BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON EDUCATION
                              Senator Carol Liu, Chair
                                2015 - 2016  Regular 

          Bill No:             AB 2017            
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          |Author:    |McCarty                                              |
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          |Version:   |May 27, 2016                             Hearing     |
          |           |Date:    June 29, 2016                               |
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          |Urgency:   |No                     |Fiscal:    |Yes              |
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          |Consultant:|Lynn Lorber                                          |
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          Subject:  College Mental Health Services Program


            SUMMARY
          
          This bill requires the Department of Health Care Services to  
          create a grant program for public postsecondary education  
          institutions to access mental health services, and appropriates  
          $40 million for this purpose.

            BACKGROUND
          
          Existing law:

             1)   Establishes the Mental Health Services Act (MHSA),  
               enacted by voters in 2004 as 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.  The MHSA provides  
               funding for programs within five components:  Community  
               Services and Supports, Prevention and Early Intervention,  
               Innovation, Capital Facilities and Technological Needs,  
               Workforce Education and Training.

             2)   Requires the Department of Health Care Services, in  
               coordination with counties, to establish a program designed  
               to prevent mental illnesses from becoming severe and  
               disabling.  Existing law requires prevention and early  
               intervention programs to include specified components.   







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               (Welfare & Institutions Code  5840)
            
          ANALYSIS
          
          This bill requires the Department of Health Care Services (DHCS)  
          to create a grant program for public postsecondary education  
          institutions to access mental health services, and appropriates  
          $40 million for this purpose.  Specifically, this bill:

          1)   Requires 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.




          Grant application

          2)   Requires CalMHSA to establish grant program guidelines and  
               develop a request for proposal, which is to include but not  
               be limited to all of the following:

               a)        Eligibility standards of applicants in order to  
                    qualify to be considered for a grant award.

               b)        Required program components to be included in the  
                    grant program.

               c)        Preferred program components to be included in  
                    the grant application.

               d)        Articulation of grant program goals and expected  
                    outcomes.

               e)        Required reporting and evaluation standards to be  
                    met by applicants that are selected for a grant award.

               f)        Timelines and deadlines for grant applications  
                    and anticipated funding award determinations.

          3)   Requires postsecondary education institutions, in  








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               collaboration with their local county behavioral health  
               department, to submit their grant application  
               electronically to California Mental Health Services  
               Authority (CalMHSA) according to the guidelines in the  
               request for application.

          Grant awards

          4)   Requires total available grant funding to colleges by  
               segment to be proportional to the number of students served  
               by that segment, and prohibits Department of Health Care  
               Services (DHCS) in any case from awarding more than $5  
               million per campus, per application.  

          5)   Requires that grant funds only be awarded to a campus that  
               can show a dollar-for-dollar match of funds or another  
               level of match to be determined by CalMHSA, in consultation  
               with the applicant, based on resources and existing mental  
               health needs of students from the campus.  This bill  
               authorizes matching funds to include in-kind funds, student  
               health fee funds, and other appropriate funds as determined  
               by DHCS in collaboration with CalMHSA and pursuant to the  
               guidelines developed by CalMHSA.

          6)   Requires grants to be awarded to applicants on a  
               competitive basis based on their ability to meet the  
               application standards (the guidelines developed by CalMHSA)  
               and prioritization of these standards as determined by  
               CalMHSA through the development of the request for proposal  
               guidelines.

          7)   Requires individual grant award allocations to be expended  
               over at least one year but not more than three years, as  
               determined by CalMHSA through the grant award process.

          8)   Authorizes grants to be awarded to a community college  
               district in the California Community College system, a  
               campus within the California State University system, a  
               campus within the University of California system, or a  
               grouping of campuses within the segments.

          9)   Provides that California Mental Health Services Authority  
               (CalMHSA) has the authority to approve grant programs and  
               requires DHCS to award funding in accordance with CalMHSA's  








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               determinations, to the extent that an application follows  
               the guidelines and specifically states what activities are  
               to be undertaken in accordance with guidelines in the  
               request for proposal.

          Required program components

          10)  Authorizes the required program components to include but  
               not be limited to, for purposes of the request for  
               proposal, the following:

               a)        The ability of the program to meet the needs of  
                    students that cannot be met through existing funds.

               b)        The ability of the program to provide the  
                    matching funds (see #5).

               c)        The ability of the campus, in partnership with  
                    the local county, to establish direct linkages for  
                    students to community-based mental health services.

               d)        The ability of the campus to address direct  
                    services including but not limited to increasing staff  
                    to student ratios and decreasing wait times.

               e)        The ability to participate in evidence-based and  
                    community defined best practice programs for mental  
                    health services improvements.

          Preferred program components

          11)  Authorizes the preferred program components to include but  
               not be limited to, for purposes of the request for  
               proposal, the following:

               a)        The ability of the campus to serve underserved  
                    and vulnerable populations.

               b)        The ability of the campus, in partnership with  
                    the local county, to establish direct linkages for  
                    students to community-based mental health services for  
                    which reimbursement is available through the student's  
                    health coverage.









