Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the continuously appropriated Mental Health Services Fund to fund various county mental health programs. Existing law establishes the Mental Health Services Oversight and Accountability Commission to oversee various parts of the act, as specified. Existing law authorizes the act to be amended by a ²/₃ vote of the Legislature if the amendments are consistent with, and further the intent of, the act. Existing law authorizes the Legislature to add provisions to clarify procedures and terms of the act by majority vote.

Existing law requires county mental health programs to develop plans for innovative programs, to be funded as provided, and requires the innovative programs to have specified purposes, including increasing access to services and underserved groups, increasing the quality of services, and promoting interagency collaboration. Existing law requires all projects included in the innovative program portion of a county plan to meet specified requirements. Existing law provides that an innovative project may affect virtually any aspect of mental health practices or assess a new or changed application of a promising approach to solving persistent, seemingly intractable mental health challenges, including, but not limited to, education and training for service providers, advocacy, services and interventions, or research, among other things. Existing law requires county mental health programs to expend funds for their innovation programs upon approval by the commission.

Existing law, the California Blueprint for Research to Advance Innovations in Neuroscience (Cal-BRAIN) Act of 2014, requests the Regents of the University of California to establish the Cal-BRAIN program to leverage Californias research assets and the federal Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiatives funding opportunities to accelerate the development of brain mapping techniques to achieve certain goals, including, among others, the development of a dynamic map of the human brain that provides researchers, physicians, and engineers with the knowledge necessary to develop new treatments and technologies that will improve lives and reduce the costs of providing health care.

This bill would, if research is chosen for an innovative project, require a county mental health program to consider, but not require a county to implement, research of the brain and its physical and biochemical processes that may have broad applications, but that have specific potential for understanding, treating, and managing mental illness, including, but not limited to, research through the Cal-BRAIN program or other collaborative, public-private initiatives designed to map the dynamics of neuron activity.

Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the continuously appropriated Mental Health Services Fund to fund various county mental health programs. Existing law establishes the Mental Health Services Oversight and Accountability Commission to oversee various parts of the act, as specified. Existing law authorizes the act to be amended by a ²/₃ vote of the Legislature if the amendments are consistent with, and further the intent of, the act. Existing law authorizes the Legislature to add provisions to clarify procedures and terms of the act by majority vote.

Existing law requires county mental health programs to develop plans for innovative programs, to be funded as provided, and requires the innovative programs to have specified purposes, including increasing access to services and underserved groups, increasing the quality of services, and promoting interagency collaboration. Existing law requires all projects included in the innovative program portion of a county plan to meet specified requirements. Existing law provides that an innovative project may affect virtually any aspect of mental health practices or assess a new or changed application of a promising approach to solving persistent, seemingly intractable mental health challenges, including, but not limited to, education and training for service providers, advocacy, services and interventions, or research, among other things. Existing law requires county mental health programs to expend funds for their innovation programs upon approval by the commission.

Existing law, the California Blueprint for Research to Advance Innovations in Neuroscience (Cal-BRAIN) Act of 2014, requests the Regents of the University of California to establish the Cal-BRAIN program to leverage Californias research assets and the federal Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiatives funding opportunities to accelerate the development of brain mapping techniques to achieve certain goals, including, among others, the development of a dynamic map of the human brain that provides researchers, physicians, and engineers with the knowledge necessary to develop new treatments and technologies that will improve lives and reduce the costs of providing health care.

This bill would, if research is chosen for an innovative project, require a county mental health program to consider, but not require a county to implement, research of the brain and its physical and biochemical processes that may have broad applications, but that have specific potential for understanding, treating, and managing mental illness, including, but not limited to, research through the Cal-BRAIN program or other collaborative, public-private initiatives designed to map the dynamics of neuron activity.

Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the continuously appropriated Mental Health Services Fund to fund various county mental health programs. Existing law establishes the Mental Health Services Oversight and Accountability Commission to oversee various parts of the act, as specified. Existing law authorizes the act to be amended by a ²/₃ vote of the Legislature if the amendments are consistent with, and further the intent of, the act. Existing law authorizes the Legislature to add provisions to clarify procedures and terms of the act by majority vote.

Existing law requires county mental health programs to develop plans for innovative programs, to be funded as provided, and requires the innovative programs to have specified purposes, including increasing access to services and underserved groups, increasing the quality of services, and promoting interagency collaboration. Existing law requires all projects included in the innovative program portion of a county plan to meet specified requirements. Existing law provides that an innovative project may affect virtually any aspect of mental health practices or assess a new or changed application of a promising approach to solving persistent, seemingly intractable mental health challenges, including, but not limited to, education and training for service providers, advocacy, services and interventions, or research, among other things. Existing law requires county mental health programs to expend funds for their innovation programs upon approval by the commission.

