Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. If a defendant who has been charged with a misdemeanor has been determined to be mentally incompetent, existing law authorizes the court to either grant diversion for a period of one year, refer the defendant to treatment, or dismiss the charge.

Existing law, the Bronzan-McCorquodale Act, governs the organization and financing of community mental health services for persons with mental disorders in every county through locally administered and locally controlled community mental health programs.

This bill would require the court to notify an individual of their ongoing need for mental health services if the individual has been found incompetent to stand trial and is not receiving court directed services. The bill would require the court to provide the individual with specified information, including the name, address, and telephone number of the county behavioral health department.

Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. If a defendant who has been charged with a misdemeanor has been determined to be mentally incompetent, existing law authorizes the court to either grant diversion for a period of one year, refer the defendant to treatment, or dismiss the charge.

Existing law, the Bronzan-McCorquodale Act, governs the organization and financing of community mental health services for persons with mental disorders in every county through locally administered and locally controlled community mental health programs.

This bill would require the court to notify an individual of their ongoing need for mental health services if the individual has been found incompetent to stand trial and is not receiving court directed services. The bill would require the court to provide the individual with specified information, including the name, address, and telephone number of the county behavioral health department.

Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. If a defendant who has been charged with a misdemeanor has been determined to be mentally incompetent, existing law authorizes the court to either grant diversion for a period of one year, refer the defendant to treatment, or dismiss the charge.

Existing law, the Bronzan-McCorquodale Act, governs the organization and financing of community mental health services for persons with mental disorders in every county through locally administered and locally controlled community mental health programs.

This bill would require the court to notify an individual of their ongoing need for mental health services if the individual has been found incompetent to stand trial and is not receiving court directed services. The bill would require the court to provide the individual with specified information, including the name, address, and telephone number of the county behavioral health department. The bill would require a county behavioral health department, in collaboration and coordination with community-based organizations, to attempt to make first contact with an individual within 48 hours of release, to track outreach attempts for an individual for at least 60 days following their release, and to offer mental health services and treatment, as appropriate, and assist with facilitating an individuals access to private insurance, if applicable. By creating new requirements for county behavioral health departments, this bill would impose a state-mandated local program.

Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. If a defendant who has been charged with a misdemeanor has been determined to be mentally incompetent, existing law authorizes the court to either grant diversion for a period of one year, refer the defendant to treatment, or dismiss the charge.

Existing law, the Bronzan-McCorquodale Act, governs the organization and financing of community mental health services for persons with mental disorders in every county through locally administered and locally controlled community mental health programs.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. If a defendant who has been charged with a misdemeanor has been determined to be mentally incompetent, existing law authorizes the court to either grant diversion for a period of one year, refer the defendant to treatment, or dismiss the charge.

Existing law, the Bronzan-McCorquodale Act, governs the organization and financing of community mental health services for persons with mental disorders in every county through locally administered and locally controlled community mental health programs.

This bill would require a county behavioral health department to maintain contact for 180 days with, and offer mental health services to, an individual charged with a misdemeanor who has been found incompetent to stand trial and who is not receiving court directed services. By creating new requirements for county behavioral health departments, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

 UNFINISHED BUSINESS  

Bill No: SB 717

Author: Stern (D)

Amended: 9/1/23

Vote: 21

SENATE HEALTH COMMITTEE: 11-0, 4/19/23

AYES: Eggman, Nguyen, Dahle, Glazer, Gonzalez, Limón, Menjivar, Roth, Rubio, Wahab, Wiener

NO VOTE RECORDED: Hurtado

SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/18/23

AYES: Portantino, Jones, Ashby, Bradford, Seyarto, Wahab, Wiener

SENATE FLOOR: 40-0, 5/25/23

AYES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

ASSEMBLY FLOOR: 77-0, 9/13/23 - See last page for vote

SUBJECT: County mental health services

SOURCE: Author

DIGEST: This bill requires an individual who has a misdemeanor charge or charges that are dismissed by the court, who is found incompetent to stand trial (IST), and who is not receiving court directed services to be notified by the court of their need for mental health services, as evidenced by having been found IST. Requires a county behavioral health department to make these individuals a top priority for engagement of mental health services.

Assembly Amendments

delete the provision in this bill that required a county to maintain contact with these individuals for 180 days after release, and instead require a court to notify them of their need for mental health services, and require a county behavioral health department to make these individuals a top priority for engagement of mental health services.

ANALYSIS:

Existing law:

1. Establishes the Bronzan-McCorquodale Act (BMA) to organize and finance community mental health (MH) services for those with MH disorders in every county through locally administered and controlled community MH programs. Requires the mission of California’s mental health system to be to enable persons experiencing severe and disabling mental illnesses and children with serious emotional disturbances to access services and programs that assist them, in a manner tailored to each individual, to better control their illness, to achieve their personal goals, and to develop skills and supports leading to their living the most constructive and satisfying lives possible in the least restrictive available settings. [WIC §5600, et seq.]
2. Specifies that community MH services should be organized to provide an array of treatment options in the following areas, to the extent resources are available: precrisis and crisis services; comprehensive evaluation and assessment; individual service plans; medication education and management; case management; 24-hour treatment services; rehabilitation and support services; vocational rehabilitation; residential services; services for the homeless; and, group services, as specified. [WIC §5600.4]
3. Deems that, to the extent resources are available, the primary goal of the use of funds deposited in the mental health account of the local health and welfare trust fund should be to serve the target populations, which includes adults and older adults who have a serious mental disorder who are arrested or convicted of crimes. [WIC §5600.3]
4. Requires the trial, judgment, or hearing on the alleged violation to be suspended if a defendant is found mentally incompetent and authorizes a court to either:
5. Make a finding that the defendant is an appropriate candidate for diversion and, if the defendant is eligible, to grant diversion for a period not to exceed one year. Prohibits a defendant from being deemed incompetent to stand trial (IST) upon dismissal of charges at the conclusion of the period of diversion; or,
6. Dismiss the charges, as specified. Requires the court, if the criminal action is dismissed, to transmit a copy of the order of dismissal to the county behavioral health director or the director’s designee. [PEN §1370.01]
7. Requires the court to dismiss the pending revocation matter and permits the return of the defendant to supervision if the defendant is found mentally incompetent and is on a grant of probation for a misdemeanor offense. Permits the court to modify the terms and conditions of supervision to include appropriate mental health treatment, as specified. [PEN §1370.01]
8. States the intent of the Legislature that a defendant subject to the terms of being found IST to receive mental health treatment in a treatment facility and not a jail. [PEN §1370.01]

This bill:

1. Requires an individual who has a misdemeanor charge or charges that are dismissed by the court, who is found IST, and who is not receiving court directed services to be notified by the court of their need for mental health services, as evidenced by having been found IST.
2. Requires a court to provide the individual with information that, at a minimum, consists of the name, address, and telephone number of the county behavioral health department; the name and contact information of the behavioral health professional that was providing services to them while incarcerated, if any; contact information for the Medi-Cal program; and, a list of available community-based organizations where the individual could obtain mental health services.
3. Requires a county behavioral health department to make these individuals a top priority for engagement of mental health services; track outreach and engagement efforts for these individuals for a period of 60 days postrelease; attempt to establish first contact within 48 hours of release to secure an individual’s agreement to participate in on-going mental health treatment; and, continue to make concerted efforts to maintain contact to engage the individual in treatment at a minimum of twice a week for the first three weeks postrelease and a minimum of at least three more times before the conclusion of the 60-day period.

Comments

1. Author’s statement. According to the author, California is facing a behavioral health crisis where an estimated 63.1% of adults with mental illness do not receive mental health treatment. As a result, vulnerable individuals are left with minimal support and resources. It is important that we do not contribute to the lack of access to treatment and work toward a solution to make mental health treatment available to those most in need. This bill works to increase access to resources to those identified as IST, have been charged with a misdemeanor, and whose cases have been dismissed by the courts. By offering up to 180 days of outreach services to individuals who are incompetent to stand trial and whose cases have been dismissed, we can bring targeted resources to an already identified impacted population.
2. Background. According to a report of recommendations by the IST Solutions Workgroup from November 2021, over the last decade, California has seen significant year-over-year growth in the number of individuals charged with a felony offense who are found IST and committed to the California Department of State Hospitals (DSH) for competency restoration services. California has responded to the substantial growth in the felony IST population through multiple investments to increase DSH’s capacity to serve these individuals with serious mental illness. However, the growth in the felony IST patients has exceeded the capacity and outpaced other efforts to respond to the growth in the felony IST population, resulting in growing waitlist and wait times to admission. In 2015, the American Civil Liberties Union sued DSH regarding the amount of time IST defendants were waiting for admission into a DSH treatment program, alleging violations of individuals’ due process rights. The Alameda Superior Court ultimately ruled that DSH must commence substantive treatment services in 28 days for felony IST patients. DSH appealed this ruling and ultimately, in the summer of 2021, the Superior Court’s order was affirmed. Meanwhile, the COVID-19 pandemic has also significantly affected DSH’s ability to meet the IST demands, and as of November 2021, over 1,700 individuals are awaiting restoration of competency treatment. The report further states a 2017 study conducted by the National Association of State Mental Health Program Directors Research Institute found that from 1999 to 2014, the overall number of forensic patients in state hospitals increased by 74% while the number of IST patients increased by 72% during that same period. Multiple state hospital systems across the country are facing lawsuits because of their inability to continuously increase the number of forensic inpatient beds available to admit and treat IST patients within court mandated timeframes, including in California, which has set a 28-day post commitment deadline for DSH to begin substantive treatment of an IST ordered to DSH.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Assembly Appropriations Committee, the courts estimate costs of an unknown amount, likely in the hundreds of thousands of dollars, in ongoing workload cost pressures to research and provide the required information to the specified population. Each individual court would need to work with their local providers to compile and keep an updated list to provide to individuals. The Judicial Council notes the requirement to provide the name and contact information of the specific professional who provided services while an individual was incarcerated creates complexity and the judicial branch is unsure of its ability to reliably gather this information for each individual who is found incompetent to stand trial (Trial Court Trust Fund).

