California Bills AB 1421, AB 1422, AB 1423,
AB 1424 & AB 1425

Recently Helen Thomson of Davis, CA., introduced 5 new bills into the California legislature.  These bills address some of the issues regarding County Mental Health services in California, but also raise some issues.  

AB 1421 implements a number of the recommendations in the RAND study, but its focus on involuntary outpatient treatment has made it a target of some consumer rights groups such as the California Network of Mental Health Clients and the Support Coalition.  AB 1421 requires the assertive community treatment service (ACT) model, which is a comprehensive, community treatment program for individuals with the most severe and persistent mental illnesses. Unlike other community-based programs, these services are not a linkage or brokerage case-management program that connects individuals to fragmented mental health, housing, or rehabilitation agencies or services. They provide highly individualized services directly to consumers by a multidisciplinary, round-the-clock team of professionals who bring their services to the consumer directly in their home or in the community wherever the services need to be delivered. ACT is a 24-7, 365 day approach to providing treatment for severely disabled people.  The concern is that AB 1421 supports involuntary treatment and implements some fundamental changes in the law.  It moves the criteria for commitment from behavioral standards to a prediction of future deterioration.  It allows for family and friends to petition for involuntary commitment and allows the commitment hearing to proceed in some cases without the presence of the person who is the subject of the hearing.  The involuntary commitment can be for a period of up to 6 months and can be followed by an additional 6 months. 

AB 1422 incorporates findings of the Little Hoover Commission report on Mental Health, declaring that our state mental health delivery system is inadequate in most critical dimensions: funding, quality, accessibility, accountability, efficiency, fragmentation, crisis driven, effectiveness. It clearly shows that we pay enormous costs not only in dollars but also in social costs by denying services, or providing inadequate services, to individuals in need of mental health treatment.

It is an omnibus style bill with many specific provisions:

1. AB 1422 Creates a Mental Health Advocacy Commission to raise private funds and promote an end to discrimination and stigma associated with mental illness to benefit our communities and the well being of all Californians.

2. AB 1422 Eliminates the statutory language that services will be provided "to the extent resources are available." In effect making mental health services an entitlement. It provides that counties receiving realignment funds do so on condition of abiding by specific minimum standards of care.

3. AB 1422 eliminates the provision allowing 10% yearly transfers out of county Mental Health, Realignment Sub-Accounts.

4. Requires the collection of data forecasting anticipated savings in criminal justice, public safety, health and public services directly related to the establishment of a mental health services entitlement.

5. Transfers payment responsibility from counties to the state general fund for local match with federal Medicaid (i.e. Medi-Cal) funds paying for mental health services in the state.

This bill addresses basic issues of funding mental health programs transferring responsibility to the state level and beginning a process of insuring consistent standards of treatment.

AB  1424 provides for more historical data to be available for court hearings and court ordered treatment programs.  It:

1. Prohibits any (HMO) plan or disability insurer to make decisions using the voluntary or involuntary status of a psychiatric inpatient admission for the purpose of determining eligibility for insurance coverage.

2. Requires that historical course evidence be admitted in court. And must include evidence presented by persons who have provided, or are providing, mental health or related support services to the patient.

3. Defines the patient's medical records, including psychiatric records, as necessary and mandatory evidence of the historical course of a person's mental disorder.

4. Clarifies that family member evidence is not required if families don't wish, but must be allowed when the families wish it, i.e. it's voluntary.

5. Requires facilities to make every reasonable effort to make information provided by family members available in court.

6. Requires the agency or facility where the person is treated pursuant to a commitment order to acquire his or her medication history.

7. Requires a hearing officer, court or jury to exclude any evidence it determines to be irrelevant due to remoteness of time or dissimilarity of circumstances.

8. Prohibits using a person's involuntary commitment status as a reason to discontinue their HMO, disability insurance or Media-Cal benefits.

9. Requires the Department of Mental Health to provide training and technical assistance to counties to train to those making treatment and commitment decisions on information relevant to legal requirements for detaining a person under involuntary commitment criteria.

10. Adds "available relevant information about the historical course of the person's mental disorder", including evidence presented by family members or persons providing mental health or related support services to the person, to information which must be considered when peace officers establish probable cause to take a person into custody for an evaluation to determine whether the person meets commitment criteria.

Families often possess unique clinical information about the course and nature of their family member’s illness, which is unobtainable from other sources. This bill provides for its consideration and for the general consideration of patient history.  The position paper for the bill states: “History is absolutely essential both for correct clinical determinations and for commitment procedures. For no other illnesses would it be excluded in important decisions. It is particularly important to review history because many individuals may 'present well' when in fact they are psychotically disorganized in their behavior and thinking, or are wildly hallucinating or are suffering from paranoid or other delusions - and, in the moment, appear otherwise.”

At press time, we still did not have information on AB 1423 or AB 1425, but we intend to have an update in our next newsletter.

Click here for comments by Tom Barresi

Click here for NAMI Position

Click here for CNMHC Position

Click here for the current status of AB 1421.

Opinions expressed in this web site do not necessarily reflect the views of NAMI Santa Cruz County, NAMI California or any affiliated organizations.  We attempt to present a balanced perspective on issues by presenting multiple viewpoints.

Copyright 2005 National Alliance for the Mentally Ill Santa Cruz County, All Rights Reserved.

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