The Steinberg Institute begins 2021, our seventh year of operation, with an ambitious legislative agenda and an elevated awareness of the urgency of our task. This past year was a year none of us will ever forget, a year when millions of people across the state experienced enormous stress and dislocation as well as physical and psychological suffering as a result of the COVID-19 pandemic.
While we are beginning to make progress getting people vaccinated, we know this pandemic is still far from over, that is has disproportionately impacted communities of color and that the pain it is causing may be with us for years to come. That knowledge fuels our determination to create policies that will ease the suffering and address the inequities.
Last year were able to achieve two of our biggest priorities by winning the passage of measures that will make it easier for people to get care, as well as to provide it:
We are grateful to the legislature for overwhelmingly passing these bills and to Governor Newsom for signing them.
This year, we have two overarching priorities for our work. One is to create a statewide crisis response system to handle mental health emergencies. We want to transform the ways local authorities in California respond to people experiencing mental health emergencies so that we stop asking police officers to do a job they are ill-equipped for, and we stop sending people suffering from mental health crises to jails.
The second is to get the state and local governments to act with a greater sense of urgency in the effort to provide housing and care for homeless people. We have seen during this pandemic that large numbers of people can be brought indoors, and they can be provided with the social supports and mental health care they need. It shouldn’t require the threat of a deadly disease to make this happen.
Will transform the way California responds to mental health emergencies to ensure those in crisis receive the urgent care they need. The new system will use a three-digit, easy-to-remember phone number — 988 — that people can call when they, a family member or friend are experiencing severe mental distress.
AB 988 will implement federal legislation passed in 2020 establishing a new national phone line for suicide prevention and mental health 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 bill mandates that calls to 911 reporting a mental health crisis be transferred to 988 and that operators for both lines have the capacity to coordinate if medical, fire or law enforcement responders are needed.
The Act is named for Miles Hall, a 23-year-old African American 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. Taun 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), David Chiu (D-San Francisco), Sharon Quirk-Silva (D-Fullerton), and Philip Ting (D-San Francisco); and co-authored by more than a dozen other legislators. It is sponsored by the Steinberg Institute, The Kennedy Forum, Contra Costa County, NAMI of Contra Costa County, and the Miles Hall Foundation.
Would demand of state and local officials a heightened sense of urgency and accountability around one of the great moral failings of our time – mass homelessness.
Before the coronavirus pandemic, an estimated 150,000 people in California were homeless
and at least 24% of them were living with a severe mental illness. The numbers also reflect unacceptable racial disparities: African Americans, for example, make up just 6.5 percent of the state’s overall population but almost 40 percent of the homeless population. These are simply unacceptable numbers.
AB 816 requires local government and the state to develop a real, actionable plan to reduce homelessness by 90 percent by 2030 and to ensure that, at every step along the way, racial and ethnic disparities in the numbers of homeless people are tracked and eliminated. It would create a Homelessness Inspector General, who can bring a legal action against the state or local governments for failing to submit or implement a plan.
AB 816 is authored by Assemblymember David Chiu and jointly authored by Richard Bloom (D-Santa Monica), Rob Bonta (D-Oakland), Sharon Quirk-Silva (D-Fullerton), Miguel Santiago (D-Los Angeles), and Buffy Wicks (D-Oakland) and sponsored by the Steinberg Institute, the Corporation for Supportive Housing, Housing California, and Sacramento Mayor Darrell Steinberg, co-chair of the Governor’s Council of Regional Homeless Advisors.
Also addresses California’s crisis of homelessness by increasing corporate tax rates on companies with annual profits of $5 million or more and dedicating the revenue to building housing and other proven strategies that reduce homelessness – and prevent more Californians from falling into it.
The bill will generate at least $2.4 billion annually to fund housing development, divided between cities and counties. It also will restructure the state’s Homeless Coordinating and Financing Council so that it is composed of the directors of various state agencies, instead of people appointed by the governor and legislature.
The council will collect data on housing providers serving homeless people and on the number of people experiencing homelessness in local jurisdictions, including their racial and ethnic backgrounds, as well as other information about their backgrounds and needs. The council will work with the State Office of Housing and Community Development to allocate the funds in two-year cycles.