SUPPORT: (Verified 9/13/23)

California Council of Community Behavioral Health Agencies

Depression and Bipolar Support Alliance

Los Angeles County Public Defender’s Office

OPPOSITION: (Verified 9/13/23)

Judicial Council of California

ARGUMENTS IN SUPPORT: The Depression and Bipolar Support Alliance states that while 180 days may not be long enough to require contact (when possible) with IST individuals, this bill is a good start to ensure continuity of care. Anyone found incompetent to stand trial should already be receiving substantial mental health services, and hopefully this bill will do more to ensure this. The California Council of Community Behavioral Health Agencies (CBHA) states that individuals found IST on misdemeanor charges often fall through the cracks, receiving little to no mental health support. This lack of assistance can exacerbate their mental health conditions, putting them at risk for further criminal justice involvement and increased personal suffering. CBHA states the extended support as required in this bill can help prevent further deterioration of a person’s mental health and reduce the likelihood of recidivism. CBHA argues by providing ongoing support to individuals found IST on misdemeanor charges, we can promote better mental health outcomes, reduce the strain on the criminal justice system, and create safer communities.

ARGUMENTS IN OPPOSITION: The Judicial Council of California (JCC) requests that the bill be amended to limit the role of courts to notify an individual of their potential need for mental health services if the individual has been found incompetent to stand trial and delete the other requirements on courts. JCC believes that the bill as currently in print creates an inappropriate role for courts by requiring courts to notify individuals about their need for mental health treatment. JCC also disagrees with requiring courts to provide a list of available community based organizations to individuals as it could give the appearance of courts endorsing certain programs, which JCC states is inappropriate for them.

ASSEMBLY FLOOR: 77-0, 9/13/23

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Luz Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO VOTE RECORDED: Bauer-Kahan, Chen, Jones-Sawyer

Click here to enter text.

Prepared by: Reyes Diaz / HEALTH / (916) 651-4111

9/14/23 11:38:37

**** END ****

SENATE THIRD READING

STR Bill Id:SB 717

Author:(Stern)

As Amended Ver:September 1, 2023

Majority vote

SUMMARY

Requires a court to notify individuals who have been found incompetent to stand trial (IST), whose misdemeanor charge(s) have been dismissed by the court, and who are not receiving court directed services, of their need for mental health (MH) services as evidenced by their having been found IST. Requires the court to provide specific information as defined. .

Major Provisions

COMMENTS

1. IST. In 2021, the Legislature charged the California Health and Human Services Agency and the California Department of State Hospitals (DSH) to convene an IST Workgroup to identify actionable solutions that address the increasing number of individuals with serious mental illness (SMI) who become justice-involved and are deemed IST on felony charges. The IST Solutions Workgroup reported in November 2021, that over the last decade, California has seen significant year-over-year growth in the number of individuals charged with a felony offense who are found IST and committed to the DSH for competency restoration services. The growth in the felony IST patients has exceeded the capacity and outpaced other efforts to respond to the growth in the felony IST population, resulting in growing waitlist and wait times to admission. California has responded to the substantial growth in the felony IST population through multiple investments to increase DSH's capacity to serve these individuals with SMI. However, in 2015, the American Civil Liberties Union sued DSH regarding the amount of time IST defendants were waiting for admission into a DSH treatment program, alleging violations of individuals' due process rights. The Alameda Superior Court ultimately ruled that DSH must commence substantive treatment services in 28 days for felony IST patients. DSH appealed this ruling and ultimately, in the summer of 2021, the Superior Court's order was affirmed.

Meanwhile, the COVID-19 pandemic also significantly affected DSH's ability to meet the IST demands. As of November 2021, over 1,700 individuals were awaiting restoration of competency treatment. The report cited a 2017 study conducted by the National Association of State Mental Health Program Directors Research Institute that found from 1999 to 2014, the overall number of forensic patients in state hospitals increased by 74% while the number of IST patients increased by 72% during that same period. Multiple state hospital systems across the country are facing lawsuits because of their inability to continuously increase the number of forensic inpatient beds available to admit and treat IST patients within court mandated timeframes, including in California, which has set a 28-day post commitment deadline for DSH to begin substantive treatment of an IST ordered to DSH.

DSH continues to seek solutions to address the significant demand for treatment. As of December 19, 2022, DSH has a total of 1,877 patients pending placement of which 1,489 are deemed IST. Efforts to increase both community-based and jail-based competency restoration treatment for ISTs along with other efforts related to serving patients in both the state hospitals and the Conditional Release program are ongoing.

1. Justice-Involved Medi-Cal Initiative. On January 26, 2023, California became the first state in the nation approved to offer a targeted set of Medicaid services to youth and eligible adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release. Through this Justice-Involved initiative, California is taking significant steps to address poor health outcomes in this population by establishing pre-release Medi-Cal enrollment strategies to ensure individuals have continuity of coverage upon their release, as well as access to key services to help them successfully return to their communities. Under the initiative, county jails, county youth correctional facilities, and state prisons are to:
   1. Ensure all eligible individuals are enrolled in Medi-Cal prior to release;
   2. Provide targeted Medi-Cal health care services to youth and eligible adults in the 90 days prior to release to prepare them to return to the community and reduce gaps in care. Eligible adults include those who have a MH diagnosis or suspected diagnosis, a substance use disorder or suspected diagnosis, a chronic clinical condition, a traumatic brain injury, intellectual or development disability, or are pregnant or postpartum. All incarcerated youth in a youth correctional facility are eligible with no clinical criteria required;
   3. Provide "warm handoffs" to health care providers to ensure that individuals who require behavioral and other health care services, medications, and other medical supplies (e.g., a wheelchair) have what they need upon re-entry;
   4. Work with community-based care managers to offer intensive, community-based care coordination for individuals at re-entry, including through Enhanced Care Management; and,
   5. Work with community-based care managers to make Community Supports (e.g., housing supports or food supports) available upon re-entry if offered by their managed care plan.

It also provides people who are reentering the community with the prescribed medications and durable medical equipment they need, and access to programs and services to support this important transition. Through early enrollment of eligible individuals it is hoped that IST transition and continuity of care will be better coordinated.

According to the Author

California is facing a behavioral health crisis where an estimated 63.1% of adults with mental illness do not receive MH treatment. As a result, vulnerable individuals are left with minimal support and resources. It is important that we do not contribute to the lack of access to treatment and work toward a solution to make MH treatment available to those most in need. This bill works to increase access to resources to those identified as IST, have been charged with a misdemeanor, and whose cases have been dismissed by the courts. The author concludes that by offering up to 180 days of outreach services to individuals who are IST and whose cases have been dismissed we can bring targeted resources to an already identified impacted population.

Arguments in Support

The California Council of Community Behavioral Health Agencies (CCBHA), sponsor of the bill, states that California is facing a significant behavioral health crisis. An estimated this 63.1% of adults with mental illness in our state receive no MH treatment. This is a significant concern, especially for individuals deemed mentally incompetent to stand trial. These individuals often find themselves without support, contributing to high rates of recidivism and homelessness, and a lack of access to treatment. This bill presents a solution to this problem, ensuring that individuals are not left to fall through the cracks. CCBHA states this bill proposes a necessary and timely intervention, mandating counties to provide outreach and engagement services to defendants whose cases have been dismissed for up to 180 days after dismissal. This bill provides an opportunity to ensure that incompetent defendants are provided resources beyond exiting our court systems, allowing California to use existing tools to help defendants get the treatment they need and avoid the cycle of incarceration. This bill is a crucial step in preventing recidivism, ensuring that individuals are not left to languish without necessary support. It is our responsibility to ensure that those who are vulnerable and in need of help are not forgotten. CCBHA concludes this bill will not only improve the lives of these individuals, but it will also alleviate the strain on our legal system and our communities by reducing rates of recidivism and promoting better access to treatment.

