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Preliminary May Revise of the State Budget for 2022-23 – Behavioral Health Issues

OVERVIEW

Governor Gavin Newsom presented the May Revision of his January budget proposal on May 13, and for the first time, the governor’s budget has surpassed $300 billion. The purpose of the Revision is to update revenues based on tax receipts and present any new administrative proposals or changes to the governor’s January proposal. The summaries below primarily reflect changes or additions to the governor’s proposed budget. Unless withdrawn, all of the governor’s proposals from January remain on the table.

CARE Court

A top priority for NAMI-CA, CARE Court is the governor’s proposal which aims to deliver services to Californians with a serious mental illness or substance use disorder who too often languish – suffering in homelessness or incarceration – without the treatment they desperately need. CARE Court would authorize specified persons – including family members, behavioral health providers, first responders, or other approved parties – to petition a civil court to create a CARE plan and implement services for individuals suffering from specified mental health disorders. If the court determines the individual is eligible for the CARE Court Program, the court would order the implementation of a CARE plan, as devised by the relevant county behavioral services agency, and would oversee the individual’s participation in the plan.

There are still many unanswered questions surrounding process and the funding mechanisms, but the May Revise responds to the funding with a $65 million investment:

The May Revision proposes the following resources for CARE Court:

  • $10 million General Fund ongoing to the Department of Aging for the CARE Court Supporter Program.
  • $15.2 million General Fund in 2022-23, $1.1 million General Fund annually between 2023-24 and 2026-27, and $1.3 million General Fund annually to the Department of Health Care Services for training and technical assistance to counties, data collection, and evaluation.
  • $39.5 million General Fund in 2022-23 and $37.7 million ongoing for the Judicial Branch to conduct CARE Court hearings and provide self-help centers.
  • The Department of Finance has additionally stated their commitment to fund new county costs.

Housing & Homelessness

Housing Production and Climate Resiliency: The May revise invests $500 million over two years to assist in building more downtown-oriented and affordable housing by converting existing infrastructure, underutilized retail space, and commercial buildings into residential buildings. This brings the total adaptive reuse proposals from the governor to $600 million over three years.

Homekey: $150 million in additional resources is proposed by the administration to total $2.9 billion in Homekey funding over two years.

Local Government Grants: As part of the May Revise, the governor is proposing $500 million over two years to house homeless individuals on state-owned land through grants to local governments for interim housing and site preparation.

Health & Human Services

Felony Incompetent to Stand Trial (IST): $535.5 million General Fund in 2022-23, increasing to $638 million General Fund in 2025-26 and ongoing is included in the May Revise to provide:

  • Funding for county sheriffs for custody supports and increased access to ISTs for stabilization teams.
  • County overhead support for administration of community-based restoration, diversion, and community housing.
  • Improvements in discharge planning for continuity of treatment.
  • Improvements in the determinations and decisions about the need for medications.

Opioid Response: $41.8 million Opioid Settlements Fund from additional projected proceeds is proposed in the May Revision.

  • $29.1 million for substance use disorder workforce training to total $51.1 million.
  • $10 million for the naloxone distribution project targeting the homeless to total $15 million.
  • $2.7 million for a public awareness campaign targeting youth opioid and fentanyl risk education to total $40.8 million.

California Advancing and Innovating Medi-Cal (CalAIM): The May Revision includes $1.1 billion ($459 million General Fund) in 2021-22 and $3.1 billion ($1.2 billion General Fund) in 2022-23, and includes updates to:

  • Delay the transition of Intermediate Care Facilities for the Developmentally Disabled (ICF-DDs) and Subacute Care Facilities into managed care from January 1, 2023 to July 1, 2023.
  • Population Health Management (PHM) Service is now anticipated to go live statewide in July 2023, with additional PHM Service capabilities incrementally phased in thereafter.
  • Additional transitions to managed care – DHCS is working to identify which additional individuals will need to transition.
  • The estimated cost of inmate pre-release has been updated to reflect the inclusion of expanded pharmacy services. DHCS is proposing to cover medications consistent with the full scope of covered outpatient drugs under Medi-Cal State Plan as part of the 90-day pre-release services.
  • The federal Centers for Medicare and Medicaid Services has not yet approved the Department’s request to reinstate federal reimbursement for certain Designated State Health Programs (DSHP). While negotiations continue, the Department has replaced CalAIM DSHP funding with General Fund support in order to ensure sufficient funding authority.
  • Trailer bill language is proposed to align the federal approvals received for CalAIM; authorize DHCS to seek federal approval for an 1115 Serious Mental Illness/Serious Emotional Disturbance Waiver; and delay the transition of ICF-DDs and Subacute Care Facilities into Medi-Cal managed care from January 1, 2023 to July 1, 2023.

Children’s Behavioral Health: The governor provides $290 million General Fund in the May Revision for the youth mental health crisis.

  • $40 million General Fund for community-based youth suicide prevention for youth at increased risk of suicide such as Black, Native American, Hispanic, and foster youth.
  • $50 million for grants to pilot school and community-based crisis response and supports following a youth suicide or suicide attempt and pilot the designation of youth suicide or suicide attempts as a reportable public health event.
  • $85 million over two years for grants for wellness and mindfulness programs and an expansion of parent support and training programs.
  • $15 million to develop and distribute a video series for parents on children’s behavioral health.
  • $25 million for the career development of 2,500 culturally diverse high schoolers interested in mental health careers.
  • $75 million for digital supports for remote and metaverse based mental health assessment and intervention.

CalHOPE Extension: $10.9 million General Fund in 2021-22, $80 million General Fund in 2022-23, and $40 million General Fund in 2023-24 is proposed to continue providing crisis counseling after Federal Management Agency grant funding ends.

Los Angeles County Misdemeanor Incompetent to Stand Trial Services and Supports: The administration is proposing $100 million General Fund for L.A. County to support access to community-based treatment and housing. This proposal replaces lease revenue bond authority competitively awarded to L.A. County through the Board of State and Community Corrections.

