BILL ANALYSIS Ó
AB 2017
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Date of Hearing: April 5, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 2017
(McCarty) - As Amended March 30, 2016
SUBJECT: College Mental Health Services Program.
SUMMARY: Establishes the College Mental Health Services Program
(CMHS Program) Act, which creates a grant program (CMHS Program
Grant) for public community colleges, colleges, and universities
to improve access to mental health services and early
identification or intervention programs. Specifically, this
bill:
1)Establishes the CMSH Trust Account to be used by the
Department of Health Care Services (DHCS) to fund the CMHS
Program Grant.
2)Annually appropriates an unspecified dollar amount from the
Mental Health Services Fund (MHSF) into the CMHS Trust
Account.
3)Requires DHCS, in consultation with the California Mental
Health Services Authority (CalMHSA), to create a grant program
for higher education campuses to improve access to mental
health services and early identification or intervention
programs, and to establish guidelines for grant funding,
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including but not limited to the ability of the campus to:
a) Match grant funding;
b) In partnership with the local county, establish direct
linkages for students to community-based mental health
services for which the students' health coverage makes them
eligible, ensuring provider reimbursement;
c) Participate in evidence-based best practice programs for
mental health services improvements;
d) Serve underserved and vulnerable populations, including,
but not limited to, lesbian, gay, bisexual, transgender,
questioning, and allied persons, victims of domestic
violence and sexual abuse, and veterans;
e) Reduce racial disparities in access to mental health
services;
f) Fund mental health stigma reduction activated; and,
g) Provide employees and students with educational training
on early identification, intervention, and referral of
students with mental health needs.
4)Permits grants to be awarded to a Community College District
in the California Community College (CCC) system, the
California State University (CSU) system, or the University of
California (UC) system. Prohibits grants from exceeding more
than $5 million per campus, per application.
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5)Requires grants to be awarded only to a campus that can show
dollar-for dollar match of funds from the campus.
6)Permits DHCS and CalMHSA to provide technical assistance to
smaller colleges and counties in the application process to
ensure equitable distribution of grant awards.
7)Requires grant recipients to report annually to the executive
office of their respective systems. Requires the report to
include the following information: a) grant funds and
matching revenue expenditures; b) available evaluation data,
including outcomes of the campus mental health programs
funded; and, c) program information regarding services being
offered and the number of individuals being served.
8)Requires the higher education executive offices that receive
the reports to annually forward the reports to DHCS, CalMHSA,
and the Legislature for evaluation of the grant program.
9)Finds and declares that this measure is consistent and
furthers the purposes of the Mental Health Services Act
(MHSA).
EXISTING LAW:
1)Establishes the MHSA, enacted by voters in 2004 by Proposition
63, to provide funds to counties to expand services, develop
innovative programs, and integrated service plans for mentally
ill children, adults, and seniors through a 1% income tax on
personal income above $1 million.
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2)Establishes the Mental Health Oversight and Accountability
Commission (Commission) to oversee the implementation of MHSA,
made up of 16 members appointed by the Governor, unless
otherwise specified.
3)Specifies that the MHSA can only be amended by a two-thirds
vote of both houses of the Legislature and only as long as the
amendment is consistent with and furthers the intent of the
MHSA. Permits provisions clarifying the procedures and terms
of the MHSA to be added by majority vote.
4)Requires DHCS to develop and implement mental health plans for
Medi-Cal beneficiaries.
5)Requires mental health plans, whether administered by public
or private entities, to be governed by specified guidelines,
including the provision of culturally competent and
age-appropriate services, to the extent feasible.
6)Requires a mental health plan to assess the cultural
competency needs of the program and to include a process to
accommodate the significant needs with reasonable timeliness.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, there are
tremendous mental health needs that Californians face related
to access, care, and homelessness. However, an often
forgotten part of this discussion is our college-age students.
Unfortunately, many of our public colleges do not have mental
health services for their students on campus, particularly
community colleges. Due to a lack of access to care,
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college-aged students often do not seek mental health services
when they need them. The stigma around mental health is
something that can be improved if we increase access to mental
health services for students. The author argues that if
students have the resources they need, which is the intent of
this bill, the more likely they will seek help.
