prevention and early intervention and creating metrics for assessing the effectiveness of how prevention and early intervention funds are used and the outcomes that are achieved. The bill would amend the Mental Health Services Act by requiring a county, commencing with the 2020–21 fiscal year, to focus the prevention and early intervention portion of its local plan on the priorities established by the commission. The bill would authorize a county to include other priorities, as determined through the stakeholder process, either in place of, or in addition to, the established priorities. If the county chooses to include other programs, the bill would require the plan to include a description of why those programs are included and metrics by which the effectiveness of those programs are to be measured. The bill would require the commission to review the plans and approve them if they meet specified requirements. The bill would prohibit funding for county prevention and early intervention programs from being distributed expended until after the approval of the county’s prevention and early intervention plan by the commission. This bill would declare that its provisions further the intent of the MHSA.
By requiring counties to include additional information in their local plans, 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.
Vote: 2/3   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

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


SECTION 1.

 The Legislature finds and declares all of the following:
(a) Mental illness affects one in four people in the United States and is the leading cause of disability worldwide.
(b) Every year, 100,000 young adults in the United States experience their first psychotic episode, frequently involving debilitating hallucinations and delusions.
(c) The average delay in receiving appropriate diagnosis and treatment is an astonishing 18.5 months after the illness takes root and the patient suffers their first psychotic break.
(d) The longer a mental illness goes untreated, the more likely it is that a young person will spiral down a damaging course and find themselves unable to graduate, form relationships, or hold a job.
(e) Fifty percent of all mental illness begins by 14 years of age and 75 percent by 24 years of age, yet young people are often reluctant and afraid to seek help.
(f) One in 10 college students has considered suicide. Suicide is the second leading cause of death among college students, claiming more than 1,100 lives nationally every year.
(g) The Adverse Childhood Experiences Study, an observational study of the relationship between trauma in early childhood and morbidity, disability, and mortality in the United States, demonstrated that trauma and other adverse experiences are associated with lifelong problems in mental health, addiction, and general health.
(h) In the United States, more than six 6 in 10 young people have been exposed to violence within the past year, including witnessing violence, assault with a weapon, sexual victimization, child maltreatment, and dating violence. Nearly one in 10 was injured.
(i) Early intervention in mental illness comes with a measurable cost benefit. A joint analysis by The the National Academies of Sciences, Engineering, and Medicine determined that every $1 invested in prevention and early intervention for mental illness and addiction programs yields $2 to $10 in savings related to health costs, criminal and juvenile justice costs, and low productivity.
(j) A multiyear review by the National Institute of Mental Health found that patients with first episode psychosis who received early intervention, with coordinated specialty care, experienced greater improvement in their symptoms, relationships, and quality of life. They were also more involved in work or school compared with patients who did not receive these services.

SEC. 2.

 The heading of Chapter 1 (commencing with Section 5840) is added to Part 3.6 of Division 5 of the Welfare and Institutions Code, to read:
CHAPTER  1. Prevention and Early Intervention Programs

SEC. 3.

 Chapter 2 (commencing with Section 5840.5) is added to Part 3.6 of Division 5 of the Welfare and Institutions Code, to read:
CHAPTER  2. Prevention and Early Intervention Program Planning

5840.5.
 It is the intent of the Legislature that this chapter achieve all of the following:
(a) Expand the provision of high quality Mental Health Services Act (MHSA) Prevention and Early Intervention (PEI) programs at the county level in California.
(b) Reduce unnecessary hospitalizations, homelessness, suicides, and inpatient days by appropriately utilizing community-based services and improving timely access to prevention and early intervention services.
(c) Increase participation in school attendance, social interactions, physical health, personal bonding relationships, and rehabilitation, including employment and daily living function development for clients.
(d) Create a more focused approach for PEI requirements.
(e) Increase programmatic and fiscal oversight of county MHSA-funded PEI programs.
(f) Reflect the stated goals as outlined in the PEI component of the MHSA, as stated in Section 5840.

5840.6.
 For purposes of this chapter, the following definitions shall apply:
(a) “Childhood trauma prevention and early intervention” refers to a program that targets children exposed to, or who are at risk of exposure to, adverse and traumatic childhood events. This may include, but is not limited to, all of the following:
(1) Focused outreach to at-risk and in-need populations.
(2) Implementation of appropriate trauma-related screening and assessment tools.
(3) Collaborative, strengths-based approaches that appreciate the resilience of trauma survivors.
(4) Peer support.
(5) Family education and support.
(6) Leveraging the healing value of traditional cultural connections, including policies, protocols, and processes that are responsive to the racial, ethnic, and cultural needs of individuals served and recognition of historical trauma.

(b)“College mental health outreach, engagement, and service delivery” refers to a program that educates and engages students and provides either on-campus, off-campus, or linkages to mental health services not provided through the campus to students who are attending colleges and universities, including, but not limited to, public community colleges. This may include, but is not limited to, all of the following:

(1)Meeting the mental health needs of students that cannot be met through existing education funds.

