Student Mental Health in the California Community Colleges January 31, 2016

Panel Dianne Avelar, MFT Coordinator of Mental Health Services Cabrillo College Laureen Campana, NP, MPH Coordinator of Health Services Columbia College Naomi Forey, RN, MSN Health Services Coordinator Clovis Community College Anna Hasselblad Director of Public Policy Steinberg Institute Becky Perelli, RN, MS Director of Student Health Services City College of San Francisco Susan Quinn, MSN, FNP Director, Student Health Services Santa Rosa Junior College

Presentation Overview Mental Health Literacy – The Big Picture Current Structure – What’s Going On in the CCCs Best Practice – What’s Working Moving forward – Filling the Gaps

Mental Health Literacy The Big Picture

The Mental Health Continuum Well Becoming Unwell Unwell Recovering Mental Health Problem Mental Illness Mental Disorder

Mental Health First Aid Substance Abuse and Mental Health Services Administration You are more likely to encounter someone in an emotional or mental health crisis than someone suffering from a heart attack. Sometimes, first aid isn’t a bandage, CPR, the Heimlich, or calling 911… sometimes, first aid is YOU!

Mental Illness in the USA 1 in 17 adults suffer from a serious mental illness Half of all mental disorders begin by age 14 three quarters by age 24 Early identification and early intervention greatly improves recovery The median delay in obtaining treatment is 10 years Only 41% of people with diagnosed mental illness use mental health services in any given year Mental Health First Aid USA, First Edition – Revised (Mental Health Association of Maryland, Missouri Department of Mental Health, and National Council for Behavioral Health, 2013)

The Problem of Stigma Stigma Rejection, Avoidance, Fear, Discrimination Suffer in Silence Stigma is the biggest barrier to seeking treatment and, therefore, the biggest barrier to recovery

The Spectrum of Mental Health Interventions Well Becoming Unwell Unwell Recovering  Stigma Reduction  Improved Sleep  Stress Management  Healthy Diet  Exercise  Resiliency Training  Building Social Network  Stigma Reduction  Improved Sleep  Stress Management  Healthy Diet  Exercise  Resiliency Training  Building Social Network  Early Identification  Early Referral  Access to Resources  Culture of Caring  Early Identification  Early Referral  Access to Resources  Culture of Caring  Medical  Psychological  Complementary  Peer Support Groups  Medical  Psychological  Complementary  Peer Support Groups Prevention Early Intervention Treatment

Evolution of Threat Assessment Teams Threat Assessment Team Behavioral InterventionT eam Care Team High Risk Problem Prone High Volume

Dynamic Interrelated Whole Overall Health Mental Health & Wellbeing Social Connections Sleep Exercise Nutrition Stress Management Mind-Body- Spirit Importance of Integrated Care

Broad Scope of Awareness, Assessment and Intervention Well Becoming Unwell Unwell Recovering

Current Structure What’s Going On in the CCCs

State Education Code Regulations CCC Health Services Not mandated Regulated by the Education Code* Must be supervised by a Master’s prepared Public Health Nurse if Health Fees are collected (see HSACCC position statement) Mandate for Health Services established prior to 1988 Must be maintained at the level of services provided at that time Qualifies for Maintenance of Effort reimbursements if Health Fee revenue does not cover expenditures to meet the mandate * ED. CODE 76355, 76401, 76403, ; TITLE 5: 53411, 54702, 54706, 54708, 53411

State Education Code Regulations Ed Codes outline what services may be provided with the Health Fee including: clinical services mental health services support services special services. District’s Board of Trustees decide whether or not to charge a Health Fee and, if so: how much to charge (max $19/sem) additional Health Fee waivers, if any, beyond those required the scope of health services provided by the District via an approved “Health Services Plan”

Non-Mandated Program: Implications No centralized data is collected by the CCC system office with complete statewide data regarding the status of health services across the State. No mechanism in place to monitor compliance by the 72 Districts regarding Health Services related Education Code. Data on the overall health status of CCC students is not collected by the system office, i.e. health insurance status, immunization status, etc.

