As California works to improve access to behavioral health services (mental health and substance use), policymakers should keep in mind the various socioeconomic factors that can contribute to the development of mental health conditions for children, youth, and adults. Research suggests that low levels of household income and mental health conditions are related.1 In addition, experiencing racism and discrimination negatively impacts mental health for multiple racial/ethnic groups, especially for children and adolescents.2 Left unaddressed, chronic stress due to experiencing poverty and/or racism can affect a child’s development and can lead to behavioral problems.3
In California, nearly 1 in 6 adults experience mental illness and 1 in 25 experience a serious mental illness.4
Serious mental illness is more common among Californians with low incomes. In 2015 – the most recent year for which these data are available – about 1 in 11 adults with incomes below the federal poverty line (FPL) had a serious mental illness. The 2015 FPL was $12,331 for a single person and $24,036 for a family of four.
Native American adults experienced the highest rates of serious mental illness in 2015, followed by Black, multiracial, and Latinx adults. White, Pacific Islander, and Asian adults experienced lower rates of serious mental illness.
* KEY TERMS: Mental illness is defined as a mental, behavioral, or emotional disorder that can vary in impact, ranging from no impairment to mild, moderate, and even severe impairment. Serious mental illness is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities.5
Nearly 1 in 13 California children and youth experience a serious emotional disturbance.
Serious emotional disturbance is most common among children and youth in families with the lowest incomes. In 2015, an estimated 1 in 10 children and youth in families living in poverty experienced a serious emotional disturbance.
Black, Latinx, Native American, and Pacific Islander children experienced the highest rates of serious emotional disturbance (at or near 8%), while rates for multiracial, Asian, and white children were just under 7%.
* KEY TERMS:Serious emotional disturbance applies to children and youth age 17 and under who have, or during the past year have had, a diagnosable mental, behavioral, or emotional disorder resulting in functional impairment that substantially interferes with or limits functioning in family, school, or community activities.6
A greater understanding of the socioeconomic factors can help advance policies that address the racial discrimination and economic disparities many California families face and lead to improved behavioral health outcomes.
4 The prevalence estimates for mental illness and serious emotional disturbance were developed by Dr. Charles Holzer and Dr. Hoang Nguyen using a sociodemographic risk model. For a description of the methodology used to develop these estimates, see page 53 in Mental Health in California: For Too Many, Care Not There.
5 National Institute of Mental Health, Mental Illness (February 2019).
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Introduction
California was the first state to broadly promote family and community well-being by providing paid time off for working people to care for an ill family member or for a child who is new to the family. Implemented in 2004, California’s paid family leave program built on the state’s longstanding disability insurance program, which allows parents to take paid time off before and after childbirth. Since California led the way on paid family leave, seven other states and Washington, D.C. have passed their own paid family leave policies. Research shows that paid leave, among other benefits, can help to foster healthy communities by promoting positive health outcomes for families. This brief highlights the health benefits of paid leave for children and birthing parents.
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Introduction
California has been a national leader in helping people receive the health coverage they need since the enactment of the federal Affordable Care Act (ACA) in 2010. Until 2016, the share of Californians without health coverage dropped substantially. But this decline slowed significantly before finally stalling out in 2018, leaving close to 3 million Californians uninsured.
This recent trend in large part reflects two factors: 1) federal efforts to undermine the ACA and 2) state policymakers’ focus on protecting California’s health coverage gains rather than boosting state health investments. After Governor Gavin Newsom took office in January 2019, state policymakers’ approach shifted and several policies that aim to improve health coverage and affordability — all of which take effect in 2020 — were adopted. California can make further progress in 2020 and in the coming years to help more people access and afford coverage — so long as the ACA remains intact and state policymakers continue to build on the investments in health they’ve made in the last decade.
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Introduction
Aggressive enforcement of immigration laws, actions to reduce the number of immigrants entering the US, and attempts to limit the legal rights of immigrants living in the US have been a signature focus of the Trump Administration.1,2,3 A recently announced change in the rule directing how immigrants can become permanent residents in the US continues the harmful and troubling changes in our nation’s immigration policies.4 For California, the consequences are stark: thousands more families working to build better a better future for themselves and our state will instead live in poverty. In addition, other individuals will be denied the ability to legally enter the country if they’re not wealthy. This rule will result in a significant loss for California’s economy and workforce and cause harm for California immigrants who already fear that receiving food or health assistance may affect their ability to continue living and working in the state and country. Moreover, as this analysis will show, the new rule, coupled with previous executive actions targeting immigrants, will have ripple-effects on the health, development, and economic outcomes of generations to come.
California: A State of Immigrants
Immigrants make up a larger share of the population in California than in any other state. More than 1 in 4 Californians are immigrants, according to US Census Bureau data.5 As of 2016 more than 3.2 million California children lived in families that included noncitizen immigrants, and nearly 90% of these children were themselves US citizens, according to a Budget Center analysis of US Census Bureau, American Community Survey data.
Immigrants also play a central role in the California economy. Immigrants and children of immigrants made up half of all California workers from 2016 to 2018, according to a Budget Center analysis of US Census Bureau, Current Population Survey data. More than 40% of Silicon Valley high-tech start-ups from 2006 to 2012 were founded by immigrants, and nearly half of the state’s Fortune 500 companies have founders who are immigrants or children of immigrants. 6 For these reasons, changes to immigration rules, such as the new public charge rule, can be expected to have a particularly significant impact on California. At the same time, California’s economy represents about one-seventh of the national economy in terms of Gross Domestic Product, and the state contributes more than one and a half times as much to national GDP as any other state economy.7 As a result, changes that negatively affect California’s residents and workers can be expected to have a substantial impact on the national economy.
What is the Public Charge Rule and Who Is Affected?
