2022 brings the Steinberg Institute’s eighth year, along with much to celebrate. In March, we welcomed Karen Larsen as our organization’s first-ever Chief Executive Officer. Karen brings more than 20 years of experience in mental health, substance use disorder and homelessness program implementation to the institute. In this new role, Larsen will elevate the Steinberg Institute’s voice and expand its reach.
We also celebrate the unprecedented investments that Governor Gavin Newsom and the California legislature have made to transform California’s system of mental health care for youth and expand mental health infrastructure, crisis services and housing.
A historic budget surplus presents lawmakers and the Newsom administration with a historic opportunity to ensure that mental health is treated with the same urgency as physical health. At the same time, concerns about potential future economic headwinds call for smart investments that will have an outsized impact on brain health policies in the state.
Our 2022 Priorities
Addressing the behavioral health workforce shortage
California is facing a devastating behavioral health workforce shortage. It was a serious issue before the Coronavirus pandemic, and now it is a crisis. People are leaving the field at record rates and the pipeline into the field is nowhere near what it needs to be in order to meet the demand. Left unaddressed, more Californians will suffer because of untreated or undertreated mental illness. In 2021 we formed the Legislative Behavioral Health Workforce Strategy Group to identify solutions aimed at addressing this crisis.
Governor Newsom’s budget includes a historic investment of $1.5 billion to bolster the healthcare workforce. The budget includes investments across the continuum, including $281 million for community health workers, $126 million for social workers and a combined $226 million for other behavioral health providers.
This year we are sponsoring SB 964, the Future of California Workforce and Surge in Behavioral Health or FOCWS-BH (pronounced “focus”) (Wiener). The legislation requires a comprehensive landscape analysis of the behavioral health workforce, delivered to the Legislature by January 1, 2024, so that long-term policy changes and investments are rooted in California’s actual workforce needs.
Mental Health Crisis Response
The new 988 Suicide Prevention Lifeline line has the potential to transform mental health crisis response in California. The institute has been hard at work to ensure this new line is launched with sustained funding and a plan to connect callers to critical services in every county. We are currently sponsoring AB 988, the Miles Hall Lifeline and Suicide Prevention Act (Bauer-Kahan), which would provide the framework and funding for 988 implementation.
In 2021 the Governor committed $20 million for the 988 launch, along with investments for mobile crisis teams and crisis receiving and stabilization. This year mobile crisis teams become a statewide Medi-Cal benefit, along with funding for 911 interoperability and a statewide 988 planning effort. While this is a strong initial proposal to launch the new line and begin rolling out mobile crisis teams statewide, policymakers must build on this proposal to fully fund the 988 system moving forward by passing a small monthly fee on phone lines to mirror the funding for 911.
Also in the budget, an additional $8 million to ensure call centers are equipped to handle the expected increase in calls in the first year of operating 988. In addition to the critical investments in the budget, AB 988 will ensure everyone in California has someone to call, someone to come, and somewhere to go.
Strengthening the Mental Health Services Act (MHSA)
The Mental Health Services Act (MHSA), passed by California voters in 2004, is funded by a 1% income tax on personal income in excess of $1 million per year. It is designed to expand and transform California’s behavioral health system to better serve individuals with, and at risk of, serious mental health issues and their families. MHSA addresses a broad continuum of prevention, early intervention, and service needs. Since its passage in 2004, the Mental Health Services Act has generated more than $29 billion to strengthen the state’s mental health infrastructure and to support mental health services focused on wellness and recovery.
Designed to promote innovation, the MHSA gives individual counties great flexibility in their use of the funds. While many counties have adopted innovative approaches to expand and improve behavioral health services, there is little accountability for measuring progress or achieving specific outcomes.
We are sponsoring SB 970, The MHSA Outcomes and Accountability Act (Talamantes Eggman) to bring measurable goals, increased collaboration across counties, and customizable approaches to ensure that the vision of the Mental Health Services Act is realized.
A Right to Behavioral Health Care and Supports
In a December 2021 legislative hearing, our founder Sacramento Mayor Darrell Steinberg, challenged lawmakers to “go big” and make behavioral health care and supports a right for all Californians. Like the rights granted to people with developmental disabilities by the Lanterman Developmental Disabilities Services Act of 1969, people living with severe mental illness or substance use disorders should have a right to health care and supports like housing, employment opportunities and other services needed to live a healthy and fulfilling life.
We believe that establishing this right will break down current barriers to care and cut through the dysfunction that has plagued our behavioral health system for too long. It’s a bold concept, but too many people are suffering in our streets, hospital emergency rooms, and jails, not getting the care they deserve.
