BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2017
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|AUTHOR: |McCarty |
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|VERSION: |May 27, 2016 |
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|HEARING DATE: |June 22, 2016 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : College Mental Health Services Program
SUMMARY : Establishes the College Mental Health Services Program Act, as
specified, until January 1, 2022, with specified dedicated
funding. Requires the Department of Health Care Services to
create a grant program for specified colleges to provide
required services to college students related to improved access
to mental health services and early identification and
intervention programs, and requires grant awardees to report to
specified entities on the use of funds for programs.
Existing law:
1)Establishes the Mental Health Services Act (MHSA), enacted by
voters in 2004 as Proposition 63, which provides funds to
counties to expand services and develop innovative programs
and integrated service plans for mentally ill children,
adults, and seniors through a one percent income tax on
personal income above $1 million to be deposited to the Mental
Health Services Fund (MHSF).
2)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.
3)Establishes the Mental Health Services Oversight and
Accountability Commission (OAC) to oversee the implementation
of the MHSA.
4)Requires each county mental health program to prepare and
submit a three-year program and expenditure plan, with annual
updates, adopted by the county board of supervisors, to the
AB 2017 (McCarty) Page 2 of ?
OAC within 30 days after adoption. Requires the plan to
include, among other things, programs for services to adults
and seniors.
This bill:
1)Establishes the College Mental Health Services Program (CMHSP)
Act and the College Mental Health Services Trust Account in
the State Treasury. Requires, beginning July 1, 2017, and
annually thereafter, $40 million to be transferred from
funding that would otherwise be allocated to MHSA Prevention
and Early Intervention (PEI) programs into the trust account
created by this bill.
2)Requires the Department of Health Care Services (DHCS), in
collaboration with the California Mental Health Services
Authority (CalMHSA), to create a grant program for public
community colleges, colleges, and universities, in
collaboration with county behavioral health departments, to
improve access to mental health services and early
identification or intervention programs. Requires CalMHSA to
establish grant guidelines and develop a request for
application for the grants to include, but not be limited to:
a) Eligibility standards of applicants in order
to qualify to be considered for a grant;
b) Required program components to be included in
the application, including the ability of the program
to meet the needs of students that cannot be met
though existing funds; the ability of the program to
fund the matching component, as specified; the ability
of the campus to address direct services like
increasing staff-to-student rations and decreasing
wait times; and the ability to participate in
evidence-based and community defined best practice
programs for service improvements;
c) Preferred program components to be included in
the application, which may include the ability of the
campus to serve underserved and vulnerable
populations, establish direct linkages to
community-based mental health services, reduce racial
disparities in access to mental health services, fund
mental health stigma reduction activities, and have an
existing or planned partnership between the campus and
the county behavioral health department to address
complex mental health needs of students, as specified;
AB 2017 (McCarty) Page 3 of ?
and
d) Required reporting and evaluation standards to
be met by applicants that are selected for a grant.
3)Requires colleges, in collaboration with their local county
behavioral health department, to submit the grant application
electronically to CalMHSA, as specified.
4)Gives CalMHSA the authority to approve grant programs, as
specified. Requires DHCS to award funding in accordance with
CalMHSA determinations. Allows grants to be awarded to a
community college district in the California Community College
system, a campus within the California State University
system, or a campus within the University of California
system, or a grouping of campuses within the segments.
5)Requires total available grant funding to colleges by segment
to be proportional to the number of students served by that
segment. Prohibits the department from awarding more than $5
million per campus, per application.
6)Requires grants to be awarded only to a campus that can show a
dollar-for-dollar match of funds or another match to be
determined by CalMHSA, as specified. Requires individual grant
award allocations to be expended over at least one year but
not to exceed three years, as determined by CalMHSA. Prohibits
grant awards from being used to supplant existing campus,
state, or county funds utilized to provide mental health
services.
7)Requires DHCS and CalMHSA to provide technical assistance to
smaller colleges and county behavioral health departments upon
request to ensure equitable distribution of the grant awards.
8)Requires all entities that have been awarded grants to report
annually on the use of grant funds to DHCS to include, but not
limited to, how the grant funds and matching funds are being
used; available evaluation data, including grant program
outcomes; information regarding services being offered and the
number of individuals served; and plans for sustainability of
mental health programs beyond the funding provided by this
bill. Requires the reports to be electronically submitted
annually to the appropriate Chancellor's offices and the
University of California Office of the President.
AB 2017 (McCarty) Page 4 of ?
9)Requires DHCS to develop an evaluation plan to assess the
impact of the CMHSP, and to submit a report to the Legislature
by February 1, 2021, evaluating the impact and providing
recommendations to further the CMHSP implementation. Requires
DHCS to make the report available to the public and to post it
on its Internet Web site.
