Existing law, the Childrens Mental Health Services Act, establishes an interagency system of care for the delivery of mental health services to seriously emotionally and behaviorally disturbed children and their families.

Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the continuously appropriated Mental Health Services Fund to fund various county mental health programs.

Existing law authorizes the act to be amended by a ²/₃ vote of the Legislature if the amendments are consistent with, and further the intent of, the act. Existing law authorizes the Legislature to add provisions to clarify procedures and terms of the act by majority vote.

This bill would declare the intent of the Legislature to enact legislation that would authorize the state and local governments to establish a series of at least 100 centers statewide to address the mental health needs of California youth. The bill would declare the intent of the Legislature to enact legislation to allocate or encourage the allocation of funding for that purpose, as specified. The bill would make related findings and declarations.

Date of Hearing: June 26, 2019

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

SBPCA Bill Id:SB 12

Author:(Beall) – As Amended Ver:May 17, 2019

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

SUMMARY:

This bill requires the Mental Health Services Oversight and Accountability Commission (Commission) to administer a program to award grants to local government entities to establish mental health drop-in centers for youth, contingent on a budget appropriation for the purpose.

It specifies grant funding criteria, requires funding to supplement and not supplant existing commitments of resources, and requires the Commission to monitor implementation, provide technical assistance and evaluate the program.

FISCAL EFFECT:

The Commission estimates cost pressure of $25 million (Mental Health Services Act (MHSA) funds, ongoing, for centers and $250,000 (MHSA funds) for administrative staffing. Specifically, the Commission estimates approximately $8.25 million (MHSA) in the first year to establish five centers and $16.5 million (MHSA) in year two to establish ten centers, for a total of $25 million (MHSA).

COMMENTS:

1. Purpose. According to the author, adolescence is a critical period of development and most youth who need mental health care do not access it because of stigma and lack of age-appropriate and culturally competent care. This bill will create youth-friendly, age-appropriate and culturally competent safe havens to go to as resources to address youth’s mental health needs.
2. Background. Proposition 63, the 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. It charges the Commission with overseeing aspects of MHSA implementation.

The “headspace” model, which has been widely adopted in Australia, offers a drop-in center for youth ages 12-25 with four core components: mental health support for those with mild to moderate issues, primary care support, alcohol and other drug early intervention, and supported education and employment, all in a youth-developed and friendly environment.

According to the Commission, certain MHSA funds can be used to established centers that follow the headspace model. The Commission recently approved $15 million of Santa Clara County Behavioral Health Services’ MHSA Innovation funds to pilot the headspace model in two locations over four years in partnership with Stanford University. Because of strong interest in this type of model, Stanford announced it is assembling a team to support implementation of the model in at least seven or eight other interested California counties and three to four other states. These centers will serve all youth who enter. This bill intends to expand the headspace model throughout California.

1. Inclusion in Budget. The 2019-20 Budget Act allocates $15 million one-time in MHSA State Administrative set-aside dollars for the same purposes contained in this bill. There has been no trailer bill language introduced on this topic.

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

Date of Hearing: June 18, 2019

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

SBPCA Bill Id:SB 12

Author:(Beall) – As Amended Ver:May 17, 2019

SENATE VOTE: 37-0

SUBJECT: Mental health services: youth.

SUMMARY: Establishes the Integrated Youth Mental Health Program (IYMHP) with the objective of establishing throughout California, centers that provide integrated mental health, substance use, physical health, social support and other services for youths 12-25 years of age, and their families. Requires, the Mental Health Services Oversight and Accountability Commission (the Commission) subject to an appropriation in the annual Budget Act or any other statute for purposes of this section, to administer the IYMHP and provide funding to specified entities. Specifically, this bill:

1. Establishes the IYMHP, and requires the Commission, subject to the availability of funds, to administer the IYMHP with the objective of establishing throughout California centers that provide integrated mental health, substance use, physical health, social support, and other services to youth ages 12-25 and their families. Permits counties, counties acting jointly, cities, or other local entities, as determined by the Commission, to receive funds for purposes of this program.
2. Requires the Commission to establish core components of the IYMHP, which may include the following:
   1. Youth-informed design for integrated youth mental health services;
   2. A focus that supports individuals with mental health needs, including mild to moderate mental health issues, anxiety, and depression;
   3. A one-stop site for access to integrated care services, including mental health, physical health, substance use, and educational, vocational, and peer support;
   4. Accessibility, such that the services will be affordable, destigmatizing, appealing to youth, and confidential pursuant to existing state and federal laws;
   5. Staff that includes, but is not limited to, psychiatrists, psychologists, physicians, substance use treatment counselors, peer and family support and others; and,
   6. A focus on vulnerable and marginalized youth including, but not limited to, LGBTQ, homeless, and indigenous youth.
3. Requires the Commission to develop selection criteria and the process for awarding the funding, to include at a minimum the following factors for consideration on which recipients to select and in determining the amount of grant awards:
   1. Development of need, including potential gaps in local services;
   2. Description of the funding request and how it will be used to facilitate the objectives and anticipated outcomes;
   3. Ability to measure key outcomes, including improved access to mental health services;
   4. Ability to obtain federal Medicaid reimbursement, when applicable;
   5. Ability to provide additional funding support to the project, including public or private funding, grants, foundation support, and other collaborative efforts;
   6. Ability to sustain the project;
   7. Level of community engagement and commitment to the project;
   8. Level of youth involvement in designing and implementing the project; and,
   9. Geographic areas or regions of the state, including rural, suburban, and urban areas.
4. Requires that funds awarded by the Commission to eligible local entities be, at the discretion of the Commission, for a period of five years. Requires the Commission to determine the funding level for each program and gives the Commission discretion to consider the level of need, population to be served and related criteria as specified.
5. Allows for a reasonable percentage of the total annual funding to be reserved for the Commission to expend on administrative, research and evaluation, and technical assistance costs.
6. Requires the Commission to develop a strategy for monitoring implementation of the IYMHP and a strategy for technical assistance, support, and evaluation to support the successful implementation of the objectives of the IYMHP.

