The Department of Mental Health (DMH) directs and coordinates statewide efforts for the treatment of mental disabilities. The department's primary responsibilities are to (1) administer the Bronzan-McCorquodale and Lanterman-Petris-Short Acts, which provide for the delivery of mental health services through a state-county partnership and for involuntary treatment of the mentally disabled, (2) operate four state hospitals, (3) manage treatment services at the California Medical Facility at Vacaville (a state prison), and (4) administer nine community programs directed at specific populations.
The state hospitals provide inpatient treatment services for mentally disabled county clients, judicially committed clients, clients civilly committed as Sexually Violent Predators (SVPs), and mentally disordered offenders and mentally disabled clients transferred from the California Department of Corrections.
The budget proposes $1.7 billion from all funds for support of DMH programs in 2000-01, which is an increase of 1 percent over estimated current-year expenditures. The budget proposes $758 million from the General Fund, which is an increase of $67 million, or 9.7 percent, above estimated current-year expenditures. The increase is primarily due to (1) increases in the judicially committed and SVP populations in the state hospitals, (2) continuation and expansion of local incentive grants for mentally ill homeless persons, and (3) special repair projects at the four state hospitals.
We recommend a reduction of $5.6 million from the General Fund for support of the state hospitals because proposed Americans with Disabilities Act compliance projects should be considered capital outlay projects, and should be resubmitted as a capital outlay budget change proposal. (Reduce Item 4440-011-0001 by $5,573,000.)
The budget proposes a General Fund increase of $5.6 million to fund projects that will bring three of the four state hospitals into compliance with the Americans with Disabilities Act (ADA). The projects would include widening doors, installing ramps and automatic door openers, and restroom modifications.
Section 3.00 of the Budget Act defines capital outlay as including any alteration, renovation, addition, or improvement which changes a structure's function, layout, capacity, or quality. Such projects are budgeted as capital outlay items. Routine maintenance and special repairs, by contrast, are intended to keep a facility functional at its designed level of services, and are budgeted as "support" items.
The department indicates that it had previously submitted requests for funding the ADA projects as capital outlay budget change proposals, but that the Department of Finance directed that stand-alone capital outlay projects relating to ADA compliance be submitted as support items. By definition, however, additions or renovations undertaken in order to comply with ADA regulations--such as installing ramps and automatic doors and modifying restrooms--are capital outlay projects, because they upgrade the quality of the existing structure or change its function. In order to be consistent with the long-standing definition of capital outlay projects, we recommend that the department resubmit its proposal as a capital outlay budget change proposal, and that the proposed $5.6 million General Fund augmentation for the support of state hospitals be denied. In this way, the proposal will be evaluated in the context of other capital outlay projects.
We also note that the proposal as currently submitted lacks sufficient information for the Legislature to evaluate it as a capital outlay project. For example, the proposal includes $4 million for work at Patton State Hospital. The information submitted in support of the request indicates that work will be undertaken in 42 buildings and will include, but not be limited to, improvements such as ramps, handrails, toilet rooms, and signs. There is no information, however, on either the existing problems in these buildings or what work will be undertaken in each of the buildings.
In addition, the budget amount is based on an estimate that was prepared in 1994 and simply updated for inflation. Information in support of the proposals for the other state hospitals is similar. In order for the Legislature to determine the need for these projects and the appropriate level of funding, the department needs to provide definitive information on existing conditions, proposed work to correct the specific problems, and the associated costs.
We recommend a reduction of $845,000 from the General Fund for support of the state hospitals because the department's request for equipment for the new administration building at Metropolitan State Hospital should be made with the 2001-02 budget request. (Reduce Item 4440-011-0001 by $845,000.)
The department has received approval to replace the receiving and treatment tower and the administration building at Metropolitan State Hospital with a new, consolidated clinical and administration facility. The new building is scheduled to be completed in November 2001, and move-in is scheduled to begin in December 2001 and be completed by February 2002.
The budget proposes $845,000 from the General Fund to purchase equipment for the new facility, including a telecommunications system, a medical records filing system, and radiology equipment. This equipment would replace equipment in the existing buildings that cannot be transferred to the new building. The "lead time" for the requested equipment--the time between when the order is placed and when the equipment is delivered--ranges from three weeks for the telecommunications system to three months for the radiology equipment and other large items.
While we believe the proposed equipment list is justified, we also believe that the request is premature, since move-in is not scheduled to begin until December 2001five months after the budget year. Therefore, we recommend that the request be resubmitted for consideration in the 2001-02 budget. We note that in the event that passage of the 2001-02 Budget Act is delayed, the department can put equipment out to bid with the provision that the contract be awarded subject to appropriation of funds by the Legislature. Upon passage of the budget act, the contracts could be awarded and the orders could be placed.
We withhold recommendation on the $20 million proposed for the continuation and expansion of pilot projects to assist the homeless mentally ill, pending review of the statutorily required report (due May 1, 2000) on the effectiveness of the three existing projects. We further recommend that, if the Legislature does approve funding to expand the pilot projects to other counties, at least one of the new projects be targeted primarily at providing assistance to parolees.
Please see "Crosscutting Issues" in the Judiciary and Criminal Justice section for our discussion of this issue and our analysis of the Governor's initiatives to keep the mentally ill out of the criminal justice system.