5600. (a) This part shall be known and may be cited as the
Bronzan-McCorquodale Act. This part is intended to organize and
finance community mental health services for the mentally disordered
in every county through locally administered and locally controlled
community mental health programs. It is furthermore intended to
better utilize existing resources at both the state and local levels
in order to improve the effectiveness of necessary mental health
services; to integrate state-operated and community mental health
programs into a unified mental health system; to ensure that all
mental health professions be appropriately represented and utilized
in the mental health programs; to provide a means for participation
by local governments in the determination of the need for and the
allocation of mental health resources under the jurisdiction of the
state; and to provide a means of allocating mental health funds
deposited in the Local Revenue Fund equitably among counties
according to community needs.
(b) With the exception of those referring to Short-Doyle Medi-Cal
services, any other provisions of law referring to the Short-Doyle
Act shall be construed as referring to the Bronzan-McCorquodale Act.
5600.1. The mission of California's mental health system shall 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.
5600.2. To the extent resources are available, public mental health
services in this state should be provided to priority target
populations in systems of care that are client-centered, culturally
competent, and fully accountable, and which include the following
factors:
(a) Client-Centered Approach. All services and programs designed
for persons with mental disabilities should be client centered, in
recognition of varying individual goals, diverse needs, concerns,
strengths, motivations, and disabilities. Persons with mental
disabilities:
(1) Retain all the rights, privileges, opportunities, and
responsibilities of other citizens unless specifically limited by
federal or state law or regulations.
(2) Are the central and deciding figure, except where specifically
limited by law, in all planning for treatment and rehabilitation
based on their individual needs. Planning should also include family
members and friends as a source of information and support.
(3) Shall be viewed as total persons and members of families and
communities. Mental health services should assist clients in
returning to the most constructive and satisfying lifestyles of their
own definition and choice.
(4) Should receive treatment and rehabilitation in the most
appropriate and least restrictive environment, preferably in their
own communities.
(5) Should have an identifiable person or team responsible for
their support and treatment.
(6) Shall have available a mental health advocate to ensure their
rights as mental health consumers pursuant to Section 5521.
(b) Priority Target Populations. Persons with serious mental
illnesses have severe, disabling conditions that require treatment,
giving them a high priority for receiving available services.
(c) Systems of Care. The mental health system should develop
coordinated, integrated, and effective services organized in systems
of care to meet the unique needs of children and youth with serious
emotional disturbances, and adults, older adults, and special
populations with serious mental illnesses. These systems of care
should operate in conjunction with an interagency network of other
services necessary for individual clients.
(d) Outreach. Mental health services should be accessible to all
consumers on a 24-hour basis in times of crisis. Assertive outreach
should make mental health services available to homeless and
hard-to-reach individuals with mental disabilities.
(e) Multiple Disabilities. Mental health services should address
the special needs of children and youth, adults, and older adults
with dual and multiple disabilities.
(f) Quality of Service. Qualified individuals trained in the
client-centered approach should provide effective services based on
measurable outcomes and deliver those services in environments
conducive to clients' well-being.
(g) Cultural Competence. All services and programs at all levels
should have the capacity to provide services sensitive to the target
populations' cultural diversity. Systems of care should:
(1) Acknowledge and incorporate the importance of culture, the
assessment of cross-cultural relations, vigilance towards dynamics
resulting from cultural differences, the expansion of cultural
knowledge, and the adaptation of services to meet culturally unique
needs.
(2) Recognize that culture implies an integrated pattern of human
behavior, including language, thoughts, beliefs, communications,
actions, customs, values, and other institutions of racial, ethnic,
religious, or social groups.
(3) Promote congruent behaviors, attitudes, and policies enabling
the system, agencies, and mental health professionals to function
effectively in cross-cultural institutions and communities.
(h) Community Support. Systems of care should incorporate the
concept of community support for individuals with mental disabilities
and reduce the need for more intensive treatment services through
measurable client outcomes.
(i) Self-Help. The mental health system should promote the
development and use of self-help groups by individuals with serious
mental illnesses so that these groups will be available in all areas
of the state.
(j) Outcome Measures. State and local mental health systems of
care should be developed based on client-centered goals and evaluated
by measurable client outcomes.
(k) Administration. Both state and local departments of mental
health should manage programs in an efficient, timely, and
cost-effective manner.
(l) Research. The mental health system should encourage basic
research into the nature and causes of mental illnesses and cooperate
with research centers in efforts leading to improved treatment
methods, service delivery, and quality of life for mental health
clients.
(m) Education on Mental Illness. Consumer and family advocates for
mental health should be encouraged and assisted in informing the
public about the nature of mental illness from their viewpoint and
about the needs of consumers and families. Mental health professional
organizations should be encouraged to disseminate the most recent
research findings in the treatment and prevention of mental illness.
5600.3. 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 identified in the following categories, which shall not
be construed as establishing an order of priority:
(a) (1) Seriously emotionally disturbed children or adolescents.
(2) For the purposes of this part, "seriously emotionally
disturbed children or adolescents" means minors under the age of 18
years who have a mental disorder as identified in the most recent
edition of the Diagnostic and Statistical Manual of Mental Disorders,
other than a primary substance use disorder or developmental
disorder, which results in behavior inappropriate to the child's age
according to expected developmental norms. Members of this target
population shall meet one or more of the following criteria:
(A) As a result of the mental disorder, the child has substantial
impairment in at least two of the following areas: self-care, school
functioning, family relationships, or ability to function in the
community; and either of the following occur:
(i) The child is at risk of removal from home or has already been
removed from the home.
(ii) The mental disorder and impairments have been present for
more than six months or are likely to continue for more than one year
without treatment.
(B) The child displays one of the following: psychotic features,
risk of suicide or risk of violence due to a mental disorder.
(C) The child meets special education eligibility requirements
under Chapter 26.5 (commencing with Section 7570) of Division 7 of
Title 1 of the Government Code.
(b) (1) Adults and older adults who have a serious mental
disorder.
(2) For the purposes of this part, "serious mental disorder" means
a mental disorder that is severe in degree and persistent in
duration, which may cause behavioral functioning which interferes
substantially with the primary activities of daily living, and which
may result in an inability to maintain stable adjustment and
independent functioning without treatment, support, and
rehabilitation for a long or indefinite period of time. Serious
mental disorders include, but are not limited to, schizophrenia,
bipolar disorder, post-traumatic stress disorder, as well as major
affective disorders or other severely disabling mental disorders.
This section shall not be construed to exclude persons with a serious
mental disorder and a diagnosis of substance abuse, developmental
disability, or other physical or mental disorder.
(3) Members of this target population shall meet all of the
following criteria:
(A) The person has a mental disorder as identified in the most
recent edition of the Diagnostic and Statistical Manual of Mental
Disorders, other than a substance use disorder or developmental
disorder or acquired traumatic brain injury pursuant to subdivision
(a) of Section 4354 unless that person also has a serious mental
disorder as defined in paragraph (2).
(B) (i) As a result of the mental disorder, the person has
substantial functional impairments or symptoms, or a psychiatric
history demonstrating that without treatment there is an imminent
risk of decompensation to having substantial impairments or symptoms.
(ii) For the purposes of this part, "functional impairment" means
being substantially impaired as the result of a mental disorder in
independent living, social relationships, vocational skills, or
physical condition.
(C) As a result of a mental functional impairment and
circumstances, the person is likely to become so disabled as to
require public assistance, services, or entitlements.
(4) For the purpose of organizing outreach and treatment options,
to the extent resources are available, this target population
includes, but is not limited to, persons who are any of the
following:
(A) Homeless persons who are mentally ill.
(B) Persons evaluated by appropriately licensed persons as
requiring care in acute treatment facilities including state
hospitals, acute inpatient facilities, institutes for mental disease,
and crisis residential programs.
(C) Persons arrested or convicted of crimes.
(D) Persons who require acute treatment as a result of a first
episode of mental illness with psychotic features.
(5) California veterans in need of mental health services and who
meet the existing eligibility requirements of this section, shall be
provided services to the extent services are available to other
adults pursuant to this section. Veterans who may be eligible for
mental health services through the United States Department of
Veterans Affairs should be advised of these services by the county
and assisted in linking to those services.
(A) No eligible veteran shall be denied county mental health
services based solely on his or her status as a veteran.
(B) Counties shall refer a veteran to the county veterans service
officer, if any, to determine the veteran's eligibility for, and the
availability of, mental health services provided by the United States
Department of Veterans Affairs or other federal health care
provider.
(C) Counties should consider contracting with community-based
veterans' services agencies, where possible, to provide high-quality,
veteran specific mental health services.
(c) Adults or older adults who require or are at risk of requiring
acute psychiatric inpatient care, residential treatment, or
outpatient crisis intervention because of a mental disorder with
symptoms of psychosis, suicidality, or violence.
(d) Persons who need brief treatment as a result of a natural
disaster or severe local emergency.
5600.35. (a) Services should be encouraged in every geographic area
to the extent resources are available for clients in the target
population categories described in Section 5600.3.
(b) Services to the target populations should be planned and
delivered so as to ensure statewide access by members of the target
populations, including all ethnic groups in the state.
5600.4. Community mental health services should be organized to
provide an array of treatment options in the following areas, to the
extent resources are available:
(a) Precrisis and Crisis Services. Immediate response to
individuals in precrisis and crisis and to members of the individual'
s support system, on a 24-hour, seven-day-a-week basis. Crisis
services may be provided offsite through mobile services. The focus
of precrisis services is to offer ideas and strategies to improve the
person's situation, and help access what is needed to avoid crisis.
The focus of crisis services is stabilization and crisis resolution,
assessment of precipitating and attending factors, and
recommendations for meeting identified needs.
(b) Comprehensive Evaluation and Assessment. Includes, but is not
limited to, evaluation and assessment of physical and mental health,
income support, housing, vocational training and employment, and
social support services needs. Evaluation and assessment may be
provided offsite through mobile services.
(c) Individual Service Plan. Identification of the short- and
long-term service needs of the individual, advocating for, and
coordinating the provision of these services. The development of the
plan should include the participation of the client, family members,
friends, and providers of services to the client, as appropriate.
(d) Medication Education and Management. Includes, but is not
limited to, evaluation of the need for administration of, and
education about, the risks and benefits associated with medication.
Clients should be provided this information prior to the
administration of medications pursuant to state law. To the extent
practicable, families and caregivers should also be informed about
medications.
(e) Case Management. Client-specific services that assist clients
in gaining access to needed medical, social, educational, and other
services. Case management may be provided offsite through mobile
services.
(f) Twenty-four Hour Treatment Services. Treatment provided in any
of the following: an acute psychiatric hospital, an acute
psychiatric unit of a general hospital, a psychiatric health
facility, an institute for mental disease, a community treatment
facility, or community residential treatment programs, including
crisis, transitional and long-term programs.
(g) Rehabilitation and Support Services. Treatment and
rehabilitation services designed to stabilize symptoms, and to
develop, improve, and maintain the skills and supports necessary to
live in the community. These services may be provided through various
modes of services, including, but not limited to, individual and
group counseling, day treatment programs, collateral contacts with
friends and family, and peer counseling programs. These services may
be provided offsite through mobile services.
(h) Vocational Rehabilitation. Services which provide a range of
vocational services to assist individuals to prepare for, obtain, and
maintain employment.
(i) Residential Services. Room and board and 24-hour care and
supervision.
(j) Services for Homeless Persons. Services designed to assist
mentally ill persons who are homeless, or at risk of being homeless,
to secure housing and financial resources.
(k) Group Services. Services to two or more clients at the same
time.