EXISTING LAW:

1. Establishes the Commission 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 1% income tax on personal income above $1 million.
2. Permits the Commission 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 Commission 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 County Behavioral Health Directors Association of California, 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 Senate Appropriations, the Commission estimates $25 million MHSA funds, ongoing, for centers and $250,000 (MHSA funds) to implement the bill’s provisions. Specifically, the Commission estimates approximately $8.25 million in the first year to establish five centers; and $16.5 million in year two to establish ten centers for a total of $25 million. The Commission approximates $1.65 million annually to operate one center based on only one large, Bay Area county (Santa Clara). To the extent centers are established in small- and medium-sized counties with less or more moderate administrative overhead, the Commission estimates fiscal impact could be minimized. The Commission also assumes there would be federal reimbursement for counties, as well as private insurance reimbursement for direct services provided to youth.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, mental health issues are among the most common health conditions faced by California’s children. Unfortunately, due to several reasons including stigma and lack of age-appropriate and culturally competent care, 79% of youth with mental health needs do not access care. Adolescence is a critical period of development for youth. Appropriate and accessible mental health resources are vital to form healthy habits of mind and body. This bill addresses those roadblocks. Youth should have youth-friendly, age-appropriate, and culturally competent safe havens to go to as resources to address their mental health needs. This bill creates centers that would serve all youth who enter, regardless of their immigration status and whether or not they are insured. The IYMHP creates one-stop sites for youth facing mental health issues through a comprehensive approach to youth wellness throughout California.
2. BACKGROUND.
   1. MHSA. The MHSA requires each county mental health program to prepare and submit a three-year plan to DHCS that must be updated each year and approved by DHCS after review and comment by the Commission. DHCS is required to provide guidelines to counties related to each component of the MHSA. In the 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 also must submit their plans for approval to the Commission before they can spend innovation program funds. The MHSA provides funding for programs within five components:
      1. Community Services and Supports (CSS): Provides direct mental health services to the severely and seriously mentally ill, such as mental health treatment, cost of health care treatment, and housing supports. Regulations require counties to direct the majority of its CSS funds to Full‑Service Partnerships (FSPs). FSPs are county coordinated plans, in collaboration with the client and the family, to provide the full spectrum of community services. These services consist of mental health services and supports, such as peer support and crisis intervention services; and non-mental health services and supports, such as food, clothing, housing, and the cost of medical treatment. Outside of FSPs, counties do not use CSS funds to assist with housing;
      2. Prevention and Early Intervention: Provides services to mental health clients in order to help prevent mental illness from becoming severe and disabling;
      3. Innovation: Provides services and approaches that are creative in an effort to address mental health clients’ persistent issues, such as improving services for underserved or unserved populations within the community;
      4. Capital Facilities and Technological Needs: Creates additional county infrastructure such as additional clinics and facilities and/or development of a technological infrastructure for the mental health system, such as electronic health records for mental health services; and,
      5. Workforce Education and Training: Provides training for existing county mental health employees, outreach and recruitment to increase employment in the mental health system, and financial incentives to recruit or retain employees within the public mental health system.
   2. Youth behavioral health incidence. According to the federal Substance Abuse and Mental Health Services Administration (SAMHSA), 50% of adult mental illness begins before the age of 14, and 75% before age 24. More than 40% of youth ages 13 to 17 have experienced a behavioral health problem by the time they reach seventh grade. In addition, suicide is the third leading cause of death among youth ages 15 to 24 after accidents and homicide. Compared with their peers, people within this age group with mental disorders are more likely to experience homelessness, be arrested, drop out of school, and be underemployed. Youth transitioning into adulthood have some of the highest rates of alcohol and substance abuse. SAMHSA states that rates of binge drinking (drinking five or more drinks on a single occasion) in 2014 were 28.5% for people ages 18 to 20 and 43.3% for people ages 21 to 25. SAMHSA states that an estimated 1.3 million U.S. adolescents ages 12 to 17 had a substance use disorder in 2014 (5% of all adolescents). The 2014 rate of past-month illicit drug use was 3.4% among those ages 12 to 13, 7.9% among youth ages 14 to 15, and 16.5% among youth ages 16 to 17. SAMHSA states that the highest rate of current illicit drug use was among youth ages 18 to 20 (22.7%), with the next highest rate occurring among people ages 21 to 25 (21.5%). Adolescents and young adults also face challenges with mental health issues:
      1. In 2014, about one in 10 youth ages 12 to 17 (11.4%) had a major depressive episode (MDE) in the past year. Among adolescents with MDE, 41.2% received treatment or counseling for depression in the past year;
      2. Combined 2010–2012 data from SAMHSA’s National Survey on Drug Use and Health indicate that one in five young adults ages 18 to 25 (18.7%) reported a mental illness in the past year and 3.9% were diagnosed with a serious mental illness; and,
      3. In 2014, 1.4% of adolescents had a co-occurring MDE and a substance use disorder.