Existing law, the California Blueprint for Research to Advance Innovations in Neuroscience (Cal-BRAIN) Act of 2014, requests the Regents of the University of California to establish the Cal-BRAIN program to leverage Californias research assets and the federal Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiatives funding opportunities to accelerate the development of brain mapping techniques to achieve certain goals, including, among others, the development of a dynamic map of the human brain that provides researchers, physicians, and engineers with the knowledge necessary to develop new treatments and technologies that will improve lives and reduce the costs of providing health care.

This bill would, if research is chosen for an innovative project, require a county mental health program to consider, but not require a county to implement, research of the brain and its physical and biochemical processes that may have broad applications, but that have specific potential for understanding, treating, and managing mental illness, including, but not limited to, research through the Cal-BRAIN program or other collaborative, public-private initiatives designed to map the dynamics of neuron activity.

Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the continuously appropriated Mental Health Services Fund to fund various county mental health programs. Existing law establishes the Mental Health Services Oversight and Accountability Commission to oversee various parts of the act, as specified. Existing law authorizes the act to be amended by a ²/₃ vote of the Legislature if the amendments are consistent with, and further the intent of, the act. Existing law authorizes the Legislature to add provisions to clarify procedures and terms of the act by majority vote.

Existing law requires county mental health programs to develop plans for innovative programs, to be funded as provided, and requires the innovative programs to have specified purposes, including increasing access to services and underserved groups, increasing the quality of services, and promoting interagency collaboration. Existing law requires all projects included in the innovative program portion of a county plan to meet specified requirements. Existing law provides that an innovative project may affect virtually any aspect of mental health practices or assess a new or changed application of a promising approach to solving persistent, seemingly intractable mental health challenges, including, but not limited to, education and training for service providers, advocacy, services and interventions, or research, among other things. Existing law requires county mental health programs to expend funds for their innovation programs upon approval by the commission.

This bill would encourage a county mental health program, would, if research is chosen for an innovative project, to conduct require a county to consider, but not require a county to implement, research of the brain and its physical and biochemical processes that may have broad applications, but have specific potential for understanding, treating, and managing mental illness, as specified. including, but not limited to, research through the Cal-BRAIN program or other collaborative, public-private initiatives designed to map the dynamics of neuron activity.

Existing law, the Substance Abuse and Crime Prevention Act of 2000, which was approved by the voters as Proposition 36 at the November 7, 2000, statewide general election, establishes the Substance Abuse Treatment Trust Fund, to provide for, among other things, drug treatment programs. Proposition 36 authorizes amendment of its provisions pursuant to a ²/₃ vote of the membership of both houses of the Legislature if the amendment furthers the act and is consistent with its purposes.

This bill would make technical, nonsubstantive changes to a provision of that act.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1215

Author:(Weber)

As Amended Ver:June 7, 2018

Majority vote

Original Committee Reference: HEALTH

SUMMARY: Encourages a county mental health program (MHP) to conduct research of the brain and its physical and biochemical processes, as specified, including, but not limited to, collaborative, public-private initiatives, if research is chosen by a county MHP for an innovative project for the purpose of assessing a new or changed application of a promising approach to solving persistent mental health challenges.

The Senate amendments require, that if research is chosen for an innovative project, that the county MHP consider, but not be required to implement, research of the brain and its physical and biochemical processes including research through the Cal-BRAIN (the California Blueprint for Research to Advance Innovations in Neuroscience) program or other collaborative, public-private initiatives designed to map the dynamics of neuron activity.

FISCAL EFFECT: None

COMMENTS: According to the author, the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative was President Obama's first major policy initiative. Since that time, significant progress has been made toward the goal of providing the science and the tools that can dramatically improve our ability to understand specific brain functions at the individual level. Much like the Genome Project, the BRAIN Initiative holds the promise of fundamentally advancing the capacity (both physically and financially) to accurately diagnose and treat mental health issues. Maintaining the momentum on this work is critical to bringing its benefits to patients. This bill clarifies the ability of these programs to seek State funding to help do so. The state has a critical interest in advancing such work because of its potential to dramatically reduce the cost of mental health related spending.