5600.5. The minimum array of services for children and youth
meeting the target population criteria established in subdivision (a)
of Section 5600.3 should include the following modes of service in
every geographical area, to the extent resources are available:
(a) Precrisis and crisis services.
(b) Assessment.
(c) Medication education and management.
(d) Case management.
(e) Twenty-four-hour treatment services.
(f) Rehabilitation and support services designed to alleviate
symptoms and foster development of age appropriate cognitive,
emotional, and behavioral skills necessary for maturation.
5600.6. The minimum array of services for adults meeting the target
population criteria established in subdivision (b) of Section 5600.3
should include the following modes of service in every geographical
area, to the extent resources are available:
(a) Precrisis and crisis services.
(b) Assessment.
(c) Medication education and management.
(d) Case management.
(e) Twenty-four-hour treatment services.
(f) Rehabilitation and support services.
(g) Vocational services.
(h) Residential services.
5600.7. The minimum array of services for older adults meeting the
target population criteria established in subdivision (b) of Section
5600.3 should include the following modes of service in every
geographical area, to the extent resources are available:
(a) Precrisis and crisis services, including mobile services.
(b) Assessment, including mobile services.
(c) Medication education and management.
(d) Case management, including mobile services.
(e) Twenty-four-hour treatment services.
(f) Residential services.
(g) Rehabilitation and support services, including mobile
services.
5600.8. (a) The department may allocate the funds appropriated in
Schedule (2) of Item 4440-101-0001 of the annual Budget Act, to
county mental health programs that meet programmatic goals and model
adult system of care programs to the satisfaction of the department.
The department shall audit and monitor the use of these funds to
ensure they are used solely in support of Adult System of Care
programming. If county programs receiving adult system of care
funding do not comply with program and audit requirements determined
by the department, funding shall be redistributed to other counties
to implement, expand, or model adult systems of care.
(b) The department may allocate the funds appropriated in Schedule
(3) of Item 4440-101-0001 of the annual Budget Act, to county mental
health programs for Children's System of Care programming. These
funds shall be utilized by counties only in support of a mental
health system serving seriously emotionally disturbed children, in
accordance with the principles and program requirements associated
with the system of care model, as set forth in Part 4 (commencing
with Section 5850). The department shall audit and monitor the use of
these funds to ensure they are used solely in support of the
Children's System of Care program. If county programs receiving
children's system of care funding do not comply with program and
audit requirements determined by the department, funds shall be
redistributed to other counties to implement, expand, or model
children's system of care programming.
5600.9. (a) Services to the target populations described in Section
5600.3 should be planned and delivered to the extent practicable so
that persons in all ethnic groups are served with programs that meet
their cultural needs.
(b) Services in rural areas should be developed in flexible ways,
and may be designed to meet the needs of the indigent and uninsured
who are in need of public mental health services because other
private services are not available.
(c) To the extent permitted by law, counties should maximize all
available funds for the provision of services to the target
populations. Counties are expressly encouraged to develop interagency
programs and to blend services and funds for individuals with
multiple problems, such as those with mental illness and substance
abuse, and children, who are served by multiple agencies. State
departments are directed to assist counties in the development of
mechanisms to blend funds and to seek any necessary waivers which may
be appropriate.
5601. As used in this part:
(a) "Governing body" means the county board of supervisors or
boards of supervisors in the case of counties acting jointly; and in
the case of a city, the city council or city councils acting jointly.
(b) "Conference" means the California Conference of Local Mental
Health Directors as established under Section 5757.
(c) Unless the context requires otherwise, "to the extent
resources are available" means to the extent that funds deposited in
the mental health account of the local health and welfare fund are
available to an entity qualified to use those funds.
(d) "Part 1" refers to the Lanterman-Petris-Short Act (Part 1
(commencing with Section 5000)).
(e) "Director of Mental Health" or "director" means the Director
of the State Department of Mental Health.
(f) "Institution" includes a general acute care hospital, a state
hospital, a psychiatric hospital, a psychiatric health facility, a
skilled nursing facility, including an institution for mental disease
as described in Chapter 1 (commencing with Section 5900) of Part 5,
an intermediate care facility, a community care facility or other
residential treatment facility, or a juvenile or criminal justice
institution.
(g) "Mental health service" means any service directed toward
early intervention in, or alleviation or prevention of, mental
disorder, including, but not limited to, diagnosis, evaluation,
treatment, personal care, day care, respite care, special living
arrangements, community skill training, sheltered employment,
socialization, case management, transportation, information,
referral, consultation, and community services.
5602. The board of supervisors of every county, or the boards of
supervisors of counties acting under the joint powers provisions of
Article 1 (commencing with Section 6500) of Chapter 5 of Division 7
of Title 1 of the Government Code shall establish a community mental
health service to cover the entire area of the county or counties.
Services of the State Department of Mental Health shall be provided
to the county, or counties acting jointly, or, if both parties agree,
the state facilities may, in whole or in part, be leased, rented or
sold to the county or counties for county operation, subject to terms
and conditions approved by the Director of General Services.
5604. (a) (1) Each community mental health service shall have a
mental health board consisting of 10 to 15 members, depending on the
preference of the county, appointed by the governing body, except
that boards in counties with a population of less than 80,000 may
have a minimum of five members. One member of the board shall be a
member of the local governing body. Any county with more than five
supervisors shall have at least the same number of members as the
size of its board of supervisors. Nothing in this section shall be
construed to limit the ability of the governing body to increase the
number of members above 15. Local mental health boards may recommend
appointees to the county supervisors. Counties are encouraged to
appoint individuals who have experience and knowledge of the mental
health system. The board membership should reflect the ethnic
diversity of the client population in the county.
(2) Fifty percent of the board membership shall be consumers or
the parents, spouses, siblings, or adult children of consumers, who
are receiving or have received mental health services. At least 20
percent of the total membership shall be consumers, and at least 20
percent shall be families of consumers.
(3) (A) In counties under 80,000 population, at least one member
shall be a consumer, and at least one member shall be a parent,
spouse, sibling, or adult child of a consumer, who is receiving, or
has received, mental health services.
(B) Notwithstanding subparagraph (A), a board in a county with a
population under 80,000 that elects to have the board exceed the
five-member minimum permitted under paragraph (1) shall be required
to comply with paragraph (2).
(b) The term of each member of the board shall be for three years.
The governing body shall equitably stagger the appointments so that
approximately one-third of the appointments expire in each year.
(c) If two or more local agencies jointly establish a community
mental health service under Article 1 (commencing with Section 6500)
of Chapter 5 of Division 7 of Title 1 of the Government Code, the
mental health board for the community mental health service shall
consist of an additional two members for each additional agency, one
of whom shall be a consumer or a parent, spouse, sibling, or adult
child of a consumer who has received mental health services.
(d) No member of the board or his or her spouse shall be a
full-time or part-time county employee of a county mental health
service, an employee of the State Department of Mental Health, or an
employee of, or a paid member of the governing body of, a mental
health contract agency.
(e) Members of the board shall abstain from voting on any issue in
which the member has a financial interest as defined in Section
87103 of the Government Code.
(f) If it is not possible to secure membership as specified from
among persons who reside in the county, the governing body may
substitute representatives of the public interest in mental health
who are not full-time or part-time employees of the county mental
health service, the State Department of Mental Health, or on the
staff of, or a paid member of the governing body of, a mental health
contract agency.
(g) The mental health board may be established as an advisory
board or a commission, depending on the preference of the county.
5604.1. Local mental health advisory boards shall be subject to the
provisions of Chapter 9 (commencing with Section 54950) of Part 1 of
Division 2 of Title 5 of the Government Code, relating to meetings
of local agencies.
5604.2. (a) The local mental health board shall do all of the
following:
(1) Review and evaluate the community's mental health needs,
services, facilities, and special problems.
(2) Review any county agreements entered into pursuant to Section
5650.
(3) Advise the governing body and the local mental health director
as to any aspect of the local mental health program.
(4) Review and approve the procedures used to ensure citizen and
professional involvement at all stages of the planning process.
(5) Submit an annual report to the governing body on the needs and
performance of the county's mental health system.
(6) Review and make recommendations on applicants for the
appointment of a local director of mental health services. The board
shall be included in the selection process prior to the vote of the
governing body.
(7) Review and comment on the county's performance outcome data
and communicate its findings to the California Mental Health Planning
Council.
(8) Nothing in this part shall be construed to limit the ability
of the governing body to transfer additional duties or authority to a
mental health board.
(b) It is the intent of the Legislature that, as part of its
duties pursuant to subdivision (a), the board shall assess the impact
of the realignment of services from the state to the county, on
services delivered to clients and on the local community.
5604.3. The board of supervisors may pay from any available funds
the actual and necessary expenses of the members of the mental health
board of a community mental health service incurred incident to the
performance of their official duties and functions. The expenses may
include travel, lodging, child care, and meals for the members of an
advisory board while on official business as approved by the director
of the local mental health program.
5604.5. The local mental health board shall develop bylaws to be
approved by the governing body which shall:
(a) Establish the specific number of members on the mental health
board, consistent with subdivision (a) of Section 5604.
(b) Ensure that the composition of the mental health board
represents the demographics of the county as a whole, to the extent
feasible.
(c) Establish that a quorum be one person more than one-half of
the appointed members.
(d) Establish that the chairperson of the mental health board be
in consultation with the local mental health director.
(e) Establish that there may be an executive committee of the
mental health board.
5607. The local mental health services shall be administered by a
local director of mental health services to be appointed by the
governing body. He shall meet such standards of training and
experience as the State Department of Mental Health, by regulation,
shall require. Applicants for such positions need not be residents of
the city, county, or state, and may be employed on a full or
part-time basis. If a county is unable to secure the services of a
person who meets the standards of the State Department of Mental
Health, the county may select an alternate administrator subject to
the approval of the Director of Mental Health.
5608. The local director of mental health services shall have the
following powers and duties:
(a) Serve as chief executive officer of the community mental
health service responsible to the governing body through
administrative channels designated by the governing body.
(b) Exercise general supervision over mental health services
provided under this part.
(c) Recommend to the governing body, after consultation with the
advisory board, the provision of services, establishment of
facilities, contracting for services or facilities and other matters
necessary or desirable in accomplishing the purposes of this
division.
(d) Submit an annual report to the governing body reporting all
activities of the program, including a financial accounting of
expenditures and a forecast of anticipated needs for the ensuing
year.
(e) Carry on studies appropriate for the discharge of his or her
duties, including the control and prevention of mental disorders.
(f) Possess authority to enter into negotiations for contracts or
agreements for the purpose of providing mental health services in the
county.
5610. (a) Each county mental health system shall comply with
reporting requirements developed by the State Department of Mental
Health which shall be uniform and simplified. The department shall
review existing data requirements to eliminate unnecessary
requirements and consolidate requirements which are necessary. These
requirements shall provide comparability between counties in reports.
(b) The department shall develop, in consultation with the
Performance Outcome Committee pursuant to Section 5611, and with the
Health and Welfare Agency, uniform definitions and formats for a
statewide, nonduplicative client-based information system that
includes all information necessary to meet federal mental health
grant requirements and state and federal medicaid reporting
requirements, as well as any other state requirements established by
law. The data system, including performance outcome measures reported
pursuant to Section 5613, shall be developed by July 1, 1992.
(c) Unless determined necessary by the department to comply with
federal law and regulations, the data system developed pursuant to
subdivision (b) shall not be more costly than that in place during
the 1990-91 fiscal year.
(d) (1) The department shall develop unique client identifiers
that permit development of client-specific cost and outcome measures
and related research and analysis.
