Under existing law, the State Department of Public Health licenses and regulates health facilities, defined to include, among others, acute psychiatric hospitals. A violation of these provisions is a crime.

Existing law, the Bronzan-McCorquodale Act, contains provisions governing the operation and financing of community mental health services for the mentally disordered in every county through locally administered and locally controlled community mental health programs.

Existing law, the Lanterman-Petris-Short Act, provides for the involuntary commitment and treatment of persons with specified mental disorders for the protection of the persons so committed. Under the act, when a person, as a result of a mental health disorder, is a danger to others, or to himself or herself, or gravely disabled, he or she may, upon probable cause, be taken into custody by a peace officer, a member of the attending staff of an evaluation facility, designated members of a mobile crisis team, or another designated professional person, and placed in a facility designated by the county and approved by the State Department of Social Services as a facility for 72-hour treatment and evaluation.

Existing law provides for the licensure, certification, and regulation of alcoholism or drug abuse recovery or treatment facilities, as defined, administered by the State Department of Health Care Services.

This bill would require the State Department of Public Health, in consultation with specified entities, to develop and submit a proposal to solicit a grant under the federal 21st Century Cures Act to develop a real-time, Internet-based database to collect, aggregate, and display information about the availability of beds in inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities, and licensed residential alcoholism or drug abuse recovery or treatment facilities for treatment purposes. The bill would require a database created using grant funds received as a result of the submission of that proposal to have the capacity to collect data and enable a specified search to identify beds that are appropriate for the treatment of individuals and to include specified information, including, among other things, the contact information for the facilitys designated employee and information on beds. The bill would require the department to confer with specified stakeholders to inform the development of the proposal and to submit an evaluation to the federal Health and Human Services Secretary and to the Legislature.

Under existing law, the State Department of Public Health licenses and regulates health facilities, defined to include, among others, acute psychiatric hospitals. A violation of these provisions is a crime.

Existing law, the Bronzan-McCorquodale Act, contains provisions governing the operation and financing of community mental health services for the mentally disordered in every county through locally administered and locally controlled community mental health programs.

Existing law, the Lanterman-Petris-Short Act, provides for the involuntary commitment and treatment of persons with specified mental disorders for the protection of the persons so committed. Under the act, when a person, as a result of a mental health disorder, is a danger to others, or to himself or herself, or gravely disabled, he or she may, upon probable cause, be taken into custody by a peace officer, a member of the attending staff of an evaluation facility, designated members of a mobile crisis team, or another designated professional person, and placed in a facility designated by the county and approved by the State Department of Social Services as a facility for 72-hour treatment and evaluation.

Existing law provides for the licensure, certification, and regulation of alcoholism or drug abuse recovery or treatment facilities, as defined, administered by the State Department of Health Care Services.

This bill would require the State Department of Public Health Health, in consultation with specified entities, to develop and submit a proposal to solicit a grant under the federal 21st Century Cures Act to develop a real-time, Internet-based database to collect, aggregate, and display information about the availability of beds in inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities, and licensed residential substance use disorder treatment facilities. alcoholism or drug abuse recovery or treatment facilities for treatment purposes. The bill would require a database created using grant funds received as a result of the submission of that proposal to have the capacity to collect data and enable a specified search to identify beds that are appropriate for the treatment of individuals and to include specified information, including, among other things, the contact information for the facilitys designated employee and information on beds. The bill would require the department to confer with specified stakeholders to inform the development of the proposal and to submit an evaluation to the federal Health and Human Services Secretary and to the Legislature.

Under existing law, the State Department of Public Health licenses and regulates health facilities, defined to include, among others, acute psychiatric hospitals. A violation of these provisions is a crime.

Existing law, the Bronzan-McCorquodale Act, contains provisions governing the operation and financing of community mental health services for the mentally disordered in every county through locally administered and locally controlled community mental health programs.

Existing law, the Lanterman-Petris-Short Act, provides for the involuntary commitment and treatment of persons with specified mental disorders for the protection of the persons so committed. Under the act, when a person, as a result of a mental health disorder, is a danger to others, or to himself or herself, or gravely disabled, he or she may, upon probable cause, be taken into custody by a peace officer, a member of the attending staff of an evaluation facility, designated members of a mobile crisis team, or another designated professional person, and placed in a facility designated by the county and approved by the State Department of Social Services as a facility for 72-hour treatment and evaluation.

Existing law provides for the licensure, certification, and regulation of alcoholism or drug abuse recovery or treatment facilities, as defined, administered by the State Department of Health Care Services.

This bill would require the State Department of Public Health to develop and submit a proposal to solicit a grant under the federal 21st Century Cures Act to develop a real-time, Internet-based database to collect, aggregate, and display information about beds in inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities, and licensed residential substance use disorder treatment facilities. The bill would require a database created using grant funds received as a result of the submission of that proposal to have the capacity to collect data and enable a specified search to identify beds that are appropriate for the treatment of individuals and to include specified information, including, among other things, the contact information for the facilitys designated employee. employee and information on beds. The bill would require the department to confer with stakeholders to inform the development of the proposal and to submit an evaluation to the federal Health and Human Services Secretary and to the Legislature.

Under existing law, the State Department of Public Health licenses and regulates health facilities, defined to include, among others, acute psychiatric hospitals. A violation of these provisions is a crime.

Existing law, the Bronzan-McCorquodale Act, contains provisions governing the operation and financing of community mental health services for the mentally disordered in every county through locally administered and locally controlled community mental health programs.

Existing law, the Lanterman-Petris-Short Act, provides for the involuntary commitment and treatment of persons with specified mental disorders for the protection of the persons so committed. Under the act, when a person, as a result of a mental health disorder, is a danger to others, or to himself or herself, or gravely disabled, he or she may, upon probable cause, be taken into custody by a peace officer, a member of the attending staff of an evaluation facility, designated members of a mobile crisis team, or another designated professional person, and placed in a facility designated by the county and approved by the State Department of Social Services as a facility for 72-hour treatment and evaluation.

Existing law provides for the licensure, certification, and regulation of alcoholism or drug abuse recovery or treatment facilities, as defined, administered by the State Department of Health Care Services.

This bill would require the State Department of Public Health to develop and submit a proposal to solicit a grant under the federal 21st Century Cures Act to develop a real-time, Internet-based database to collect, aggregate, and display information about beds in inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities, and licensed residential substance use disorder treatment facilities. The bill would require a database created using grant funds received as a result of the submission of that proposal to have the capacity to collect data and enable a specified search and to include specified information, including, among other things, the contact information for the facilitys designated employee. The bill would require the department to confer with stakeholders to inform the development of the proposal and to submit an evaluation to the federal Health and Human Services Secretary and to the Legislature.

Under existing law, the State Department of Public Health licenses and regulates health facilities, defined to include, among others, acute psychiatric hospitals. A violation of these provisions is a crime.

Existing law, the Bronzan-McCorquodale Act, contains provisions governing the operation and financing of community mental health services for the mentally disordered in every county through locally administered and locally controlled community mental health programs.

Existing law, the Lanterman-Petris-Short Act, provides for the involuntary commitment and treatment of persons with specified mental disorders for the protection of the persons so committed. Under the act, when a person, as a result of a mental health disorder, is a danger to others, or to himself or herself, or gravely disabled, he or she may, upon probable cause, be taken into custody by a peace officer, a member of the attending staff of an evaluation facility, designated members of a mobile crisis team, or another designated professional person, and placed in a facility designated by the county and approved by the State Department of Social Services as a facility for 72-hour treatment and evaluation.

Existing law provides for the licensure, certification, and regulation of alcoholism or drug abuse recovery or treatment facilities, as defined, administered by the State Department of Health Care Services.

