Position Category: MHAC

SB 999 (Cortese) Mental Health and Substance Use Disorders Health Coverage – Support

March 18, 2024

The Honorable Dave Cortese
California State Senate
1021 O Street, Suite 6630
Sacramento, CA 95814

RE: Senate Bill 999 (Cortese) — Support

Dear Senator Cortese:

Mental Health America of California (MHAC) is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues through voluntary services that are delivered in their local community with compassion and respect for everyone’s dignity and autonomy. MHAC is pleased to support Senate Bill 999 (Cortese), legislation which would increase access to mental health and substance use disorder care.

SB 999 (Cortese) ensures utilization review determinations are made by a healthcare provider practicing in the relevant clinical specialty with the same level of education and experience as the health care provider requesting the authorization. By ensuring that individuals making the utilization review determination have relevant experience and knowledge as a provider, a more informed decision can be made about the necessity of the request, which can lead to more individuals receiving the care they want and need.

Additionally, this bill requires health plans or insurers to provide direct access and communication between health plans or insurers and health care providers. Increasing access to direct communication reduces the time it takes to conduct a utilization review and increases the delivery of care in a timely manner.  

Furthermore, the legislation guarantees certain rights to healthcare providers and health plan enrollees such as the name and credentials of the individual or health care provider performing utilization review, the basis for a denial including citations to the clinical guidelines reviewed, and an analysis of why the health plan enrollee did not meet the clinical criteria. Should a utilization review result in denial, a health plan enrollee can appeal using the provided information, empowering individuals to self-advocate for their care.  

For these reasons, we support Senate Bill 999 (Cortese). If you or your staff have any questions, or if Mental Health America of California can be of any assistance on this or any other behavioral health bill, please do not hesitate to contact me at hstrunk@mhac.org, or our Director of Public Policy, Karen Vicari at kvicari@mhacofca.org.

In Community,

Heidi Strunk
President & CEO
Mental Health America of California

SB 26 (Umberg) Community Assistance, Recovery, and Empowerment (CARE) Scholarship Program at HCAI – Oppose

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

AB 2466 (Carrillo) Timely Access to Behavioral Health Services for Medi-Cal Recipients – Support

April 5, 2024

The Honorable Mia Bonta
Chair, Assembly Health Committee
California State Assembly
1020 N Street, Room 390
Sacramento, CA 95814

Re: Support for AB 2466 (Carrillo)

Dear Chair Bonta:

Mental Health America of California (MHAC) is pleased to support AB 2466 (Carrillo), legislation which would improve timely access to behavioral health services for Medi-Cal recipients by strengthening appointment standards, establishing repercussions for non-compliance, and establishing requirements for data collection and reporting.

MHAC is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues through voluntary services that are delivered in a timely manner in their local community with compassion and respect for everyone’s dignity and autonomy. 

Delays in the delivery of services can mean the difference between managing one’s mental health challenges and experiencing a mental health crisis. According to an audit of the Department of Managed Health Care, non-urgent appointments had an average wait time of 23 days, surpassing the standard time frame by nearly two weeks.[1] Urgent appointments saw an average wait time of 13 days, exceeding the standard urgent appointment time frame by 9 days.

AB 2466 (Carillo) aims to address these delays and ensure accountability among Medi-Cal managed health plans. For these reasons we support AB 2566 and ask for your “Aye” vote. If you have any questions, or if MHAC can provide any assistance on this bill or any other behavioral health legislation, please do not hesitate to contact me or our Interim Public Policy Director, Karen Vicari, at kvicari@mhaofca.org.

In Community,

Heidi L. Strunk
President & CEO

[1] Department of Health Care Services and Department of Managed Health Care. Report 2023-115. (n.d.). https://www.auditor.ca.gov/reports/2023-115/index.html

AB 2417 (Hoover) Repealing Housing First – Oppose

March 18, 2024

The Honorable Christopher M. Ward
Chair, Assembly Committee on Housing and Community Development
1020 N Street, Room 156
Sacramento, CA 95814

RE: Opposition of AB 2417 (Hoover)

Dear Assemblymember Ward,

Mental Health America of California (MHAC) writes in opposition to AB 2417 (Hoover), legislation that would repeal Housing First policies and the requirement of state agencies and departments to incorporate the core components of Housing First.

MHAC is a peer-run organization leading the state in behavioral health public policy and
advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues through voluntary services that are delivered in their local community with compassion and respect for everyone’s dignity and autonomy. Housing First plays a vital role in advancing MHAC’s mission and vision of enhancing individual recovery by safeguarding and emphasizing housing and services for homeless individuals facing behavioral health challenges.