(2) The department's collection and use of client information, and
the development and use of client identifiers, shall be consistent
with clients' constitutional and statutory rights to privacy and
confidentiality.
(3) Data reported to the department may include name and other
personal identifiers. That information is confidential and subject to
Section 5328 and any other state and federal laws regarding
confidential client information.
(4) Personal client identifiers reported to the department shall
be protected to ensure confidentiality during transmission and
storage through encryption and other appropriate means.
(5) Information reported to the department may be shared with
local public mental health agencies submitting records for the same
person and that information is subject to Section 5328.
(e) All client information reported to the department pursuant to
Chapter 2 (commencing with Section 4030) of Part 1 of Division 4 and
Sections 5328 to 5780, inclusive, and any other state and federal
laws regarding reporting requirements, consistent with Section 5328,
shall not be used for purposes other than those purposes expressly
stated in the reporting requirements referred to in this subdivision.
(f) The department may adopt emergency regulations to implement
this section in accordance with the Administrative Procedure Act,
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code. The adoption of emergency
regulations to implement this section that are filed with the Office
of Administrative Law within one year of the date on which the act
that added this subdivision took effect shall be deemed to be an
emergency and necessary for the immediate preservation of the public
peace, health and safety, or general welfare and shall remain in
effect for no more than 180 days.
5611. (a) The Director of Mental Health shall establish a
Performance Outcome Committee, to be comprised of representatives
from the PL 99-660 Planning Council and the California Conference of
Local Mental Health Directors. Any costs associated with the
performance of the duties of the committee shall be absorbed within
the resources of the participants.
(b) Major mental health professional organizations representing
licensed clinicians may participate as members of the committee at
their own expense.
(c) The committee may seek private funding for costs associated
with the performance of its duties.
5612. (a) (1) The Performance Outcome Committee shall develop
measures of performance for evaluating client outcomes and cost
effectiveness of mental health services provided pursuant to this
division. The reporting of performance measures shall utilize the
data collected by the State Department of Mental Health in the
client-specific, uniform, simplified, and consolidated data system.
The performance measures shall take into account resources available
overall, resource imbalance between counties, other services
available in the community, and county experience in developing data
and evaluative information.
(2) During the 1992-93 fiscal year, the committee shall include
measures of performance for evaluating client outcomes and
cost-effectiveness of mental health services provided by state
hospitals.
(b) The committee should consider outcome measures in the
following areas:
(1) Numbers of persons in identified target populations served.
(2) Estimated number of persons in identified target populations
in need of services.
(3) Treatment plans development for members of the target
population served.
(4) Treatment plan goals met.
(5) Stabilization of living arrangements.
(6) Reduction of law enforcement involvement and jail bookings.
(7) Increase in employment or education activities.
(8) Percentage of resources used to serve children and older
adults.
(9) Number of patients' rights advocates and their duties.
(10) Quality assurance activities for services, including peer
review and medication management.
(11) Identification of special projects, incentives, and
prevention programs.
(c) Areas identified for consideration by the committee are for
guidance only.
5613. (a) Counties shall annually report data on performance
measures established pursuant to Section 5612 to the local mental
health advisory board and to the Director of Mental Health.
(b) The Director of Mental Health shall annually make available to
the Legislature, no later than March 15, data on county performance.
5614. (a) The department, in consultation with the Compliance
Advisory Committee that shall have representatives from relevant
stakeholders, including, but not limited to, local mental health
departments, local mental health boards and commissions, private and
community-based providers, consumers and family members of consumers,
and advocates, shall establish a protocol for ensuring that local
mental health departments meet statutory and regulatory requirements
for the provision of publicly funded community mental health services
provided under this part.
(b) The protocol shall include a procedure for review and
assurance of compliance for all of the following elements, and any
other elements required in law or regulation:
(1) Financial maintenance of effort requirements provided for
under Section 17608.05.
(2) Each local mental health board has approved procedures that
ensure citizen and professional involvement in the local mental
health planning process.
(3) Children's services are funded pursuant to the requirements of
Sections 5704.5 and 5704.6.
(4) The local mental health department complies with reporting
requirements developed by the department.
(5) To the extent resources are available, the local mental health
department maintains the program principles and the array of
treatment options required under Sections 5600.2 to 5600.9,
inclusive.
(6) The local mental health department meets the reporting
required by the performance outcome systems for adults and children.
(c) The protocol developed pursuant to subdivision (a) shall focus
on law and regulations and shall include, but not be limited to, the
items specified in subdivision (b). The protocol shall include data
collection procedures so that state review and reporting may occur.
The protocol shall also include a procedure for the provision of
technical assistance, and formal decision rules and procedures for
enforcement consequences when the requirements of law and regulations
are not met. These standards and decision rules shall be established
through the consensual stakeholder process established by the
department.
5614.5. (a) The department, in consultation with the Quality
Improvement Committee which shall include representatives of the
California Mental Health Planning Council, local mental health
departments, consumers and families of consumers, and other
stakeholders, shall establish and measure indicators of access and
quality to provide the information needed to continuously improve the
care provided in California's public mental health system.
(b) The department in consultation with the Quality Improvement
Committee shall include specific indicators in all of the following
areas:
(1) Structure.
(2) Process, including access to care, appropriateness of care,
and the cost effectiveness of care.
(3) Outcomes.
(c) Protocols for both compliance with law and regulations and for
quality indicators shall include standards and formal decision rules
for establishing when technical assistance, and enforcement in the
case of compliance, will occur. These standards and decision rules
shall be established through the consensual stakeholder process
established by the department.
(d) The department shall report to the legislative budget
committees on the status of the efforts in Section 5614 and this
section by March 1, 2001. The report shall include presentation of
the protocols and indicators developed pursuant to this section or
barriers encountered in their development.
5615. If they so elect, cities that were operating independent
public mental health programs on January 1, 1990, shall continue to
receive direct payments.
5616. Nothing in this part shall prevent any city or combination of
cities from owning, financing, and operating a mental health
program.
5618. Mental health plans shall be responsible for providing
information to potential clients, family members, and caregivers
regarding specialty Medi-Cal mental health services offered by the
mental health plans upon request of the individual. This information
shall be written in a manner that is easy to understand and is
descriptive of the complete services offered.
5622. (a) A licensed inpatient mental health facility, as described
in subdivision (c) of Section 1262 of the Health and Safety Code,
operated by a county or pursuant to a county contract, shall, prior
to the discharge of any patient who was placed in the facility,
prepare a written aftercare plan. The aftercare plan, to the extent
known, shall specify the following:
(1) The nature of the illness and followup required.
(2) Medications, including side effects and dosage schedules. If
the patient was given an informed consent form with his or her
medications, the form shall satisfy the requirement for information
on side effects of the medications.
(3) Expected course of recovery.
(4) Recommendations regarding treatment that are relevant to the
patient's care.
(5) Referrals to providers of medical and mental health services.
(6) Other relevant information.
(b) Any person undergoing treatment at a facility under the
Lanterman-Petris-Short Act or a county Bronzan-McCorquodale facility
and the person's conservator, guardian, or other legally authorized
representative shall be given a written aftercare plan prior to being
discharged from the facility. The person shall be advised by
facility personnel that he or she may designate another person to
receive a copy of the aftercare plan.
(c) A copy of the aftercare plan shall be given to any person
designated under subdivision (b). A patient who is released from any
local treatment facility described in subdivision (c) of Section 1262
of the Health and Safety Code on a voluntary basis may refuse any or
all services under the written aftercare plan.
5623.5. Commencing October 1, 1991, and to the extent resources are
available, no county shall deny any person receiving services
administered by the county mental health program access to any
medication which has been prescribed by the treating physician and
approved by the federal Food and Drug Administration and the Medi-Cal
program for use in the treatment of psychiatric illness.
5600. (a) This part shall be known and may be cited as the
Bronzan-McCorquodale Act. This part is intended to organize and
finance community mental health services for the mentally disordered
in every county through locally administered and locally controlled
community mental health programs. It is furthermore intended to
better utilize existing resources at both the state and local levels
in order to improve the effectiveness of necessary mental health
services; to integrate state-operated and community mental health
programs into a unified mental health system; to ensure that all
mental health professions be appropriately represented and utilized
in the mental health programs; to provide a means for participation
by local governments in the determination of the need for and the
allocation of mental health resources under the jurisdiction of the
state; and to provide a means of allocating mental health funds
deposited in the Local Revenue Fund equitably among counties
according to community needs.
(b) With the exception of those referring to Short-Doyle Medi-Cal
services, any other provisions of law referring to the Short-Doyle
Act shall be construed as referring to the Bronzan-McCorquodale Act.
5600.1. The mission of California's mental health system shall 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.
5600.2. To the extent resources are available, public mental health
services in this state should be provided to priority target
populations in systems of care that are client-centered, culturally
competent, and fully accountable, and which include the following
factors:
(a) Client-Centered Approach. All services and programs designed
for persons with mental disabilities should be client centered, in
recognition of varying individual goals, diverse needs, concerns,
strengths, motivations, and disabilities. Persons with mental
disabilities:
(1) Retain all the rights, privileges, opportunities, and
responsibilities of other citizens unless specifically limited by
federal or state law or regulations.
(2) Are the central and deciding figure, except where specifically
limited by law, in all planning for treatment and rehabilitation
based on their individual needs. Planning should also include family
members and friends as a source of information and support.
(3) Shall be viewed as total persons and members of families and
communities. Mental health services should assist clients in
returning to the most constructive and satisfying lifestyles of their
own definition and choice.
(4) Should receive treatment and rehabilitation in the most
appropriate and least restrictive environment, preferably in their
own communities.
(5) Should have an identifiable person or team responsible for
their support and treatment.
(6) Shall have available a mental health advocate to ensure their
rights as mental health consumers pursuant to Section 5521.
(b) Priority Target Populations. Persons with serious mental
illnesses have severe, disabling conditions that require treatment,
giving them a high priority for receiving available services.
(c) Systems of Care. The mental health system should develop
coordinated, integrated, and effective services organized in systems
of care to meet the unique needs of children and youth with serious
emotional disturbances, and adults, older adults, and special
populations with serious mental illnesses. These systems of care
should operate in conjunction with an interagency network of other
services necessary for individual clients.
(d) Outreach. Mental health services should be accessible to all
consumers on a 24-hour basis in times of crisis. Assertive outreach
should make mental health services available to homeless and
hard-to-reach individuals with mental disabilities.
(e) Multiple Disabilities. Mental health services should address
the special needs of children and youth, adults, and older adults
with dual and multiple disabilities.
(f) Quality of Service. Qualified individuals trained in the
client-centered approach should provide effective services based on
measurable outcomes and deliver those services in environments
conducive to clients' well-being.
(g) Cultural Competence. All services and programs at all levels
should have the capacity to provide services sensitive to the target
populations' cultural diversity. Systems of care should:
(1) Acknowledge and incorporate the importance of culture, the
assessment of cross-cultural relations, vigilance towards dynamics
resulting from cultural differences, the expansion of cultural
knowledge, and the adaptation of services to meet culturally unique
needs.
(2) Recognize that culture implies an integrated pattern of human
behavior, including language, thoughts, beliefs, communications,
actions, customs, values, and other institutions of racial, ethnic,
religious, or social groups.
(3) Promote congruent behaviors, attitudes, and policies enabling
the system, agencies, and mental health professionals to function
effectively in cross-cultural institutions and communities.
(h) Community Support. Systems of care should incorporate the
concept of community support for individuals with mental disabilities
and reduce the need for more intensive treatment services through
measurable client outcomes.
