Existing law, the Mental Health Services Act, an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the Mental Health Services Oversight and Accountability Commission, and authorizes the commission to take specified actions, including developing strategies to overcome stigma and discrimination and accomplish the objectives of the Mental Health Services Act.

This bill would authorize the commission to establish a framework and voluntary standard for mental health in the workplace that serves to reduce mental health stigma, increase public, employee, and employer awareness of the recovery goals of the Mental Health Services Act, and provide guidance to Californias employer community to put in place strategies and programs, determined by the commission, to support the mental health and wellness of employees. The bill would require the commission to consult with the Labor and Workforce Development Agency or its designee to develop the standard.

Existing law, the Mental Health Services Act, an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the Mental Health Services Oversight and Accountability Commission, and authorizes the commission to take specified actions, including developing strategies to overcome stigma and discrimination and accomplish the objectives of the Mental Health Services Act.

This bill would authorize the commission to establish a framework and voluntary standard for mental health in the workplace that serves to reduce mental health stigma, increase public, employee, and employer awareness of the recovery goals of the Mental Health Services Act, and provide guidance to Californias employer community to put in place strategies and programs, determined by the commission, to support the mental health and wellness of employees. The bill would require the commission to consult with the Labor and Workforce Development Agency or its designee to develop the standard.

Existing law, the Mental Health Services Act, an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the Mental Health Services Oversight and Accountability Commission, and authorizes the commission to take specified actions, including developing strategies to overcome stigma and discrimination and accomplish the objectives of the Mental Health Services Act.

This bill would authorize the commission to establish a framework and voluntary standard for mental health in the workplace that serves to reduce mental health stigma, increase public, employee, and employer awareness of the recovery goals of the Mental Health Services Act, and provide guidance to Californias employer community to put in place strategies and programs, determined by the commission, to support the mental health and wellness of employees. The bill would require the commission to consult with the Labor and Workforce Development Agency or its designee to develop the standard.

Existing law, the Mental Health Services Act, an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the Mental Health Services Oversight and Accountability Commission, and authorizes the commission to take specified actions, including developing strategies to overcome stigma and discrimination and accomplish the objectives of the Mental Health Services Act.

This bill would authorize the commission to establish a framework and voluntary standard for mental health in the workplace that serves to reduce mental health stigma, increase public, employee, and employer awareness of the recovery goals of the Mental Health Services Act, and provide guidance to Californias employer community to put in place strategies and programs, determined by the commission, to support the mental health and wellness of employees.

Existing law, the Mental Health Services Act, an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the Mental Health Services Oversight and Accountability Commission, and authorizes the commission to take specified actions, including developing strategies to overcome stigma and discrimination and accomplish the objectives of the Mental Health Services Act.

This bill would authorize the commission to establish a framework and voluntary standard for mental health in the workplace that serves to reduce mental health stigma, increase public, employee, and employer awareness of the recovery goals of the Mental Health Services Act, and provide guidance to Californias employer community to put in place strategies and programs, determined by the commission, to support the mental health and wellness of employees.

 UNFINISHED BUSINESS  

Bill No: SB 1113

Author:

: 8/13/18

Vote:

SENATE HEALTH COMMITTEE: 9-0, 4/4/18

AYES: Hernandez, Nguyen, Leyva, Mitchell, Monning, Newman, Nielsen, Pan, Roth

SENATE APPROPRIATIONS COMMITTEE: 7-0, 4/23/18

AYES: Lara, Bates, Beall, Bradford, Hill, Nielsen, Wiener

SENATE FLOOR: 35-0, 4/26/18

AYES: Allen, Atkins, Bates, Beall, Bradford, Cannella, Dodd, Fuller, Gaines, Galgiani, Glazer, Hernandez, Hertzberg, Hill, Hueso, Jackson, Lara, Leyva, McGuire, Mitchell, Monning, Moorlach, Newman, Nguyen, Nielsen, Pan, Portantino, Roth, Skinner, Stern, Stone, Vidak, Wieckowski, Wiener, Wilk

NO VOTE RECORDED: Anderson, Berryhill, De León, Morrell

ASSEMBLY FLOOR: 80-0, 8/20/18 - See last page for vote

SUBJECT:

SOURCE: Mental Health Services Oversight and Accountability Commission

Steinberg Institute

DIGEST:

This bill permits the Mental Health Services Oversight and Accountability Commission (MHSOAC) to establish a framework and voluntary standard for mental health in the workplace, as specified, and to provide guidance to California’s employer community to support the mental health and wellness of employees, as specified.

Assembly Amendments require the MHSOAC to consult with the Labor and Workforce Development Agency or its designee to develop the standard, and make other technical, nonsubstantive changes.

ANALYSIS:

Existing law:

1. Establishes the MHSOAC to oversee the implementation of 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 integrate service plans for mentally ill children, adults, and seniors through a one percent income tax on personal income above $1 million. [WIC §5845]
2. Permits the MHSOAC to perform various functions in carrying out its duties and responsibilities, such as:
   1. Meeting at least once quarterly in locations convenient and open to the public;
   2. Establishing technical advisory committees, such as a committee of consumers and family members;
   3. Obtaining data and information from state or local entities that receive MHSA funds, as specified, to allow the MHSOAC to utilize in its oversight, review, training and technical assistance, accountability, and evaluation capacity, as specified;
   4. Assisting in providing technical assistance to accomplish the purposes of the MHSA; and,
   5. Working in collaboration with the Department of Health Care Services (DHCS), the California Behavioral Health Planning Council, and the California Mental Health Directors Association, as specified, to design a joint plan for a coordinated evaluation of client outcomes in the community-based mental health system, as specified. [WIC §5845]
3. Requires DHCS, in coordination with counties, to establish a program designed to prevent mental illnesses from becoming severe and disabling, including an emphasis on improving timely access to services for underserved populations. Requires the program to include, among other things, outreach to families, employers, primary care health care providers, and others to recognize the early signs of potentially severe and disabling mental illnesses. [WIC §5840]

This bill:

1. Permits the MHSOAC to establish a framework and voluntary standard for mental health in the workplace that serves to:
   1. Reduce mental health stigma;
   2. Increase public, employee, and employer awareness of the recovery goals of the MHSA; and,
   3. Provide guidance to California’s employer community to put in place strategies and programs, as determined by the MHSOAC, to support the mental health and wellness of employees.
2. Requires the MHSOAC to consult with the Labor and Workforce Development Agency or its designee to develop the standard.
3. Makes other technical, nonsubstantive changes.