1. The Kavli Foundation. This bill is sponsored by the Kavli Foundation, which seeks to provide the private half of the public-private initiative encouraged by this bill. According to its Website, the Kavli Foundation, based in Oxnard, California, is dedicated to the goals of advancing science for the benefit of humanity and promoting increased public understanding and support for scientists and their work. The Kavli Foundation's mission is implemented through an international program of research institutes, professorships, and symposia in the fields of astrophysics, nanoscience, neuroscience, and theoretical physics as well as prizes in the fields of astrophysics, nanoscience, and neuroscience. The Kavli Foundation has established Kavli Institutes on numerous campuses across the world, including the University of California, Santa Barbara; Stanford University; the University of Chicago; the Massachusetts Institute of Technology; Yale University; Columbia University; the University of California, San Diego; Harvard University; Peking University; the Chinese Academy of Sciences; the University of Cambridge; the University of California, Berkeley; and, Johns Hopkins University.
2. Funding. The Mental Health Services Act provides funding for programs within five components, discussed below. The public portion of the public-private research initiative that this bill encourages would be allocated from the innovation program.
   1. Community Services and Supports: Provides direct mental health services to the severely and seriously mentally ill, such as mental health treatment, cost of health care treatment, and housing supports. Regulation requires counties to direct the majority of its Community Services and Supports funds to Full‑Service Partnerships (FSPs). FSPs are county coordinated plans, in collaboration with the client and the family to provide the full spectrum of community services. These services consist of mental health services and supports, such as peer support and crisis intervention services; and non-mental health services and supports, such as food, clothing, housing, and the cost of medical treatment;
   2. Prevention and Early Intervention: Provides services to mental health clients in order to help prevent mental illness from becoming severe and disabling;
   3. Innovation: Provides services and approaches that are creative in an effort to address mental health clients' persistent issues, such as improving services for underserved or unserved populations within the community;
   4. Capital Facilities and Technological Needs: Creates additional county infrastructure such as additional clinics and facilities and/or development of a technological infrastructure for the mental health system, such as electronic health records for mental health services; and,
   5. Workforce Education and Training: Provides training for existing county mental health employees, outreach and recruitment to increase employment in the mental health system, and financial incentives to recruit or retain employees within the public mental health system.

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0003675

 CONSENT  

Bill No: AB 1215

Author:

:

Vote:

SENATE HEALTH COMMITTEE: 9-0, 6/27/18

AYES: Pan, Nguyen, Beall, Hernandez, Leyva, Mitchell, Monning, Nielsen, Roth

ASSEMBLY FLOOR: 69-0, 5/18/17 (Consent) - See last page for vote

SUBJECT:

SOURCE: Kavli Institute for Brain and Mind

DIGEST:

This bill requires county mental health programs, if research is chosen for an innovative project, to consider research of the brain and its physical and biochemical processes that may have broad applications but that have specific potential for understanding, treating, and managing mental illness, as specified.

ANALYSIS:

Existing law:

1. Establishes the Mental Health Services Oversight and Accountability Commission (MHSOAC) to oversee the implementation of the Mental Health Services Act (MHSA), enacted by voters in 2004 as Proposition 63, to provide funds to counties to expand services, develop innovative programs, and integrate service plans for mentally ill children, adults, and seniors through a 1% income tax on personal income above $1 million. [WIC §5845]
2. Requires each county mental health program (MHP) to prepare and submit a three-year program and expenditure plan, and annual updates, as specified, to the MHSOAC and the Department of Health Care Services (DHCS) within 30 days after adoption by the county board of supervisors. [WIC §5847]
3. Permits an innovative project to affect virtually any aspect of mental health practices or assess a new or changed application of a promising approach to solving persistent, seemingly intractable mental health challenges, including, but not limited to, any of the following:
   1. Administrative, governance, and organizational practices, processes, or procedure;
   2. Advocacy;
   3. Education and training for service providers, including nontraditional mental health practitioners;
   4. Outreach, capacity building, and community development;
   5. System development;
   6. Public education efforts;
   7. Research;
   8. Services and interventions, including prevention, early intervention, and treatment; and,
   9. Permanent supportive housing development. [WIC §5830]
4. Requires an innovative project work plan to transition to another category of MHSA funding if it has proven to be successful and an MHP chooses to continue it. [WIC §5830]
5. Requests the Regents of the University of California (UC Regents), pursuant to the California Blueprint for Research to Advance Innovations in Neuroscience (Cal-BRAIN) Act of 2014, to establish the Cal-BRAIN program to leverage California’s research assets and the federal Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative’s funding opportunities to accelerate the development of brain mapping techniques to achieve certain goals, including, among others, the development of a dynamic map of the human brain that provides researchers, physicians, and engineers with the knowledge necessary to develop new treatments and technologies that will improve lives and reduce the costs of providing health care. [EDC §92985, et seq.]

This bill requires a MHP, if research is chosen for an innovative project, to consider, but does not require an MHP to implement, research of the brain and its physical and biochemical processes that may have broad applications but that have specific potential for understanding, treating, and managing mental illness, including, but not limited to, research through the Cal-BRAIN program or other collaborative, public-private initiatives designed to map the dynamics of neuron activity.