The bill is authored by Assemblymember Rivas and jointly authored by Richard Bloom (D-Santa Monica), David Chiu (D-San Francisco, and Buffy Wicks (D-Oakland). AB 71 is sponsored by the Steinberg Institute; Corporation for Supportive Housing; Housing California; the City of Los Angeles and Mayor Eric Garcetti; the City of San Francisco and Mayor London Breed; the City of Oakland and Mayor Libby Schaaf; All Home; Brilliant Corners; Episcopal Community Services-San Francisco; HOPICS; John Burton Advocates for Youth; National Alliance to End Homelessness; Non-Profit Housing Assn. of Northern California; and United Way of Greater Los Angeles.
AB 32 (Aguiar-Curry, D-Winters) Parity for telehealth services in Medi-Cal
Would require Medi-Cal, the state health insurance program for low-income people, to pay for health care services furnished by an enrolled clinic using telehealth technology on the same basis and at the same rate as if those services had been provided in person. During the coronavirus pandemic, health care providers were given greater flexibility to use telehealth as a way to provide care to patients while reducing the risk of infection. This bill would continue indefinitely that flexibility and require the State Department of Health Care Services to seek expert input, conduct an evaluation, and provide recommendations to the legislature on how telehealth should best be used and paid for in the future.
The bill is authored by Cecilia Aguiar-Curry and co-authored by Assembly Members Arambula, Bauer-Kahan, Burke, Cunningham, Cristina Garcia, Petrie-Norris, Quirk-Silva, Blanca Rubio, and Santiago.Sponsors include the California Association of Public Hospitals and Health Systems, California Health+ Advocates/California Primary Care Association, California Medical Association, Essential Access Health, and Planned Parenthood Affiliates of California.
AB 451 (Joaquin Arambula, D-Fresno) Emergency psychiatric treatment
Would require that psychiatric units within hospitals that accepts patients in order to evaluate whether they are suffering from an acute psychiatric condition to also treat that patient. The measure is intended to minimize the unnecessary transfer of patients from one facility for diagnosis to another for treatment.
AB 573 (Wendy Carillo, D-Lakewood) Youth Mental Health Boards
Would establish a 15-member state youth mental health board within the Health and Human Services Agency to advise the Governor and Legislature on challenges facing youth with mental health needs and suggest improvements. The members must be aged 15 to 23, at least half of whom are consumers of mental health services or their siblings. It would also require community mental health service agencies to have their own youth mental health boards, also made up of young mental health consumers.
AB 942 (Jim Wood, D-Santa Rosa) Specialty mental health services and substance use disorder treatment
Would require the State Department of Health Care Services to assist counties in preparing for the statewide implementation of CalAIM, which reorganizes the delivery of behavioral health services within Medi-Cal to reduce barriers faced by people with complex needs. The bill would establish a Behavioral Health Quality Improvement Account to fund these services, which are aimed at helping patients get screened, assessed and treated.
AB 1011 (Marie Waldron, R-Escondido) Health coverage for substance use disorders
Would require health insurers to cover all medically necessary prescription drugs approved by the FDA for treating substance use disorders and to place those drugs on the lowest cost-sharing tier of the insurer’s plan or drug formulary. It also restricts insurers’ ability to impose barriers such as requirements for prior authorization or step therapy. The bill is co-authored by Scott Winer (D-San Francisco).
AB 1051 (Steve Bennett, D-Ventura) Mental health services for foster youth
Would establish presumptive eligibility for Medi-Cal for foster youth placed outside of their county.
AB 1178 (Jacqui Irwin, D-Thousand Oaks) Increasing access within Medi-Cal to prescription drugs
Would eliminate the requirement for prior authorization for prescription drugs for treating severe mental illness and allow for a 90-day supply of medications to a patient.
SB 14 (Anthony Portantino, D-La Cañada) Student mental health
Would allow students to take an excused absence for behavioral health conditions. Would also require school districts to provide training on youth behavioral health to at least half of their classified and certificated school employees who have direct contact with pupils, using a state-identified evidence-based training program. Principal coauthor: Assemblymember Lo. Coauthors: Senators Pan, Rubio, and Umberg; Assembly Members Cunningham, Lee, and Quirk-Silva. Sponsors: Disability Rights California and California Behavioral Health Agencies.