Comments

1. Author’s statement. According to the author, the MHSOAC is charged with supporting the implementation of the MHSA. Among other responsibilities, the MHSOAC provides technical assistance to California’s counties, which operate the state’s public mental health system. The MHSOAC also is charged with addressing stigma and discrimination that often creates a barrier to accessing mental health services and supports. Under current statute, it is unclear if the MHSOAC has the authority to develop a voluntary standard for mental health in the workplace. SB 1113 would clarify this authority, and create a new, expansive opportunity to improve access to mental health services, reduce stigma, and build support for mental health.
2. Current state efforts. The MHSOAC oversees the implementation of the MHSA, develops strategies to overcome stigma, and advises the Governor and the Legislature on ways the state can improve care and services to people with mental illness. The MHSOAC consists of 16 voting members, including statewide elected officials, members of the legislature, and Governor appointees, such as individuals with mental illness and their family members, health care professionals, and employers. DHCS currently does not have a specific program directed at employers to improve mental health but does provide general information and referral to county mental health plans on its Internet Web site for individuals and businesses to obtain further assistance. DHCS also states that counties are permitted to use MHSA funds to support outreach activities to identify and engage those with mental illness in MHSA-funded programs. Counties are also permitted to outreach to employers in order to facilitate the hiring of persons with mental illness. The MHSOAC states that California’s employer community is increasingly recognizing the value of robust strategies to support those with mental illness in their workforce, including access to high quality care. The MHSOAC intends to convene a workgroup to explore how the state can encourage employers to support mental health awareness, access to care, and improved mental health outcomes, including reducing unemployment.
3. Mental illness in California. According to the federal Substance Abuse and Mental Health Services Administration’s Behavioral Health Barometer: California, Volume 4, in 2014-15 an annual average of about 1.12 million adults, or about 3.8%, had serious suicidal thoughts in the past year, and an annual average of about one million adults, or about 3.5%, had a serious mental illness. Of adults with any reported mental illness in California, only about 1.87 million, or about 37.2%, received mental health services in the past year between 2011-15. The national annual average rate for those who received mental health services in the past year was 42.9%. In 2015, of mental health consumers aged 21 to 64 who received services in the public mental health system in California, 8.5% were employed and 12.8% were unemployed. Of those aged 18-20, 8.2% were employed and 12.4% were unemployed.
4. Mental health in the workplace and federal protections. A September 2017 information sheet, “Mental Health in the Workplace,” issued by the World Health Organization (WHO) states that more than 300 million people suffer depression and anxiety disorders, which cost the global economy $1 trillion each year in lost productivity. A workplace that promotes mental health and supports people with mental disorders is more likely to reduce absenteeism, increase productivity, and benefit from associated economic gains. The WHO states that risks to mental health include inadequate health and safety policies, low levels of support for employees, and inflexible work hours. The WHO also suggests that access to evidence-based treatments has shown to be beneficial for depression and other mental disorders. The WHO states that, because of the stigma associated with mental disorders, employers need to ensure that individuals feel supported and able to ask for support in continuing with or returning to work.

A December 2016 press release from the U.S. Equal Employment Opportunity Commission (EEOC) explains that job applicants and employees with mental health conditions are protected from employment discrimination and harassment based on their conditions. Data shows that in 2016 the EEOC resolved almost 5,000 charges of discrimination based on mental health conditions, and obtained approximately $20 million for individuals who were unlawfully denied employment and reasonable accommodation. The EEOC states that many people with common mental health conditions have important protections under federal law, and that employers, job applicants, and employees should know mental health conditions are no different than physical health conditions under the law.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

According to the Assembly Appropriations Committee, one-time costs of approximately $50,000 (Mental Health Services Fund) for a consultant and MHSOAC meeting expenses related to the establishment of a framework and voluntary mental health standard that may be adopted by employers. Any ongoing outreach and engagement expenses incurred by the MHSOAC would be minor and absorbable.

SUPPORT: (Verified 8/20/18)

Mental Health Services Oversight and Accountability Commission (co-source)

Steinberg Institute (co-source)

California Access Coalition

California Council of Community Behavioral Health Agencies

California Hospital Association

California Medical Association

Disability Rights California

JED Foundation

One Mind Initiative at Work

Sutter Health

OPPOSITION: (Verified 8/20/18)

Department of Finance

ARGUMENTS IN SUPPORT: The MHSOAC, cosponsor of this bill, states that its mission is to provide vision and leadership to ensure Californians understand that mental health is essential to overall health, and that it is tasked with promoting wellness, recovery, and resiliency to improve outcomes for people with mental health needs. The MHSOAC states that the voluntary standards developed pursuant to this bill will tap into the excellent work that a number of organizations have already started relative to workplace mental health, and will help achieve the goals of increasing awareness, combating stigma, and promoting mental health through workplace strategies. The Steinberg Institute, another cosponsor, states that misconceptions about mental health persist in our country, and mental illnesses are not a concern for leaders of public, private, and non-profit organizations. Yet, the impact of these conditions on organizations of all sizes is significant and affects the health, wealth, and success of employees and employers alike. The Steinberg Institute and the California Medical Association (CMA) argue that the costs of untreated depression far outweigh the costs of treatment. Productivity losses are the most significant drivers of these costs: depressed employees miss between six and 25 more days per year and suffer from impaired performance between 13% and 29% of the time at work. The Steinberg Institute and CMA further state that in this country one in four people in the general population are living with a mental health condition, and it is time that we accommodate mental health in the workplace with the same urgency and attention that we give to physical health conditions. The California Access Coalition states that mental health symptoms are often first noticed in schools and in the workplace, and that this bill allows for increased early intervention with employees of businesses in California by helping individuals seek the help they need. The California Hospital Association (CHA) states that openness about physical health conditions has improved, but for many, mental wellness remains a topic fraught with shame and stigma. CHA states that as stigma starts to erode, more employers will seek guidance that helps support employee and employer awareness. Disability Rights California states that this effort to encourage the private sector to foster mental health and psychological safety by crafting a standard will assist in improving the mental health of their workers. The California Council of Community Behavioral Health Agencies (CCCBHA) states that for many years employers have recognized the importance of physical health in the workplace by promoting healthy lifestyles, such as exercise space and funding health club memberships. CCCBHA argues that employers are just starting to realize the value of making similar investment in employee mental health and psychological safety in the workplace.

ARGUMENTS IN OPPOSITION: The Department of Finance (DOF) argues that this bill creates a funding pressure that was not included in the 2018-19 fiscal plan and broadens the MHSOAC’s statutory role and responsibility of providing oversight and accountability for the MHSA. DOF states that policies such as these should be considered within the California Labor and Workforce Development Agency and Health and Human Services Agency. DOF also notes employers do not provide MHSA services, and many employees receive health insurance through their employers or through the Health Benefit Exchange (Covered California). DOF states that this bill’s efforts would likely focus on access to mental health services that may typically be provided through employers’ health insurance options, and individual employers in consultation with their associated health insurance providers may be better placed to develop programs tailored to their individualized workplace. DOF argues it is unclear whether a framework, generalized across all California employers, would adequately address the individualized mental health needs of employees. DOF states that as this bill focuses on public and private employers, it is unclear whether this bill is appropriately aligned, as employers do not provide these services in the current mental health delivery system.

ASSEMBLY FLOOR: 80-0, 8/20/18

AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bonta, Brough, Burke, Caballero, Calderon, Carrillo, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Rivas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

Prepared by:

8/21/18 13:33:07

**** END ****

SENATE THIRD READING

STR Bill Id:SB 1113

Author:(Monning)

As Amended Ver:August 13, 2018

Majority vote

SENATE VOTE: 35-0

SUMMARY: Permits the Mental Health Services Oversight and Accountability Commission (MHSOAC) to establish a framework and voluntary standard for mental health in the workplace that serves to reduce mental health stigma and increase public, employee, and employer awareness of the recovery goals of the Mental Health Services Act (MHSA), and to provide guidance to California's employer community to put in place strategies and programs, as determined by the MHSOAC, to support the mental health and wellness of employees. Requires the MHSOAC to consult with the Labor and Workforce Development Agency to establish a voluntary standard for mental health in the workplace.

