Our public policy team is pressing forward with a package of sponsored bills that so far has garnered strong support from legislators on both sides of the aisle. It’s a bold agenda that advances some key themes: scaling up best practices for prevention and early intervention in mental illness; marshaling far more resources to combat the state’s crisis of homelessness; continuing the push toward a system of care in which mental health is treated with the same sweep and urgency as physical health; and growing our mental health workforce. Below is a snapshot of our priorities for the 2018 legislative session. You can access the full agenda here.
Prevention and Early Intervention
SB 1004 by Senators Scott Wiener and John Moorlach would bring strategic focus to how California spends more than $400 million each year on prevention and early intervention services. The measure would require counties to spend their PEI funds on three core areas of need: early psychosis and mood disorder detection and intervention; outreach and engagement for college-aged youth; and childhood trauma-informed care. What’s our aim? To maximize impact of our PEI spending, scale up programs that work, and ensure access to timely, quality mental health care is not limited by ZIP code.
Mental Health in the Workplace
One in four Californians experience a mental illness in any given year, and yet mental health remains an uncomfortable topic in the workplace. The result: Employees don’t always seek the care and support they need; and employers sustain substantial economic losses because of absenteeism, accidents and turnover. We are co-sponsoring SB 1113 by Senator William Monning to establish the nation’s first voluntary standards for workplace mental health. The bill would authorize the Mental Health Services Oversight and Accountability Commission to work with public and private employers, employee groups, consumers, and mental health experts to create voluntary guidelines to combat stigma and normalize discussion of mental health in the workplace. Here’s our Government Affairs Director Adrienne Shilton testifying on the bill before Senate Health.
https://youtu.be/MTYtbXIVMw4
Stemming a Public Health Crisis
It is no exaggeration to say California’s homeless problem has escalated to a public health crisis. More than 134,000 people are subsisting on our streets, finding food, warmth and companionship as they can. Research tells us as many as a third of them are suffering with untreated mental illness. AB 3171 by Assemblyman Phil Ting, D-San Francisco, calls for creation of the Local Homelessness Solutions Program, to be funded with 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 immediate, effective solutions, including triage shelters, rental assistance and permanent supportive housing. To access funds, cities would have to match the allocation.
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, ballot for validation by voters. 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. SB 1206 would bypass the legal hurdles so we can get this vital revenue stream out to counties.
Expanding the Definition of “Gravely Disabled”
Fifty-one years after its passage, the Lanterman-Petris-Short Act is in 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. This bar has proven too high and subjective. Every year, hundreds of people die on the streets in California because their mental illness has clouded their ability to seek life-saving medical care for a treatable physical illness.
AB 1971, by Assemblymembers Miguel Santiago, D-Los Angeles, Laura Friedman, D-Glendale, and Phillip Chen, R-Diamond Bar, would expand the definition of “grave disability” to include people who are unable to seek urgently needed medical treatment because of their mental illness.
A Safety Net After Disaster
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.
Toppling Barriers To Same-Day Billing
For years now, California has lagged behind other states 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.
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 Department of Health Care Services will reimburse for only one “visit,” meaning both providers can’t be adequately reimbursed. A patient must make a return trip for that treatment to count as a second “visit.” SB 1125, authored by Senate President Pro Tem Toni Atkins, D-San Diego, would 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.
Growing the Mental Health Workforce
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 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 allow psychiatric trainees who meet necessary criteria to be eligible for loan repayment during their training. 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, bolstered by specialized training, to deliver valuable support services in a treatment setting. Across California, peer providers are already utilized in many settings. SB 906 would help scale up best practices by establishing a statewide standard of practice, consistent curriculum and training standards.