Many unhoused individuals are susceptible to substance use and mental health challenges while living on the streets. An analysis of the U.S. Department of Housing and Urban Development’s Continuum of Care Program found that 25% of unhoused Californian’s have a mental health challenge.[1] As California continues to invest in resources that best support our unhoused community, housing remains the most effective tool in getting people off the street and connected to mental and behavioral health services.

Housing First reduces obstacles for unhoused individuals to access housing assistance and shields them from eviction stemming from their behavioral health issues. These safeguards encompass shielding individuals from housing discrimination, irrespective of their substance use, treatment history, or engagement in services. Additionally, it ensures protection from eviction solely based on alcohol or drug use, without the presence of other lease violations.

It is for these reasons we oppose AB 2417 (Hoover) and ask for your “No” vote. If you have any questions, or if MHAC can provide any assistance on this bill or any other behavioral health legislation, please do not hesitate to contact me or our Interim Public Policy Director, Karen Vicari, at kvicari@mhaofca.org.

In Community,

Heidi L. Strunk
President & CEO

[1] U.S. Department of Housing and Urban Development. (n.d.). CoC Homeless Populations and Subpopulations Reports. Welcome to HUD Exchange – HUD Exchange. https://www.hudexchange.info/programs/coc/coc-homeless-populations-and-subpopulations-reports/

AB 2161 (Arambula) Early Psychosis Intervention Plus Program – Support

May 31, 2024

The Honorable Joaquin Arambula
California State Assembly
1021 O Street, Suite 6130
Sacramento, CA 95814

RE: Support for AB 2161 (Arambula)

Dear Assemblymember Arambula, 

Mental Health America of California (MHAC) is pleased to support Assembly Bill 2161, legislation which would require the Behavioral Health Services Oversight and Accountability Commission and the State Department of Health Care Services to create a strategic plan to achieve specific goals, including improving the understanding of psychosis. Additionally, it would seek to partner with the University of California to develop a plan to establish the Center for Mental Health Wellness and Innovations to promote the widespread availability of evidence-based practices to improve behavioral health services.

MHAC is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues through voluntary services that are delivered in their local community with compassion and respect for everyone’s dignity and autonomy.  We are proud to support early psychosis and mood disorder detection, enabling the state to invest in voluntary services and support before crises arise.

Early interventions can lead to significant long-term health benefits. Upstream preventative services have demonstrated effectiveness in reducing the need for inpatient care, allowing individuals to remain in their local communities, closer to home. Furthermore, providing resources and services as early as possible helps support children and youth development to better manage their mental health challenges leading to more productive and full lives.

For these reasons we support AB 2161 (Arambula). If you have any questions, or if MHAC can provide any assistance on this bill or any other behavioral health legislation, please do not hesitate to contact me or our Public Policy Director, Karen Vicari, at kvicari@mhaofca.org.      

In Community, 

Heidi L. Strunk 
President & CEO

AB 2142 (Haney)Therapy in Correctional Facilities – Cosponsored

March 28, 2024

The Honorable Kevin McCarty
Chair, Assembly Committee on Public Safety
California State Assembly
1020 N Street, Room 111
Sacramento, CA 95814

Subject: Cosponsor Support for AB 2142 (Haney)

Dear Assemblymember McCarty,

Mental Health America of California (MHAC) is pleased to cosponsor AB 2142 (Haney), legislation which would create a pilot program at select prisons to ensure that behavioral health therapy is accessible to incarcerated people who do not have a California Department of Corrections and Rehabilitation (CDCR) severe mental health disorder classification. As a result, this bill would increase access to behavioral health services to individuals not currently eligible to receive them.  

MHAC is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues through voluntary services that are delivered in their local community with compassion and respect for everyone’s dignity and autonomy. Everyone, even individuals who are justice involved, have a right to recovery and should not be denied behavioral health services that could prevent self-harm, improve wellness and reduce recidivism.

According to a 2022 CDCR report, 45.5% of recorded prison suicides were among the Hispanic population, while 27.9% were among African Americans.[1]  These significant disparities underscore the lack of support reaching our most underserved communities. Furthermore, 67,000 incarcerated Californians have no access to any mental health care at all, rendering them unable to process trauma, work on addiction, and address other behavioral health issues. AB 2142 offers a mechanism to broaden preventive services to these individuals, without being classified as having a serious mental health condition, thereby reducing the likelihood of crises. This preventative measure can help identify and support underserved communities and ensure delivery of culturally responsive support and services. The access to preventive services is essential for addressing the trauma individuals experience before and during incarceration.