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               c)        The ability of the campus to reduce racial  
                    disparities in access to mental health services.

               d)        The ability of the campus to fund mental health  
                    stigma reduction activities.



               e)        The ability of the campus to provide employees  
                    and students with education and training on early  
                    identification, intervention, and referral of students  
                    with mental health needs.

               f)        The ability of the campus to screen students  
                    receiving other health care services and provide  
                    linkages to services from the appropriate mental 
                    health provider based on the insurance status of that  
                    student, for those students who are shown to have a  
                    need for services.

               g)        Evidence of an existing or planned partnership  
                    between the campus and the county behavioral health  
                    department to address complex mental health needs of  
                    students based on their health insurance status and  
                    based on the extent to which there are students whose  
                    needs cannot be met through their health plan, health  
                    insurance, or Medi-Cal.

          Appropriation

          12)  Establishes the College Mental health Services Trust  
               Account, and provides the moneys are to be continuously  
               appropriated to the Department of Health Care Services  
               (DHCS) to fund the grant program established by this bill.

          13)  Requires, beginning July 1, 2017, and annually thereafter,  
               $40 million to be transferred from funding that would  
               otherwise be allocated to Mental Health Services Act (MHSA)  
               Prevention and Early Intervention Programs into the College  
               Mental Health Services Trust Account annually.

          Report and evaluation

          14)  Requires campuses of the California Community Colleges,  








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               California State University and University of California  
               that have been awarded grants to report annually on the use  
               of grant funds to DHCS.  This bill requires the report to  
               include but not be limited to, all of the following:

               a)        How grant funds and matching funds are being  
                    used.

               b)        Available evaluation data, including outcomes of  
                    the campus mental health programs funded pursuant to  
                    the grant program.

               c)        Program information regarding services being  
                    offered and the number of individuals being served.

               d)        Plans for sustainability of mental health  
                    programming beyond the funding from the College Mental  
                    Health Services Trust Account.

          15)  Requires the campuses to electronically submit the reports,  
               annually, to the California Community College Chancellor's  
               Office, the California State University Chancellor's  
               Office, and the University of California Office of the  
               President.

          16)  Requires DHCS to develop an evaluation plan to assess the  
               impact of the grant program, requires DHCS to submit a  
               report to the Legislature by February 1, 2021, evaluating  
               the grant program and providing recommendations for further  
               implementation, and make the report available to the public  
               and post it on its Web site.

          Miscellaneous

          17)  Requires Department of Health Care Services (DHCS) and  
               California Mental Health Services Authority (CalMHSA) to  
               provide technical assistance to smaller colleges and county  
               behavioral health departments upon request during the  
               application process to ensure equitable distribution of the  
               grant award.

          18)  Limits administrative costs associated with administering  
               an approved program at 5% of the total grant amount for any  
               grantee.  This bill requires administrative costs incurred  








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               by DHCS to be reimbursed from the College Mental Health  
               Services Trust Account, and limits the reimbursement to up  
               to 5% of the total funds expended annually from the  
               account.

          19)  Prohibits the funding from being used to supplant existing  
               campus, state, or county funds use to provide mental health  
               services.

          20)  States legislative findings and declarations relative to  
               students' needs for mental health services.

          21)  Sunsets the provisions of this bill on January 1, 2022.

          STAFF COMMENTS
          
          1)   Need for the bill.  According to the author, "Access to  
               mental health services on public college campuses varies by  
               systems, with some offering direct access to services and  
               others with no mental health professional on campus.   
               Considering the growing number of students seeking  
               counseling, there is an even greater need to support  
               effective services, such as peer-to-peer programs, and  
               community and intra-campus engagement.  Currently,  
               California college campuses and higher education systems do  
               not meet national staffing standards for psychiatric  
               services and other mental health professionals.  Recent  
               data and reports have shown college students are  
               experiencing increased rates of mental health issues and  
               demand for treatment services.  By investing in prevention  
               and early intervention activities for mental health  
               services, the state can have positive outcomes that improve  
               student success and have a significant return on  
               investment."

          2)   Mental Health Services Act funding for schools and  
               colleges.  In June 2007, the Mental Health Services  
               Oversight and Accountability Commission voted to approve  
               $60 million in statewide initiative funds in response to  
               the mass shooting that occurred on the campus of Virginia  
               Polytechnic Institute.  This Student Mental Health  
               Initiative (SMHI) allocated $34 million from MHSA  
               Prevention and Early Intervention funds to higher education  
               institutions and $26 million for K-12 programs for a period  








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               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. 

          Under the Student Mental Health Initiative (SMHI), the  
               systemwide offices of the California State University and  
               University of California were each awarded approximately $7  
               million for a 3-year grant (which ended in December 2015)  
               to primarily provide outreach and education activities.  In  
               October 2011, the California Community Colleges  
               Chancellor's Office (CCCCO) was awarded $7 million by  
               California Mental Health Services Authority (CalMHSA) to  
               establish a partnership between the CCCCO and the  
               Foundation for Community Colleges.  In June of 2015, the  
               program was awarded $1.4 million ($700,000 per year) to  
               support phase 2 of the program; implementation began on  
               October 1, 2015 and will conclude on June 30, 2017. 

