General (10)
Theresa Bass
From:Theresa Bass
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To:Public Comment
Subject:FW: \[EXTERNAL\] CA State law school districts required Pupil suicide prevention
policies
Attachments:20150AB2246_95 (2).pdf; 20190AB1767_94-1.pdf
From: Craig A Durfey <
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To: Craig A Durfey < ; Ryan Durfey < ; durfeycraig778@gmail. Nick Dibs
< ; GGEA President <president@ggea.org>; editor at oc-breeze.com <editor@oc-breeze.com>;
Theresa Bass <TBass@anaheim.net>; fgozalez@ocsheriff.gov; COB_Response <response@ocgov.com>; Supervisor
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Doug Chaffee <Fourth.District@ocgov.info>
Subject: \[EXTERNAL\] CA State law school districts required Pupil suicide prevention policies
Warning: This email originated from outside the City of Anaheim. Do not click links or open attachments unless you
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from
Craig A Durfey
To whom it may concern see section 215
AB-1767 Pupil suicide prevention policies.
(2019-2020)
https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200AB1767
AB-2246 Pupil suicide prevention policies.
(2015-2016)
https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB2246
1
SB 224
Page 1
Date of Hearing: July 7, 2021
ASSEMBLY COMMITTEE ON EDUCATION
Patrick O'Donnell, Chair
SB 224 (Portantino) – As Amended May 20, 2021
SENATE VOTE: 39-0
SUBJECT: Student instruction: mental health education
SUMMARY: Requires each local educational agency (LEA) and charter school to ensure that
all students in grades 1 to 12 receive medically accurate, age-appropriate mental health education
from trained instructors, at least once in elementary school, junior high school or middle school,
and high school. Specifically, this bill:
1) Requires each school district, county office of education, charter school, and the State
Special Schools for the Blind and the Deaf to ensure that all students in grades 1 through 12
receive evidence-based, age-appropriate mental health education from instructors trained in
the appropriate courses.
2) Requires that each student receive this instruction at least once in elementary school, at least
once in junior high school or middle school, and at least once in high school.
3) Requires this instruction to include all of the following:
a) Reasonably designed instruction on the overarching themes and c ore principles of mental
health;
b) Defining signs and symptoms of common mental health challenges. Depending on
student age and developmental level, this may include defining conditions such as
depression, suicidal thoughts and behaviors, schizophrenia, bipolar disorder, eating
disorders, and anxiety, including post-traumatic stress disorder;
c) Elucidating the evidence-based services and supports that effectively help individuals
manage mental health challenges;
d) Promoting mental health wellness and protective factors, which includes positive
development, social and cultural connectedness and supportive relationships, resiliency,
problem solving skills, coping skills, self-esteem, and a positive school and ho me
environment in which students feel comfortable;
e) The ability to identify warning signs of common mental health problems in order to
promote awareness and early intervention so that students know to take action before a
situation turns into a crisis. Requires that this include instruction on both of the
following:
i. How to seek and find assistance from professionals and services within the school
district that includes, but is not limited to, school counselors with a student
SB 224
Page 2
personnel services credential, school psychologists, and school social workers,
and in the community for themselves or others; and
ii. Evidence-based and culturally responsive practices that are proven to help
overcome mental health challenges.
f) The connection and importance of mental health to overall health and academic success
and to co-occurring conditions, such as chronic physical conditions, chemical
dependence, and substance abuse;
g) Awareness and appreciation about the prevalence of mental health challenges across all
populations, races, ethnicities, and socioeconomic statuses, including the impact of race,
ethnicity, and culture on the experience and treatment of mental health challenges; and
h) Stigma surrounding mental health challenges and what can be done to overcome stigma,
increase awareness, and promote acceptance. Requires that this include, to the extent
possible, classroom presentations of narratives by trained peers and other individuals who
have experienced mental health challenges and how they coped with their situations,
including how they sought help and acceptance.
4) Requires instruction and materials to be:
a) Appropriate for use with students of all races, genders, sexual orientations, and ethnic and
cultural backgrounds, students with disabilities, and English learners;
b) Accessible to students with disabilities, including, providing a modified curriculum,
materials and instruction in alternative formats, and auxiliary aids;
c) Not reflect or promote bias against any person on the basis of any category protected by
anti-discrimination provisions of current law; and
d) Coordinated with any existing on-campus mental health providers including, but not
limited to, providers with a pupil personnel services credential, who may be immediately
called upon by students for assistance.
5) States that these requirements do not limit a student’s health and mental health privacy or
confidentiality rights.
6) Prohibits a student receiving this instruction from being required to disclose their confidential
health or mental health information at any time in the course of receiving that instruction,
including for the purpose of the peer component of instruction authorized by the measure.
7) Establishes the following definitions for purposes of the measure:
a) “Age appropriate” has the same meaning as defined refers to topics, messages, and
teaching methods suitable to particular ages or age groups of children and adolescents,
based on developing cognitive, emotional, and behavioral capacity typical for the age or
age group;
SB 224
Page 3
b) “English learner” has the same meaning as used in federal law;
c) “Evidence-based” means verified or supported by research conducted in compliance with
scientific methods and published in peer-reviewed journals, where appropriate, and
recognized as accurate and objective by professional organizations and agencies with
expertise in the mental health field; and
d) “Instructors trained in the appropriate courses” means instructors with knowledge of the
most recent evidence-based research on mental health.
EXISTING LAW:
1) Requires the adopted course of study for grades 1 to 6, inclusive, to include instruction,
beginning in grade 1 and continuing through grade 6, in specified areas of study that include
health, including instruction in the principles and practices of individual, family, and
community health.
2) Requires the Instructional Quality Commission (IQC), during the next revision of the
publication “Health Framework for California Public Schools” (Health Curriculum
Framework), to consider developing, and recommending for adoption by the State Board of
Education (SBE), a distinct category on mental health instruction to educate students about
all aspects of mental health.
3) Requires, for purposes of this requirement, that “mental health instruction” include, but not
be limited to, all of the following:
a) Reasonably designed and age-appropriate instruction on the overarching themes and core
principles of mental health;
b) Defining common mental health challenges such as depression, suicidal thoughts and
behaviors, schizophrenia, bipolar disorder, eating disorders, and anxiety, including post-
traumatic stress disorder;
c) Elucidating the services and supports that effectively help individuals manage mental
health challenges;
d) Promoting mental health wellness, which includes positive development, social
connectedness and supportive relationships, resiliency, problem solving skills, coping
skills, self-esteem, and a positive school and home environment in which students feel
comfortable;
e) Ability to identify warning signs of common mental health problems in order to promote
awareness and early intervention so students know to take action before a situation turns
into a crisis. This should include instruction on both of the following:
i. Ho w to appropriately seek and find assistance from mental health professionals and
services within the school district and in the community for themselves or others;
and
SB 224
Page 4
ii. Appropriate evidence-based research and practices that are proven to help
overcome mental health challenges.
f) The connection and importance of mental health to overall health and academic success
as well as to co-occurring conditions, such as chronic physical conditions and chemical
dependence and substance abuse;
g) Awareness and appreciation about the prevalence of mental health challenges across all
populations, races, ethnicities, and socioeconomic statuses, including the impact of
culture on the experience and treatment of mental he alth challenges;
h) Stigma surrounding mental health challenges and what can be done to overcome stigma,
increase awareness, and promote acceptance. Requires that this include, to the extent
possible, classroom presentations of narratives by peers and other individuals who have
experienced mental health challenges, and how they coped with their situations, including
how they sought help and acceptance;
4) Requires the IQC, in the normal course of recommending curriculum frameworks to the
SBE, to ensure that one or more experts in the mental health and educational fields provides
input in the development of the mental health instruction in the health framework.
