The Steinberg Institute is focused on early detection, prevention and intervention of psychosis and other symptoms of serious brain illness; supportive housing and services for homeless people living with brain illness; continuing education requirements for primary care providers that help integrate mental and physical health care; expanding suicide prevention programs to all public college campuses; decriminalizing brain illness through appropriate pre-trial diversion programs and expanded sentencing options; and expanding psychiatric crisis care services.
Find our 2017 Legislative Package here.
Find our 2016 Legislative Package here.
Find our 2015 Legislative Package here.
AB 1315 (Mullin) has the potential to transform the landscape for mental health care in California. The measure, signed into law in October 2017, will expand resources for early detection of psychosis and other symptoms of serious brain illness in young people, and for evidence-based intervention and treatments that help stem conditions such as schizophrenia, bipolar disorder and other serious thought and mood disorders before they become disabling.
Consider these facts: Fifty 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, generally involving frightening and isolating hallucinations and delusions. 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 mental illness, early intervention can make all the difference. With the right treatment, young people who receive early intervention have a rapid remission of symptoms. Over the course of their lives, they have lower rates of hospitalization and suicide.
AB 1315 sets up a public-private partnership that provides both funding and incentive for counties to focus significant resources on early detection of psychosis and prevention of full-blown mental illness. The legislation creates a special account dedicated to funding programs proven effective in early detection and treatment of psychosis and other early markers of brain illness. That account will be fully supported by private donations and federal, state and private grants. The bill creates an expert advisory committee charged with developing guidelines and recommendations for model early psychosis programs. Counties can apply for grants, and if awarded, will have to provide matching funding.
At its core, this legislation aims to shift our approach to mental health care from a fail-first model to a system that uses proven methodology to identify and treat brain illness well before it ruins lives and families.
Suicide remains a prevalent — and yet preventable — plague on California’s college campuses. In our public colleges alone we lose nearly 200 students each year to suicide. That means 200 lives cut short, 200 families forever changed, and thousands of campus communities left wondering, how could this have happened? What could we have done to help?
AB 917 (Arambula) is a start to answering these questions.
The bill would require all California community college campuses and the California State University system to adopt policies on suicide prevention, and it would strongly urge the University of California system and all private colleges to do the same. The policies would include information on how to recognize signs of suicidal thinking, and on where and how to get help.
We know such policies work. Researchers have documented intervention strategies that help students feel connected and stem suicide rates. But California has no universal requirement for institutes of higher learning to develop and enact such policies. AB 917 would ensure that we build a comprehensive safety net for our students, and give staff and fellow students the tools they need to save lives. This is a two-year bill that will move forward in 2018.
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.
Meanwhile, demand for mental health services is on the rise. Depression is now a leading cause of disability in the U.S. Estimates indicate one in four families are struggling with some aspect of mental illness. A recent Milbank Memorial Fund report said among children ages 9 to 17, as many as one in five may have a diagnosable psychiatric disorder.
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. Meanwhile, 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 and diagnose common mental health conditions, and provide appropriate treatment and referrals.
AB 1340 (Maienschein) will help ensure such training is built into the continuing education requirements for practicing medical professionals. The bill, signed into law in October 2017, 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. At its core, the legislation marks a basic and practical step toward building an integrated system of care, in which brain health is treated with the same urgency and sweep as physical health.
With this historic 2016 legislation, the Steinberg Institute and a bipartisan coalition of partners secured $2 billion for permanent supportive housing and services for homeless people living with serious mental illness. The advisory commission overseeing the rollout of the “No Place Like Home” initiative is finalizing guidelines for the competitive grant process for housing funds, which will launch in 2018. Another $200 million is already available to counties for planning.
California has more than one third of the nation’s chronically homeless, nearly 30,000 people. The vast majority contend with untreated brain illness and other significant problems. Historically, they have spiraled through a disabling and often deadly cycle, from the streets to emergency rooms and jail, absorbing a huge proportion of public resources. “No Place Like Home” aims to break that cycle, connecting this vulnerable population with housing and “whatever it takes” services that assist with mental health treatment, training and employment. The state is funding the effort by re-purposing a small percentage of funds generated by the 2004 Mental Health Services Act to leverage a $2 billion revenue bond and billions of additional dollars from local, state, and federal funds.