Long-standing immigration law, going back to the late 1800s, provides that individuals who are likely to become a “public charge,” or in need of public supports, can be denied entry to the US or denied permission to remain in the US. However, for decades the criteria determining whether someone is considered a public charge has been defined quite narrowly as receiving the majority of resources from monthly cash income supports or relying on publicly-funded long-term institutional care.8
The new public charge rule – officially published August 14 and scheduled to take effect October 15 – makes the definition of public charge much broader in two primary ways. For one, having a family income less than 125% of the federal poverty line, or about $32,000 for a family four currently, will now be considered a negative factor.9 Secondly, the new rule expands the types of public supports considered to include certain non-cash supports including food assistance through SNAP (the Supplemental Nutrition Assistance Program, or CalFresh in California), housing subsidies, and public health insurance for adults age 21 and older through Medicaid (Medi-Cal in California).10 In addition, much more modest use of public supports will be considered an indication of becoming a likely public charge.11 This new definition is extremely broad, considering that more than half of US-born citizens are likely to access the supports included in the new definition at some point in their lifetimes.12
In a draft of the proposed rule, the Department of Homeland Security acknowledged that the rule “has the potential to erode family stability and decrease disposable income of families and children because the action provides a strong disincentive for the receipt or use of public benefits by aliens, as well as their household members, including US children.”13
It is important to notewhen the public charge rule is applied. The public charge rule applies when individuals are seeking to enter the US or seeking to adjust their immigration status to long-term permanent resident status. It does not apply to immigrants who already have green cards or to naturalized US citizens, and it does not apply to US-born children of immigrants.14 Use of public supports by other family members, such as US-born children, is not considered a negative factor.15 Also, the new rule defines having income below 125% of the poverty line or using specific public supports as negative factors in determining public charge, but an immigrant’s overall circumstances are considered when an immigration official makes the determination, so these negative factors do not automatically result in denial of permission to enter or remain in the US. Some categories of immigrants are also exempt from the public charge rule, including refugees and survivors of human trafficking or domestic violence.16
Since the rule was published, the state of California, as well as advocacy groups have filed lawsuitsto block implementation of the rule.17
The Rule’s “Chilling Effect” and Increased Poverty for Californians
Though the public charge rule only applies in specific, fairly narrow circumstances, it is likely to change the behavior of many more individuals who will never likely be formally assessed under the public charge rule. This is because the new rule is likely to produce a “chilling effect” on use of public supports among individuals in families that include noncitizen immigrants, whereby families do not access public supports to address basic needs for which their family members are eligible, and disenroll from supports that they currently access, out of fear and confusion about the consequences of accessing these types of supports.18 Studies of prior changes to immigrant eligibility for public supports through the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) found rates of disenrollment from public supports of 15% to 35% among noncitizen immigrants and citizen children in families that included noncitizen immigrants, with substantial disenrollment observed even among individuals to whom the eligibility changes did not technically apply, such as refugees.19
Similar patterns of disenrollment can reasonably be expected from the changes to the public charge rule. If the new public charge rule results in rates of disenrollment that are similar to those observed as a result of PRWORA, then many thousands of Californians can be expected to disenroll from public supports for which they are eligible and which they currently use to meet basic needs for food, shelter, health care, and other necessities. This disenrollment is likely to result in a substantial increase in the number of Californians living in poverty, according to a Budget Center analysis of US Census Bureau, American Community Survey data for 2016 used to produce the California Poverty Measure, a joint project of the Stanford Center on Poverty and Inequality and the Public Policy Institute of California.
The two supports newly included in the public charge determination that most directly affect poverty status under the California Poverty Measure are CalFresh food assistance and housing subsidies. Under conservative assumptions for the chilling effect of the new public charge rule – assuming that 15% of families that include noncitizens and include family members that are receiving CalFresh or housing subsidies disenroll from those supports – the number of Californians in poverty will increase by an estimated 76,000, and the number in deep poverty (with family resources equal to less than half of the poverty threshold) will increase by an estimated 51,000. If disenrollment rates for these two supports are instead 35%, as observed in some research on PRWORA, the increase in individuals in poverty will be substantially higher, with an estimated 165,000 more Californians pushed into poverty and 115,000 more into deep poverty.
Moreover, out of fear and confusion about the details of the proposed public charge changes, disenrollment can be expected not only from the public supports included in the new rule, but also from public supports that are not included in the public charge determination, such as WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children). If 35% of families that include noncitizens and include family members receiving public supports disenroll from all public supports that they currently access, then the number of Californians in poverty will increase by an estimated 461,000, and the number in deep poverty will increase by an estimated 402,000. These estimated increases in the number of Californians in poverty are particularly troubling because California already has the highest poverty rate in the USwhen accounting for the cost of living.20 By pushing more Californians into poverty, the new public charge rule threatens the health, well-being, and economic security of thousands of children and adults, with potential cascading effects on the state and even national economy over the short term and long term.
It’s important to note too that the new public charge rule follows previous executive actions targeting immigrants, and this latest move only compounds the fear and confusion that may keep families from accessing public supports. Other recent actions include the “Muslim ban” limiting immigration from certain countries and theattempt to end the legal protections provided through the Deferred Action for Childhood Arrivals (DACA) program.21,22 Immigrants (even those who already have legal permanent resident status), refugees, and US-born children of immigrants all are at risk of increased hunger and food insecurity, unmet health care needs, and poverty under the Trump Administration’s recent orders and actions.
Public Health and the Economy will Suffer
The analysis above considers the effects of disenrollment in public supports that most directly affect whether families are considered to be in poverty under the California Poverty Measure. The new public charge rule can also be expected to cause individuals to disenroll from Medi-Cal, California’s public health insurance program, which has a less direct effect on the calculation of poverty status but very significant effects on health and well-being.
In a study among adults who are foreign-born or living with foreign-born family members conducted in December 2018, after publication of the proposed public charge rule, one in seven (13.7%) adults reported that they or a family member did not participate in a noncash benefit program out of fear of risking future green card status. This rate was higher (20.7%) among adults in families earning less than 200% Federal Poverty Level. Health insurance through Medicaid or the Children’s Health Insurance Program was the second-most-common program for which chilling was reported (after food assistance through SNAP).23 Health care providers across California that serve immigrant communities also reported increasing concerns about enrollment in Medi-Cal, WIC, and CalFresh among their patients.24
The chilling effect of public charge could impact up to 2.2 million Californians in immigrant families enrolled in CalFresh and/or Medi-Cal, most of whom would not be subject to the new public charge test. Disenrollment from these programs would most significantly impact Latinx and Asian families, as well as children.25 The Children’s Partnership estimated the impact of the changes to public charge on children’s enrollment in public programs and found that the uninsured rate among all children in California would rise from 3% to as high as 8.2% and up to 311,000 children in immigrant families would lose access to CalFresh despite remaining eligible.26 Furthermore, if immigrant mothers forgo essential pregnancy and postpartum-related services due to (unfounded) fears of being deemed a public charge, this could lead to higher rates of poor birth outcomes—including higher rates of low birthweight and infant mortality—which can lead to poorer long-term health and developmental outcomes for children.