FISCAL EFFECT: According to the Senate Appropriations Committee, this bill could result in
a reimbursable state mandate ranging from the millions to low tens millions of dollars statewide
in Proposition 98 General Fund each year for LEAs to provide the prescribed mental health
education. This estimate assumes LEA training costs that range from $1,000 to $5,000 for each
school in the state. Charter schools would also incur additional costs but are not eligible to claim
reimbursement for state mandated activities. However, they do receive funding from the K -12
Mandates Block Grant and this bill could lead to pressure to increase it (Proposition 98 General
Fund).
COMMENTS:
Need for the bill. According to the author’s office, “Education about mental health is one of the
best ways to increase awareness, empower students to seek help, and reduce the stigma
associated with mental health challenges. Schools are ideally positioned to be centers of mental
health education, healing, and support. As children and youth spend more daytime hours at
school than at home, the public education system is the most efficient and effec tive setting for
providing universal mental health education to children and youth.
Historically, health education in subjects such as alcohol, tobacco and drugs, the early detection
of certain cancers, and HIV have become required because they were reco gnized as public health
crises. The mental health of our children and youth has reached a crisis point. California must
make educating its youth about mental health a top priority.”
Health education in California schools. According to data published by the California
Department of Education (CDE), in the 2018-19 school year, over 170,400 middle and high
school students were enrolled in a Health Education course. Nearly 12,000 health courses were
offered, in over 1,600 schools. Health education is sometimes provided in courses not
specifically designated as health courses, such as in physical education and or an advisory
SB 224
Page 5
period, and if this bill were to be enacted, LEAs which do not require a health course for
graduation would need to provide this instruction in such a manner. As noted above, the adopted
course of study for grades 1 to 6, inclusive, includes content in health, but the amount of time
dedicated to health education in those grades is not reported to the state.
A course in health is not a statewide graduation requirement, but current law authorizes school
districts to establish local graduation requirements in addition to those required by state law , and
some school districts have chosen to make a course in health a local graduation requireme nt.
According to school district websites reviewed this year, 6 of the largest 10 school districts by
enrollment require a course in health for graduation.
This bill is modeled after the California Healthy Youth Act (CHYA), which requires schools to
teach comprehensive sexual health education and HIV prevention education in three grade spans
and specifies content, instructional, and instructor training requirements. The content of the
instruction required by this bill largely mirrors the content required to be considered for inclusion
in the Health Curriculum Framework under current law.
Recently adopted Health Curriculum Framework includes mental health content . California
has adopted both content standards and a curriculum framework for health. On May 8, 2019, the
SBE adopted the current Health Education Curriculum Framework. The revised framework
includes a significant amount of content and guidance on instructional strategies relating to
mental health, including most if not all of the content required to be considered for inclusion
under current law. After a new curriculum framework is adopted, the SBE typically adopts
instructional materials for grades K -8 which align to the framework, but in 2020 the SBE
cancelled the adoption of health instructional materials due to lack of publisher interest.
Youth mental health crisis intensifying as a result of the COVID -19 pandemic. The American
Academy of Pediatrics noted in recent guidance that “emotional and behavioral
health challenges were of growing concern before the COVID-19 pandemic, and the public
health emergency has only exacerbated these challenges.” Prior to the COVID 19 pandemic, the
incidence of youth mental health crises was incre asing at an alarming rate. Suicide rates among
youth ages 10-24 increased over 57% between 2007 and 2018, and as of 2018 suicide was the
second leading cause of death for youth ages 15 -19, according to the Centers for Disease Control
and Prevention (CDC). Youth visits to pediatric emergency departments for suicide and suicidal
ideation also doubled during this time period (Burstein, 2019).
The COVID 19 pandemic has dealt a particularly hard blow to students’ mental health and well-
being. The pandemic in creased social isolation, disrupted routines, and eliminated social
traditions and rites of passage, all while also reducing students’ access to schools, which serve as
the de facto mental health system for children and adolescents. For students from families also
facing economic and other challenges, the crisis is deeper still.
The available evidence documents intensifying mental health impacts among students during the
pandemic:
FAIR Health analyzed data from its database of over 32 billion private healthcare insurance
claim records, tracking month-by-month changes from January to November 2020 compared
to the same months in 2019 and found:
SB 224
Page 6
o Overall Mental Health: In March and April 2020, mental health claim lines for
individuals aged 13-18, as a percentage of all medical claim lines, approximately
doubled over the same months in the previous year;
o Intentional Self-Harm: Claims for intentional self-harm as a percentage of all
medical claim lines in the 13 -18 age group comparing April 2020 to April 2019,
doubled (100%);
o Overdoses: For the age group 13-18, claim lines for overdoses increased by 119% in
April 2020 over the same month the year before; and
o Anxiety and Depressive Disorders: For the age group 13-18, in April 2020, claim
lines for generalized anxiety disorder increased 93.6% as a percentage of all medical
claim lines over April 2019, while major depressive disorder claim lines increased
84% and adjustment disorder claim lines 90%.. Claims for obsessive compulsive
disorder also increased for children aged 6-12.
California Department of Public Health (CDPH) data showed 134 youth under age 18 in
California died by suicide in 2020, up 24% from 108 in 2019, and well above totals from
2017 and 2018.
According to the University of California, San Francisco, data from hospitals in the Bay
Area showed a 66-75% increase among 10- to 17-year-olds screening positive for active
or recent suicidal ideation in the last year.
National data from the CDC showed a 50% increase in emergency department visits for
suicide attempts among American adolescents (mainly girls) during the pandemic.
Arguments in support. Children Now writes, “Now more than ever, it is critical that California
equip all of its students with the information and tools necessary to p romote positive mental
health, and to seek mental health support and treatment when needed. SB 224 will ensure that
students receive mental health education from a qualified instructor at least once during
elementary school, once during middle school, and once during high school. This education will
help increase awareness, empower students to seek support, and reduce the stigma associated
with experiencing mental health challenges.”
Arguments in opposition. The Citizens Commission on Human Rights writes, “We believe that
the right to informed consent for all mental health treatment – a right which is firmly established
in California law – is a fundamental right for all citizens. SB 224 does not require that student
education on mental health include training on the right of informed consent.”
Recommended Committee amendments. Staff recommends that the bill be amended as
follows:
1) Require instead that LEAs and charter schools which currently offer one or more courses in
health education to middle or high school to students shall include in those courses content in
mental health that meets the requirements of this section (content and requirements of SB
224). State that nothing in the act shall be construed to limit local educational agencies and
charter schools in offering or requiring instruction in mental health as specified in this act.
SB 224
Page 7
2) Require that, on or before January 1, 2024, the CDE develop a plan to expand mental health
instruction in California public schools.
Related legislation. SB 14 (Portantino) of this Session would add “for the benefit of the mental
or behavioral health of the student” to the list of categories of excused absences for purpose s of
school attendance; would require the CDE to identify an evidence-based training program for
LEAs to use to train classified and certificated school employees having direct contact with
students in youth mental and behavioral health and an evidence-based mental and behavioral
health training program with a curriculum tailored for students in grades 10 to 12, inclusive.
AB 309 (Gabriel) of this Session requires the CDE to develop model student mental health
referral protocols, in consultation with relevant stakeholders, subject to the availability of
funding for this purpose.
AB 563 (Berman) of this Session requires the CDE to establish an Office of School-Based
Health Programs for the purpose of improving the operation of, and participation in, school-
based health programs. Requires that $500,000 in federal reimbursements be made available for
transfer through an interagency agreement to CDE for the support of the Office.
AB 586 (O’Donnell) of this Session establishes the School Health Demonstration Project to
expand comprehensive health and mental health services to students by pr oviding intensive
assistance and support to selected LEAs to build the capacity for long-term sustainability through
leveraging multiple funding streams and partnering with county Mental Health Plans, Managed
Care Organizations, and community-based providers. Lessons learned through the pilot project
would be used as a basis to scale up robust and sustainable school-based health and mental health
services throughout the state.