Arguments in Opposition

The American Federation of State, County and Municipal Employees (AFSCME), AFL-CIO, in an oppose position states that recent research shows that 93% of behavioral health workers report being stressed out and stretched too thin and 82% report being emotionally and physically exhausted. Likewise, the top reasons that behavioral health professionals indicated for leaving their positions included insufficient staffing, intensity of workload, and the emotional toll of the job. AFSCME concludes that while understanding and appreciative of the author's intent to ensure that Californians have access to adequate behavioral health services, the workforce concerns articulated above requires an oppose position.

Arguments in Opposition Unless Amended

The County Behavioral Health Directors Association (CBHDA) in an oppose unless amended position, states that this bill would require county behavioral health agencies to maintain contact for 60 days with an individual who has committed a misdemeanor and been found IST, but is not receiving services or treatment through a court diversion program. CBHDA shares the author's concern for a population that could benefit from voluntarily engaging in behavioral health treatment and services. However, the requirement that county behavioral health agencies maintain contact for 60 days is a significant additional burden that would require the hiring of multiple additional staff per county at a time when there is already a catastrophic workforce crisis that is significantly impacting patient care. CBHDA states that even for Medi-Cal clients, outreach and engagement are not reimbursable services. Further, a significant proportion of this population will be privately insured and this bill does not require reimbursement for providing taxpayer-funded services to a privately insured population. As such, CBHDA requests an amendment that would limit the scope of the bill to a notification requirement to these individuals by the courts, notifying them of their eligibility for voluntary behavioral health services and treatment, depending upon their insurance provider, at the time of their dismissal from the court system. CBHDA further requests amendments that would bring together representatives from county behavioral health agencies, commercial insurance providers and Medi-Cal managed care plans to help inform the development of a second notification by mail about their eligibility for behavioral health treatment and services, depending on their insurance provider.

FISCAL COMMENTS

According to the Assembly Appropriations Committee, the courts estimate costs of an unknown amount, likely in the hundreds of thousands of dollars, in ongoing workload cost pressures to research and provide the required information to the specified population. Each individual court would need to work with their local providers to compile and keep an updated list to provide to individuals. The Judicial Council notes the requirement to provide the name and contact information of the specific professional who provided services while an individual was incarcerated creates complexity and the judicial branch is unsure of its ability to reliably gather this information for each individual who is found incompetent to stand trial (Trial Court Trust Fund).

VOTES

SENATE FLOOR: 40-0-0

YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

ASM HEALTH: 15-0-0

YES: Wood, Waldron, Aguiar-Curry, Arambula, Boerner, Wendy Carrillo, Flora, Vince Fong, Maienschein, McCarty, Joe Patterson, Rodriguez, Santiago, Villapudua, Weber

ASM APPROPRIATIONS: 13-2-1

YES: Holden, Bryan, Calderon, Wendy Carrillo, Mike Fong, Hart, Lowenthal, Mathis, Papan, Pellerin, Sanchez, Weber, Wilson

NO: Megan Dahle, Dixon

ABS, ABST OR NV: Soria

UPDATED

VERSION: September 1, 2023

CONSULTANT: Judith Babcock / HEALTH / (916) 319-2097 FN: 0001634

Date of Hearing: August 23, 2023

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Chris Holden, Chair

SBPCA Bill Id:SB 717

Author:(Stern) – As Amended Ver:July 5, 2023

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

SUMMARY:

This bill requires a court to notify an individual of their need for mental health services and to provide specified information to help the individual find mental health services if the individual has been found incompetent to stand trial (IST) and is not receiving court-directed services. This bill also requires a county behavioral health department (CBHD), within 48 hours of the individual’s release and in collaboration with community-based organizations, to attempt to contact the individual for the purpose of engaging the individual in mental health treatment, and to maintain contact for 60 days post-release, as specified.

FISCAL EFFECT:

The County Behavioral Health Directors Association (CBHDA) estimates CBHDs will need to hire 175 to 525 new staff to provide outreach and engagement to persons found IST, at annual costs to counties of $16 million to $27.5 million statewide, based on serving a minimum of 760 individuals and a per person cost of $21,000 to $36,000. CBHDA indicates many such individuals are homeless and lack contact information, which makes maintaining contact a significant burden when counties are already facing a severe workforce shortage. If the Commission on State Mandates determines this bill imposes a state mandate, the state will need to reimburse counties for these costs (General Fund).

COMMENTS:

1. Purpose. This bill is sponsored by the California Council of Community Behavioral Health Agencies. According to the author:

California is facing a behavioral health crisis where an estimated 63.1% of adults with mental illness do not receive mental health treatment. As a result, vulnerable individuals are left with minimal support and resources. It is important that we do not contribute to the lack of access to treatment and work toward a solution to make mental health treatment available to those most in need. SB 717 works to increase access to resources to those identified as incompetent to stand trial, have been charged with a misdemeanor, and whose cases have been dismissed by the courts. By offering up to 180 days of outreach services to individuals who are incompetent to stand trial and whose cases have been dismissed we can bring targeted resources to an already identified impacted population.

1. Background. If a defendant charged with a misdemeanor is found incompetent to stand trial, existing law authorizes the court to either grant diversion for one year and then refer the defendant to treatment, or dismiss the charge. Individuals who are granted diversion and are later referred to treatment have higher levels of engagement with service providers. However, defendants whose cases are dismissed are often not interested in services at the time of dismissal and choose to not engage any further. The author states this bill would fill a gap in providing services and support to individuals who have been identified as IST, have been charged with a misdemeanor, and whose cases have been dismissed.
2. Opposition. The American Federation of State, County and Municipal Employees (AFSCME), AFL-CIO, states in opposition to this bill that recent research shows 93% of behavioral health workers report being stressed out and stretched too thin, and 82% report being emotionally and physically exhausted. The top reasons behavioral health professionals indicated for leaving their positions included insufficient staffing, intensity of workload, and the emotional toll of the job.
3. Oppose Unless Amended. CBHDA notes there is already a catastrophic workforce crisis that is significantly impacting patient care, and outreach and engagement are not reimbursable services, even for Medi-Cal clients. Further, a significant proportion of the IST population will be privately insured and this bill does not require reimbursement for providing taxpayer-funded services to a privately insured population. Finally, CBHDA contends requiring CBHDs to try to engage with individuals who do not wish to engage takes resources away from those who do want help.

CBHDA requests an amendment to limit the scope of the bill to requiring the courts to notify individuals of their eligibility for voluntary behavioral health services and treatment, depending upon their insurance provider, at the time of their dismissal from the court system. CBHDA further requests amendments to require representatives from county behavioral health agencies, commercial insurance providers and Medi-Cal managed care plans to help inform the development of a second notification about their eligibility for behavioral health treatment and services, depending on their insurance provider.

1. Related Legislation.
   1. AB 1584 (Weber) requires, in part, the court to determine whether restoration to competency is in the interests of justice when a defendant in a felony case has been deemed IST. If the restoration of the defendant’s mental competence is not in the interests of justice, AB 1584 requires the court to either grant mental health diversion or dismiss the charges against the defendant, as specified. AB 1584 is pending in Senate Appropriations Committee.
   2. SB 349 (Roth) requires, if a court raises a question as to a defendant’s mental competence, the question of the defendant’s mental competence to be presumed to apply to all cases pending against the defendant in that county, as specified. Hearing of SB 349 in Assembly Public Safety Committee was canceled at the author’s request.
2. Prior Legislation.
   1. SB 317 (Stern), Chapter 599, Statutes of 2021, revised the procedures when a defendant is found IST on misdemeanor charges and allowed a defendant to earn conduct credits when committed as IST to a state hospital or other mental health treatment facility, in the same manner as if they were held in county jail.
   2. AB 1810 (Committee on Budget), Chapter 34, Statutes of 2018, specified a defendant determined to be IST may be considered a candidate for mental health diversion.
   3. SB 1187 (Beall), Chapter 1008, Statutes of 2018, reduced, from three years to two years, the maximum term for commitment to a treatment facility when a defendant has been found IST on a felony. Sb 1187 also specified that when a defendant has been found IST and is held in a county jail treatment center while undergoing treatment for restoration to competency that person is entitled to custody credits in the same manner as any other inmate confined to a county jail.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: July 11, 2023