In addition to poorer health outcomes, the rule would also have adverse effects on the state economy and the financial stability of many hospitals. California could lose up to $1.67 billion in federal benefits if 35% of Californians impacted by the chilling effect disenroll from Medi-Cal and CalFresh, according toan analysis by the UCLA Center for Health Policy Research. Given that these federal dollars would have been cycled through California’s economy multiple times, this would yield an even greater loss of spending throughout the broader state economy. Other detrimental effects include up to 17,700 lost jobs, primarily from the health care sector and food-related industries and up to $151 million lost in state and local tax revenue. The financial stability of hospitals across the state, particularly those in communities with large immigrant populations, would also experience a loss. California, with 406 hospitals, is estimated to lose up to $5.2 billion in Medicaid and CHIP payments.27
Public Charge Continues Efforts to Harm Immigrant Families
The new public charge rule will push thousands of Californians into poverty, negatively impact the health and well-being of immigrant families across the state, and result in damages to the state economy. Even the threat of being classified as a “public charge” has sowed fear in immigrant communities and has caused many families to forgo much needed health, food, and housing assistance. Furthermore, it is not only another blatant attack on immigrant families and communities, it is also an attack on families and individuals whoaccess public benefits more broadly. This latest rule, along with many other harsh actions taken by this Administration, will harm the socioeconomic well-being of many California families today and future generations.
1084 Federal Register 41292 (2019), p. 41501. Medicaid benefits used in certain situations would not count toward public charge under the new rule. These exceptions include emergency medical care, services under the Individuals with Disabilities Education Act (IDEA), school-based services, and pregnancy and the first 60 days of post-partum care.
Senate Bill 13, as amended in the state Assembly on August 12, 2019, would help to facilitate the development of accessory dwelling units (ADUs) and provide amnesty for unpermitted ADUs to become compliant. SB 13 may have housing- and income-related health impacts on both homeowners and tenants. This review finds:
strong evidence that easing restrictions on the development of ADUs provides incentives for homeowners to build ADUs and, as a result, increases the supply of permanent housing.[1]
a fair amount of evidence that ADUs are affordable within the neighborhood where they are located, but may not be a viable housing option for lower-income residents in the absence of government incentives.[2]
a fair amount of evidence that rent from ADUs provides homeowners with additional income to maintain their properties, sustain their mortgages, and increase disposable income.[3] There is a fair amount of evidence that seniors (age 65+) do not own or live in ADUs at higher rates than other age groups;[4] instead, there is a concentration of ownership among middle-aged adults.[5]
a fair amount of evidence that infill development in higher-income areas could increase the social and economic diversity of neighborhoods, providing more residents with access to better services.[6]
a fair amount of evidence that an amnesty program for unpermitted ADUs encourages landlords to bring units into compliance with permitting requirements, but it is not well researched if this results in health- and safety-related improvements in units with unhealthy or unsafe conditions.[7] The impact of an amnesty policy on rents is not well researched.
What Is the Goal of the Health Note?
Policy decisions made outside of the public health and health care sectors, such as in education, land use, or criminal justice, can affect health and well-being. HealthNotes are intended to provide objective, nonpartisan information to help legislators understand the connections between these sectors and health. Health Notes are not intended to make definitive or causal predictions.
The California Budget & Policy Center selected SB 13 as an illustrative example to demonstrate potential health impacts of proposed legislation. Developing ADUs to increase the supply of housing has been cited by housing advocates and housing policy researchers as a potentially important strategy in California.
What Are the Potential Health Impacts of SB 13?
There are many ways in which housing and where one lives may influence health. For instance, housing affordability, the conditions in neighborhoods and communities, and the physical conditions within homes all affect individual health outcomes.[8] SB 13 aims to facilitate the development of ADUs and encourage landlords with unpermitted ADUs to become compliant. In doing so, this bill could help to provide more affordable housing options for renters, provide additional income for homeowners who build ADUs, increase renters’ access to well-established resource areas — higher-income neighborhoods — and improve the physical conditions of unpermitted ADUs that become compliant.
Both renters and homeowners may benefit from the development of ADUs by helping to lower their cost of living. Given that ADUs are often seen as affordable housing options for renters, particularly in urban areas, increasing the supply of ADUs may allow renters to spend less on housing.[9],[10] Homeowners who build and rent ADUs could also benefit from additional income support. Research shows that families that experience difficulty paying their rent, mortgage, or utility bills are more likely to lack a sufficient food supply and are less likely to have a consistent source of medical care.[11] Difficulty paying rent or mortgage is also a marker of housing instability and may lead to food insecurity and homelessness.[12] Therefore, this bill could lead to a change in income-related health outcomes for renters and homeowners, including a decrease in chronic health conditions and mental health conditions such as stress and anxiety.
Furthermore, given that access to affordable housing is a problem that disproportionately affects low-income households, and that the majority of individuals with high housing cost burdens in California are people of color, the development of more affordable housing options could help to address health inequities based on race and ethnicity.[13]
Building more ADUs could help with housing affordability even if the ADUs themselves are not considered to be affordable units. The development of ADUs could lead to an increase in the supply of housing, which could potentially reduce the cost of housing in the overall market. More specifically, it could be expected to slow the rate of increase in the cost of housing compared to the increase expected without adding those units to the housing supply.
ADUs could be particularly beneficial for middle-aged and elderly homeowners by allowing them to more easily remain in their homes as they transition into fixed or reduced incomes towards the end of their lives. Research demonstrates that “aging in place” significantly reduces stress and improves mental health among seniors.[16] The income from renting out either an ADU or the main house could help older adults achieve the financial stability needed to age in place, thereby allowing them to stay near their established networks and decreasing the risk of isolation and depression.[17] ADUs could also be beneficial for seniors because they can be built with ADA accessibility standards to allow easy mobility throughout the home.