LGBTQ+ Youth: The administration provides $5 million for grants to counties and community-based organizations to improve capacity, training, and culturally responsive care.

Administration of Justice

Officer Wellness Grants: $50 million General Fund is proposed to fund grants to improve officer health and improve community trust and relations.

Mobile Probation Centers: The May Revise includes $20 million General Fund to establish a competitive grant program for counties to create mobile probation centers.

Post Release Community Supervision: The May Revision provides $20.9 million General Fund, a reduction of $2.3 million from January’s estimate due to lower prison release projections.

Drug Interdiction Efforts: The governor is proposing a $10 million augmentation to the $20 million he proposed to expand the California Military Departments drug interdiction efforts in four High Intensity Drug Trafficking Areas ($15 million in 2022-23 and $15 million in 2023-24).

Prison Capacity and Closures: Deuel Vocational Institution in Tracy was closed in September 2021, providing state savings of $150.3 million annually beginning in 2022-23. The State intends to close the California Correctional Center in Susanville saving $122 million annually, however, the City is currently litigating the closure. The administration estimates that based on prison population projections, three additional state prisons may be closed by 2024-25.

Support NAMI CA This Tax Season

Take Action: Support the NAMI California Sponsored Mental Health Crisis Prevention Tax Contribution Fund – Line 445 on California Form 540.

Support Mental Health & Public Safety

This tax season, help NAMI California strengthen mental health and public safety by contributing to the Mental Health Crisis Prevention Tax Contribution Fund – Line 445 on California Income Tax Form 540. This program allows Californians to divert a portion of their tax returns to support and expand successful mental health crisis intervention strategies. To date, more than 10,000 law enforcement personnel have received training on de-escalation skills, scenario-based training for mental health crisis response, instruction from experienced officers, including the input from individuals and families impacted by mental illness. Funding will also be used to expand work to provide internal support groups for officers, leadership training and greater coordination with community organizations. We have an aggressive fundraising goal of $250,000 and we need your support!

Learn how you can support the NAMI California Sponsored Mental Health Crisis Prevention Tax Contribution Fund >> 

NAMI CA Official Position on the CARE Court — Support

Dear Governor Newsom:

NAMI-CA is in support of the Administration’s CARE Court framework, which intends to deliver services to Californians with a serious mental illness or substance use disorder who too often languish – suffering in homelessness or incarceration – without the treatment they desperately need.

NAMI-CA is the statewide affiliate of the country’s largest mental health advocacy organization, the National Alliance on Mental Illness. Our over 110,000 active advocates and 58 affiliates include many people living with serious mental illnesses, their families, and supporters. NAMI-CA advocates on their behalf, providing education and support to its members and the broader community.

NAMI-CA believes that all people should have the right to make their own decisions about medical treatment. However, we are aware that there are individuals with serious mental illnesses who have very high complex needs, at times, due to their illness, lack insight or good judgment about their need for medical treatment. In cases like this, a higher level of care may be necessary, but must be the last resort. Our members have been calling for reform for their loved ones for years.

NAMI-CA believes that the availability of effective, comprehensive, community- based systems of care for persons suffering from serious mental illnesses will diminish the need for assisted outpatient treatment. Before we reach the stage of last resort, we must fully fund, build and staff our community-based system, so all who need care can access it long before they reach a crisis level.

NAMI-CA urges the state to ensure that any services that are made available through the CARE Court model are also available as voluntary services in the community care continuum. There is currently no statewide standard that specifies that specific services be available to all people in all counties. We can no longer accept a fail-first system composed of partially realized solutions.

NAMI-CA deplores the higher rates of involuntary commitment and incarceration in penal facilities that occurs among communities of color with serious mental illnesses. We are thankful to have an Administration that understands that equity must be a top tenet of policymaking. Recognizing that communities of color and other underrepresented communities often suffer the unintended consequence of the court system serving as their behavioral health delivery system, the Administration must work closely with underrepresented communities to ensure that CARE Courts serve as an example of health equity in action.

NAMI-CA is heartened to see that accountability is one of the pillars of the CARE Court framework. We must hold the system accountable at all delivery points. We cannot take anything for granted in the implementation of a framework, as its effectiveness lies in the words that end up in statute, how it is implemented through the regulatory process, and to how each of our 58 counties will interpret the framework.

Additionally, more can be done to ensure the public (family members and consumers, in particular) and policymakers have the information they need to be assured that public programs treating people with serious mental illness are doing so effectively. In particular, little information is currently collected or shared about one of the most profound roles government plays in the mental health field – involuntary evaluation, treatment, and conservatorship under the LPS Act.

Many questions remain to be answered. What will the court process look like? What does success look like? If an individual has been diverted from legal proceedings, will their record be expunged upon completion of the CARE Court process? Who will qualify as a Supporter? What new resources will be directed to the proposal other than the preexisting federal, homelessness and county funds that were underscored in the framework? NAMI-CA looks forward to working closely with the Administration to implement the promise of the CARE Court framework.

I may be reached at jessica@namica.org or (916) 567-0163. Sincerely,

Jessica Cruz,
MPA/HS
Chief Executive Officer

Cc: Ana J. Matosantos, Cabinet Secretary, Office of Governor Gavin Newsom
Dr. Mark Ghaly, Secretary, California Health and Human Services Agency (CHHS) Stephanie Welch, Deputy Secretary, CHHS
Michelle Baass, Director, DHCS
Dr. Kelly Pfeifer, Deputy Director, Behavioral Health, DHCS
Stephanie Clendenin, Director, DSH
Mary Watanabe, Director, DMHC
Richard Figueroa, Office of the Governor
Tam Ma, Office of the Governor
Marjorie Swartz, Office of the Senate President Pro Tempore
Chris Woods, Office of the Senate President Pro Tempore
Agnes Lee, Office of the Speaker of the Assembly
Jason Sisney, Office of the Speaker of the Assembly
Joe Parra, Senate Republican Fiscal Office

Joe Shinstock, Assembly Republican Fiscal Office Corey Hashida, Legislative Analyst’s Office (LAO) Ben Johnson, LAO

2022 State Legislation

AB 1969 (Gipson D) Pupil health: peer-to-peer mental health program.

