BILL ANALYSIS                                                                                                                                                                                                    



          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  







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            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;  








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                    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.









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          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:                          |                            |
          |------------------------------------+----------------------------|
          |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  








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            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  








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                 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.









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            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

                                      -- END --