If ADUs are developed in well-established resource areas, they could improve opportunities for renters to be healthy. Research suggests that people living in lower-income areas rate their own health lower than those living in higher-income neighborhoods.[18] In addition, low-income neighborhoods contribute to higher rates of obesity and chronic disease due to many factors, including a higher density of fast food restaurants, decreased accessibility to fresh foods, and environments that are not conducive to physical activity.[19] Building ADUs in well-established resource areas could help to increase access to the amenities that are often found in these areas, such as higher-performing and better-funded schools, better police protection, and transit stations. Furthermore, ADUs could help to increase social equity — defined as ensuring that social services are delivered fairly and equitably to all social groups.[20] Social equity also reflects the notion that increasingly diverse populations are the foundation for a more creative and more tolerant society.[21]
By providing amnesty to owners of unpermitted ADUs, this bill may help to achieve a higher level of housing quality, which would promote good physical and mental health.[22] Research shows that poor conditions are associated with various negative health outcomes, such as injury, chronic disease, and poor mental health.[23] Features of poor housing conditions include a lack of air conditioning, inadequate plumbing, and/or exposure to hazards such as carbon monoxide, allergens, and lead in paint, pipes, and faucets.[24] People living in units with poor housing conditions may be more likely to be exposed to damaged appliances, exposed nails, or peeling paint, which could lead to illness or injury.[25] Waiving certain fees and penalties may help to provide a pathway for unpermitted ADUs to meet health and safety standards that would be less harmful to an occupant’s health.
Why Do These Findings Matter for California?
The high cost of housing and lack of affordable housing are among the primary drivers of California’s high poverty rate, ranked first among the 50 states under the Supplementary Poverty Measure.[26] The high costs disproportionately affect renters and households with low incomes.[27] More than half of renters are “cost burdened,” meaning they pay more than 30% of income toward housing.[28] Eight in 10 households with incomes below 200% of the federal poverty line were housing cost burdened in 2017.[29] Additionally, more than 2 in 3 Californians who struggle to afford housing are people of color.[30] High costs are in part driven by the shortage of rental housing.[31]
As the state continues to debate policy solutions to improve housing affordability, encouraging the development of ADUs may be an effective strategy to increase the supply of housing because it allows homeowners to increase the number of available units without requiring direct government investments in large development projects.[32] Compared to other forms of low-income and affordable housing, studies show that ADUs are relatively inexpensive to build. The Terner Center for Housing Innovation at UC Berkeley found that costs to build ADUs in the cities of Portland, Oregon, Seattle, and Vancouver were low because they did not include land costs and construction duration is short.[33]
Recent state legislation by Senators Wieckowski and Bloom in 2016 and 2017 helped to facilitate the development of ADUs by requiring cities to limit parking requirements, eliminate some utility connection fees, and streamline review and approval processes.[34] San Diego had 17 ADU applications in 2016, which increased to 64 in 2017. [35] Similarly, Oakland saw an increase in the number of applications received from 99 in 2016 to 247 in 2017.[36] Los Angeles had the largest increase, receiving 80 ADU applications in 2016 and 1,980 through November of 2017.[37] Still, remaining barriers prevent further proliferation. Burdensome development fees and building codes continue to inhibit the construction of ADUs.[38] For example, the Terner Center survey of Portland, Seattle, and Vancouver found that city permits and utility connections accounted for over 10% of construction costs.[39]
What Are the Potential Effects of SB 13 on the Supply of Permanent Housing?
There is strong evidence that easing restrictions on the development of ADUs provides incentives for homeowners to build ADUs and, as a result, increases the supply of permanent housing.[40]
Studies analyzing the effect of easing strict land-use regulations on the development of ADUs conclude that incentives are an effective policy tool to increase the supply of such units. In 2010, Portland, Oregon waived development fees covering sewer, water, and other infrastructure connections, reducing costs by $8,000 to $11,000 per unit.[41] In 2013, the city received almost 200 ADU applications, six times more than the yearly average from 2000-2009.[42]
A recent study found that localities in California with the least restrictive laws regulating ADUs were 67% more likely to receive frequent applications than localities with restrictive laws.[43] This study found that localities without off-street parking requirements were much more likely to receive monthly applications.[44] Another study analyzing single family lots within half a mile of five Bay Area Rapid Transit (BART) stations in the cities of Berkeley, El Cerrito, and Oakland estimated that 2,149 potential ADUs could be constructed if cities had less stringent lot-size, parking, and setback requirements than under the zoning laws at the time.[45]
The Terner Center survey of Portland, Seattle, and Vancouver found that 60% of ADUs were used for permanent housing, compared to 12% for short term rentals.[46] Results from another study in Oregon showed that about 82% of respondents used ADUs as someone’s permanent residence, which is similar to an analysis conducted in 2011 in the East Bay Area, where 85% of owners reported using ADUs as long-term housing.[47]
What Are the Potential Effects of SB 13 on the Supply of Affordable Housing?
There is a fair amount of evidence that ADUs are affordable within the neighborhood where they are located, but may not be a viable housing option for lower-income residents in the absence of government incentives.[48]
Some research finds that ADUs offer affordable rents, in part because of their smaller unit size, and that they often rent at below market rates. [49] The Terner Center study of Portland, Seattle, and Vancouver found that 58% of homeowners reported renting below market rate.[50] Similarly, a study in the East Bay Area concluded that average rents of ADUs were affordable to households earning at or below 62% of area median income. (Many ADUs included in this study were unpermitted, which may have decreased rents.[51]) In contrast, a study conducted in Portland, Oregon found that about 80% of ADUs were rented at market rate or sometimes even at a premium compared to apartments of similar size and location.[52]
Interwoven with the shortage in housing supply is the need to provide low-income housing to the state’s most financially strained residents. There is mixed evidence that permitted ADUs house low-income households, despite localities’ ability — since 2002 — to count ADUs as low-income housing for the Regional Housing Needs Assessment.[53]
Additional policies could guarantee that newly built ADUs have affordable rents. Research by Ramsey-Musolf finds that unless a local zoning code regulates an ADU’s maximum rent, occupancy income, and/or effective period, then the city or state will be unable to ensure that units are available to people with low income.[54] One strategy implemented in Los Angeles, through The Backyard Homes Project, provides owners with support through technical assistance and financing in return for agreeing to rent their ADUs to households using subsidized housing vouchers.[55] Another example is the city of Pasadena, which reduces permit fees from roughly $20,000 to $1,000 per unit if homeowners agree to a seven-year rent restriction.[56]
What Are the Potential Effects of SB 13 on Housing Stability for Homeowners and Seniors?