A federal government website dedicated to youth facts (youth.gov) states that substance abuse and problematic patterns of substance use among youth can lead to problems at school, cause or aggravate physical and mental health-related issues, promote poor peer relationships, cause motor-vehicle accidents, and place stress on the family. They can also develop into lifelong issues such as substance dependence, chronic health problems, and social and financial consequences.

• 1. Headspace model. According to a report by Stanford Medicine, “Developing Australia’s headspace Program in the United States,” in 2015, nine million young people in the U.S. had mental health issues. $20.5 billion was spent on direct mental health services for young people, and $120 billion was spent on direct costs, loss of earnings, and disability costs for children and youth ages 5-25 (not taking into consideration costs of homelessness, incarceration, comorbid conditions, or mortality). The headspace model offers one-stop shops for youth ages 12-25 with four core components in a youth-developed and friendly environment: mental health support for those with mild to moderate issues, primary care support, alcohol and other drug early intervention, and supported education and employment. There are headspace centers in Australia (89), Denmark (8), Israel (1), Ireland (10), and Canada (5). There are also headspace services that offer confidential, free, and secure online services for youth or their families to chat, email, or speak on the phone with a qualified youth mental health professional. Some studies suggest that more than 220,000 youth have been helped by such headspace centers, and more than 1.3 million services have been provided to youth.

According to information provided by the author’s office, the Commission recently approved $15 million of Santa Clara County Behavioral Health Services’ MHSA Innovation funds to pilot the headspace model in two locations over four years in partnership with Stanford University. Because of strong interest in this type of model, Stanford announced that it is assembling a team to support implementation of the model in at least seven or eight other interested California counties and three to four other states. These centers will serve all youth who enter, regardless of being insured, underinsured, uninsured, or immigration status. This bill would expand the headspace model throughout California.

1. SUPPORT. The Commission, sponsor of this bill, states that data shows that youth are struggling with increased and unmet mental health needs in California. Each year, the number of youth who struggle with depression, thoughts of suicide, and self-harm has increased. The Stanford Psychiatry Center for Youth Mental Health and Wellbeing is spearheading a new national vision for adolescent and young adult wellness through implementation of a groundbreaking international integrated youth mental health care model. The goal of this model is to develop sites reflective of the unique adolescent/young adult culture of each geographic community being served. These centers will serve all youth who enter, no matter if they are insured, underinsured, or uninsured and regardless of immigration status. The Commission concludes that this bill is an opportunity to increase early detection and treatment to greatly improve the health of adolescents in California as they transition to adulthood.
2. RELATED LEGISLATION.
   1. AB 916 (Muratsuchi) requires that the target populations identified in the California Suicide Prevention Act of 2000 be expanded to include community college, four-year College, and university undergraduate and graduate students for purposes of public awareness and education campaign on suicide prevention and treatment. AB 916 is pending in the Senate Health Committee.
   2. AB 1689 (McCarty), requires the Commission, subject to appropriation by the Legislature, to create a grant program for public community colleges, colleges, and universities for the purpose of improving access to mental health services on those campuses, as specified. Requires campuses that have been awarded grants to report annually on the use of those grant funds and to post that information on their internet websites. AB 1689 was held in the Assembly Appropriations Committee.
   3. SB 331 (Hurtado) requires counties to create a suicide prevention strategic plan that places particular emphasis on preventing suicide in children who are less than 19 years of age. SB 331 is pending in the Assembly Health Committee.
   4. SB 582 (Beall) requires the Commission to allocate at least one-half of Investment in Mental Health Wellness Act of 2013 triage grant program funds to local educational agency and mental health partnerships, as specified, to support prevention, early intervention, and direct services to children and youth. SB 582 is pending in the Assembly Health Committee.
3. PREVIOUS LEGISLATION.
   1. AB 1315 (Mullin), Chapter 414, Statutes of 2017, establishes the Early Psychosis Intervention Plus Program and requires specified programs to use evidence-based approaches and services to identify and support clinical and functional recovery of individuals by reducing the severity of first, or early, episode psychotic symptoms and mood disorders, as specified.
   2. AB 2246 (O’Donnell), Chapter 642, Statutes of 2016, requires the governing board or body of a local educational agency, as defined, that serves pupils in grades seven to 12, inclusive, to, before the beginning of the 2017–18 school year, adopt a policy on pupil suicide prevention, as specified, that specifically addresses the needs of high-risk groups.
   3. SB 1004 (Wiener and Moorlach), Chapter 843, Statutes of 2018, requires, on or before January 1, 2020, the Commission to establish priorities, a statewide strategy for monitoring and technical assistance to support the successful implementation of prevention and early intervention (PEI) funds provided by the MHSA.
   4. SB 1019 (Beall) of 2018, would have permitted a county, or a qualified provider operating as part of the county mental health plan network, and a local educational agency to enter into a partnership for the purpose of providing pupils with mental health services at school, as specified. SB 1019 was vetoed by the Governor.