10)Specifies that the CMHSP remains in effect only until January
1, 2022, unless a later enacted statute deletes or extends
that date.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Appropriates $40 million annually from the Mental Health
Services Account to fund the grant program.
2)Staff costs to DHCS of $240,000 for fiscal year 2016-17, and
$364,000 ongoing for the length of the program (Mental Health
Services Account).
3)Systems note potential difficulty in generating matching
funds.
PRIOR
VOTES :
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|Assembly Floor: |77 - 0 |
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|Assembly Appropriations Committee: |19 - 0 |
|Assembly Higher Education |13 - 0 |
|Committee: | |
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|Assembly Health Committee: |16 - 0 |
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COMMENTS :
1)Author's statement. According to the author, Californians face
a tremendous mental health need, often related to access,
care, and homelessness. However, an often forgotten part of
this discussion is college-age students. Unfortunately, many
of our public colleges do not have adequate mental health
services for their students on campus, particularly community
AB 2017 (McCarty) Page 5 of ?
colleges. In many cases, college aged students do not ask for
help when they need it. The stigma around seeking mental
health treatment is still prevalent in our society, but we can
help change it if we increase access to mental health services
for students. Once students have the resources they need, the
more likely they will seek help, and this can positively
impact all our students' success.
2)MHSA. The MHSA provides funding for programs within five
components:
a) Community Services and Supports (CSS): provides
direct mental health services to the severely and
seriously mentally ill, such as mental health treatment,
cost of health care treatment, and housing supports. CSS
requires counties to direct the majority of its funds to
full-service partnerships, which are county-coordinated
plans, in collaboration with the client and the family to
provide the full spectrum of community services and
utilize a "whatever it takes" approach to providing
services. Such services include peer support and crisis
intervention services, and non-mental health services and
supports, such as food, clothing, housing, and the cost
of medical treatment;
b) PEI: provides services to mental health clients in
order to help prevent mental illness from becoming severe
and disabling, emphasizing improving timely access to
services for underserved populations. PEI programs are
also required to emphasize strategies to reduce negative
outcomes resulting from untreated mental illness,
including suicide, school failure or dropout,
incarcerations, and unemployment;
c) Innovation: provides services and approaches that
are creative in an effort to address mental health
clients' persistent issues, such as improving services
for underserved or unserved populations within the
community. Innovation is funded by 5% from CSS and 5%
from PEI funds;
d) Capital Facilities and Technological Needs: creates
additional county infrastructure, such as additional
clinics and facilities, and/or development of a
technological infrastructure for the mental health
system, such as electronic health records for mental
health services; and,
e) Workforce Education and Training: provides training
AB 2017 (McCarty) Page 6 of ?
for existing county mental health employees, outreach and
recruitment to increase employment in the mental health
system, and financial incentives to recruit or retain
employees within the public mental health system.
3)PEI. The 2015-16 fiscal year (FY) Governor's Budget projected
that $1.776 billion would be deposited into the MHSF, with
$320.5 million dedicated to the PEI component. The 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 OAC.
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 OAC before the counties may spend certain
categories of funding.
According to its Web site, the OAC controls funding approval
for PEI. The goal of PEI is to help counties implement
services that promote wellness, foster health, and prevent the
suffering that can result from untreated mental illness. The
PEI component requires collaboration with consumers and family
members in the development of PEI projects and programs. In
October 2015, the OAC finalized regulations for the PEI
component, which among other things, requires the Program and
Evaluation Report to describe the evaluation of each PEI
component program and two strategies: access and linkage to
treatment, and improving timely access to services for
underserved populations.
In its FY 2014-15 MHSA Expenditure Report, DHCS noted that
CalMHSA, operating under a joint powers authority, is
responsible for three PEI statewide programs-Suicide
Prevention, Student Mental Health, and Stigma and
Discrimination Reduction-for which a total of $146.8 million
of PEI funds was dedicated. Some highlights noted were:
a) Nearly 1,500 Californians certified in suicide
crisis intervention;
b) 126,925 hotline calls served;
c) 279,533 Web site views, and 104,557 mobile device
views;
d) 153 educators certified to identify symptoms of
mental illness;
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e) 8,700 participants in regional mental health
demonstration programs;
f) Establishment of a mental health clearinghouse
( http://www.regionalk12smhi.org/ ); and,
g) 76 of the 112 colleges (68%) participated in one or
more available trainings provided by CalMHSA.
