In just more than three years of operation, the Steinberg Institute has had an outsized impact on California’s legislative agenda. Key to our mission is inspiring legislative champions – and 2018 marks another leap forward, with introduction of more than two dozen bills dedicated to improving mental health care in California.
In recent legislative sessions, we have pushed for – and won – decisive gains in the areas of prevention and early intervention in mental illness; housing and treatment for homeless people living with mental illness; crisis support services; veterans support services; law enforcement training; suicide prevention; and college mental health services. We have done so with bipartisan support, reaching across party lines to grow awareness of brain health issues; and through thousands of calls and meetings with elected officials, agency heads, advocacy groups, business leaders and research groups, as we educate, advocate, and build our network of supporters.
We are inspired by the strong cadre of legislative champions who have identified brain health as a priority in 2018. Our sponsored legislative package reflects our continued commitment to scaling up effective prevention and early intervention programs for young people in the early stages of mental illness, so access to care is not limited by region; promoting an integrated system of health care that treats both care for the brain and care for the body with sweep and urgency; strategically growing our mental health workforce; establishing standards for addressing mental health in the workplace; and ensuring a coordinated mental health response in the wake of major traumas and disasters.
SB 1004 is authored by Senators John Moorloch, R-Costa Mesa, and Scott Wiener, D-San Francisco, and co-authored by a diverse array of legislators: Senator Anthony Portantino, D-La Canada; and Assemblymembers Kevin Mullin, D-South San Francisco; Dr. Joaquin Arambula, D-Fresno; David Chiu, D-San Francisco; Susan Eggman, D-Stockton; and Chad Mayes, R-Yucca Valley. The legislation is another major step in our efforts to standardize high-quality Prevention and Early Intervention programs funded by the Mental Health Services Act, ensuring access to quality care across the state.
The bill would require the state Mental Health Services Oversight and Accountability Commission to review and approve county proposals for prevention and early intervention programs. Unless there is evidence of other needs, counties would be required to spend those funds on three program categories: Early psychosis and mood disorder detection and intervention. Mental health outreach, engagement and service delivery to college-aged youth. Childhood trauma prevention and early intervention.
Why these areas? Fewer than half of the counties in California offer the evidence-based models of early psychosis care that are proven most effective in intervening during the early stages of serious mental illness. California’s suicide rate, like the nation’s, remains stubbornly high. And the Adverse Childhood Experiences Study (ACES) shows the importance of early intervention to lessen the impacts of trauma and violence on a young person’s mental health.
The Governor’s January budget projects continued growth of MHSA funds, with an estimate of $2.2 billion in revenue for the 2018-19 fiscal year. More than $400 million of these funds are set aside specifically for PEI programs, but there is a marked and inequitable disparity across the state as to how each county utilizes these funds. Our aim with SB 1004 is to scale up best practices across California.
One in four Californians experience a mental illness in any given year, and yet mental health remains an uncomfortable and often unaddressed topic in workplaces large and small. The result: Employees don’t always seek the care and support they need; and employers sustain substantial economic losses because of reduced productivity, absenteeism, accidents and turnover. We are co-sponsoring SB 1113 in partnership with Senator William Monning, D-Monterey, and the Mental Health Services Oversight and Accountability Commission to establish a voluntary standard for workplace mental health. Our goal is to normalize discussion of mental health in the workplace and establish basic standards for supporting and accommodating workers who live with a mental illness.
The shortage of psychiatrists in the United States has reached crisis levels. In its 2017 report outlining the challenges, the National Council for Behavioral Health projected demand for psychiatry would outstrip services by 25 percent in 2025. The dynamic is evident in California where county mental health departments labor, often in vain, to fill psychiatrist vacancies. According to state records, 23 of California’s 58 counties have fewer than one psychiatrist per 10,000 residents, while six counties have no psychiatrists at all.
Part of the answer lies in tackling the burden of debt that so many students shoulder as they pursue an advanced medical degree. With the California Psychiatric Association, we are co-sponsoring AB 2018, by Assemblymember Brian Maienschein, R-San Diego, to amend statute to allow psychiatric trainees who meet necessary criteria to be eligible for loan repayment during their training. Currently, the state’s primary loan incentive program aimed at enticing students to work in community psychiatry commences loan repayment only after a student has completed residency training and is employed in a community mental health setting. With early loan repayment as an incentive, we can increase the capacity of specialized training programs.
In addition, we are supporting efforts to diversify and elevate other key sectors of the mental health workforce. SB 906, authored jointly by Senators Jim Beall, D-Santa Clara, and Joel Anderson, R-Alpine, would establish a peer certification process in California. A peer provider is a person who draws on lived experience with mental illness and/or substance use disorder and recovery, bolstered by specialized training, to deliver valuable support services in a treatment setting. Across the nation, peer support programs have emerged as an evidence-based practice with proven benefits to both peers and the clients they assist, including reduced hospitalizations, alleviation of depression and enhanced self-advocacy. A peer support program also creates a career ladder so that consumers and family members working in mental health care have the opportunity to fully contribute, translating their experience into meaningful employment. Across California, peer providers are already utilized in many settings. However, there is no statewide standard of practice, consistent curriculum, training standards, supervision standards, or certification protocol. SB 906 would create those standards.