REGISTERED SUPPORT / OPPOSITION:

Support

Mental Health Services Oversight and Accountability Commission (sponsor)

Arc of California

Association of Community Human Service Agencies

Association of Regional Center Agencies

California Alliance of Child and Family Services

California Chronic Care Coalition

California Civil Liberties Advocacy

California State PTA

City of San Jose

City Of Santa Monica

Courage Campaign

Disability Rights California

John Burton Advocates for Youth

Junior Leagues of California State Public Affairs Committee

Mental Health Association in California

Motivating Individual Leadership for Public Awareness

National Association of Social Workers, California Chapter

Orange County

San Diego County District Attorney's Office

San Jose-Evergreen Community College District

Santa Clara County

Seneca Family of Agencies

Services, Immigration Rights and Education Network

Steinberg Institute

United Cerebral Palsy Collaboration of California

Opposition

None on file.

Analysis Prepared by: Judith Babcock / HEALTH / (916) 319-2097

 THIRD READING  

Bill No: SB 12

Author: Beall (D) and Portantino (D), et al.

Amended: 5/17/19

Vote: 21

SENATE HEALTH COMMITTEE: 9-0, 3/27/19

AYES: Pan, Stone, Durazo, Grove, Hurtado, Leyva, Mitchell, Monning, Rubio

SENATE APPROPRIATIONS COMMITTEE: 6-0, 5/16/19

AYES: Portantino, Bates, Bradford, Hill, Jones, Wieckowski

SUBJECT: Mental health services: youth

SOURCE: Mental Health Services Oversight and Accountability Commission

DIGEST:

This bill establishes the Integrated Youth Mental Health Program (IYMHP), and requires, subject to an appropriation, the Mental Health Services Oversight and Accountability Commission (MHSOAC) to administer the IYMHP throughout the state made up of centers that provide integrated services, as specified, to youth ages 12-25 and their families by providing funding to specified entities.

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 County Behavioral Health Directors Association of California, 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]

This bill:

1. Establishes the IYMHP, and requires, subject to an appropriation in the annual Budget Act or any other statute, as specified, the MHSOAC to administer the IYMHP throughout the state made up of centers that provide integrated mental health, substance use, physical health, social support, and other services to youth ages 12-25 and their families. Permits counties, counties acting jointly, cities, or other local entities, as determined by the MHSOAC, to receive funds for purposes of this program.
2. Requires the MHSOAC to establish core components of the IYMHP, which may include the following:
   1. A focus that supports individuals with mild to moderate mental health issues, anxiety, and depression;
   2. A one-stop site for access to integrated care services, including mental health, physical health, substance use, and educational, vocational, and peer support;
   3. Accessibility, such that services will be affordable, destigmatizing, appealing to youth, and confidential pursuant to existing state and federal laws;
   4. Staff that includes psychiatrists, psychologists, physicians, substance use treatment counselors, peer and family support, and others; and,
   5. A focus on vulnerable and marginalized youth, such as LGBTQ, homeless, and indigenous youth.
3. Requires the MHSOAC to develop selection criteria and a process for awarding funding to entities, and permits the MHSOAC to consider factors, such as description of need, ability to measure key outcomes, ability to obtain federal Medicaid reimbursement, ability to provide additional funding from other sources, and the ability to sustain funded projects.
4. Requires funds awarded by the MHSOAC to be for a period of five years, at the discretion of the MHSOAC. Permits the MHSOAC to serve a reasonable percentage of the total annual funding for administrative, research and evaluation, and technical assistance costs related to the IYMHP.
5. Requires the MHSOAC to develop a strategy for monitoring implementation of the IYMHP and for technical assistance, support, and evaluation for the successful implementation of the objectives of the IYMHP.