This bill would require the State Department of Public Health to develop and submit a proposal to solicit a grant under the federal 21st Century Cures Act to develop a real-time, Internet-based database to collect, aggregate, and display information about beds in inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities, and licensed residential substance use disorder treatment facilities. The bill would require a database created using grant funds received as a result of the submission of that proposal to have the capacity to collect data and enable a specified search and to include specified information, including, among other things, the contact information for the facilitys designated employee. The bill would require the department to confer with stakeholders to inform the development of the proposal. proposal and to submit an evaluation to the federal Health and Human Services Secretary and to the Legislature.

Under existing law, the State Department of Public Health licenses and regulates health facilities, defined to include, among others, acute psychiatric hospitals. A violation of these provisions is a crime.

Existing law, the Bronzan-McCorquodale Act, contains provisions governing the operation and financing of community mental health services for the mentally disordered in every county through locally administered and locally controlled community mental health programs.

Existing law, the Lanterman-Petris-Short Act, provides for the involuntary commitment and treatment of persons with specified mental disorders for the protection of the persons so committed. Under the act, when a person, as a result of a mental health disorder, is a danger to others, or to himself or herself, or gravely disabled, he or she may, upon probable cause, be taken into custody by a peace officer, a member of the attending staff of an evaluation facility, designated members of a mobile crisis team, or another designated professional person, and placed in a facility designated by the county and approved by the State Department of Social Services as a facility for 72-hour treatment and evaluation.

Existing law provides for the licensure, certification, and regulation of alcoholism or drug abuse recovery or treatment facilities, as defined, administered by the State Department of Health Care Services.

This bill would require the State Department of Public Health to develop and submit a proposal to solicit a grant under the federal 21st Century Cures Act to develop a real-time, Internet-based database to collect, aggregate, and display information about beds in inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities, and residential substance use disorder treatment facilities. The bill would require a database created using grant funds received as a result of the submission of that proposal to have the capacity to collect data and to include specified information, including, among other things, the contact information for the facilitys designated employee. The bill would require the department to confer with stakeholders to inform the development of the proposal.

Under existing law, the State Department of Public Health licenses and regulates health facilities, defined to include, among others, acute psychiatric hospitals. A violation of these provisions is a crime.

Existing law, the Bronzan-McCorquodale Act, contains provisions governing the operation and financing of community mental health services for the mentally disordered in every county through locally administered and locally controlled community mental health programs.

Existing law, the Lanterman-Petris-Short Act, provides for the involuntary commitment and treatment of persons with specified mental disorders for the protection of the persons so committed. Under the act, when a person, as a result of a mental health disorder, is a danger to others, or to himself or herself, or gravely disabled, he or she may, upon probable cause, be taken into custody by a peace officer, a member of the attending staff of an evaluation facility, designated members of a mobile crisis team, or another designated professional person, and placed in a facility designated by the county and approved by the State Department of Social Services as a facility for 72-hour treatment and evaluation.

Existing law provides for the licensure, certification, and regulation of alcoholism or drug abuse recovery or treatment facilities, as defined, administered by the State Department of Health Care Services.

This bill would require the State Department of Public Health to develop and submit a proposal to solicit a grant under the federal 21st Century Cures Act to develop a real-time, Internet-based database to collect, aggregate, and display information about beds in inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities, and residential substance use disorder treatment facilities.

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2017 - 2018 Regular Session

AB 1136 (Eggman) - Health facilities: residential mental health or substance use disorder treatment.

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

Requires the Department of Public Health (DPH) to develop and submit a proposal to solicit a federal grant, as specified, to develop a real-time, Internet-based database to help identify and designate facilities with available beds for the treatment of individuals experiencing a mental health or substance use disorder crisis. Requires CDPH to submit an evaluation of the effect of the grant to the federal Health and Human Services Secretary and to the Legislature.

Fiscal Impact:

• One-time $1 million contract (Licensing and Certification Program Fund) for CDPH to develop the database development and initial programming, plus ongoing IT funding of $100,000. Absorbable staff time to provide helpdesk services.
• $116,757 (L&C Program Fund) in budget year and $114,757 (L&C Program Fund), ongoing, for 1.0 full-time research analyst to apply and maintain federal grants, and assist in enforcement efforts. Staff notes budget year would depend on the year CDPH is awarded the grant, likely 2019-20.
• $410,000 (General Fund) in FY 2019-20 and $383,000 annually (General Fund) funded for Department of Health Care Services workload: 1.0 Health Program Specialist I (HPS I) to monitor the registry for timeliness, accuracy, and completeness and provide technical assistance to facilities pertaining to the database requirements and collaborating with CDPH as it relates to the data collection; and 2.0 full-time Associate Governmental Program Analyst positions to research and develop guidelines.

Background:

1. The Helping Families Act requires the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to award competitive grants to state and local governments and Indian tribes and tribal organizations to enhance community-based crisis response systems, or to develop, maintain, or enhance a database of beds at inpatient psychiatric facilities, crisis stabilization units, and residential community mental health and residential SUD treatment facilities. The Helping Families Act also authorizes the appropriation of $12.5 million each year for the period of fiscal years 2018 through 2022 for the purpose of creating an enhanced community-based crisis response system or database of beds. In order to receive a grant, states are required to submit an application to SAMHSA with a plan that includes, but is not limited to, promoting integration and coordination between local public and private entities engaged in crisis response, developing memoranda of understanding with public and private entities, addressing gaps in community resources for crisis intervention and prevention, and developing models for minimizing hospital readmissions, including through appropriate discharge planning. A state’s application is required to establish a database of beds to include a plan for developing, maintaining, or enhancing a real-time, Internet-based bed database to collect, aggregate, and display information about beds, as specified. Entities that receive a grant are required to submit to SAMHSA an evaluation of the effect of the grant, including, but not limited to, individuals reporting improved functional outcomes and receiving regular follow-up care following a crisis.

Proposed Law:

The bill includes the following provisions, among others:

• Requires the CDPH, in consultation with the Department of Health Care Services (DHCS), State Department of Social Services (CDSS), and County Behavioral Health Directors Association of California (CBHDA), to develop and submit a proposal to solicit a grant authorized under the federal 21st Century Cures Act (Public Law 114-255) to develop a real-time, Internet-based database to collect, aggregate, and display information about beds in inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities, and licensed residential alcoholism or drug abuse recovery or treatment facilities in order to facilitate the identification and designation of facilities for the temporary treatment of individuals in mental health or substance use disorder crisis.
• Except as specified, requires the database created using grant funds received as a result of the proposal submitted to include, at a minimum, all of the following:
• The contact information for the facility’s designated employee.
• The facility’s license type.
• If the facility provides substance use disorder, mental health, or medical treatment.
• If the bed is secure for the treatment of a person who, as a result of a mental health disorder, is a danger to others, or to himself or herself, or gravely disabled, pursuant to Part 1 (commencing with Section 5000) of Division 5 of the Welfare and Institutions Code.
• The types of diagnoses for which the bed is appropriate.
• The age ranges for which the bed is appropriate.
• Whether the bed is available.
• Requires the database to have the capacity to collect data and enable searches to identify beds that are appropriate for the treatment of individuals in a mental health or substance use disorder crisis.
• A database created using grant funds received as a result of the proposal submitted pursuant to subdivision (a) shall not include any information relating to state hospitals under the jurisdiction of the State Department of State Hospitals.
• Requires CDPH to confer with specified stakeholders to inform the development of the proposal developed pursuant to this article.
• Requires the department, in consultation with DHCS, DSS, and CBHDA, to submit to the federal Health and Human Services Secretary and the Legislature an evaluation of the effect of any grant funds received as a result of the proposal on all of the following:
• Local crisis response services and measures for individuals receiving crisis planning and early intervention supports.
• Individuals reporting improved functional outcomes.
• Individuals receiving regular follow-up care following a crisis.