FISCAL EFFECT: According to the Senate Appropriations Committee, one-time costs of approximately $50,000 Mental Health Services Fund for a consultant and MHSOAC meeting expenses related to the establishment of a framework and voluntary mental health standard that may be adopted by employers. Any ongoing outreach and engagement expenses incurred by the MHSOAC would be minor and absorbable.

COMMENTS: According to the author, the MHSOAC is charged with supporting the implementation of the MHSA. Among other responsibilities, the MHSOAC provides technical assistance to California's counties, which operate the state's public mental health system. The MHSOAC also is charged with addressing stigma and discrimination that often creates a barrier to accessing mental health services and supports. Under current law, it is unclear if the MHSOAC has the authority to develop a voluntary standard for mental health in the workplace. This bill would clarify that authority, and create a new, expansive opportunity to improve access to mental health services, reduce stigma, and build support for mental health.

The MHSA was enacted by Proposition 63 which was passed by voters in November 2004. The MHSA imposes a 1% income tax on personal income in excess of $1 million and creates the 16 member Commission charged with overseeing the implementation of MHSA. The 2017-18 Governor's Budget projected that $2.2 billion in revenue would be deposited into the Mental Health Services Fund in fiscal year 2018-19. The MHSA addresses a broad continuum of prevention, early intervention, and service needs, as well as providing 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 administrative functions performed by a variety of state entities such as the Department of Health Care Services (DHCS) and the Office of Statewide Health Planning and Development. It also funds evaluation of the MHSA by the MHSOAC.

The role of the MHSOAC is to oversee the implementation of the MHSA. The MHSOAC oversees the Adults and Older Adults Systems of Care Act; Human Resources; Innovative Programs; Prevention & Early Intervention Programs; and the Children's Mental Health Services Act. 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 MHSOAC. In their three-year plans, counties are required to include a list of all programs for which MHSA funding is being requested and that identifies how the funds will be spent and which populations will be served. Counties must submit their plans for approval to the MHSOAC before the counties may spend certain categories of funding.

According to a report by the California HealthCare Foundation entitled "Mental Health in California: For Too Many, Care Not There" nearly one in six California adults experience a mental illness of some kind, and one in 24 have a serious mental illness that makes it difficult to carry out major life activities. One in 13 children has an emotional disturbance that limits participation in daily activities. The report concluded that about two-thirds of adults with a mental illness and two-thirds of adolescents with major depressive episodes did not get treatment. The World Health Organization estimates that the United States loses $1 trillion per year in productivity due to the economic impacts of depression on workers. Harassment and bullying at work are commonly reported problems, and can have a substantial adverse impact on mental health. There are many effective actions that organizations can take to promote mental health in the workplace; and, such actions may also benefit productivity. A recent guide from the World Economic Forum suggests that interventions should take a three-pronged approach:

1. Protect mental health by reducing work–related risk factors;
2. Promote mental health by developing the positive aspects of work and the strengths of employees; and,
3. Address mental health problems regardless of cause.

The MHSOAC, co-sponsor of this bill, states that this bill will authorize the MHSOAC to engage workplace mental health experts, consumers, family members, and public and private agencies to create what may be the first publicly established, voluntary standard for mental health in the workplace within the United States. The MHSOAC states that these voluntary standards will tap into the excellent work that a number of organizations have already started relative to workplace mental health.

The Steinberg Institute, also a co-sponsor of this bill, states that the costs of untreated depression far outweigh the costs of treatment. For an employer, the costs not related to treatment are approximately eight times the cost of treating depression and comorbid disorders. The Steinberg Institute states that productivity losses are the most significant drivers of these costs: depressed employees miss between six and 25 more days per year and suffer from impaired performance between 13% and 29% of the time at work. This bill will help achieve the goals of increasing awareness, combating stigma, and promoting mental health through workplace strategies.

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0003958

SENATE THIRD READING

STR Bill Id:SB 1113

Author:(Monning)

As Amended Ver:April 9, 2018

Majority vote

SENATE VOTE: 35-0

SUMMARY: Permits the Mental Health Services Oversight and Accountability Commission (MHSOAC) to establish a framework and voluntary standard for mental health in the workplace that serves to reduce mental health stigma and increase public, employee, and employer awareness of the recovery goals of the Mental Health Services Act (MHSA), and to provide guidance to California's employer community to put in place strategies and programs, as determined by the MHSOAC, to support the mental health and wellness of employees.

FISCAL EFFECT: According to the Senate Appropriations Committee, one-time costs of approximately $50,000 Mental Health Services Fund for a consultant and MHSOAC meeting expenses related to the establishment of a framework and voluntary mental health standard that may be adopted by employers. Any ongoing outreach and engagement expenses incurred by the MHSOAC would be minor and absorbable.

COMMENTS: According to the author, the MHSOAC is charged with supporting the implementation of the MHSA. Among other responsibilities, the MHSOAC provides technical assistance to California's counties, which operate the state's public mental health system. The MHSOAC also is charged with addressing stigma and discrimination that often creates a barrier to accessing mental health services and supports. Under current law, it is unclear if the MHSOAC has the authority to develop a voluntary standard for mental health in the workplace. This bill would clarify that authority, and create a new, expansive opportunity to improve access to mental health services, reduce stigma, and build support for mental health.

The MHSA was enacted by Proposition 63 which was passed by voters in November 2004. The MHSA imposes a 1% income tax on personal income in excess of $1 million and creates the 16 member Commission charged with overseeing the implementation of MHSA. The 2017-18 Governor's Budget projected that $2.2 billion in revenue would be deposited into the Mental Health Services Fund in fiscal year 2018-19. The MHSA addresses a broad continuum of prevention, early intervention, and service needs, as well as providing 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 administrative functions performed by a variety of state entities such as the Department of Health Care Services (DHCS) and the Office of Statewide Health Planning and Development. It also funds evaluation of the MHSA by the MHSOAC.

The role of the MHSOAC is to oversee the implementation of the MHSA. The MHSOAC oversees the Adults and Older Adults Systems of Care Act; Human Resources; Innovative Programs; Prevention & Early Intervention Programs; and the Children's Mental Health Services Act. 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 MHSOAC. In their three-year plans, counties are required to include a list of all programs for which MHSA funding is being requested and that identifies how the funds will be spent and which populations will be served. Counties must submit their plans for approval to the MHSOAC before the counties may spend certain categories of funding.

According to a report by the California HealthCare Foundation entitled "Mental Health in California: For Too Many, Care Not There" nearly one in six California adults experience a mental illness of some kind, and one in 24 have a serious mental illness that makes it difficult to carry out major life activities. One in 13 children has an emotional disturbance that limits participation in daily activities. The report concluded that about two-thirds of adults with a mental illness and two-thirds of adolescents with major depressive episodes did not get treatment. The World Health Organization estimates that the United States loses $1 trillion per year in productivity due to the economic impacts of depression on workers. Harassment and bullying at work are commonly reported problems, and can have a substantial adverse impact on mental health. There are many effective actions that organizations can take to promote mental health in the workplace; and, such actions may also benefit productivity. A recent guide from the World Economic Forum suggests that interventions should take a three-pronged approach:

1. Protect mental health by reducing work–related risk factors;
2. Promote mental health by developing the positive aspects of work and the strengths of employees; and,
3. Address mental health problems regardless of cause.