Comments

1. Author’s statement. According to the author, mental health problems are among the most common health conditions faced by California children. One in 13 children has an emotional disturbance that limits participation in daily activities. Yet many youth go without treatment. Two-thirds of adolescents with major depressive episodes did not get treatment, and low-income families are even less likely to obtain treatment. With more than 75% of mental health issues developing before a person turns 25, early detection and treatment greatly improves the health of adolescents as they transition to adulthood. This bill takes proactive steps to reduce the number of underserved or unserved youth by bolstering the mental health/behavioral health treatment infrastructure for adolescents regardless of insurance or immigration status.
2. MHSA. The MHSA requires each county mental health program to prepare and submit a three-year plan to DHCS that must be updated each year and approved by DHCS after review and comment by the MHSOAC. DHCS is required to provide guidelines to counties related to each component of the MHSA. In the 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 also must submit their plans for approval to the MHSOAC before they can spend innovation program funds. The MHSA provides funding for programs within five components:
   1. Community Services and Supports (CSS): Provides direct mental health services to the severely and seriously mentally ill, such as mental health treatment, cost of health care treatment, and housing supports. Regulations require counties to direct the majority of its CSS funds to Full‑Service Partnerships (FSPs). FSPs are county coordinated plans, in collaboration with the client and the family, to provide the full spectrum of community services. These services consist of mental health services and supports, such as peer support and crisis intervention services; and non-mental health services and supports, such as food, clothing, housing, and the cost of medical treatment. Outside of FSPs, counties do not use CSS funds to assist with housing;
   2. Prevention and Early Intervention: Provides services to mental health clients in order to help prevent mental illness from becoming severe and disabling;
   3. Innovation: Provides services and approaches that are creative in an effort to address mental health clients’ persistent issues, such as improving services for underserved or unserved populations within the community;
   4. Capital Facilities and Technological Needs: Creates additional county infrastructure such as additional clinics and facilities and/or development of a technological infrastructure for the mental health system, such as electronic health records for mental health services; and,
   5. Workforce Education and Training: Provides training for existing county mental health employees, outreach and recruitment to increase employment in the mental health system, and financial incentives to recruit or retain employees within the public mental health system.
3. Youth behavioral health incidence. According to the federal Substance Abuse and Mental Health Services Administration (SAMHSA), half of adult mental illness begins before the age of 14, and three-fourths before age 24. More than 40% of youth ages 13 to 17 have experienced a behavioral health problem by the time they reach seventh grade. In addition, suicide is the third leading cause of death among youth ages 15 to 24 after accidents and homicide. Compared with their peers, people within this age group with mental disorders are more likely to experience homelessness, be arrested, drop out of school, and be underemployed. Youth transitioning into adulthood have some of the highest rates of alcohol and substance abuse. SAMHSA states that rates of binge drinking (drinking five or more drinks on a single occasion) in 2014 were 28.5% for people ages 18 to 20 and 43.3% for people ages 21 to 25. SAMHSA states that an estimated 1.3 million U.S. adolescents ages 12 to 17 had an SUD in 2014 (5% of all adolescents). The 2014 rate of past-month illicit drug use was 3.4% among those ages 12 to 13, 7.9% among youth ages 14 to 15, and 16.5% among youth ages 16 to 17. SAMHSA states that the highest rate of current illicit drug use was among youth ages 18 to 20 (22.7%), with the next highest rate occurring among people ages 21 to 25 (21.5%). Adolescents and young adults also face challenges with mental health issues:
   1. In 2014, about one in ten youth ages 12 to 17 (11.4%) had a major depressive episode (MDE) in the past year. Among adolescents with MDE, 41.2% received treatment or counseling for depression in the past year;
   2. Combined 2010–2012 data from SAMHSA’s National Survey on Drug Use and Health indicate that one in five young adults ages 18 to 25 (18.7%) reported a mental illness in the past year and 3.9% were diagnosed with a serious mental illness; and,
   3. In 2014, 1.4% of adolescents had a co-occurring MDE and a substance use disorder.

A federal government Web site dedicated to youth facts, youth.gov, states that substance abuse and problematic patterns of substance use among youth can lead to problems at school, cause or aggravate physical and mental health-related issues, promote poor peer relationships, cause motor-vehicle accidents, and place stress on the family. They can also develop into lifelong issues such as substance dependence, chronic health problems, and social and financial consequences.

1. Headspace model. According to a report by Stanford Medicine, “Developing Australia’s headspace Program in the United States,” in 2015, nine million young people in the U.S. had mental health issues. $20.5 billion was spent on direct mental health services for young people, and $120 billion was spent on direct costs, loss of earnings, and disability costs for children and youth ages 5-25 (not taking into consideration costs of homelessness, incarceration, comorbid conditions, or mortality). The headspace model offers one-stop shops for youth ages 12-25 with four core components in a youth-developed and friendly environment: mental health support for those with mild to moderate issues, primary care support, alcohol and other drug early intervention, and supported education and employment. There are headspace centers in Australia (89), Denmark (8), Israel (1), Ireland (10), and Canada (5). There are also headspace services that offer confidential, free, and secure online services for youth or their families to chat, email, or speak on the phone with a qualified youth mental health professional. Some studies suggest that more than 220,000 youth have been helped by such headspace centers, and more than 1.3 million services have been provided to youth.

According to information provided by the author’s office, the MHSOAC recently approved $15 million of Santa Clara County Behavioral Health Services’ MHSA Innovation funds to pilot the headspace model in two locations over four years in partnership with Stanford University. Because of strong interest in this type of model, Stanford announced that it is assembling a team to support implementation of the model in at least seven or eight other interested California counties and three to four other states. These centers will serve all youth who enter, regardless of being insured, underinsured, uninsured, or immigration status.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee, the MHSOAC estimates $25 million (MHSA funds, ongoing, for centers and $250,000 MHSA funds) for 2.0 PY to implement the bill’s provisions. Specifically, the MHSOAC estimates approximately $8.25 million (MHSA) in the first year to establish five centers; and $16.5 million (MHSA) in year two to establish ten centers, for a total of $25 million (MHSA).

SUPPORT: (Verified 5/17/19)

Mental Health Services Oversight and Accountability Commission (source)

Alcohol Justice

Anti-Recidivism Coalition

Association of California School Administrators

Association of Community Human Service Agencies

Association of Regional Center Agencies

Bay Area Community Services

California Alliance of Child and Family Services

California Association of Local Behavioral Health Boards and Commissions

California Civil Liberties Advocacy

California Coalition for Mental Health

California PTA

City of San Jose

City of Santa Monica

College of San Francisco

Community Mental Health Certificate Program at City College of San Francisco

Courage Campaign

Disability Rights California

Evergreen Community College

Hathaway-Sycamores

Junior Leagues of California State Public Affairs Committee

Mental Health America of California

National Association of Social Workers, California Chapter

nited Cerebral Palsy California

Orange County Board of Supervisors

Peninsula Health Care District

San Jose Evergreen Community College District

Seneca Family of Agencies

The Arc and United Cerebral Palsy California Collaboration

One individual

OPPOSITION: (Verified 5/17/19)

None received

ARGUMENTS IN SUPPORT: MHSOAC, sponsor of this bill, and other supporters largely made up of mental health advocates argue that data shows that youth are struggling with increased and unmet mental health needs in California, and each year the number of youth who struggle with depression, thoughts of suicide, and self-harm has increased. Supporters cite that Stanford is spearheading a new national vision for adolescent and young adult wellness through implementation of the headspace model. Supporters state that the goal of the model is to develop sites reflective of the unique adolescent/young adult culture of each geographic community being served, and that these sites become the local youths’ own independent place foe mental and physical health care.