Health Services Association of California Community Colleges Non-profit volunteer organization founded in the early 1980’s Made up of health care professionals working in the CCC system Advocates for student health issues legislatively Supports the establishment and development of health services on CCC campuses. Collects data on the health needs of CCC students and CCC health services infrastructure (see HSACCC-NCHA Consortium project)(see HSACCC-NCHA Consortium project)

Select Data from the HSACCC Annual Survey Colleges Reporting Funding Scope of Service Compliance Staffing

Note: $1 Health Fee Increase COLA allowed in 2009 and 2011 (none since) HSACCC Annual Survey – Five Year Change 2010 to 2015

Revenue Sources : Trend from to Health Services Revenue Sources Health Services Revenue Sources 14-15

Provider Visits: 43 Health Centers Reporting An average of 5935 professional service visits provide each year An average of 161 classroom presentations and seminars provided each year 4.15 FTE Average Staffing Level, Permanent And Non- Permanent 2.9 FTE Average Staffing Level Permanent 72% Of Personnel Are Permanent Staff

Screening, Brief Intervention, Treatment, and Referral of Students in Health Centers Domestic Violence Health Insurance

Behavioral Intervention Teams 82% of colleges reporting have Behavioral Intervention Teams established

Average number of visits: 5 78% of MH Services 100% Funded by Health Fee

Board Approved Health Services Plan Mental Health Reporting to the Health Services Director

Other Tidbits 74% of Mental Health Services have Mental Health internship training programs on site 72.7% offer Nurse Practitioner services 23.3% prescribe psychotropic medications for students (NP/MD) 26.7% have a structured peer health support program 80.0% utilize Kognito online training for at-risk students 45.5% provide Student Health 101 online health magazine for students

Best Practice What’s Working

California Community College Students 2.3 million students 30,339 veterans 6,835 military active duty (Spring 2015) 14,191+ foster youth (Spring 2015) 71,124 students with psychological disability supported by DSPS ( ) California Community College Chancellor’s Office – Data Mart, Retrieved January 25, 2016 from

17,271 California Community College Students surveyed in % felt hopeless and overwhelmed 18.3% had periods of overwhelming anxiety 9.1% seriously considered suicide 2.5% attempted suicide American College Health Association - National College Health Assessment II: California Community College Reference Group Executive Summary, Spring 2013.

Factors Affecting Individual Academic Performance 28.8% Stress 20.5% Work 19.5% Sleep Difficulties 18.3% Anxiety 14.5% Cold/Flu 13.5% Depression 11.1% Finances American College Health Association - National College Health Assessment II: California Community College Reference Group Executive Summary, Spring 2013.

California Community College Student Mental Health Program (CCC SMHP) Peer-to-Peer Support Suicide Prevention Support Underserved Students Faculty and Staff Training Foster Partnerships Ambassador Program Riverside City College Building Collaborative Relationships Santa Rosa Junior College At-Risk Suicide Gatekeeper Training LA Pierce College All College Approach to Support Student Mental Health West Valley College All College Approach to Support Student Mental Health West Valley College Veterans Drop Zone Orange Coast College

Moving Forward Filling the Gaps

Gaps to Address Stigma reduction Staff and faculty training Student training/peer support Improved partnerships with County Mental Health and other community resources Improved student access to community resources Campus-wide awareness and prevention efforts Early recognition Integrated care Mental health screening Consistent funding for Health Services

Summary Mental Health Literacy – The Big Picture Current Structure – What’s Going On in the CCCs Best Practice – What’s Working Moving forward – Filling the Gaps

References Health Services Association of California Community Colleges (HSACCC) hsaccc.orghsaccc.org Mental Health and Wellness Association (MHWA) Steinberg Institute – Advancing Behavioral Health Policy and Leadership Mental Health First Aid – USA CCC Student Mental Health Program (CCC SMHP) National Behavioral Intervention Team Association (NaBITA) Select findings of HSACCC Annual Survey - URL good for one year NCHA Consortium info with select 2013 data - URL good for one year

Questions