(i) Self-Help. The mental health system should promote the
development and use of self-help groups by individuals with serious
mental illnesses so that these groups will be available in all areas
of the state.
(j) Outcome Measures. State and local mental health systems of
care should be developed based on client-centered goals and evaluated
by measurable client outcomes.
(k) Administration. Both state and local departments of mental
health should manage programs in an efficient, timely, and
cost-effective manner.
(l) Research. The mental health system should encourage basic
research into the nature and causes of mental illnesses and cooperate
with research centers in efforts leading to improved treatment
methods, service delivery, and quality of life for mental health
clients.
(m) Education on Mental Illness. Consumer and family advocates for
mental health should be encouraged and assisted in informing the
public about the nature of mental illness from their viewpoint and
about the needs of consumers and families. Mental health professional
organizations should be encouraged to disseminate the most recent
research findings in the treatment and prevention of mental illness.
5600.3. 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 identified in the following categories, which shall not
be construed as establishing an order of priority:
(a) (1) Seriously emotionally disturbed children or adolescents.
(2) For the purposes of this part, "seriously emotionally
disturbed children or adolescents" means minors under the age of 18
years who have a mental disorder as identified in the most recent
edition of the Diagnostic and Statistical Manual of Mental Disorders,
other than a primary substance use disorder or developmental
disorder, which results in behavior inappropriate to the child's age
according to expected developmental norms. Members of this target
population shall meet one or more of the following criteria:
(A) As a result of the mental disorder, the child has substantial
impairment in at least two of the following areas: self-care, school
functioning, family relationships, or ability to function in the
community; and either of the following occur:
(i) The child is at risk of removal from home or has already been
removed from the home.
(ii) The mental disorder and impairments have been present for
more than six months or are likely to continue for more than one year
without treatment.
(B) The child displays one of the following: psychotic features,
risk of suicide or risk of violence due to a mental disorder.
(C) The child meets special education eligibility requirements
under Chapter 26.5 (commencing with Section 7570) of Division 7 of
Title 1 of the Government Code.
(b) (1) Adults and older adults who have a serious mental
disorder.
(2) For the purposes of this part, "serious mental disorder" means
a mental disorder that is severe in degree and persistent in
duration, which may cause behavioral functioning which interferes
substantially with the primary activities of daily living, and which
may result in an inability to maintain stable adjustment and
independent functioning without treatment, support, and
rehabilitation for a long or indefinite period of time. Serious
mental disorders include, but are not limited to, schizophrenia,
bipolar disorder, post-traumatic stress disorder, as well as major
affective disorders or other severely disabling mental disorders.
This section shall not be construed to exclude persons with a serious
mental disorder and a diagnosis of substance abuse, developmental
disability, or other physical or mental disorder.
(3) Members of this target population shall meet all of the
following criteria:
(A) The person has a mental disorder as identified in the most
recent edition of the Diagnostic and Statistical Manual of Mental
Disorders, other than a substance use disorder or developmental
disorder or acquired traumatic brain injury pursuant to subdivision
(a) of Section 4354 unless that person also has a serious mental
disorder as defined in paragraph (2).
(B) (i) As a result of the mental disorder, the person has
substantial functional impairments or symptoms, or a psychiatric
history demonstrating that without treatment there is an imminent
risk of decompensation to having substantial impairments or symptoms.
(ii) For the purposes of this part, "functional impairment" means
being substantially impaired as the result of a mental disorder in
independent living, social relationships, vocational skills, or
physical condition.
(C) As a result of a mental functional impairment and
circumstances, the person is likely to become so disabled as to
require public assistance, services, or entitlements.
(4) For the purpose of organizing outreach and treatment options,
to the extent resources are available, this target population
includes, but is not limited to, persons who are any of the
following:
(A) Homeless persons who are mentally ill.
(B) Persons evaluated by appropriately licensed persons as
requiring care in acute treatment facilities including state
hospitals, acute inpatient facilities, institutes for mental disease,
and crisis residential programs.
(C) Persons arrested or convicted of crimes.
(D) Persons who require acute treatment as a result of a first
episode of mental illness with psychotic features.
(5) California veterans in need of mental health services and who
meet the existing eligibility requirements of this section, shall be
provided services to the extent services are available to other
adults pursuant to this section. Veterans who may be eligible for
mental health services through the United States Department of
Veterans Affairs should be advised of these services by the county
and assisted in linking to those services.
(A) No eligible veteran shall be denied county mental health
services based solely on his or her status as a veteran.
(B) Counties shall refer a veteran to the county veterans service
officer, if any, to determine the veteran's eligibility for, and the
availability of, mental health services provided by the United States
Department of Veterans Affairs or other federal health care
provider.
(C) Counties should consider contracting with community-based
veterans' services agencies, where possible, to provide high-quality,
veteran specific mental health services.
(c) Adults or older adults who require or are at risk of requiring
acute psychiatric inpatient care, residential treatment, or
outpatient crisis intervention because of a mental disorder with
symptoms of psychosis, suicidality, or violence.
(d) Persons who need brief treatment as a result of a natural
disaster or severe local emergency.
5600.35. (a) Services should be encouraged in every geographic area
to the extent resources are available for clients in the target
population categories described in Section 5600.3.
(b) Services to the target populations should be planned and
delivered so as to ensure statewide access by members of the target
populations, including all ethnic groups in the state.
5600.4. Community mental health services should be organized to
provide an array of treatment options in the following areas, to the
extent resources are available:
(a) Precrisis and Crisis Services. Immediate response to
individuals in precrisis and crisis and to members of the individual'
s support system, on a 24-hour, seven-day-a-week basis. Crisis
services may be provided offsite through mobile services. The focus
of precrisis services is to offer ideas and strategies to improve the
person's situation, and help access what is needed to avoid crisis.
The focus of crisis services is stabilization and crisis resolution,
assessment of precipitating and attending factors, and
recommendations for meeting identified needs.
(b) Comprehensive Evaluation and Assessment. Includes, but is not
limited to, evaluation and assessment of physical and mental health,
income support, housing, vocational training and employment, and
social support services needs. Evaluation and assessment may be
provided offsite through mobile services.
(c) Individual Service Plan. Identification of the short- and
long-term service needs of the individual, advocating for, and
coordinating the provision of these services. The development of the
plan should include the participation of the client, family members,
friends, and providers of services to the client, as appropriate.
(d) Medication Education and Management. Includes, but is not
limited to, evaluation of the need for administration of, and
education about, the risks and benefits associated with medication.
Clients should be provided this information prior to the
administration of medications pursuant to state law. To the extent
practicable, families and caregivers should also be informed about
medications.
(e) Case Management. Client-specific services that assist clients
in gaining access to needed medical, social, educational, and other
services. Case management may be provided offsite through mobile
services.
(f) Twenty-four Hour Treatment Services. Treatment provided in any
of the following: an acute psychiatric hospital, an acute
psychiatric unit of a general hospital, a psychiatric health
facility, an institute for mental disease, a community treatment
facility, or community residential treatment programs, including
crisis, transitional and long-term programs.
(g) Rehabilitation and Support Services. Treatment and
rehabilitation services designed to stabilize symptoms, and to
develop, improve, and maintain the skills and supports necessary to
live in the community. These services may be provided through various
modes of services, including, but not limited to, individual and
group counseling, day treatment programs, collateral contacts with
friends and family, and peer counseling programs. These services may
be provided offsite through mobile services.
(h) Vocational Rehabilitation. Services which provide a range of
vocational services to assist individuals to prepare for, obtain, and
maintain employment.
(i) Residential Services. Room and board and 24-hour care and
supervision.
(j) Services for Homeless Persons. Services designed to assist
mentally ill persons who are homeless, or at risk of being homeless,
to secure housing and financial resources.
(k) Group Services. Services to two or more clients at the same
time.
5600.5. The minimum array of services for children and youth
meeting the target population criteria established in subdivision (a)
of Section 5600.3 should include the following modes of service in
every geographical area, to the extent resources are available:
(a) Precrisis and crisis services.
(b) Assessment.
(c) Medication education and management.
(d) Case management.
(e) Twenty-four-hour treatment services.
(f) Rehabilitation and support services designed to alleviate
symptoms and foster development of age appropriate cognitive,
emotional, and behavioral skills necessary for maturation.
5600.6. The minimum array of services for adults meeting the target
population criteria established in subdivision (b) of Section 5600.3
should include the following modes of service in every geographical
area, to the extent resources are available:
(a) Precrisis and crisis services.
(b) Assessment.
(c) Medication education and management.
(d) Case management.
(e) Twenty-four-hour treatment services.
(f) Rehabilitation and support services.
(g) Vocational services.
(h) Residential services.
5600.7. The minimum array of services for older adults meeting the
target population criteria established in subdivision (b) of Section
5600.3 should include the following modes of service in every
geographical area, to the extent resources are available:
(a) Precrisis and crisis services, including mobile services.
(b) Assessment, including mobile services.
(c) Medication education and management.
(d) Case management, including mobile services.
(e) Twenty-four-hour treatment services.
(f) Residential services.
(g) Rehabilitation and support services, including mobile
services.
5600.8. (a) The department may allocate the funds appropriated in
Schedule (2) of Item 4440-101-0001 of the annual Budget Act, to
county mental health programs that meet programmatic goals and model
adult system of care programs to the satisfaction of the department.
The department shall audit and monitor the use of these funds to
ensure they are used solely in support of Adult System of Care
programming. If county programs receiving adult system of care
funding do not comply with program and audit requirements determined
by the department, funding shall be redistributed to other counties
to implement, expand, or model adult systems of care.
(b) The department may allocate the funds appropriated in Schedule
(3) of Item 4440-101-0001 of the annual Budget Act, to county mental
health programs for Children's System of Care programming. These
funds shall be utilized by counties only in support of a mental
health system serving seriously emotionally disturbed children, in
accordance with the principles and program requirements associated
with the system of care model, as set forth in Part 4 (commencing
with Section 5850). The department shall audit and monitor the use of
these funds to ensure they are used solely in support of the
Children's System of Care program. If county programs receiving
children's system of care funding do not comply with program and
audit requirements determined by the department, funds shall be
redistributed to other counties to implement, expand, or model
children's system of care programming.
5600.9. (a) Services to the target populations described in Section
5600.3 should be planned and delivered to the extent practicable so
that persons in all ethnic groups are served with programs that meet
their cultural needs.
(b) Services in rural areas should be developed in flexible ways,
and may be designed to meet the needs of the indigent and uninsured
who are in need of public mental health services because other
private services are not available.
(c) To the extent permitted by law, counties should maximize all
available funds for the provision of services to the target
populations. Counties are expressly encouraged to develop interagency
programs and to blend services and funds for individuals with
multiple problems, such as those with mental illness and substance
abuse, and children, who are served by multiple agencies. State
departments are directed to assist counties in the development of
mechanisms to blend funds and to seek any necessary waivers which may
be appropriate.
5601. As used in this part:
(a) "Governing body" means the county board of supervisors or
boards of supervisors in the case of counties acting jointly; and in
the case of a city, the city council or city councils acting jointly.
(b) "Conference" means the California Conference of Local Mental
Health Directors as established under Section 5757.
(c) Unless the context requires otherwise, "to the extent
resources are available" means to the extent that funds deposited in
the mental health account of the local health and welfare fund are
available to an entity qualified to use those funds.
(d) "Part 1" refers to the Lanterman-Petris-Short Act (Part 1
(commencing with Section 5000)).
(e) "Director of Mental Health" or "director" means the Director
of the State Department of Mental Health.