Prepared by: Reyes Diaz / HEALTH / (916) 651-4111

5/20/19 13:45:24

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2019 - 2020 Regular Session

SB 12 (Beall) - Mental health services: youth

Bill Summary:

Senate Bill 12 would establish the Integrated Youth Mental Health Program (IYMHP), the purpose of which is to establish integrated service centers throughout the state for youths aged 12 to 25, and their families. Subject to available funds, requires the Mental Health Services Oversight and Accountability Commission to administer the program and grant awards to specified entities.

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on May 16, 2019

Fiscal Impact:

The Mental Health Oversight and Accountability Commission (OAC) estimates $25 million (Mental Health Services Act [MHSA] funds, ongoing, for centers and $250,000 (MHSA funds) for 2.0 PY to implement the bill’s provisions. Specifically, the OAC estimates approximately $8.25 million (MHSA) in the first year to establish five centers; and $16.5 million (MHSA) in year two to establish ten centers, for a total of $25 million (MHSA). The committee amendments make the fiscal impact a cost pressure of a like-amount.

Committee Amendments:

The committee amendments would make the bill contingent upon a budget appropriation or other statute for the bill’s specified purposes.

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SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2019 - 2020 Regular Session

SB 12 (Beall) - Mental health services: youth.

Bill Summary:

Establishes the Integrated Youth Mental Health Program (IYMHP), the purpose of which is to establish integrated service centers throughout the state for youths aged 12 to 25, and their families. Subject to available funds, requires the Mental Health Services Oversight and Accountability Commission to administer the program and grant awards to specified entities.

Fiscal Impact:

The Mental Health Oversight and Accountability Commission (OAC) estimates $25 million (Mental Health Services Act [MHSA] funds, ongoing, for centers and $250,000 (MHSA funds) for 2.0 PY to implement the bill’s provisions. Specifically, the OAC estimates approximately $8.25 million (MHSA) in the first year to establish five centers; and $16.5 million (MHSA) in year two to establish ten centers, for a total of $25 million (MHSA). For additional OAC assumptions, please see Staff Comments.

Background:

In 2004, California voters enacted Proposition 63, known as the Mental Health Services Act (MHSA), to provide funds to counties to expand services, develop innovative programs, and integrate service plans for children, adults, and seniors who were mentally ill, through a one-percent income tax on personal income above
$1 million. The MHSA provides funding for programs within five components:
(1) community services and supports; (2) prevention and early intervention; (3) innovation; (4) capital facilities and technological needs; and (5) workforce education and training.

The OAC was established to oversee the implementation of MHSA funds and works in collaboration with the Department of Health Care Services (DHCS), the California Behavioral Health Planning Council, and other stakeholders to design a joint plan for coordinated evaluation of client outcomes in community-based mental health. In these three-year plans, counties must include a list of all programs for which MHSA funding is being requested, identify expenditures and which populations will be served. Counties also must submit their plans for approval to the OAC before they can spend innovation program funds.

Proposed Law:

Senate Bill 12 establishes the Integrated Youth Mental Health Program (IYMHP) and includes the following provisions:

Program Objective. The bill provides the objective of IYMHP is to establish, throughout the state, centers that provide integrated mental health, substance use, physical health, social support, and other services for youths aged 12 to 25, inclusive, and their families, to approach youth wellness in an innovative, comprehensive, and youth-friendly way, reaching adolescents and young adults in clinical sites, online, in schools, or other venues.

Program Administration. The bill requires the OAC, subject to available funds, to administer the Integrated Youth Mental Health Program. The bill authorizes counties, counties acting jointly, cities, or other local entities, as determined by the commission, to receive funds from the commission.

Program Core Components. The bill requires the OAC to establish core components, which may include the following:

• Youth-informed design for integrated youth mental health services.
• A focus that supports individuals with mental health needs, including mild to moderate mental health issues, anxiety, and depression.
• A one-stop site for access to integrated care services, including mental health, physical health, substance use, and educational, vocational, and peer support.
• Accessibility, such that the services will be affordable, destigmatizing, appealing to youth, and confidential pursuant to existing state and federal laws.
• Staff that includes, but is not limited to, psychiatrists, psychologists, physicians, substance use treatment counselors, peer and family support, and others.
• A focus on vulnerable and marginalized youth including, but not limited to, LGBTQ, homeless, and indigenous youth.