For these reasons, we support AB 2142 and ask for your “Aye” vote. If you have any questions, or if MHAC can provide any assistance on this bill or any other behavioral health legislation, please do not hesitate to contact me or our Interim Public Policy Director, Karen Vicari, at kvicari@mhaofca.org.

In Community,

Heidi L. Strunk
President & CEO

[1] 2022 annual report on suicides and suicide prevention … (n.d.). https://cchcs.ca.gov/wp-content/uploads/sites/60/2022-Annual-Report.pdf

AB 2051 (Bonta) PSYPACT – Sponsor

March 5, 2024

The Honorable Marc Berman, Chair
Assembly Committee on Business and Professions 1020 N Street, Room 379
Sacramento, CA 95814

Subject: AB 2051 (Bonta) PSYPACT – Sponsor

Dear Chair Berman,

Mental Health America of California and the Steinberg Institute are proud to co-sponsor AB 2051 (Bonta) to add California to the Psychology Interjurisdictional Compact (PSYPACT), which will increase Californian’s access to behavioral services at a critical time when we are facing both a mental health crisis and a workforce shortage. We respectfully request your support when this bill comes before you.

Today, nearly one in six Californians is experiencing some form of mental health challenges, but access to care is devastatingly limited. According to a 2018 poll by the California Health Care Foundation and the Kaiser Family Foundation, only 23% of Californians received the mental health services they needed. This disparity between need and access to care is in large part due to the ever- worsening behavioral health workforce shortage.

Due to the workforce shortage, California cannot meet the growing demand for behavioral health services. Attrition across the industry will exacerbate this shortage in the years to come. According to the Steinberg Institute, to meet the growing need for behavioral health services and attrition across the field, California will need to add nearly 375,000 workers over the next decade, or 32,000 workers a year. Specifically, California will need to add approximately 30,000 psychologists to California’s workforce over the next 10 years.

When Californians do find a psychologist, they cannot see them when they are travelling out of state, or if they relocate to another state, disrupting their care. This is critically important for young adults who move out of the state to attend college. The current psychology workforce and existing laws surrounding the practice of psychology do not adequately address or accurately reflect the needs of Californians.

Occupational licensure compacts are one way that we can address the behavioral health workforce shortage and get Californians the care they need now. Through licensure compacts, states establish and agree upon uniform standards that enable multi-state practice. There are currently 15 Occupational Licensure Compacts recognized by the National Center for Interstate Compacts.

PSYPACT, the occupational licensure compact for psychologists, was created by the Association of State and Provincial Psychology Boards (ASSPB) in 2014. To date, 40 states have enacted PSYPACT legislation, joining the compact. By providing a means for psychologists to practice across state lines, PSYPACT increases access to care and allows for continuity of care when patients or providers relocate or travel. Because all compact states enact the same model legislation, PSYPACT promotes cooperation between states and provides a means for telepsychology regulation and consumer protection.

California can’t afford not to join PSYPACT. We must use all tools at our disposal to address our behavioral health workforce shortage and ensure clients have continuity of care. For these reasons, Mental Health America of California and the Steinberg Institute are proud to co-sponsor AB 2051 and respectfully request your support when this bill comes before your committee. If you have any questions, please feel free to contact Karen Vicari at kvicari@mhaofca.org and Tara Gamboa-Eastman at tara@steinberginstitute.org.

Sincerely,

Heidi L. Strunk
President & CEO
Mental Health America of California

Tara Gamboa-Eastman
Director of Government Affairs
Steinberg Institute

AB 2007 (Boerner) Transitional Housing for Homeless Youth – Support

April 12, 2024

The Honorable Alex Lee

Chair, Committee on Human Services
California State Assembly
1020 N Street, Room 124
Sacramento, CA 95814

RE: Support for AB 2007

Dear Chair Lee,

Mental Health America of California (MHAC) is pleased to support Assembly Bill 2007 (Boerner), legislation which upon appropriation by the Legislature would establish the Unicorn Homes Transitional Housing for Homeless LGBTQ+ Youth Program for LGBTQ+ youth ages 18 to 14.

MHAC is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues through voluntary services that are delivered in their local community with compassion and respect for everyone’s dignity and autonomy.

Housing plays a crucial role in fostering a supportive environment for one’s recovery and wellness. This is especially important for our transitional age youth, ages 15 to 26, as 75% of mental health disorders manifest by age 24.[1] AB 2007 aims to support our homeless LGBTQ+ transitional age youth who have additionally experienced an Adverse Childhood Experience (ACE) of parental abandonment and neglect, with safe and stable housing.