1)Student mental health data. According to national data
compiled by the Center for Collegiate Mental Health at Penn
State over six academic years (2009-15) from over 93
participating institutions, on average, the growth in the
number of students seeking services at campus 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 seriously considered suicide") has
increased substantially over the last five years from 23.8% to
more than 32.9%. 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.
2)Double referral. If this bill passes out of this committee, it
will be referred to the Senate Education Committee.
3)Related legislation. AB 1644 (Bonta), renames the 1991
School-Based Early Mental Health Intervention and Prevention
Services for Children Act 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 passed out of the Senate Health
Committee on a 9 to 0 vote on June 15, 2016, and was referred
to the Senate Education Committee.
AB 2017 (McCarty) Page 8 of ?
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 Senate Health
Committee.
SB 1273 (Moorlach), clarifies that counties may use MHSF
moneys for services when co-located with involuntary services.
SB 1273 is pending in the Assembly Health Committee.
4)Prior legislation. SB 585 (Steinberg, Chapter 288, Statutes of
2013), allows counties, when included in their plans, to use
Mental Health Services Fund monies for Assisted Outpatient
Treatment, known as "Laura's Law," if a county elects to
participate in and implement Laura's Law.
5)Support. Supporters argue that the state's public colleges
serve nearly three million students, and studies show that
mental health needs of this population are great, with as many
as one in four students having a diagnosable mental illness
and only 40% of them seeking help when they need it.
Supporters argue that colleges lack the level of needed mental
health professionals and resources to help college students,
who often suffer from depression, anxiety, psychosis, or other
mental health conditions due to social and emotional stress,
academic expectations, increasing debt, and other major life
transitions. Supporters further argue that using a portion of
the MHSA will expand mental health services for students, and
research shows that investing in student mental health
improves their wellness, increases graduations rates, and has
a return of investment of between $6-11 for every $1
committed. The Steinberg Institute states that MHSA revenue
has grown an average of 8% annually over the past 11 years and
is expected to continue to grow. The Steinberg Institute
argues that earmarking a small percentage of the MHSA, and
requiring a match from colleges and a plan for program
sustainability beyond the life of the grant program, is a good
way to incentivize programs that have been proven to work.
6)Support in concept. NAMI California writes in support of the
concept of this bill but has concerns about the funding
mechanism identified. NAMI California believes that the
state's public colleges must provide adequate mental health
services, as a 2011 survey by NAMI found that, of 765
individuals diagnosed with a mental health condition that were
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either enrolled in college or had been within the last five
years, stigma associated with mental illness was the top
barrier identified to seeking help. NAMI California also
argues that the funding approach in this bill is inconsistent
with the requirements in the MHSA, which are to cover only
portions of mental health services that cannot be paid for
with other funds, including mental health funds, public and
private insurance, and other local, state, and federal funds.
NAMI California further argues that both the California
Community Colleges and the University of California receive a
portion of the 5% administrative cost component of the MHSA
for the development of policies and practices that support
student mental health; CalMHSA is funded through county MHSA
money for stigma reduction programs in high schools and
college campuses; the 2015-16 Budget included significant
investments for mental health services on college campuses;
and NAMI California provides programs on campuses for all
students, whether they live with a mental health condition,
have family and friends with mental health conditions, or have
an interest in mental illness.
7)Policy comment. While the Steinberg Institute notes that the
MHSA has projected growth, and the requirement for the
transfer of funds that otherwise would have been dedicated to
the PEI component of the MHSA takes into consideration the
projected growth, the author may wish to consider whether this
bill creates an unintended consequence of diverting funds from
prevention and early intervention programs currently funded by
the MHSA, which are meant to prevent mental illness from
becoming severe and disabling, thus requiring more costly
care.
SUPPORT AND OPPOSITION :
Support: California State Student Association (cosponsor)
Faculty Association of California Community Colleges
(cosponsor)
Steinberg Institute (cosponsor)
University of California Student Association
(cosponsor)
Academic Senate for California Community Colleges
American Association for Marriage and Family Therapy,
California Division
Association of California Community College
Administrators
Board of Governors of the California Community
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Colleges/Chancellor's Office
California Association for Postsecondary Education and
Disability
California Association of Marriage and Family
Therapists
California Black Health Network
California Board of Psychology
California Civil Liberties Advocacy
California Council of Community Behavioral Health
Agencies
California Faculty Association
California Federation of Teachers
California Pan-Ethnic Health Network
California Youth Empowerment Network
Community College League of California
Kern Community College District
Los Angeles Community College District
Los Rios Community College District
National Association of Social Workers, California
Chapter
North Orange County Community College District
San Bernardino Community College District
San Jose/Evergreen Community College District
Student Senate for California Community Colleges
West Kern Community College District
Oppose: None received
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