SB 428 (Pan) of the 2019-20 Session would have required the CDE to identify an evidence-
based training program for local educational agencies to use to train classified and certificated
school employees having direct contact with students in youth mental and behavioral health. SB
428 was vetoed by the Governor, who stated:
This bill would require the CDE to identify an evidence-based training program on youth
mental health for LEAs to use to train classified and certificated employees who have direct
contact with students at each school site. Providing support for students facing ment al health
is of critical importance. Multiple public agencies beyond CDE hold a responsibility for
addressing the mental health crisis impacting young people today. That is why I worked with
the Legislature to appropriate $50 million in this year's budget to create the Mental Health
Student Services Act. Mental health partnerships among county mental health or behavioral
health departments, school districts, charter schools and county offices of education are best
positioned to address the diverse mental health needs of young people.
AB 1808 (Committee on Budget) Chapter 32, Statutes of 2018 , requires the CDE to identify one
or more evidence-based online training programs that an LEA can use to train school staff and
students as part of the LEA’s policy on student suicide prevention. Also requires the CDE to
provide a grant to a COE to acquire a training program identified by the CDE and disseminate
that training program to LEAs at no cost. Also appropriates, for the 2018 –19 fiscal year, the sum
of $1,700,000 from the General Fund to the SPI for these purposes.
SB 224
Page 8
AB 329 (Weber), Chapter 398, Statutes of 2015, requires LEAs to provide instruction in sexual
health education, revises HIV prevention education content, expands topics covered in sexual
health education, requires this instruction to be inclusive of different sexual orientations, and
clarifies parental consent policy.
SB 330 (Padilla), Chapter 481, Statutes of 2013, requires, when the Health Framework was next
revised, the IQC to consider developing and recommending to the SBE a distinct category on
mental health instruction to educate pupils about all aspects of mental health.
REGISTERED SUPPORT / OPPOSITION :
Support
California Alliance of Child and Family Services (co -sponsor)
California Association of Student Councils (co-sponsor)
Generation Up (co-sponsor)
Mental Health Services Oversight and Accountability Commission (co-sponsor)
National Alliance on Mental Illness (co-sponsor)
National Center for Youth Law (co-sponsor)
The Children's Partnership (co-sponsor)
AFSCME, AFL-CIO
Alliance for Children's Rights
American Academy of Pediatrics, California
American Civil Liberties Union of Northern California, Southern California, S an Diego and
Imperial Counties
Aviva Family and Children's Services
California Council of Community Behavioral Health Agencies
California Academy of Child and Adolescent Psychiatry
California Access Coalition
California Association for Bilingual Education
California Association for Health, Physical Education, Recreation and Dance
California Association of Local Behavioral Health Boards and Commissions
California Association of Marriage and Family Therapists
California Association of School Psychologists
California Catholic Conference
California Hospital Association/C alifornia Association of Hospitals and Health Systems
California Psychological Association
California School-based Health Alliance
Californians for Justice
Californians Together
Casa Pacifica Centers for Children and Families
Children Now
City of Santa Monica
County Behavioral Health Directors Association of California
DBSA California
Disability Rights California
Dolores Huerta Foundation
Five Acres - the Boys' and Girls' Aid Society of Los Angeles County
Hathaway-Sycamores
SB 224
Page 9
Hillsides
Jewish Public Affairs Committee
Los Angeles County Office of Education
Mental Health America of Los Angeles
NAMI California
National Association of Social Workers, California Chapter
Nextgen California
Psychiatric Physicians Alliance of California
Public Advocates
San Francisco Unified School District
Steinberg Institute
The Kennedy Forum
United Parents
Vision Y Compromiso
Wellness Together
Westcoast Children's Clinic
Several individuals
Opposition
Citizens Commission on Human Rights
Analysis Prepared by: Tanya Lieberman / ED. / (916) 319-2087
SENATE COMMITTEE ON EDUCATION
Senator Connie Leyva, Chair
2021 - 2022 Regular
Bill No: SB 224 Hearing Date: March 10, 2021
Author: Portantino
Version: January 14, 2021
Urgency: No Fiscal: Yes
Consultant: Brandon Darnell
Subject: Pupil instruction: mental health education
SUMMARY
This bill requires each school district to ensure that all pupils in grades 1 to 12,
inclusive, receive medically accurate, age -appropriate mental health education from
instructors trai ned in the appropriate courses, and that e ach pupil receive this instruction
at least once in elementary school, at least once in junio r high school or middle school,
and at least once in high school.
BACKGROUND
Existing law:
1) Requires the adopted course of study for grades 1 to 6, inclusive, to include
instruction, beginning in grade 1 and continuing through grade 6, in specified
areas of study that include health, including instruction in the principles and
practices of individual, family, and community health. (E ducation Code § 51210)
2) Requires the Instructional Quality Commission (IQC), during the next revision of
the publication “Health Framework for California Public Schools” (health
framework), to consider developing, and recommending for adoption by the State
Board of Education (SBE), a distinct category on mental health instruction to
educate pupils about all aspects of mental health. (EC §51900.5)
3) Specifies, for purposes of (1) above, that “mental health instructio n” shall include,
but not be limited to, all of the following:
a) Reasonably designed and age -appropriate instruction on the overarching
themes and core principles of mental health.
b) Defining common mental health challenges such as depression, suicidal
thoughts and behaviors, schizophrenia, bipolar disorder, eating disorders,
and anxiety, including post-traumatic stress disorder.
c) Elucidating the services and supports that effectively help individuals
manage mental health challenges.
d) Promoting mental health wellness, which includes positive development,
social connectedness and supportive relationships, resiliency, problem
SB 224 (Portantino) Page 2 of 6
solving skills, coping skills, self-esteem, and a positive school and home
environment in which pupils feel comfortable.
e) Ability to identify warning signs of common mental health problems in
order to promote awareness and early intervention so pupils know to take
action before a situation turns into a crisis. This should include instruction
on both of the following:
i) How to appropriately seek and find assistance from mental health
professionals and services within the school district and in the
community for themselves or others.
ii) Appropriate evidence -based research and practices that are proven
to help overcome mental health challenges.
f) The connection and importance of mental health to overall health and
academic success as well as to co -occurring conditions, such as chronic
physical conditions and chemical dependence and substance abuse.
g) Awareness and appreci ation about the prevalence of mental health
challenges across all populations, races, ethnicities, and socioeconomic
statuses, including the impact of culture on the experience and treatment
of mental health challenges.
h) Stigma surrounding mental health challenges and what can be done to
overcome stigma, increase awareness, and promote acceptance. This
shall include, to the extent possible, classroom presentations of narratives
by peers and other individuals who have experienced mental health
challenges, and how they coped with their situations, including how they
sought help and acceptance. (EC §51900.5)
4) Requires the IQC, i n the normal course of recommending curriculum frameworks
to the SBE, to ensure that one or more experts in the mental health and
educational fields provides input in the development of the mental health
instruction in the health framework. (EC §51900.5)
ANALYSIS
This bill requires each school district to ensure that all pupils in grades 1 to 12,
inclusive, receive medically accurate, age -appropriate mental health education from
instructors trai ned in the appropriate courses, and that e ach pupil receive this instruction
at least once in elementary school, at least once in junior high school or middle school,
and at least once in high school. Specifically, this bill:
1) Requires the instruction to include all of the following:
a) Reasonably designed instruction on the overarching themes and core
principles of mental health.