Related Legislation:

The Legislature has considered similar policies, including:

• AB 1372 (Levine, 2018) permits a certified crisis stabilization unit, as specified, to provide medically necessary crisis stabilization services to individuals beyond the service time of 24 hours, as required in current law, in cases where an individual needs inpatient psychiatric care or outpatient care, and inpatient psychiatric beds or outpatient services are not reasonably available. AB 1372 is on the inactive file on the Senate Floor.
• AB 2743 (Eggman, 2016) was substantially similar to this bill. AB 2743 was held on the Assembly Appropriations Committee suspense file.

Staff Comments:

If CDPH was awarded the grant, and a database was created, DHCS would need to monitor the facilities it oversees to ensure compliance with any guidelines or timeframes that CDPH establishes to implement the database requirements. This would likely include onsite monitoring visits and technical assistance to facilities. In addition DHCS assumes it would need to designate staff to act as a liaison with CDPH to coordinate data collection efforts. 

The State of Virginia launched the Virginia Acute Psychiatric and Community Services Board Bed Registry, a mandatory web-based registry in March of 2014, which was developed through a multi-year partnership between the Virginia Department of Behavioral Health and Developmental Services (DBHDS), the Virginia Hospital and Healthcare Association, the Community Services Boards (CSBs)/Behavioral Health Authorities in Virginia (which are similar to California’s county MHPs), and the Virginia Health Information. A January 2016 report published by the Virginia Office of the State Inspector General (OSIG report) examined the utility of the registry as a tool for emergency services staff to facilitate the identification and designation of facilities for the temporary detention and treatment of individuals including the registry’s successes, challenges, and efficiencies, and the impact of the current registry-related operations on various health facilities and stakeholders. A survey of registry users indicated that for 55% of respondents it was taking more time to locate a willing facility than prior to the implementation of the registry.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: AB 1136

SUBJECT: Health facilities: residential mental health or substance use disorder treatment.

SUMMARY:

Requires the Department of Public Health (DPH) to develop and submit a proposal to solicit a federal grant, as specified, to develop a real-time, Internet-based database to help identify and designate facilities with available beds for the treatment of individuals experiencing a mental health or substance use disorder crisis. Require DPH to submit an evaluation of the effect of the grant to the federal Health and Human Services Secretary and to the legislature.

Existing federal law: Establishes the 21^st Century Cures Act which authorizes the Helping Families in Mental Health Crisis Reform Act of 2016 (Helping Families Act) for the purpose of increasing the availability of psychiatric hospital beds and supports the creation of a database of beds at facilities that treat those with mental health and substance use disorders, as specified. [Public Law 114-255 §520F]

Existing state law:

1. Establishes DPH to license and regulate hospitals, including a general acute care hospital and an acute psychiatric hospital. [HSC §1250, et. seq.]
2. Establishes the Department of Health Care Services (DHCS) to license and regulate residential alcoholism or drug abuse recovery or treatment facilities. [HSC §11834.02, et seq.]
3. Requires DHCS and counties to provide specialty mental health services for Medi-Cal beneficiaries through a county mental health plan (MHP), as specified, which may include crisis stabilization services and inpatient psychiatric care. [WIC §14705 and 14712]
4. Establishes the Department of Social Services (DSS) to license community care facilities, including any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children, and may include crisis residential services. [HSC §1501, et seq.]
5. Establishes psychiatric health facilities, licensed by DHCS, which provide 24-hour inpatient care for people with mental health disorders that includes, but is not limited to, the following basic services: psychiatry; clinical psychology; psychiatric nursing; social work; rehabilitation drug administration; and, appropriate food services for those persons whose physical health needs can be met in an affiliated hospital or in outpatient settings. [HSC §1250.2 and WIC §4080]
6. Establishes the Lanterman-Petris-Short (LPS) Act, which authorizes a person to be involuntarily detained for a period of up to 72 hours for assessment, evaluation, and crisis intervention (known as a “5150” hold), when as a result of a mental disorder the person is a danger to self or others, or is “gravely disabled,”. Defines “gravely disabled” as a condition in which a person, as a result of a mental disorder, is unable to provide for his or her basic personal needs for food, clothing, or shelter. [WIC §5008 and 5150]
7. Requires facilities, for the purposes of detaining a person for up to 72-hour treatment and evaluation, to be designated by a county and approved by DHCS, which may be a licensed psychiatric hospital, a licensed psychiatric health facility, and a certified crisis stabilization unit. [WIC §5008]

This bill:

1. Requires DPH, in consultation with DHCS, DSS, and the County Behavioral Health Directors Association of California (CBHDAC), to develop and submit a proposal to solicit a grant under the Helping Families Act to develop a real-time, Internet-based database to collect, aggregate, and display information about beds in inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities, and licensed residential alcoholism or drug abuse recovery or treatment facilities in order to facilitate the identification and designation of facilities for the temporary treatment of individuals in mental health or substance use disorder (SUD) crisis.
2. Requires the database to have the capacity to collect data and enable searches to identify beds that are appropriate for the treatment of individuals in a mental health or SUD crisis and to include, at a minimum, all of the following:
3. The contact information for the facility’s designated employee;
4. The facility’s license type;
5. If the facility provides SUD, mental health, or medical treatment;
6. If the bed is secure for the treatment of a person who is involuntarily detained on a 5150;
7. The types of diagnoses for which the bed is appropriate;
8. The age ranges for which the bed is appropriate; and,
9. Whether the bed is available.
10. Prohibits the database from including information relating to state hospitals under the jurisdiction of the Department of State Hospitals.
11. Requires DPH to confer with stakeholders to inform the development of the proposal to include, but not be limited to, DHCS, DSS, CBHDAC, and organizations that have experience providing inpatient psychiatric care, psychiatric crisis stabilization, residential community mental health services, and residential alcoholism or drug abuse recovery or treatment services.
12. Requires DPH, in consultation with DHCS, DSS, and CBHDAC, to submit to the federal Health and Human Services Secretary, and to the Legislature, an evaluation of the effect of any grant funds received for the development of a database on all of the following:
13. Local crisis response services and measures for individuals receiving crisis planning and early intervention supports;
14. Individuals reporting improved functional outcomes; and,
15. Individuals receiving regular follow-up care following a crisis.

FISCAL EFFECT:

According to the Assembly Appropriations Committee:

1. One-time staff costs to research and submit a grant proposal, likely in the range of $50,000 (General Fund (GF) or Licensing and Certification Fund).
2. Assuming the grant application was accepted, estimated one-time cost potentially in excess of $1 million in contract information technology costs (federal funds).
3. Annual ongoing contract funding for approximately $100,000 for maintenance of the registry system, and $100,000 in staffing costs GF or Licensing and Certification Fund).
4. Contract costs for an evaluation report, estimated in the low hundreds of thousands of dollars (federal funds or Licensing and Certification Fund).