In March, Governor Newsom proposed a new framework for ensuring care for people with mental health and substance use disorders called Community Assistance, Recovery and Empowerment (CARE) Court. As announced, CARE Court connects a person struggling with an untreated schizophrenia spectrum and psychotic disorders with a year-long Care Plan. Each plan is managed by a care team in the community and can include clinically prescribed, individualized interventions with several supportive services, medication and a housing plan. The approach also includes legal counsel and supporters to empower each participant in self-directed care decisions, in addition to their full clinical team.
All counties across the state will participate in CARE Court under the proposal. If local governments do not meet their specified duties under court-ordered Care Plans, the court will have the ability to order sanctions and, in extreme cases, appoint an agent to ensure services are provided.
Homelessness and Mental Health
Tent encampments continue to grow under freeways, unsheltered individuals are dying during severe weather and public safety agencies are overwhelmed with calls for service. An estimated 55,000+ of our neighbors experiencing homelessness live with an untreated serious mental illness. The trauma and stress of living outside exacerbate these conditions and create significant barriers to effective treatment. California’s homelessness crisis is directly linked to our society’s failure to offer these individuals adequate treatment and housing options.
This year’s budget homelessness package totals $10.2 billion over two years and an additional $2.9 billion for affordable housing production and homeownership opportunities.
FOCWS-BH requires a comprehensive landscape analysis of the behavioral health workforce, delivered to the Legislature by January 1, 2024, so that long-term policy changes and investments are rooted in California’s actual workforce needs.
The study includes analysis of:
- All aspects of the behavioral health labor market, including workforce turnover and exit rates relative to other health professions and services
- Workforce demographics, including information on race, ethnicity, sexual orientation, age, geographic location, language and lived experience to address disparities in workforce equity and access to care
- California’s behavioral health licensing requirements to eliminate unnecessary bureaucratic barriers to well-trained and talented workers from entering the field and working at the top of their scope
- Scope of practice laws to ensure certified behavioral health workers are able to practice up to their full potential while maintaining quality care
988 will transform the way California responds to mental health emergencies to ensure those in crisis receive the urgent care they need. The new national 911 for mental health crises, 988 will ensure that everyone experiencing a mental health crisis has someone to call, someone to come, and somewhere to go.
AB 988 will implement federal legislation passed in 2020 establishing a new national phone line for suicide prevention and mental health and substance use disorder crises. Call centers will connect people calling or texting 988 with trained counselors and dispatch mobile crisis support teams – staffed by mental health professionals and trained peers instead of police officers — to help a person in crisis.
The Act is named for Miles Hall, a 23-year-old Black man who was shot and killed by officers in 2019 while in the midst of a mental health crisis. His mother, Taun Hall, had spoken to police officers about her son numerous times over several years and had called the local police department the day before the shooting to warn that Miles was having an unstable period. Ms. Hall writes about the pain of losing her son, Miles, and why we need AB 988 in this CalMatters article.
AB 988 takes a monumental step forward in addressing these systemic inequities in our mental health system by decriminalizing our response to mental health, dismantling a major source of systemic injustice and addressing a major driver of homelessness.
The legislation is authored by Assemblymember Rebecca Bauer-Kahan, who represents the district where Miles lived and died; is jointly authored by Marc Berman (D-Menlo Park), Sharon Quirk-Silva (D-Fullerton), Philip Ting (D-San Francisco), Mike Gipson (D-Garden), and James Ramos (D-Rancho Cucamonga); and co-authored by more than two dozen other legislators. It is sponsored by the Steinberg Institute, The Kennedy Forum, Los Angeles County, Contra Costa County, Mental Health America of California, NAMI California, the Miles Hall Foundation, and NAMI of Contra Costa County.
The Mental Health Services Act was designed to foster innovation in county behavioral health departments to ensure Californians with severe mental illness receive the care they need. But without accountability, that innovation isn’t being fully realized. It’s time to utilize what we’ve learned in the 17 years since MHSA’s passage. Measurable goals, increased collaboration across counties and customizable approaches are necessary to ensure that the vision of the Mental Health Services Act is realized.
SB 970 requires the Health and Human Services Agency to convene a technical working group with expertise in developing metrics using available data sources. Based on their recommendations and goals specified in the bill, HHS will establish measurable outcomes from which each county, in consultation with local stakeholders, will identify its priority goals.
Counties will engage in self-assessment, informed by local data and community stakeholder involvement to track their performance on the outcomes, followed by a self-improvement plan and regular progress updates. An online dashboard will make the information easily accessible and allow policymakers and the public to compare counties’ progress. With a focus on continuous quality improvement, counties will receive technical assistance to ensure their success in improving the outcomes.
The state will also provide technical assistance to support counties in reaching their goals. This will leverage state expertise and create a collaborative space for counties to learn from each other.