Comments

1. Author’s statement. According to the author, the MHSA holds the promise of fundamentally advancing the capacity (both physically and financially) to accurately diagnose and treat mental health issues. This bill seeks to identify eligible funding through the existing Innovation fund for much needed research for brain mapping and related research designed to improve mental health and other brain related diagnosis and treatment. This bill clarifies the ability of programs such as the Cal-BRAIN program or other collaborative, public-private initiatives to seek state funding to ensure that this important research will continue by encouraging and clarifying that these programs are eligible for Innovation program funding.

Clarifying state funding avenues for this work will have great impact given the uncertain environment for federal funding for this research.

1. MHSA. The MHSA requires each county MHP to prepare and submit a three-year plan to DHCS that must be updated each year and approved by DHCS after review and comment by the MHSOAC. In the three-year plans, county MHPs are required to include a list of all programs for which MHSA funding is being requested and that identifies how the funds will be spent and which populations will be served. MHPs also must submit their plans for approval to the MHSOAC before they can spend funds from the Innovative program category. The MHSA provides funding for programs within five components:
   1. Community Services and Supports (CSS): Provides direct mental health services to the severely and seriously mentally ill, such as mental health treatment, cost of health care treatment, and housing supports. Regulations require counties to direct the majority of CSS funds to Full‑Service Partnerships (FSPs). FSPs are county-coordinated plans, in collaboration with the client and the family, to provide the full spectrum of community services. These services consist of mental health services and supports, such as peer support and crisis intervention services, and non-mental health services and supports, such as food, clothing, the cost of medical treatment, and housing, including rent subsidies, housing vouchers and payments, and transitional and temporary housing;
   2. Prevention and Early Intervention: Provides services to mental health clients in order to help prevent mental illness from becoming severe and disabling;
   3. Innovative programs: Provides services and approaches that are creative in an effort to address mental health clients’ persistent issues, such as improving services for underserved or unserved populations within the community, and allows for research;
   4. Capital Facilities and Technological Needs: Creates additional county infrastructure, such as additional clinics and facilities and/or development of a technological infrastructure, for the mental health system, such as electronic health records for mental health services; and,
   5. Workforce Education and Training: Provides training for existing county mental health employees, outreach and recruitment to increase employment in the mental health system, and financial incentives to recruit or retain employees within the public mental health system.
2. Cal-BRAIN. According to an April 28, 2015, UC San Diego News Center article, Cal-BRAIN is a California research grants program that aims to revolutionize our understanding of the brain and represent efforts around the state to create new technologies capable of measuring brain activity in greater depth, breadth, and detail than is currently possible. The program is the California complement to the federal BRAIN Initiative announced by President Obama in 2013. Cal-BRAIN projects seek to measure four different aspects of the brain’s activity: electrical activity, neurochemical activity, metabolic activity, and gene activity. The technological strategies include advances in microscopy, brain imaging, sensors based on nanotechnology, and neural prosthetics. All of the projects aim at innovations that will be applicable to the full spectrum of brain disorders, and several are specifically keyed to traumatic brain injury, paralysis, epilepsy, and Alzheimer’s. Upon its inception, Cal-BRAIN received $2 million aimed at developing new technologies for brain activity recording and mapping.
3. Brain research and mental illness. On April 2, 2013, President Obama launched the BRAIN Initiative to accelerate the development and application of new technologies that would enable researchers to show how individual brain cells and complex neural circuits interact at the speed of thought. The National Institutes of Health (NIH) allocated $46 million in 2014 and $81.4 million in 2015 for this purpose. According to the NIH BRAIN Initiative Web page, neurological and psychiatric disorders, such as Alzheimer’s disease, Parkinson’s disease, autism, epilepsy, schizophrenia, depression, and traumatic brain injury exact a tremendous toll on individuals, families, and society, and despite the many advances in neuroscience in recent years, the underlying causes of most of neurological and psychiatric conditions remain largely unknown due to the vast complexity of the human brain. NIH states that certain discoveries in the last decade have yielded unprecedented opportunities for integration across scientific fields, such as combining advanced genetic and optical techniques in order to use pulses of light in animal models to determine how specific cell activities within the brain affect behavior.

