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

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Date Published: 09/27/2018 09:00 PM
SB1004:v92#DOCUMENT

Senate Bill No. 1004
CHAPTER 843

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.

[ Approved by Governor  September 27, 2018. Filed with Secretary of State  September 27, 2018. ]

LEGISLATIVE COUNSEL'S DIGEST


SB 1004, 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 require the commission to establish a strategy for technical assistance, support, and evaluation to support the successful implementation of the objectives, metrics, data collection, and reporting strategy. The bill would amend the Mental Health Services Act by requiring the portion of the funds in the county plan relating to prevention and early intervention to focus 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 authorize counties to act jointly to meet specified requirements. The bill would require the commission to review the plans and approve them if they meet specified requirements. 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) Toxic stress, which is the result of frequent or prolonged biological responses to adversity, can damage a developing brain and increase the likelihood of significant mental illness and problems that may emerge immediately or in years to come.
(i) In California, nearly 1 in 7 children have experienced abuse or neglect.
(j) In the United States, more than 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 1 in 10 was injured.
(k) Early intervention in mental illness comes with a measurable cost benefit. A joint analysis by 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.
(l) 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.
(m) A report conducted by the University of California at Los Angeles Center for Health Policy Research in 2015 states that more than 70 percent of behavioral health conditions are diagnosed and treated within the primary care setting, underscoring the critical role of primary care in linking clients to care across their lifespans.
(n) As documented in “Mental Health: A Report of the Surgeon General” and its supplement, “Mental Health: Culture, Race, and Ethnicity,” racial and ethnic minorities have less access to mental health services, are less likely to receive needed care, and are more likely to receive poor quality care when treated.
(o) A report, entitled “Mental Health Services for Older Adults: Creating a System that Tells the Story,” conducted by the University of California at Los Angeles Center for Health Policy Research in January 2018, states that services provided under the Mental Health Services Act are insufficient. The report identifies the need to further involve and include older adults in the Prevention and Early Intervention programs, including the planning process and outreach efforts, and improve the coordination and administration of the older adult system of care at the statewide level.
(p) Older adults face a significant risk of mental health conditions due to failing health, isolation, economic insecurity, and vulnerability to exploitation, often leading to depression, anxiety, and psychological traumas.
(q) The average age for onset of a major depressive disorder is 32.5 years.
(r) Older adults consist of 13 percent of the population. However, this population has the highest suicide rate of any age group, and older adults account for 20 percent of the people who commit suicide.

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) Increase the number of PEI programs and systems, including those utilizing community-defined practices, that focus on reducing disparities for unserved, underserved, and inappropriately served racial, ethnic, and cultural communities.
(c) Reduce unnecessary hospitalizations, homelessness, suicides, and inpatient days by appropriately utilizing community-based services and improving timely access to prevention and early intervention services.
(d) Increase participation in community activities, school attendance, social interactions, physical and primary health care services, personal bonding relationships, and rehabilitation, including employment and daily living function development for clients.
(e) Increase collaboration and coordination among primary care, mental health, and aging service providers, and reduce hesitance to seek treatment and services due to mental health stigma.
(f) Create a more focused approach for PEI requirements.
(g) Increase programmatic and fiscal oversight of county MHSA-funded PEI programs.
(h) Encourage counties to coordinate and blend funding streams and initiatives to ensure services are integrated across systems.
(i) Encourage counties to leverage innovative technology platforms.
(j) 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) “Commission” means the Mental Health Services Oversight and Accountability Commission established pursuant to Section 5845.
(b) “County” also includes a city receiving funds pursuant to Section 5701.5.
(c) “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.
(d) “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 and prolonged toxic stress in order to deal with the early origins of mental health needs and prevent long-term mental health concerns. This may include, but is not limited to, all of the following:
(1) Focused outreach and early intervention to at-risk and in-need populations.
(2) Implementation of appropriate trauma and developmental screening and assessment tools with linkages to early intervention services to children that qualify for these services.
(3) Collaborative, strengths-based approaches that appreciate the resilience of trauma survivors and support their parents and caregivers when appropriate.
(4) Support from peer support specialists and community health workers trained to provide mental health services.
(5) Multigenerational family engagement, education, and support for navigation and service referrals across systems that aid the healthy development of children and families.
(6) Linkages to primary care health settings, including, but not limited to, federally qualified health centers, rural health centers, community-based providers, school-based health centers, and school-based programs.
(7) 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.
(8) Coordinated and blended funding streams to ensure individuals and families experiencing toxic stress have comprehensive and integrated supports across systems.
(e) “Early psychosis and mood disorder detection and intervention” has the same meaning as set forth in paragraph (2) of subdivision (b) of Section 5835 and may include programming across the age span.
(f) “Youth outreach and engagement” means strategies that target secondary school and 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. Outreach and engagement 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.
(10) Interventions for youth with signs of behavioral or emotional problems who are at risk of, or have had any, contact with the juvenile justice system.
(11) Integrated youth mental health programming.
(12) Suicide prevention programming.
(g) “Culturally competent and linguistically appropriate prevention and intervention” refers to a program that creates critical linkages with community-based organizations, including, but not limited to, clinics licensed or operated under subdivision (a) of Section 1204 of the Health and Safety Code, or clinics exempt from clinic licensure pursuant to subdivision (c) of Section 1206 of the Health and Safety Code.
(1) “Culturally competent and linguistically appropriate” means the ability to reach underserved cultural populations and address specific barriers related to racial, ethnic, cultural, language, gender, age, economic, or other disparities in mental health services access, quality, and outcomes.
(2) “Underserved cultural populations” means those who are unlikely to seek help from any traditional mental health service because of stigma, lack of knowledge, or other barriers, including members of ethnically and racially diverse communities, members of the gay, lesbian, bisexual, and transgender communities, and veterans, across their lifespans.
(h) “Strategies targeting the mental health needs of older adults” means, but is not limited to, all of the following:
(1) Outreach and engagement strategies that target caregivers, victims of elder abuse, and individuals who live alone.
(2) Suicide prevention programming.
(3) Outreach to older adults who are isolated.
(4) Early identification programming of mental health symptoms and disorders, including, but not limited to, anxiety, depression, and psychosis.

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) Early psychosis and mood disorder detection and intervention, and mood disorder and suicide prevention programming that occurs across the lifespan.
(3) Youth outreach and engagement strategies that target secondary school and transition age youth, with a priority on partnership with college mental health programs.
(4) Culturally competent and linguistically appropriate prevention and intervention.
(5) Strategies targeting the mental health needs of older adults.
(6) Other programs the commission identifies, with stakeholder participation, that are proven effective in 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. The commission shall analyze and monitor the established metrics using existing data, if available, and shall propose new data collection and reporting strategies, if necessary.
(c) The commission shall establish a strategy for technical assistance, support, and evaluation to support the successful implementation of the objectives, metrics, data collection, and reporting strategy.
(d) (1) The portion of funds in the county plan relating to prevention and early intervention shall focus on the established priorities, and shall be allocated, as determined by the county, with stakeholder input. 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 is to be measured.
(2) Counties may act jointly to meet the requirements of this section.
(e)  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.
 Notwithstanding the rulemaking provisions of the Administrative 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.