Mental Health May Revision
RE: Mental Health May Revision Proposals - OPPOSE
May 24, 2010
Honorable Denise Moreno Ducheny
Senate Budget Committee
Capitol Building, Room 5019
Sacramento, CA 95814
Dear Senator Ducheny:
Disability Rights Californi`¡a, a non-profit advocacy organization mandated to advance the human and legal rights of people with disabilities, opposes the following May revision proposals regarding mental health.
Proposal to shift mental health realignment trust funds to county social services programs, resulting in General Fund savings and the same loss in funding in mental health programs at the local level. Mental health services scaled back under Medi-Cal to only in-patient treatment and medications for adults and Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT) for children identified as seriously emotionally disturbed.
Counties Currently Unable to Meets the Needs
This would be a catastrophic cut to the state’s mental health system as counties are already unable to meet the needs of people with serious psychiatric disabilities. The patchwork of community mental health services across the state is fast disintegrating.
Sacramento County is in the process of dismantling four regional support teams that serve over 5,000 individuals. Their alternative services remain in limbo. Since February 2009, Riverside County has been turning away nearly all persons who seek outpatient mental health services unless they have Medi-Cal insurance. Indigent individuals can find little, if any, rehabilitative mental health services, including medication support services. Orange County has discontinued or severely restricted access to individual therapy even for Medi-Cal recipients. Crisis residential programs were an important piece of the recovery continuum under the Mental Health Services Act (MHSA), but Los Angeles County has a mere 21 crisis residential beds.
It is essential that the state properly fund and develop an array of comprehensive, voluntary, community-based mental health services. Such services are significantly less expensive than involuntary treatment, and are effective when implemented. They have been proven highly effective in reducing incarceration, psychiatric hospitalization, and homelessness in a cost-effective manner.
Finally, for California men and women in uniform, who fight for our country and state, the safety net for mental health problems are the counties. The Veterans Administration process can take much time and effort. The state's mental health system is already failing to serve many veterans and the governor's proposed mental health funding cut would leave more by the side of the road.
We agree with the California State Association of Counties (CSAC) that mental health infrastructure is on the brink of collapse. Shifting 60% of realignment mental health trust funds to other social service programs would further underfund the mental health system and restrict development of community mental health services putting the mental health system in complete disarray. Failing to fund and develop community mental health services will destroy the lives of people with psychiatric disabilities, their families and communities.
Proposal Violates MHSA Maintenance of Effort Requirement
The proposal to change the funding structure under realignment most likely violates the MHSA maintenance of effort requirement vis-à-vis state funding for community mental health. Section 5891(a) of the Welfare and Institutions Code provides that the state may “not make any change to the structure of financing mental health services, which increases a county’s share of costs or financial risk for mental health services unless the state includes adequate funding to fully compensate for such increased costs or financial risk.” A sixty percent reduction in realignment mental health funding is a structural change to mental health services financing, which increases a county’s share of cost or financial risk for mental health service provision, and therefore violates the MHSA requirement to maintain mental health funding at least at 2003-04 levels.
Proposal Violates the Integration Mandate of the ADA
The Governor’s proposal would radically shift the focus of the state’s mental health system from home and community services primarily to hospital and institutional care. This would most likely violate the “integration mandate” under the Americans with Disabilities Act (ADA). (42 U.S.C § 12132; 28 C.F.R. § 35.130(d)). The United States Supreme Court in Olmstead v. L.C. ex rel. Zimring, 527 U.S. 581 (1999), held that the “integration mandate” required that persons with disabilities be served at home and in the community when (1) community services would be appropriate, (2) the individual does not oppose community services, and (3) community services can be reasonably accommodated. Id. at 607.
Proposal Does Not Make Good Financial Sense and may Violate Mental Health Parity Laws
The Governor’s proposal to scrap all but in-patient treatment and medications for adult recipients under the Medi-Cal program is unreasonable. The state adopted the Rehabilitation Option for home and community mental health services, effective 1993, because it made programmatic and financial sense. Evidence-based practices have set state and national standards on psychosocial rehabilitation and recovery programs, which include: crisis residential services, peer support, individual rehabilitation, day programs, adult residential programs, crisis intervention and counseling. If it repealed the Rehabilitation Option under its State Medicaid Plan, the State would forego 50% federal financial participation or reimbursement for such assistance that it otherwise provided.
The State’s repeal of the Rehabilitation Option under the State Medi-Cal program would also raise serious legal questions about its compliance with federal and state mental health parity laws.
Proposal to suspend the AB 3632 mandate, for $52 million in savings
AB 3632 mandates that counties provide mental health services to children who need them pursuant to an Individualized Education Plan (IEP). The Individuals with Disabilities Education Act (IDEA) requires funding for free and appropriate public education, including related services (such as mental health services) necessary for a child to benefit from his or her special education. While local educational entities would ultimately be responsible for providing the mental health services identified in a child’s IEP, suspension of AB 3632 would most likely result in complete disarray and gaps in services for children as shifts in responsibility for and funding of the services occur.
California school districts simply do not have the experience or staff to provide the services that county mental health agencies have provided for two decades. It is unrealistic to expect school districts to take over assessing, identifying mental health service needs and placement alternatives for special education students with mental health needs. Further we believe counties must be reimbursed for the mental health services they provide to special education students.
Please contact me if you have any questions about our position on this matter.
Very truly yours,
Margaret Johnson, Esq.
Disability Rights California
Advocacy Director
CC: Honorable Members of the Senate Budget Committee
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