(f) "Institution" includes a general acute care hospital, a state
hospital, a psychiatric hospital, a psychiatric health facility, a
skilled nursing facility, including an institution for mental disease
as described in Chapter 1 (commencing with Section 5900) of Part 5,
an intermediate care facility, a community care facility or other
residential treatment facility, or a juvenile or criminal justice
institution.
(g) "Mental health service" means any service directed toward
early intervention in, or alleviation or prevention of, mental
disorder, including, but not limited to, diagnosis, evaluation,
treatment, personal care, day care, respite care, special living
arrangements, community skill training, sheltered employment,
socialization, case management, transportation, information,
referral, consultation, and community services.
5602. The board of supervisors of every county, or the boards of
supervisors of counties acting under the joint powers provisions of
Article 1 (commencing with Section 6500) of Chapter 5 of Division 7
of Title 1 of the Government Code shall establish a community mental
health service to cover the entire area of the county or counties.
Services of the State Department of Mental Health shall be provided
to the county, or counties acting jointly, or, if both parties agree,
the state facilities may, in whole or in part, be leased, rented or
sold to the county or counties for county operation, subject to terms
and conditions approved by the Director of General Services.
5604. (a) (1) Each community mental health service shall have a
mental health board consisting of 10 to 15 members, depending on the
preference of the county, appointed by the governing body, except
that boards in counties with a population of less than 80,000 may
have a minimum of five members. One member of the board shall be a
member of the local governing body. Any county with more than five
supervisors shall have at least the same number of members as the
size of its board of supervisors. Nothing in this section shall be
construed to limit the ability of the governing body to increase the
number of members above 15. Local mental health boards may recommend
appointees to the county supervisors. Counties are encouraged to
appoint individuals who have experience and knowledge of the mental
health system. The board membership should reflect the ethnic
diversity of the client population in the county.
(2) Fifty percent of the board membership shall be consumers or
the parents, spouses, siblings, or adult children of consumers, who
are receiving or have received mental health services. At least 20
percent of the total membership shall be consumers, and at least 20
percent shall be families of consumers.
(3) (A) In counties under 80,000 population, at least one member
shall be a consumer, and at least one member shall be a parent,
spouse, sibling, or adult child of a consumer, who is receiving, or
has received, mental health services.
(B) Notwithstanding subparagraph (A), a board in a county with a
population under 80,000 that elects to have the board exceed the
five-member minimum permitted under paragraph (1) shall be required
to comply with paragraph (2).
(b) The term of each member of the board shall be for three years.
The governing body shall equitably stagger the appointments so that
approximately one-third of the appointments expire in each year.
(c) If two or more local agencies jointly establish a community
mental health service under Article 1 (commencing with Section 6500)
of Chapter 5 of Division 7 of Title 1 of the Government Code, the
mental health board for the community mental health service shall
consist of an additional two members for each additional agency, one
of whom shall be a consumer or a parent, spouse, sibling, or adult
child of a consumer who has received mental health services.
(d) No member of the board or his or her spouse shall be a
full-time or part-time county employee of a county mental health
service, an employee of the State Department of Mental Health, or an
employee of, or a paid member of the governing body of, a mental
health contract agency.
(e) Members of the board shall abstain from voting on any issue in
which the member has a financial interest as defined in Section
87103 of the Government Code.
(f) If it is not possible to secure membership as specified from
among persons who reside in the county, the governing body may
substitute representatives of the public interest in mental health
who are not full-time or part-time employees of the county mental
health service, the State Department of Mental Health, or on the
staff of, or a paid member of the governing body of, a mental health
contract agency.
(g) The mental health board may be established as an advisory
board or a commission, depending on the preference of the county.
5604.1. Local mental health advisory boards shall be subject to the
provisions of Chapter 9 (commencing with Section 54950) of Part 1 of
Division 2 of Title 5 of the Government Code, relating to meetings
of local agencies.
5604.2. (a) The local mental health board shall do all of the
following:
(1) Review and evaluate the community's mental health needs,
services, facilities, and special problems.
(2) Review any county agreements entered into pursuant to Section
5650.
(3) Advise the governing body and the local mental health director
as to any aspect of the local mental health program.
(4) Review and approve the procedures used to ensure citizen and
professional involvement at all stages of the planning process.
(5) Submit an annual report to the governing body on the needs and
performance of the county's mental health system.
(6) Review and make recommendations on applicants for the
appointment of a local director of mental health services. The board
shall be included in the selection process prior to the vote of the
governing body.
(7) Review and comment on the county's performance outcome data
and communicate its findings to the California Mental Health Planning
Council.
(8) Nothing in this part shall be construed to limit the ability
of the governing body to transfer additional duties or authority to a
mental health board.
(b) It is the intent of the Legislature that, as part of its
duties pursuant to subdivision (a), the board shall assess the impact
of the realignment of services from the state to the county, on
services delivered to clients and on the local community.
5604.3. The board of supervisors may pay from any available funds
the actual and necessary expenses of the members of the mental health
board of a community mental health service incurred incident to the
performance of their official duties and functions. The expenses may
include travel, lodging, child care, and meals for the members of an
advisory board while on official business as approved by the director
of the local mental health program.
5604.5. The local mental health board shall develop bylaws to be
approved by the governing body which shall:
(a) Establish the specific number of members on the mental health
board, consistent with subdivision (a) of Section 5604.
(b) Ensure that the composition of the mental health board
represents the demographics of the county as a whole, to the extent
feasible.
(c) Establish that a quorum be one person more than one-half of
the appointed members.
(d) Establish that the chairperson of the mental health board be
in consultation with the local mental health director.
(e) Establish that there may be an executive committee of the
mental health board.
5607. The local mental health services shall be administered by a
local director of mental health services to be appointed by the
governing body. He shall meet such standards of training and
experience as the State Department of Mental Health, by regulation,
shall require. Applicants for such positions need not be residents of
the city, county, or state, and may be employed on a full or
part-time basis. If a county is unable to secure the services of a
person who meets the standards of the State Department of Mental
Health, the county may select an alternate administrator subject to
the approval of the Director of Mental Health.
5608. The local director of mental health services shall have the
following powers and duties:
(a) Serve as chief executive officer of the community mental
health service responsible to the governing body through
administrative channels designated by the governing body.
(b) Exercise general supervision over mental health services
provided under this part.
(c) Recommend to the governing body, after consultation with the
advisory board, the provision of services, establishment of
facilities, contracting for services or facilities and other matters
necessary or desirable in accomplishing the purposes of this
division.
(d) Submit an annual report to the governing body reporting all
activities of the program, including a financial accounting of
expenditures and a forecast of anticipated needs for the ensuing
year.
(e) Carry on studies appropriate for the discharge of his or her
duties, including the control and prevention of mental disorders.
(f) Possess authority to enter into negotiations for contracts or
agreements for the purpose of providing mental health services in the
county.
5610. (a) Each county mental health system shall comply with
reporting requirements developed by the State Department of Mental
Health which shall be uniform and simplified. The department shall
review existing data requirements to eliminate unnecessary
requirements and consolidate requirements which are necessary. These
requirements shall provide comparability between counties in reports.
(b) The department shall develop, in consultation with the
Performance Outcome Committee pursuant to Section 5611, and with the
Health and Welfare Agency, uniform definitions and formats for a
statewide, nonduplicative client-based information system that
includes all information necessary to meet federal mental health
grant requirements and state and federal medicaid reporting
requirements, as well as any other state requirements established by
law. The data system, including performance outcome measures reported
pursuant to Section 5613, shall be developed by July 1, 1992.
(c) Unless determined necessary by the department to comply with
federal law and regulations, the data system developed pursuant to
subdivision (b) shall not be more costly than that in place during
the 1990-91 fiscal year.
(d) (1) The department shall develop unique client identifiers
that permit development of client-specific cost and outcome measures
and related research and analysis.
(2) The department's collection and use of client information, and
the development and use of client identifiers, shall be consistent
with clients' constitutional and statutory rights to privacy and
confidentiality.
(3) Data reported to the department may include name and other
personal identifiers. That information is confidential and subject to
Section 5328 and any other state and federal laws regarding
confidential client information.
(4) Personal client identifiers reported to the department shall
be protected to ensure confidentiality during transmission and
storage through encryption and other appropriate means.
(5) Information reported to the department may be shared with
local public mental health agencies submitting records for the same
person and that information is subject to Section 5328.
(e) All client information reported to the department pursuant to
Chapter 2 (commencing with Section 4030) of Part 1 of Division 4 and
Sections 5328 to 5780, inclusive, and any other state and federal
laws regarding reporting requirements, consistent with Section 5328,
shall not be used for purposes other than those purposes expressly
stated in the reporting requirements referred to in this subdivision.
(f) The department may adopt emergency regulations to implement
this section in accordance with the Administrative Procedure Act,
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code. The adoption of emergency
regulations to implement this section that are filed with the Office
of Administrative Law within one year of the date on which the act
that added this subdivision took effect shall be deemed to be an
emergency and necessary for the immediate preservation of the public
peace, health and safety, or general welfare and shall remain in
effect for no more than 180 days.
5611. (a) The Director of Mental Health shall establish a
Performance Outcome Committee, to be comprised of representatives
from the PL 99-660 Planning Council and the California Conference of
Local Mental Health Directors. Any costs associated with the
performance of the duties of the committee shall be absorbed within
the resources of the participants.
(b) Major mental health professional organizations representing
licensed clinicians may participate as members of the committee at
their own expense.
(c) The committee may seek private funding for costs associated
with the performance of its duties.
5612. (a) (1) The Performance Outcome Committee shall develop
measures of performance for evaluating client outcomes and cost
effectiveness of mental health services provided pursuant to this
division. The reporting of performance measures shall utilize the
data collected by the State Department of Mental Health in the
client-specific, uniform, simplified, and consolidated data system.
The performance measures shall take into account resources available
overall, resource imbalance between counties, other services
available in the community, and county experience in developing data
and evaluative information.
(2) During the 1992-93 fiscal year, the committee shall include
measures of performance for evaluating client outcomes and
cost-effectiveness of mental health services provided by state
hospitals.
(b) The committee should consider outcome measures in the
following areas:
(1) Numbers of persons in identified target populations served.
(2) Estimated number of persons in identified target populations
in need of services.
(3) Treatment plans development for members of the target
population served.
(4) Treatment plan goals met.
(5) Stabilization of living arrangements.
(6) Reduction of law enforcement involvement and jail bookings.
(7) Increase in employment or education activities.
(8) Percentage of resources used to serve children and older
adults.
(9) Number of patients' rights advocates and their duties.
(10) Quality assurance activities for services, including peer
review and medication management.
(11) Identification of special projects, incentives, and
prevention programs.
(c) Areas identified for consideration by the committee are for
guidance only.
5613. (a) Counties shall annually report data on performance
measures established pursuant to Section 5612 to the local mental
health advisory board and to the Director of Mental Health.
(b) The Director of Mental Health shall annually make available to
the Legislature, no later than March 15, data on county performance.
5614. (a) The department, in consultation with the Compliance
Advisory Committee that shall have representatives from relevant
stakeholders, including, but not limited to, local mental health
departments, local mental health boards and commissions, private and
community-based providers, consumers and family members of consumers,
and advocates, shall establish a protocol for ensuring that local
mental health departments meet statutory and regulatory requirements
for the provision of publicly funded community mental health services
provided under this part.
(b) The protocol shall include a procedure for review and
assurance of compliance for all of the following elements, and any
other elements required in law or regulation:
(1) Financial maintenance of effort requirements provided for
under Section 17608.05.
(2) Each local mental health board has approved procedures that
ensure citizen and professional involvement in the local mental
health planning process.