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

SBPCA Bill Id:SB 717

Author:(Stern) – As Amended Ver:July 5, 2023

SENATE VOTE: 40-0

SUBJECT: County mental health services

SUMMARY: Requires a court to notify individuals who have been found incompetent to stand trial (IST), whose misdemeanor charge(s) have been dismissed by the court, and who are not receiving court directed services, of their need for mental health (MH) services as evidenced by their having been found IST. Requires the court to provide specific information as defined. Requires the county behavioral health department to track outreach and engagement efforts as specified for these individuals for a period of 60 days post release. Specifically, this bill:

1. Requires a court to notify individuals who have been found IST, whose misdemeanor charge(s) have been dismissed by the court, and who are not receiving court directed services, of their need for MH services as evidenced by their having been found IST.
2. Requires a court to provide the individuals identified in 1) above with the following:
   1. The name, addresses and, telephone number of the county behavioral health department;
   2. The name and contact information of the behavioral health professional that was providing services to them while incarcerated (if any);
   3. The contact information for the Medi-Cal program; and,
   4. A list of available community based organizations where they could obtain MH services.
3. Requires a behavioral health department to make an individual identified in 1) above a top priority for engagement of MH services.
4. Requires the county behavioral health department to track outreach and engagement efforts for these individuals for a period of 60 days post release.
5. Requires the county behavioral department to, in collaboration and coordination with community based organizations, seek to establish first contact for the purpose of securing an individual’s agreement to participate in on-going MH treatment either through private insurance coverage, Medi-Cal, or county based programs.
6. Requires the county behavioral health department to make concerted efforts to maintain contact for the purpose of engaging the individual in treatment at a minimum of twice a week for the first three weeks post release and a minimum of at least three more times before the conclusion of the 60 day period.

EXISTING LAW:

1. Establishes the Bronzan-McCorquodale Act to organize and finance community MH services for those with MH disorders in every county through locally administered and controlled community MH programs. The mission of California’s MH system is to enable persons experiencing severe and disabling mental illnesses and children with serious emotional disturbances to access services and programs that assist them, in a manner tailored to each individual, to better control their illness, to achieve their personal goals, and to develop skills and supports leading to their living the most constructive and satisfying lives possible in the least restrictive available settings. [Welfare and Institutions Code (WIC) §5600, et seq.]
2. Specifies that community MH services should be organized to provide an array of treatment options in the following areas, to the extent resources are available: pre-crisis and crisis services; comprehensive evaluation and assessment; individual service plans; medication education and management; case management; 24-hour treatment services; rehabilitation and support services; vocational rehabilitation; residential services; services for the homeless; and, group services, as specified. [WIC §5600.4]
3. Deems that, to the extent resources are available, the primary goal of the use of funds deposited in the MH account of the local health and welfare trust fund is to serve the target populations, including adults and older adults who have a serious mental disorder who are arrested or convicted of crimes. [WIC §5600.3]
4. Requires the trial, judgment, or hearing on the alleged violation to be suspended if a defendant is found mentally IST and authorizes a court to either:
5. Make a finding that the defendant is an appropriate candidate for diversion and, if the defendant is eligible, to grant diversion for a period not to exceed one year. Prohibits a defendant from being deemed IST upon dismissal of charges at the conclusion of the period of diversion; or,
6. Dismiss the charges, as specified. Requires the court, if the criminal action is dismissed, to transmit a copy of the order of dismissal to the county behavioral health director or the director’s designee. [Penal Code (PEN) §1370.01]
7. Requires the court to dismiss the pending revocation matter and permits the return of the defendant to supervision if the defendant is found mentally incompetent and is on a grant of probation for a misdemeanor offense. Permits the court to modify the terms and conditions of supervision to include appropriate MH treatment, as specified. [PEN §1370.01]
8. States the intent of the Legislature that a defendant subject to the terms of being found IST to receive MH treatment in a treatment facility and not a jail. [PEN §1370.01]

FISCAL EFFECT: According to the Senate Appropriations Committee, there are unknown cost increases to county behavioral health departments to locate and maintain contact with individuals for 180 days for purposes of offering treatment services. Unknown cost pressures to the General Fund, as costs to counties for administration would be potentially reimbursable by the state, subject to a determination by the Commission on State Mandates.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, California is facing a behavioral health crisis where an estimated 63.1% of adults with mental illness do not receive MH treatment. As a result, vulnerable individuals are left with minimal support and resources. It is important that we do not contribute to the lack of access to treatment and work toward a solution to make MH treatment available to those most in need. This bill works to increase access to resources to those identified as IST, have been charged with a misdemeanor, and whose cases have been dismissed by the courts. The author concludes that by offering up to 180 days of outreach services to individuals who are IST and whose cases have been dismissed we can bring targeted resources to an already identified impacted population.
2. BACKGROUND.
   1. IST. In 2021, the Legislature charged the California Health and Human Services Agency and the California Department of State Hospitals (DSH) to convene an IST Workgroup to identify actionable solutions that address the increasing number of individuals with serious mental illness (SMI) who become justice-involved and are deemed IST on felony charges. The IST Solutions Workgroup reported in November 2021, that over the last decade, California has seen significant year-over-year growth in the number of individuals charged with a felony offense who are found IST and committed to the DSH for competency restoration services. The growth in the felony IST patients has exceeded the capacity and outpaced other efforts to respond to the growth in the felony IST population, resulting in growing waitlist and wait times to admission. California has responded to the substantial growth in the felony IST population through multiple investments to increase DSH’s capacity to serve these individuals with SMI. However, in 2015, the American Civil Liberties Union sued DSH regarding the amount of time IST defendants were waiting for admission into a DSH treatment program, alleging violations of individuals’ due process rights. The Alameda Superior Court ultimately ruled that DSH must commence substantive treatment services in 28 days for felony IST patients. DSH appealed this ruling and ultimately, in the summer of 2021, the Superior Court’s order was affirmed.
      
      Meanwhile, the COVID-19 pandemic also significantly affected DSH’s ability to meet the IST demands. As of November 2021, over 1,700 individuals were awaiting restoration of competency treatment. The report cited a 2017 study conducted by the National Association of State Mental Health Program Directors Research Institute that found from 1999 to 2014, the overall number of forensic patients in state hospitals increased by 74% while the number of IST patients increased by 72% during that same period. Multiple state hospital systems across the country are facing lawsuits because of their inability to continuously increase the number of forensic inpatient beds available to admit and treat IST patients within court mandated timeframes, including in California, which has set a 28-day post commitment deadline for DSH to begin substantive treatment of an IST ordered to DSH.
      
      DSH continues to seek solutions to address the significant demand for treatment. As of December 19, 2022, DSH has a total of 1,877 patients pending placement of which 1,489 are deemed IST. Efforts to increase both community-based and jail-based competency restoration treatment for ISTs along with other efforts related to serving patients in both the state hospitals and the Conditional Release program are ongoing.
   2. Justice-Involved Medi-Cal Initiative. On January 26, 2023, California became the first state in the nation approved to offer a targeted set of Medicaid services to youth and eligible adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release. Through this Justice-Involved initiative, California is taking significant steps to address poor health outcomes in this population by establishing pre-release Medi-Cal enrollment strategies to ensure individuals have continuity of coverage upon their release, as well as access to key services to help them successfully return to their communities. Under the initiative, county jails, county youth correctional facilities, and state prisons are to:
      1. Ensure all eligible individuals are enrolled in Medi-Cal prior to release;
      2. Provide targeted Medi-Cal health care services to youth and eligible adults in the 90 days prior to release to prepare them to return to the community and reduce gaps in care. Eligible adults include those who have a MH diagnosis or suspected diagnosis, a substance use disorder or suspected diagnosis, a chronic clinical condition, a traumatic brain injury, intellectual or development disability, or are pregnant or postpartum. All incarcerated youth in a youth correctional facility are eligible with no clinical criteria required;
      3. Provide “warm handoffs” to health care providers to ensure that individuals who require behavioral and other health care services, medications, and other medical supplies (e.g., a wheelchair) have what they need upon re-entry;
      4. Work with community-based care managers to offer intensive, community-based care coordination for individuals at re-entry, including through Enhanced Care Management; and,
      5. Work with community-based care managers to make Community Supports (e.g., housing supports or food supports) available upon re-entry if offered by their managed care plan.

It also provides people who are reentering the community with the prescribed medications and durable medical equipment they need, and access to programs and services to support this important transition. Through early enrollment of eligible individuals it is hoped that IST transition and continuity of care will be better coordinated.

