Hot Legislative Topics in January 2016: Housing and School Mental Health

(January 25, 2016)

A Lot More in Housing than Just the Prop 63 $2 Billion Bond Proposal

Housing has centered on the $2 Billion Proposition 63 Mental Health Services Act (MHSA) proposal by Senate President Pro Tem Kevin de Leon and Darrell Steinberg that was presented together with a proposal to have local pilot programs to house other homeless people through new state funds as well as an increase in the SSI/SSP benefit for people who are disabled.

Besides that proposal, the governor’s budget reinforced the need to increase the SSI/SSP benefit and proposed funding to cities, counties and providers to provide housing and services for people coming out of state prison.

The budget also noted that there is now $400 million (two years of funding) in the Cap and Trade Program – a fee for manufacturers and energy producers to offset carbon emissions – for transit-oriented housing and the potential to increase the allocations from housing because the total funds in that program have nearly doubled from the amounts in last year’s budget. While that housing has been targeted to working people to show that it would reduce home to work commutes, we believe a case could be made to designate some of that funding for housing near transit and health and behavioral health services for people with severe mental illnesses and other chronic conditions – who would otherwise have to be transported for many medical visits each month.

Senator Jim Beall, who chairs both the Mental Health Caucus and the Senate Committee for Transportation and Housing, has also introduced a housing bond measure that could be on the November 2016 (or later) ballot.

With housing prices rising dramatically in most parts of the state, and a recognition of increased homelessness in spite of a strong economy, there is a level of interest in housing focused on homeless people that is unprecedented in recent years.

Audit of Special Education Mental Health Realignment and Multi Tiered Systems and Supports (MTSS) funding highlight many efforts to improve school based mental health

School mental health was an issue in 2015, but the only enacted measures were to call for an audit of AB 114 (which shifted responsibility for mental health for special education students from counties to schools) and $10 million in the state budget for academic and behavioral multi-tiered systems of support” for students – the funding  primarily consisting of statewide technical assistance through a single county office of education that could also fund pilot projects for best practices.

County offices of education have until mid-February to submit competitive proposals for the this program. The governor’s 2016-17 January budget adds $30 million to that program. It will be reviewed by the legislature and it is not clear at this time how the two amounts of funding will be combined.

Nonetheless, it creates a foundation upon which to establish comprehensive support systems that could include funding for the multi tiered mental health pilot programs proposed in CCCBHA sponsored AB 1025 (Thurmond) which was approved by the Assembly and is pending in the Senate Appropriations Committee.

That legislation is based upon two model programs that reflect partnerships between county funded MediCal EPSDT providers and school districts to provide a three tiered mental health support system:
  1. Universal support for all students that incorporates elements of Positive Behavioral Intervention and Supports (PBIS),
  2. Timely early intervention services for those showing “at risk” symptoms and can include services similar to the Early Mental Health Initiative which was a program for schools for students K-3 and was funded through the Department of Mental Health from 1991 through 2011. (AB 1644 Bonta would bring this program back through grants from the State Department of Public Health.)
  3. Comprehensive services for students with more serious problems – generally those who meet Special Education criteria.

That model is currently in place in Oakland through CCCBHA member Seneca and in San Bernardino County run by the Desert Mountain SELPA (Special Education Local Plan Area). Both entities report that this model saves schools money in reduced need for high cost special education placements. It was referenced in the state auditor’s report on AB 114 and is also a topic for discussion in the state department of education’s federal SAMHSA grant called “Now is the Time” which is in the second of a five year program implementing new approaches to school mental health including the National Council for Behavioral Health’s model program Mental Health First Aid.

The 99 page state auditor’s report on AB 114 which transferred responsibility for special education mental health services from counties to schools came out on January 20th together with a summary and fact sheet. (add links).

The title of the report reflects its main conclusions: 
“Some Students’ Services Were Affected by a New State Law, and the State Needs to Analyze Student Outcomes and Track Service Costs.”
The report makes it clear that the status quo cannot be sustained. Different interest groups can argue whether counties or schools are the more logical entities responsible for this element of behavioral health care, there should be no disagreement about the need for a new model to emerge that reflects a strong partnership between schools and counties to serve all needs of all students built around a prevention and early intervention model with a strong system of outcome and cost accountability – and that ensures that all students will get all of the care that they need and utilizes several funding sources that could include all of the following and will likely vary by school:
  • EPSDT mental health funds
  • Special Education Mental Health
  • County Alcohol and Drug funds
  • Mental Health Services Act (MHSA/Prop 63) Prevention and Early Intervention Funds
  • School funds for student supports
  • Commercial insurance
  • MediCal “Mild to Moderate” mental health through health plans
The Department of Health Care Services (DHCS) is making significant progress in developing the needed outcome accountability system and already has EPSDT cost reports. While that system is designed for MediCal it could easily be applied to services for other students.
Two “spot bills” have been introduced in the legislature -SB 884 (Beall) and AB 1576 (Eggman) – that could become vehicles to respond to the report. CCCBHA is developing its response which will be presented at a legislative hearing on February 3rd.
That hearing will likely be the just the first of many legislative discussions about how to best meet the needs of public school students.
All of these programs build upon the work being done through counties and CalMHSA (California Mental Health Services Authority) which dedicate significant portions of Proposition 63/MHSA funds to school mental health.
Darrell Steinberg and University of California students have made college student mental health another priority that needs to be addressed.
Jim Gilmer, President of Mental Health America of California, notes that mental health needs to become part of the student success support system at community colleges, which looks a lot like the MTSS model but appears to omit any mental health evaluation or support as initially implemented based upon 2012 legislation.
When you put it all together there is finally a broad state and local, education and mental health consensus emerging that we need to build new models to support all students and that 2016 appears likely to be a year in which the legislature takes major steps to make that happen.

 

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