Grant Award Selection Criteria. The bill requires the OAC to develop selection criteria and the process for awarding the funding. At a minimum, the OAC may consider the following factors when selecting recipients and determining grant award amounts:

• Description of need, including potential gaps in local services.
• Description of the funding request and how it will be used to facilitate the objectives and anticipated outcomes.
• Ability to measure key outcomes, including improved access to mental health services.
• Ability to obtain federal Medicaid reimbursement, when applicable.
• Ability to provide additional funding support to the project, including public or private funding, grants, foundation support, and other collaborative efforts.
• Ability to sustain the project.
• Level of community engagement and commitment to the project.
• Level of youth involvement in designing and implementing the project.
• Geographic areas or regions of the state, including rural, suburban, and urban areas.

Grant Awards. The bill requires funds awarded to be eligible to local entities, at the discretion of OAC, to be for a period of five years. The OAC must determine the funding level for each program and has discretion to consider the level of need, population to be served, and other specified criteria.

The bill authorizes funds awarded to be used to supplement, but not supplant, existing financial and resource commitments of a county, counties acting jointly, or a city mental health department, and requires a reasonable percentage of the total annual funding to be reserved for OAC’s administrative, research and evaluation, and technical assistance costs.

Grant Monitoring and Evaluation. The bill requires the OAC to develop a strategy for program monitoring and evaluation, and to develop a technical assistance strategy.

Other. The bill authorizes the OAC to implement the bill’s provisions through informational letters, bulletins, or other notices, without having to take formal regulatory action.

Staff Comments:

The OAC approximates $1.65 million annually to operate one center. This assumption is based off of only one large, Bay Area county (Santa Clara). To the extent centers are established in small- and medium-sized counties with less or more moderate administrative overhead (leasing space costs), the OAC estimates fiscal impact could be minimized. The OAC also assumes there would be federal reimbursement for counties, as well as private insurance reimbursement for direct services provided to youth.

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SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: SB 12

SUBJECT: Mental health services: youth.

SUMMARY:

Establishes the Integrated Youth Mental Health Program (IYMHP), and requires, subject to the availability of funds, the Mental Health Services Oversight and Accountability Commission to administer the IYMHP throughout the state made up of centers that provide integrated services, as specified, to youth ages 12-25 and their families by providing funding to specified entities.

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 County Behavioral Health Directors Association of California, 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]

This bill:

1. Establishes the Integrated Youth Mental Health Program (IYMHP), and requires, subject to the availability of funds, the MHSOAC to administer the IYMHP throughout the state made up of centers that provide integrated mental health, substance use, physical health, social support, and other services to youth ages 12-25 and their families. Permits counties, counties acting jointly, cities, or other local entities, as determined by the MHSOAC, to receive funds for purposes of this program.

1. Requires the MHSOAC to establish core components of the IYMHP, which may include the following:
2. A focus that supports individuals with mild to moderate mental health issues, anxiety, and depression;
3. A one-stop site for access to integrated care services, including mental health, physical health, substance use, and educational, vocational, and peer support;
4. Accessibility, such that services will be affordable, destigmatizing, appealing to youth, and confidential pursuant to existing state and federal laws;
5. Staff that includes psychiatrists, psychologists, physicians, substance use treatment counselors, peer and family support, and others; and,
6. A focus on vulnerable and marginalized youth, such as LGBTQ, homeless, and indigenous youth.
7. Requires the MHSOAC to develop selection criteria and a process for awarding funding to entities, and permits the MHSOAC to consider factors, such as description of need, ability to measure key outcomes, ability to obtain federal Medicaid reimbursement, ability to provide additional funding from other sources, and the ability to sustain funded projects.
8. Requires funds awarded by the MHSOAC to be for a period of five years, at the discretion of the MHSOAC. Permits the MHSOAC to serve a reasonable percentage of the total annual funding for administrative, research and evaluation, and technical assistance costs related to the IYMHP.
9. Requires the MHSOAC to develop a strategy for monitoring implementation of the IYMHP and for technical assistance, support, and evaluation for the successful implementation of the objectives of the IYMHP.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, mental health problems are among the most common health conditions faced by California children. One in 13 children has an emotional disturbance that limits participation in daily activities. Yet many youth go without treatment. Two-thirds of adolescents with major depressive episodes did not get treatment, and low-income families are even less likely to obtain treatment. With more than 75% of mental health issues developing before a person turns 25, early detection and treatment greatly improves the health of adolescents as they transition to adulthood. This bill takes proactive steps to reduce the number of underserved or unserved youth by bolstering the mental health/behavioral health treatment infrastructure for adolescents regardless of insurance or immigration status.
2. MHSA. The MHSA requires each county mental health program to prepare and submit a three-year plan to DHCS that must be updated each year and approved by DHCS after review and comment by the MHSOAC. DHCS is required to provide guidelines to counties related to each component of the MHSA. In the 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 also must submit their plans for approval to the MHSOAC before they can spend innovation program funds. The MHSA provides funding for programs within five components:
   1. Community Services and Supports (CSS): Provides direct mental health services to the severely and seriously mentally ill, such as mental health treatment, cost of health care treatment, and housing supports. Regulations require counties to direct the majority of its CSS funds to Full‑Service Partnerships (FSPs). FSPs are county coordinated plans, in collaboration with the client and the family, to provide the full spectrum of community services. These services consist of mental health services and supports, such as peer support and crisis intervention services; and non-mental health services and supports, such as food, clothing, housing, and the cost of medical treatment. Outside of FSPs, counties do not use CSS funds to assist with housing;
   2. Prevention and Early Intervention: Provides services to mental health clients in order to help prevent mental illness from becoming severe and disabling;
   3. Innovation: Provides services and approaches that are creative in an effort to address mental health clients’ persistent issues, such as improving services for underserved or unserved populations within the community;
   4. Capital Facilities and Technological Needs: Creates additional county infrastructure such as additional clinics and facilities and/or development of a technological infrastructure for the mental health system, such as electronic health records for mental health services; and,
   5. Workforce Education and Training: Provides training for existing county mental health employees, outreach and recruitment to increase employment in the mental health system, and financial incentives to recruit or retain employees within the public mental health system.
3. Youth behavioral health incidence. According to the federal Substance Abuse and Mental Health Services Administration (SAMHSA), half of adult mental illness begins before the age of 14, and three-fourths before age 24. More than 40% of youth ages 13 to 17 have experienced a behavioral health problem by the time they reach seventh grade. In addition, suicide is the third leading cause of death among youth ages 15 to 24 after accidents and homicide. Compared with their peers, people within this age group with mental disorders are more likely to experience homelessness, be arrested, drop out of school, and be underemployed. Youth transitioning into adulthood have some of the highest rates of alcohol and substance abuse. SAMHSA states that rates of binge drinking (drinking five or more drinks on a single occasion) in 2014 were 28.5% for people ages 18 to 20 and 43.3% for people ages 21 to 25. SAMHSA states that an estimated 1.3 million U.S. adolescents ages 12 to 17 had an SUD in 2014 (5% of all adolescents). The 2014 rate of past-month illicit drug use was 3.4% among those ages 12 to 13, 7.9% among youth ages 14 to 15, and 16.5% among youth ages 16 to 17. SAMHSA states that the highest rate of current illicit drug use was among youth ages 18 to 20 (22.7%), with the next highest rate occurring among people ages 21 to 25 (21.5%). Adolescents and young adults also face challenges with mental health issues:
4. In 2014, about one in ten youth ages 12 to 17 (11.4%) had a major depressive episode (MDE) in the past year. Among adolescents with MDE, 41.2% received treatment or counseling for depression in the past year;
5. Combined 2010–2012 data from SAMHSA’s National Survey on Drug Use and Health indicate that one in five young adults ages 18 to 25 (18.7%) reported a mental illness in the past year and 3.9% were diagnosed with a serious mental illness; and,
6. In 2014, 1.4% of adolescents had a co-occurring MDE and a substance use disorder.