          The Mental Health Services Act (MHSA) Prevention and Early  
               Intervention funding for SMHI has been primarily used to  
               support outreach and education activities within the higher  
               education segments.  This bill provides for funding to be  
               used to support both direct services as well as education  
               and outreach.  This bill appropriates $40 million from MHSA  
               Prevention and Early Intervention funds, which are  
               currently used for a variety of programs (not only at  
               postsecondary education institutions).

          3)   Student health fee.  This bill authorizes matching funds to  
               include in-kind funds, student health fee funds, among  
               other sources.  The student health fee is voted upon by  
               students.  The author wishes to amend this provision to  
               require notification of the student association before  
               using a student health fee.  Staff recommends this  
               amendment be adopted. 

          4)   Author's amendments.  The author wishes to amend this bill  
               to:









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               a)        Add as a preferred program component, evidence of  
                    an existing or planned partnership between the campus  
                    and local safety net providers to ensure linkages to  
                    primary care and community-based mental health care,  
                    regardless of the health insurance status of the  
                    student.

               b)        Add a requirement that the participating campuses  
                    post the annual report on the use of the funds on the  
                    campus' Web site.

          5)   Heard by the Senate Health Committee.  This bill was heard  
               by the Senate Health Committee on June 22, where it passed  
               on an 8-0 vote.

          6)   Fiscal impact.  This bill makes a continuous appropriation  
               of $40 million.  The Assembly version of the 2016 Budget  
               included this appropriation for the purposes of this bill,  
               but no funding was included in the final conference  
               committee report. 




          According to the Assembly Appropriations Committee, this bill  
          imposes the following costs:

               a)        Appropriates $40 million annually from the Mental  
                    Health Services Account to fund the grant program. 

               b)        Staff costs to the Department of Health Care  
                    Services of $240,000 for fiscal year 2016-17, and  
                    $364,000 ongoing for the length of the program (Mental  
                    Health Services Account). 

               c)        The public systems of postsecondary education  
                    note potential difficulty in generating matching  
                    funds.  

          7)   Related legislation.  AB 1644 (Bonta) requires the  
               Department of Public Health (DPH) to establish a four-year  
               program to support local decisions to provide funding for  
               early mental health support services, requires DPH to  
               provide technical assistance to local educational agencies,  








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               and requires DPH to select and support schoolsites to  
               participate in the program.  AB 1644 is scheduled to be  
               heard by this Committee on June 29.

          SB 1113 (Beall) authorizes local educational agencies to enter  
               into partnerships, as specified, with county mental health  
               plans for the provision of Early and Periodic Screening,  
               Diagnosis, and Treatment mental health services, and to  
               expand the allowable uses of specified mental health funds.  
                SB 1113 is pending in the Senate Appropriations Committee.

          8)   Prior legislation.  AB 1133 (Achadjian, 2015) established a  
               four-year pilot program, the School-Based Early Mental  
               Health Intervention and Prevention Services Support Program  
               (EMHI Support Program), to provide outreach, free regional  
               training, and technical assistance for local educational  
               agencies in providing mental health services at school  
               sites.  AB 1133 was held in the Assembly Appropriations  
               Committee.

          AB 1025 (Thurmond, 2015) required California Department of  
               Education (CDE) to establish a three-year pilot program in  
               school districts to encourage inclusive practices that  
               integrate mental health, special education, and school  
               climate interventions following a multi-tiered framework.   
               AB 1025 was held in the Senate Appropriations Committee.

          AB 1018 (Cooper, 2015) required the Department of Health Care  
               Services and CDE to convene a joint taskforce to examine  
               the delivery of mental health services to children.  AB  
               1018 was held in the Senate Appropriations Committee.

          AB 580 (O'Donnell, 2015) required the CDE to develop model  
               referral protocols for voluntary use by schools to address  
               the appropriate and timely referral by school staff of  
               students with mental health concerns.  AB 580 was vetoed by  
               the Governor, whose veto message read:

                    California does not currently have specific model  
                    referral protocols for addressing student mental  
                    health as outlined by this bill. However, the  
                    California Department of Education recently  
                    received a grant from the federal Department of  
                    Health and Human Services, Substance Abuse and  








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                    Mental Health Services Administration to identify  
                    and address critical student and family mental  
                    health needs. 

                    It's premature to impose an additional and overly  
                    prescriptive requirement until the current  
                    efforts are completed and we can strategically  
                    target resources to best address student mental  
                    health.

            SUPPORT
          
          Faculty Association of California Community Colleges
          Kern Community College District
          Los Angeles Community College District
          Los Rios Community College District
          San Bernardino Community College District
          South Orange County Community College District
          West Kern Community College District

            OPPOSITION
           
           None received.

                                      -- END --