SB 224 (Portantino) Page 3 of 6
b) Defining common mental health challenges. Depending on pupil age and
developmental level, this may include defining conditions such as
depression, suicidal thoughts and behaviors, schizophrenia, bipolar
disorder, eating disorders, and anxiety, including post-traumatic stress
disorder.
c) Elucidating the medically accurate services and supports that effectively
help individuals manage mental health challenges.
d) Promoting mental health wellness, which includes positive development,
social connectedness and supportive relationships, resiliency, problem
solving skills, coping skills, self-esteem, and a positive school and home
environment in which pupils feel comfortable.
e) The ability to identify warning signs of common mental health problems i n
order to promote awareness and early intervention so that pupils know to
take action before a situation turns into a crisis. This shall include
instruction on both of the following:
i) How to seek and find assistance from mental health professionals
and services within the school district and in the community for
themselves or others.
ii) Medically accurate evidence-based research and culturally
responsive practices that are proven to help overcome mental
health challenges.
f) The connection and importance of mental health to overall health and
academic success and to co-occurring conditions, such as chronic
physical conditions, chemical dependence, and substance abuse.
g) Awareness and appreciation about the prevalence of mental health
challenges across all populations, races, ethnicities, and socioeconomic
statuses, including the impact of race, ethnicity, and culture on the
experience and treatment of mental health challenges.
h) Stigma surrounding mental health challenges and what can be done to
overcome stigma, increase awareness, and promote acceptance. This
shall include, to the extent possible, classroom presentations of narratives
by trained peers and other individuals who have experienced mental
health challenges and how they coped with their situations, including how
they sought help and acceptance.
STAFF COMMENTS
1) Need for the bill. According to the author’s office, “Education about mental
health is one of the best ways to increase awareness, empower students to seek
help, and reduce the stigma associated with mental health challenges. Schools
are ideally positioned to be centers o f mental health education, healing, and
support. As children and youth spend more hours at school than at home, the
SB 224 (Portantino) Page 4 of 6
public education system is the most efficient and effective setting for providing
universal mental health education to children and youth.
Historically, health education in subjects such as alcohol, tobacco and drugs, the
early detection of certain cancers, and HIV have become required because they
were recognized as public health crises. The mental health of our children and
youth has reached a crisis point. California must make educating its youth about
mental health a top priority.”
2) Increasing occurrences of pupil mental health issues. According to a Pew
Research Center analysis of data from the 2017 National Survey on Drug Use
and Health, in 2017, 3.2 million teens aged 12 -17 said they had at least one
depressive episode within the past 12 months. This is up by 1.2 million from the
same survey conducted by the National Survey on Drug Use and Health in 2007.
One-in-five (2.4 million) teenage girls reported experiencing one depressive
episode in 2017, compared to 845,000 teenage boys. According to data from the
Centers for Disease Control and Prevention, 13 percent of students in grades 9 -
12 in California in 2017 reported experiencing at least one depressive episode
within the last 12 months. 32 percent felt sad or hopeless almost every day for 2
or more weeks in a row so that they stopped doing some usual activities within
the past year, compared to 31 percent for the United States. 17 percent of pupils
in grades 9-12 reported considering suicide attempts, while 9 percent reported
they attempted suicide at least once within the past 12 month.
This trend is confirmed by data from the Office of Statewide Health Planning and
Development. In 2019, emergency rooms throughout California treated 84,584
young patients’ ages 13 to 21 who had a primary diagnosis involving mental
health. That is up from 59,705 in 2012, a 42 percent increase.
3) COVID -19 has had an exacerbating effect on me ntal health issues.
According to the 2020 report, “Roadmap for Resilience: The California Surgeon
General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health,”
COVID-19 has only furthered the mental health issues children face. As the
report notes, “For many children, the school is a bedrock of community
belonging. The pandemic has not only disrupted children’s academic
opportunities and connections with their peers and educators, it has also
surfaced new and difficult experiences in the home: fear, anxiety, financial
distress, food and housing insecurity, and countless other challenges. Economic
uncertainty is associated with increases in harsh parenting, which increases risk
for child abuse and neglect, and the loss of friends and family through illness a nd
isolation can also increase the total dose of acute stress and adversity and
reduce the dose of buffering supports available from caregivers, educators, and
other adults.”
4) Health is not a required course or topic in middle school or high school. As
noted above, the adopted course of study for grades 1 to 6, inclusive, includes
health. However, there is not similar requirement for the adopted course of study
for grades 7 to 12, inclusive. Health is also not a statewide graduation
requirement. While it is true that many local educational agencies teach health in
some capacity in middle school and high school, there is no requirement to do so
SB 224 (Portantino) Page 5 of 6
beyond the requirement to teach comprehensive sexual health education and
HIV prevention education, which is not specific to mental health, which is
required at least once in middle school and once in high school via the California
Healthy Youth Act (CHYA). This bill mimics the CHYA’s approach to require
specific mental health instruction in school districts. Recently, the CHYA was
amended to apply to all local educational agencies, including charter schools (AB
2601 (Weber, Ch. 495, Stats. 2018). Accordingly, staff recommends that the
bill be amended to apply to all local educational agencies, including school
districts, county offices of education, state special schools, and charter schools.
5) Recently adopted heath framework includes mental health. While health is
not a specifically required topic or course in middle school or high school, the
SBE has adopted both content standards and a curriculum framework for health.
On May 8, 2019, the SBE adopted the 2019 Health Education Curriculum
Framework for California Public Schools, Transitional Kindergarten Through
Grade Twelve. The revised framework includes additional instructional strategies
relating to mental health. While this bill includes that the same language relating
to mental health that existing law required the IQC to consider including in the
revised framework, to the extent that the framework d oes not include each
specific item, the bill would require instruction that the health framework does not
require. This would repeat a similar problem raised by the CHYA, which required
instruction for several years that was not covered by the health fram ework until
its recent revision. The health framework will not be revised again until 2027.
6) Related legislation. SB 14 (Portantino, 2021) (1) specifically adds “for the
benefit of the mental or behavioral health of the pupil” to the list of categories of
excused absences for purposes of school attendance, and (2) requires the
California Department of Education (CDE) to identify (A) an evidence-based
training program for local education agencies (LEAs) to use to train classified and
certificated school employees having direct contact with pupils in youth mental
and behavioral health, and (B) an evidence-based mental and behavioral health
training program with a curriculum tailored for pupils in grades 1 0 to 12, inclusive.
SB 14 is scheduled to be heard by this committee on March 10, 2021.
SUPPORT
California Association of Student Councils (Co -sponsor)
The Children's Partnership (Co -sponsor)
American Civil Liberties Union – California
Aviva Family and Children's Services
California Academy of Child and Adolescent Psychiatry
California Association of Health, Physical Education, Recreation & Dance
California Association of Marriage and Family Therapists
California Association of Local Behavioral Health Boards and Commissions
California Hospital Association
California School-based Health Alliance
CASA Pacifica Centers for Children and Families
Children Now
City of Santa Monica
SB 224 (Portantino) Page 6 of 6
County Behavioral Health Directors Association of California
Disability Rights California
Five Acres - the Boys' and Girls' Aid Society of Los Angeles County
Generation Up
Mental Health America of Los Angeles
Mental Health Services Oversight and Accountability Commission
Public Advocates, Inc.
Psychiatric Physicians Alliance of Ca lifornia
San Francisco Unified School District
The Kennedy Forum
Wellness Together
OPPOSITION
None received
-- END --
SENATE RULES COMMITTEE
Office of Senate Floor Analyses
(916) 651-1520 Fax: (916) 327-4478
SB 224
THIRD READING
Bill No: SB 224
Author: Portantino (D) and Rubio (D), et al.
Amended : 5/20/21
Vote: 21
SENATE EDUCATION COMMITTEE: 7-0, 3/10/21
AYES: Leyva, Ochoa Bogh, Cortese, Dahle, Glazer, McGuire, Pan
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/20/21
AYES: Portantino, Bates, Bradford, Jones, Kamlager, Laird, Wieckowski
SUBJECT: Pupil instruction: mental health education
SOURCE: California Alliance of Child & Family Services
California Association of Student Councils
California Yo uth Empowerment Network
Mental Health Services Oversight & Ac countability Commission
National Alliance on Mental Illness
National Center for Youth Law
The Children’s Partnership
DIGEST: This bill requires each school district , county office of education
(COE), state special school, and charter scho ol to ensure that all pupils in grades 1
to 12, inclusive, receive evidence-based , age-appropriate mental health education
from instructors trained in the appropriate courses, and that each pupil receive this
instruction at least once in elementary school, at least once in junior high school or
middle school, and at least once in high school.
