The Steinberg Institute began this, our sixth year of operation, with high hopes and a deep sense of urgency. The urgency came from our awareness of the enormous need and suffering in California as a result of the exploding number of people facing mental illness and homelessness. The hope came from our sense that we’d be able to work closely with a new governor who prioritized mental health reform and who named our board chair as his mental health advisor.
In February of this year, Governor Newsom devoted almost the entirety of his State of the State speech to outlining an ambitious agenda focused on addressing these crises. Less than a month after that speech came the coronavirus — and California went into lockdown. In the months since, the Governor and the Legislature have been consumed by the need to manage an unprecedented crisis and to cope with massive reductions in state revenue.
During this same period, the killings of George Floyd, Breonna Taylor and other African Americans by police officers led to a wave of protest across the country and a national reawakening about social and racial injustice in America.
In this environment, we know that our work as advocates for mental health and social justice is more important than ever. We are painfully aware of the terrible toll that the pandemic is already causing and is likely to bring in the future, increasing rates of stress, isolation, depression and suicide. We know, too, that communities of color are shouldering an even greater burden from Covid-19 and that this burden is magnified by the weight of racism and the history of trauma.
One result of the pandemic and lockdown was the legislature drastically truncated the number of bills it considered and brought to committees for hearings. Though we continued to support several important mental health bills, we were forced to limit our sponsored legislative agenda for the year to three bills that we deemed especially important. The legislature boldly prioritized mental health reform in 2020, especially in the face of the pandemic, sending our sponsored legislative agenda to the Governor for his signature.
The Steinberg Institute is proud to call Governor Newsom a true mental health champion, as he signed the majority of our legislative package on September 25th, in a historic bill signing ceremony. These new laws place California at the forefront of efforts by states to address a nationwide mental health crisis that has been made more acute by the coronavirus pandemic.
For a list of all of the mental health bills the Governor signed, click here.
SB 855 (Wiener), was one of the most important mental health bills that have come before the legislature for many years and creates a new national model. It takes a huge step in bringing true mental health parity to the people of California by requiring commercial health insurers to cover needed mental health and substance use services, just as they cover treatment for physical health. See AP article, by Adam Beam.
The second, SB 803 (Beall) is a bill we’ve spent many years fighting for. It will enable peer support specialists – people with lived experience with the mental health system who have received training to work with mental health consumers — to have their skills recognized, standardized and certified by the state. This will also allow agencies that hire them to bill the federal government for part of the cost of their services. See CalMatters article, by Jocelyn Weiner.
Our third sponsored bill is AB 1766 (Bloom), designed to gather actionable data on board and care homes that provide a crucial housing option for people with severe mental illness. Despite the important role board and care homes play in providing desperately needed housing, policymakers lack solid data about their availability, their closure rate, and their impact on reducing homelessness. See CalMatters article, by Jocelyn Weiner.
Bills We Sponsored
REAL MENTAL HEALTH PARITY
It’s hard to overstate how important this bill is. Patrick Kennedy, the former Congressman and author of federal parity legislation passed in 2008, says its passage would make California a national leader and set a new standard in the effort to achieve true parity. Our founder, Sacramento Mayor Darrell Steinberg, sees the bill as the “most important mental health bill in many years.”
For decades, people who purchase commercial health insurance or get it through their employers have been frustrated by their inability to get their health plans to cover mental health or substance use treatment. This problem led to the passage of two federal laws – the Mental Health Parity Act of 1996 and the Mental Health Parity and Addiction Equity Act of 2008 – as well as a state law passed in 1999. But these bills had loopholes and didn’t achieve full parity. As a result, people needing mental health and substance use treatment still feel the sting of discrimination and stigma as private health insurers often make it extraordinarily difficult – if not impossible – to get the services they need.
For example, California’s existing law names nine specific types of mental illness, along with serious emotional disturbance in children, and requires commercial insurers to cover them. However, this list excludes a wide range of mental health and substance use disorders including conditions such as post-traumatic stress disorder (PTSD), generalized anxiety disorder, opioid, alcohol and stimulant use disorders, binge eating disorder and traumatic brain injury. Instead of cherry picking a limited number of conditions, SB 855 expands the law to encompass any treatable mental health or substance use disorder described in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
SB 855 also closes a critical loophole. Under current law, insurance companies are essentially able to determine for themselves whether a recommended mental health treatment is “medically necessary.” SB 855 creates clear standards with a uniform definition of medical necessity tied to generally accepted standards of care.
Last year, before the COVID-19 pandemic hit, 71,000 American died of drug overdoses, a new record, with deaths in California surging 16%. Today, with double-digit unemployment in California as a result of the pandemic, rates of alcohol consumption, substance abuse, and suicide are poised to rise. The need for people to get help for their mental health and substance use disorders has never been greater. This bill can make a huge difference and allow California and its governor to be national leaders on a critically important issue.
