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Program Enhancements and Other Adjustments
Department of Mental Health
The Department of Mental Health (DMH) ensures that a continuum of care exists throughout the state for children and adults who are mentally ill by providing oversight of community mental health programs and direct services through state mental hospitals. The Governor's Budget includes $4.8 billion ($1.9 billion General Fund) for the DMH, a net increase of $652.8 million (a decrease of $217.2 million General Fund) from the revised 2006-07 budget and an increase of $1.1 billion ($201.1 million General Fund) from the Budget Act of 2006.
This net change primarily reflects continued growth in the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program, the impact of Proposition 83, also known as Jessica's Law, elimination of the Integrated Services for Homeless Adults with Serious Mental Illness program, and the removal of one-time costs for prior-year AB 3632 mandate claims.
PROPOSITION 83 (JESSICA'S LAW)
Jessica's Law, approved by California voters in November 2006, enhances public safety by changing the laws that provide for the commitment, control and supervision of sex offenders. Jessica's Law has the potential to increase sexually violent predator (SVP) commitments to state hospitals from an average of 49 to 440 annually. The population increase of SVPs in state hospitals is reflected in the increased costs at state hospitals.
By expanding the definition of a sexually violent offense and lowering the current two victim criterion to one victim, Jessica's Law significantly increases the number of case referrals to DMH. The number of cases referred to DMH for screening is expected to increase almost tenfold (from 582 to 5,528 cases annually). The Governor's Budget includes $25.0 million General Fund for additional SVP contractor evaluations and expert court testimonies, $24.1 million General Fund for state hospitals to support 440 expected SVP commitments and $449,000 General Fund for Coalinga State Hospital to support the increase in SVP referrals. The budget also includes $4.3 million General Fund and 41.8 positions at DMH headquarters to contract, monitor, record and report information for the multiple evaluations and expert court testimonies required by Jessica's Law.
To immediately begin implementing Jessica's Law, the Governor's Budget reflects a current-year augmentation of $15.2 million General Fund for the increased cost of contractor evaluations and expert court testimonies, $12.1 million General Fund for state hospitals to support 271 new SVP commitments, $927,000 General Fund and 21 positions at DMH headquarters to be phased in during the year, and $678,000 General Fund and 7.2 positions for Coalinga State Hospital to be phased in during the year to support the increase in SVP referrals. The CDCR section discusses the impacts of Jessica's Law on that department.
COMMUNITY MENTAL HEALTH SERVICES
The Administration recognizes the value of providing mental health services in communities to prevent commitment to a state hospital or incarceration. The Governor's Budget includes $3.4 billion ($762.9 million General Fund), an increase of $927.6 million ($47.4 million General Fund) compared to the revised 2006-07 budget, for community mental health services.
Early and Periodic Screening, Diagnosis and Treatment Program
The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program is an entitlement program for children and adults under age 21. The program provides services to approximately 185,571 Medi-Cal-eligible children and young adults to ameliorate a diagnosed mental illness.
In 2006-07, there is an increase in the General Fund appropriation of $302.7 million that includes a deficiency request related to EPSDT of $243.0 million for unpaid county claims from prior years. The federal reimbursement authority is increased by $275.7 million to reflect an adjustment to the funding level for EPSDT services and to pay prior years claims. In 2007-08, there is an increase of $92.7 million General Fund and $95.1 million federal reimbursement authority above the Budget Act of 2006 attributable to increases in the cost and volume of claims, including the effect of the Mental Health Services Act (Proposition 63) on EPSDT services provided.
The Department of Finance's Office of Statewide Evaluations and Audits (OSAE) is reviewing EPSDT estimating methodology, and the Administration will have a proposal to improve this methodology in the spring. The OSAE also is assisting the DMH in an internal control review of DMH's system and processes.
Integrated Services for Homeless Adults with Serious Mental Illness
The Governor's Budget proposes elimination of the Integrated Services for Homeless Adults with Serious Mental Illness program. This program currently provides funding to local mental health agencies to act as the single point of responsibility for the comprehensive service needs of individuals who are homeless or at risk of homelessness or incarceration and have a serious mental illness. Similar services are available to individuals under Proposition 63. Eliminating General Fund for these programs results in annual ongoing local assistance savings of $54.9 million. Significant increases in the EPSDT program in both current and budget year allow for the elimination of this program while still meeting the Proposition 63 maintenance-of-effort requirements.