The MHSOAC, co-sponsor of this bill, states that this bill will authorize the MHSOAC to engage workplace mental health experts, consumers, family members, and public and private agencies to create what may be the first publicly established, voluntary standard for mental health in the workplace within the United States. The MHSOAC states that these voluntary standards will tap into the excellent work that a number of organizations have already started relative to workplace mental health.

The Steinberg Institute, also a co-sponsor of this bill, states that the costs of untreated depression far outweigh the costs of treatment. For an employer, the costs not related to treatment are approximately eight times the cost of treating depression and comorbid disorders. The Steinberg Institute states that productivity losses are the most significant drivers of these costs: depressed employees miss between six and 25 more days per year and suffer from impaired performance between 13% and 29% of the time at work. This bill will help achieve the goals of increasing awareness, combating stigma, and promoting mental health through workplace strategies.

Anlysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0003754

Date of Hearing: June 27, 2018

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

SBPCA Bill Id:SB 1113

Author:(Monning) – As Amended Ver:April 9, 2018

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill authorizes the Mental Health Services Oversight and Accountability Commission (MHSOAC) to establish a framework and voluntary standard for mental health in the workplace that serves to support the mental health and wellness of employees.

FISCAL EFFECT:

One-time costs of approximately $50,000 (Mental Health Services Fund) for a consultant and MHSOAC meeting expenses related to the establishment of a framework and voluntary mental health standard that may be adopted by employers. Any ongoing outreach and engagement expenses incurred by the MHSOAC would be minor and absorbable.

COMMENTS:

1. Purpose. The MHSOAC is authorized to address stigma and discrimination that can create a barrier to accessing mental health services and supports. However, it is unclear if the MHSOAC has the authority to develop a voluntary standard for mental health in the workplace. This bill would provide such authority to inform workplace mental health efforts. This bill is co-sponsored by the MHSOAC and the Steinberg Institute, and has no opposition.
2. Background. Proposition 63, the Mental Health Services Act (MHSA), was passed by voters in November 2004. The MHSA imposes a 1% income tax on personal income in excess of $1 million to fund counties for a broad continuum of mental health prevention, early intervention, and other services. Implementation and oversight of MHSA funding and activities is shared between the MHSOAC and the Department of Health Care Services (DHCS).

Workplace mental health issues can be both work-related and non-work-related. Untreated mental health conditions harm workers, families, and businesses. Stigma and lack of awareness pose barriers to treatment. Since people spend much of their days at the workplace, to the extent they are adopted, voluntary workplace mental health-related standards may help promote better outcomes.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: June 12, 2018

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

SBPCA Bill Id:SB 1113

Author:(Monning) – As Amended Ver:April 9, 2018

SENATE VOTE: 35-0

SUBJECT: Mental health in the workplace: voluntary standards.

SUMMARY: Permits the Mental Health Services Oversight and Accountability Commission (MHSOAC) to establish a framework and voluntary standard for mental health in the workplace that serves to reduce mental health stigma and increase public, employee, and employer awareness of the recovery goals of the Mental Health Services Act (MHSA), and to provide guidance to California’s employer community to put in place strategies and programs, as determined by the MHSOAC, to support the mental health and wellness of employees.

EXISTING LAW:

1. Establishes the 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.
2. Establishes the MHSOAC to oversee the implementation of MHSA, made up of 16 members appointed by the Governor, and the Legislature, as 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 amended by majority vote.
4. Permits the MHSOAC to perform various functions in carrying out its duties and responsibilities, such as:
   1. Meeting at least once quarterly in locations convenient and open to the public;
   2. Establishing technical advisory committees, such as a committee of consumers and family members;
   3. Obtaining data and information from state or local entities that receive MHSA funds, as specified, to allow the MHSOAC to utilize in its oversight, review, training and technical assistance, accountability, and evaluation capacity, as specified;
   4. Providing technical assistance to accomplish the purposes of the MHSA, and;
   5. Working in collaboration with the Department of Health Care Services (DHCS), the California Behavioral Health Planning Council, and the California Mental Health Directors Association, as specified, to design a joint plan for a coordinated evaluation of client outcomes in the community-based mental health system, as specified.

FISCAL EFFECT: According to the Senate Appropriations Committee, one-time costs of approximately $50,000 (Mental Health Services Fund (MHSF)) for a consultant and MHSOAC meeting expenses related to the establishment of a framework and voluntary mental health standard that may be adopted by employers. Any ongoing outreach and engagement expenses incurred by the MHSOAC would be minor and absorbable.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, the MHSOAC is charged with supporting the implementation of the MHSA. Among other responsibilities, the MHSOAC provides technical assistance to California’s counties, which operate the state’s public mental health system. The MHSOAC also is charged with addressing stigma and discrimination that often creates a barrier to accessing mental health services and supports. Under current law, it is unclear if the MHSOAC has the authority to develop a voluntary standard for mental health in the workplace. This bill would clarify that authority, and create a new, expansive opportunity to improve access to mental health services, reduce stigma, and build support for mental health.
2. BACKGROUND.
   1. MHSA. The MHSA was enacted by Proposition 63 which was passed by voters in November 2004. The MHSA imposes a 1% income tax on personal income in excess of $1 million and creates the 16 member Commission charged with overseeing the implementation of MHSA. The 2017-18 Governor’s Budget projected that $2.2 billion in revenue would be deposited into the MHSF in fiscal year 2018-19. The MHSA addresses a broad continuum of prevention, early intervention, and service needs, as well as providing 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 administrative functions performed by a variety of state entities such as DHCS and the Office of Statewide Health Planning and Development. It also funds evaluation of the MHSA by the MHSOAC.
      
      The role of the MHSOAC is to oversee the implementation of the MHSA. The MHSOAC oversees the Adults and Older Adults Systems of Care Act; Human Resources; Innovative Programs; Prevention & Early Intervention Programs; and the Children’s Mental Health Services Act. 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 MHSOAC. In their three-year plans, counties are required to include a list of all programs for which MHSA funding is being requested and that identifies how the funds will be spent and which populations will be served. Counties must submit their plans for approval to the MHSOAC before the counties may spend certain categories of funding.
   2. Mental Illness in California and in the Workplace. According to a report by the California HealthCare Foundation entitled "Mental Health in California: For Too Many, Care Not There" nearly one in six California adults experience a mental illness of some kind, and one in 24 have a serious mental illness that makes it difficult to carry out major life activities. One in 13 children has an emotional disturbance that limits participation in daily activities. The report concluded that about two-thirds of adults with a mental illness and two-thirds of adolescents with major depressive episodes did not get treatment. The World Health Organization estimates that the United States loses $1 trillion per year in productivity due to the economic impacts of depression on workers. Harassment and bullying at work are commonly reported problems, and can have a substantial adverse impact on mental health. There are many effective actions that organizations can take to promote mental health in the workplace; and, such actions may also benefit productivity. A recent guide from the World Economic Forum suggests that interventions should take a three-pronged approach:
      1. Protect mental health by reducing work–related risk factors;
      2. Promote mental health by developing the positive aspects of work and the strengths of employees; and,
      3. Address mental health problems regardless of cause.
3. SUPPORT. The MHSOAC, co-sponsor of this bill, states that this bill will authorize the MHSOAC to engage workplace mental health experts, consumers, family members, and public and private agencies to create what may be the first publicly established, voluntary standard for mental health in the workplace within the United States. The MHSOAC states that these voluntary standards will tap into the excellent work that a number of organizations have already started relative to workplace mental health.
   