(2)Establishing direct linkages for students to community-based mental health services.

(3)Addressing direct services, including, but not limited to, increasing college mental health staff-to-student ratios and decreasing wait times.

(4)Participating in evidence-based and community-defined best practice programs for mental health services.

(5)Serving underserved and vulnerable populations, including, but not limited to, lesbian, gay, bisexual, transgender, and queer persons, victims of domestic violence and sexual abuse, and veterans.

(6)Establishing direct linkages for students to community-based mental health services for which reimbursement is available through the students’ health coverage.

(7)Reducing racial disparities in access to mental health services.

(8)Funding mental health stigma reduction training and activities.

(9)Providing college employees and students with education and training in early identification, intervention, and referral of students with mental health needs.

(c)

(b) “Commission” means the Mental Health Services Oversight and Accountability Commission established pursuant to Section 5845.

(d)

(c) “County” also includes a city receiving funds pursuant to Section 5701.5.

(e)

(d) “Early psychosis and mood disorder detection and intervention” has the same meaning as set forth in paragraph (2) of subdivision (b) of Section 5835.
(e) “Outreach and engagement” means strategies that target transition age youth, with a priority on partnerships with college mental health programs that educate and engage students and provide either on-campus, off-campus, or linkages to mental health services not provided through the campus to students who are attending colleges and universities, including, but not limited to, public community colleges. This may include, but is not limited to, all of the following:
(1) Meeting the mental health needs of students that cannot be met through existing education funds.
(2) Establishing direct linkages for students to community-based mental health services.
(3) Addressing direct services, including, but not limited to, increasing college mental health staff-to-student ratios and decreasing wait times.
(4) Participating in evidence-based and community-defined best practice programs for mental health services.
(5) Serving underserved and vulnerable populations, including, but not limited to, lesbian, gay, bisexual, transgender, and queer persons, victims of domestic violence and sexual abuse, and veterans.
(6) Establishing direct linkages for students to community-based mental health services for which reimbursement is available through the students’ health coverage.
(7) Reducing racial disparities in access to mental health services.
(8) Funding mental health stigma reduction training and activities.
(9) Providing college employees and students with education and training in early identification, intervention, and referral of students with mental health needs.
(f) “Prevention and early intervention funds” means funds from the Mental Health Services Fund allocated for prevention and early intervention programs pursuant to paragraph (3) of subdivision (a) of Section 5892.

5840.7.
 (a) On or before January 1, 2020, the commission shall establish priorities for the use of prevention and early intervention funds. These priorities shall include, but are not limited to, the following:
(1) Childhood trauma prevention and early intervention to deal with the early origins of mental health needs.
(2) Outreach and engagement strategies that target transition age youth, with a priority on partnership with college mental health programs. As the program evolves, the commission shall include outreach to college age individuals who are not in college.
(3) Early psychosis and mood disorder detection and intervention.
(4) Other programs the commission identifies identifies, with stakeholder participation, that are proven effective in achieving achieving, and are reflective of, the goals stated in Section 5840.
(b) On or before January 1, 2020, the commission shall develop a statewide strategy for monitoring implementation of this part, including enhancing public understanding of prevention and early intervention and creating metrics for assessing the effectiveness of how prevention and early intervention funds are used and the outcomes that are achieved. If the commission requires additional resources for these purposes, it may prepare a proposal for consideration by the appropriate policy committees of the Legislature.

5840.8.
 (a) Commencing with the 2020–21 fiscal year, the portion of the county plans required pursuant to Section 5847 that specifies programs for prevention and early intervention, as required pursuant to paragraph (1) of subdivision (b) of Section 5847, shall be reviewed by the commission and approved if the plan meets the requirements of subdivision (b).
(b) The portion of the county plan relating to prevention and early intervention shall focus on the priorities established by the commission pursuant to Section 5840.7. A county may include other priorities, as determined through the stakeholder process, either in place of, or in addition to, the established priorities. If the county chooses to include other programs, the plan shall include a description of why those programs are included and metrics by which the effectiveness of those programs are to be measured. The commission shall consider a county’s current spending on the priorities established pursuant to Section 5840.7 when reviewing and approving a plan that includes other priorities.
(c) Commencing with the 2020–21 fiscal year, funding for county prevention and early intervention programs distributed pursuant to Section 5892 shall be distributed expended only after the commission approves the county’s prevention and early intervention plan.

5840.9.
 Notwithstanding the rulemaking provisions of the Administrative Procedures Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the commission may implement this chapter without taking regulatory action until regulations are adopted. The commission may use information notices or related communications to implement this chapter.

SEC. 4.

 The Legislature finds and declares that this act furthers the intent of the Mental Health Services Act, enacted by Proposition 63 at the November 2, 2004, statewide general election.

SEC. 5.

 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.