Steinberg Institute CEO calls for more accountability and oversight in committee testimony

On May 2, 2023, Steinberg Institute CEO Karen Larsen was invited to provide testimony to the California Assembly Select Committee on California’s Mental Health Crisis. 

Greetings. I am proud to have worked in the Mental Health and Substance Use Disorders field for nearly three decades in California, first as a family therapist, then later for 23 years in Yolo County. Thank you for the opportunity to share some remarks with you today.

The Steinberg Institute was created to upend the status quo and dramatically raise the profile and increase the effectiveness of mental health policy-making in California. Founded by Sacramento Mayor and former state Senate President Pro Tem Darrell Steinberg, the institute is an independent nonprofit organization that is dedicated to advancing sound public policy and inspiring leadership on mental health and substance use disorders.

Karen Larsen

Karen Larsen

If you want to get a sense of California’s behavioral health picture, don’t start by looking in the systems created to address challenges. Instead, visit our Jails. Sidewalks. Hospital Emergency Rooms. Instead of finding help, these are where too many folks living with serious mental illness and substance use issues find themselves in California. The question is…why? Today, I’d like to discuss outcomes and accountability and why they are more important than ever.

When I became the Director of Yolo County’s Health and Human Services Agency in 2016, our county was like all other California counties. We were spending money on services, but too many people were not getting the needed care. Agencies didn’t talk to one another or share a common framework for success.

Our problem wasn’t financial. It wasn’t a lack of will. We were working in a system that didn’t prioritize tracking how people were faring. Were they getting better? Finding recovery? We needed to find out.

So we started tracking outcomes. Were the lives of people receiving mental health and substance use services actually improving? We set goals and held ourselves accountable. It worked. Yolo County significantly reduced homelessness, reduced incarceration of people with mental health and substance use disorder, reduced hospitalization, and more. Tracking outcomes empowered and ultimately required our team to adjust our systems and services to become better.

The state did not require Yolo County to do this work, but it should have. I joined the Steinberg Institute a year ago as its first CEO because this keeps me up at night: California’s investment in mental health and substance use services has more than doubled in the past decade, but penetration rates (people actually being helped) haven’t increased at all.

The Steinberg Institute has been a driving force behind legislation resulting in securing billions of dollars addressing the workforce shortage, implementing 988, creating more housing for people with serious mental illness, and supporting prevention and early intervention for California’s youth. We are proud of our work, but now it’s time to look at how effective California’s reforms have been in improving the lives of those receiving care.

We don’t need statistics to see the challenge facing us. A pandemic further exacerbated mental health challenges; substances like fentanyl are rapidly infiltrating communities, and our homelessness crisis continues to grow.

Of course, more funding may be needed to address these challenges, but my experience in Yolo County tells me that today’s critical focus must be on outcomes and accountability. California has never required providers–neither counties nor health plans–to report on outcomes. Without asking the question, “Is someone better off?” and tracking the answer, we will never significantly impact the lives of Californians. We will never be equipped to improve and transform our systems. We’ll just keep pouring money into a broken system.

It’s worth noting that the state is increasing its focus in this area with its Comprehensive Quality Strategy and the administration’s focus on modernizing behavioral healthcare. Still, a framework is needed to evaluate the most meaningful data and publicly tell that story, emphasizing improving lives today.

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