1. SUPPORT. The California Council of Community Behavioral Health Agencies (CCBHA), sponsor of the bill, states that California is facing a significant behavioral health crisis. An estimated this 63.1% of adults with mental illness in our state receive no MH treatment. This is a significant concern, especially for individuals deemed mentally incompetent to stand trial. These individuals often find themselves without support, contributing to high rates of recidivism and homelessness, and a lack of access to treatment. This bill presents a solution to this problem, ensuring that individuals are not left to fall through the cracks. CCBHA states this bill proposes a necessary and timely intervention, mandating counties to provide outreach and engagement services to defendants whose cases have been dismissed for up to 180 days after dismissal. This bill provides an opportunity to ensure that incompetent defendants are provided resources beyond exiting our court systems, allowing California to use existing tools to help defendants get the treatment they need and avoid the cycle of incarceration. This bill is a crucial step in preventing recidivism, ensuring that individuals are not left to languish without necessary support. It is our responsibility to ensure that those who are vulnerable and in need of help are not forgotten. CCBHA concludes this bill will not only improve the lives of these individuals, but it will also alleviate the strain on our legal system and our communities by reducing rates of recidivism and promoting better access to treatment.
2. OPPOSE. The American Federation of State, County and Municipal Employees (AFSCME), AFL-CIO, in an oppose position states that recent research shows that 93% of behavioral health workers report being stressed out and stretched too thin and 82% report being emotionally and physically exhausted. Likewise, the top reasons that behavioral health professionals indicated for leaving their positions included insufficient staffing, intensity of workload, and the emotional toll of the job. AFSCME concludes that while understanding and appreciative of the author’s intent to ensure that Californians have access to adequate behavioral health services, the workforce concerns articulated above requires an oppose position.
3. OPPOSE UNLESS AMENDED. The County Behavioral Health Directors Association (CBHDA) in an oppose unless amended position, states that this bill would require county behavioral health agencies to maintain contact for 180 days with an individual who has committed a misdemeanor and been found IST, but is not receiving services or treatment through a court diversion program. CBHDA shares the author’s concern for a population that could benefit from voluntarily engaging in behavioral health treatment and services. However, the requirement that county behavioral health agencies maintain contact for six months with individuals, many of whom are homeless, lack contact information, phones, or a permanent address, is a significant additional burden that would require the hiring of multiple additional staff per county at a time when there is already a catastrophic workforce crisis that is significantly impacting patient care. CBHDA states that even for Medi-Cal clients, outreach and engagement are not reimbursable services. Further, a significant proportion of this population will be privately insured and this bill does not require reimbursement for providing taxpayer-funded services to a privately insured population. As such, CBHDA requests an amendment that would limit the scope of the bill to a notification requirement to these individuals by the courts, notifying them of their eligibility for voluntary behavioral health services and treatment, depending upon their insurance provider, at the time of their dismissal from the court system. CBHDA further requests amendments that would bring together representatives from county behavioral health agencies, commercial insurance providers and Medi-Cal managed care plans to help inform the development of a second notification by mail about their eligibility for behavioral health treatment and services, depending on their insurance provider. In conclusion, CBHDA opposes the bill unless amended.
4. RELATED LEGISLATION.
   1. AB 1584 (Weber) requires, in part, the court, upon a finding of mental incompetence of a defendant charged with a felony that is not ineligible for diversion, to determine if it is in the interests of justice to restore the defendant to competence. Requires the court, if the restoration of the defendant’s mental competence is not in the interests of justice, to either grant MH diversion to the defendant or dismiss the charges against the defendant, as specified. AB 1584 is pending referral in the Senate Rules Committee.
   2. SB 349 (Roth) requires, if a question is raised by the court as to a defendant’s mental competence, the question of the defendant’s mental competence to be presumed to apply to all cases pending against the defendant in that county, as specified. SB 349 is pending hearing in the Assembly Public Safety Committee.
5. PREVIOUS LEGISLATION.
   1. AB 1810 (Committee on Budget), Chapter 34, Statutes of 2018, specifies that when a defendant is determined to be IST the court can find that they are an appropriate candidate for MH diversion.
   2. SB 317 (Stern), Chapter 599, Statutes of 2021, revises the procedures when a defendant is found IST on misdemeanor charges. Permits a defendant to earn conduct credits when they are committed to a state hospital or other MH treatment facility as IST in the same manner as if they were held in county jail.
   3. SB 1187 (Beall), Chapter 1008, Statutes of 2018, reduces the maximum term for commitment to a treatment facility when a defendant has been found IST on a felony from three years to two years. Specifies that when a defendant has been found IST and is held in a county jail treatment center while undergoing treatment for restoration to competency that person is entitled to custody credits in the same manner as any other inmate confined to a county jail.
      

REGISTERED SUPPORT / OPPOSITION:

Support

California Council of Community Behavioral Health Agencies, sponsor
Depression and Bipolar Support Alliance-California

Opposition

American Federation of State, County and Municipal Employees, AFL-CIO

Analysis Prepared by: Judith Babcock / HEALTH / (916) 319-2097

Date of Hearing: June 27, 2023

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

SBPCA Bill Id:SB 717

Author:(Stern) – As Introduced Ver:February 16, 2023

SENATE VOTE: 40-0

SUBJECT: County mental health services.

SUMMARY: Requires a county behavioral health department to maintain contact for 180 days with, and to offer mental health (MH) services and treatment to, an individual found incompetent to stand trial (IST) who is not receiving court directed services through diversion, as specified.

EXISTING LAW:

1. Establishes the Bronzan-McCorquodale Act to organize and finance community MH services for those with MH disorders in every county through locally administered and controlled community MH programs. The mission of California’s MH system is to enable persons experiencing severe and disabling mental illnesses and children with serious emotional disturbances to access services and programs that assist them, in a manner tailored to each individual, to better control their illness, to achieve their personal goals, and to develop skills and supports leading to their living the most constructive and satisfying lives possible in the least restrictive available settings. [Welfare and Institutions Code (WIC) §5600, et seq.]
2. Specifies that community MH services should be organized to provide an array of treatment options in the following areas, to the extent resources are available: pre-crisis and crisis services; comprehensive evaluation and assessment; individual service plans; medication education and management; case management; 24-hour treatment services; rehabilitation and support services; vocational rehabilitation; residential services; services for the homeless; and, group services, as specified. [WIC §5600.4]
3. Deems that, to the extent resources are available, the primary goal of the use of funds deposited in the MH account of the local health and welfare trust fund is to serve the target populations, including adults and older adults who have a serious mental disorder who are arrested or convicted of crimes. [WIC §5600.3]
4. Requires the trial, judgment, or hearing on the alleged violation to be suspended if a defendant is found mentally IST and authorizes a court to either:
5. Make a finding that the defendant is an appropriate candidate for diversion and, if the defendant is eligible, to grant diversion for a period not to exceed one year. Prohibits a defendant from being deemed IST upon dismissal of charges at the conclusion of the period of diversion; or,
6. Dismiss the charges, as specified. Requires the court, if the criminal action is dismissed, to transmit a copy of the order of dismissal to the county behavioral health director or the director’s designee. [Penal Code (PEN) §1370.01]
7. Requires the court to dismiss the pending revocation matter and permits the return of the defendant to supervision if the defendant is found mentally incompetent and is on a grant of probation for a misdemeanor offense. Permits the court to modify the terms and conditions of supervision to include appropriate MH treatment, as specified. [PEN §1370.01]
8. States the intent of the Legislature that a defendant subject to the terms of being found IST to receive MH treatment in a treatment facility and not a jail. [PEN §1370.01]

FISCAL EFFECT: According to the Senate Appropriations Committee, there are unknown cost increases to county behavioral health departments to locate and maintain contact with individuals for 180 days for purposes of offering treatment services. Unknown cost pressures to the General Fund, as costs to counties for administration would be potentially reimbursable by the state, subject to a determination by the Commission on State Mandates.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, California is facing a behavioral health crisis where an estimated 63.1% of adults with mental illness do not receive MH treatment. As a result, vulnerable individuals are left with minimal support and resources. It is important that we do not contribute to the lack of access to treatment and work toward a solution to make MH treatment available to those most in need. This bill works to increase access to resources to those identified as IST, have been charged with a misdemeanor, and whose cases have been dismissed by the courts. The author concludes that by offering up to 180 days of outreach services to individuals who are IST and whose cases have been dismissed we can bring targeted resources to an already identified impacted population.
2. BACKGROUND.
   1. IST. In 2021, the Legislature charged the California Health and Human Services Agency and the California Department of State Hospitals (DSH) to convene an IST Workgroup to identify actionable solutions that address the increasing number of individuals with serious mental illness (SMI) who become justice-involved and are deemed IST on felony charges. The IST Solutions Workgroup reported in November 2021, that over the last decade, California has seen significant year-over-year growth in the number of individuals charged with a felony offense who are found IST and committed to the DSH for competency restoration services. The growth in the felony IST patients has exceeded the capacity and outpaced other efforts to respond to the growth in the felony IST population, resulting in growing waitlist and wait times to admission. California has responded to the substantial growth in the felony IST population through multiple investments to increase DSH’s capacity to serve these individuals with SMI. However, in 2015, the American Civil Liberties Union sued DSH regarding the amount of time IST defendants were waiting for admission into a DSH treatment program, alleging violations of individuals’ due process rights. The Alameda Superior Court ultimately ruled that DSH must commence substantive treatment services in 28 days for felony IST patients. DSH appealed this ruling and ultimately, in the summer of 2021, the Superior Court’s order was affirmed.
      