A federal government Website dedicated to youth facts, youth.gov, states that substance abuse and problematic patterns of substance use among youth can lead to problems at school, cause or aggravate physical and mental health-related issues, promote poor peer relationships, cause motor-vehicle accidents, and place stress on the family. They can also develop into lifelong issues such as substance dependence, chronic health problems, and social and financial consequences.

1. Headspace model. According to a report by Stanford Medicine, “Developing Australia’s headspace Program in the United States,” in 2015, nine million young people in the U.S. had mental health issues. $20.5 billion was spent on direct mental health services for young people, and $120 billion was spent on direct costs, loss of earnings, and disability costs for children and youth ages 5-25 (not taking into consideration costs of homelessness, incarceration, comorbid conditions, or mortality). The headspace model offers one-stop shops for youth ages 12-25 with four core components in a youth-developed and friendly environment: mental health support for those with mild to moderate issues, primary care support, alcohol and other drug early intervention, and supported education and employment. There are headspace centers in Australia (89), Denmark (8), Israel (1), Ireland (10), and Canada (5). There are also headspace services that offer confidential, free, and secure online services for youth or their families to chat, email, or speak on the phone with a qualified youth mental health professional. Some studies suggest that more than 220,000 youth have been helped by such headspace centers, and more than 1.3 million services have been provided to youth.

According to information provided by the author’s office, the MHSOAC recently approved $15 million of Santa Clara County Behavioral Health Services’ MHSA Innovation funds to pilot the headspace model in two locations over four years in partnership with Stanford University. Because of strong interest in this type of model, Stanford announced that it is assembling a team to support implementation of the model in at least seven or eight other interested California counties and three to four other states. These centers will serve all youth who enter, regardless of being insured, underinsured, uninsured, or immigration status.

1. Support. MHSOAC, sponsor of this bill, and other supporters largely made up of mental health advocates argue that data shows that youth are struggling with increased and unmet mental health needs in California, and each year the number of youth who struggle with depression, thoughts of suicide, and self-harm has increased. Supporters cite that Stanford is spearheading a new national vision for adolescent and young adult wellness through implementation of the headspace model. Supporters state that the goal of the model is to develop sites reflective of the unique adolescent/young adult culture of each geographic community being served, and that these sites become the local youths’ own independent place foe mental and physical health care.

SUPPORT AND OPPOSITION:

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

Alcohol Justice

Anti-Recidivism Coalition

Association of Community Human Service Agencies

Association of Regional Center Agencies

California Alliance of Child and Family Services

California Civil Liberties Advocacy

California Coalition for Mental Health

City of San Jose

Community Mental Health Certificate Program at City College of San Francisco

Disability Rights California

Mental Health America of California

Seneca Family of Agencies

The Arc and United Cerebral Palsy California Collaboration

One individual

Oppose: None received

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