2)BACKGROUND.
a) Proposition 63. Proposition 63 was passed by voters in
November 2004. The MHSA imposes a one percent income tax
on personal income in excess of $1 million and creates the
16 member Commission charged with overseeing the
implementation of MHSA. The fiscal year (FY) 2015-16
Governor's Budget projected that $1.776 billion would be
deposited into the MHSF in FY 2015-16. The MHSA addresses
a broad continuum of prevention, early intervention, and
service needs, as well as provided funding for
infrastructure, technology, and training needs for the
community mental health system. In addition to local
programs, the MHSA authorizes up to 5% of revenues for
state administration. These include administrative
functions performed by a variety of state entities
such as the DHCS and the Office of Statewide Health
Planning and Development (OSHPD). It also funds evaluation
of the MHSA by the Commission, which was established by the
MHSA.
-------------------------------------------------
| FY | Revenue | Estimated Revenue |
| | Generated | Expended |
| | | |
| | | |
|---------+---------------+-----------------------|
| 2012-13 |$1.478 billion | $1.632 billion |
| | | |
| | | |
|---------+---------------+-----------------------|
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| 2013-14 |$1.376 billion | $1.484 billion |
| | | |
| | | |
|---------+---------------+-----------------------|
| 2014-15 |$1.588 billion | $1.443 billion |
| | | |
| | | |
|---------+---------------+-----------------------|
| 2015-16 |$1.776 billion | TBD |
| | (projected) | |
| | | |
| | | |
-------------------------------------------------
b) Commission. MHSA requires each county mental health
department to prepare and submit a three-year plan to DHCS
that must be updated each year and approved by DHCS after
review and comment by the Commission. In their three-year
plans, counties are required to include a list of all
programs for which MHSA funding is being requested, that
identify how the funds will be spent, and which populations
will be served. Counties must submit their plans for
approval to the Commission before the counties may spend
certain categories of funding.
c) Collegiate Mental Health. According to national data
compiled by the Center for Collegiate Mental Health over
six academic years (2009-15) from over 93 institutions, on
average, the growth in the number of students seeking
services at counseling centers (+29.6%) was more than five
times the rate of institutional enrollment (+5.6%).
Further, the growth in counseling center appointments
(+38.4) is more than seven times the rate of institutional
enrollment. The lifetime prevalence rate for serious
suicidal ideation among college students (i.e., "I have
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seriously considered suicide") has increased substantially
over the last five years from 23.8% to more than 32.9%, a
considerable change, especially in the context of other
indices that are decreasing, at, or increasing only
slightly.
According to data compiled by the California Electronic Violent
Death Reporting System (CalEVDRS), a total of 6,471 individuals
from 20 to 24 years of age were treated for a suicide attempt in
2014. This represents a 17% increase (5,553 to 6,471) from 2000
to 2014 in individuals who attempted suicide who received
professional treatment by either being hospitalized or treated
in an emergency department. CalEVDRS provides detailed
information from participating counties on violent deaths,
including homicides and suicides by linking data from vital
statistics death files, supplementary homicide reports from the
California Department of Justice, and coroners' investigations.
d) Student Mental Health Initiative (SMHI). In June 2007,
the Commission voted to approve $60 million in statewide
initiative funds for a SMHI in response to the mass
shooting that occurred on the campus of Virginia
Polytechnic Institute and State University where 32 people
were killed and 17 people were wounded. The proposal
allocated $34 million to higher education institutions and
$26 million for K-12 programs for a period of four years.