Early Mental Health Initiative
The Governor's Budget includes a $5 million increase in Proposition 98 General Fund to augment the budget for the Early Mental Health Initiative (EMHI), which provides grants to local education agencies for supportive, non-clinical mental health intervention and prevention services to children (grades K-3) who have mild to moderate school adjustment difficulties. This augmentation will increase total program funding to $15 million in 2007-08.
STATE HOSPITALS
State hospitals operated by DMH provide long-term care and services to the mentally ill. The General Fund supports judicially committed, Penal Code and SVP patients, while counties fund other civil commitments. In 2006-07, there is an increase of $98.1 million ($95.2 million General Fund) and 269.9 positions for state hospitals due primarily to the impact of Jessica's Law and a technical correction to the level-of-care staffing included in the Budget Act of 2006. The Governor's Budget includes $1.2 billion ($1.1 billion General Fund) and 10,898.8 positions for 2007-08, an increase of $114.8 million ($88.3 million General Fund) and 1,020.3 positions from the revised 2006-07 budget, due primarily to a projected increase of 440 SVP commitments and resources to comply with the Civil Rights for Institutionalized Persons Act and Jessica's Law. The patient population is projected to reach a total of 6,544 in 2007-08.
The Governor's Budget includes funding to address the second - and final - phase of the Administration's commitment to implementing a fully functioning hospital police department at Patton State Hospital. An additional $1.7 million General Fund and 28.3 positions will establish 24-hours-a-day, 7 days-a-week coverage to ensure the safety and security of patients, hospital staff and the general public.
Special education and related services must be provided to all eligible pupils who reside in state hospitals and psychiatric programs operated by DMH. The Governor's Budget includes $3.4 million to provide education services to adolescents at Metropolitan State Hospital (MSH). Due to the declining adolescent population at MSH, coupled with the incentive to place youth in the community, the DMH is examining the need to continue operating this unit. The DMH is collaborating with counties regarding their need for these beds and has a contract in place to continue educational services for the current school year.
Continued Activation of Coalinga State Hospital
Coalinga State Hospital opened in September 2005 and began admitting SVP patients transferred from Atascadero State Hospital. However, patient transfers have been slower than anticipated due to difficulty in filling staff positions at Coalinga. The DMH has been working to address the delayed hiring of level-of-care staff necessary for bed activation by continuing aggressive recruitment efforts throughout California and the United States, using recruitment and retention differentials where appropriate and contracting for nursing registry services as needed. As patient transfers to Coalinga increase, additional patients currently awaiting transfer from local jails will be admitted to the state hospital system. The Administration estimates that the population at Coalinga will be 1,362 patients in 2007-08, an increase of 645 patients over the Budget Act of 2006.
Coleman Court Order
In June 2006, the director of the DMH was named as a co-defendant in Coleman v. Schwarzenegger, the federal lawsuit claiming that the CDCR is not providing adequate mental health services to inmates. This lawsuit will require the DMH to participate in Coleman hearings, review and comment on monitoring reports, objections, stipulations and court orders and provide information as requested by the court regarding California hospitals and psychiatric programs. The Governor's Budget includes an increase of $145,000 for legal resources to assist with this effort.
In addition, the Coleman decision requires that mental health classifications in CDCR receive salary increases beginning in the current year. The Governor's Budget includes $3.9 million General Fund in 2006-07 and $5.5 million General Fund in 2007-08 to increase the salaries of the same classifications of staff working in DMH psychiatric programs operating within Salinas Valley State Prison and the California Medical Facility at Vacaville.
Salary Increases for Medical Services Personnel
The Governor's Budget contains an increase of $7.1 million ($6.9 million General Fund) to bring salaries for classifications providing medical services at the DMH to within 18 percent of the Plata court-ordered salaries for CDCR. This will allow hiring and retention of medical staff at state hospitals.
MENTAL HEALTH SERVICES ACT (PROPOSITION 63)
Revenues to the Mental Health Services Fund are projected to increase over previous estimates by $312.1 million in 2006-07 and $495.7 million in 2007-08, for a total estimate of $1.6 billion in 2006-07 and $1.8 billion in 2007-08.
Funds are continuously appropriated to the DMH for county implementation of Proposition 63. Almost all counties have completed their community planning process. Counties are in the process of local implementation of the Community Services and Supports component of Proposition 63, which provides additional mental health services to individuals with serious mental illness. The other four components (Child and Adult/Older Adult Services, Education and Training, Capital Facilities and Technology Needs and Innovation) are expected to be implemented by the end of 2007-08.
The Governor's Budget proposes no changes in state administration expenditures for the DMH for Proposition 63. The need for any additional staff and contract funding will be addressed in the spring budget process when more information is available on future needs based upon an updated implementation plan.
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