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, mental illness, like many other health conditions, when treated early and with appropriate supports and services, can resolve in recovery. Although 16% of California adults live with a mental illness, more than 60% of those do not receive treatment. From 2004 to 2013, the number of hospital beds in the state remained largely unchanged while the number of acute psychiatric beds decreased by 22%. A Web-based bed registry would improve mental health service access by getting patients who are dealing with mental health crises to the appropriate professionals more quickly, and streamlining communication to reduce patient waiting time. The inclusion of other community mental health and SUD treatment providers will also help psychiatric facilities find appropriate placements when patients are ready for a lower level of care. This bill demonstrates California’s dedication to improving access to mental health services while leveraging federal dollars to maximize the benefit to the state.
2. Background. The Helping Families Act requires the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to award competitive grants to state and local governments and Indian tribes and tribal organizations to enhance community-based crisis response systems, or to develop, maintain, or enhance a database of beds at inpatient psychiatric facilities, crisis stabilization units, and residential community mental health and residential SUD treatment facilities. The Helping Families Act also authorizes the appropriation of $12.5 million each year for the period of fiscal years 2018 through 2022 for the purpose of creating an enhanced community-based crisis response system or database of beds. In order to receive a grant, states are required to submit an application to SAMHSA with a plan that includes, but is not limited to, promoting integration and coordination between local public and private entities engaged in crisis response, developing memoranda of understanding with public and private entities, addressing gaps in community resources for crisis intervention and prevention, and developing models for minimizing hospital readmissions, including through appropriate discharge planning. A state’s application is required to establish a database of beds to include a plan for developing, maintaining, or enhancing a real-time, Internet-based bed database to collect, aggregate, and display information about beds, as specified. Entities that receive a grant are required to submit to SAMHSA an evaluation of the effect of the grant, including, but not limited to, individuals reporting improved functional outcomes and receiving regular follow-up care following a crisis.
3. Insufficient inpatient psychiatric beds. According to the California Hospital Association (CHA), since 1995 the state has lost 44 facilities, either through the elimination of psychiatric inpatient care, or complete hospital closure, representing a nearly 25% drop. CHA states that while there has been an increase in psychiatric beds since 2012, according to 2015 data, California has lost nearly 30% of the psychiatric beds it had in 1995, a drop of almost 2,800 beds, making the state’s psychiatric bed rate one bed for every 5,922 people, compared to a national average of one bed for every 5,006 people. CHA states that the recommended number of psychiatric beds is 50 per 100,000 individuals, which is contingent upon the availability of appropriate outpatient services in the community. As of 2015, California has 16.91 inpatient beds per 100,000 people. A CBHDA of California Governing Board Policy Brief from November 2015 cites specific challenges that contribute to the lack of crisis and inpatient care capacity, including:
   1. The federal Medicaid Institution for Mental Disease exclusion, which prohibits states from receiving federal matching funds for mental health inpatient services they provide to adult Medicaid enrollees aged 18-65 years in a hospital, nursing home, or other inpatient care setting with more than 16 beds;
   2. Stigma and discrimination, due to negative attitudes and myths about the dangerousness of people with mental illness. Counties and providers often face substantial community opposition when attempting to construct or repurpose a facility intended to be used for individuals in psychiatric crisis or in need of inpatient care; and,
   3. Divestment in acute psychiatric care and competing demands on hospitals, as, according to a report by the California HealthCare Foundation, hospitals have focused more in the last decade on general acute care services (both adult and newborn intensive care capacity) over skilled nursing and acute psychiatric services. According to the American Hospital Association, hospitals have been closing psychiatric units because of low payments from public and private payers, uncompensated care for uninsured patients, and a dearth of psychiatrists willing to work in hospitals.
4. State of Virginia registry. The State of Virginia launched the Virginia Acute Psychiatric and Community Services Board Bed Registry, a mandatory web-based registry in March of 2014, which was developed through a multi-year partnership between the Virginia Department of Behavioral Health and Developmental Services (DBHDS), the Virginia Hospital and Healthcare Association, the Community Services Boards (CSBs)/Behavioral Health Authorities in Virginia (which are similar to California’s county MHPs), and the Virginia Health Information. A January 2016 report published by the Virginia Office of the State Inspector General (OSIG report) examined the utility of the registry as a tool for emergency services staff to facilitate the identification and designation of facilities for the temporary detention and treatment of individuals including the registry’s successes, challenges, and efficiencies, and the impact of the current registry-related operations on various health facilities and stakeholders. A survey of registry users indicated that for 55% of respondents it was taking more time to locate a willing facility than prior to the implementation of the registry. Additionally, 36% of respondents indicated that the registry did not improve the time that it took to identify an available bed, and only 9% reported that the amount of time it took to identify an available bed decreased. The OSIG report further states that facilities, CSBs, and/or providers are not uniformly updating the registry whenever there is a change in bed availability, and in addition to requiring duplicative efforts by staff, the registry resulted in diverting limited staff time and resources, preventing individuals from placement in an appropriate bed in the most efficient manner, and preventing emergency services staff from proceeding to other emergencies. The OSIG report recommended that DBHDS ensure that all providers are in full compliance with the registry requirements by developing a system for monitoring providers’ procedures for updating it whenever a change in bed availability occurs, and to develop a process for addressing non-compliance.
5. Related legislation. AB 1372 (Levine) permits a certified crisis stabilization unit, as specified, to provide medically necessary crisis stabilization services to individuals beyond the service time of 24 hours, as required in current law, in cases where an individual needs inpatient psychiatric care or outpatient care, and inpatient psychiatric beds or outpatient services are not reasonably available. AB 1372 is on the inactive file on the Senate Floor.

AB 1971 (Santiago, Chen, and Friedman) expands the definition of “gravely disabled” in existing law to include a person’s inability to provide for his or her personal needs for “medical treatment,” as defined, if the failure to receive medical treatment results in a deteriorating physical condition or death. AB 1971 passed this Committee by a vote of 7-2 on June 20, 2018.

1. Prior legislation. AB 2743 (Eggman of 2016) was substantially similar to this bill. AB 2743 was held on the Assembly Appropriations Committee suspense file.

SB 743 (Committee on Health, Chapter 612, Statutes of 2009) extended the amount of time, up to 24 hours, a non-designated hospital can detain persons who meet criteria for a 5150 hold and also extended civil and criminal liability protection to non-designated hospitals and specified staff.

1. Support. The California Psychiatric Association (CPA) and the Steinberg Institute, the cosponsors of this bill, and other supporters, largely advocates and provider organizations, argue that people who experience mental health crisis often receive a first assessment in an emergency department (ED), and once that occurs and the individual needs more specialized crisis care, the problem of access arises. Supporters argue that people often languish in EDs for hours or days, and this issue is only increasing across the state as the number of hospital acute psychiatric beds has decreased by 22% from 2004 to 2013, while other hospital beds remained largely unchanged. Supporters argue that a database will allow updates in real-time in order to assist the transfer of patients in need of services, making the process more efficient. Supporters state that the current system is outdated and arduous, requiring EDs to make phone calls to facilities, ask for a current status, and track that information internally. Supporters state that this problem is widely reported by ED doctors and staff, individuals and families, and mental health professionals across the state. CPA states that California is one of 24 states that lack a statewide computerized tracking database, or other electronic system, for the tracking of available psychiatric beds in community-based hospitals. Supporters also state that a database would require contact information for a facility admissions coordinator in order to ensure that the right person is available to discuss bed availability, as, currently, in large hospitals and other types of facilities, not knowing with whom to speak about available beds can result in a missed connection and creates a barrier to access.
2. Opposition. DPH argues that this bill will not address the decline in total acute psychiatric beds across the state, and that county-level professionals and mental health departments are better suited to assist facilities in finding inpatient psychiatric placements. DPH states that a state-level registry that does not collaborate with county and local mental health professionals will cause confusion and potentially delay access to care. DPH, the California Children’s Hospital Association, and the California Hospital Association (CHA) argue that attempts in other states to develop real-time bed databases have not always proven reliable, and have instead redirected critical staff within hospitals to administrative functions and away from patient care. CHA argues that a registry would not remove the necessity for professionals to call facilities with available beds to ascertain appropriateness for the patient, the capability and capacity of the facility, or the need to work with individuals and family to make treatment decisions.
3. Policy comment. As noted in the Virginia OSIG report, entities that use the bed registry are not uniformly performing updates. The report recommends that the Virginia DBHDS develop a system for monitoring providers’ procedures for updating the registry. The author may wish to clarify how DPH will ensure that the various facility types identified in this bill use the database.

