In fewer than three years of operation, the Steinberg Institute has had outsized impact on California’s legislative agenda. Key to our mission is inspiring legislative champions – and 2017 saw the largest number of bills dedicated to mental health in recent history in California.
In addition, we have pushed for – and won – decisive gains in the areas of homeless housing and services, foster youth, law enforcement training, suicide prevention, and college mental health services. We have done so with bipartisan support, reaching across party lines to grow awareness of brain health issues; and through thousands of calls and meetings with elected officials, agency heads, advocacy groups, business leaders and research groups, as we educated, advocated and systematically built our network of supporters.
This year, we have added to the mix a consuming new focus: shifting the treatment paradigm for mental health care from one centered on Stage 4 crisis care to one in which the emphasis is early detection, prevention and intervention, before a brain illness becomes disabling. How do we get there? Our two priority bills this year will start that work, by generating significant new resources for evidence-based early intervention services; and educating primary care providers in early detection of common psychiatric conditions. Both bills passed the Legislature with bipartisan support and were signed into law in October by Gov. Jerry Brown.
We believe AB 1315, by Assemblymember Kevin Mullin, D-South San Francisco, has the potential to spark a transformation of mental health care in California. The measure expands resources for early detection of psychosis and other symptoms of serious brain illness in young people, and funds evidence-based intervention and treatments that have proven effective in arresting conditions such as schizophrenia, bipolar disorder and other mood disorders before they become disabling.
Here’s why we think it’s a game-changer: Research shows 50 percent of brain illness begins by the age of 14, and 75 percent by the age of 25. Every year in this country, about 100,000 young adults experience their first psychotic episode. The average delay in receiving appropriate diagnosis and treatment after a psychotic episode is an astonishing 18.5 months. The longer the illness goes untreated, the more likely that young person will veer down a damaging and potentially deadly path, failing to graduate, unable to form relationships, unable to hold a job.
On the other hand, the best research out there shows us that for people prone to serious brain illness, early intervention can make all the difference. Model programs in operation in California, New York, Oregon and multiple other states and nations have shown dramatic benefits when young people receive treatment in the early stages of illness, often resulting in rapid remission of symptoms. But fewer than half of California counties offer such services, and the 24 counties that do can’t support programs large enough to meet local demand.
AB 1315 sets up a public-private partnership – called EPI-Plus — that will provide both funding and incentive for counties to focus new resources on early detection of psychosis and prevention of full-blown mental illness. The legislation creates a special account dedicated to funding programs proven to be effective. That account will be fully supported by private donations and federal, state and private grants. Counties can apply for awards, and if chosen, will have to come up with matching funds – essentially doubling their investment.
Following more than a year of effort, we have a written pledge from private industry to raise money for EPI-Plus – and crucial buy-in from tech leaders, who now are actively seeking to partner with counties on innovative pilot projects.
Shifting the paradigm will also require more people trained to recognize the early signs and symptoms of psychosis. Multiple recent reports document the alarming disconnect between supply and demand for psychiatric services in the United States. According to the National Council for Behavioral Health, the ratio of psychiatrists to population in the U.S. declined by 10 percent between 2003-2013. Nearly half the nation’s psychiatrists are private practitioners who operate on a cash-only basis. Another recent study found 55 percent of counties in the continental U.S. have no psychiatrists, and 77 percent have a severe shortage.
Pediatricians and other primary care practitioners are living with the fallout. An estimated 40 percent of patients seen in a primary care setting on any given day have an active psychiatric problem. Half the patients referred by a primary care provider for psychiatric treatment are unable to access services. Complicating this gap in care: The vast majority of primary care providers have minimal training in psychiatric diagnosis and treatment.
We can’t magically multiply the number of psychiatrists in the U.S. — but we can do far more to ensure primary care providers have the basic training they need to recognize the symptoms of common mental health conditions, and provide appropriate treatment or referrals.
AB 1340, by Assemblymember Brian Maienschein, R-San Diego, helps ensure such training is built into the continuing education requirements for medical professionals. The bill requires that the Medical Board of California consider including in its continuing medical education requirements a course on integrating mental and physical health care in primary care settings, especially as it pertains to children.
Find our full 2017 Legislative Package here.
Find our full 2016 Legislative Package here.
Find our full 2015 Legislative Package here.