Position: Support

Summary: Authorize K-12 school districts to develop peer-to-peer mental health programs. The bill would support LEAs that develop peer-to-peer mental health programs in providing mental health training, in partnership with community-based organizations (CBOs), to all pupil mental health advisors who participate in the program.

NAMI-CA Public Policy Statement: (4.4.2) Peer-designed and peer-directed educational programs, at every stage of the life cycle, must be valued and promoted as an integral part of the service system. Specific government grants must be made available to support the development and administration of peer-directed programs. In addition, system resources must be made available to develop and evaluate peer educational programs and to establish an evidence base comparable to the rigorous scientific studies conducted by fully-funded system-based programs.

AB 2124 (Garcia, Cristina D) Pupil Support Training Program.

Position: Support

Summary: Establishes the Pupil Peer Support Training Program, a competitive grant program for school districts that funds peer support training programs at schools for students in grades 9 to 12. The bill would require training and ongoing supervision of any peer support training programs be conducted by school staff holding a Pupil Personnel Services credential.

NAMI-CA Public Policy Statement: (4.4.2) Peer-designed and peer-directed educational programs, at every stage of the life cycle, must be valued and promoted as an integral part of the service system. Specific government grants must be made available to support the development and administration of peer-directed programs. In addition, system resources must be made available to develop and evaluate peer educational programs and to establish an evidence base comparable to the rigorous scientific studies conducted by fully-funded system-based programs.

AB 2281 (Lackey R) Mental Health Preschool Services Act.

Position: Support

Summary: Establishes the Mental Health Preschool Services Act, to award grants to mental health entities funding partnerships between these entities and preschool and daycare programs for children from birth to 5 years of age.

NAMI-CA Public Policy Statement: (2.8.2) NAMI California believes that, at the earliest possible time in their lives, all children and adolescents with serious mental illnesses deserve to be diagnosed, appropriately treated, and offered the services necessary to achieve and maintain their recovery.

Read NAMI California’s Letter of Support

AB 2317 (Ramos D) Children’s psychiatric residential treatment facilities.

Position: Support

Summary: Although the federal government currently allows PRTF rates to include “room and board’ as a Medicaid reimbursable expense, the state has chosen to separate “room and board” from mental health services in constructing a rate for Children’s Crisis Residential Programs (CCRP). As a result, there is no federal share of “room and board” costs for children treated in CCRPs and county Mental Health Plans must use state or county general funds to cover the entirety of the “room and board” portion of the costs. There are no CCRP programs in California as a result. This bill adds a new licensing category in state statute, the Psychiatric Residential Treatment Facility (PRTF) so that counties and community-based providers can develop crisis residential programs for children with an appropriate licensing category.

NAMI-CA Public Policy Statement: (3.6.1) Inpatient services ranging from short-term acute care or respite care to long-term care must be available and accessible. Linkages between inpatient and outpatient treatment and community support systems must be in place to ensure continuity of care.

Read NAMI California’s letter of support

AB 2786 (Stone D) Children’s Crisis Continuum Pilot Program.

Position: Support

Summary: This bill expands the Children’s Crisis Continuum Program which was set up so we would stop placing foster youth with complex behavioral needs in out-of-state facilities. The program was originally set up for only dependent youth. This expands it to non-dependent youth who are eligible for Medi-Cal. Each continuum must include the following integrated programs or be able to demonstrate the presence of treatment options that represent each tier of community-based and intensive services:

  • A Crisis Stabilization Unit (CSU) where youth can be assessed, stabilized, and supported in returning home, avoiding unnecessary hospitalization;
  • Psychiatric Health Facility (PHF) services providing hospitalization in the rare circumstances when youth require that level of support and stabilization;
  • A series of step-down options, including crisis residential treatment as an intensive, hospital alternative;
  • Respite care for parents, legal guardians or caregivers;
  • Community-based supportive services, offering 24/7 support and front- and back-end integrated case management with a core team of staff who can support each youth to help sustain treatment gains and reduce unnecessary visits to emergency departments or involvement of law enforcement.
  • A full range of tiered settings for foster youth including Intensive Services Foster Care (ISFC).

NAMI-CA Public Policy Statement: (3.6.1) Inpatient services ranging from short-term acute care or respite care to long-term care must be available and accessible. Linkages between inpatient and outpatient treatment and community support systems must be in place to ensure continuity of care.

Read NAMI’s California’s letter of support

SB 1229 (McGuire D) Mental health workforce grants.

Position: Support

Summary: This bill will establish a program to provide 10,000 grants of up to $25,000 each for students pursuing MSWs, MFTs, MA in Psychology, MA in School Counseling, or MA in School Psychology. The goal is to increase the number of behavioral health professionals serving children and youth at California public schools and in community-based organizations.

NAMI-CA Public Policy Statement: (8.6.3) NAMI California supports federal budget expenditures for the clinical training of professionals that provide stipends to students in psychiatry, psychiatric rehabilitation, psychiatric social work, psychiatric nursing, and psychology programs at the baccalaureate, masters, and doctoral levels. NAMI California believes that all grants must include a pay-back provision for two years of service in a public sector setting.

SB 1302 (Portantino D) Pupil health: pupil wellness centers: grant program.

Position: Support

Summary: This bill appropriate appropriates $1 billion to the Superintendent of Public Instruction (SPI) to provide grants to high schools for student wellness centers.

NAMI-CA Public Policy Statement: (4.2.1) Elementary, Middle, and High Schools: Undiagnosed, untreated, and inadequately treated mental illnesses significantly interfere with a student’s ability to learn, to grow, and to develop. Because children spend much of their productive time in school, and services can be integrated into their regular daily routine, NAMI believes that both public and private elementary, middle, and high schools should provide and/or facilitate and sustain provision of appropriate mental health services, supports, and appropriate accommodations.