The higher education programs focused on three key
strategic directions: training; peer support activities;
and, suicide prevention. Any college, district,
multi-campus collaborative, or system within one of the
three California public higher education systems was
eligible and program applications were based on
demonstrated need that emphasized culturally relevant and
appropriate approaches. According to the California
Community College Student Mental Health Program (CCC SMHP)
2012-2015 Program Report, approximately 167,000 community
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college students, faculty, staff, and community members
have been reached through prevention and early intervention
trainings, presentations, events, and workshops. More than
38,000 students, faculty and staff have completed training
to address chronic disease, Post-Traumatic Stress Disorder,
behavioral health, suicide prevention, substance abuse,
screening and brief intervention, and social change.
e) CCC SMHP. In October 2011, as part of Phase I of the
SMHI, the California Community Colleges Chancellor's Office
(Chancellor) was awarded $7 million by CalMHSA to establish
the CCC SMHP. The CCC SMHP is a partnership between the
Chancellor and the Foundation for Community Colleges. The
goals of the CCC SMHP are the development and
implementation of prevention and early intervention
strategies which address the mental health needs of
students, and advance the collaboration between educational
settings, county services, and the community at large. In
June of 2015, CCC SMHP was awarded $1.4 million ($700,000
per year) to support the CCC SMHP Phase II. Program
implementation began on October 1, 2015 and will conclude
on June 30, 2017.
f) 2016 "No Place Like Home" Initiative. On January 4,
2016 the California State Senate announced a proposed
legislative package intended to re-purposes $2 billion of
Proposition 63 bond funds and leverage additional dollars
from other local, state, and federal funding for purposes
of providing housing for chronically homeless persons with
mental illness. The initiative includes proposals to
construct permanent supportive housing for chronically
homeless persons with mental illness, provide $200 million
over four years in shorter-term, rent subsidies while the
permanent housing is constructed or rehabilitated and
support for special housing programs that will assist
families that are part of the child welfare system or are
enrolled in California Work Opportunity and Responsibility
to Kids Housing Support Program.
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3)SUPPORT. The Faculty Association of California Community
Colleges (FACCC), a cosponsor of the bill, writes i that this
bill would improve the capacity of individual campuses to
identify, support, and intervene with at-risk students. The
increase in available services along with support from fellow
students, faculty, and staff would also greatly reduce stigma
around mental health. FACCC states that students should be
able to access mental health services as part of their overall
health care. Social adjustment, family dysfunction, substance
abuse, anger management, and suicide prevention all require
the services of trained mental health professionals.
The Student Senate for California Community Colleges indicates
the availability of student mental health has been long
overlooked as a statewide priority and that mental illness,
family violence, and suicide prevention are but three areas in
which mental health professionals can make a significant
difference in the lives of students.
The Steinberg Institute, also a cosponsor of the bill, and the
California Federation of Teachers state in support that
California is home to 113 CCC campuses, 23 California State
Universities, and 10 UC campuses that, in total, serve nearly
3 million public college students. Supporters note that
studies show the mental health needs of this population are
great and that one out of four individuals live with a mental
illness, meaning at any given moment a minimum of 750,000
students are suffering from depression, anxiety, psychosis, or
some other mental health condition. The Steinberg Institute
argues that establishing a CMHS Trust Account would
dramatically change the lives of these students by providing
funding to target improved linkages and increased services for
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students.
The California Civil Liberties Advocacy (CCLA) asserts that
many individuals with adverse mental health conditions do not
receive treatment until much later in life and that it is
important to identify mental illness as early as possible in
order to prevent a lifetime of disability. CCLA notes that
making mental health services more accessible to community
college students will augment the goal of identifying and
treating mental illnesses earlier, thereby contributing to the
overall well-being of the community.
4)SUPPORT IN CONCEPT. The National Alliance on Mental Illness,
California (NAMI) writes that they support the intentions and
concept of this bill to provide adequate mental health
services to California's college students. However, they have
concerns about the funding mechanism currently identified in
this bill.
5)RELATED LEGISLATION.
a) AB 847 (Mullin) requires DHCS to develop a proposal to
participate in demonstration programs administered by the
federal Secretary of Health and Human Services (HHS
Secretary) to improve mental health services furnished by
certified community behavioral health clinics to Medi-Cal
beneficiaries and would appropriate $1 million from the
MHSF for the purpose of developing a competitive proposal.