In a February 4, 2015, article on Stanford Medicine’s Web site, a study that analyzed whole-brain images identified a pattern across a spectrum of psychiatric disorders that are widely perceived as distinct. Researchers pooled data from 193 separate studies containing magnetic-resonance images of the brains of patients that fell into one of six diagnostic categories: schizophrenia, bipolar disorder, major depression, addiction, obsessive compulsive disorder, and a variety of related anxiety disorders. Researchers identified three separate brain structures with a diminished volume of gray matter, which serves to process information. The three structures are part of a network in the brain that is associated with higher-level executive function, such as concentrating while distracted, multitasking or task switching, planning and decision-making, and inhibition of counterproductive impulses. The gray matter loss in the three brain structures was similar across patients with different psychiatric conditions, and further analysis showed that the gray-matter shrinkage was independent of any medication effects or overlapping psychiatric conditions. Researchers stated that their findings were similar to other research, notably a genetic analysis conducted in 2013 at Massachusetts General Hospital; however, the most recent study was the first to use actual images of the brain.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

SUPPORT: (Verified 6/28/18)

Kavli Institute for Brain and Mind (source)

Alzheimer’s Association

Epilepsy California

San Diego Brain Injury Foundation

One individual

OPPOSITION: (Verified 6/28/18)

None received

ARGUMENTS IN SUPPORT: The Kavli Institute for Brain and Mind, the sponsor of this bill, and other supporters argue that this bill will enable support for important scientific research that will provide the basis for early diagnosis and treatment of mental health disorders, improve the quality of life and reduce costs to patients, and help family members in understanding the challenges of their loved ones. Supporters state that this bill will have great impact given the uncertain environment for federal funding for this type of research.

ASSEMBLY FLOOR: 69-0, 5/18/17

AYES: Acosta, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Cervantes, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dababneh, Dahle, Daly, Eggman, Flora, Fong, Gallagher, Cristina Garcia, Eduardo Garcia, Gomez, Gonzalez Fletcher, Gray, Grayson, Harper, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood

NO VOTE RECORDED: Aguiar-Curry, Calderon, Chau, Frazier, Friedman, Gipson, Gloria, Holden, Mullin, Santiago, Rendon

Prepared by:

7/3/18 15:57:57

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: AB 1215

SUBJECT: Mental Health Services Act: innovative programs: research.

SUMMARY:

Requires county mental health programs, if research is chosen for an innovative project, to consider research of the brain and its physical and biochemical processes that may have broad applications but that have specific potential for understanding, treating, and managing mental illness, as specified.

Existing law:

1. Establishes the Mental Health Services Oversight and Accountability Commission (MHSOAC) to oversee the implementation of the Mental Health Services Act (MHSA), enacted by voters in 2004 as Proposition 63, to provide funds to counties to expand services, develop innovative programs, and integrate service plans for mentally ill children, adults, and seniors through a 1% income tax on personal income above $1 million. [WIC §5845]
2. Requires each county mental health program (MHP) to prepare and submit a three-year program and expenditure plan, and annual updates, as specified, to the MHSOAC and the Department of Health Care Services (DHCS) within 30 days after adoption by the county board of supervisors. [WIC §5847]
3. Permits an innovative project to affect virtually any aspect of mental health practices or assess a new or changed application of a promising approach to solving persistent, seemingly intractable mental health challenges, including, but not limited to, any of the following:
   1. Administrative, governance, and organizational practices, processes, or procedure;
   2. Advocacy;
   3. Education and training for service providers, including nontraditional mental health practitioners;
   4. Outreach, capacity building, and community development;
   5. System development;
   6. Public education efforts;
   7. Research;
   8. Services and interventions, including prevention, early intervention, and treatment; and,
   9. Permanent supportive housing development. [WIC §5830]
4. Requires an innovative project work plan to transition to another category of MHSA funding if it has proven to be successful and an MHP chooses to continue it. [WIC §5830]
5. Requests the Regents of the University of California (UC Regents), pursuant to the California Blueprint for Research to Advance Innovations in Neuroscience (Cal-BRAIN) Act of 2014, to establish the Cal-BRAIN program to leverage California’s research assets and the federal Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative’s funding opportunities to accelerate the development of brain mapping techniques to achieve certain goals, including, among others, the development of a dynamic map of the human brain that provides researchers, physicians, and engineers with the knowledge necessary to develop new treatments and technologies that will improve lives and reduce the costs of providing health care. [EDC §92985, et seq.]

This bill: Requires a MHP, if research is chosen for an innovative project, to consider, but does not require an MHP to implement, research of the brain and its physical and biochemical processes that may have broad applications but that have specific potential for understanding, treating, and managing mental illness, including, but not limited to, research through the Cal-BRAIN program or other collaborative, public-private initiatives designed to map the dynamics of neuron activity.

FISCAL EFFECT:

This bill has been keyed nonfiscal.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, the MHSA holds the promise of fundamentally advancing the capacity (both physically and financially) to accurately diagnose and treat mental health issues. This bill seeks to identify eligible funding through the existing Innovation fund for much needed research for brain mapping and related research designed to improve mental health and other brain related diagnosis and treatment. This bill clarifies the ability of programs such as the Cal-BRAIN program or other collaborative, public-private initiatives to seek state funding to ensure that this important research will continue by encouraging and clarifying that these programs are eligible for Innovation program funding.

