NAMI
Position on AB 1421,1422 & 1424
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Randall Hagar
URGENT ACTION ALERT!
by Randall Hagar,
NAMI California Legislative Director
(916) 721-1293 / randall@sl.net
Budget Item Hearing Action Request: AB 1421, AB 1422 & AB 1424
Friday, April 06, 2001
NAMI California's three priority bills for the year are all going to be heard in committee within the next 2 ½ weeks. We need to have letters sent. The bills are explained in the attached position papers. Unfortunately, with all three bills we need separate letters on each separate bill. We know it's a lot of work, but when you see the subjects of these bills I think you'll agree that we have an extraordinary opportunity which requires an extraordinary effort.
Contents:
- Position Papers on AB 1421 (Thomson), AB 1422 (Thomson), AB 1424 (Thomson)
- Sample Letters for all these bills.
- Committee Contact information for Assembly Health (AB 1421 & AB 1422) and for Assembly Judiciary (AB 1424).
Instructions:
- Write directly to your legislator if he or she is on either committee, with a copy to the chair.
- Write to the Committee Chair if you are not a constituent.
- In all cases, please make sure a copy of your letter goes to the author, Helen
Thomson, directly.
- In order of preference: it's more effective to write a letter. If time considerations make unlikely that a letter would arrive in time, then fax is the next preferable means of contact. If you haven't composed a letter and time is short, under these conditions a phone call is always preferable to no contact.
- Follow up a letter or a fax with a phone call to a district office if you are a constituent, to the committee chair if you are not.
- We need letterhead for official organizational support letters, and also as many letters from your individual members as you can get.
- For organizations in support to be listed in the committee analysis your letterhead should be into the Chair's office by Thursday before the hearing. This is very important: all members check to see who's in support and who's opposed before they vote. Getting on this list therefore is of high importance.
DATES:
April 17: Assembly Health Committee Hearing: AB 2421, AB 1422
April 24 (tentative): Assembly Judiciary Committee Hearing: AB 1424
AB 1421 (Thomson) Briefing Paper
AB 1421 incorporates key elements of the RAND report on "The Effectiveness of Involuntary Outpatient Treatment."
AB 1421 has not yet been amended to incorporate the following provisions, but it is anticipated that they will be introduced soon. There will be four components:
- Assisted Outpatient Treatment (AOT, i.e. court ordered outpatient commitment);
- Specified intensive community services for treatment of those under court orders;
- A voluntary service contract option for those who can survive safely in the community and who wish to receive services without court order;
- Rigorous outcome reporting of 16 quality of life indicators to demonstrate the validity of AOT as both a cost effective and therapeutic intervention which promotes stability and integration into the community in a least restrictive manner.
AB 1421 will, therefore, provide both the legal and treatment structure necessary to give severely disabled people with mental illness, who are unable to accept treatment on their own, the support they need to achieve stability and recovery, and to regain a meaningful life in the community. Typically these are individuals who have histories of multiple hospitalizations, incarcerations, or who have badly deteriorated clinical circumstances and may be languishing in the back bedrooms of family homes.
The due process provisions for both AOT and the voluntary service contracts are both vigorous and specified in detail.
The assertive community treatment service (ACT) model provided for in AB 1421 is a proven, evidence based, 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. Rather, it provides 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 helping severely disabled people achieve a real road to recovery. In over 25 years of existence, ACT is the most studied and successful model for reintegrating the most severely disabled into the community.
The combination of AOT and ACT is a powerful combination which will reach those people incapable of accessing or accepting services in California's currently fragmented mental health system.
AB 1422 (Thomson) Briefing Paper
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:
- 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.
- 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.
- AB 1422 eliminates the provision allowing 10 % yearly transfers out of county Mental Health, Realignment Sub-Accounts.
- 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.
- 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.