      Meanwhile, the COVID-19 pandemic also significantly affected DSH’s ability to meet the IST demands. As of November 2021, over 1,700 individuals were awaiting restoration of competency treatment. The report cited a 2017 study conducted by the National Association of State Mental Health Program Directors Research Institute that found from 1999 to 2014, the overall number of forensic patients in state hospitals increased by 74% while the number of IST patients increased by 72% during that same period. Multiple state hospital systems across the country are facing lawsuits because of their inability to continuously increase the number of forensic inpatient beds available to admit and treat IST patients within court mandated timeframes, including in California, which has set a 28-day post commitment deadline for DSH to begin substantive treatment of an IST ordered to DSH.
      
      DSH continues to seek solutions to address the significant demand for treatment. As of December 19, 2022, DSH has a total of 1,877 patients pending placement of which 1,489 are deemed IST. Efforts to increase both community-based and jail-based competency restoration treatment for ISTs along with other efforts related to serving patients in both the state hospitals and the Conditional Release program are ongoing.
   2. Justice-Involved Medi-Cal Initiative. On January 26, 2023, California became the first state in the nation approved to offer a targeted set of Medicaid services to youth and eligible adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release. Through this Justice-Involved initiative, California is taking significant steps to address poor health outcomes in this population by establishing pre-release Medi-Cal enrollment strategies to ensure individuals have continuity of coverage upon their release, as well as access to key services to help them successfully return to their communities. Under the initiative, county jails, county youth correctional facilities, and state prisons are to:
      1. Ensure all eligible individuals are enrolled in Medi-Cal prior to release;
      2. Provide targeted Medi-Cal health care services to youth and eligible adults in the 90 days prior to release to prepare them to return to the community and reduce gaps in care. Eligible adults include those who have a MH diagnosis or suspected diagnosis, a substance use disorder or suspected diagnosis, a chronic clinical condition, a traumatic brain injury, intellectual or development disability, or are pregnant or postpartum. All incarcerated youth in a youth correctional facility are eligible with no clinical criteria required;
      3. Provide “warm handoffs” to health care providers to ensure that individuals who require behavioral and other health care services, medications, and other medical supplies (e.g., a wheelchair) have what they need upon re-entry;
      4. Work with community-based care managers to offer intensive, community-based care coordination for individuals at re-entry, including through Enhanced Care Management; and,
      5. Work with community-based care managers to make Community Supports (e.g., housing supports or food supports) available upon re-entry if offered by their managed care plan.

It also provides people who are reentering the community with the prescribed medications and durable medical equipment they need, and access to programs and services to support this important transition. Through early enrollment of eligible individuals it is hoped that IST transition and continuity of care will be better coordinated.

1. SUPPORT. The California Council of Community Behavioral Health Agencies (CCBHA), sponsor of the bill, states that California is facing a significant behavioral health crisis. An estimated this 63.1% of adults with mental illness in our state receive no MH treatment. This is a significant concern, especially for individuals deemed mentally incompetent to stand trial. These individuals often find themselves without support, contributing to high rates of recidivism and homelessness, and a lack of access to treatment. This bill presents a solution to this problem, ensuring that individuals are not left to fall through the cracks. CCBHA states this bill proposes a necessary and timely intervention, mandating counties to provide outreach and engagement services to defendants whose cases have been dismissed for up to 180 days after dismissal. This bill provides an opportunity to ensure that incompetent defendants are provided resources beyond exiting our court systems, allowing California to use existing tools to help defendants get the treatment they need and avoid the cycle of incarceration. This bill is a crucial step in preventing recidivism, ensuring that individuals are not left to languish without necessary support. It is our responsibility to ensure that those who are vulnerable and in need of help are not forgotten. CCHBA concludes this bill will not only improve the lives of these individuals, but it will also alleviate the strain on our legal system and our communities by reducing rates of recidivism and promoting better access to treatment.
2. OPPOSE UNLESS AMENDED. The County Behavioral Health Directors Association (CBHDA) in an oppose unless amended position, states that this bill would require county behavioral health agencies to maintain contact for 180 days with an individual who has committed a misdemeanor and been found IST, but is not receiving services or treatment through a court diversion program. CBHDA shares the author’s concern for a population that could benefit from voluntarily engaging in behavioral health treatment and services. However, the requirement that county behavioral health agencies maintain contact for six months with individuals, many of whom are homeless, lack contact information, phones or a permanent address, is a significant additional burden that would require the hiring of multiple additional staff per county at a time when there is already a catastrophic workforce crisis that is significantly impacting patient care. CBHDA states that even for Medi-Cal clients, outreach and engagement are not reimbursable services. Further, a significant proportion of this population will be privately insured and this bill does not require reimbursement for providing taxpayer-funded services to a privately insured population. As such, CBHDA requests an amendment that would limit the scope of the bill to a notification requirement to these individuals by the courts, notifying them of their eligibility for voluntary behavioral health services and treatment, depending upon their insurance provider, at the time of their dismissal from the court system. CBHDA further requests amendments that would bring together representatives from county behavioral health agencies, commercial insurance providers and Medi-Cal managed care plans to help inform the development of a second notification by mail about their eligibility for behavioral health treatment and services, depending on their insurance provider. In conclusion, CBHDA opposes the bill unless amended.
3. RELATED LEGISLATION.
   1. AB 1584 (Weber) requires, in part, the court, upon a finding of mental incompetence of a defendant charged with a felony that is not ineligible for diversion, to determine if it is in the interests of justice to restore the defendant to competence. Requires the court, if the restoration of the defendant’s mental competence is not in the interests of justice, to either grant MH diversion to the defendant or dismiss the charges against the defendant, as specified. AB 1584 is pending referral in the Senate Rules Committee.
   2. SB 349 (Roth) requires, if a question is raised by the court as to a defendant’s mental competence, the question of the defendant’s mental competence to be presumed to apply to all cases pending against the defendant in that county, as specified. SB 349 is pending hearing in the Assembly Public Safety Committee.
4. PREVIOUS LEGISLATION.
   1. AB 1810 (Committee on Budget), Chapter 34, Statutes of 2018, specifies that when a defendant is determined to be IST the court can find that they are an appropriate candidate for MH diversion.
   2. SB 317 (Stern), Chapter 599, Statutes of 2021, revises the procedures when a defendant is found IST on misdemeanor charges. Permits a defendant to earn conduct credits when they are committed to a state hospital or other MH treatment facility as IST in the same manner as if they were held in county jail.
   3. SB 1187 (Beall), Chapter 1008, Statutes of 2018, reduces the maximum term for commitment to a treatment facility when a defendant has been found IST on a felony from three years to two years. Specifies that when a defendant has been found IST and is held in a county jail treatment center while undergoing treatment for restoration to competency that person is entitled to custody credits in the same manner as any other inmate confined to a county jail.
      
5. COMMITTEE AMENDMENTS. In an effort to remove opposition, the author has agreed to the following amendments:
   1. Requires the court, when dismissing misdemeanor charges of an individual found incompetent to stand trial to:
      1. Advise the individual of their need for behavioral health services as evidenced by their having been found incompetent to stand trial; and
      2. Provide the individual with information that, at a minimum consists of the name, address and telephone number of the county behavioral health department; the name and contact information of the behavioral health professional that was providing services to them while incarcerated (if any), contact information for the State Medicaid program; and, a list of available community based organization where behavioral health services could be obtain.
   2. Requires a county behavioral health department, in collaboration and coordination with community based organizations, to make every effort to maintain contact with and track outreach attempts for an individual for at least 120 days following their release. Requires a county behavioral health department to offer behavioral health services and treatment as appropriate. Requires, if an individual has private health insurance, the county behavioral health department to assist in facilitating the individual’s access to their private insurance.

REGISTERED SUPPORT / OPPOSITION:

Support

California Council of Community Behavioral Health Agencies, sponsor
Depression and Bipolar Support Alliance-California

Opposition

None on file.

Analysis Prepared by: Judith Babcock / HEALTH / (916) 319-2097

 THIRD READING  

Bill No: SB 717

Author: Stern (D)

Introduced: 2/16/23

Vote: 21

SENATE HEALTH COMMITTEE: 11-0, 4/19/23

AYES: Eggman, Nguyen, Dahle, Glazer, Gonzalez, Limón, Menjivar, Roth, Rubio, Wahab, Wiener

NO VOTE RECORDED: Hurtado

SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/18/23

AYES: Portantino, Jones, Ashby, Bradford, Seyarto, Wahab, Wiener

SUBJECT: County mental health services

SOURCE: Author

DIGEST:

This bill requires a county behavioral health department to maintain contact for 180 days with, and to offer mental health services and treatment to, an individual found incompetent to stand trial who is not receiving court directed services through diversion, as specified.