   The Steinberg Institute, also a co-sponsor of this bill, states that the costs of untreated depression far outweigh the costs of treatment. For an employer, the costs not related to treatment are approximately eight times the cost of treating depression and comorbid disorders. The Steinberg Institute states that productivity losses are the most significant drivers of these costs: depressed employees miss between six and 25 more days per year and suffer from impaired performance between 13% and 29% of the time at work. This bill will help achieve the goals of increasing awareness, combating stigma, and promoting mental health through workplace strategies.
4. RELATED LEGISLATION. SB 1101 (Pan) requires the MHSOAC to establish five statewide objectives for the treatment and prevention of mental illness and metrics, to be reviewed and revised, as specified, by which progress toward each of those objectives may be measured. Requires all counties to annually submit a report to the MHSOAC and the Legislature that documents their progress toward the statewide objectives, as specified. SB 1101 was held under submission in the Senate Appropriations Committee.
5. PREVIOUS LEGISLATION.
   1. AB 1134 (Gloria), Chapter 412, Statutes of 2017, permits the MHSOAC to establish a fellowship program, in accordance with specified principles, for the purpose of providing an experiential learning opportunity for a mental health consumer and a mental health professional.
   2. AB 860 (Cooley) of 2017 would have permitted the MHSOAC to conduct a fact-finding tour of a mental health facility or location not open to the public, as specified. AB 860 was vetoed by the Governor, stating that "individual MHSOAC members can and do visit locked mental health facilities, jails, psychiatric hospitals, and schools to observe mental health care services firsthand, and that this bill could disrupt treatment programs or compromise the privacy of those receiving services."
   3. AB 850 (Chau) of 2017 would have added a Governor-appointed member to the MHSOAC who has knowledge and experience in reducing mental health disparities, especially for racial and ethnic communities. AB 850 was vetoed by the Governor who stated that the MHSOAC as currently constituted is up to the task entrusted to it.
   4. AB 462 (Thurmond), Chapter 403, Statutes of 2017, permits the Director of the Employment Development Department to share information with the MHSOAC related to quarterly wage data to assist the MHSOAC in fulfilling its duties under the MHSA, as specified.
   5. AB 745 (Chau) of 2015 would have added a Governor-appointed member to the MHSOAC who has experience providing supportive housing to persons with a severe mental illness. AB 745 was vetoed by the Governor who stated that while supportive housing can help improve the lives of those with serious mental illness the current 16 members of the MHSOAC are adequate to the task.
   6. AB 253 (Roger Hernández) of 2015 would have required specified government entities responsible for administering the Veterans Housing and Homeless Prevention Act of 2014 (VHHP) to give preference to applicants for funding from the VHHP for supportive housing projects, as specified. AB 253 would also have required the Governor to appoint two additional members to the MHSOAC with mental health experience, including mental health disparities. Would have required DHCS to post specified information from mental health plans to a dedicated Internet Web page and to notify appropriate committees of the Legislature, as specified. AB 253 was not heard in the Senate Transportation and Housing Committee.

REGISTERED SUPPORT / OPPOSITION:

Support

Mental Health Services Oversight and Accountability Commission (cosponsor)

Steinberg Institute (cosponsor)

Association of California Life and Health Insurance Companies

California Access Coalition

California Council of Community Behavioral Health Agencies

California Hospital Association

California Medical Association

California Police Chiefs Association

Disability Rights California

Jed Foundation

One Mind Initiative at Work

Opposition

None on file.

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097

 THIRD READING  

Bill No: SB 1113

Author:

:

Vote:

SENATE HEALTH COMMITTEE: 9-0, 4/4/18

AYES: Hernandez, Nguyen, Leyva, Mitchell, Monning, Newman, Nielsen, Pan, Roth

SENATE APPROPRIATIONS COMMITTEE: 7-0, 4/23/18

AYES: Lara, Bates, Beall, Bradford, Hill, Nielsen, Wiener

SUBJECT:

SOURCE: Mental Health Services Oversight and Accountability Commission

Steinberg Institute

DIGEST:

This bill permits the Mental Health Services Oversight and Accountability Commission to establish a framework and voluntary standard for mental health in the workplace, as specified, and to provide guidance to California’s employer community to support the mental health and wellness of employees.

ANALYSIS:

Existing law:

1. Establishes the Mental Health Services Oversight and Accountability Commission (MHSOAC) to oversee the implementation of 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 integrate service plans for mentally ill children, adults, and seniors through a one percent income tax on personal income above $1 million. [WIC §5845]
2. Permits the MHSOAC to perform various functions in carrying out its duties and responsibilities, such as:
   1. Meeting at least once quarterly in locations convenient and open to the public;
   2. Establishing technical advisory committees, such as a committee of consumers and family members;
   3. Obtaining data and information from state or local entities that receive MHSA funds, as specified, to allow the MHSOAC to utilize in its oversight, review, training and technical assistance, accountability, and evaluation capacity, as specified;
   4. Assisting in providing technical assistance to accomplish the purposes of the MHSA; and,
   5. Working in collaboration with the Department of Health Care Services (DHCS), the California Behavioral Health Planning Council, and the California Mental Health Directors Association, as specified, to design a joint plan for a coordinated evaluation of client outcomes in the community-based mental health system, as specified. [WIC §5845]
3. Requires DHCS, in coordination with counties, to establish a program designed to prevent mental illnesses from becoming severe and disabling, including an emphasis on improving timely access to services for underserved populations. Requires the program to include, among other things, outreach to families, employers, primary care health care providers, and others to recognize the early signs of potentially severe and disabling mental illnesses. [WIC §5840]

This bill:

1. Permits the MHSOAC to establish a framework and voluntary standard for mental health in the workplace that serves to:
   1. Reduce mental health stigma;
   2. Increase public, employee, and employer awareness of the recovery goals of the MHSA; and,
   3. Provide guidance to California’s employer community to put in place strategies and programs, as determined by the MHSOAC, to support the mental health and wellness of employees.
2. Makes other technical changes.