Clarifying state funding avenues for this work will have great impact given the uncertain environment for federal funding for this research.

1. MHSA. The MHSA requires each county MHP to prepare and submit a three-year plan to DHCS that must be updated each year and approved by DHCS after review and comment by the MHSOAC. In the three-year plans, county MHPs are required to include a list of all programs for which MHSA funding is being requested and that identifies how the funds will be spent and which populations will be served. MHPs also must submit their plans for approval to the MHSOAC before they can spend funds from the Innovative program category. The MHSA provides funding for programs within five components:
   1. Community Services and Supports (CSS): Provides direct mental health services to the severely and seriously mentally ill, such as mental health treatment, cost of health care treatment, and housing supports. Regulations require counties to direct the majority of CSS funds to Full‑Service Partnerships (FSPs). FSPs are county-coordinated plans, in collaboration with the client and the family, to provide the full spectrum of community services. These services consist of mental health services and supports, such as peer support and crisis intervention services, and non-mental health services and supports, such as food, clothing, the cost of medical treatment, and housing, including rent subsidies, housing vouchers and payments, and transitional and temporary housing;
   2. Prevention and Early Intervention: Provides services to mental health clients in order to help prevent mental illness from becoming severe and disabling;
   3. Innovative programs: Provides services and approaches that are creative in an effort to address mental health clients’ persistent issues, such as improving services for underserved or unserved populations within the community, and allows for research;
   4. Capital Facilities and Technological Needs: Creates additional county infrastructure, such as additional clinics and facilities and/or development of a technological infrastructure, for the mental health system, such as electronic health records for mental health services; and,
   5. Workforce Education and Training: Provides training for existing county mental health employees, outreach and recruitment to increase employment in the mental health system, and financial incentives to recruit or retain employees within the public mental health system.
2. Cal-BRAIN. According to an April 28, 2015, UC San Diego News Center article, Cal-BRAIN is a California research grants program that aims to revolutionize our understanding of the brain and represent efforts around the state to create new technologies capable of measuring brain activity in greater depth, breadth, and detail than is currently possible. The program is the California complement to the federal BRAIN Initiative announced by President Obama in 2013. Cal-BRAIN projects seek to measure four different aspects of the brain’s activity: electrical activity, neurochemical activity, metabolic activity, and gene activity. The technological strategies include advances in microscopy, brain imaging, sensors based on nanotechnology, and neural prosthetics. All of the projects aim at innovations that will be applicable to the full spectrum of brain disorders, and several are specifically keyed to traumatic brain injury, paralysis, epilepsy, and Alzheimer’s. Upon its inception, Cal-BRAIN received $2 million aimed at developing new technologies for brain activity recording and mapping.
3. Brain research and mental illness. On April 2, 2013, President Obama launched the BRAIN Initiative to accelerate the development and application of new technologies that would enable researchers to show how individual brain cells and complex neural circuits interact at the speed of thought. The National Institutes of Health (NIH) allocated $46 million in 2014 and $81.4 million in 2015 for this purpose. According to the NIH BRAIN Initiative Web page, neurological and psychiatric disorders, such as Alzheimer’s disease, Parkinson’s disease, autism, epilepsy, schizophrenia, depression, and traumatic brain injury exact a tremendous toll on individuals, families, and society, and despite the many advances in neuroscience in recent years, the underlying causes of most of neurological and psychiatric conditions remain largely unknown due to the vast complexity of the human brain. NIH states that certain discoveries in the last decade have yielded unprecedented opportunities for integration across scientific fields, such as combining advanced genetic and optical techniques in order to use pulses of light in animal models to determine how specific cell activities within the brain affect behavior.

In a February 4, 2015, article on Stanford Medicine’s Web site, a study that analyzed whole-brain images identified a pattern across a spectrum of psychiatric disorders that are widely perceived as distinct. Researchers pooled data from 193 separate studies containing magnetic-resonance images of the brains of patients that fell into one of six diagnostic categories: schizophrenia, bipolar disorder, major depression, addiction, obsessive compulsive disorder, and a variety of related anxiety disorders. Researchers identified three separate brain structures with a diminished volume of gray matter, which serves to process information. The three structures are part of a network in the brain that is associated with higher-level executive function, such as concentrating while distracted, multitasking or task switching, planning and decision-making, and inhibition of counterproductive impulses. The gray matter loss in the three brain structures was similar across patients with different psychiatric conditions, and further analysis showed that the gray-matter shrinkage was independent of any medication effects or overlapping psychiatric conditions. Researchers stated that their findings were similar to other research, notably a genetic analysis conducted in 2013 at Massachusetts General Hospital; however, the most recent study was the first to use actual images of the brain.