SUPPORT AND OPPOSITION:

Support: California Psychiatric Association (cosponsor)

Steinberg Institute (cosponsor)

Association of California Cities-Orange County

California Academy of Child and Adolescent Psychiatry

California Access Coalition

California Chapter of the American College of Emergency Physicians

California Consortium of Addiction Programs and Professionals

California Council of Community Behavioral Health Agencies

California State Sheriffs’ Association

Depression and Bipolar Support Alliance

National Association of Social Workers, California Chapter

State Council on Developmental Disabilities

Oppose: California Children’s Hospital Association

California Hospital Association

Department of Public Health

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 1136

Author:(Eggman)

As Amended Ver:May 26, 2017

Majority vote

SUMMARY: Requires the Department of Public Health (DPH) to develop and submit a proposal to solicit a federal grant to develop an Internet-based database to collect information about beds in inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities, and residential substance use disorder (SUD) treatment facilities. Specifically, this bill:

1. Requires DPH to develop and submit a proposal to solicit a grant under the federal 21st Century (SUD) Cures Act (Cures Act) to develop a real-time, Internet-based database to collect, aggregate, and display information about beds in inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities, and residential substance use disorder treatment facilities.
2. Requires the database to include, at minimum, all of the following:
   1. The contact information for the psychiatric health facility's designated employee;
   2. The license type of the facility;
   3. Whether the facility provides substance abuse treatment;
   4. Whether the facility provides medical treatment;
   5. Whether the available bed is secure;
   6. The types of diagnoses for which the available bed is appropriate; and,
   7. The age ranges for which the bed is appropriate.
3. Requires the database to have the capacity to collect data.
4. Requires DPH to confer with stakeholders to inform the development of the proposal to be submitted, requires stakeholders to include, but not be limited to, organizations that have experience providing inpatient psychiatric care, organizations that have experience providing psychiatric crisis stabilization, organizations that have experience providing residential community mental health services, and organizations that have experience providing residential SUD treatment.

FISCAL EFFECT: According to the Assembly Appropriations Committee:

1. One-time staff costs to research and submit a grant proposal, likely in the range of $50,000 (General Fund or Licensing and Certification Fund).
2. Assuming the grant application was accepted, estimated one-time cost potentially in excess of $1 million in contract information technology costs (federal funds).
3. Annual ongoing contract funding for approximately $100,000 for maintenance of the registry system, and $100,000 in staffing costs (General Fund or Licensing and Certification Fund).
4. Contract costs for an evaluation report, estimated in the low hundreds of thousands of dollars (federal funds or Licensing and Certification Fund).

COMMENTS: According to the author, mental illness, like many other health conditions, when treated early and with appropriate supports and services, can resolve in recovery. Although 16% of California adults live with a mental illness, more than 60% of those do not receive treatment. From 2004 to 2013, the number of hospital beds in the state remained largely unchanged, while the number of acute psychiatric beds decreased by 22%. A Web-based psychiatric bed registry would improve mental health service access by getting patients dealing with mental health crises to the appropriate professionals more quickly and streamlining communication and reduce patient waiting time. This bill demonstrates California’s dedication to improving access to mental health services, while leveraging federal dollars to maximize the benefit to the state.

1. Psychiatric Bed Shortages. According to 2011 Office of Statewide Health Planning and Development data analyzed by the California Hospital Association (CHA), California has lost 44 psychiatric facilities from 1995-2011, either through the elimination of psychiatric inpatient care, or complete hospital closure, representing a 24% drop. This represents a loss of almost 32%, or nearly 3000 beds compared to 1995. California’s bed rate is one bed for every 5,975 people, as of 2011, compared to the nation’s average of one bed for every 4,758 people. Additionally, 26 of California’s 58 counties have no inpatient psychiatric services. The California HealthCare Foundation estimates that as of 2011 there are approximately 6,000 acute psychiatric beds in California.
2. Virginia Registry. A large number of states have some sort of computerized tracking database in place for acute psychiatric beds, with wide variation on the type of bed tracked. Alabama, Connecticut, and Texas track available beds only in their state hospitals or state-run funded beds while some states, like Massachusetts, track private acute care beds. However, all states that have comprehensive databases rely on voluntary participation. The exception to this is the state of Virginia, which launched the Virginia Acute Psychiatric and Community Services Board Bed Registry, a mandatory web-based registry in March of 2014. A January 2016, report published by the Virginia Office of the State Inspector General (OSIG report) examined the utility of the registry as a tool for emergency services staff to facilitate the identification and designation of facilities for the temporary detention and treatment of individuals including the registry’s successes, challenges, and efficiencies, and the impact of the current registry-related operations on various health facilities and stakeholders. While the OSIG report found full compliance with the mandates in statute, a survey of registry users indicated that for 55% of respondents it was taking more time to locate a willing facility than prior to the implementation of the registry. Additionally, 36% of respondents indicated that the registry did not improve the time that it took to identify an available bed, and only 9% reported that the amount of time it took to identify an available bed decreased. The OSIG report states that the lack of regular updating of the registry, in addition to requiring duplicative efforts by staff, resulted in diverting limited staff time and resources, preventing individuals from placement in an appropriate bed in the most efficient manner, and preventing emergency services staff from proceeding to other emergencies.
3. 21st Century Cures Act. The Cures Act, enacted in December of 2016, provides the NIH with $4.8 billion in new funding that will help advance the Precision Medicine Initiative to drive research into the genetic, lifestyle, and environmental variations of disease ($1.5 billion); bolster cancer research ($1.8 billion); and invest in the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative to improve understanding of diseases like Alzheimer's. The second half of the Cures Act also authorized the Helping Families in Mental Health Crisis Act, which included the following provisions:
   1. Creating a new Assistant Secretary for Mental Health and Substance Use to replace the Administrator at the Substance Abuse and Mental Health Services Administration (SAMHSA) and coordinate mental health programs across the federal government;
   2. Establishing the National Mental Health and Substance Use Policy Lab to drive evidence based grant making within SAMHSA;
   3. Directing the HHS Secretary to undertake guidance to clarify when communication can take place under Health Insurance Portability and Accountability Act to help ensure communication among providers, families, and patients to improve mental health treatment;
   4. Improving mental health care for children with serious emotional disturbance, or adults with serious mental illness, through targeted authorizations and reauthorizations, including the expansion of Assisted Outpatient Treatment.
   5. Strengthening the nation’s mental health workforce;
   6. Reducing government spending by $5 million according to a preliminary analysis from the Congressional Budget Office; and,
   7. An appropriation of $12.5 million for the period of fiscal years 2018 through 2022 for states to establish an enhanced community-based crisis response system or EBD.

The California Psychiatric Association (CPA), sponsor of the bill, states that this bill would increase access to acute psychiatric inpatient beds, crisis stabilization facility openings, as well as residential mental health and residential substance use disorder treatment facilities by providing an accessible tool to help match patients in a timely way with open beds when they are in crisis and need emergency care, or need the intensive services provided in residential care. An online, statewide bed registry would streamline the process of identification and would serve to provide access to the level of care appropriate for individual patients more timely.

The California Chapter of the American College of Emergency Physicians (Cal ACEP) states in support that currently there is no way of accurately knowing how many psychiatric beds are available at an given time, in any region of California. Patients unable to receive adequate mental health services often find themselves in the ED. Between 1992 and 2001, the number of mental health related ED visits increased by 38%, compared to an 8% increase in overall ED usage. Cal ACEP states that this bill is necessary to demonstrate where capacity is sufficient and where more is needed.