(3) Children's services are funded pursuant to the requirements of
Sections 5704.5 and 5704.6.
(4) The local mental health department complies with reporting
requirements developed by the department.
(5) To the extent resources are available, the local mental health
department maintains the program principles and the array of
treatment options required under Sections 5600.2 to 5600.9,
inclusive.
(6) The local mental health department meets the reporting
required by the performance outcome systems for adults and children.
(c) The protocol developed pursuant to subdivision (a) shall focus
on law and regulations and shall include, but not be limited to, the
items specified in subdivision (b). The protocol shall include data
collection procedures so that state review and reporting may occur.
The protocol shall also include a procedure for the provision of
technical assistance, and formal decision rules and procedures for
enforcement consequences when the requirements of law and regulations
are not met. These standards and decision rules shall be established
through the consensual stakeholder process established by the
department.
5614.5. (a) The department, in consultation with the Quality
Improvement Committee which shall include representatives of the
California Mental Health Planning Council, local mental health
departments, consumers and families of consumers, and other
stakeholders, shall establish and measure indicators of access and
quality to provide the information needed to continuously improve the
care provided in California's public mental health system.
(b) The department in consultation with the Quality Improvement
Committee shall include specific indicators in all of the following
areas:
(1) Structure.
(2) Process, including access to care, appropriateness of care,
and the cost effectiveness of care.
(3) Outcomes.
(c) Protocols for both compliance with law and regulations and for
quality indicators shall include standards and formal decision rules
for establishing when technical assistance, and enforcement in the
case of compliance, will occur. These standards and decision rules
shall be established through the consensual stakeholder process
established by the department.
(d) The department shall report to the legislative budget
committees on the status of the efforts in Section 5614 and this
section by March 1, 2001. The report shall include presentation of
the protocols and indicators developed pursuant to this section or
barriers encountered in their development.
5615. If they so elect, cities that were operating independent
public mental health programs on January 1, 1990, shall continue to
receive direct payments.
5616. Nothing in this part shall prevent any city or combination of
cities from owning, financing, and operating a mental health
program.
5618. Mental health plans shall be responsible for providing
information to potential clients, family members, and caregivers
regarding specialty Medi-Cal mental health services offered by the
mental health plans upon request of the individual. This information
shall be written in a manner that is easy to understand and is
descriptive of the complete services offered.
5622. (a) A licensed inpatient mental health facility, as described
in subdivision (c) of Section 1262 of the Health and Safety Code,
operated by a county or pursuant to a county contract, shall, prior
to the discharge of any patient who was placed in the facility,
prepare a written aftercare plan. The aftercare plan, to the extent
known, shall specify the following:
(1) The nature of the illness and followup required.
(2) Medications, including side effects and dosage schedules. If
the patient was given an informed consent form with his or her
medications, the form shall satisfy the requirement for information
on side effects of the medications.
(3) Expected course of recovery.
(4) Recommendations regarding treatment that are relevant to the
patient's care.
(5) Referrals to providers of medical and mental health services.
(6) Other relevant information.
(b) Any person undergoing treatment at a facility under the
Lanterman-Petris-Short Act or a county Bronzan-McCorquodale facility
and the person's conservator, guardian, or other legally authorized
representative shall be given a written aftercare plan prior to being
discharged from the facility. The person shall be advised by
facility personnel that he or she may designate another person to
receive a copy of the aftercare plan.
(c) A copy of the aftercare plan shall be given to any person
designated under subdivision (b). A patient who is released from any
local treatment facility described in subdivision (c) of Section 1262
of the Health and Safety Code on a voluntary basis may refuse any or
all services under the written aftercare plan.
5623.5. Commencing October 1, 1991, and to the extent resources are
available, no county shall deny any person receiving services
administered by the county mental health program access to any
medication which has been prescribed by the treating physician and
approved by the federal Food and Drug Administration and the Medi-Cal
program for use in the treatment of psychiatric illness.
5600. (a) This part shall be known and may be cited as the
Bronzan-McCorquodale Act. This part is intended to organize and
finance community mental health services for the mentally disordered
in every county through locally administered and locally controlled
community mental health programs. It is furthermore intended to
better utilize existing resources at both the state and local levels
in order to improve the effectiveness of necessary mental health
services; to integrate state-operated and community mental health
programs into a unified mental health system; to ensure that all
mental health professions be appropriately represented and utilized
in the mental health programs; to provide a means for participation
by local governments in the determination of the need for and the
allocation of mental health resources under the jurisdiction of the
state; and to provide a means of allocating mental health funds
deposited in the Local Revenue Fund equitably among counties
according to community needs.
(b) With the exception of those referring to Short-Doyle Medi-Cal
services, any other provisions of law referring to the Short-Doyle
Act shall be construed as referring to the Bronzan-McCorquodale Act.
5600.1. The mission of California's mental health system shall 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.
5600.2. To the extent resources are available, public mental health
services in this state should be provided to priority target
populations in systems of care that are client-centered, culturally
competent, and fully accountable, and which include the following
factors:
(a) Client-Centered Approach. All services and programs designed
for persons with mental disabilities should be client centered, in
recognition of varying individual goals, diverse needs, concerns,
strengths, motivations, and disabilities. Persons with mental
disabilities:
(1) Retain all the rights, privileges, opportunities, and
responsibilities of other citizens unless specifically limited by
federal or state law or regulations.
(2) Are the central and deciding figure, except where specifically
limited by law, in all planning for treatment and rehabilitation
based on their individual needs. Planning should also include family
members and friends as a source of information and support.
(3) Shall be viewed as total persons and members of families and
communities. Mental health services should assist clients in
returning to the most constructive and satisfying lifestyles of their
own definition and choice.
(4) Should receive treatment and rehabilitation in the most
appropriate and least restrictive environment, preferably in their
own communities.
(5) Should have an identifiable person or team responsible for
their support and treatment.
(6) Shall have available a mental health advocate to ensure their
rights as mental health consumers pursuant to Section 5521.
(b) Priority Target Populations. Persons with serious mental
illnesses have severe, disabling conditions that require treatment,
giving them a high priority for receiving available services.
(c) Systems of Care. The mental health system should develop
coordinated, integrated, and effective services organized in systems
of care to meet the unique needs of children and youth with serious
emotional disturbances, and adults, older adults, and special
populations with serious mental illnesses. These systems of care
should operate in conjunction with an interagency network of other
services necessary for individual clients.
(d) Outreach. Mental health services should be accessible to all
consumers on a 24-hour basis in times of crisis. Assertive outreach
should make mental health services available to homeless and
hard-to-reach individuals with mental disabilities.
(e) Multiple Disabilities. Mental health services should address
the special needs of children and youth, adults, and older adults
with dual and multiple disabilities.
(f) Quality of Service. Qualified individuals trained in the
client-centered approach should provide effective services based on
measurable outcomes and deliver those services in environments
conducive to clients' well-being.
(g) Cultural Competence. All services and programs at all levels
should have the capacity to provide services sensitive to the target
populations' cultural diversity. Systems of care should:
(1) Acknowledge and incorporate the importance of culture, the
assessment of cross-cultural relations, vigilance towards dynamics
resulting from cultural differences, the expansion of cultural
knowledge, and the adaptation of services to meet culturally unique
needs.
(2) Recognize that culture implies an integrated pattern of human
behavior, including language, thoughts, beliefs, communications,
actions, customs, values, and other institutions of racial, ethnic,
religious, or social groups.
(3) Promote congruent behaviors, attitudes, and policies enabling
the system, agencies, and mental health professionals to function
effectively in cross-cultural institutions and communities.
(h) Community Support. Systems of care should incorporate the
concept of community support for individuals with mental disabilities
and reduce the need for more intensive treatment services through
measurable client outcomes.
(i) Self-Help. The mental health system should promote the
development and use of self-help groups by individuals with serious
mental illnesses so that these groups will be available in all areas
of the state.
(j) Outcome Measures. State and local mental health systems of
care should be developed based on client-centered goals and evaluated
by measurable client outcomes.
(k) Administration. Both state and local departments of mental
health should manage programs in an efficient, timely, and
cost-effective manner.
(l) Research. The mental health system should encourage basic
research into the nature and causes of mental illnesses and cooperate
with research centers in efforts leading to improved treatment
methods, service delivery, and quality of life for mental health
clients.
(m) Education on Mental Illness. Consumer and family advocates for
mental health should be encouraged and assisted in informing the
public about the nature of mental illness from their viewpoint and
about the needs of consumers and families. Mental health professional
organizations should be encouraged to disseminate the most recent
research findings in the treatment and prevention of mental illness.
5600.3. 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 identified in the following categories, which shall not
be construed as establishing an order of priority:
(a) (1) Seriously emotionally disturbed children or adolescents.
(2) For the purposes of this part, "seriously emotionally
disturbed children or adolescents" means minors under the age of 18
years who have a mental disorder as identified in the most recent
edition of the Diagnostic and Statistical Manual of Mental Disorders,
other than a primary substance use disorder or developmental
disorder, which results in behavior inappropriate to the child's age
according to expected developmental norms. Members of this target
population shall meet one or more of the following criteria:
(A) As a result of the mental disorder, the child has substantial
impairment in at least two of the following areas: self-care, school
functioning, family relationships, or ability to function in the
community; and either of the following occur:
(i) The child is at risk of removal from home or has already been
removed from the home.
(ii) The mental disorder and impairments have been present for
more than six months or are likely to continue for more than one year
without treatment.
(B) The child displays one of the following: psychotic features,
risk of suicide or risk of violence due to a mental disorder.
(C) The child meets special education eligibility requirements
under Chapter 26.5 (commencing with Section 7570) of Division 7 of
Title 1 of the Government Code.
(b) (1) Adults and older adults who have a serious mental
disorder.
(2) For the purposes of this part, "serious mental disorder" means
a mental disorder that is severe in degree and persistent in
duration, which may cause behavioral functioning which interferes
substantially with the primary activities of daily living, and which
may result in an inability to maintain stable adjustment and
independent functioning without treatment, support, and
rehabilitation for a long or indefinite period of time. Serious
mental disorders include, but are not limited to, schizophrenia,
bipolar disorder, post-traumatic stress disorder, as well as major
affective disorders or other severely disabling mental disorders.
This section shall not be construed to exclude persons with a serious
mental disorder and a diagnosis of substance abuse, developmental
disability, or other physical or mental disorder.
(3) Members of this target population shall meet all of the
following criteria:
(A) The person has a mental disorder as identified in the most
recent edition of the Diagnostic and Statistical Manual of Mental
Disorders, other than a substance use disorder or developmental
disorder or acquired traumatic brain injury pursuant to subdivision
(a) of Section 4354 unless that person also has a serious mental
disorder as defined in paragraph (2).
(B) (i) As a result of the mental disorder, the person has
substantial functional impairments or symptoms, or a psychiatric
history demonstrating that without treatment there is an imminent
risk of decompensation to having substantial impairments or symptoms.
(ii) For the purposes of this part, "functional impairment" means
being substantially impaired as the result of a mental disorder in
independent living, social relationships, vocational skills, or
physical condition.
(C) As a result of a mental functional impairment and
circumstances, the person is likely to become so disabled as to
require public assistance, services, or entitlements.
(4) For the purpose of organizing outreach and treatment options,
to the extent resources are available, this target population
includes, but is not limited to, persons who are any of the
following:
(A) Homeless persons who are mentally ill.
(B) Persons evaluated by appropriately licensed persons as
requiring care in acute treatment facilities including state
hospitals, acute inpatient facilities, institutes for mental disease,
and crisis residential programs.