ANALYSIS:
Existing law:
1) Requires the adopted course of study for grades 1 to 6, inclusive, to include
instruction, beginning in grade 1 and continuing through gra de 6, in specified
areas of study that include health, including instruction in the principles and
SB 224
Page 2
practices of individual, family, and community health. (Education Code §
51210)
2) Requires the Instructional Quality Commission (IQC), during the next revision
of the publication “Health Framework for California Public Schools” (health
framework), to consider developing, and recommending for adoption by the
State Board of Education (SBE), a distinct category on mental health instruction
to educate pupils ab out all aspects of mental health. (EC §51900.5)
3) Requires the IQC, in the normal course of recommending curriculum
frameworks to the SBE, to ensure that one or more experts in the mental health
and educational fields provides input in the development o f the mental health
instruction in the health framework. (EC §51900.5)
This bill requires each school district, COE, state special school, and charter to
ensure that all pupils in grades 1 to 12, inclusive, receive evidence-based , age-
appropriate mental health education from instructors trained in the appropriate
courses, and that each pupil receive this instruction at least once in elementary
school, at least once in junior high school or middle school, and at least once in
high school. Specifically, this bill:
1) Requires the instruction to include all of the following:
a) Reasonably designed instruction on the overarching themes and core
principles of mental health.
b) Defining signs and symptoms of common mental health challenges.
Depending on pupil age and developmental level, this may include defining
conditions such as depression, suicidal thoughts and behaviors,
schizophrenia, bipolar disorder, eating disorders, and anxiety, including
post-traumatic stress disorder.
c) Elucidating the evidence-based services and supports that effectively help
individuals manage mental health challenges.
d) Promoting mental health wellness and protective factors , which includes
positive development, social and cultural connectedness and supportive
relationships, resiliency, problem solving skills, coping skills, self -esteem,
and a positive school and home environment in which pupils feel
comfortable.
SB 224
Page 3
e) The ability to identify warning signs of common mental health problems in
order to promote awareness and early intervention so that pupils know to
take action before a situation turns into a crisis. This shall include
instruction on both of the following:
i) How to seek and find assistance from professionals and services within
the school district that includes, but is not limited to, school counselors
with a pupil personnel services credential, school psychologists, and
school social workers, and in the community for themselves or others.
ii) Evidence-based research and culturally responsive practices that are
proven to help overcome mental health challenges.
f) The connection and importance of mental health to overall health and
academic success and to co -occurring conditions, such as chronic physical
conditions, chemical dependence, and substance ab use.
g) Awareness and appreciation about the prevalence of mental health
challenges across all populations, races, ethnicities, and socioeconomic
statuses, including the impact of race, ethnicity, and culture on the
experience and treatment of mental health challenges.
h) Stigma surrounding mental health challenges and what can be done to
overcome stigma, increase awareness, and promote acceptance. This shall
include, to the extent possible, classroom presentations of narratives by
trained peers and other individuals who have experienced mental health
challenges and how they coped with their situations, including how they
sought help and acceptance.
2) Requires instruction and materials required for these purposes to satisfy all of
the following:
a) Be appropriate for use with pupils of all races, genders, sexual orientations,
and ethnic and cultural backgrounds, pupils with disabilities, and English
learners.
b) Be accessible to pupils with disabilities, including, but not limited to,
providing a mod ified curriculum, materials and instruction in alternative
formats, and auxiliary aids.
SB 224
Page 4
c) Not reflect or promote bias against any person on the basis of any category
protected by state law.
3) Specifies that its provisions do not limit not a pupil’s health and mental health
privacy or confidentiality rights .
4) Prohibits a pupil from being required to disclose their confidential health or
mental health information at any time in the course of receiving that instruction,
including, but not limited to, for the purpose of the peer component.
5) Specifies the following definitions:
a) “Age appropriate” refers to topics, messages, and teaching methods suitable
to particular ages or age groups of children and adolescents, based on
developing cognitive, emotional, and behavioral capacity typical for the age
or age group.
b) “Evidence-based” means verified or supported by research conducted in
compliance with scientific methods and published in peer -reviewed journals,
where appropriate, and recognized as accurate and objective by professional
organizations and agencies with expertise in the mental health field.
c) “Instructors trained in the appropriate courses” means instructors with
knowledge of the most recent evidence-based research on mental health.
6) Includes legislative findings and declarations relating to these provisions.
Comments
1) Need for th is bill. According to the author’s office, “Education about mental
health is one of the best ways to increase awareness, empower students to seek
help, and reduce the stigma associated with mental health challenges. Schools
are ideally positioned to be centers o f mental health education, healing, and
support. As children and youth spend more hours at school than at home, the
public education system is the most efficient and effective setting for providing
universal mental health education to children and youth.
“Historically, health education in subjects such as alcohol, tobacco and drugs,
the early detection of certain cancers, and HIV have become required because
SB 224
Page 5
they were recognized as public health crises. The mental health of our children
and youth has reached a crisis point. California must make educating its youth
about mental health a top priority.”
2) Increasing occurrences of pupil mental health issues. According to a Pew
Research Center analysis of data from the 2017 National Survey on Drug Use
and Health, in 2017, 3.2 million teens aged 12-17 said they had at least one
depressive episode within the past 12 months. This is up by 1.2 million from
the s ame survey conducted by the National Survey on Drug Use and Health in
2007. One-in -five (2.4 million) teenage girls reported experiencing one
depressive episode in 2017, compared to 845,000 teenage boys. According to
data from the Centers for Disease Control and Prevention, 13 percent of
students in grades 9-12 in California in 2017 reported experiencing at least one
depressive episode within the last 12 months. Thirty-two percent felt sad or
hopeless almost every day for two or more weeks in a row so that they stopped
doing some usual activities within the past year, compared to 31 percent for the
United States. Seventeen percent of pupils in grades 9-12 reported considering
suicide attempts, while nine percent reported they attempted suicide at least
once within the past 12 months .
This trend is confirmed by data from the Office of Statewide Health Planning
and Development. In 2019, emergency rooms throughout California treated
84,584 young patients’ ages 13 to 21 who had a primary diagnosis involvin g
mental health. That is up from 59,705 in 2012, a 42 percent increase.
3) COVID -19 has had an exacerbating effect on mental health issues. According
to the 2020 report, “Roadmap for Resilience: The California Surgeon General’s
Report on Adverse Childho od Experiences, Toxic Stress, and Health,” COVID-
19 has only furthered the mental health issues children face. As the report
notes, “For many children, the school is a bedrock of community belonging.
The pandemic has not only disrupted children’s academic opportunities and
connections with their peers and educators, it has also surfaced new and
difficult experiences in the home: fear, anxiety, financial distress, food and
housing insecurity, and countless other challenges. Economic uncertainty is
associated with increases in harsh parenting, which increases risk for child
abuse and neglect, and the loss of friends and family through illness and
isolation can also increase the total dose of acute stress and adversity and
reduce the dose of buffering supports available from caregivers, educators, and
other adults.”
SB 224
Page 6
4) Health is not a required course or topic in middle school or high school . As
noted above, the adopted course of study for grades 1 to 6, inclusive, includes
health. However, there is not similar requirement for the adopted course of
study for grades 7 to 12, inclusive. Health is also not a statewide graduation
requirement. While it is true that many local educational agencies (LEAs) teach
health in some capacity in middle school and high sc hool, there is no
requirement to do so beyond the requirement to teach comprehensive sexual
health education and HIV prevention education, which is not specific to mental
health, which is required at least once in middle school and once in high school
via the California Healthy Youth Act (CHYA). This bill mimics the CHYA’s
approach to require specific mental health instruction in school districts.
5) Recently adopted heath framework includes mental health. While health is not
a specifically required to pic or course in middle school or high school, the SBE
has adopted both content standards and a curriculum framework for health. On
May 8, 2019, the SBE adopted the 2019 Health Education Curriculum
Framework for California Public Schools, Transitional Kindergarten Through
Grade Twelve. The revised framework includes additional instructional
strategies relating to mental health. While this bill includes that the same
language relating to mental health that existing law required the IQC to
consider including in the revised framework, to the extent that the framework
does not include each specific item, the bill would require instruction that the
health framework does not require. This would repeat a similar problem raised
by the CHYA, which required instruction for several years that was not covered
by the health framework until its recent revision. The health framework will
not be revised again until 2027.