CHA states in opposition that this bill fails to establish a mechanism whereby the efficacy and outcomes are measured and show improvement in placement and access to care. Furthermore, "real-time" bed registries have been tried in other states and they have proven to be very difficult to implement and have not shown significantly improved efficiencies. CHA further states that individuals outside of the hospital setting believe that a mandated registry would alleviate ED delays in accessing crisis behavioral health services. Although this may sound like an easy solution, it does nothing to solve the gaps in access to services at all levels of crisis care, nor does it ensure that individuals will gain treatment in the least restrictive setting possible. CHA concludes that this bill would do little to improve the availability or access to inpatient beds for individuals in need of emergency inpatient psychiatric care and would redirect critical staff within the hospitals and administrative functions and away from patient care.

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0000701

Date of Hearing: May 10, 2017

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 1136

Author:(Eggman) – As Amended Ver:May 1, 2017

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires the California Department of Public Health (CDPH) to apply for a specified federal grant to develop a real-time, web-based database to collect, aggregate, and display information about available beds in specified inpatient, crisis stabilization, and residential behavioral health facilities.

FISCAL EFFECT:

1. One-time staff costs to research and submit a grant proposal, likely in the range of $50,000 (GF or Licensing and Certification Fund).
2. Assuming the grant application was accepted, estimated one-time cost potentially in excess of $1 million in contract information technology costs (federal funds).
3. Annual ongoing contract funding for approximately $100,000 for maintenance of the registry system, and $100,000 in staffing costs (GF or Licensing and Certification Fund).
4. Contract costs for an evaluation report, estimated in the low hundreds of thousands of dollars (federal funds or Licensing and Certification Fund).
5. Minor costs (GF) to the Department of State Hospitals for training staff and reporting to the registry, if this bill applies to state hospitals. State hospitals would likely be considered inpatient psychiatric facilities, but only Napa State Hospital routinely accepts patients in psychiatric crisis.

COMMENTS:

1. Purpose. The author indicates this bill is necessary in order to facilitate the identification and designation of facilities for the temporary treatment of individuals in mental or substance use disorder crisis.
2. Background. Finding appropriate behavioral health care is difficult for those in crisis. According to 2011 OSHPD data analyzed by the California Hospital Association, California has lost nearly 32%, or nearly 3,000 inpatient psychiatric beds compared to 1995. California’s bed rate is one bed for every 5,975 people, as of 2011, compared to the nation’s average of one bed for every 4,758 people. Additionally, 26 of California’s 58 counties have no inpatient psychiatric services. Other states have implemented similar registries to track availability of inpatient psychiatric beds, generally on a voluntary basis. Virginia, however, recently implemented mandatory electronic reporting to a registry. An independent evaluation noted this approach had some important strengths but also significant challenges and limited impact in reducing wait times for locating facilities.
3. Available Federal Funding. The federal 21^st Century Cures Act, enacted in December of 2016, authorized the Helping Families in Mental Health Crisis Act, which included, among other things, an appropriation of $12.5 million for states to establish enhanced community-based crisis response systems or electronic bed registries.
4. Support. The California Psychiatric Association, a cosponsor of this bill, argues that the need is critical because the loss of about 3,000 California psychiatric beds in the last two decades has made open beds more difficult to find. The Steinberg Institute, also a cosponsor of the bill, the California Chapter of the American College of Emergency Physicians (Cal/ACEP), and other groups write in support.
5. Opposition. The California Hospital Association (CHA) and numerous individual hospitals oppose this bill, contending an electronic bed registry would do little to improve the availability or access to inpatient beds for individuals in need of emergency inpatient psychiatric care and would redirect critical staff within the hospitals to administrative functions and away from patient care. CHA argues that “real-time” bed registries have been tried in other states (both on a voluntary and mandated basis) and they have proven to be very difficult to implement and have not shown significantly improved efficiencies. CHA concludes that an electronic registry would not remove the necessity for professionals to call facilities with available beds to ascertain appropriateness for the patient, the capability and capacity of the facility, nor the need to work with the individual and family to make treatment decisions.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 25, 2017

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 1136

Author:(Eggman) – As Amended Ver:April 17, 2017

SUBJECT: Health facilities: residential mental or substance use disorder treatment.

SUMMARY: Requires the Department of Public Health (DPH) to develop and submit a proposal to solicit a federal grant to develop an Internet-based database to collect information about beds in inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities, and residential substance use disorder (SUD) treatment facilities. Specifically, this bill:

1. Requires DPH to develop and submit a proposal to solicit a grant under the federal 21st Century (SUD) Cures Act (Cures Act) to develop a real-time, Internet-based database to collect, aggregate, and display information about beds in inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities, and residential substance use disorder treatment facilities.
2. Requires the database to include, at minimum, all of the following:
   1. The contact information for the psychiatric health facility's designated employee;
   2. The license type of the facility;
   3. Whether the facility provides substance abuse treatment;
   4. Whether the facility provides medical treatment;
   5. Whether the available bed is secure;
   6. The types of diagnoses for which the available bed is appropriate; and,
   7. The age ranges for which the bed is appropriate.
3. Requires the database to have the capacity to collect data.
4. Requires DPH to confer with stakeholders to inform the development of the proposal to be submitted, requires stakeholders to include, but not be limited to, organizations that have experience providing inpatient psychiatric care, organizations that have experience providing psychiatric crisis stabilization, organizations that have experience providing residential community mental health services, and organizations that have experience providing residential SUD treatment.

EXISTING FEDERAL LAW:

1. Establishes the 21^st Century Cures Act (H.R. 6, Public Law 114-225) which authorized $6.3 billion in funding for the National Institutes of Health (NIH) for the purpose of reducing opioid abuse, medical research, and drug development and authorized the Helping Families In Mental Health Crisis Act for the purpose of increasing the availability of psychiatric hospital beds, establishing a new Assistant Secretary for Mental Health and SUDs in the federal Department of Health and Human Services (HHS), and boosting treatment for young mental health patients, among other provisions.
   
2. Requires the HHS Secretary to award competitive grants to state and local governments and Indian tribes and tribal organizations, to enhance community-based crisis response systems; or to states to develop, maintain, or enhance an electronic bed database (EBD) at inpatient psychiatric facilities, crisis stabilization units, and residential community mental health and residential SUD treatment facilities, for adults with a serious mental illness, children with a serious emotional disturbance, or individuals with a SUD.
   
3. Appropriates $12.5 million each year for the period of fiscal years 2018 through 2022 for the purpose of creating an enhanced community-based crisis response system or EBD.
   
4. Requires a state, in order to receive a grant, to submit to the HHS Secretary an application, at such time, in such manner, and containing such information as the HHS Secretary may require that includes a plan for the following:
   1. Promoting integration and coordination between local public and private entities engaged in crisis response, including first responders, emergency health care providers, primary care providers, law enforcement, court systems, health care payers, social service providers, and behavioral health providers;
   2. Developing memoranda of understanding with public and private entities to implement crisis response services;
   3. Addressing gaps in community resources for crisis intervention and prevention; and,
   4. Developing models for minimizing hospital readmissions, including through appropriate discharge planning.
      
5. Requires an application to establish an EBD to include a plan for developing, maintaining, or enhancing a real-time, Internet-based bed database to collect, aggregate, and display information about beds in inpatient psychiatric facilities and crisis stabilization units, and residential community mental health and residential SUD treatment facilities to facilitate the identification and designation of facilities for the temporary treatment of individuals in mental or SUD crisis.
   
6. Requires an EBD established by a state to provide the following:
   1. Information on inpatient psychiatric facilities, crisis stabilization units, and residential community mental health and residential SUD facilities in the State involved, including contact information for the facility or unit;
   2. Real-time information about the number of beds available at each facility or unit and, for each available bed, the type of patient that may be admitted, the level of security provided, and any other information that may be necessary to allow for the proper identification of appropriate facilities for treatment of individuals in mental or SUD crisis; and,
   3. Enable searches of the EBD to identify available beds that are appropriate for the treatment of individuals in mental or SUD crisis.

