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

1. Student Mental Healthin the California Community CollegesJanuary 31, 2016

2. 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

3. 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

4. Mental Health LiteracyThe Big Picture

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

6. Mental Health First Aid 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! Substance Abuse and Mental Health Services Administration

7. 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)

8. The Problem of Stigma Stigma is the biggest barrier to seeking treatment and, therefore, the biggest barrier to recovery

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

10. Evolution of Threat Assessment Teams High Risk Problem Prone High Volume

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

12. Broad Scope of Awareness, Assessmentand Intervention Well Becoming Unwell Unwell Recovering

13. Current StructureWhat’s Going On in the CCCs

14. 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, 76407 ; TITLE 5: 53411, 54702, 54706, 54708, 53411

15. 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”

16. 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.

17. 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)

18. Select Data from the HSACCC Annual Survey2014-2015 53 Colleges Reporting Funding Scope of Service Compliance Staffing

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

20. Revenue Sources : Trend from 13-14 to 14-15 Health Services Revenue Sources 13-14 Health Services Revenue Sources 14-15

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

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

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

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

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

26. 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

27. Best PracticeWhat’s Working

28. 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 (2014-15) California Community College Chancellor’s Office – Data Mart, Retrieved January 25, 2016 from http://datamart.cccco.edu/Services/DSPS_Status.aspx

29. 17,271 California Community College Students surveyed in 2013 • 22% 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.

30. 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.

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

32. Moving ForwardFilling the Gaps

33. 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

34. 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

35. References • Health Services Association of California Community Colleges (HSACCC) hsaccc.org • Mental Health and Wellness Association (MHWA) http://www.mhwa.org/ • Steinberg Institute – Advancing Behavioral Health Policy and Leadership http://steinberginstitute.org/ • Mental Health First Aid – USA http://www.mentalhealthfirstaid.org/cs/ • CCC Student Mental Health Program (CCC SMHP) http://cccstudentmentalhealth.org/main.php • National Behavioral Intervention Team Association (NaBITA) https://nabita.org/ • Select findings of 14-15 HSACCC Annual Survey - URL good for one year http://www2.santarosa.edu/f/?nEyWKEVv • NCHA Consortium info with select 2013 data  - URL good for one year http://www2.santarosa.edu/f/?nADEPHXV

36. Questions