Read NAMI California’s letter of support

AB 2288 (Choi R) Advance health care directives: mental health treatment.

Position: Support

Summary: Clarifies current law to specifically create an advanced mental health care directive for those who may suffer from severe mental illness or other mentally debilitating issues in anticipation of a future mental health episode.

NAMI-CA Public Policy Statement: (9.3) Advance Directives and Healthcare Proxies
NAMI California supports efforts of persons with serious mental illnesses, family members, caregivers and service providers to work collaboratively to develop plans for treatment, services, and supports that are followed, when, and if, needed in the future.

Read NAMI California’s Letter of Support

SB 1019 (Gonzalez D) Medi-Cal managed care plans: mental health benefits.

Position: Support

Summary: Requires Medi-Cal managed care plans to engage in direct education of their enrollees and mental health service providers, develop and implement culturally and linguistically relevant outreach, and require DHCS to develop tools to better understand and address these discrepancies.

NAMI-CA Public Policy Statement: (2.3.1) Persons of cultural, racial, religious, and ethnic diversity and those for whom English is not the primary language have unique characteristics that sometimes impede their abilities to benefit fully from existing treatment, training, and rehabilitation programs. These differences must be respected and afforded appropriate representation must be strived for, both within the governance of the services sector and within NAMI California.

AB 1816 (Bryan D) Reentry Housing and Workforce Development Program.

Position: Support

Summary: Creates a grant program for counties, community-based organizations and continuums of care that provide homeless, reentry services and workforce development for people recently released from incarceration who are experiencing or at risk of falling into homelessness services like:

1. Rental assistance in permanent housing
2. Incentives to landlords
3. Wraparound services, including linkage to mental health treatment under Medi-Cal

NAMI-CA Public Policy Statement: (5.3.3) Housing options should offer appropriate supportive services, including but not limited to: case management; tenancy support; clinical services; employment training and education; transportation; and crisis intervention. Housing should also be monitored by the appropriate licensing and enforcement agencies for quality, including cleanliness and safety.

NAMI-CA Housing Position Paper: NAMI-CA supports efforts to address poverty and the high cost of housing in California for people living with a serious mental illness, including but not limited to:

  • Increases to SSI/SSDI rates
  • Employment and training assistance to increase individuals’ earning potential
  • Rental subsidies and home utility assistance
  • Benefits advocacy to help people find services for which they may be eligible, including SSI/SSDI, veterans’ benefits, food, clothing, childcare assistance, and health insurance

2022 Survey Priority 4: Housing

Read NAMI California’s letter of support

AB 2547 (Nazarian D) Housing Stabilization to Prevent and End Homelessness Among Older Adults and People with Disabilities Act.

Position: Support

Summary: Provides housing subsidies to people at risk of homelessness. The subsidies would be made available to acutely low-income Californians (receiving 20% or below of the area’s median income) who are either experiencing homelessness or are at imminent risk of homelessness and allowing enrollees to afford housing that exists in the private market or in non-profit affordable projects. The Department of Aging would disburse funding through a competitive process to community-based organizations, continuums of care, and/or local housing authorities to administer subsidies to landlords or tenants.

NAMI-CA Public Policy Statement: (5.3.3) Housing options should offer appropriate supportive services, including but not limited to: case management; tenancy support; clinical services; employment training and education; transportation; and crisis intervention. Housing should also be monitored by the appropriate licensing and enforcement agencies for quality, including cleanliness and safety.

2022 Survey Priority 4: Housing

Read NAMI California’s letter of support

AB 1859 (Levine D) Mental health services.

Position: Support

Summary: Requires that a patient released from involuntary mental health hospitalization receives authorization and an appointment for care within 48 hours of their release. The bill requires that the location of the facilities providing the mental health services will be within reasonable proximity of the business or residence of the patient.

NAMI-CA Public Policy Statement: Access to Treatment (3.1.1) NAMI California believes that individuals with mental illnesses must have timely access to treatments that have been recognized as effective by the Food and Drug Administration (FDA) and the National Institute of Mental Health (NIMH). NAMI California is adamant that individuals with mental illness have timely access to clinically appropriate medications, evidence-based services, and treatment, including psychotherapy, that are provided in a person-centered approach.

NAMI-CA LPS White Paper: According to the 2019-20 Medi-Cal Specialty Mental Health External Quality Review, it takes as long as nine days for people who have just been discharged from a psychiatric hospital to be seen for follow-up care. In large counties, it takes an average of fifteen days. California must shorten the time between a psychiatric hospital discharge and a follow-up aftercare appointment.

Read NAMI California’s Letter of Support

AB 2144 (Ramos D) Mental health: information sharing

Position: Support

Summary: This bill requires designated facilities to submit quarterly reports on LPS holds to the Department of Health Care Services (DHCS). This bill will satisfy one of the top recommendations of a recent audit of the LPS system and provide transparent data to develop best practices.

NAMI-CA Public Policy Statement: (8.9.1) Data collection practices, deliverables, and outcome measurements should be established at the outset of all new programs; consumers, families, and stakeholders must be meaningfully involved in this process.

NAMI-CA Public Policy Statement: (8.9.3) Program data must be made available to the public.

NAMI-CA LPS White Paper: More can be done to ensure the public (family members and consumers, in particular) and policymakers have the information they need to be assured that public programs treating people with serious mental illness are doing so effectively. In particular, little information is currently collected or shared about one of the most profound roles government plays in the mental health field – involuntary evaluation, treatment, and conservatorship under the LPS Act. Noting the lack of data surrounding LPS Act implementation, the BSA audit of the LPS Act made several recommendations which NAMI-CA supports.

Read NAMI California’s letter of support

AB 2853 (Lackey R) Mental health: involuntary holds.