There is a fair amount of evidence that rent from ADUs provides homeowners with additional income to maintain their properties, sustain their mortgages, and increase disposable income.[57] There is a fair amount of evidence that seniors (age 65+) currently do not own or live in ADUs at higher rates than other age groups;[58] instead, there is a concentration of ownership among middle-aged adults.[59]
While more research is needed to better understand the social-economic breakdown of homeowners who are able to build ADUs, available information suggests that ADUs can provide additional income support. Research shows income received from rent is a major factor prompting homeowners to build ADUs. Building an ADU to have an extra source of income was the number one reason for initiating construction of an ADU, according to a recent Terner Center survey.[60] Furthermore, a study in Seattle found that 64% of respondents said they built ADUs for extra income, 53% to reduce house payments, and 47% to increase home value.[61]
It is often cited that ADUs can provide seniors with the ability to age in place, extend their independence, and allow caretakers to live in proximity. However, research over the past few decades has consistently shown that seniors do not own or live in ADUs at higher rates than other age groups.[62] Major barriers for seniors include the hardships entailed in construction, renting, and maintaining ADUs as well as reluctance to take on debt.[63],[64]
As the population of ADU owners ages, there may be a significant increase in the percentage of seniors who own ADUs and could benefit by living-closer to family, housing a caretaker, receiving additional income from rent, or downsizing. A survey in Oregon found that about 30% of ADU owners were 55 to 64 years old and nearly 23% were 45 to 54 years old. In contrast seniors (65+) accounted for 20% of homeowners in the areas surveyed.[65] Furthermore, opinion polls show that as many as 70% to 80% of Baby Boomers express a preference for aging in place.[66] Therefore, while seniors do not currently own or occupy ADUs at especially high rates, middle-aged adults do, and they could benefit from owning ADUs when they become seniors.
What Are the Potential Effects of SB 13 on Access to Neighborhood-Based Resources?
There is a fair amount of evidence that infill development in higher-income areas could increase the social and economic diversity of neighborhoods, providing more residents with access to better services.[67]
Research shows that when ADUs are located in higher-income areas and provide housing for middle- and low-income families, “place diversity” can increase.[68] “Place diversity” refers to the spatial diversity of people and functions.[69] It can increase social equity by mixing different social groups in one area, providing more people with access to key resources.[70] A recent study found that geographical disparities in life expectancy in US counties are large and increased from 1980 to 2014.[71] Furthermore, research shows that growing up in a neighborhood with concentrated poverty may decrease one’s well-being.[72]
Infill development — when new buildings are constructed in previously developed areas rather than on raw land — could provide more residents with access to better schools, safety, and other vital services that improve health and well-being, assuming that these new units are located in well-established resource areas.[73] In contrast, infill units in neighborhoods with high crime and low-performing schools would not provide access to crucial resources.
What Are the Potential Effects of SB 13 on Unpermitted ADUs?
There is a fair amount of evidence that an amnesty program for unpermitted ADUs encourages landlords to bring units into compliance with permitting requirements, but it is not well researched if this results in health- and safety-related improvements in units with unhealthy or unsafe conditions.[74] The impact of an amnesty policy on rents is not well researched.
Existing literature on ADUs notes that the majority of existing units are unpermitted.[75] A 2014 study estimated 25,000 unpermitted ADUs in Los Angeles alone.[76] Unpermitted ADUs may not have the proper living amenities and may not meet local health and safety standards, which could have health implications. One study in the East Bay Area found that ADUs were more likely to have substandard cooking facilities than other types of rental units, due largely to the number of unpermitted ADUs and construction carried out in an amateur manner.[77]
Research demonstrates that various amnesty programs throughout California have proven successful encouraging many homeowners to register unpermitted units.[78] For example, in just two years, 60 units were legalized in Marin County.[79]Their success was attributed to a limited grace period coupled with fee reduction and regulatory concessions.[80] However, it is unknown if ADU amnesty programs lead to improvements in the health and safety conditions of unpermitted units. Research is needed to determine how to most effectively structure an amnesty program to ensure that owners of unpermitted units in poor conditions may have a path to receive permits and also have incentives to improve the quality of their ADUs.
It is not well researched whether providing a pathway for unpermitted ADUs to become compliant changes rents for tenants. The informal manner in which many ADUs are built, managed, and supplied contributes to relatively lower rents.[81] As noted above, a 2011 study in the East Bay Area found that rents were affordable to someone earning at or below 62% of the area median income.[82] However, this same study found that upwards of 90% of ADUs in the city of Berkeley, one of three cities within the area researched, lacked building and zoning permits.[83] Further research is required to make conclusive claims regarding the effects widespread amnesty might have on rents.
Which Populations Are Most Likely to Be Affected by SB 13?
Research suggests ADUs are composed of smaller households and younger adults compared to the primary residence. Also, ADUs may have important implications for middle age adults, seniors, and communities of color.
The Terner Center study found that ADU households in Portland, Seattle, and Vancouver generally are small: 57% of ADUs consisted of one person and 36% consisted of two people.[84] A study in Oregon found similar results: 64.2% of households included one person and 34.3% two people.[85] It also found that nearly 60% of occupants were female.[86]
Various studies have found that ADU tenants are younger than residents of the primary unit and that most do not have children. A study conducted in the Bay Area found that adults in ADUs were, on average, 11 years younger than those residing in the main residence.[87] It also found an average of 0.18 children per ADU household compared to 0.37 in households in the primary residence.[88] Other studies suggest that ADUs can be an affordable housing option for students near college campuses.[89]
In addition, ADUs can help middle-aged and elderly homeowners who build and rent ADUs. Although seniors currently do not disproportionally utilize ADUs more than other age groups, ADUs may become a source of income for them in the long run. ADUs could provide seniors with the ability to live in multi-generational homes near their children, house caretakers, or downsize to live in a smaller unit while renting the primary residence for extra income.
Facilitating the development and legalization of ADUs could have important implications for communities of color. The majority of individuals in California facing high housing cost burdens are people of color, so if SB 13 led to an increase in the housing supply — particularly in the supply of affordable housing, with resulting effects on health as described above — people of color might especially benefit.[90] At the community level, one study found the most restrictive ADU laws are in communities of color with lower household incomes, greater declines in income during 2010s, and lower median home values.[91] More research is needed to understand why these communities have chosen to enact more restrictive ADU laws in order to understand the benefits and tradeoffs that these communities could experience if SB 13 becomes law.
How Large Might the Impact Be?