ANALYSIS:

Existing law:

1. Establishes the Bronzan-McCorquodale Act (BMA) to organize and finance community mental health (MH) services for those with MH disorders in every county through locally administered and controlled community MH programs. Requires the mission of California’s mental health system to be to enable persons experiencing severe and disabling mental illnesses and children with serious emotional disturbances to access services and programs that assist them, in a manner tailored to each individual, to better control their illness, to achieve their personal goals, and to develop skills and supports leading to their living the most constructive and satisfying lives possible in the least restrictive available settings. [WIC §5600, et seq.]
2. Specifies that community MH services should be organized to provide an array of treatment options in the following areas, to the extent resources are available: precrisis and crisis services; comprehensive evaluation and assessment; individual service plans; medication education and management; case management; 24-hour treatment services; rehabilitation and support services; vocational rehabilitation; residential services; services for the homeless; and, group services, as specified. [WIC §5600.4]
3. Deems that, to the extent resources are available, the primary goal of the use of funds deposited in the mental health account of the local health and welfare trust fund should be to serve the target populations, which includes adults and older adults who have a serious mental disorder who are arrested or convicted of crimes. [WIC §5600.3]
4. Requires the trial, judgment, or hearing on the alleged violation to be suspended if a defendant is found mentally incompetent and authorizes a court to either:
5. Make a finding that the defendant is an appropriate candidate for diversion and, if the defendant is eligible, to grant diversion for a period not to exceed one year. Prohibits a defendant from being deemed incompetent to stand trial (IST) upon dismissal of charges at the conclusion of the period of diversion; or,
6. Dismiss the charges, as specified. Requires the court, if the criminal action is dismissed, to transmit a copy of the order of dismissal to the county behavioral health director or the director’s designee. [PEN §1370.01]
7. Requires the court to dismiss the pending revocation matter and permits the return of the defendant to supervision if the defendant is found mentally incompetent and is on a grant of probation for a misdemeanor offense. Permits the court to modify the terms and conditions of supervision to include appropriate mental health treatment, as specified. [PEN §1370.01]
8. States the intent of the Legislature that a defendant subject to the terms of being found IST to receive mental health treatment in a treatment facility and not a jail. [PEN §1370.01]

This bill requires a county behavioral health department to maintain contact for 180 days with, and to offer mental health services and treatment to, an individual found IST who is not receiving court directed services through diversion, as specified.

Comments

1. Author’s statement. According to the author, California is facing a behavioral health crisis where an estimated 63.1% of adults with mental illness do not receive mental health treatment. As a result, vulnerable individuals are left with minimal support and resources. It is important that we do not contribute to the lack of access to treatment and work toward a solution to make mental health treatment available to those most in need. This bill works to increase access to resources to those identified as IST, have been charged with a misdemeanor, and whose cases have been dismissed by the courts. By offering up to 180 days of outreach services to individuals who are incompetent to stand trial and whose cases have been dismissed, we can bring targeted resources to an already identified impacted population.
2. Background. According to a report of recommendations by the IST Solutions Workgroup from November 2021, over the last decade, California has seen significant year-over-year growth in the number of individuals charged with a felony offense who are found IST and committed to the California Department of State Hospitals (DSH) for competency restoration services. California has responded to the substantial growth in the felony IST population through multiple investments to increase DSH’s capacity to serve these individuals with serious mental illness. However, the growth in the felony IST patients has exceeded the capacity and outpaced other efforts to respond to the growth in the felony IST population, resulting in growing waitlist and wait times to admission. In 2015, the American Civil Liberties Union sued DSH regarding the amount of time IST defendants were waiting for admission into a DSH treatment program, alleging violations of individuals’ due process rights. The Alameda Superior Court ultimately ruled that DSH must commence substantive treatment services in 28 days for felony IST patients. DSH appealed this ruling and ultimately, in the summer of 2021, the Superior Court’s order was affirmed. Meanwhile, the COVID-19 pandemic has also significantly affected DSH’s ability to meet the IST demands, and as of November 2021, over 1,700 individuals are awaiting restoration of competency treatment. The report further states a 2017 study conducted by the National Association of State Mental Health Program Directors Research Institute found that from 1999 to 2014, the overall number of forensic patients in state hospitals increased by 74% while the number of IST patients increased by 72% during that same period. Multiple state hospital systems across the country are facing lawsuits because of their inability to continuously increase the number of forensic inpatient beds available to admit and treat IST patients within court mandated timeframes, including in California, which has set a 28-day post commitment deadline for DSH to begin substantive treatment of an IST ordered to DSH.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes

According to the Senate Appropriations Committee, unknown cost increases to county behavioral health departments to locate and maintain contact with individuals for 180 days for purposes of offering treatment services. Unknown cost pressures to the General Fund, as costs to counties for administration would be potentially reimbursable by the state, subject to a determination by the Commission on State Mandates.

SUPPORT: (Verified 5/19/23)

California Council of Community Behavioral Health Agencies

Depression and Bipolar Support Alliance

OPPOSITION: (Verified 5/19/23)

County Behavioral Health Directors Association

ARGUMENTS IN SUPPORT: The Depression and Bipolar Support Alliance states that while 180 days may not be long enough to require contact (when possible) with IST individuals, this bill is a good start to ensure continuity of care. Anyone found incompetent to stand trial should already be receiving substantial mental health services, and hopefully this bill will do more to ensure this. The California Council of Community Behavioral Health Agencies (CBHA) states that individuals found IST on misdemeanor charges often fall through the cracks, receiving little to no mental health support. This lack of assistance can exacerbate their mental health conditions, putting them at risk for further criminal justice involvement and increased personal suffering. CBHA states the extended support as required in this bill can help prevent further deterioration of a person’s mental health and reduce the likelihood of recidivism. CBHA argues by providing ongoing support to individuals found IST on misdemeanor charges, we can promote better mental health outcomes, reduce the strain on the criminal justice system, and create safer communities.

ARGUMENTS IN OPPOSITION: The County Behavioral Health Directors Association (CBHDA) states that they share the author’s concern for a population that could benefit from voluntarily engaging in behavioral health treatment and services. However, the requirement that county behavioral health agencies maintain contact for six months with these individuals, many of whom are homeless, lack contact information, phones, or a permanent address is a significant additional burden that would require the hiring of multiple additional staff per county at a time when we are already facing a catastrophic workforce crisis that is significantly impacting patient care. Even for Medi-Cal clients, outreach and engagement are not reimbursable services. CBHDA states that in addition, a significant proportion of this population will be privately insured, and this bill does not require reimbursement for providing taxpayer-funded services to a privately insured population. To that end, CBHDA requests an amendment to this bill to limit the scope of the bill to a notification requirement to IST individuals by the courts, notifying them of their eligibility for voluntary behavioral health services and treatment, depending upon their insurance provider, at the time of their dismissal from the court system. In addition, CBHDA states that representatives from county behavioral health agencies, commercial insurance providers, and Medi-Cal managed care plans should be brought in to help inform the development of a second notification by mail about their eligibility for behavioral health treatment and services, depending on their insurance provider.

Prepared by: Reyes Diaz / HEALTH / (916) 651-4111

5/20/23 13:05:33

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SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

SB 717 (Stern) - County mental health services

Bill Summary:

SB 717 would require a county behavioral health department to maintain contact for 180 days with, and to offer mental health services and treatment to, an individual found incompetent to stand trial (IST) who is not receiving court directed services, as specified.

Fiscal Impact:

Unknown cost increases to county behavioral health departments to locate and maintain contact with individuals for 180 days for purposes of offering treatment services. Unknown cost pressures to the General Fund, as costs to counties for administration would be potentially reimbursable by the state, subject to a determination by the Commission on State Mandates.

Background:

Existing law establishes the Bronzan-McCorquodale Act to organize and finance community mental health services for those with mental health disorders in every county through locally administered and controlled community mental health programs. Current law requires the mission of California’s mental health system to be to enable persons experiencing severe and disabling mental illnesses and children with serious emotional disturbances to access services and programs that assist them, in a manner tailored to each individual, to better control their illness, to achieve their personal goals, and to develop skills and supports leading to their living the most constructive and satisfying lives possible in the least restrictive available settings.

Current law requires the trial, judgment, or hearing on an alleged criminal misdemeanor violation to be suspended if a defendant is found mentally incompetent and authorizes a court to either:

a) Conduct a hearing to determine if the defendant is an appropriate candidate for diversion and, if the defendant is eligible, to grant diversion as specified; if the defendant is ineligible for diversion, the court may hold a hearing to refer the defendant to other treatment/programs; or,

b) Dismiss the charges, as specified. Requires the court, if the criminal action is dismissed, to transmit a copy of the order of dismissal to the county behavioral health director or the director’s designee.