Position: Support

Summary: Requires the Department of Health Care Services (DHCS) to establish guidelines for the application of LPS to ensure that it is uniformly applied by counties, including, at a minimum, an explanation of how to determine if a person meets the definition of gravely disabled and if a person is a danger to themselves or others. Requires DHCS to establish a maximum period of time for which a person can be detained for a 5150 evaluation.

NAMI-CA Public Policy Statement (9.2.5): Involuntary commitment and court-ordered treatment decisions must be made expeditiously.

Read NAMI California’s letter of support

SB 929 (Eggman D) Community mental health services: data collection.

Position: Support

Summary: Requires the Department of Health Care Services (DHCS) to collect additional data on the implementation LPS annually, including:

– outcomes for individuals placed in each type of hold
– the services provided to individuals in each category
– the waiting periods for individuals prior to receiving care
– current and future needs for treatment beds and services

NAMI-CA Public Policy Statement (8.9.1) Data collection practices, deliverables, and outcome measurements should be established at the outset of all new programs; consumers, families, and stakeholders must be meaningfully involved in this process.

NAMI-CA Public Policy Statement (8.9.3) Program data must be made available to the public.

LPS White Paper: Hold the State and Counties Accountable for the Impact LPS Act Services Have on People with Serious Mental Illness

SB 1303 (Jones R) Conservatorships: serious mental illness and substance use disorders: counties.

Position: Support

Summary: Expands the SB 1045/SB 40 pilot program (SF, SD, L.A.) by allowing any county to opt in to establish housing conservatorships for homeless individuals who have been consistently and repeatedly detained on 5150 holds.

NAMI-CA Public Policy Statement (9.2.13): Court-ordered outpatient treatment should be considered as a less restrictive, more beneficial, and less costly treatment alternative to involuntary inpatient treatment.

SB 1154 (Eggman D) Facilities for mental health or substance use disorder crisis: database.

Position: Support

Summary: Streamlines access to care: Requires the California Department of Public Health (CDPH) to establish a database for bed openings – psychiatric, substance use disorder, and community mental health, to be updated and maintained as changes in availability occur in order to streamline communication and reduce patient waiting time.

NAMI-CA Public Policy Statement (8.9.1) Data collection practices, deliverables, and outcome measurements should be established at the outset of all new programs; consumers, families, and stakeholders must be meaningfully involved in this process.

AB 2526 (Cooper D) Incarcerated persons: health records.

Position: Support

Summary: Ensures that inmates’ mental health records follow an inmate as they transfer between Corrections and State Hospitals in order to provide appropriate treatment and complete Offenders w/ Mental Health Disorders program (OMHD) evaluations. This bill requires transmission of inmates’ mental health records upon transfer of custody or within seven days of the transfer.

NAMI-CA Public Policy Statement (3.6.1) Inpatient services ranging from short-term acute care or respite care to long-term care must be available and accessible. Linkages between inpatient and outpatient treatment and community support systems must be in place to ensure continuity of care.

Public Policy Survey 2022 – Priority #5 Criminal Justice Issues

Read NAMI California’s letter of support

AB 2632 (Holden D) Segregated confinement.

Position: Support

Summary: Bans solitary confinement, across all facilities, or vulnerable populations, including people with a serious mental illness or is exhibiting self-harm, disorientation, deterioration of hygiene, elevated, anxious, agitated, or unresponsive mood, or other behavior indicating the presence of a serious mental health disorder or other evidence that an individual is experiencing a mental health crisis.

NAMI-CA Public Policy Statement 10.11: NAMI California opposes the use of solitary confinement in Secure Housing Units (SHU) for individuals living with mental illness that are incarcerated with the California Department of Corrections and Rehabilitation (CDCR).

Due to a lack of mental stimulation, psychological research has found that inmates subjected to solitary confinement suffer from a variety of psychological and psychiatric illnesses. For inmates who are already diagnosed with serious mental illness, such confinement severely exacerbates their conditions. We believe that, even when incarcerated, individuals living with mental illness have a right to humane, effective treatment in the least restrictive but secure setting.

Read NAMI California’s letter of support

AB 2657 (Stone D) Incarcerated person’s competence.

Position: Support

Summary: Removes individuals deemed incompetent to stand trial from Death Row & re-sentences them to Life without Parole.

Authorizes incarcerated people on death row to file petitions raising their permanent incompetence at any time after their conviction becomes final, if a psychiatrist or licensed psychologist provides a declaration attesting to their permanent incompetence.

NAMI-CA Public Policy Statement (10.9.1.3): Sentences of death shall be reduced to lesser punishment if prisoners under such sentences are found at any time subsequent to sentencing to have a mental disorder or disability that significantly impairs their ability:
(a) to understand and appreciate the nature of the punishment or its purpose,
(b) to understand and communicate information relating the death sentence and any proceedings brought to set it aside, or
(c) to make rational choices about such proceedings.

Read NAMI California’s letter of support

SB 882 (Eggman D) Advisory Council on Improving Interactions between People with Intellectual and Development Disabilities and Law Enforcement.

Position: Support

Summary: Documents whether a person in use-of-force case had an intellectual, developmental, physical, or mental disability to improve data and understanding of these events. It would also create the Advisory Council on Improving Interactions between People with IDD and police within the Attorney General’s office to evaluate existing training for law enforcement regard to working with these populations, identifying gaps in training, and making recommendations to the Legislature for improving the outcomes of these interactions.

NAMI-CA Public Policy Statement (10.4) NAMI California believes that state and local mental health authorities must work closely in conjunction with state and local correctional and law enforcement agencies to develop strategies and programs for compassionate intervention by law enforcement, jail diversion, treatment of individuals with serious mental illnesses who are incarcerated, and discharge planning and community reintegration services for individuals with serious mental illnesses released from correctional facilities.

Read NAMI California’s Letter of Support

SB 1223 (Becker D) Criminal procedure: mental health diversion.