1. Prior legislation. SB 836 (Corbett of 2014) would have established the Cal-BRAIN Act of 2014 and requested the UC Regents to establish the Cal-BRAIN program. SB 836 was never heard in the Assembly Higher Education Committee.

SB 860 (Committee on Budget and Fiscal Review, Chapter 34, Statutes of 2014) established, among other things, the Cal-BRAIN Act of 2014 and requests the UC Regents to establish the Cal-BRAIN program to leverage California’s vast research assets and federal funding opportunities to accelerate the development of brain mapping techniques, including the development of new technologies.

1. Support. The Kavli Institute for Brain and Mind, the sponsor of this bill, and other supporters argue that this bill will enable support for important scientific research that will provide the basis for early diagnosis and treatment of mental health disorders, improve the quality of life and reduce costs to patients, and help family members in understanding the challenges of their loved ones. Supporters state that this bill will have great impact given the uncertain environment for federal funding for this type of research.

SUPPORT AND OPPOSITION:

Support: Kavli Institute for Brain and Mind (sponsor)

Alzheimer’s Association

Epilepsy California

San Diego Brain Injury Foundation

One individual

Oppose: None received

-- END --

Date of Hearing: May 9, 2017

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 1215

Author:(Ridley-Thomas) – As Amended Ver:March 21, 2017

SUBJECT: Mental Health Services Act: innovative programs: research.

SUMMARY: Encourages a county mental health program (MHP) to conduct research of the brain and its physical and biochemical processes, as specified, including, but not limited to, collaborative, public-private initiatives, if research is chosen by a county MHP for an innovative project for the purpose of assessing a new or changed application of a promising approach to solving persistent mental health challenges.

EXISTING LAW:

1. Establishes the Mental Health Services Act (MHSA), enacted by voters in 2004 as Proposition 63, to provide funds to counties to expand services, develop innovative programs, and integrated service plans for mentally ill children, adults, and seniors through a 1% income tax on personal income above $1 million.
2. Establishes the Mental Health Services Oversight and Accountability Commission (Commission) to oversee the implementation of MHSA, made up of 16 individuals appointed by the Governor, and the Legislature, as specified.
3. Specifies that the MHSA can only be amended by a two-thirds vote of both houses of the Legislature and only as long as the amendment is consistent with and furthers the intent of the MHSA. Permits provisions clarifying the procedures and terms of the MHSA to be added by majority vote.
4. Requires all expenditures for county MHPs to be consistent with a currently approved mental health plan or update.
5. Requires county MHPs to develop plans for innovative programs to be funded through the MHSA with the following purposes:
   1. To increase access to underserved groups;
   2. To increase the quality of services, including better outcomes;
   3. To promote interagency collaboration; and,
   4. To increase access to services, including, but not limited to, services provided through permanent supportive housing.
6. Requires all projects included in the innovative program portion of the county MHP to meet both of the following requirements:
   1. Address one of the following purposes as its primary purpose:
      1. Increase access to underserved groups, including providing access through the provision of permanent supportive housing;
      2. Increase the quality of services, including measurable outcomes;
      3. Promote interagency and community collaboration; and,
      4. Increase access to services, including providing access through the provision of permanent supportive housing.
   2. Support innovative approaches by doing one of the following:
      1. Introducing new mental health practices or approaches, including, but not limited to, prevention and early intervention;
      2. Making a change to an existing mental health practice or approach, including, but not limited to, adaptation for a new setting or community;
      3. Introducing a new application to the mental health system of a promising community-driven practice or an approach that has been successful in nonmental health contexts or settings; and,
      4. Participating in a housing program designed to stabilize a person’s living situation while also providing supportive services on site.
7. An innovative project may affect virtually any aspect of mental health practices or assess a new or changed application of a promising approach to solving persistent, seemingly intractable mental health challenges, including, but not limited to, any of the following:
   1. Administrative, governance, and organizational practices, processes, or procedures;
   2. Advocacy;
   3. Education and training for service providers, including nontraditional mental health practitioners;
   4. Outreach, capacity building, and community development;
   5. System development;
   6. Public education efforts;
   7. Research;
   8. Services and interventions, including prevention, early intervention, and treatment; and,
   9. Permanent supportive housing development.
8. Requires a project workplan to be transitioned to another category of funding if an innovative project has proven to be successful and a county chooses to continue it.