The history of zoning in the United States and California has led to urban sprawl and strict limitations on density, which makes ADUs a potential solution to increase the supply of housing in desirable neighborhoods. ADUs allow for infill development of housing in single-family-home neighborhoods. Census data from 2000 show that 56% of overall housing stock in California is composed of single-family detached units.[92] The concentration of single-family-home neighborhoods is even higher in some cities. For example, 94% of residential land in San Jose is zoned for detached single-family homes.[93] After state policymakers eased ADU regulations in 2016, applications in San Jose increased from 45 in 2016 to 166 in 2017.[94] Many other cities, including Los Angeles, Oakland, and San Francisco, also saw significant growth in the number of applications. Oakland received 99 ADU applications in 2016, and 247 in 2017.[95] Therefore, ADUs are a potential strategy to boost the supply of housing in areas that offer few opportunities for large scale multi-family and apartment developments.[96]
Bill Information
Bill number: SB 13
Bill topic: Accessory Dwelling Units (ADUs)
Primary Sponsor: Senator Bob Wieckowski
The bill aims to facilitate the construction of ADUs in single-family and multi-family areas. Key components of the bill prohibit a local agency from:
Requiring the replacement of parking spaces if a garage, carport, or covered parking is demolished to construct an ADU.
Imposing parking standards on ADUs located within a traversable distance of one-half mile of public transit.
Establishing a minimum square footage.
Establishing a maximum square footage that is either less than 850 square feet, or 1,000 square feet for ADUs with more than one bedroom.
Requiring owner occupancy for either the primary residence or the ADU until January 1, 2025.
Imposing any impact fees upon the development of an ADU that is less than 750 square feet. For larger ADUs, the bill would require any impact fees to be proportional to the square footage of the primary dwelling unit.
SB 13 requires a local agency to consider an application within 60 days, instead of the current 120-day review window. In addition, the bill encourages owners of unpermitted ADUs – those built before January 1, 2020 – to register their units and come into compliance with local building standards. Specifically, a local agency, upon request of an owner, would be required to delay enforcement of a local building standard for five years.
Methodology
Once the bill was selected, the research team hypothesized the bill’s likely impacts, including health outcomes. The bill components were mapped into steps on a pathway of impacts. Research questions and a list of keywords to search were developed. They reached consensus on the final conceptual model, research questions, contextual background questions, keywords, and keyword combinations. Internal and external subject matter experts reviewed a draft of the note. A copy of the conceptual model is available upon request.
Our research questions related to the bill components examined:
To what extent do ADUs affect the supply of housing?
To what extent do ADUs affect the supply of affordable housing?
To what extent do ADUs affect the supply of housing in areas zoned for single-family/multi-family dwelling use?
To what extent do ADUs affect access to well-established neighborhoods with services and transportation?
To what extent do ADUs affect access to safe and quality neighborhoods?
To what extent does rent from ADUs supplement homeowner income to pay for mortgages?
To what extent does rent from ADUs help seniors supplement income?
To what extent do ADUs help seniors retire in place?
To what extent do ADUs affect household disposable income?
To what extent do ADUs affect housing instability?
To what extent do ADUs provide long-term housing?
To what extent do ADUs house families compared to individuals?
To what extent do ADUs provide quality housing?
To what extent do ADUs affect homelessness?
To what extent does legislation incentivize the construction of ADUs?
To what extent does amnesty of unpermitted ADUs lead owners to register and become fully compliant?
The research team then conducted an expedited literature review using a systematic approach to minimize bias and answer each of the identified research questions.[97] They limited the search to systematic reviews and meta-analyses of studies first, since they provide analyses of multiple studies or address multiple research questions. If no appropriate systematic reviews or meta-analyses were found for a specific question, we searched for nonsystematic research reviews, original articles, and research reports from US agencies and nonpartisan organizations. The search was limited to electronically available sources published between January 2014 and January 2019. Research cited by these sources was also explored, some of which were outside these dates.
The research team searched PubMed and EBSCO databases along with the following leading journals to explore each research question: The American Journal of Public Health, Social Science and Medicine, Health Affairs, Social Science Research, Journal of Urban Economics, Housing Policy Debate, Housing Studies, and Journal of Housing and Community Development. For all searches, the research team used the following key terms: Accessory Dwelling Units, supply of housing, affordable housing, proximity to services, quality housing, healthy housing, transportation, disposable income, rent, rent burden, housing stability, mortgages, seniors, aging, low-income families, green housing, and secondary income.
The research team also searched the websites of leading relevant policy organizations, including the Terner Center at UC Berkeley, the Lincoln Institute of Land Policy, the US Department of Housing and Urban Development, the Brookings Institute, and the Urban Institute.
After following the above protocol, the research team screened 95 abstracts. They reviewed and identified 36 peer-reviewed and grey literature sources for full-text review, excluding 18 titles. The remaining 18 sources were included in the Health Note. In addition, the research team identified other peer-reviewed sources through the original articles and identified additional resources with relevant research outside of the peer-reviewed literature. A final sample of 26 resources was used to create the Health Note.
Of the studies included, the strength of the evidence was qualitatively described and categorized as: not well researched, mixed evidence, a fair amount of evidence, strong evidence, or very strong evidence. The evidence categories were adapted from a similar approach from another state.
Very strong evidence: The literature review yielded robust evidence supporting a causal relationship with few if any contradictory findings. The evidence indicates that the scientific community largely accepts the existence of the relationship.
Strong evidence: The literature review yielded a large body of evidence on the association, but the body of evidence contained some contradictory findings or studies that did not incorporate the most robust study designs or execution or had a higher than average risk of bias; or some combination of those factors.
A fair amount of evidence: The literature review yielded several studies supporting the association, but a large body of evidence was not established; or the review yielded a large body of evidence but findings were inconsistent with only a slightly larger percent of the studies supporting the association; or the research did not incorporate the most robust study designs or execution or had a higher than average risk of bias.
Mixed evidence: The literature review yielded several studies with contradictory findings regarding the association.
Not well researched: The literature review yielded few if any studies or yielded studies that were poorly designed or executed or had high risk of bias.
Additional Information
This Health Note was produced using a methodology and approach developed by the Health Impact Project at The Pew Charitable Trusts, and is part of a pilot program in several jurisdictions to test the use of Health Notes to inform policymaking at state and local levels. This Health Note is supported by a grant from the Health Impact Project. The views expressed are those of the authors and do not necessarily reflect the views of the Health Impact Project or The Pew Charitable Trusts.