Our 2022 Legislative Package
Would require a health care service plan or health insurance policy to approve and provide mental health services for detained persons having received a 72-hour treatment and schedule an outpatient appointment within 48 hours of that person’s release. The mental health services for the enrollee must be reasonably close to their business or residence and they will not pay more for the appointment than they would from a contracting provider. As local agencies’ violation of the bill would be a crime, the bill acts as a state-mandated local program.
This bill builds from the existing Knox-Keene Health Care Service Plan Act of 1975, which regulates health care service plans by the Department of Managed Health and health insurers by the Department of Insurance (DOI). This bill is a reintroduction of Levine’s AB 2242 from 2020, which stalled due to the COVID-19 pandemic.
Would require counties, coordinating with CalAIM, to create a warm handoff system for persons with mental illness exiting jails. Currently, county sheriffs are authorized to release incarcerated persons at any time on their last day and to offer a voluntary program for an incarcerated person to stay in jail for 16 additional hours to be discharged to a treatment center. This bill would require a sheriff to make the release standards, release processes, and release schedules of a county jail available to incarcerated persons. While sheriffs are currently required to allow the person to make a telephone call, under this bill, such incarcerated persons are granted 3 free telephone calls from the county jail to plan for a safe release. This bill would impose a state-mandated local program.
Sponsors include the California Judges Association, Public Defenders Association, and Association of Regional Center Agencies.
The State Department of Public Health (DPH) regulates chemical dependency recovery hospitals, facilities that provide 24-hour inpatient care for those with an alcohol or drug dependency. Currently, chemical dependency recovery services are offered on a supplemental basis and in buildings with a “free-standing,” or separate foundation from psychiatric or care hospitals. This bill would allow a chemical dependency recovery hospital to exist within a distinguished acute psychiatric or care hospital, but on a separate floor equipped for substance use services.
This bill is a response to the Mills-Pennisula issue, in which the application for a substance use disorder services on a separate floor of the Mills Health Center was rejected by the Department of Public Health. The bill is sponsored by Sutter Health.
Would target root causes of homelessness at the state level by implementing a state-wide strategic plan to end homelessness through measurable objectives and state accountability. This bill would place the California Interagency Council on Homelessness under the authority of the Office of the Interagency Council on Homelessness, an agency within the Governor’s office under the control of an appointed director. The Governor would appoint the director. The bill describes the office’s duties as coordinating homeless programs, services, data, and policies. The bill requires state agencies, departments with representatives on council, and workgroups created by the council to work with the director of the office.
The bill is authored by Assembly members James Ramos and Luz Rivas. Co-authors include Assembly members Mike Fong, Timothy Grayson, and Sharon Quirk-Silva and Senator Robert Hertzberg. Sponsors include the Corporation for Supportive Housing and Housing California.
Would require the Department of Corrections and Rehabilitation to refer parolees and inmates re-entering the community for substance use disorder treatment (SUDT) if needed. The bill requires the department to enroll all inmates entering parole into Medi-Cal, the state health insurance program for low-income individuals.
This bill is sponsored by the California Council of Community Behavioral Health Agencies.
Would require Medi-Cal Managed Care Plans (MCP’s) to implement inclusive cultural and linguistic outreach to inform Medi-Cal members of their right to mental health services and to educate primary care physicians of such services. Recognizing the disparities that exist in access to and awareness of mental health services in Black, Indigenious and People of Color (BIPOC) communities, this bill requires the Department of Health Care Services (DHCS) to evaluate the quality of care and the disparities that exist in the utilization of mental health services.
This bill is sponsored by CA Pan Ethnic Health Network.
Would require the Department of Public Health (DPH), alongside the Department of Health Care Services (DHCS) and the Department of Social Services (DSS), to establish an online database to collect and reflect real-time information about available beds in inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities, and licensed residential alcoholism or drug abuse recovery or treatment facilities. The database would include basic information about the facility, such as contact information, and allow for searches to find appropriate beds for individuals in a mental health or substance abuse disorder crisis.
The bill is sponsored by the Psychiatric Physicians Alliance of California.
Would annually allocate $1 billion from the General Fund to the Department of Health Care Services (DHCS) for the Behavioral Health Continuum Infrastructure Program. Furthermore, this bill would authorize the DHCS to prioritize qualified entities that construct, acquire, and rehabilitate real estate assets in recently closed hospitals or skilled nursing facilities to receive grants that expand behavioral health treatment resources.
This bill is co-authored by Assembly member Philip Chen.
Would require a health care service plan contract or health insurance policy to provide coverage for coordinated specialty care (CSC) services for first-episode psychosis. CSC is defined as a team-based service delivery method composed of specified treatment modalities and affiliated activities. This bill would require the Department of Health Care Services (DHCS) and the Department of Insurance (DOI) to regulate CSC and create a working group to establish CSC guidelines. The bill requires the health care service plans or health insurers to use specified billing procedures for CSC services.
The bill is an amendment to the state’s parity law.