Related/Prior Legislation
SB 14 (Portantino, 2021) includes, specifically, “for the benefit of the mental or
behavioral health of the pupil” to the “illness” category for excused absences for
purposes of school attendance; and requires the California Department of
Education to identify (1) an evidence-based training program for LEAs to use to
train clas sified and certificated school employees having direct contact with pupils
in youth mental and behavioral health, and (2) an evidence-based mental and
behavioral health training program with a curriculum tailored for pupils in grades
10 to 12, inclusive. SB 14 is pending on the Senate F loor.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes
SB 224
Page 7
According to the Senate Appropriations Committee, this bill could result in a
reimbursable state mandate ranging from the millions to low tens millions of
dollars statewide in Proposition 98 General Fund each year for LEAs to provide
the prescribed mental health education. This estimate assumes LEA training costs
that range from $1,000 to $5,000 for each school in the state. Charter schools
would also incur additional costs but are not eligible to claim reimbursement for
state mandated activities. However, they do receive funding from the K-12
Mandates Block Grant and this bill could lead to pressure to increase it
(Proposition 98 General Fund).
SUPPORT: (Verified 5/21/21)
California Alliance of Child & Family Services (co-source)
California Association of Student Councils (co-source)
California Youth Empowerment Network (co-source)
Mental Health Services Oversight & Accountability Commission (co-source)
National Alliance on Mental Illness (co-source)
National Center for Youth Law (co-source)
The Children's Partnership (co-source)
AFSCME
Alliance for Children’s Rights
American Academy of Pediatrics
American Civil Liberties Union – California
Aviva Family and Children's Services
California Academy of Child and Adolescent Psychiatry
California Association for Bilingual Education
California Association for Health, Physical Education, Recreation & Dance
California Association of Local Behavioral Health Boards and Commissions
California Association of Marriage and Family Therapists
California Catholic Conference
California Hospital Association
California School-based Health Alliance
Californians for Justice
Californians Together
CASA Pacifica Centers fo r Children and Families
Children Now
City of Santa Monica
County Behavioral Health Directors Association of California
Disability Rights California
Five Acres - the Boys' and Girls' Aid Society of Los Angeles County
Generation Up
SB 224
Page 8
Hillsides
Los Angeles County Office of Education
Mental Health America of Los Angeles
National Association of Social Workers, California Chapter
NextGen California
Psychiatric Physicians Alliance of California
Public Advocates
San Francisco Unified School District
Steinberg Institute
The Kennedy Forum
United Parents
Wellness Together
Westcoast Children’s Clinic
OPPOSITION: (Verified 5/21/21)
None received
Prepared by: Brandon Darnell / ED. / (916) 651-4105
5/25/21 10:10:13
**** END ****
SENATE RULES COMMITTEE
Office of Senate Floor Analyses
(916) 651-1520 Fax: (916) 327-4478
SB 224
UNFINISHED BUSINESS
Bill No: SB 224
Author: Portantino (D) and Rubio (D), et al.
Amended: 8/30/21
Vote: 21
SENATE EDUCATION COMMITTEE: 7-0, 3/10/21
AYES: Leyva, Ochoa Bogh, Cortese, Dahle, Glazer, McGuire, Pan
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/20/21
AYES: Portantino, Bates, Bradford, Jones, Kamlager, Laird, Wieckowski
SENATE FLOOR: 39-0, 6/1/21
AYES: Allen, Archuleta, Atkins, Bates, Becker, Borgeas, Bradford, Caballero,
Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hertzberg,
Hueso, Hurtado, Jones, Kamlager, Laird, Leyva, Limón, McGuire, Min,
Newman, Nielsen, Ochoa Bogh, Pan, Portantino, Roth, Rubio, Skinner, Stern,
Umberg, Wieckowski, Wiener, Wilk
NO VOTE RECORDED: Melendez
ASSEMBLY FLOOR: 72-1, 9/2/21 - See last page for vote
SUBJECT: Pupil instruction: mental health education
SOURCE: California Alliance of Child & Family Services
California Association of Student Councils
California Youth Empowerment Network
Mental Health Services Oversight & Accountability Commission
National Alliance on Mental Illness
National Center for Youth Law
The Children’s Partnership
DIGEST: This bill requires schools that offer one or more courses in health
education to pupils in middle school or high school to include in those courses
instruction in mental health, as specified.
SB 224
Page 2
Assembly Amendments (1) delete the requirement that all pupils in grades 1 to 12
receive mental health instruction, and instead limit the scope of this bill to apply
requirements only to those schools that offer courses in he alth in middle or high
schools; (2) delete the requirement that pupils receive this instruction at least once
in elementary school, at least once in middle/junior high school, and at least once
in high school; and (3) require the California Department of Education (CDE) to
develop a plan, by January 1, 2024, to expand mental health instruction in
California public schools.
ANALYSIS:
Existing law:
1) Requires the adopted course of study for grades 1 to 6, inclusive, to include
instruction, beginning in grade 1 and continuing through grade 6, in specified
areas of study that include health, including instruction in the principles and
practices of individual, family, and community health. (Education Code §
51210)
2) Requires the Instructional Quality Commission (IQC), during the next revision
of the publication “Health Framework for California Public Schools” (health
framework), to consider developing, and recommending for adoption by the
State Board of Education (SBE), a distinct category on mental health instruction
to educate pupils about all aspects of mental health. (EC §51900.5)
3) Requires the IQC, in the normal course of recommending curriculum
frameworks to the SBE, to ensure that one or more experts in the mental health
and educational fields provides input in the development of the mental health
instruction in the health framework. (EC §51900.5)
This bill requires schools that offer one or more courses in health education to
pupils in middle school or high school to include in those courses instruction in
mental health. Specifically, this bill:
1) Requires each school district, county office of education, state special school,
and charter school that offers one or more courses in health education to pupils
in middle school or high school to include in those courses instruction in mental
health that meets the requirements of this bill.
2) Provides that this is not to be construed to limit a school district, county office
of education, state special school, or charter school in offering or requiring
instruction in mental health as specified in this bill.
SB 224
Page 3
3) Requires the instruction to include all of the following:
a) Reasonably designed instruction on the overarching themes and core
principles of mental health.
b) Defining signs and symptoms of common mental health challenges.
Depending on pupil age and developmental level, this may include defining
conditions such as depression, suicidal thoughts and behaviors,
schizophrenia, bipolar disorder, eating disorders, and anxiety, including
post-traumatic stress disorder.
c) Elucidating the evidence-based services and supports that effectively help
individuals manage mental health challenges.
d) Promoting mental health wellness and protective factors, which includes
positive development, social and cultural connectedness and supportive
relationships, resiliency, problem solving skills, coping skills, self-esteem,
and a positive school and home environment in which pupils feel
comfortable.
e) The ability to identify warning signs of common mental health problems in
order to promote awareness and early intervention so that pupils know to
take action before a situation turns into a crisis. This shall include instruction
on both of the following:
i) How to seek and find assistance from professionals and services within
the school district that includes, but is not limited to, school counselors
with a pupil personnel services credential, school psychologists, and
school social workers, and in the community for themselves or others.
ii) Evidence-based research and culturally responsive practices that are
proven to help overcome mental health challenges.
f) The connection and importance of mental health to overall health and
academic success and to co-occurring conditions, such as chronic physical
conditions, chemical dependence, and substance abuse.
g) Awareness and appreciation about the prevalence of mental health
challenges across all populations, races, ethnicities, and socioeconomic
statuses, including the impact of race, ethnicity, and culture on the
experience and treatment of mental health challenges.