FISCAL EFFECT: None

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative was President Obama’s first major policy initiative. Since that time, significant progress has been made toward the goal of providing the science and the tools that can dramatically improve our ability to understand specific brain functions at the individual level. Much like the Genome Project, the BRAIN Initiative holds the promise of fundamentally advancing the capacity (both physically and financially) to accurately diagnose and treat mental health issues. Maintaining the momentum on this work is critical to bringing its benefits to patients. This bill clarifies the ability of these programs to seek State funding to help do so. The state has a critical interest in advancing such work because of its potential to dramatically reduce the cost of mental health related spending.
2. BACKGROUND.
   1. BRAIN Initiative. The White House BRAIN Initiative is a collaborative, public-private research initiative announced by the Obama Administration on April 2, 2013, with the goal of supporting the development and application of innovative technologies that can create a dynamic understanding of brain function. Inspired by the Human Genome Project, the BRAIN Initiative aims to help researchers uncover the mysteries of brain disorders, such as Alzheimer's and Parkinson's diseases, depression, and traumatic brain injury. According to the BRAIN Initiative Website, by accelerating the development and application of innovative technologies, researchers will be able to produce a revolutionary new dynamic picture of the brain that, for the first time, shows how individual cells and complex neural circuits interact in both time and space. This will fill major gaps in the current knowledge and provide unprecedented opportunities for exploring exactly how the brain enables the human body to record, process, utilize, store, and retrieve vast quantities of information, all at the speed of thought.
   2. The Kavli Foundation. This bill is sponsored by the Kavli Foundation, which seeks to provide the private half of the public-private initiative encouraged by this bill. According to its Website, the Kavli Foundation, based in Oxnard, California, is dedicated to the goals of advancing science for the benefit of humanity and promoting increased public understanding and support for scientists and their work. The Kavli Foundation's mission is implemented through an international program of research institutes, professorships, and symposia in the fields of astrophysics, nanoscience, neuroscience, and theoretical physics as well as prizes in the fields of astrophysics, nanoscience, and neuroscience. The Kavli Foundation has established Kavli Institutes on numerous campuses across the world, including the University of California, Santa Barbara; Stanford University; the University of Chicago; the Massachusetts Institute of Technology; Yale University; Columbia University; the University of California, San Diego; Harvard University; Peking University; the Chinese Academy of Sciences; the University of Cambridge; the University of California, Berkeley; and, Johns Hopkins University.
   3. Proposition 63/Commission. The MHSA creates the 16 member Commission charged with overseeing the implementation of MHSA. The 2017-18 Governor’s Budget projected that $1.34 billion would be deposited into the Mental Health Services Act Fund in fiscal year 2015-16. The MHSA addresses a broad continuum of prevention, early intervention and service needs as well as providing funding for infrastructure, technology and training needs for the community mental health system. The MHSA requires each county mental health department to prepare and submit a three-year plan to DHCS that must be updated each year and approved by the Department of Health Care Services (DHCS) after review and comment by the Commission. Counties must submit their plans for approval to the Commission before the counties may spend certain categories of funding.
   4. Funding. The MHSA provides funding for programs within five components, discussed below. The public portion of the public-private research initiative that this bill encourages would be allocated from the innovation program.
      1. Community Services and Supports: Provides direct mental health services to the severely and seriously mentally ill, such as mental health treatment, cost of health care treatment, and housing supports. Regulation requires counties to direct the majority of its Community Services and Supports funds to Full‑Service Partnerships (FSPs). FSPs are county coordinated plans, in collaboration with the client and the family to provide the full spectrum of community services. These services consist of mental health services and supports, such as peer support and crisis intervention services; and non-mental health services and supports, such as food, clothing, housing, and the cost of medical treatment;
      2. Prevention and Early Intervention: Provides services to mental health clients in order to help prevent mental illness from becoming severe and disabling;
      3. Innovation: Provides services and approaches that are creative in an effort to address mental health clients’ persistent issues, such as improving services for underserved or unserved populations within the community;
      4. Capital Facilities and Technological Needs: Creates additional county infrastructure such as additional clinics and facilities and/or development of a technological infrastructure for the mental health system, such as electronic health records for mental health services; and,
      5. Workforce Education and Training: Provides training for existing county mental health employees, outreach and recruitment to increase employment in the mental health system, and financial incentives to recruit or retain employees within the public mental health system.
3. RELATED LEGISLATION.
   1. AB 974 (Quirk-Silva) requires counties to report the amount of MHSA funds spent on mental health services for veterans to the DHCS and the Commission for purposes of the Annual Mental Health Services Act Revenue and Expenditure Report.
   2. AB 727 (Nazarian) clarifies that counties may spend MHSA monies on housing assistance, as defined, for people in the target population identified in the MHSA. AB 727 is pending on the Assembly Floor.

REGISTERED SUPPORT / OPPOSITION:

Support

None on file.

Opposition

None on file.

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