SB 106 (Umberg, D-Santa Ana) MHSA Flexibility
Will make it easier for counties to spend hundreds of millions of dollars from the Mental Health Services Act (MHSA) that were earmarked for “Innovation” programs but have gone unspent and are sitting in county accounts. The Innovation category is aimed at finding new and different ways to provide services, but counties are not always able to create the programs and spend these funds. The bill would make it easy to transfer these funds so they can pay for another proven model known as full-service partnerships (FSPs), which provide intensive, highly flexible and individualized outpatient care for severely mentally ill patients. SB 106 would pre-approve the transfer of Innovation funds as long as they are used to create or expand FSPs.
The bill is co-authored by Senator Eggman.
SB 221 (Scott Wiener, D-San Francisco) Timely access to follow-up mental health services
Would require that health providers and insurers schedule follow-up appointments with psychotherapists or other non-physician specialists within ten days of an initial appointment for a non-urgent mental health or substance use disorder.
Providers are now required to schedule an initial appointment with a clinician within 10 days of a person seeking help. But after that first appointment, it can often take weeks for people to get a follow-up appointment, seriously disrupting their ability to get the help they need. If a health plan is unable to set up a follow-up appointment within 10 days using their own contracted providers, they would be required to provide access to clinicians outside their network at network rates. The bill also establishes a timeline for other types of behavioral health services.
The bill is co-authored by Senators Leyva, Kamlager and Newman and Assemblymembers Arambula and Waldron. It is sponsored by the National Union of Healthcare Workers.
SB 224 (Anthony Portantino, D-La Cañada and Susan Rubio, D-Baldwin Park) Mental health education for K-12 students
Would require K-12 students in public schools to receive mental health education from a qualified instructor at least once during elementary school, once during middle school or junior high, and once during high school. The instruction would address, in an age-appropriate way, overarching themes and core principles of mental health.
The bill is co-authored by Senators Cortese, Glazer, Hueso, Hurtado, Laird, Nielsen, Ochoa Bogh, and Umberg, and Assemblymembers Burke, Frazier, Cristina Garcia, Lackey, Nguyen, Rodriguez, and Santiago. It is Sponsored by CA Youth Empowerment Network, CA Alliance of Child and Family Services, CA Children’s Partnership, National Alliance on Mental Illness, and National Center for Youth Law.
SB 284 (Henry Stern, D-Los Angeles) Worker compensation for crisis responders with post-traumatic stress
Would expand the number of emergency response workers eligible to receive workers’ compensation benefits when they develop post-traumatic stress disorder in the course of their jobs and work. Under current California law, when firefighters and police officers develop PTSD on the job, the disorder is presumed to be work-related, and they are entitled to full worker’s compensation benefits. This bill would extend these benefits to a list of other public employees including public safety dispatchers, public safety telecommunicators, and emergency response communication employees, among others.
SB 317 (Henry Stern, D-Los Angeles) Competence to stand trial
Would change current law governing the treatment of people accused of crimes who are thought to be mentally ill. Under the provisions of the bill, if a defendant was found incompetent to stand trial on a misdemeanor charge, the court would be able to refer that defendant to diversion or community treatment programs, consider a referral to a conservatorship proceeding or dismiss the charges. If a defendant is confined pending a trial in a state hospital or treatment facility, they would be eligible for partial credit against a subsequent sentence for the time they spent in the facility. The bill is sponsored by the California Public Defenders Association.
SB-428 (Melissa Hurtado, D-Sanger) Health care coverage for adverse childhood experiences screenings
Would require private health insurers to cover screening for adverse childhood experiences (ACEs).
SB 782 (Steven Glazer, D-Orinda) Expanding the ability to seek mandated assisted outpatient treatment
Would allow county behavioral health directors to file a petition in Superior Court seeking an order to compel assisted outpatient treatment for a person exiting a conservatorship and would expand the categories of people who could ask the director to seek such a petition.
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