Comments

1. Author’s statement. According to the author, the MHSOAC is charged with supporting the implementation of the MHSA. Among other responsibilities, the MHSOAC provides technical assistance to California’s counties, which operate the state’s public mental health system. The MHSOAC also is charged with addressing stigma and discrimination that often creates a barrier to accessing mental health services and supports. Under current statute, it is unclear if the MHSOAC has the authority to develop a voluntary standard for mental health in the workplace. SB 1113 would clarify this authority, and create a new, expansive opportunity to improve access to mental health services, reduce stigma, and build support for mental health.
2. Current state efforts. The MHSOAC oversees the implementation of the MHSA, develops strategies to overcome stigma, and advises the Governor and the Legislature on ways the state can improve care and services to people with mental illness. The MHSOAC consists of 16 voting members, including statewide elected officials, members of the legislature, and Governor appointees, such as individuals with mental illness and their family members, health care professionals, and employers. DHCS currently does not have a specific program directed at employers to improve mental health but does provide general information and referral to county mental health plans on its Internet Web site for individuals and businesses to obtain further assistance. DHCS also states that counties are permitted to use MHSA funds to support outreach activities to identify and engage those with mental illness in MHSA-funded programs. Counties are also permitted to outreach to employers in order to facilitate the hiring of persons with mental illness. The MHSOAC states that California’s employer community is increasingly recognizing the value of robust strategies to support those with mental illness in their workforce, including access to high quality care. The MHSOAC intends to convene a workgroup to explore how the state can encourage employers to support mental health awareness, access to care, and improved mental health outcomes, including reducing unemployment.
3. Mental illness in California. According to the federal Substance Abuse and Mental Health Services Administration’s Behavioral Health Barometer: California, Volume 4, in 2014-15 an annual average of about 1.12 million adults, or about 3.8%, had serious suicidal thoughts in the past year, and an annual average of about one million adults, or about 3.5%, had a serious mental illness. Of adults with any reported mental illness in California, only about 1.87 million, or about 37.2%, received mental health services in the past year between 2011-15. The national annual average rate for those who received mental health services in the past year was 42.9%. In 2015, of mental health consumers aged 21 to 64 who received services in the public mental health system in California, 8.5% were employed and 12.8% were unemployed. Of those aged 18-20, 8.2% were employed and 12.4% were unemployed.
4. Mental health in the workplace and federal protections. A September 2017 information sheet, “Mental Health in the Workplace,” issued by the World Health Organization (WHO) states that more than 300 million people suffer depression and anxiety disorders, which cost the global economy $1 trillion each year in lost productivity. A workplace that promotes mental health and supports people with mental disorders is more likely to reduce absenteeism, increase productivity, and benefit from associated economic gains. The WHO states that risks to mental health include inadequate health and safety policies, low levels of support for employees, and inflexible work hours. The WHO also suggests that access to evidence-based treatments has shown to be beneficial for depression and other mental disorders. The WHO states that, because of the stigma associated with mental disorders, employers need to ensure that individuals feel supported and able to ask for support in continuing with or returning to work.

A December 2016 press release from the U.S. Equal Employment Opportunity Commission (EEOC) explains that job applicants and employees with mental health conditions are protected from employment discrimination and harassment based on their conditions. Data shows that in 2016 the EEOC resolved almost 5,000 charges of discrimination based on mental health conditions, and obtained approximately $20 million for individuals who were unlawfully denied employment and reasonable accommodation. The EEOC states that many people with common mental health conditions have important protections under federal law, and that employers, job applicants, and employees should know mental health conditions are no different than physical health conditions under the law.

Related/Prior Legislation

SB 1004 (Wiener, 2018) requires the MHSOAC to establish priorities for the use of MHSA Prevention and Early Intervention (PEI) funds, as specified, and to develop a statewide strategy for monitoring the implementation of PEI programs, as specified. Requires, commencing with fiscal year 2020-2021, funding for PEI programs to be expended only after the MHSOAC approves the PEI plans, as specified. SB 1004 is pending in the Senate Appropriations Committee.

SB 1101 (Pan, 2018) requires the MHSOAC to establish statewide objectives and metrics, as specified, to bring focus on the state’s mental health system and to assist the public in understanding whether progress is being made toward meeting the goals of the MHSA, as specified. Requires the MHSOAC to collect data and monitor the established metrics, and to work with specified stakeholders to monitor counties’ progress toward meeting the statewide objectives, as specified. Requires counties to report to the MHSOAC and the Legislature, as specified. SB 1101 is set to be heard in the Senate Health Committee on April 25, 2018.

AB 1134 (Gloria, Chapter 412, Statutes of 2017) permits the MHSOAC to establish a fellowship program, in accordance with specified principles, for the purpose of providing an experiential learning opportunity for a mental health consumer and a mental health professional.

AB 860 (Cooley of 2017) would have permitted the MHSOAC to conduct a fact-finding tour of a facility or location that is not open to the public, as specified. AB 860 was vetoed by the Governor who stated that individual MHSOAC members can and do visit locked mental health facilities, jails, psychiatric hospitals, and schools to observe mental health care services firsthand, and that this bill could disrupt treatment programs or compromise the privacy of those receiving services.

AB 850 (Chau of 2017) would have added a Governor-appointed member to the MHSOAC who has knowledge and experience in reducing mental health disparities, especially for racial and ethnic communities. AB 850 was vetoed by the Governor who stated that the MHSOAC as currently constituted is up to the task entrusted to it.

AB 462 (Thurmond, Chapter 403, Statutes of 2017) permits the Director of the Employment Development Department to share information with the MHSOAC related to quarterly wage data to assist the MHSOAC in fulfilling its duties under the MHSA, as specified.

AB 745 (Chau of 2015) would have added a Governor-appointed member to the MHSOAC who has experience providing supportive housing to persons with a severe mental illness. AB 745 was vetoed by the Governor who stated that while supportive housing can help improve the lives of those with serious mental illness the current 16 members of the MHSOAC are adequate to the task.

AB 253 (Roger Hernández of 2015) would have required specified government entities responsible for administering the Veterans Housing and Homeless Prevention Act of 2014 (VHHP) to give preference to applicants for funding from the VHHP for supportive housing projects, as specified. Required the Governor to appoint two additional members to the MHSOAC with mental health experience, including mental health disparities. Required DHCS to post specified information from mental health plans to a dedicated Internet Web page and to notify appropriate committees of the Legislature, as specified. AB 253 was not heard in the Senate Transportation and Housing Committee.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

According to the Senate Appropriations Committee, one-time costs of approximately $50,000 (Mental Health Services Fund) for a consultant and MHSOAC meeting expenses related to the establishment of a framework and voluntary mental health standard that may be adopted by employers. Any ongoing outreach and engagement expenses incurred by the MHSOAC would be minor and absorbable.

SUPPORT: (Verified 4/24/18)

Mental Health Services Oversight and Accountability Commission (co-source)

Steinberg Institute (co-source)

California Access Coalition

California Council of Community Behavioral Health Agencies

California Hospital Association

California Medical Association

Disability Rights California

JED Foundation

One Mind Initiative at Work

Sutter Health

OPPOSITION: (Verified 4/24/18)