Position: Support

Summary: Requires a court to consider granting a defendant mental health diversion if the defendant has been diagnosed with a mental disorder, as described, and states that the court shall find the mental disorder was a significant factor in the commission of the offense, unless there is clear and convincing evidence that it was not.

NAMI-CA Public Policy Statement (10.7.1): NAMI California believes that persons who have committed offenses due to states of mind or behavior caused by a serious mental illness do not belong in penal or correctional institutions. Such persons require treatment, not punishment. A prison or jail is never an optimal therapeutic setting.

(10.7.2) NAMI California supports a variety of approaches to diverting individuals from unnecessary incarceration into appropriate treatment, including pre-booking (police-based) diversion, post-booking (court-based) diversion, alternative sentencing programs, and post-adjudication diversion (conditional release).

AB 2182 (Wicks D) Discrimination: family responsibilities.

Position: Support

Summary: Prohibits employers from discriminating against employees based on their family responsibilities by adding “family responsibilities” to the list of protected characteristics (e.g., race, sex, sexual orientation, marital status, religion, etc.) that are already prohibited bases of discrimination under the employment provisions of the Fair Employment and Housing Act.

Public Policy Survey 2022 – Priority #2 Family Involvement in Treatment

SB 964 (Wiener D) Behavioral health.

Position: Support

Summary: Establishes a Behavioral Health Workforce Preservation and Restoration Fund to provide hiring and/or performance-based bonuses, salary augmentation, overtime pay, and/or hazard pay for workers in the behavioral health sector. SB 964 also creates a stipend program for students in MSW programs with a specialized focus on public behavioral health. Students will be eligible for a stipend of $18,500 per year for up to two years and will be required to complete two years of continuous and full-time employment in a public behavioral health agency.

NAMI-CA Public Policy Statement (8.6.3): NAMI California supports federal budget expenditures for the clinical training of professionals that provide stipends to students in psychiatry, psychiatric rehabilitation, psychiatric social work, psychiatric nursing, and psychology programs at the baccalaureate, masters, and doctoral levels. NAMI California believes that all grants must include a pay-back provision for two years of service in a public sector setting.

Read NAMI California’s Letter of Support

SB 1338 (Umberg D, Eggman D) Legislative vehicle for Governor Gavin Newsom’s CARE Court proposal.

Position: Support

Summary: CARE Court is a proposed framework to deliver mental health and substance use disorder services to the most severely impaired Californians who too often languish – suffering in homelessness or incarceration – without the treatment they desperately need.

It connects a person in crisis with a court-ordered Care Plan for up to 12 months, with the possibility to extend for an additional 12 months. The framework would provide individuals with a clinically appropriate, community-based set of services and supports that are culturally and linguistically competent. This includes short-term stabilization medications, wellness and recovery supports, and connection to social services and a housing plan.

Read NAMI California’s Letter of Support

Take Action: Local Policies

Support Mental Health Education

Sign our petition in support of Senate Bill 224 to provide California students in grades 1-12 with the mental health education they need. Thank you those who have already signed our petition in support of The bill passed the Senate and moves to the Assembly!

Support Mental Health Crisis Response and Services

Sign our petition in support of Assembly Bill 1065 to help improve the outcomes of crisis calls involving people who are mentally ill, by allowing taxpayers to make voluntary contributions on their California tax returns to support much-needed law enforcement training programs to better equip them to engage safely with individuals living with a mental illness.

Sign our petition in support of Assembly Bill 1331 to establish a new position at the Department of Health Care Services (DHCS) to improve our crisis care system.

IST Advocacy

People who have committed offenses due to states of mind or behavior caused by a serious mental illness do not belong in penal or correctional institutions. Such persons require treatment, not punishment.

Read our full position paper

More than 115 respondents from across California participated in our recent survey to provide their experience with the IST process and try to improve the system for families in the future.

See the results

Take Action: National Policies

Urge Congress to Fund Crisis Services

Next year, 988, a 3-digit number for mental health crises, will be available nationwide. But what crisis services will be available in your community if you or someone you know needs this life-saving line? NAMI is urging Congress to fund mental health crisis services. We need you to email your member of Congress to help ensure that there is more federal funding for crisis services in your community. Find out more and sign NAMI’s petition.

Urge Congress to Support Mental Health Research

Imagine if cancer, heart disease or diabetes was diagnosed just by using a short list of questions to assess symptoms. Sadly, due to the complexity of the brain and lack of strong research, this is how people are currently diagnosed with mental health conditions. This results in many mistakes in diagnosis and ineffective treatment. We need Congress to invest in research for mental health conditions. Find out more and sign NAMI’s petition

Support NAMI National’s Advocacy Actions

Sign up for advocacy actions and updates from NAMI National, and sign letters in their action center

Be a Local Advocate

Join TeamNAMIca

Become a NAMI CA member, and contact your local NAMI California affiliate to find out ways to get involved locally.

Share Your Voice

Find your local representatives and let them know about the issues that matter to you. Use our Advocacy Toolkit to learn how to best communicate what matters to you.

Vote

Every local, state and national election provides us with an opportunity to vote for leaders and laws to improve mental health services for our communities. Find out about voting in California.

Stay Informed

Sign up for our newsletter and follow us on social media (@namicalifornia) to find out about our progress, action alerts, information on our Advocacy Day events, and more.

Preliminary State Budget Update for 2022-23 – Behavioral Health Issues

OVERVIEW

The COVID-19 pandemic has exacerbated behavioral health needs and placed significant demands on the existing system of care. Workforce shortages have widened the inequities across the system, worsened by the COVID-19 Pandemic. Californians across all demographics, but especially youth, communities of color, and LGBTQ individuals, and other disadvantaged Californians are experiencing increased levels of stress, anxiety, depression and isolation. In California, consistent with national trends, overdose deaths have risen as well as suicidal ideation and hospitalization for self-harming behavior.