(C) Persons arrested or convicted of crimes.
(D) Persons who require acute treatment as a result of a first
episode of mental illness with psychotic features.
(5) California veterans in need of mental health services and who
meet the existing eligibility requirements of this section, shall be
provided services to the extent services are available to other
adults pursuant to this section. Veterans who may be eligible for
mental health services through the United States Department of
Veterans Affairs should be advised of these services by the county
and assisted in linking to those services.
(A) No eligible veteran shall be denied county mental health
services based solely on his or her status as a veteran.
(B) Counties shall refer a veteran to the county veterans service
officer, if any, to determine the veteran's eligibility for, and the
availability of, mental health services provided by the United States
Department of Veterans Affairs or other federal health care
provider.
(C) Counties should consider contracting with community-based
veterans' services agencies, where possible, to provide high-quality,
veteran specific mental health services.
(c) Adults or older adults who require or are at risk of requiring
acute psychiatric inpatient care, residential treatment, or
outpatient crisis intervention because of a mental disorder with
symptoms of psychosis, suicidality, or violence.
(d) Persons who need brief treatment as a result of a natural
disaster or severe local emergency.
5600.35. (a) Services should be encouraged in every geographic area
to the extent resources are available for clients in the target
population categories described in Section 5600.3.
(b) Services to the target populations should be planned and
delivered so as to ensure statewide access by members of the target
populations, including all ethnic groups in the state.
5600.4. Community mental health services should be organized to
provide an array of treatment options in the following areas, to the
extent resources are available:
(a) Precrisis and Crisis Services. Immediate response to
individuals in precrisis and crisis and to members of the individual'
s support system, on a 24-hour, seven-day-a-week basis. Crisis
services may be provided offsite through mobile services. The focus
of precrisis services is to offer ideas and strategies to improve the
person's situation, and help access what is needed to avoid crisis.
The focus of crisis services is stabilization and crisis resolution,
assessment of precipitating and attending factors, and
recommendations for meeting identified needs.
(b) Comprehensive Evaluation and Assessment. Includes, but is not
limited to, evaluation and assessment of physical and mental health,
income support, housing, vocational training and employment, and
social support services needs. Evaluation and assessment may be
provided offsite through mobile services.
(c) Individual Service Plan. Identification of the short- and
long-term service needs of the individual, advocating for, and
coordinating the provision of these services. The development of the
plan should include the participation of the client, family members,
friends, and providers of services to the client, as appropriate.
(d) Medication Education and Management. Includes, but is not
limited to, evaluation of the need for administration of, and
education about, the risks and benefits associated with medication.
Clients should be provided this information prior to the
administration of medications pursuant to state law. To the extent
practicable, families and caregivers should also be informed about
medications.
(e) Case Management. Client-specific services that assist clients
in gaining access to needed medical, social, educational, and other
services. Case management may be provided offsite through mobile
services.
(f) Twenty-four Hour Treatment Services. Treatment provided in any
of the following: an acute psychiatric hospital, an acute
psychiatric unit of a general hospital, a psychiatric health
facility, an institute for mental disease, a community treatment
facility, or community residential treatment programs, including
crisis, transitional and long-term programs.
(g) Rehabilitation and Support Services. Treatment and
rehabilitation services designed to stabilize symptoms, and to
develop, improve, and maintain the skills and supports necessary to
live in the community. These services may be provided through various
modes of services, including, but not limited to, individual and
group counseling, day treatment programs, collateral contacts with
friends and family, and peer counseling programs. These services may
be provided offsite through mobile services.
(h) Vocational Rehabilitation. Services which provide a range of
vocational services to assist individuals to prepare for, obtain, and
maintain employment.
(i) Residential Services. Room and board and 24-hour care and
supervision.
(j) Services for Homeless Persons. Services designed to assist
mentally ill persons who are homeless, or at risk of being homeless,
to secure housing and financial resources.
(k) Group Services. Services to two or more clients at the same
time.
5600.5. The minimum array of services for children and youth
meeting the target population criteria established in subdivision (a)
of Section 5600.3 should include the following modes of service in
every geographical area, to the extent resources are available:
(a) Precrisis and crisis services.
(b) Assessment.
(c) Medication education and management.
(d) Case management.
(e) Twenty-four-hour treatment services.
(f) Rehabilitation and support services designed to alleviate
symptoms and foster development of age appropriate cognitive,
emotional, and behavioral skills necessary for maturation.
5600.6. The minimum array of services for adults meeting the target
population criteria established in subdivision (b) of Section 5600.3
should include the following modes of service in every geographical
area, to the extent resources are available:
(a) Precrisis and crisis services.
(b) Assessment.
(c) Medication education and management.
(d) Case management.
(e) Twenty-four-hour treatment services.
(f) Rehabilitation and support services.
(g) Vocational services.
(h) Residential services.
5600.7. The minimum array of services for older adults meeting the
target population criteria established in subdivision (b) of Section
5600.3 should include the following modes of service in every
geographical area, to the extent resources are available:
(a) Precrisis and crisis services, including mobile services.
(b) Assessment, including mobile services.
(c) Medication education and management.
(d) Case management, including mobile services.
(e) Twenty-four-hour treatment services.
(f) Residential services.
(g) Rehabilitation and support services, including mobile
services.
5600.8. (a) The department may allocate the funds appropriated in
Schedule (2) of Item 4440-101-0001 of the annual Budget Act, to
county mental health programs that meet programmatic goals and model
adult system of care programs to the satisfaction of the department.
The department shall audit and monitor the use of these funds to
ensure they are used solely in support of Adult System of Care
programming. If county programs receiving adult system of care
funding do not comply with program and audit requirements determined
by the department, funding shall be redistributed to other counties
to implement, expand, or model adult systems of care.
(b) The department may allocate the funds appropriated in Schedule
(3) of Item 4440-101-0001 of the annual Budget Act, to county mental
health programs for Children's System of Care programming. These
funds shall be utilized by counties only in support of a mental
health system serving seriously emotionally disturbed children, in
accordance with the principles and program requirements associated
with the system of care model, as set forth in Part 4 (commencing
with Section 5850). The department shall audit and monitor the use of
these funds to ensure they are used solely in support of the
Children's System of Care program. If county programs receiving
children's system of care funding do not comply with program and
audit requirements determined by the department, funds shall be
redistributed to other counties to implement, expand, or model
children's system of care programming.
5600.9. (a) Services to the target populations described in Section
5600.3 should be planned and delivered to the extent practicable so
that persons in all ethnic groups are served with programs that meet
their cultural needs.
(b) Services in rural areas should be developed in flexible ways,
and may be designed to meet the needs of the indigent and uninsured
who are in need of public mental health services because other
private services are not available.
(c) To the extent permitted by law, counties should maximize all
available funds for the provision of services to the target
populations. Counties are expressly encouraged to develop interagency
programs and to blend services and funds for individuals with
multiple problems, such as those with mental illness and substance
abuse, and children, who are served by multiple agencies. State
departments are directed to assist counties in the development of
mechanisms to blend funds and to seek any necessary waivers which may
be appropriate.
5601. As used in this part:
(a) "Governing body" means the county board of supervisors or
boards of supervisors in the case of counties acting jointly; and in
the case of a city, the city council or city councils acting jointly.
(b) "Conference" means the California Conference of Local Mental
Health Directors as established under Section 5757.
(c) Unless the context requires otherwise, "to the extent
resources are available" means to the extent that funds deposited in
the mental health account of the local health and welfare fund are
available to an entity qualified to use those funds.
(d) "Part 1" refers to the Lanterman-Petris-Short Act (Part 1
(commencing with Section 5000)).
(e) "Director of Mental Health" or "director" means the Director
of the State Department of Mental Health.
(f) "Institution" includes a general acute care hospital, a state
hospital, a psychiatric hospital, a psychiatric health facility, a
skilled nursing facility, including an institution for mental disease
as described in Chapter 1 (commencing with Section 5900) of Part 5,
an intermediate care facility, a community care facility or other
residential treatment facility, or a juvenile or criminal justice
institution.
(g) "Mental health service" means any service directed toward
early intervention in, or alleviation or prevention of, mental
disorder, including, but not limited to, diagnosis, evaluation,
treatment, personal care, day care, respite care, special living
arrangements, community skill training, sheltered employment,
socialization, case management, transportation, information,
referral, consultation, and community services.
5602. The board of supervisors of every county, or the boards of
supervisors of counties acting under the joint powers provisions of
Article 1 (commencing with Section 6500) of Chapter 5 of Division 7
of Title 1 of the Government Code shall establish a community mental
health service to cover the entire area of the county or counties.
Services of the State Department of Mental Health shall be provided
to the county, or counties acting jointly, or, if both parties agree,
the state facilities may, in whole or in part, be leased, rented or
sold to the county or counties for county operation, subject to terms
and conditions approved by the Director of General Services.
5604. (a) (1) Each community mental health service shall have a
mental health board consisting of 10 to 15 members, depending on the
preference of the county, appointed by the governing body, except
that boards in counties with a population of less than 80,000 may
have a minimum of five members. One member of the board shall be a
member of the local governing body. Any county with more than five
supervisors shall have at least the same number of members as the
size of its board of supervisors. Nothing in this section shall be
construed to limit the ability of the governing body to increase the
number of members above 15. Local mental health boards may recommend
appointees to the county supervisors. Counties are encouraged to
appoint individuals who have experience and knowledge of the mental
health system. The board membership should reflect the ethnic
diversity of the client population in the county.
(2) Fifty percent of the board membership shall be consumers or
the parents, spouses, siblings, or adult children of consumers, who
are receiving or have received mental health services. At least 20
percent of the total membership shall be consumers, and at least 20
percent shall be families of consumers.
(3) (A) In counties under 80,000 population, at least one member
shall be a consumer, and at least one member shall be a parent,
spouse, sibling, or adult child of a consumer, who is receiving, or
has received, mental health services.
(B) Notwithstanding subparagraph (A), a board in a county with a
population under 80,000 that elects to have the board exceed the
five-member minimum permitted under paragraph (1) shall be required
to comply with paragraph (2).
(b) The term of each member of the board shall be for three years.
The governing body shall equitably stagger the appointments so that
approximately one-third of the appointments expire in each year.
(c) If two or more local agencies jointly establish a community
mental health service under Article 1 (commencing with Section 6500)
of Chapter 5 of Division 7 of Title 1 of the Government Code, the
mental health board for the community mental health service shall
consist of an additional two members for each additional agency, one
of whom shall be a consumer or a parent, spouse, sibling, or adult
child of a consumer who has received mental health services.
(d) No member of the board or his or her spouse shall be a
full-time or part-time county employee of a county mental health
service, an employee of the State Department of Mental Health, or an
employee of, or a paid member of the governing body of, a mental
health contract agency.
(e) Members of the board shall abstain from voting on any issue in
which the member has a financial interest as defined in Section
87103 of the Government Code.
(f) If it is not possible to secure membership as specified from
among persons who reside in the county, the governing body may
substitute representatives of the public interest in mental health
who are not full-time or part-time employees of the county mental
health service, the State Department of Mental Health, or on the
staff of, or a paid member of the governing body of, a mental health
contract agency.
(g) The mental health board may be established as an advisory
board or a commission, depending on the preference of the county.
5604.1. Local mental health advisory boards shall be subject to the
provisions of Chapter 9 (commencing with Section 54950) of Part 1 of
Division 2 of Title 5 of the Government Code, relating to meetings
of local agencies.
5604.2. (a) The local mental health board shall do all of the
following:
(1) Review and evaluate the community's mental health needs,
services, facilities, and special problems.