It is no exaggeration to say California’s homeless problem has escalated to a public health crisis. As a state, we hold 25 percent of the nation’s homeless. More than 134,000 people are subsisting on our streets, huddled in alleys and doorways, bushes and riverbanks, finding food, warmth and companionship as they can. Research tells us as many as a third of them are suffering with untreated mental illness. And the misery in no way ends there.
The weight of this crisis is straining our neighborhoods, our businesses, our law enforcement officers and our community conscience. It demands a dramatic, coordinated response from our cities and our state.
AB 3171 by Assemblyman Phil Ting, D-San Francisco, would provide exactly that. It calls for creation of the Local Homelessness Solutions Program, to be funded with a one-time investment of up to $1.5 billion from the state’s budget surplus. The money would be apportioned to cities based on their homeless counts for use on bold, innovative and immediate solutions, including triage shelters, rapid-rehousing programs, rental assistance and permanent supportive housing. To access funds, cities would have to match the allocation, doubling our collective investment.
In addition, we are sponsoring SB 1206 by Senator Kevin de Leon, D-Los Angeles, which would place the No Place Like Home Act on the November 6, 2018, statewide general election ballot. Voters would be given the opportunity to verify that No Place Like Home meets the intent and furthers the purposes of the Mental Health Services Act.
The Steinberg Institute was the proud sponsor of the No Place Like Home initiative in 2016. This legislation secured a $2 billion bond for permanent supportive housing and services for homeless people living with a serious mental illness. But implementation has been indefinitely delayed by the courts. Two years after passage of this historic effort, we are not able to get this vital revenue stream out to counties to provide life-changing housing and treatment to the most vulnerable among us. SB 1206 would ensure that happens.
Too often family members have watched a loved one die on the streets because a brain illness has clouded that person’s ability to understand he or she is in urgent need of medical care. And the state law that defines when people can be taken into custody and compelled to take treatment remains rigidly narrow.
Fifty-one years after its passage, the Lanterman-Petris-Short Act is in dire need of an update. As written, it allows authorities to take people into custody and compel treatment only within a very limited set of circumstances: if that person is judged a danger to himself or others; or is deemed “gravely disabled,” which the law defines as unable to provide for the basic human needs of food, clothing or shelter. It is a bar that has proven too high and subjective.
AB 1971, by Assemblymembers Miguel Santiago, D-Los Angeles, Laura Friedman, D-Glendale, and Phillip Chen, R-Diamond Bar, offers a targeted fix. The measure, which we are co-sponsoring with Los Angeles County, would expand the definition of “grave disability” to include people who are unable to seek urgently needed medical treatment because of their mental illness.
We understand that this legislation is just one piece of a broader network of community care needed for long-term recovery. We are working with our partners to promote parallel efforts to help counties expand the intensive, wrap-around services and supportive housing models that have proven effective.
SB 1125, authored by Senate President Pro Tem Toni Atkins, D-San Diego, would dismantle a regulatory barrier that keeps some of California’s poorest and most vulnerable residents from being able to access services for both mental health and physical health on the same day.
For years now, California has lagged behind other states – and ignored federal recommendations – when it comes to reimbursing Federally Qualified Health Centers and Rural Health Clinics for services provided on the same day to patients who need both physical and mental health care. Across the state, these vital centers provide care to more than 6.5 million patients. The vast majority of their clients live at or below the poverty line, and a substantial number are enrolled in Medi-Cal.
Under current state policy, if a patient receives treatment through Medi-Cal at a community health center from both a medical provider and a mental health specialist on the same day, the State Department of Health Care Services will reimburse for only one “visit,” meaning both providers can’t be adequately reimbursed for their time. A patient must make a return trip for that treatment to count as a second “visit.” As you can imagine, those return trips often never materialize, particularly in low-income communities where taking time off work and finding transportation for health care can prove challenging.
SB 1125 is a simple, straightforward fix to an inequitable policy. It will require the state to allow community health centers to bill Medi-Cal for two visits if a patient is provided mental health services on the same day he or she receives other medical services. This will help ensure early intervention in mental illness and promote an integrated approach to health care that prioritizes both brain and body.
California has borne more than its share of disaster in recent years, from mass shootings to devastating wildfires and deadly mudslides. Research is clear that such trauma has effects on mental health that can grow and linger long after the disaster itself is over. AB 2333, authored by Assemblymember Jim Wood, D-Healdsburg, would help establish a standardized, coordinated response to mental health needs in the wake of disaster, similar to the state’s approach to needs such as food and shelter.
AB 2333 bill would create a mental health Deputy Director position within the Governor’s Office of Emergency Services. The Deputy Director would be charged with preparing for and coordinating trauma-related support in the aftermath of a natural disaster or declaration of a state of emergency. The bill would help ensure that the state includes mental health needs in its broader strategies for supporting and rebuilding communities in the wake of disaster.
Even as death rates from cancer and heart disease fall across the nation, our suicide rate remains stubbornly high. AB 1436, authored by Assemblymember Marc Levine, D-Marin County, would expand the pool of experts trained to recognize the signs of distress. Specifically, it would require the California Board of Behavioral Sciences to ensure that applicants for licensure in the fields of marriage and family therapist, educational psychologist, clinical social worker and professional clinical counselor have completed a minimum of six hours of coursework in suicide risk assessment and intervention.
Find our full 2017 Legislative Package here.
Find our full 2016 Legislative Package here.
Find our full 2015 Legislative Package here.