Taken together, Assembly Bills 1315 and 1340 would help launch a paradigm shift for mental health care in California, fueling a move from a fail-first to a care-first model.
SACRAMENTO, CA – The California Legislature has moved to Gov. Jerry Brown two groundbreaking measures that aim to transform mental health care in California, helping shift the treatment paradigm from one centered on Stage 4 crisis care to one in which the emphasis is on early detection, prevention and intervention, before a brain illness becomes disabling.
On Monday, the Assembly gave final passage to AB 1315, by Assemblymember Kevin Mullin, D-South San Francisco. The bill would create a first-of-its-kind public-private partnership to generate new funding and resources for programs that provide early diagnosis and intervention services for young people experiencing the early stages of serious thought and mood disorders.
Last week, the Legislature sent the governor a related measure, AB 1340 by Assemblymember Brian Maienschein, R-San Diego, that would urge incorporation of basic psychiatric training into the continuing medical education options for primary care providers.
The Steinberg Institute is sponsoring the measures as part of its broader effort to move toward a more integrated and equitable system of health care in California, one in which brain health is treated with the same urgency and sweep as physical health. Both measures moved through the Legislature with bipartisan support, backed by an array of health care, advocacy, government and business groups.
Each year, one in four families in America grapple with some aspect of mental illness, according to studies. And each year, an estimated 100,000 young adults in the U.S. experience their first psychotic episode, an outgrowth of serious mental illness that frequently involves debilitating hallucinations and delusions.
The average delay in receiving appropriate diagnosis and treatment after a first psychotic break is an astonishing 18.5 months in the U.S. By comparison, in Australia and Britain – which operate advanced models of care in this area – the average duration of untreated psychosis ranges from a few weeks to under three months. The longer the illness goes untreated, the more likely that young person will spiral down a damaging course, unable to graduate, unable to form relationships, unable to hold a job.
On the other hand, the best research makes clear that early intervention can make all the difference in altering the course of serious mental illness – just as it does with serious physical ailments such as cancer and kidney disease. Model programs 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.
Because of constraints on funding and training capacity, fewer than half of California counties offer such services, and the 24 counties that do can’t support programs large enough to meet demand.
AB 1315 would set up a public-private partnership – called EPI-Plus – to provide additional funding and incentive for counties to focus resources on early detection and prevention of mental illness. The legislation creates a special account dedicated to funding early intervention services proven to be effective. That account would be funded by private donations and federal, state and private grants. Counties could apply for awards, and if chosen, would have to provide matching funds – essentially doubling the investment of their mental health dollars.
Shifting the treatment paradigm also will require more people trained to recognize the early signs and symptoms of mental illness. 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 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 — 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 referrals or treatment.
AB 1340 would help ensure such training is built into the continuing education requirements for medical professionals. The bill would require 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.
Both measures have drawn support from numerous organizations in the public and private sectors committed to advancing the science surrounding mental illness.
Among the industry leaders and nonprofit organizations supporting AB 1315: Verily Life Sciences; Mindstrong; One Mind Institute; The Jed Foundation; California Hospital Association; California Psychiatric Association; California College of Emergency Room Physicians; California State Association of Counties; County Behavioral Health Directors Association; Orygen, a leading research institute based in Australia; and California Police Chiefs Association.
Among the groups supporting AB 1340: the California Psychiatric Association; County Behavioral Health Directors Association; California Access Coalition; Depression and Bipolar Support Alliance; and California Alliance of Child and Family Services.
For more context on the bills:
AB 1315: The Cost Benefits of Early Intervention in Mental Illness
AB 1340: How Primary Care Providers Can Help Solve Our Psychiatrist Shortage
For more information, contact Steinberg Institute Government Affairs Director Adrienne Shilton, (916) 553-4167.
The Steinberg Institute is a Sacramento-based nonprofit organization dedicated to advancing sound public policy and inspiring leadership on issues of mental health.
