Existing law 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.

This bill would state the intent of the Legislature to enact legislation to enable the provision of prompt evaluation and treatment of persons with a mental health disorder, a substance use disorder, or both, to protect public safety, and to encourage the full use of all existing agencies, professional personnel, and public funds.

Date of Hearing: April 25, 2017

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 477

Author:(Ridley-Thomas) – As Amended Ver:March 23, 2017

SUBJECT: Behavioral Health Stakeholder Advisory Panel.

SUMMARY: Establishes the Behavioral Health Stakeholder Advisory Panel (advisory panel) as an independent, statewide advisory board to provide ongoing advice and assistance on behavioral health program needs and priorities to the California Health and Human Services Agency (CHHSA), including making recommendations on actions to improve the collaboration and processes of the multiple agencies involved in California’s behavioral health delivery system. Specifically, this bill:

1. Establishes the advisory panel to provide ongoing advice and assistance on behavioral health program needs and priorities to CHHSA and requires the members to be appointed by the Secretary of CHHSA and serve on a voluntary basis and without compensation.
2. Requires the advisory panel to consist of at least seven members from each of the following:
   1. The mental health provider community;
   2. The substance abuse provider community;
   3. The county public health provider community;
   4. The health plan community;
   5. The patient advocacy community;
   6. The law enforcement community; and,
   7. The education community.
3. Requires the advisory panel to elect a chairperson from among its members.
4. Specifies that the advisory panel’s powers and duties include, but are not limited to, both of the following:
   1. To advise the Secretary of CHHSA on all policies, regulations, and operations of the various agencies involved in the delivery of behavioral health services in the state; and,
   2. To meet at least quarterly, unless deemed unnecessary by the chairperson.
5. Specifies that the CHHSA's powers and duties include, but not be limited to, all of the following:
   1. To provide general support and staff assistance to the advisory panel; and,
   2. To convene and attend meetings of the advisory panel at least quarterly, unless deemed unnecessary by the chairperson, at locations that are easily accessible to the public and advisory panel members, are of sufficient duration for presentation, discussion, and public comment on each agenda item, and are in accordance with the Bagley-Keene Open Meeting Act.
6. Requires the advisory panel to submit an annual report to the Legislature on the advisory panel’s accomplishments, effectiveness, efficiency, including any recommendations for statutory changes needed to improve the effective delivery of behavioral health services in the state and the ability of the advisory panel to fulfill its purpose.
7. Requires this bill to be implemented only to the extent that funding from nonstate sources is received for its purposes.

EXISTING LAW:

1. Requires the Department of Health Care Services (DHCS) to the extent resources are available, to do all of the following:
   1. Conduct, sponsor, coordinate, and disseminate results of research and evaluation directed to the public policy issues entailed in the selection of resource utilization and service delivery in the state;
   2. Make available technical assistance to local mental health programs incorporating the results of research, evaluation, and quality assurance to local mental health programs;
   3. Implement a system of required performance reporting by local mental health programs; and,
   4. Perform any other activities useful to improving and maintaining the quality of community mental health programs.
2. Permits DHCS or the State Department of State Hospitals (DSH) to conduct, or contract for, research or evaluation studies that have application to mental health policy and management issues. Requires DHCS or DSH, in selecting areas for study, to be guided by the information needs of state and local policymakers and managers, and suggestions from the County Behavioral Health Directors Association of California.
3. Requires DHCS to serve as a clearinghouse for information on research and evaluation studies relevant to mental health and to review and disseminate the results of local, state, and national research and evaluation studies that have important implications for mental health policy or management.
4. Requires DHCS to provide, to the extent resources are available, technical assistance, through its own staff, or by contract, to county mental health programs and other local mental health agencies in the areas of program operations, research, evaluation, demonstration, or quality assurance projects.
5. Requires DHCS, to the extent resources are available, to provide program development guidelines, evaluation models, and operational assistance on all aspects of services to mentally ill persons of all ages. These services include, but are not limited to, the following:
   1. Self-help programs;
   2. Housing development;
   3. Disaster preparation;
   4. Vocational services;
   5. Regional programs; and,
   6. Multiple diagnosis programs.
6. 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 integrate service plans for mentally ill children, adults, and seniors through a 1% income tax on personal income above $1 million.
7. Requires DHCS, pursuant to the MHSA and in coordination with counties, to establish a program designed to prevent mental illnesses from becoming severe and disabling and requires the program to emphasize strategies to reduce the following negative outcomes that may result from untreated mental illness:
   1. Suicide;
   2. Incarcerations;
   3. School failure or dropout;
   4. Unemployment;
   5. Prolonged suffering;
   6. Homelessness; and,
   7. Removal of children from their homes.

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

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, significant studies of California’s behavioral health system have concluded that it is fragmented, unresponsive to consumers’ needs, does not emphasize recovery, and serves only a fraction of those suffering from mental illness. There is a strong need to ensure Californians experiencing a behavioral health crisis have access to appropriate services while preserving their individual rights.
2. BACKGROUND.
   1. California Mental Health Planning Council (Council). The Council is a majority consumer and family member advisory body to state and local government, the Legislature, and residents of California on mental health services in California. According to its Website, the vision and mission of the Council guides its evaluation of California's system of mental health care through targeted committee studies, community site visits, and General Session forums and presentations. The Council informs the Administration and the Legislature on priority issues through publications and reports, provides feedback on mental health policy and regulations, and on legislative actions based on its Policy Platform. The Council is currently working on the 2017 Data Notebook project with the county mental health boards statewide.  The data notebook is a snapshot of current mental health indicators that is compared to statewide indicators.  It is anticipated that the 2017 Data Notebook will be released in late 2017.  
   2. Proposition 63/Mental Health Services Oversight and Accountability Commission (Commission). The Mental Health Services Act (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 DHCS after review and comment by the Commission. In their three-year plans, counties 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. Counties must submit their plans for approval to the Commission before the counties may spend certain categories of funding.
3. SUPPORT. The California Hospital Association (CHA), sponsor of the bill, states that significant studies of California’s behavioral health system have concluded that it is fragmented, unresponsive to consumers’ needs, does not emphasize recovery, and serves only a fraction of those suffering from mental illness. There is a strong need to ensure Californians experiencing a behavioral health crisis have access to appropriate services while preserving their individual rights. CHA further states that it is imperative for the State of California to begin addressing the many deficiencies in our current behavioral health delivery system.
4. RELATED LEGISLATION. AB 473 (Waldron) requires the DHCS to establish a four-year pilot project, in conjunction with the Department of Corrections and Rehabilitation and administered by the University of California Criminal Justice and Health Consortium, to assist eligible counties in creating cost-effective programming for mentally ill adults in county jail systems with co-occurring substance use disorders. AB 473 is pending in the Assembly Health Committee.
5. POLICY COMMENTS. A variety of entities already exist for the purpose of advising on mental and behavioral health policy including the Council, the Commission, and County Behavioral Health Agencies. It is unclear what other functions this advisory panel could contribute that are not already tasked to these other entities.

REGISTERED SUPPORT / OPPOSITION:

Support

California Hospital Association (sponsor)

Opposition

None on file.

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