These measures in concert will do nothing less than reverse the staggering neglect of 30 years of broken promises to the severely mentally ill and their families. It will re-enfranchise, with a virtual right to treatment, the most severely ill of our citizens. It will provide real hope for the successful integration into communities of our most vulnerable citizens. For the first time it will give those individuals a chance at a life of real satis- faction and fulfillment such as many of our other citizens take for granted and consider a birthright.
We are strongly in support and urge an "AYE" vote.
AB 1424 (Thomson) Briefing Paper
- 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.
- 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.
- Defines the patient's medical records, including psychiatric records, as necessary and mandatory evidence of the historical course of a person's mental disorder.
- 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.
- Requires facilities to make every reasonable effort to make information provided by family members available in court.
- Requires the agency or facility where the person is treated pursuant to a commitment order to acquire his or her medication history.
- 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.
- Prohibits using a person's involuntary commitment status as a reason to discontinue their HMO, disability insurance or Media-Cal benefits.
- 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 persons under involuntary commitment criteria.
- 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 members illness which is unobtainable from other sources. It is absolutely essential that it be considered.
History is also absolutely essential both for correct clinical determinations but 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.
The Fourth Edition of the DSM IV, the latest in a series of Diagnostic and Statistical Manuals, provides the criteria for diagnosis of mental disorders: it also requires, for the first time, the taking of input from families. To do any less does not meet the criteria for diagnosis. It's about time. We think it absolutely critical that the State of California follow suit.
We urge your strong Support.
[AB 1421 SAMPLE LETTER]
[your assembly person or the chair]
State Capitol Building, Rm. ____
Sacramento, Ca 95814
FAX 916-319-____
Re: SUPPORT, AB 1421 (Thomson)
Dear Assemblymember [Name]:
Assertive community treatment (ACT) coupled with an Assisted Outpatient Treatment order will reduce homelessness, revolving door hospitalization, and violence. The money spent in this preventative treatment will come back to the state in savings related to reductions in criminalization and revolving door hospitalizations. It will provide treatment for those least able to access it and most in need of it.
[Place a paragraph telling a personal story about how you or your loved one would benefit from the ACT and AOT combination. Use details, names, places and times if possible: the more concrete the better]
Individuals with mental illness deserve the chance to become contributing members of our society.
We [I] urge your support
Sincerely,
Your Name
Your Organization, if any
Your address
[AB 1422 SAMPLE LETTER]
[your assemblyperson or the chair]
State Capitol Building, Rm. ____
Sacramento, Ca 95814
FAX 916-319-____
Re: SUPPORT, AB 1422 (Thomson)
Dear Assemblymember [Name]:
Please support AB 1422 (Thomson).
We need to reverse the staggering neglect of 30 years of broken promises to the severely mentally ill and their families.
[here place a paragraph that tells your story which outlines the suffering and consequences of poor services, or no services]
Nothing more than a full entitlement to services will do. We must have this in order to correct so many deficiencies in mental health services. The additional provisions are absolutely essential to this effort as well.
Sincerely,
Your Name
Your Organization, if any
Your address
[AB 1424 SAMPLE LETTER]
[your assemblyperson or the chair]
State Capitol Building, Rm. ____
Sacramento, Ca 95814
FAX 916-319-____
Re: SUPPORT, AB 1424 (Thomson)
Dear Assemblymember [Name]:
Please [or "We" support if to the author herself] support AB 1424 (Thomson).
History and medical records are absolutely essential to include in commitment hearings.
Involuntary or voluntary inpatient status shouldn't determine what is medically necessary in payment for services.
[here place a paragraph that tells your story which outlines the suffering and consequences because family history or medical or medication history was either not sought or was disregarded, either by crisis emergency psychiatric personnel or by police officers]
Nothing more than a full entitlement to services will do. We must have this in order to correct so many deficiencies in mental health services. The additional provisions are absolutely essential to this effort as well.
Sincerely,
Your Name
Your Organization, if any
Your address
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