7) Requires an entity receiving a grant to submit to the HHS Secretary an evaluation of the effect of such grant on:

• 1. Local crisis response services and measures for individuals receiving crisis planning and early intervention supports;
  2. Individuals reporting improved functional outcomes; and,
  3. Individuals receiving regular follow-up care following a crisis.

EXISTING STATE LAW:

1. Establishes the Department of Health Care Services (DHCS) to license adult alcoholism or drug abuse recovery or treatment facilities. Permits new licenses to be issued for a period of two years and requires DHCS to conduct onsite program visits for compliance at least once during the two year licensing period.
2. Defines “alcoholism or drug abuse recovery or treatment facility” (treatment facility) as any premise, place, or building that provides 24-hour residential, nonmedical services to adults who are recovering from problems related to alcohol, drug, or alcohol and drug misuse or abuse, and who need alcohol, drug, or alcohol and drug recovery treatment or detoxification services.
3. Establishes requirements for application for licensure of a facility, requires DHCS to terminate licensure if these requirements are not met, and authorizes DHCS to deny a license of applicants that do not demonstrate an ability to comply with specified requirements.
4. Defines a psychiatric health facility, as a health facility licensed by DHCS that provides 24-hour inpatient care for people with mental health disorders. Specifies that this care must include, but not be limited to, the following basic services: psychiatry; clinical psychology; psychiatric nursing; social work; rehabilitation drug administration; and, appropriate food services for those persons whose physical health needs can be met in an affiliated hospital or in outpatient settings.
5. Provides for the involuntary commitment and treatment of individuals with specified mental disorders and for the protection of committed individuals, with the declared goal of ending inappropriate, indefinite, and involuntary commitment of mentally disordered persons, developmentally disabled persons, and persons impaired by chronic alcoholism.
6. Defines “designated facility” or “facility designated by the county for evaluation and treatment” as a facility that is licensed or certified as a mental health treatment facility or a hospital, as defined by the DPH regulations, and may include, but is not limited to, a licensed psychiatric hospital, a licensed psychiatric health facility, and a certified crisis stabilization unit.
7. Establishes the Lanterman-Petris Short Act (LPS Act), which authorizes a person to be involuntarily detained for a period of up to 72 hours for assessment, evaluation, and crisis intervention, when, as a result of a mental disorder, the person is a danger to him or herself or to others, or is “gravely disabled.”
8. Defines “gravely disabled” to mean a condition in which a person, as a result of a mental disorder, is unable to provide for his or her basic personal needs for food, clothing, or shelter.
9. Allows, under the LPS Act, a person who is gravely disabled to be involuntarily detained for further inpatient mental health treatment for an additional 14 days, as provided, which can be extended for 14 days if the person presents an imminent threat of taking his or her own life.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, mental illness, like many other health conditions, when treated early and with appropriate supports and services, can resolve in recovery. Although 16% of California adults live with a mental illness, more than 60% of those do not receive treatment. From 2004 to 2013, the number of hospital beds in the state remained largely unchanged, while the number of acute psychiatric beds decreased by 22%. A Web-based psychiatric bed registry would improve mental health service access by getting patients dealing with mental health crises to the appropriate professionals more quickly and streamlining communication and reduce patient waiting time. This bill demonstrates California’s dedication to improving access to mental health services, while leveraging federal dollars to maximize the benefit to the state.
2. BACKGROUND.
   1. Psychiatric Bed Shortages. According to 2011 Office of Statewide Health Planning and Development (OSHPD) data analyzed by the California Hospital Association (CHA), California has lost 44 psychiatric facilities from 1995-2011, either through the elimination of psychiatric inpatient care, or complete hospital closure, representing a 24% drop. This represents a loss of almost 32%, or nearly 3000 beds compared to 1995. California’s bed rate is one bed for every 5,975 people, as of 2011, compared to the nation’s average of one bed for every 4,758 people. Additionally, 26 of California’s 58 counties have no inpatient psychiatric services. The California HealthCare Foundation estimates that as of 2011 there are approximately 6,000 acute psychiatric beds in California.
   2. Crisis Residential Programs and Crisis Stabilization. According to a 2010 report by the California Mental Health Planning Council, crisis residential programs are a lower-cost, community-based treatment option in home-like settings that help reduce emergency department (ED) visits and divert hospitalization and incarcerations. These programs include peer-run programs such as crisis respites that offer safer, trauma-informed alternatives to psychiatric emergency units, or other locked facilities. The report indicates that crisis residential programs reduce unnecessary stays in psychiatric hospitals, reduce the number and expense of ED visits, and divert inappropriate incarcerations while producing the same or superior outcomes to those of institutionalized care. The report states that, as the costs for inpatient treatment continue to rise, the need to expand an appropriate array of acute treatment settings becomes more urgent, and state and county mental health systems should encourage and support alternatives to costly institutionalization and improve the continuum of care to better serve individuals experiencing an acute psychiatric episode. Crisis stabilization services are those lasting less than 24 hours for individuals who are in psychiatric crisis whose needs cannot be accommodated safely in a residential service setting. Crisis stabilization must be provided onsite at a 24-hour health facility, hospital-based outpatient program, or at other certified provider sites. The goal of crisis stabilization is to stabilize the consumer and re-integrate him or her back into the community quickly. According to various reports, costs of providing care in a crisis stabilization unit are significantly lower than inpatient hospitalization. Crisis stabilization units include both EDs and urgent care units licensed for the purpose of crisis stabilization.
   3. Licensed SUD Facilities. Licensed alcoholism or drug abuse recovery or treatment facilities provide 24-hour non-medical care and specialize in providing services to chemically dependent adults who do not require treatment in an acute-care medical facility on an inpatient, intensive outpatient, outpatient, and partial hospitalization basis. These facilities range in size from six-bed facilities in residential neighborhoods to centers that accommodate more than 100 beds. The basic services provided by facilities include group, individual, and educational sessions, alcoholism or drug abuse, recovery and treatment planning. Detoxification services are also provided and are defined by DHCS as services to support and assist an individual in the alcohol and/or drug withdrawal process and to explore plans for continued treatment. These services can be provided by a variety of health care providers such as alcohol and drug counselors, mental health therapists, social workers, psychologists, nurses, and physicians. According to information provided on the California Health and Human Services Agency open data portal, there are 18,768 licensed SUD treatment beds in California.
   4. Virginia Registry. A large number of states have some sort of computerized tracking database in place for acute psychiatric beds, with wide variation on the type of bed tracked. Alabama, Connecticut, and Texas track available beds only in their state hospitals or state-run funded beds while some states, like Massachusetts, track private acute care beds. However, all states that have comprehensive databases rely on voluntary participation. The exception to this is the state of Virginia, which launched the Virginia Acute Psychiatric and Community Services Board Bed Registry, a mandatory web-based registry in March of 2014. A January 2016, report published by the Virginia Office of the State Inspector General (OSIG report) examined the utility of the registry as a tool for emergency services staff to facilitate the identification and designation of facilities for the temporary detention and treatment of individuals including the registry’s successes, challenges, and efficiencies, and the impact of the current registry-related operations on various health facilities and stakeholders. While the OSIG report found full compliance with the mandates in statute, a survey of registry users indicated that for 55% of respondents it was taking more time to locate a willing facility than prior to the implementation of the registry. Additionally, 36% of respondents indicated that the registry did not improve the time that it took to identify an available bed, and only 9% reported that the amount of time it took to identify an available bed decreased. The OSIG report states that the lack of regular updating of the registry, in addition to requiring duplicative efforts by staff, resulted in diverting limited staff time and resources, preventing individuals from placement in an appropriate bed in the most efficient manner, and preventing emergency services staff from proceeding to other emergencies.
   5. OSHPD reporting requirements. Under existing law, OSHPD is the single state agency that collects specified health facility or clinic data for use by all state agencies. All licensed acute care hospitals, including psychiatric health facilities, are required to file with OSHPD certain reports, including a Hospital Discharge Abstract Data Record that includes 19 specified patient-based data elements for each admission, including date of birth, sex, admission date, discharge date, principal diagnosis, other diagnoses, principal procedures, and disposition of the patient. In addition to this discharge report, hospitals are required to file an Emergency Care Data Record for each patient encounter in a hospital ED, and hospitals and freestanding ambulatory surgery clinics are required to file an Ambulatory Surgery Data Record for each patient encounter during which at least one ambulatory surgery procedure is performed. For all three reports, OSHPD is permitted to make additions or deletions to the data elements required in these reports, as long as OSHPD adds no more than a net of 15 elements to each data set over any five-year period, and as long as OSHPD considers the costs and benefits of data collection and other factors prior to adding or deleting any data element.
   6. 21^st Century Cures Act. The Cures Act, enacted in December of 2016, provides the NIH with $4.8 billion in new funding that will help advance the Precision Medicine Initiative to drive research into the genetic, lifestyle, and environmental variations of disease ($1.5 billion); bolster cancer research ($1.8 billion); and invest in the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative to improve understanding of diseases like Alzheimer's. The second half of the Cures Act also authorized the Helping Families in Mental Health Crisis Act, which included the following provisions:
      1. Creating a new Assistant Secretary for Mental Health and Substance Use to replace the Administrator at the Substance Abuse and Mental Health Services Administration (SAMHSA) and coordinate mental health programs across the federal government;
      2. Establishing the National Mental Health and Substance Use Policy Lab to drive evidence based grant making within SAMHSA;
      3. Directing the HHS Secretary to undertake guidance to clarify when communication can take place under Health Insurance Portability and Accountability Act to help ensure communication among providers, families, and patients to improve mental health treatment;
      4. Improving mental health care for children with serious emotional disturbance, or adults with serious mental illness, through targeted authorizations and reauthorizations, including the expansion of Assisted Outpatient Treatment.
      5. Strengthening the nation’s mental health workforce;
      6. Reducing government spending by $5 million according to a preliminary analysis from the Congressional Budget Office; and,
      7. An appropriation of $12.5 million for the period of fiscal years 2018 through 2022 for states to establish an enhanced community-based crisis response system or EBD.
3. SUPPORT. The California Psychiatric Association (CPA), sponsor of the bill, states that this bill would increase access to acute psychiatric inpatient beds, crisis stabilization facility openings, as well as residential mental health and residential substance use disorder treatment facilities by providing an accessible tool to help match patients in a timely way with open beds when they are in crisis and need emergency care, or need the intensive services provided in residential care.