Citing the recently signed SB 855, Attorney General Xavier Becerra is asking CA’s largest healthcare providers to show their compliance with our parity laws ensuring access to mental health care.
CERTIFICATION FOR PEER SUPPORT SPECIALISTS IN MENTAL HEALTH
California’s burgeoning mental health crisis, visible on its streets and hidden in the homes of newly unemployed workers, is further complicated by a large and growing shortage of mental health professionals of all types. One part of the mental health workforce with the capacity to immediately grow larger and help bring needed support and services to people grappling with mental health problems is peer support specialists.
Peer support specialists are people with “lived experience” who provide vital support to others trying to manage their own mental health challenges. These specialists have struggled with their own mental health and have had experience navigating the social service, mental health and substance use or criminal justice systems. Their experience gives them a unique ability to cut through stigma, as well as to understand, empathize and gain the trust and confidence of people going through similar experiences. They are not clinicians, but they can work as part of clinical or support teams and help people get the multifaceted support they need.
The federal Centers for Medicare and Medicaid Services (CMS) have for years recognized the value that peer support specialists provide for mental health recovery. Research has shown that peer support specialists offer a substantial return on investment by reducing emergency room visits and in-patient hospital stays and boosting resilience and recovery. CMS provides reimbursement for peer services through the Medicaid system to states that build these services into their state Medicaid plans and, most importantly, establish a system for training and certifying these workers. Today, California is one of only two states that has failed to set up a certification program (the other is South Dakota).
SB 803 would finally change that reality by establishing a statewide peer support specialist certification and training program, using a core curriculum that defines the skills and competencies required of a peer support specialist for any California county that chooses to opt-in to the program.
We salute Senator Jim Beall, a San Jose Democrat who for years has claimed mental health as a priority, and has worked diligently to strengthen our mental health care system. Termed out of the State Senate in 2020, we know he will continue to find ways to ensure people receive the care they need.2018 Mental Health Champion.
PRESERVING BOARD AND CARE HOMES
Adult residential facilities – better known as board-and-care homes — are a vital and rapidly vanishing housing resource for people suffering from severe mental illness or cognitive impairment. These facilities provide a place to live, meals, and other assistance for people who are vulnerable, unable to care for themselves, and at high risk of becoming homeless. Many have been recently discharged from hospitals or prisons or are in a conservatorship. Nearly everyone living in these homes receives federal disability benefits that help pay the cost of their housing and meals.
This vital housing resource is disappearing because many operators, faced with low reimbursement rates, are closing their facilities or converting them to other use. Los Angeles County recently reported a loss of 200 beds in just one year but there is little hard information on the number of these facilities that are still operating across the state. Without this basic information, it is impossible to develop strategies to preserve those that remain.
AB 1766 would require the State Department of Social Services to collect data on the number of people with severe mental illness who live in adult residential facilities and to issue quarterly public reports on the number of facilities and beds that have been lost in the previous quarter. It would also require the department to notify counties of planned closures.
2020 Full Legislative Package
SB 66 (Atkins) – Improved Access to Mental Health Services in Primary Care
About 6.5 million people receive primary care, mental health and other services at 1,300 community health centers in California. As many as 40% of patients seen in primary care on any given day also have a mental health condition. Health systems have found that being able to bring a patient from primary care to an on-site mental health specialist on the same day makes it far more likely patients will get the care they need. Current rules prevent providers from being reimbursed for more than one visit in a single day. SB 66 would allow health centers to bill Medi-Cal for two visits if they receive mental health and medical care on the same day. This bill failed passage in the legislature.
SB 331 (Hurtado) – Teen Suicide Prevention
Youth suicide has been rising steadily and is now the second leading cause of death among young people aged 15 to 24. In California, almost 20% of all high school students and almost half of LGBTQ students report that they seriously considered attempting suicide in the previous year. Studies show prevention and early intervention efforts can reduce suicide. Santa Clara County has had a concerted suicide prevention effort since 2010, and in 2016 and 2017 suicides there decreased by 11% and 14%. But since 2009, only seven of California’s fifty-eight counties have adopted suicide prevention strategic plans. SB 66 will require all California counties to bring together diverse stakeholders to create and implement strategic suicide prevention plans, with the emphasis on young people. This bill failed passage in the legislature.
SB 854 (Beall)– Access to Medication Assisted Treatment (MAT) from Private Health Insurers
Eleven medications approved by the FDA for treatment of opioid, alcohol and tobacco use disorders have been found effective, in combination with counseling, at helping people recover. Yet barriers imposed by health insurers limit the ability of patients to get access to medication-assisted treatment (MAT). SB 854 would bar insurers from excluding from coverage FDA-approved medications used to treat substance use disorders or from imposing rules requiring patients to get prior authorization to use MAT or to go through a “step therapy” process before MAT is approved. This bill failed passage in the legislature.