AB 847 is pending action on the Governor's desk.
b) AB 1576 (Eggman) establishes a Mental Health Delivery
Demonstration Project (Demonstration Project) and
authorizes health care service plans that offer health care
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services within the greater Sacramento area to require
enrollees seeking services for a mental health condition to
participate in the Demonstration Project as specified. AB
1576 is pending in the Assembly Health Committee.
c) AB 1644 (Bonta) reestablishes the 1991 School-Based
Early Mental Health Intervention and Prevention Services
for Children Act, rename it the Healing from Early
Adversity to Level the Impact of Trauma in Schools Act, to
provide outreach, free regional training, and technical
assistance for local educational agencies in providing
mental health services at school sites. AB 1644 is pending
in the Assembly Education Committee.
d) AB 2279 (Cooley) requires DHCS to annually compile
county revenue and expenditure information related to the
MHSA based on the existing Annual Mental Health Services
Act Revenue and Expenditure Report. AB 2279 is pending in
the Assembly Appropriations Committee.
e) SB 1273 (Moorlach) clarifies that the counties may use
MHSF moneys to provide crisis stabilization services,
including temporary commitment. SB 1273 is pending in the
Senate Health Committee.
f) SB 1466 (Mitchell) requires screening services provided
by Early and Periodic Screening, Diagnosis, and Treatment
Program to include screening for trauma and would require
any victim of child abuse and neglect or a child removed
from a parent or legal guardian by a child welfare agency
to be screened for trauma. SB 1644 is pending in the
Senate Health Committee.
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6)DOUBLE REFERRAL. This bill is double referred and upon
passage of this Committee it will be referred to the Assembly
Committee on Higher Education.
7)POLICY COMMENTS.
a) Funding Amount. Since its inception, the MHSA has
generated over $1 billion annually and most of the funds
are expended annually for various mental health purposes.
Currently, there are various initiatives pending to
re-appropriate Proposition 63 funds (see background above
and related legislation below). Without a specific
appropriation amount, it is difficult to anticipate the
impact of this bill other programs funded by the MHSA. The
Committee may wish to recommend to the author to
appropriate a specific amount for the purposes of this
measure.
b) Sunset. This bill requires grant recipients to annually
report on the use of grant funds and such reports must be
submitted to the Legislature for evaluation of the grant
program. In order to give the Legislature oversight of the
program and program outcomes, the Committee may wish to
include a sunset date for this measure.
c) Ensuring Equal Distribution. California's Community
College system serves approximately 2.3 million students,
the UC system serves approximately 250,000 students and the
CSU system serves approximately 500,000 students. This
bill does not proportionately allocate the funds based on
the number of students served within each system/campus,
and this could result in a campus serving 100,000 students
to be subject to the same funding limit as a campus that
serves 10,000. To ensure proportionate allocation, the
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Committee may wish to consider recommending a tiered grant
system where the award is based on the number of students
served.
8)SUGGESTED AMENDMENTS.
a) Technical amendments. The Committee recommends the
following technical amendment:
5832.2 (b) The Chancellor's Office and the University of
California Office of the President shall forward
electronically submit the reports of the campuses
required pursuant to subdivision (a), at one time
annually, to the department, CalMHSA, and the Legislature
for evaluation of the grant program.
b) Consistency with Proposition 63 requirements.
i) Cap on Program Administration. Proposition 63
requires that up to 5% of revenues under Proposition 63
could be used for administrative purposes. The author
may wish to include a similar cap in this measure.
ii) Non-supplantation. Proposition 63 requires that
funds cannot be used to supplant existing state or county
funds for mental health services. To be consistent with
this requirement, the author may wish to amend this bill
to adopt a similar provision.
REGISTERED SUPPORT / OPPOSITION:
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Support
Faculty Association of California Community Colleges (cosponsor)
The Steinberg Institute (cosponsor)
American Association for Marriage and Family Therapy
California Civil Liberties Advocacy
California Federation of Teachers
Community College League of California
California Black Health Network
National Association of Social Workers - California Chapter
North Orange County Community College District
Student Senate for California Community Colleges
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Opposition
None on file.
Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097