Thanks in part to a budget surplus in the tens of billions of dollars (projected between $32 and $46 billion), the Governor’s $286.4 billion Budget has made substantial new investments in behavioral health programs to meet the behavioral health needs of all Californians, and particularly those most vulnerable such as individuals experiencing homelessness and those who are justice-involved,

Below, you will find the behavioral health items included in the Governor’s proposed State Budget for Fiscal Year (FY) 2022-23, which was released on January 10. The Legislature now begins its work of vetting and approving, rejecting or modifying the various proposals in the governor’s budget through the budget subcommittee process, which will go into the month of March. Please note that updated information will be provided as additional and final actions are taken by the Legislature. The Legislature must pass the budget by June 15 in order to begin the fiscal year on July 1.

GOVERNOR HINTS AT MAJOR CHANGES TO COME

In addition to all of the funding proposals announced yesterday, the Governor also hinted – minus any details – at major reforms on conservatorship laws and the Mental Health Services Act. Despite multiple questions from journalists, the Governor only said that we can expect announcements within the next few weeks. “I’m purposely going to obfuscate in terms of the response,” said Newsom, “because we want to lay it out in more detail and specificity and build more understanding, but we are leaning into conservatorships this year.” We will be monitoring activity closely and keep you apprised of any details as they emerge.

HEALTH CARE

Universal Health Care: The governor proposes to expand full-scope Medi-Cal coverage to adults aged 26 through 49, regardless of immigration status, effective no sooner than January 1, 2024 (currently, undocumented immigrants aged 26-49 are ineligible). Anticipated costs are:

  • $819 million in Fiscal Year 2023-24
  • $2.3 billion ongoing

This proposal is expected to gather much attention, particularly since it crosses the path of the Legislature’s more ambitious, albeit costlier single payer package. When questioned about his opinion of the single payer proposal, Governor Newsom stated that he had not seen the proposal yet.

CalAIM – MEDI-CAL TRANSFORMATION

In 2019, the Department of Health Care Services (DHCS) proposed the California Advancing and Innovating Medi-Cal (CalAIM, the framework for changes to the Medi-Cal program that encompass broad-based delivery system, program, and payment reform. DHCS indicates CalAIM advances several key priorities of the Newsom Administration by leveraging Medicaid as a tool to help address many of the complex challenges facing California’s most vulnerable residents, such as homelessness, behavioral health care access, children with complex medical conditions, the growing number of justice-involved populations who have significant clinical needs, and the growing aging population

Updates to the State’s Section 1115 CalAIM demonstration and Section 1915(b) waiver (which the federal government recently approved), will enable the state to execute the CalAIM initiative, providing benefits to certain high-need, hard-to-reach populations, with the objective of improving health outcomes for Medi-Cal beneficiaries and other low-income individuals in the state.

Taking a whole-system, person-centered approach to health and social care, CalAIM invests about half a billion dollars in state General Funds during calendar year 2022, with increasing amounts over time.

CalAIM initiatives being implemented in 2022-23 include:

  • Mandatory enrollment into managed care of beneficiaries eligible for both Medi-Cal and Medicare
  • Mandates that all managed care plans cover long-term care
  • Targeted set of Medicaid services to eligible justice-involved populations prior to release
  • The “Providing Access and Transforming Health” (PATH) initiative, detailed below

Incarcerated individuals leaving correctional facilities are at high risk of poor outcomes due to high rates of mental illness, substance use disorders, complex medical conditions, and potential social needs such as housing insecurity, unemployment, and inadequate social connections. CalAIM proposes to improve outcomes for this population by mandating a county pre-release Medi-Cal application process for incarcerated individuals, allowing Medi-Cal reimbursement for services in the 90-day time period prior to release, and to encourage a facilitated referral and linkage (“warm hand-off”) to behavioral health services, both to providers in managed care networks and to county behavioral health departments.

IMD Waiver: Currently, federal law prohibits states from using Medicaid to pay for care provided in “institutions for mental disease” (IMDs), which are psychiatric hospitals or other residential treatment facilities that have more than 16 beds. This is the only part of federal Medicaid law that prohibits payment for the cost of providing medically necessary care because of the type of illness being treated. This discriminatory exclusion has been in place since Medicaid’s enactment in 1965, and it has resulted in unequal coverage of mental health care.

Recently, states were given the option to cover short-term stays in psychiatric hospitals by applying for a waiver from the federal government, meaning states could  receive federal funds for mental services provided to populations with a Serious Mental Illness or Serious Emotional Disturbance (SMI/SED). DHCS plans to submit a proposal to CMS for the SMI/SED Demonstration Waiver in the fall of 2022.

Equity and Practice Transformation Payments: DHCS proposes to make equity and practice transformation payments to qualifying Medi-Cal providers, to close critical health equity gaps; address gaps in preventive, maternity, and behavioral health care measures; and address gaps in care arising out of the COVID-19 Public Health Emergency. These payments are intended to promote patient-centered models of care in pediatric, primary care, obstetrics and gynecology, and behavioral health settings and to align with the goals of the Medi-Cal Comprehensive Quality and Equity Strategy.

CHILDREN & YOUTH

The proposed budget includes the following in FY 2022-23 as part of the Children and Youth Behavioral Health Initiative:

  • $87 million to implement Dyadic Services, a model that has been proven to improve access to preventive care for children, rates of immunization completion, coordination of care, child social-emotional health and safety, developmentally appropriate parenting and maternal mental health. In this integrated behavioral care model, pediatric mental health professionals are available to address developmental and behavioral health concerns as soon as they are identified, bypassing the many obstacles families face when referred to offsite behavioral health services. In this model, health care for the child is delivered in the context of the caregiver and family (i.e. “dyadic health care services”) so that families are screened for behavioral health problems, interpersonal safety, tobacco and substance misuse and social determinants of health such as food insecurity and housing instability. Families who are given referrals receive follow-up to make sure they received the services.
  • $429 million for evidence-based behavioral health practices.
  • $450 million for school behavioral health partnerships and capacity (on top of the $100 million provided for FY 2021-22).
  • $230 million for the Behavioral Health Services and Supports Platform and related e-Consult service and provider training (on top of the $10 million that was provided in FY 2021-22).