When patients with mental health issues are in extremely vulnerable or fragile states, their condition may be deteriorating, and particularly if they are verging on being a danger to themselves, or a danger to others, a bed in a facility where they can get intensive inpatient treatment quickly is critical. The sooner they can get into an appropriate level of care, the sooner they can start being treated. If they are a danger to themselves or others, this aspect may also be a public safety issue. An online, statewide bed registry would streamline the process of identification and would serve to provide access to the level of care appropriate for individual patients more timely.

The California Chapter of the American College of Emergency Physicians (Cal ACEP) states that currently there is no way of accurately knowing how many psychiatric beds are available at an given time, in any region of California. Patients unable to receive adequate mental health services often find themselves in the ED. Between 1992 and 2001, the number of mental health related ED visits increased by 38%, compared to an 8% increase in overall ED usage. Cal ACEP states that this bill is necessary to demonstrate where capacity is sufficient and where more is needed.

The California State Sheriffs' Association (CSSA) states in support that law enforcement officers often encounter persons in the community who present a danger to themselves or others because of mental health disorders. CSSA states that this bill will help address the problem of bed availability by assisting in the development of an Internet database that will streamline the identification of health facilities that have beds available for temporary detention and treatment. Mental health patients will be more likely to be placed in an appropriate environment, while law enforcement and medical professionals will not have to take unnecessary steps to search for available beds.

1. OPPOSITION. CHA states that this bill fails to establish a mechanism whereby the efficacy and outcomes are measured and show improvement in placement and access to care. Furthermore, "real-time" bed registries have been tried in other states and they have proven to be very difficult to implement and have not shown significantly improved efficiencies. CHA further states that individuals outside of the hospital setting believe that a mandated registry would alleviate ED delays in accessing crisis behavioral health services. Although this may sound like an easy solution, it does nothing to solve the gaps in access to services at all levels of crisis care, nor does it ensure that individuals will gain treatment in the least restrictive setting possible. CHA concludes that this bill would do little to improve the availability or access to inpatient beds for individuals in need of emergency inpatient psychiatric care and would redirect critical staff within the hospitals and administrative functions and away from patient care.
2. RELATED LEGISLATION. AB 1539 (Chen) expands, for purposes of the LPS Act, the definition of “gravely disabled” to also include a condition in which a person, as a result of a mental health disorder or chronic alcoholism, as applicable, is unable to provide for his or her medical care. AB 1539 is pending in the Assembly Health Committee.
3. PREVIOUS LEGISLATION.
   1. AB 2743 (Eggman) of 2016, would have required DPH to establish an Internet web-based electronic acute psychiatric bed registry to collect, aggregate, and display information regarding the availability of acute psychiatric beds in psychiatric health facilities. AB 2743 was held in the Assembly Appropriations Committee.
   2. AB 1300 (Ridley-Thomas) of 2015, would have made numerous changes to the provisions regarding evaluation procedures, terms, and lengths of detention, and criteria for release and transfer protocol related to the involuntary detention of individuals. AB 1300 was held in the Senate Rules Committee
   3. AB 1194 (Eggman), Chapter 570, Statutes of 2015, requires, when an individual is determining if a person is a danger as a result of a mental health disorder, the individual to consider available relevant information about the historical course of the person's mental disorder, if the individual concludes that the information has a reasonable bearing on the determination and specifies danger is not limited to danger of imminent harm.
4. POLICY COMMENT. As noted above, AB 2743 (Eggman) of 2016 was a substantially similar bill limited to an EBD for acute psychiatric beds. An analysis by the Assembly Appropriations Committee indicated a $1 million one-time cost and $200,000 in annual on-going costs. This bill expands the EBD to include inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities, and residential SUD treatment facilities, at a likely significantly higher cost. The entirety of the federal funds available is $12.5 million and will likely not cover the cost of a state-wide EBD as provided for in this bill.
5. SUGGESTED AMENDMENTS.
   1. The Committee may consider the following amendments to be consistent with the requirements of the Cures Act:
      1. Requiring the EBD to enable searches of the database to identify available beds that are appropriate for the treatment of individuals in mental or SUD crisis, and
      2. An evaluation of the program that includes local crisis response services and measures for individuals receiving crisis planning and early intervention supports; the number of individuals reporting improved functional outcomes; and the number of individuals receiving regular follow-up care following a crisis.
   2. The Committee may also wish to consider requiring the evaluation in ii) above to be submitted to the appropriate policy committees of the Legislature.

REGISTERED SUPPORT / OPPOSITION:

Support

California Psychiatric Association (co-sponsor)

Steinberg Institute (co-sponsor)

California Access Coalition

California Chapter of the American College of Emergency Physicians

California Council of Community Behavioral Health Agencies

California State Sheriffs' Association

National Association of Social Workers – California Chapter

Tenet Healthcare

Opposition

California Hospital Association

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097