In addition to housing, this bill aims to support the youth in addressing their adverse experiences with their families, in hopes of reunifying them. For this reason, we support AB  2007 (Boerner) and ask for your “Aye” vote. If you have any questions, or if MHAC can provide any assistance on this bill or any other behavioral health legislation, please do not hesitate to contact me or our Public Policy Director, Karen Vicari, at kvicari@mhaofca.org.

In Community,

Heidi L. Strunk
President & CEO

[1] California, S. of. (2024a, March 21). Early psychosis intervention plus. Mental Health Services Oversight and Accountability Commission . https://mhsoac.ca.gov/initiatives/early-psychosis-intervention-plus/

AB 1936 (Cervantes) Maternal mental health screenings – Support

April 8, 2024

The Honorable Mia Bonta

Chair, Assembly Committee on Health
California State Assembly
1020 N Street, Room 390
Sacramento, CA 95814

Re: Support for AB 1936 (Cervantes)

Dear Chair Bonta, 

Mental Health America of California (MHAC) is pleased to support AB 1936 (Cervantes), legislation which would require maternal mental health programs to conduct at least one maternal mental health screening during pregnancy, and at least one additional screening during the first 6 months of the postpartum period.

MHAC is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. We are committed to assisting and encouraging communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues through voluntary services that are delivered in their local community with compassion and respect for everyone’s dignity and autonomy. Our commitment extends to expanding preventative services that help identify potential mental health challenges and the proper support to address them.

Pregnant individuals are vulnerable to such challenges during and after pregnancy, with 1 in 3 pregnant individuals experiencing anxiety or depression.[1] Additionally, 5% to 14% of people who are pregnant or postpartum have suicidal ideations. AB 1936 aims to address these issues by identifying potential challenges during and after pregnancy and ensuring adequate support and services are accessible.

For this reason, we support AB 2670 and ask for your “Aye” vote. If you have any questions, or if MHAC can provide any assistance on this bill or any other behavioral health legislation, please do not hesitate to contact me or our Public Policy Director, Karen Vicari, at kvicari@mhaofca.org. 

In Community,

Heidi L. Strunk 
President & CEO

[1] Maternal and Infant Health Assessment (MIHA) Survey, 2020-2021. Maternal, Child and Adolescent Health Division, California Department of Public Health

AB 3221 (Pellerin) Department of Managed Health Care: review of records – Support

March 26, 2024

The Honorable Mia Bonta
Chair, Assembly Health Committee
1020 N Street, Room 390
Sacramento, CA 95814

Re: AB 3221 (Pellerin) – SUPPORT

Dear Chair Bonta:

Mental Health America of California (MHAC) is writing to express our support of AB 3221 (Pellerin) which will allow the Department of Managed Health Care (DMHC) to take enforcement action more swiftly and more efficiently when health plans violate the law.

Too often, people with mental health challenges don’t receive the behavioral health care they need, and that they have paid for, in the timely and appropriate manner they are entitled to under the law. California has been at the forefront of passing groundbreaking behavioral health parity (SB 855) and timely access laws (SB 221), which could alleviate this crisis if the Department of Managed Health Care were empowered to take faster, stronger, and more efficient action.

As stated in my testimony before the Senate Select Committee on Mental Health and Addition in August 2022, I have firsthand experience as a family member and employer with care that is frequently delayed seven or more months and often only after incorporating the assistance of DMHC.

Under The Knox-Keene Health Care Service Plan of 1975, health care service plans are required to keep their books, records and papers open to inspection by the DMHC director.  DMHC is required to conduct periodic on site medical surveys, publicly report results, and issue final reports after public review. They must also conduct follow-up reviews to evaluate a health plan’s efforts to correct deficiencies. But several of the provisions are outdated, ineffective, or both. Records are not provided electronically, which delays and costs the department, and penalties are not required for failure to provide full records in a timely manner. Additionally, when DMHC seeks approval for actions on behalf of consumers, they are required to go to Superior Court, which is overburdened and less efficient than Administrative law judges.

AB 3221 will allow DMHC to request that health plan records be furnished electronically, making those records faster to receive and easier to review. It will allow DMHC to seek relief on patients’ behalf through an administrative hearing rather than the slower and more burdensome Superior Court hearing process, and empower DMHC’s director to take disciplinary action when a health plan fails to respond to a request for records fully or in a timely manner.

These common-sense changes will allow DMHC to take important enforcement actions more quickly and efficiently, improving compliance with the groundbreaking behavioral health parity and timely access laws California recently enacted.

For all of these reasons, Mental Health America of California supports AB 3221 (Pellerin), and we respectfully request an “AYE” vote.

Sincerely,

Heidi L. Strunk
Chief Executive Officer