Dr. Sherice Janaye Nelson is a professor at St. Mary’s College of California and researches the effects of the Black Diaspora with emphasis in the United States. Her study of Black Americans encompasses the economic and political behaviors and the effect of those behaviors in a modern-day democracy. Dr. Nelson served as our external subject matter expert. Sara Kimberlin, Senior Policy Analyst at the Budget Center, served as internal subject matter expert and guided the development of the Health Note.
Aureo Mesquita, Adriana Ramos-Yamamoto, and Monica Davalos prepared this Health Note. The Budget Center was established in 1995 to provide Californians with a source of timely, objective, and accessible expertise on state fiscal and economic policy issues. The Budget Center engages in independent fiscal and policy analysis and public education with the goal of improving public policies affecting the economic and social well-being of low- and middle-income Californians. General operating support for the Budget Center is provided by foundation grants, subscriptions, and individual contributions.
The early childhood years are the foundation for lifelong well-being. Yet, despite the state’s strong economic growth, about 1 in 10 of California’s children are born without important resources strongly associated with child health and well-being, such as access to health care or economic resources.[1] Children with fewer “assets” are at higher risk for adverse experiences — such as abuse — that expose them to harmful stress.[2] Chronic exposure to stress, especially in the early years, undermines children’s healthy development, with long-term health, behavioral, and academic consequences.[3]
Research indicates that early intervention tools like evidence-based home visiting can reduce or prevent the effects of adverse experiences for children.[4] Home visitors, who are often social workers or nurses, provide parenting education and other assistance to at-risk parents.[5] These services can boost children’s and parents’ well-being by enhancing child and maternal health, helping prevent child abuse, and improving child development.[6] However, the number of children in California who would most benefit from home visiting outweighs the current service levels. In the 2017-18 state fiscal year, 31,800 children benefitted from federally- and locally-funded evidence-based or evidence-informed home visiting, compared to the estimated 151,500 children ages 0 to 2 who would most likely benefit from home visiting services.[7]
Home visiting in California is largely funded and coordinated by local First 5 commissions, the California Home Visiting Program in the California Department of Public Health (CDPH), and — beginning January 2019 — the CalWORKs Home Visiting Program.[8] The 2019-20 budget also expanded support for home visiting by providing funding for services through CDPH, which represents the state’s first financial investment in home visiting for non-CalWORKs families.
Without adequate resources, children are at higher risk to experience traumatic life events. This can jeopardize children’s potential success, imposing significant costs on children, their families, and society. Recognizing this, California is investing in early interventions like home visiting in order to improve outcomes for children and their families. Yet, with home visiting programs out of reach for so many children who could benefit from them, policymakers should consider ways to continue to close the gap. Increasing state funding to expand home visiting is a step in the right direction. Additionally, state policymakers should also strengthen the infrastructure for home visiting by improving local service coordination and data collection, and building workforce capacity.
Support for this Fact Sheet was provided by First 5 California.
[1] Email correspondence with Emily Putnam-Hornstein (USC Suzanne Dworak-Peck School of Social Work Children’s Data Network) on April 30, 2019. Analysis is based on data from the California Strong Start Index. The index counts how many resources are present at birth and assigns a birth asset score from 0 to 12.
[7] The estimated number of children who would most likely benefit from home visiting is based on statewide birth data from the California Department of Public Health (CDPH) and from data provided by Emily Putnam-Hornstein and Regan Foust (USC Suzanne Dworak-Peck School of Social Work Children’s Data Network) on April 30, 2019 and May 9, 2019. This analysis defines children born with 6 or fewer California Strong Start assets as children most likely to benefit from home visiting services. Compared to other children in the state, this population experiences significantly higher rates of childhood adversities, such as a fatality or reports of abuse or neglect by age 5. Putnam-Hornstein provided the share of children who were born with 0 to 6 assets in 2016. This analysis assumes that share is constant in both 2015 and 2017. Data on the number of children receiving home visiting comes from the CDPH and from First 5 California and applies to the 2017-18 state fiscal year. It is not possible to ascertain the asset scores of children receiving home visiting services. For example, some children receiving services may have an asset score that is greater than 6. This analysis does not include the CalWORKs Home Visiting Program, which was implemented in January 2019.
[8] The California Home Visiting Program receives funding from federal grants and, as of the 2019-20 budget agreement, the state. First 5 supports both national evidence-based home visiting models and local models. The CalWORKs Home Visiting Program, which provides up to 24 months of home visiting for CalWORKs parents who are pregnant or parenting children under age 2, was introduced in the 2018-19 state budget and made permanent in the 2019-20 budget. It is currently supported by federal Temporary Assistance for Needy Families funds and the state General Fund. See Esi Hutchful, Home Visiting is a Valuable Investment in California Families (California Budget & Policy Center: May 2018), California Budget & Policy Center, First Look: 2018-19 State Budget Invests in Reserves and an Array of Vital Services, Sets Course for Future Advances (June 2018), and California Budget & Policy Center,First Look: 2019-20 Budget Includes Balanced Investments, Leaves Opportunities to Improve the Economic Well-Being of More Californians (July 2019).
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College can be stressful for students, especially during this time of the year as students are completing final examinations and graduating. Considering the challenging academic workload, it is normal for students to feel worried, anxious, restless, or sad from time to time. If these feelings or other mental health symptoms persist and start to interfere with daily living and academic performance, it may be indicative of a mental health issue. Without treatment for mental health issues, college students are more likely to drop out, abuse substances, and even commit suicide.
Years of rising demand in mental health services among California college students have contributed to longer wait times and growing pressure to improve access to these services. California higher education leaders and policymakers are taking steps to reduce the gap between students’ need for mental health services and their use of these services.
In light of Mental Health Awareness Month, and as budget deliberations are underway in the state legislature, this piece describes mental health trends and examines current state proposals to maintain, improve, and/or expand access to mental health supports in college campuses across California.
Mental Health Trends in California Colleges
The 2018 National College Health Assessment reports that in the past year, 63% of college students surveyed felt overwhelming anxiety, 42% felt so depressed that it was difficult to function, 62% felt very lonely, and 12% seriously considered suicide. Researchers at UC Berkeley found that nationally, the percentage of students who reported being diagnosed or treated for anxiety disorder in the past year doubled from 2008 to 2016 from 10% to 20%.