None received

ARGUMENTS IN SUPPORT: The MHSOAC, cosponsor of this bill, states that its mission is to provide vision and leadership to ensure Californians understand that mental health is essential to overall health, and that it is tasked with promoting wellness, recovery, and resiliency to improve outcomes for people with mental health needs. The MHSOAC states that the voluntary standards developed pursuant to this bill will tap into the excellent work that a number of organizations have already started relative to workplace mental health, and will help achieve the goals of increasing awareness, combating stigma, and promoting mental health through workplace strategies. The Steinberg Institute, another cosponsor, states that misconceptions about mental health persist in our country, and mental illnesses are not a concern for leaders of public, private, and non-profit organizations. Yet, the impact of these conditions on organizations of all sizes is significant and affects the health, wealth, and success of employees and employers alike. The Steinberg Institute and the California Medical Association (CMA) argue that the costs of untreated depression far outweigh the costs of treatment. Productivity losses are the most significant drivers of these costs: depressed employees miss between six and 25 more days per year and suffer from impaired performance between 13% and 29% of the time at work. The Steinberg Institute and CMA further state that in this country one in four people in the general population are living with a mental health condition, and it is time that we accommodate mental health in the workplace with the same urgency and attention that we give to physical health conditions. The California Access Coalition states that mental health symptoms are often first noticed in schools and in the workplace, and that this bill allows for increased early intervention with employees of businesses in California by helping individuals seek the help they need. The California Hospital Association (CHA) states that openness about physical health conditions has improved, but for many, mental wellness remains a topic fraught with shame and stigma. CHA states that as stigma starts to erode, more employers will seek guidance that helps support employee and employer awareness. Disability Rights California states that this effort to encourage the private sector to foster mental health and psychological safety by crafting a standard will assist in improving the mental health of their workers. The California Council of Community Behavioral Health Agencies (CCCBHA) states that for many years employers have recognized the importance of physical health in the workplace by promoting healthy lifestyles, such as exercise space and funding health club memberships. CCCBHA argues that employers are just starting to realize the value of making similar investment in employee mental health and psychological safety in the workplace.

Prepared by:

4/25/18 14:42:56

**** END ****

SENATE COMMITTEE ON

Senator Ricardo Lara, Chair

2017 - 2018 Regular Session

SB 1113 (Monning) - Mental health in the workplace: voluntary standards

This bill does not meet the criteria for referral to the Suspense File.

Bill Summary:

SB 1113 would authorize the Mental Health Services Oversight and Accountability Commission (Commission) to establish a framework and voluntary standard for mental health in the workplace, as specified.

Fiscal Impact:

• One-time costs of approximately $50,000 (Mental Health Services Fund) for a consultant and Commission meeting expenses related to the establishment a framework and voluntary mental health standard that may be adopted by employers. Any ongoing outreach and engagement expenses incurred by the Commission would be minor and absorbable.

Background:

The Mental Health Services Act (MHSA - Proposition 63 of 2004) imposes an additional 1% personal income tax on incomes over $1 million. Most of the funding from the MHSA is transferred to counties to provide support for mental health services, and state administrative spending is limited to 5% of revenues. Counties are required to prepare three-year program and expenditure plans (with annual updates), which are submitted to the state. In addition, under direction from the Department of Health Care Services, counties are required to develop annual revenue and expenditure reports. The proposed Governor’s Budget projects that $2.23 billion will be deposited into the Mental Health Services Fund in 2018-19.

Existing law establishes the 16-member Commission, which is authorized to perform specified functions in carrying out its duties and responsibilities, including: holding public meetings at least quarterly; establishing technical advisory committees; obtaining data and information from state and local entities that receive MHSA funds (for use in its oversight, review, training, technical assistance, and evaluation responsibilities); developing strategies to overcome stigma and discrimination; providing technical assistance to accomplish the purposes of the MHSA; and working in collaboration with specified state entities to design a joint plan for a coordinated evaluation of client outcomes in the community-based mental health system.

Proposed Law:

SB 1113 would authorize the Commission to establish a framework and voluntary standard for mental health in the workplace that serves to: (1) reduce mental health stigma; (2) increase public, employee, and employer awareness of the recovery goals of the MHSA; and (3) provide guidance to California’s employer community to put in place strategies and programs, as determined by the Commission, to support the mental health and wellness of employees.

Staff Comments:

The Commission expects to hold up to four advisory committee meetings to engage workplace mental health experts, consumers, family members, and public and private agencies to inform the development of a voluntary standard for mental health in the workplace. The voluntary standard for workplace mental health will be informed by the Psychological Health and Safety in the Workplace Standard, which has been implemented in Canada, and other existing workplace mental health and psychological health and safety research. The Commission proposes to hire a consultant to assist in the development of the framework and voluntary standard, and a graphic designer to develop materials for distribution to industry leaders, public agencies, and employers. Total one-time costs for the consultant, graphic designer, and meeting expenses would be approximately $50,000. Any ongoing expenses for Commission outreach and engagement are expected to be minor and absorbable.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: SB 1113

SUBJECT: Mental health in the workplace: voluntary standards

SUMMARY:

Permits the Mental Health Services Oversight and Accountability Commission to establish a framework and voluntary standard for mental health in the workplace, as specified, and to provide guidance to California’s employer community to support the mental health and wellness of employees.

Existing law:

1. Establishes the Mental Health Services Oversight and Accountability Commission (MHSOAC) to oversee the implementation of 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 integrate service plans for mentally ill children, adults, and seniors through a one percent income tax on personal income above $1 million. [WIC §5845]
2. Permits the MHSOAC to perform various functions in carrying out its duties and responsibilities, such as:
3. Meeting at least once quarterly in locations convenient and open to the public;
4. Establishing technical advisory committees, such as a committee of consumers and family members;
5. Obtaining data and information from state or local entities that receive MHSA funds, as specified, to allow the MHSOAC to utilize in its oversight, review, training and technical assistance, accountability, and evaluation capacity, as specified;
6. Assisting in providing technical assistance to accomplish the purposes of the MHSA; and,
7. Working in collaboration with the Department of Health Care Services (DHCS), the California Behavioral Health Planning Council, and the California Mental Health Directors Association, as specified, to design a joint plan for a coordinated evaluation of client outcomes in the community-based mental health system, as specified. [WIC §5845]
8. Requires DHCS, in coordination with counties, to establish a program designed to prevent mental illnesses from becoming severe and disabling, including an emphasis on improving timely access to services for underserved populations. Requires the program to include, among other things, outreach to families, employers, primary care health care providers, and others to recognize the early signs of potentially severe and disabling mental illnesses. [WIC §5840]

This bill:

1. Permits the MHSOAC to establish a framework and voluntary standard for mental health in the workplace that serves to:
   1. Reduce mental health stigma;
   2. Increase public, employee, and employer awareness of the recovery goals of the MHSA; and,
   3. Provide guidance to California’s employer community to put in place strategies and programs, as determined by the MHSOAC, to support the mental health and wellness of employees.
2. Makes other technical changes.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, the MHSOAC is charged with supporting the implementation of the MHSA. Among other responsibilities, the MHSOAC provides technical assistance to California’s counties, which operate the state’s public mental health system. The MHSOAC also is charged with addressing stigma and discrimination that often creates a barrier to accessing mental health services and supports. Under current statute, it is unclear if the MHSOAC has the authority to develop a voluntary standard for mental health in the workplace. SB 1113 would clarify this authority, and create a new, expansive opportunity to improve access to mental health services, reduce stigma, and build support for mental health.
2. Current state efforts. The MHSOAC oversees the implementation of the MHSA, develops strategies to overcome stigma, and advises the Governor and the Legislature on ways the state can improve care and services to people with mental illness. The MHSOAC consists of 16 voting members, including statewide elected officials, members of the legislature, and Governor appointees, such as individuals with mental illness and their family members, health care professionals, and employers. DHCS currently does not have a specific program directed at employers to improve mental health but does provide general information and referral to county mental health plans on its Internet Web site for individuals and businesses to obtain further assistance. DHCS also states that counties are permitted to use MHSA funds to support outreach activities to identify and engage those with mental illness in MHSA-funded programs. Counties are also permitted to outreach to employers in order to facilitate the hiring of persons with mental illness. The MHSOAC states that California’s employer community is increasingly recognizing the value of robust strategies to support those with mental illness in their workforce, including access to high quality care. The MHSOAC intends to convene a workgroup to explore how the state can encourage employers to support mental health awareness, access to care, and improved mental health outcomes, including reducing unemployment.
3. Mental illness in California. According to the federal Substance Abuse and Mental Health Services Administration’s Behavioral Health Barometer: California, Volume 4, in 2014-15 an annual average of about 1.12 million adults, or about 3.8%, had serious suicidal thoughts in the past year, and an annual average of about one million adults, or about 3.5%, had a serious mental illness. Of adults with any reported mental illness in California, only about 1.87 million, or about 37.2%, received mental health services in the past year between 2011-15. The national annual average rate for those who received mental health services in the past year was 42.9%. In 2015, of mental health consumers aged 21 to 64 who received services in the public mental health system in California, 8.5% were employed and 12.8% were unemployed. Of those aged 18-20, 8.2% were employed and 12.4% were unemployed.
4. Mental health in the workplace and federal protections. A September 2017 information sheet, “Mental Health in the Workplace,” issued by the World Health Organization (WHO) states that more than 300 million people suffer depression and anxiety disorders, which cost the global economy $1 trillion each year in lost productivity. A workplace that promotes mental health and supports people with mental disorders is more likely to reduce absenteeism, increase productivity, and benefit from associated economic gains. The WHO states that risks to mental health include inadequate health and safety policies, low levels of support for employees, and inflexible work hours. The WHO also suggests that access to evidence-based treatments has shown to be beneficial for depression and other mental disorders. The WHO states that, because of the stigma associated with mental disorders, employers need to ensure that individuals feel supported and able to ask for support in continuing with or returning to work.

A December 2016 press release from the U.S. Equal Employment Opportunity Commission (EEOC) explains that job applicants and employees with mental health conditions are protected from employment discrimination and harassment based on their conditions. Data shows that in 2016 the EEOC resolved almost 5,000 charges of discrimination based on mental health conditions, and obtained approximately $20 million for individuals who were unlawfully denied employment and reasonable accommodation. The EEOC states that many people with common mental health conditions have important protections under federal law, and that employers, job applicants, and employees should know mental health conditions are no different than physical health conditions under the law.

1. Related legislation. SB 1101 (Pan) requires the MHSOAC to establish five statewide objectives for the treatment and prevention of mental illness and metrics, to be reviewed and revised, as specified, by which progress toward each of those objectives may be measured. Requires all counties to annually submit a report to the MHSOAC and the Legislature that documents their progress toward the statewide objectives, as specified. SB 1101 is pending in the Senate Rules Committee.
2. Prior legislation. AB 1134 (Gloria, Chapter 412, Statutes of 2017) permits the MHSOAC to establish a fellowship program, in accordance with specified principles, for the purpose of providing an experiential learning opportunity for a mental health consumer and a mental health professional.

AB 860 (Cooley of 2017) would have permitted the MHSOAC to conduct a fact-finding tour of a facility or location that is not open to the public, as specified. AB 860 was vetoed by the Governor who stated that individual MHSOAC members can and do visit locked mental health facilities, jails, psychiatric hospitals, and schools to observe mental health care services firsthand, and that this bill could disrupt treatment programs or compromise the privacy of those receiving services.

AB 850 (Chau of 2017) would have added a Governor-appointed member to the MHSOAC who has knowledge and experience in reducing mental health disparities, especially for racial and ethnic communities. AB 850 was vetoed by the Governor who stated that the MHSOAC as currently constituted is up to the task entrusted to it.

AB 462 (Thurmond, Chapter 403, Statutes of 2017) permits the Director of the Employment Development Department to share information with the MHSOAC related to quarterly wage data to assist the MHSOAC in fulfilling its duties under the MHSA, as specified.

AB 745 (Chau of 2015) would have added a Governor-appointed member to the MHSOAC who has experience providing supportive housing to persons with a severe mental illness. AB 745 was vetoed by the Governor who stated that while supportive housing can help improve the lives of those with serious mental illness the current 16 members of the MHSOAC are adequate to the task.

AB 253 (Roger Hernández of 2015) would have required specified government entities responsible for administering the Veterans Housing and Homeless Prevention Act of 2014 (VHHP) to give preference to applicants for funding from the VHHP for supportive housing projects, as specified. Required the Governor to appoint two additional members to the MHSOAC with mental health experience, including mental health disparities. Required DHCS to post specified information from mental health plans to a dedicated Internet Web page and to notify appropriate committees of the Legislature, as specified. AB 253 was not heard in the Senate Transportation and Housing Committee.

1. Support. The MHSOAC, cosponsor of this bill, states that its mission is to provide vision and leadership to ensure Californians understand that mental health is essential to overall health, and that it is tasked with promoting wellness, recovery, and resiliency to improve outcomes for people with mental health needs. The MHSOAC states that the voluntary standards developed pursuant to this bill will tap into the excellent work that a number of organizations have already started relative to workplace mental health, and will help achieve the goals of increasing awareness, combating stigma, and promoting mental health through workplace strategies. The Steinberg Institute, another cosponsor, states that misconceptions about mental health persist in our country, and mental illnesses are not a concern for leaders of public, private, and non-profit organizations. Yet, the impact of these conditions on organizations of all sizes is significant and affects the health, wealth, and success of employees and employers alike. The Steinberg Institute and the California Medical Association (CMA) argue that the costs of untreated depression far outweigh the costs of treatment. Productivity losses are the most significant drivers of these costs: depressed employees miss between six and 25 more days per year and suffer from impaired performance between 13% and 29% of the time at work. The Steinberg Institute and CMA further state that in this country one in four people in the general population are living with a mental health condition, and it is time that we accommodate mental health in the workplace with the same urgency and attention that we give to physical health conditions. The California Access Coalition states that mental health symptoms are often first noticed in schools and in the workplace, and that this bill allows for increased early intervention with employees of businesses in California by helping individuals seek the help they need. The California Hospital Association (CHA) states that openness about physical health conditions has improved, but for many, mental wellness remains a topic fraught with shame and stigma. CHA states that as stigma starts to erode, more employers will seek guidance that helps support employee and employer awareness. Disability Rights California states that this effort to encourage the private sector to foster mental health and psychological safety by crafting a standard will assist in improving the mental health of their workers. The California Council of Community Behavioral Health Agencies (CCCBHA) states that for many years employers have recognized the importance of physical health in the workplace by promoting healthy lifestyles, such as exercise space and funding health club memberships. CCCBHA argues that employers are just starting to realize the value of making similar investment in employee mental health and psychological safety in the workplace.
2. Technical amendment. The author may wish to consider the following technical amendment to reflect a statutory name change for the following organization:
   1. On page 4, lines 13 and 14, strike “California Mental Health Directors Association,” and insert:

County Behavioral Health Directors Association of California

SUPPORT AND OPPOSITION:

Support: Mental Health Services Oversight and Accountability Commission (cosponsor)

Steinberg Institute (cosponsor)

California Access Coalition

California Council of Community Behavioral Health Agencies

California Hospital Association

California Medical Association

Disability Rights California

Oppose: None received

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