HOMELESSNESS & HOUSING

Behavioral Health Bridge Housing: While $5.8 billion in last year’s budget for Homekey provided a remarkable investment in long-term housing and services for people experiencing unsheltered homelessness who have serious behavioral health conditions, there is a need for immediate bridge solutions as those new units are built.

The Budget includes an additional $1.5 billion over the next 2 years to address immediate housing and treatment needs, adding 55,000 new homes and treatment beds, and including medication and family supports. Funding will be administered through DHCS’ Behavioral Health Continuum Infrastructure Program and can be used to purchase and install tiny homes and to provide time-limited operational supports in these tiny homes or in other bridge housing settings including existing assisted living settings.

The Administration will develop a strategy that addresses the stabilization and treatment of this extremely vulnerable population of Californians with the most severe and untreated behavioral health conditions. Rather than criminalize the homeless population with behavioral health needs, the strategy will provide community-based care upstream to prevent institutionalization and incarceration.

WORKFORCE

Behavioral Health Workload: The Budget will add new positions for several critical behavioral health projects in California:

  • $350 million to recruit and certify 25,000 new community health workers
  • $210 million for social worker training via scholarships and stipends
  • $120 million for psychiatric workforce
  • 90-day justice-involved in-reach program
  • Implementation of the new federal 988 hotline
  • New mobile crisis services
  • Managing new federal behavioral health grant opportunities
  • Intensifying oversight of county behavioral health systems
  • Support of the Children’s Crisis Continuum pilot
  • Support of the Family First Prevention Services Act.

Felony Incompetent to Stand Trial Waitlist Solutions: California is home to thousands of vulnerable and sick individuals who, because of limited community-based and early intervention treatment, decompensate to a point where engagement and treatment is difficult. For many of these Californians with the most severe behavioral health conditions, they enter into a cycle of untreated mental illness, homelessness, and incarceration. Criminal defendants who are unable to understand criminal proceedings or assist counsel in their defense are determined by a court to be Incompetent to Stand Trial (IST). If these individuals are charged with a felony, they can be committed to the Department of State Hospitals (DSH) to provide clinical and medical services with the goal of restoring their competency and enabling them to return to court to resume their criminal proceedings.

Informed by the deliberations of the IST Solutions Workgroup, which NAMI-CA participated in, the Budget includes spending of $93 million in 2021-22 and $571 million in 2022-23 and ongoing to provide for:

  • Early Stabilization and Community Care Coordination to provide immediate solutions to support access to treatment for the nearly 1,700 individuals currently found IST on felony charges and waiting in jail and to reduce the flow of new incoming referrals.
  • Expand Diversion and Community-Based Restoration Capacity to increase IST treatment alternatives provided by investing in the community infrastructure required to support the felony IST population.

Medi-Cal Community-Based Mobile Crisis Services: California will add multi-disciplinary mobile response services for behavioral health crises as a new Medi-Cal benefit, as soon as January 1, 2023. The American Rescue Plan Act of 2021 authorizes an 85% federal match for a Medicaid mobile crisis response services benefit, available during a five-year period. Over the five-year period authorized by the Act, total costs of this new benefit are projected to be $1.4 billion. This builds on the $205 million and other funds the 2021 Budget provided to counties for infrastructure development in preparation for the implementation of the mobile crisis benefit.

988 Implementation: NAMI California is a co-sponsor of AB 988, The Miles Hall Lifeline Act, which establishes the “9-8-8” emergency response system for Californians experiencing a mental health crisis.

In 2020, the federal government established “988” as the new three-digit number for mental health crisis hotlines. At the national level, NAMI played a critical role in the federal 988 legislation and mobilized grassroots support to ensure its passage. Once implemented in California, 988 will connect callers with around-the-clock intervention, including mobile crisis support teams staffed by mental health professionals and trained peers. Mental health crisis services and alternatives to calling 911 can be an effective alternative to a law enforcement response, provide an opportunity to effectively co-respond with mental health-law enforcement teams, and divert people with mental illness away from criminal justice system involvement.

NAMI has a long history of partnering with law enforcement, including directly training first responders and promoting standards of justice system policies and practices to make their encounters with people in a mental health crisis effective and safe. NAMI and its national partners have developed many resources to support local communities to start or enhance their crisis intervention programs with first responders. In California, NAMI-CA worked on legislation to improve required training for law enforcement, emergency dispatchers, and other first responders. At the local level, many of our 62 affiliate NAMI-CA chapters work hand-in-hand with local law enforcement and community mental health providers to reduce arrests of our loved ones and address racial justice challenges.

The current mental health crisis response system relies on law enforcement and puts people suffering from mental illness through an expensive and traumatizing revolving-door as they shuttle between jails, emergency rooms, and the street. A comprehensive crisis response system can prevent these tragedies, save money, and increase access to appropriate care. Establishing 988 is an important first step and must be accompanied by new statewide investments that repair holes in community safety nets.

The 2022-23 Budget includes $7.5 million ($6 million ongoing) for the California Governor’s Office of Emergency Services (Cal-OES) to advance implementation of the 9-8-8 call system and support call handling equipment so existing crisis hotline centers have the needed resources to process additional 9-8-8 calls and coordinate and transfer calls with no loss of information between the 9-8-8 and 911 systems.

OTHER PROPOSALS

Opioid Response: In response to the growing problem of increased availability of synthetic opioids and related overdose deaths, the Budget includes $96 million in 2022-23 and $61 million ongoing to expand access to Medication Assisted Treatment. In addition, the Budget includes one-time $86 million opioid settlement funds which will be dedicated to a public awareness campaign targeted towards youth opioids education and awareness and fentanyl risk education ($50 million) and improving the state’s ability to collect and analyze data on opioid overdose trends ($5 million), provider training on opioid treatment ($26 million), and distributing naloxone to homeless service providers ($5 million).