May 31, 2024
The Honorable Thomas Umberg
1021 O St, Suite 6530
Sacramento, California 95814
Re: SB 26 – as amended 1/11/24
OPPOSE UNLESS AMENDED
Dear Senator Umberg:
The undersigned organizations regret that we must respectfully oppose your SB 26, which would establish the Community Assistance, Recovery, and Empowerment (CARE) Scholarship Program at HCAI, unless it is amended to broaden the scholarship to more comprehensively address mental health workforce needs related to the population SB 26 seeks to serve.
Our organizations share your interest in expanding the workforce available to support individuals living with serious mental illness who are unlikely to survive safely in the community without supports, and whose condition is substantially deteriorating. As you described in your author’s statement about SB 26, many of these individuals are unhoused in our community and face high risks for repeated hospitalization, incarceration, institutionalization, mental health conservatorship, and premature death. The numbers show that California does not have enough mental health professionals, peers, and outreach workers specialized in supporting this population, and we agree that the State must immediately take steps to fill this gap.
In light of this need, we urge you to expand SB 26 to incentivize mental health professionals to serve in an array of roles and programs evidenced to meet the needs of individuals with serious mental illness and housing instability. The undersigned organizations will oppose SB 26 unless it is amended to expand the proposed scholarship program to accept applicants who agree to work for a county behavioral health agency for at least 3 years in support of any of the county’s programs to treat individuals with serious mental illness and housing instability, not just CARE Court as SB 26 currently proposes.
In addition to our proposed amendments, we recommend expanding scholarship opportunities to assist the certification of other critical types of professionals who serve individuals with serious mental illness and housing instability, such as certified peer support specialists.
Counties across California have myriad unfilled job postings for licensed mental health professionals to serve this exact population in outpatient care, outreach and case management roles, crisis response
programs, and other settings. Counties are also working to roll out new mental health programs that will require significant personnel, such as mobile crisis teams. However, SB 26 proposes to only incentivize licensed mental health professionals to serve in roles related to CARE Court, a new program that has no evidence basis or proven results, while leaving counties still unable to fill roles in their existing and other emerging programs.
This year, the challenging budget climate will limit the new programs state agencies can create, and many existing safety-net mental health programs are at risk due to changes to the Mental Health Services Act. It is critical that California builds systems that stabilize and strengthen its existing mental health programs and all its new initiatives, rather than hyper-focusing workforce development and funding efforts on untested CARE Court initiatives.
Our commitment to these proposed amendments is further reinforced by our conviction that CARE Court is the wrong approach to address the growing houselessness and mental health crises in California and is likely to do real harm to the populations it aims to help. Our concerns are deepened by the striking lack of research evidence for any clinical or social benefits deriving from court-ordered outpatient programs such as CARE Court when compared to voluntary community-based treatment. California and its counties are already dedicating overwhelming funding and operations resources to CARE Court while other, less restrictive, more effective approaches flounder for lack of funding and personnel. Let us not also take this faulty approach to addressing mental health workforce shortages.
We should consider whether counties’ difficulty finding mental health professionals to work in CARE Court programs is rooted in reasons deeper than the mental health workforce crisis. Arguably, the court-based and coercive setting of CARE Court programs conflicts with the core principles of many mental health professions, who have a duty to provide services in the least restrictive environment. For example, as articulated in their professional code of ethics, social workers have an ethical responsibility to “respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals.” Emerging professionals may be unwilling to provide services in an environment that invites moral and ethical conflict and lacks evidence basis for success, but perhaps would be willing to work in other county programs serving the same population if they had financial incentive to do so via SB 26 as we propose to amend it.
For these reasons, our organizations will respectfully oppose SB 26 unless it is amended to broaden the scholarship applicant pool and address workforce shortages across all county-based programs that serve high-risk individuals living with serious mental illness.
Sincerely,
Carmen-Nicole Cox, Director of Government Affairs
ACLU California Action
Danny Thirukal, Public Policy Coordinator
California Youth Empowerment Network (CAYEN)
Deb Roth, Senior Legislative Advocate
Disability Rights California
Karen Vicari, Director of Public Policy
Mental Health America (MHA) of California
cc: Members and Committee Staff, Assembly Health Committee