AB 451 (Arambula) – Health facilities: Emergency Services and Care
This bill aims to overcome the challenges faced by physicians. This bill would require psychiatric units within a general acute care hospital, a psychiatric health facility, or an acute psychiatric hospital regardless of whether it maintains an emergency department, to provide emergency care and services to relieve or eliminate a psychiatric emergency medical condition. The provisions in AB 451 ensure that patients who are in need of more extensive psychiatric emergency care obtain it. This bill failed passage in the legislature, but was reintroduced, passed and signed in 2021.
AB 890 (Wood) – Nurse Practitioners: Scope of Practice
AB 890 would enable licensed nurse practitioners to work to the full scope of their license by expanding their ability to treat patients, including those affected by mental health challenges, without a physician’s supervision. Nurse practitioners are registered nurses with extra training who have earned advanced degrees — either a master’s degree or a doctorate. Expanding the role and authority of nurse practitioners will help address the large and growing shortage of primary care physicians in California. There are currently nearly 28,000 nurse practitioners in California, according to the California Board of Registered Nursing.
AB 1845 (Luz Rivas and Chiu) – Creating an Office to End Homelessness
Would create, within the Governor’s office, the Office to End Homelessness, to be run by a Secretary on Homelessness appointed by the Governor. The office would be the lead state entity for ending homelessness in California and would coordinate with local, state and federal agencies. The bill was vetoed.
AB 1976 (Eggman) – Revises Laura’s Law and makes it permanent
Laura’s Law, first passed in 2002 and since revised, enabled counties to start Assisted Outpatient Treatment (AOT) programs for people with severe mental illness who are deemed likely to deteriorate to the point that they would meet the standard for involuntary commitment if they didn’t get help. Counties that voted to take part in the program had to first offer intensive outpatient treatment on a voluntary basis. If a person declined to take part, the law authorizes county officials to institute a judicial proceeding and allows judges, after a hearing, to order them to receive outpatient treatment.AB 1976 would change several aspects of the program, including these: It would require counties that do not wish to take part to opt out of the program, rather than allowing counties to opt in. It would extend the program beyond 2022, the current sunset date, and make it permanent. And it would allow groups of counties to implement the program together. This bill was signed into law by Governor Newsom.
AB 2054 (Kamlager) – Establishes CRISES Act Grant Pilot Program
The bill would create a pilot program called the Community Response Initiative to Strengthen Emergency Systems (CRISES) and give grants of at least $250,000 to community organizations to help them expand community participation in emergency response efforts. This bill was vetoed, but subsequently passed in 2021 (AB 118, Kamlager).
AB 2112 (Ramos) – Establishes Office of Suicide Prevention
Would set up an Office of Suicide Prevention in the State Department of Public Health to assess existing efforts, make recommendations and build efforts to reduce suicide in California. This bill was signed into law by Governor Newsom.
AB 2360 (Maienschein) – Mental Health Services via Telehealth for Children and New Mothers
Would require health plans to provide mental health consultation services via telehealth for children, pregnant women and postpartum women for up to one year after the birth of their child. This bill was vetoed.
AB 2589 (Maienschein) – Including Board-and-Care Homes in No Place Like Home program
In 2016, Governor Brown signed into law No Place Like Home, a $2 billion bond program championed by the Steinberg Institute. It funds the creation or rehabilitation of permanent supportive housing for chronically homeless people grappling with severe mental illness.AB 2589 would amend the law to expand the definition of permanent supportive housing to include licensed adult residential facilities and residential care facilities for the elderly, commonly known as board-and-care homes. These kinds of facilities are rapidly vanishing because operators do not earn enough money to continue operating them. Making these facilities eligible to be renovated or newly constructed with funding from No Place Like Home will protect and perhaps expand this vital affordable housing resource. This bill failed passage in the legislature.
2377 (Chiu) – Requiring Public Notice When Board and Care Operators Plan to Close Facilities
Would require operators of board and care facilities to provide 180 days of notice before closing. This bill was signed into law by Governor Newsom.
AB 3269 (Chiu) – Creating an Inspector General for Housing and Homelessness
Would create a new position, Inspector General for Housing and Homelessness, and require the state Homeless Coordinating and Financing Council and local governments to develop plans to address homelessness. This bill failed passage in the legislature.
AB 3242 (Irwin) – Allows Evaluations by Telehealth for Persons Considered for Involuntary Commitment
This bill authorizes physicians to use telehealth to examine and assess individuals for the purposes of involuntarily detention under the Lanterman-Petris-Short Act. This bill was signed into law by Governor Newsom.