Students in California’s public colleges report similar experiences. At the California State University (CSU), students reported an increase in hopelessness, loneliness, sadness, depression, anxiety, and suicidal thoughts in the past two years and 16% of students received some psychological counseling or treatment on campuses last year. At the University of California (UC), the percentage of students seeking mental health services in the past 10 years rose 78%, nearly three times higher than enrollment growth during the same period. While the demand for mental health services has increased significantly, it may actually understate the need, as many students may choose not to seek support due to the stigma attached to counseling.
At California Community Colleges (CCC), students experience similar rates of psychological distress as UC and CSU students — uncomfortable feelings or emotions that affect daily living — according to a recent study. However, students from CCC reported higher rates of impaired academic performance due to mental health issues than students at CSU and UC campuses. CCC students were half as likely to receive referrals for counseling or mental health services by a faculty member and were also less likely to receive services on campuses than their UC and CSU counterparts.
Availability of Mental Health Services and Resources for College Students Varies Across the State
The UC, CSU, and CCC have long recognized the need to provide mental health resources on campus, but have differed in their responses to meet increasing demand due to budget constraints and other factors. For that reason, students’ access to mental health services varies depending on the sector and campus.
At the UC, each campus has a Student Counseling Center that provides direct services, outreach and prevention services, and campus consultation services. In response to the increasing demand for mental health services at these centers, the UC Board of Regents approved a 5% annual increase in the Student Services Fee (SSF) for five consecutive years (2014 – 2019), with half of revenues earmarked for Student Mental Health. In 2018-19, the UC received $4.8 million in State General Fund in lieu of another SSF increase. As a result of this funding, UC was able to hire 70 Full Time Equivalent (FTE) counseling providers, reduce the average wait times for intakes from 12-18 days to 9-11 days, increase the use of case managers and launch integrated care efforts, and more.
The CSU campuses also provide myriad services to support students, focusing on efforts around education outreach, training, and acute crisis care. All campuses provide baseline mental health services: counseling, suicide and violence prevention, emergency crisis interventions, outreach, consultation, and referral resources.
Several CSU campuses have attempted to address the increased demand for mental health in a variety of innovative ways. Some campuses offer wellness workshops, a series of emotional well-being workshops led by counselors. At CSU Fresno, the Let’s Talk Program has allowed counselors to meet with students anonymously for 20-minute sessions in locations around campus, during which the counselor assesses the student’s need. Campuses have also invested in peer mentoring programs, which have “increased academic and social integration” as well as “improved student outcomes for all students, particularly those from historically underserved communities,” according to the CSU Office of the Chancellor.
CSU is also working to strengthen community partnerships in order to increase mental health services. Earlier this year, the Office of the Chancellor hosted a systemwide convening to connect campuses with their local county behavioral health offices. The goal of this convening was to develop partnerships that will bring additional mental health services to CSU students.
Compared to the UC and CSU systems, mental health services at the CCC appear to be less consistent, partly because community colleges typically do not offer their own health insurance plans. Currently, 90 of the 115 community colleges offer mental health services, with students averaging one to three counseling sessions per semester. Establishing health services is optional for community college districts, and districts that provide health services cannot charge a student health fee that exceeds $21 per semester, which means student health services are typically more scarce on campuses with relatively small student populations.
In 2011, CCC implemented the California Community Colleges Student Mental Health Program (CCC SMHP), a statewide effort focusing on prevention and early intervention. The CCC SMHP promotes faculty and staff training, peer counseling, and suicide prevention. According to a recent CCC SMHP report, nearly 168,000 students, faculty, and community members have been reached through prevention and early intervention trainings.
Barriers to Accessing Mental Health Support
One of the greatest challenges on California college campuses is that mental health funding has not kept pace with demand. This disinvestment in crucial services results in understaffed counseling offices, long wait times, and inadequate facilities — all of which negatively affect students seeking help.
The International Association of Counseling Services advisesthere to be one professional for every 1,000 to 1,500 students — an effort pushed for by legislators and vetoed by Governor Brown in 2018. Recent reports suggest that staffing ratios at the UC and CSU are close to that ratio (about 1,100 students per counselor at UC and 2,000 students per counselor at CSU); however, ratios at the CCC exceed more than 7,000 students per counselor. While the rates of both perceived and personal stigma have decreased in recent years, it is particularly salient for black students, Latinx students, and others who may already suffer from discrimination. Ensuring diversity among counseling staff may help with stigmatization and is a priority advocated for by students.
Before students can receive counseling, many must wait up to a few weeks for an available appointment. Additionally, many campuses have inadequate counseling infrastructure, with appointments taking place in non-discrete locations.
Current Budget and Policy Proposals to Improve Access to Mental Health Services
Improving access to mental health services for college students is a widely shared goal among policymakers, students, and institutional leaders. Several budget and policy proposals have been introduced this year from the legislature, Governor, and educational institutions.
In the legislature, AB1689 (McCarty) would create the College Mental Health Services Program, a matching grant program to enhance the provision of mental health services at CSU, UC, and CCC. Additionally, the Assembly’s budget provides $2 million ongoing and $3 million one-time of Proposition 63 state administration fund to support student mental health services at UC and CSU, and $10 million ongoing and $12 million one-time Proposition 63 state administration fund for the community colleges. The Senate’s budget allocates $550 million for “Mental Health Partnerships” between local behavioral health departments and K-12 schools, county offices of education, and public colleges within a county region.
For the UC, Governor Newsom’s proposed 2019-20 budget includes $5.3 million ongoing General Fund to improve mental health programs on campuses, which UC proposes using to hire more counselors and stabilize funding for existing counselors. Ultimately, UC notes that this funding would help to improve capacity for direct services, further enhance provider diversity, and bolster targeted prevention efforts for vulnerable students. In 2018-19, UC received $4.8 million in State General Funds to support expanding mental health services. This year, UC asked to make this funding permanent and ongoing and warned that without it, there is a potential for counseling staff layoffs, worsening accessibility, longer wait times, and decreased provider diversity.
For the CCC, there are no funds included in the Governor’s budget for the mental health needs of students. However, last year the legislature approved $10 million dollars of one-time funding in the 2018-19 state budget for California Community Colleges to support mental health services and training.
Mental Health Services Are Critical to Student Success
Given the increased rate of mental health issues among college students, California colleges must work to improve access to mental health services and treatment. Increased mental health funding should be directed to prevention and early intervention as well as direct services for students, considering that the demand for these services already exceeds the availability at many campuses across the state. Adequately funding these services can help mitigate the negative toll that mental health conditions can take and help students succeed academically.
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