Progress for Mental Health in California
If you're not familiar, CA SB855 just went into effect on January 1st, 2021. This bill requires medical insurance providers to provide coverage for medically necessary treatment for mental health and/or substance abuse disorders. SB855 will strengthen the recognition of mental health disorders as a medical necessity under the California Parity Act that went into effect in 1999. The California Parity Act was a significant step in the right direction but with one major flaw... It didn't specify mental health or substance abuse disorders as medical conditions. Under SB855, several non-profit organizations will determine medical necessity criteria vs. the health insurance companies. The idea is to increase access to necessary mental health and substance abuse treatment. It will also help ensure that people get adequate treatment, not just the least expensive options.
It is estimated that 1 in 5 adults in the US struggle with mental health disorders (pre-pandemic), and 1 in 13 individuals 12 and over experience substance abuse disorder. Often, this substance abuse starts to self-medicate to numb the pain, quiet the voices of a person with Schizophrenia or help the ADHD adult who has been brushed off as 'drug-seeking' to seek out other substances in an attempt to function. This lack of treatment can be costly, not only for individuals who may find themselves incarcerated, homeless, or some combination of the two. It costs you, the taxpayer, even more money than it would be addressing the problem in the first place.
I can tell you firsthand that I saw this while working for the mental health program, Genesis, at Loaves & Fishes in Sacramento. I provided therapy for homeless individuals, but I also worked closely with the Sacramento Downtown Partnership to do homeless mental health outreach. Homeless individuals are misunderstood; they're often quickly judged as "drug addicts" or "criminals." Many of them didn't start that way; they're someone's family member. A few individuals stand out for me; I will change their names for privacy.
Sally could often be found in a doorway screaming profanities and threatening to harm someone. People were afraid; they would make sure to keep a distance or would cross the street. Sally was written off as dangerous and most likely on drugs by those who passed by her. However, this was not the case at all. Sally was a grandmother who worked most of her life, providing for her children as a single mother. Sally has Schizophrenia; this made it very hard for Sally to keep her job and her home. Sally and those around her didn't know what was going on or how to help her. Sally never used drugs but was considered to be under the influence due to her behaviors. Sally was the sweetest woman if you took the chance to talk to her; she welcomed interaction and the distraction from the voices in her head telling her how disgusting she was. I worked for over two years to gain her trust enough to allow me to coordinate with my colleagues to get her to the treatment facility to get antipsychotic medication to help her. Unfortunately, this never came to fruition due to the significant barriers for homeless individuals to get appropriate treatment.
Paul, he a successful businessman in his younger days. He even owned a multi-million dollar home in the Bay Area. This home was sold by his family, who had power of attorney. The money from the sale was put in an account he couldn't access, and he was given an "allowance" regularly to help with basic needs while he remained homeless. You see, Paul too had significant mental health problems and was a very kind and generous man who was often a target of financial fraud by others on the streets. It wasn't safe for him to have access to large amounts of money. He did get caught up in substance abuse while on the streets, only exacerbating his mental health problems even more. He later died on the streets despite having a family who supported him and wealth.
I have so many more stories I could tell you about these individuals, but I will limit it. These individuals would not have had to suffer as much if our mental health care system wasn't so broken. I believe that Reagan had good intentions in closing the state-run hospitals because there was widespread abuse and corruption. However, the solution didn't work. This isn't a popular opinion, but mental health institutions are the best bet for some individuals. You certainly can't tell me that allowing them to continue to be homeless is a better alternative. Another unpopular opinion, the housing first emphasis to end homelessness also doesn't work. You can’t put people in housing without support to access the care they need and expect them to be successful. Without this support, the situation isn't sustainable, and frequently, these individuals are evicted and back out on the streets. We need comprehensive programs to help individuals get back on track, empower them to take control of their lives, and achieve stabilization.
Ok back on track because this blog wasn't intended to be about homelessness. But you really can't talk about one without the other. That brings me to an additional bill, SB221. SB221 is currently in the Senate Appropriations Committee to review the amendments as of this blog's writing. On March 17th, it was voted 9-0 in favor of by the Committee on Health.
SB221 is a bill that would require health insurers to provide timely access to return appointments for mental health and substance abuse within 10 business days. It would also require that a referral to a specialist by another provider meet the same standards. SB221 also stipulates that if there is a shortage of in-network providers in the area, coverage would have to be arranged for an out-of-network provider. While this is excellent progress and something I am very passionate about, it also presents additional feats. California is experiencing a severe shortage of mental health providers, even before the pandemic. The pandemic has only exacerbated the increased need for providers. We need to make going into mental health as a provider more attractive and worthwhile for many. Increasing the number of Master's level programs available statewide would help. Providing financial incentives to help offset tuition costs is another idea. For instance, the bill that allows for student loan forgiveness for mental health providers is very confusing and has many unnecessary limitations for qualification.
I am not sure what other large providers are doing. I know that Kaiser is making an effort to improve the candidate' pool by providing its employees (even part-time) tuition assistance to attend one of these programs. Last year they launched a Master's level program in collaboration with several universities and are paying 75% of the tuition. Later this year, they are expanding the program to include Doctorate level programs as well. Again this will consist of coverage of 75% of the tuition. While this is an attractive opportunity for most, this will only make a small dent in the deficit. We need more opportunities from other organizations.
As you can see, there is a lot of progress happening in California when it comes to mental health and substance abuse treatment access. These are exciting times! However, it is only the beginning. The process won't happen overnight. If you are considering a career in mental health, I will tell you now is a better time than ever to jump in. We need you, patients need you, and the state needs you as a whole you.
If you have any questions or would like to suggest a topic for a future blog, you can reach out to me by email at Colleen@ScatteredPotential.com, subscribe to my blog or my newsletter by filling out the form below. Follow me on Facebook, Twitter, and Instagram.