SB 224
Page 4
h) Stigma surrounding mental health challenges and what can be done to
overcome stigma, increase awareness, and promote acceptance. This shall
include, to the extent possible, classroom presentations of narratives by
trained peers and other individuals who have experienced mental health
challenges and how they coped with their situations, including how they
sought help and acceptance.
4) Requires instruction and materials required for these purposes to satisfy all of
the following:
a) Be appropriate for use with pupils of all races, genders, sexual orientations,
and ethnic and cultural backgrounds, pupils with disabilities, and English
learners.
b) Be accessible to pupils with disabilities, including, but not limited to,
providing a modified curriculum, materials and instruction in alternative
formats, and auxiliary aids.
c) Not reflect or promote bias against any person on the basis of any category
protected by state law.
5) Specifies that its provisions do not limit not a pupil’s health and mental health
privacy or confidentiality rights.
6) Prohibits a pupil from being required to disclose their confidential health or
mental health information at any time in the course of receiving that instruction,
including, but not limited to, for the purpose of the peer component.
7) Requires CDE to develop a plan, by January 1, 2024, to expand mental health
instruction in California public schools.
8) Specifies the following definitions:
a) “Age appropriate” refers to topics, messages, and teaching methods suitable
to particular ages or age groups of children and adolescents, based on
developing cognitive, emotional, and behavioral capacity typical for the age
or age group.
b) “Evidence-based” means verified or supported by research conducted in
compliance with scientific methods and published in peer-reviewed journals,
where appropriate, and recognized as accurate and objective by professional
organizations and agencies with expertise in the mental health field.
SB 224
Page 5
c) “Instructors trained in the appropriate courses” means instructors with
knowledge of the most recent evidence-based research on mental health.
9) Includes legislative findings and declarations relating to these provisions.
Comments
1) Need for this bill. According to the author’s office, “Education about mental
health is one of the best ways to increase awareness, empower students to seek
help, and reduce the stigma associated with mental health challenges. Schools
are ideally positioned to be centers of mental health education, healing, and
support. As children and youth spend more hours at school than at home, the
public education system is the most efficient and effective setting for providing
universal mental health education to children and youth.
“Historically, health education in subjects such as alcohol, tobacco and drugs,
the early detection of certain cancers, and HIV have become required because
they were recognized as public health crises. The mental health of our children
and youth has reached a crisis point. California must make educating its youth
about mental health a top priority.”
2) Increasing occurrences of pupil mental health issues. According to a Pew
Research Center analysis of data from the 2017 National Survey on Drug Use
and Health, in 2017, 3.2 million teens aged 12 -17 said they had at least one
depressive episode within the past 12 months. This is up by 1.2 million from the
same survey conducted by the National Survey on Drug Use and Health in
2007. One-in-five (2.4 million) teenage girls reported experiencing one
depressive episode in 2017, compared to 845,000 teenage boys. According to
data from the Centers for Disease Control and Prevention, 13 percent of
students in grades 9-12 in California in 2017 reported experiencing at least one
depressive episode within the last 12 months. Thirty-two percent felt sad or
hopeless almost every day for two or more weeks in a row so that they stopped
doing some usual activities within the past year, compared to 31 percent for the
United States. Seventeen percent of pupils in grades 9 -12 reported considering
suicide attempts, while nine percent reported they attempted suicide at least
once within the past 12 months.
This trend is confirmed by data from the Office of Statewide Health Planning
and Development. In 2019, emergency rooms throughout California treated
84,584 young patients’ ages 13 to 21 who had a primary diagnosis involving
mental health. That is up from 59,705 in 2012, a 42 percent increase.
SB 224
Page 6
3) COVID-19 has had an exacerbating effect on mental health issues. According
to the 2020 report, “Roadmap for Resilience: The California Surgeon General’s
Report on Adverse Childhood Experiences, Toxic Stress, and Health,” COVID-
19 has only furthered the mental health issues children face. As the report notes,
“For many children, the school is a bedrock of community belonging. The
pandemic has not only disrupted children’s academic opportunities and
connections with their peers and educators, it has also surfaced new and
difficult experiences in the home: fear, anxiety, financial distress, food and
housing insecurity, and countless other challenges. Economic uncertainty is
associated with increases in harsh parenting, which increases risk for child
abuse and neglect, and the loss of friends and family through illness and
isolation can also increase the total dose of acute stress and adversity and
reduce the dose of buffering supports available from caregivers, educators, and
other adults.”
4) Health is not a required course or topic in middle school or high school. As
noted above, the adopted course of study for grades 1 to 6, inclusive, includes
health. However, there is not similar requirement for the adopted course of
study for grades 7 to 12, inclusive. Health is also not a statewide graduation
requirement. While it is true that many local educational agencies (LEAs) teach
health in some capacity in middle school and high school, there is no
requirement to do so beyond the requirement to teach comprehensive sexual
health education and HIV prevention education, which is not specific to mental
health, which is required at least once in middle school and once in high school
via the California Healthy Youth Act.
5) Recently adopted heath framework includes mental health. While health is not a
specifically required topic or course in middle school or high school, the SBE
has adopted both content standards and a curriculum framework for health. On
May 8, 2019, the SBE adopted the 2019 Health Education Curriculum
Framework for California Public Schools, Transitional Kindergarten Through
Grade Twelve. The revised framework includes additional instructional
strategies relating to mental health. While this bill includes that the same
language relating to mental health that existing law required the IQC to
consider including in the revised framework, to the extent that the framework
does not include each specific item, the bill would require the inclusion of
instruction that the health framework does not require. This would repeat a
similar problem raised by the CHYA, which required instruction for several
years that was not covered by the health framework until its recent revision.
The health framework will not be revised again until 2027.
SB 224
Page 7
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
According to the Assembly Appropriations Committee:
1) Unknown, though potentially significant, ongoing Proposition 98 General Fund
costs to LEAs that offer courses in health instruction to include instruction in
mental health in those courses. Costs would vary by LEA and likely would be
associated with preparing teachers to instruct in these topics or hire consultants
to instruct on these topics and potentially to purchase materials and other tools
to aid in instruction. Although this bill does not require teacher preparation on
these topics, it is reasonable to assume some teachers will require additional
supports to ensure their instruction complies with the bill's provisions.
According to CDE data, in the 2018-19 academic year, about 1,600 LEAs
offered about 12,000 courses in health education to about 170,000 students. If
each LEA offering health courses spent $1,000 for teacher preparation and
other costs to comply this bill, statewide costs to schools would be $1.6 million.
Because LEAs opt into offering health education courses, placing additional
requirements on these courses, as this bill does, likely would not constitute a
state-mandated local program.
2) Minor and absorbable costs to CDE to develop a plan to increase mental health
instruction in California public schools. According to CDE, its newly created
Office of School-Based Health Programs can absorb this workload.