(2) Review any county agreements entered into pursuant to Section
5650.
(3) Advise the governing body and the local mental health director
as to any aspect of the local mental health program.
(4) Review and approve the procedures used to ensure citizen and
professional involvement at all stages of the planning process.
(5) Submit an annual report to the governing body on the needs and
performance of the county's mental health system.
(6) Review and make recommendations on applicants for the
appointment of a local director of mental health services. The board
shall be included in the selection process prior to the vote of the
governing body.
(7) Review and comment on the county's performance outcome data
and communicate its findings to the California Mental Health Planning
Council.
(8) Nothing in this part shall be construed to limit the ability
of the governing body to transfer additional duties or authority to a
mental health board.
(b) It is the intent of the Legislature that, as part of its
duties pursuant to subdivision (a), the board shall assess the impact
of the realignment of services from the state to the county, on
services delivered to clients and on the local community.
5604.3. The board of supervisors may pay from any available funds
the actual and necessary expenses of the members of the mental health
board of a community mental health service incurred incident to the
performance of their official duties and functions. The expenses may
include travel, lodging, child care, and meals for the members of an
advisory board while on official business as approved by the director
of the local mental health program.
5604.5. The local mental health board shall develop bylaws to be
approved by the governing body which shall:
(a) Establish the specific number of members on the mental health
board, consistent with subdivision (a) of Section 5604.
(b) Ensure that the composition of the mental health board
represents the demographics of the county as a whole, to the extent
feasible.
(c) Establish that a quorum be one person more than one-half of
the appointed members.
(d) Establish that the chairperson of the mental health board be
in consultation with the local mental health director.
(e) Establish that there may be an executive committee of the
mental health board.
5607. The local mental health services shall be administered by a
local director of mental health services to be appointed by the
governing body. He shall meet such standards of training and
experience as the State Department of Mental Health, by regulation,
shall require. Applicants for such positions need not be residents of
the city, county, or state, and may be employed on a full or
part-time basis. If a county is unable to secure the services of a
person who meets the standards of the State Department of Mental
Health, the county may select an alternate administrator subject to
the approval of the Director of Mental Health.
5608. The local director of mental health services shall have the
following powers and duties:
(a) Serve as chief executive officer of the community mental
health service responsible to the governing body through
administrative channels designated by the governing body.
(b) Exercise general supervision over mental health services
provided under this part.
(c) Recommend to the governing body, after consultation with the
advisory board, the provision of services, establishment of
facilities, contracting for services or facilities and other matters
necessary or desirable in accomplishing the purposes of this
division.
(d) Submit an annual report to the governing body reporting all
activities of the program, including a financial accounting of
expenditures and a forecast of anticipated needs for the ensuing
year.
(e) Carry on studies appropriate for the discharge of his or her
duties, including the control and prevention of mental disorders.
(f) Possess authority to enter into negotiations for contracts or
agreements for the purpose of providing mental health services in the
county.
5610. (a) Each county mental health system shall comply with
reporting requirements developed by the State Department of Mental
Health which shall be uniform and simplified. The department shall
review existing data requirements to eliminate unnecessary
requirements and consolidate requirements which are necessary. These
requirements shall provide comparability between counties in reports.
(b) The department shall develop, in consultation with the
Performance Outcome Committee pursuant to Section 5611, and with the
Health and Welfare Agency, uniform definitions and formats for a
statewide, nonduplicative client-based information system that
includes all information necessary to meet federal mental health
grant requirements and state and federal medicaid reporting
requirements, as well as any other state requirements established by
law. The data system, including performance outcome measures reported
pursuant to Section 5613, shall be developed by July 1, 1992.
(c) Unless determined necessary by the department to comply with
federal law and regulations, the data system developed pursuant to
subdivision (b) shall not be more costly than that in place during
the 1990-91 fiscal year.
(d) (1) The department shall develop unique client identifiers
that permit development of client-specific cost and outcome measures
and related research and analysis.
(2) The department's collection and use of client information, and
the development and use of client identifiers, shall be consistent
with clients' constitutional and statutory rights to privacy and
confidentiality.
(3) Data reported to the department may include name and other
personal identifiers. That information is confidential and subject to
Section 5328 and any other state and federal laws regarding
confidential client information.
(4) Personal client identifiers reported to the department shall
be protected to ensure confidentiality during transmission and
storage through encryption and other appropriate means.
(5) Information reported to the department may be shared with
local public mental health agencies submitting records for the same
person and that information is subject to Section 5328.
(e) All client information reported to the department pursuant to
Chapter 2 (commencing with Section 4030) of Part 1 of Division 4 and
Sections 5328 to 5780, inclusive, and any other state and federal
laws regarding reporting requirements, consistent with Section 5328,
shall not be used for purposes other than those purposes expressly
stated in the reporting requirements referred to in this subdivision.
(f) The department may adopt emergency regulations to implement
this section in accordance with the Administrative Procedure Act,
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code. The adoption of emergency
regulations to implement this section that are filed with the Office
of Administrative Law within one year of the date on which the act
that added this subdivision took effect shall be deemed to be an
emergency and necessary for the immediate preservation of the public
peace, health and safety, or general welfare and shall remain in
effect for no more than 180 days.
5611. (a) The Director of Mental Health shall establish a
Performance Outcome Committee, to be comprised of representatives
from the PL 99-660 Planning Council and the California Conference of
Local Mental Health Directors. Any costs associated with the
performance of the duties of the committee shall be absorbed within
the resources of the participants.
(b) Major mental health professional organizations representing
licensed clinicians may participate as members of the committee at
their own expense.
(c) The committee may seek private funding for costs associated
with the performance of its duties.
5612. (a) (1) The Performance Outcome Committee shall develop
measures of performance for evaluating client outcomes and cost
effectiveness of mental health services provided pursuant to this
division. The reporting of performance measures shall utilize the
data collected by the State Department of Mental Health in the
client-specific, uniform, simplified, and consolidated data system.
The performance measures shall take into account resources available
overall, resource imbalance between counties, other services
available in the community, and county experience in developing data
and evaluative information.
(2) During the 1992-93 fiscal year, the committee shall include
measures of performance for evaluating client outcomes and
cost-effectiveness of mental health services provided by state
hospitals.
(b) The committee should consider outcome measures in the
following areas:
(1) Numbers of persons in identified target populations served.
(2) Estimated number of persons in identified target populations
in need of services.
(3) Treatment plans development for members of the target
population served.
(4) Treatment plan goals met.
(5) Stabilization of living arrangements.
(6) Reduction of law enforcement involvement and jail bookings.
(7) Increase in employment or education activities.
(8) Percentage of resources used to serve children and older
adults.
(9) Number of patients' rights advocates and their duties.
(10) Quality assurance activities for services, including peer
review and medication management.
(11) Identification of special projects, incentives, and
prevention programs.
(c) Areas identified for consideration by the committee are for
guidance only.
5613. (a) Counties shall annually report data on performance
measures established pursuant to Section 5612 to the local mental
health advisory board and to the Director of Mental Health.
(b) The Director of Mental Health shall annually make available to
the Legislature, no later than March 15, data on county performance.
5614. (a) The department, in consultation with the Compliance
Advisory Committee that shall have representatives from relevant
stakeholders, including, but not limited to, local mental health
departments, local mental health boards and commissions, private and
community-based providers, consumers and family members of consumers,
and advocates, shall establish a protocol for ensuring that local
mental health departments meet statutory and regulatory requirements
for the provision of publicly funded community mental health services
provided under this part.
(b) The protocol shall include a procedure for review and
assurance of compliance for all of the following elements, and any
other elements required in law or regulation:
(1) Financial maintenance of effort requirements provided for
under Section 17608.05.
(2) Each local mental health board has approved procedures that
ensure citizen and professional involvement in the local mental
health planning process.
(3) Children's services are funded pursuant to the requirements of
Sections 5704.5 and 5704.6.
(4) The local mental health department complies with reporting
requirements developed by the department.
(5) To the extent resources are available, the local mental health
department maintains the program principles and the array of
treatment options required under Sections 5600.2 to 5600.9,
inclusive.
(6) The local mental health department meets the reporting
required by the performance outcome systems for adults and children.
(c) The protocol developed pursuant to subdivision (a) shall focus
on law and regulations and shall include, but not be limited to, the
items specified in subdivision (b). The protocol shall include data
collection procedures so that state review and reporting may occur.
The protocol shall also include a procedure for the provision of
technical assistance, and formal decision rules and procedures for
enforcement consequences when the requirements of law and regulations
are not met. These standards and decision rules shall be established
through the consensual stakeholder process established by the
department.
5614.5. (a) The department, in consultation with the Quality
Improvement Committee which shall include representatives of the
California Mental Health Planning Council, local mental health
departments, consumers and families of consumers, and other
stakeholders, shall establish and measure indicators of access and
quality to provide the information needed to continuously improve the
care provided in California's public mental health system.
(b) The department in consultation with the Quality Improvement
Committee shall include specific indicators in all of the following
areas:
(1) Structure.
(2) Process, including access to care, appropriateness of care,
and the cost effectiveness of care.
(3) Outcomes.
(c) Protocols for both compliance with law and regulations and for
quality indicators shall include standards and formal decision rules
for establishing when technical assistance, and enforcement in the
case of compliance, will occur. These standards and decision rules
shall be established through the consensual stakeholder process
established by the department.
(d) The department shall report to the legislative budget
committees on the status of the efforts in Section 5614 and this
section by March 1, 2001. The report shall include presentation of
the protocols and indicators developed pursuant to this section or
barriers encountered in their development.
5615. If they so elect, cities that were operating independent
public mental health programs on January 1, 1990, shall continue to
receive direct payments.
5616. Nothing in this part shall prevent any city or combination of
cities from owning, financing, and operating a mental health
program.
5618. Mental health plans shall be responsible for providing
information to potential clients, family members, and caregivers
regarding specialty Medi-Cal mental health services offered by the
mental health plans upon request of the individual. This information
shall be written in a manner that is easy to understand and is
descriptive of the complete services offered.
5622. (a) A licensed inpatient mental health facility, as described
in subdivision (c) of Section 1262 of the Health and Safety Code,
operated by a county or pursuant to a county contract, shall, prior
to the discharge of any patient who was placed in the facility,
prepare a written aftercare plan. The aftercare plan, to the extent
known, shall specify the following:
(1) The nature of the illness and followup required.
(2) Medications, including side effects and dosage schedules. If
the patient was given an informed consent form with his or her
medications, the form shall satisfy the requirement for information
on side effects of the medications.
(3) Expected course of recovery.
(4) Recommendations regarding treatment that are relevant to the
patient's care.
(5) Referrals to providers of medical and mental health services.
(6) Other relevant information.
(b) Any person undergoing treatment at a facility under the
Lanterman-Petris-Short Act or a county Bronzan-McCorquodale facility
and the person's conservator, guardian, or other legally authorized
representative shall be given a written aftercare plan prior to being
discharged from the facility. The person shall be advised by
facility personnel that he or she may designate another person to
receive a copy of the aftercare plan.
(c) A copy of the aftercare plan shall be given to any person
designated under subdivision (b). A patient who is released from any
local treatment facility described in subdivision (c) of Section 1262
of the Health and Safety Code on a voluntary basis may refuse any or
all services under the written aftercare plan.
5623.5. Commencing October 1, 1991, and to the extent resources are
available, no county shall deny any person receiving services
administered by the county mental health program access to any
medication which has been prescribed by the treating physician and
approved by the federal Food and Drug Administration and the Medi-Cal
program for use in the treatment of psychiatric illness.
