BILL ANALYSIS                                                                                                                                                                                                    



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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