SUPPORT: (Verified 9/2/21)
California Alliance of Child & Family Services (co-source)
California Association of Student Councils (co-source)
California Youth Empowerment Network (co-source)
Mental Health Services Oversight & Accountability Commission (co-source)
National Alliance on Mental Illness (co-source)
National Center for Youth Law (co-source)
The Children's Partnership (co-source)
AFSCME
Alliance for Children’s Rights
American Academy of Pediatrics
American Civil Liberties Union – California
Aviva Family and Children's Services
California Academy of Child and Adolescent Psychiatry
California Association for Bilingual Education
California Association for Health, Physical Education, Recreation & Dance
SB 224
Page 8
California Association of Local Behavioral Health Boards and Commissions
California Association of Marriage and Family Therapists
California Catholic Conference
California Hospital Association
California School-based Health Alliance
Californians for Justice
Californians Together
CASA Pacifica
Centers for Children and Families
Children Now
City of Santa Monica
County Behavioral Health Directors Association of California
Depression and Bipolar Support Alliance
Disability Rights California
Five Acres - the Boys' and Girls' Aid Society of Los Angeles County
Generation Up
Hillsides
Jewish Public Affairs Committee
Los Angeles County Office of Education
Mental Health America of Los Angeles
National Association of Social Workers, California Chapter
NextGen California
Parent Institute for Quality Education
Psychiatric Physicians Alliance of California
Public Advocates
San Francisco Unified School District
Steinberg Institute
The Kennedy Forum
The Miles Hall Foundation
United Parents
Wellness Together
Westcoast Children’s Clinic
OPPOSITION: (Verified 9/2/21)
None received
ASSEMBLY FLOOR: 72-1, 9/2/21
AYES: Aguiar-Curry, Arambula, Bauer-Kahan, Bennett, Berman, Bloom, Boerner
Horvath, Bryan, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi,
SB 224
Page 9
Cooley, Cooper, Cunningham, Megan Dahle, Daly, Davies, Flora, Fong,
Friedman, Gabriel, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gray,
Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Lee, Levine, Low,
Maienschein, Mathis, Mayes, McCarty, Mullin, Muratsuchi, O'Donnell,
Patterson, Petrie-Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert
Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Seyarto, Smith, Stone, Ting,
Valladares, Villapudua, Voepel, Waldron, Ward, Akilah Weber, Wicks, Wood
NOES: Frazier
NO VOTE RECORDED: Bigelow, Lorena Gonzalez, Medina, Nazarian, Nguyen,
Rendon
Prepared by: Brandon Darnell / ED. / (916) 651-4105
9/2/21 18:49:43
**** END ****
Senate Bill No. 224
CHAPTER 675
Anact to addArticle 6 (commencing with Section51925) to Chapter 5.5
of Part 28 of Division 4 of Title 2 of the Education Code, relating to pupil
instruction.
[Approved by Governor October 8, 2021. Filed with Secretary
of State October 8, 2021.]
SB 224, Portantino. Pupil instruction: mental health education.
Existing lawrequires, during the next revision of the publication“Health
Framework for California Public Schools,” the Instructional Quality
Commission to consider developing, and recommending for adoption by
theStateBoardofEducation,adistinctcategoryonmentalhealthinstruction
to educate pupils about all aspects of mental health. Existing law requires
mental health instruction for these purposes to include, but not be limited
to, specified elements, including reasonably designed and age-appropriate
instruction on the overarching themes and core principles of mental health.
This bill would require each school district, county office of education,
state special school, and charter school that offers one or more courses in
health education to pupils in middle school or high school to include in
those courses instruction in mental health that meets the requirements of
the bill, as specified. The bill would require that instruction to include,
among other things, reasonably designed instruction on the overarching
themes and core principles of mental health. The bill would require that
instruction and related materials to, among other things, be appropriate for
use with pupils of all races, genders, sexual orientations, and ethnic and
culturalbackgrounds,pupilswithdisabilities,andEnglishlearners.Thebill
wouldrequiretheStateDepartmentofEducationtodevelopaplantoexpand
mental health instruction in California public schools on or before January
1, 2024.
The people of the State of California do enact as follows:
SECTION1. (a) TheLegislaturefindsanddeclaresallofthefollowing:
(1) Mental health is critical to overall health, well-being, and academic
success.
(2) Mental health challenges affect all age groups, races, ethnicities,and
socioeconomic classes.
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(3) Millions of Californians, including at least one in five youths, live
with mental health challenges. Millions more are affected by the mental
healthchallengesof someoneelse,suchas aclosefriendorfamilymember.
(4) Mentalhealtheducationisoneofthebest waystoincreaseawareness
and the seeking of help, while reducing the stigma associated with mental
health challenges. The public education system is the most efficient and
effective setting for providing this education to all youth.
(b) Fortheforegoingreasons,itistheintentoftheLegislatureinenacting
this measure to ensure that all California pupils ingrades 1 to12, inclusive,
have the opportunity to benefit from a comprehensive mental health
education.
SEC.2. Article6(commencingwithSection51925)isaddedtoChapter
5.5 of Part 28 of Division 4 of Title 2 of the Education Code, to read:
Article 6. Mandatory Mental Health Education
51925. Each school district, county office of education, state special
school,andcharterschoolthatoffersoneormorecoursesinhealtheducation
to pupils in middle school or high school shall include in those courses
instruction in mental health that meets the requirements of this article.This
section shall not be construed to limit a school district, county office of
education, state special school, or charter school in offering or requiring
instructioninmentalhealthasspecifiedinthisarticle.This instructionshall
include all of the following:
(a) Reasonablydesigned instruction onthe overarching themes and core
principles of mental health.
(b) Defining signs and symptoms of common mental health challenges.
Dependingonpupil age anddevelopmental level,thismayincludedefining
conditions such as depression, suicidal thoughts and behaviors,
schizophrenia, bipolar disorder, eating disorders, and anxiety, including
post-traumatic stress disorder.
(c) Elucidatingthe evidence-basedservicesandsupports that effectively
help individuals manage mental health challenges.
(d) Promoting mental health wellness and protective factors, which
includes positive development, social and cultural connectedness and
supportive relationships, resiliency, problem solving skills, coping skills,
self-esteem, and a positive school and home environment in which pupils
feel comfortable.
(e) The ability to identify warning signs of common mental health
problemsinordertopromoteawarenessandearlyinterventionsothatpupils
know to take action before a situation turns into a crisis. This shall include
instruction on both of the following:
(1) How to seek and find assistance from professionals and services
within the school district that includes, but is not limited to, school
counselorswithapupilpersonnel servicescredential,school psychologists,
and school social workers, and in the community for themselves or others.
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—2 —Ch. 675
(2) Evidence-based and culturally responsive practices that are proven
to help overcome mental health challenges.
(f) Theconnectionandimportanceofmentalhealthtooverall healthand
academic success and to co-occurring conditions, such as chronic physical
conditions, chemical dependence, and substance abuse.
(g) Awareness and appreciation about the prevalence of mental health
challenges across all populations, races, ethnicities, and socioeconomic
statuses,includingtheimpactofrace,ethnicity,andcultureontheexperience
and treatment of mental health challenges.
(h) Stigma surrounding mental health challenges and what can be done
toovercomestigma,increaseawareness,andpromoteacceptance.Thisshall
include, to the extent possible, classroom presentations of narratives by
trained peers and other individuals who have experienced mental health
challenges and how they coped with their situations, including how they
sought help and acceptance.
51926. Instruction and materials required pursuant to this article shall
satisfy all of the following:
(a) Be appropriate for use with pupils of all races, genders, sexual
orientations, and ethnic and cultural backgrounds, pupils with disabilities,
and English learners.
(b) Be accessible to pupils with disabilities, including, but not limited
to,providinga modifiedcurriculum,materialsandinstructioninalternative
formats, and auxiliary aids.
(c) Not reflect or promote bias against any person on the basis of any
category protected by Section 220.
(d) Becoordinatedwithanyexistingon-campusmental healthproviders
including, but not limited to, providers with a pupil personnel services
credential, who may be immediately called upon by pupils for assistance.
51927. (a) This article does not limit a pupil’s healthand mental health
privacy or confidentiality rights.
(b) A pupil receiving instruction pursuant to this article shall not be
required to disclose their confidential health or mental health information
at any time in the course of receiving that instruction, including, but not
limited to, for the purpose of the peer component described in subdivision
(h) of Section 51925.
51928. For purposes of this article, the following definitions apply:
(a) “Ageappropriate”hasthesamemeaningasdefinedinSection51931.
(b) “Englishlearner”hasthesamemeaningasdefinedinSection51931.
(c) “Evidence-based”meansverifiedorsupportedbyresearchconducted
in compliance with scientific methods and published in peer-reviewed
journals, where appropriate, and recognized as accurate and objective by
professional organizations and agencies with expertise in the mental health
field.
(d) “Instructors trained in the appropriate courses” means instructors
withknowledgeofthemostrecentevidence-basedresearchonmentalhealth.
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Ch. 675—3 —
51929. On or before January 1, 2024, the department shall develop a
plan to expand mental health instruction in California public schools.
O
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—4 —Ch. 675