Proposed Law:

SB 717 would require a county behavioral health department to maintain contact for 180 days with, and to offer mental health services and treatment to, an individual charged with a misdemeanor and found IST who is not receiving court directed services, as specified.

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SENATE COMMITTEE ON HEALTH

Senator Dr. Susan Talamantes Eggman, Chair

BILL NO: SB 717

SUBJECT: County mental health services

SUMMARY:

Requires a county behavioral health department to maintain contact for 180 days with, and to offer mental health services and treatment to, an individual found incompetent to stand trial who is not receiving court directed services through diversion, as specified.

Existing law:

1. Establishes the Bronzan-McCorquodale Act (BMA) to organize and finance community mental health (MH) services for those with MH disorders in every county through locally administered and controlled community MH programs. Requires the mission of California’s mental health system to be to enable persons experiencing severe and disabling mental illnesses and children with serious emotional disturbances to access services and programs that assist them, in a manner tailored to each individual, to better control their illness, to achieve their personal goals, and to develop skills and supports leading to their living the most constructive and satisfying lives possible in the least restrictive available settings. [WIC §5600, et seq.]
2. Specifies that community MH services should be organized to provide an array of treatment options in the following areas, to the extent resources are available: precrisis and crisis services; comprehensive evaluation and assessment; individual service plans; medication education and management; case management; 24-hour treatment services; rehabilitation and support services; vocational rehabilitation; residential services; services for the homeless; and, group services, as specified. [WIC §5600.4]
3. Deems that, to the extent resources are available, the primary goal of the use of funds deposited in the mental health account of the local health and welfare trust fund should be to serve the target populations, which includes adults and older adults who have a serious mental disorder who are arrested or convicted of crimes. [WIC §5600.3]
4. Requires the trial, judgment, or hearing on the alleged violation to be suspended if a defendant is found mentally incompetent and authorizes a court to either:
5. Make a finding that the defendant is an appropriate candidate for diversion and, if the defendant is eligible, to grant diversion for a period not to exceed one year. Prohibits a defendant from being deemed incompetent to stand trial (IST) upon dismissal of charges at the conclusion of the period of diversion; or,
6. Dismiss the charges, as specified. Requires the court, if the criminal action is dismissed, to transmit a copy of the order of dismissal to the county behavioral health director or the director’s designee. [PEN §1370.01]
7. Requires the court to dismiss the pending revocation matter and permits the return of the defendant to supervision if the defendant is found mentally incompetent and is on a grant of probation for a misdemeanor offense. Permits the court to modify the terms and conditions of supervision to include appropriate mental health treatment, as specified. [PEN §1370.01]
8. States the intent of the Legislature that a defendant subject to the terms of being found IST to receive mental health treatment in a treatment facility and not a jail. [PEN §1370.01]

This bill: Requires a county behavioral health department to maintain contact for 180 days with, and to offer mental health services and treatment to, an individual found IST who is not receiving court directed services through diversion, as specified.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, California is facing a behavioral health crisis where an estimated 63.1% of adults with mental illness do not receive mental health treatment. As a result, vulnerable individuals are left with minimal support and resources. It is important that we do not contribute to the lack of access to treatment and work toward a solution to make mental health treatment available to those most in need. This bill works to increase access to resources to those identified as IST, have been charged with a misdemeanor, and whose cases have been dismissed by the courts. By offering up to 180 days of outreach services to individuals who are incompetent to stand trial and whose cases have been dismissed, we can bring targeted resources to an already identified impacted population.
2. Background. According to a report of recommendations by the IST Solutions Workgroup from November 2021, over the last decade, California has seen significant year-over-year growth in the number of individuals charged with a felony offense who are found IST and committed to the California Department of State Hospitals (DSH) for competency restoration services. California has responded to the substantial growth in the felony IST population through multiple investments to increase DSH’s capacity to serve these individuals with serious mental illness. However, the growth in the felony IST patients has exceeded the capacity and outpaced other efforts to respond to the growth in the felony IST population, resulting in growing waitlist and wait times to admission. In 2015, the American Civil Liberties Union sued DSH regarding the amount of time IST defendants were waiting for admission into a DSH treatment program, alleging violations of individuals’ due process rights. The Alameda Superior Court ultimately ruled that DSH must commence substantive treatment services in 28 days for felony IST patients. DSH appealed this ruling and ultimately, in the summer of 2021, the Superior Court’s order was affirmed. Meanwhile, the COVID-19 pandemic has also significantly affected DSH’s ability to meet the IST demands, and as of November 2021, over 1,700 individuals are awaiting restoration of competency treatment. The report further states a 2017 study conducted by the National Association of State Mental Health Program Directors Research Institute found that from 1999 to 2014, the overall number of forensic patients in state hospitals increased by 74% while the number of IST patients increased by 72% during that same period. Multiple state hospital systems across the country are facing lawsuits because of their inability to continuously increase the number of forensic inpatient beds available to admit and treat IST patients within court mandated timeframes, including in California, which has set a 28-day post commitment deadline for DSH to begin substantive treatment of an IST ordered to DSH.
3. Related legislation. SB 349 (Roth) requires, if a question is raised by the court as to a defendant’s mental competence, the question of the defendant’s mental competence to be presumed to apply to all cases pending against the defendant in that county, as specified. SB 349 is set to be heard in the Senate Appropriations Committee on April 17, 2023.

AB 1584 (Weber) requires, in part, the court, upon a finding of mental incompetence of a defendant charged with a felony that is not ineligible for diversion, to determine if it is in the interests of justice to restore the defendant to competence. Requires the court, if the restoration of the defendant’s mental competence is not in the interests of justice, to either grant mental health diversion to the defendant or dismiss the charges against the defendant, as specified. AB 1584 is set to be heard in the Assembly Public Safety Committee on April 18, 2023.

1. Prior legislation. SB 317 (Stern, Chapter 599, Statutes of 2021) revises the procedures when a defendant is found IST on misdemeanor charges. Permits a defendant to earn conduct credits when they are committed to a state hospital or other mental health treatment facility as IST in the same manner as if they were held in county jail.

SB 1187 (Beall, Chapter 1008, Statutes of 2018) reduces the maximum term for commitment to a treatment facility when a defendant has been found IST on a felony from three years to two years. Specifies that when a defendant has been found IST and is held in a county jail treatment center while undergoing treatment for restoration to competency that person is entitled to custody credits in the same manner as any other inmate confined to a county jail.

AB 1810 (Committee on Budget, Chapter 34, Statutes of 2018) specifies that when a defendant is determined to be IST the court can find that they are an appropriate candidate for mental health diversion.

1. Support. The Depression and Bipolar Support Alliance states that while 180 days may not be long enough to require contact (when possible) with IST individuals, this bill is a good start to ensure continuity of care. Anyone found incompetent to stand trial should already be receiving substantial mental health services, and hopefully this bill will do more to ensure this. The California Council of Community Behavioral Health Agencies (CBHA) states that individuals found IST on misdemeanor charges often fall through the cracks, receiving little to no mental health support. This lack of assistance can exacerbate their mental health conditions, putting them at risk for further criminal justice involvement and increased personal suffering. CBHA states the extended support as required in this bill can help prevent further deterioration of a person’s mental health and reduce the likelihood of recidivism. CBHA argues by providing ongoing support to individuals found IST on misdemeanor charges, we can promote better mental health outcomes, reduce the strain on the criminal justice system, and create safer communities.
2. Oppose unless amended. The County Behavioral Health Directors Association (CBHDA) states that they share the author’s concern for a population that could benefit from voluntarily engaging in behavioral health treatment and services. However, the requirement that county behavioral health agencies maintain contact for six months with these individuals, many of whom are homeless, lack contact information, phones, or a permanent address is a significant additional burden that would require the hiring of multiple additional staff per county at a time when we are already facing a catastrophic workforce crisis that is significantly impacting patient care. Even for Medi-Cal clients, outreach and engagement are not reimbursable services. CBHDA states that in addition, a significant proportion of this population will be privately insured, and this bill does not require reimbursement for providing taxpayer-funded services to a privately insured population. To that end, CBHDA requests an amendment to this bill to limit the scope of the bill to a notification requirement to IST individuals by the courts, notifying them of their eligibility for voluntary behavioral health services and treatment, depending upon their insurance provider, at the time of their dismissal from the court system. In addition, CBHDA states that representatives from county behavioral health agencies, commercial insurance providers, and Medi-Cal managed care plans should be brought in to help inform the development of a second notification by mail about their eligibility for behavioral health treatment and services, depending on their insurance provider.

SUPPORT AND OPPOSITION:

Support: California Council of Community Behavioral Health Agencies

Depression and Bipolar Support Alliance

Oppose: County Behavioral Health Directors Association (unless amended)

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