WE WILL BRING THE SELECT
COMMITTEE ON CALIFORNIA'S MENTAL
HEALTH CRISIS TO ORDER I WANT TO
WELCOME EVERYONE TO OUR THIRD
SCHEDULED HEARING ON CALIFORNIA
SOME MENTAL HEALTH CRISIS. FOR
THOSE WHO WISH TO PARTICIPATE IN
PUBLIC COMMENT VIA PHONE. YOU
MAY DO SO BY CALLING 877692. AND
THE PUBLIC ACCESS CODE IS
1315444. AND IT SHOULD ALSO BE
ON YOUR TELEVISION SCREEN.
PUBLIC COMMENT WILL BE CONDUCTED
AT THE END OF THE HEARING. TODAY
WE ARE JOINED BY PEOPLE WHO WILL
PROVIDE TESTIMONY FROM THEIR
VARIOUS PERSPECTIVES AND FIELDS
ON ADDRESSING CALIFORNIA'S
MENTAL HEALTH CRISIS AND
UNDERSTANDING THE PROGRAM
PROBLEM IN ITS FULL SCOPE. OUR
FIRST PANEL IS A CONTINUATION OF
OUR SECOND HEARING ABOUT
DEFINING MENTAL HEALTH AND
UNDERSTANDING THE UNIQUE MENTAL
HEALTH CHALLENGES FROM VARIOUS
POPULATIONS OF CALIFORNIA. UM
AFTER THAT, WE WILL HAVE OUR
SECOND PANEL, WHICH WILL BEGIN
TO TALK ABOUT WHERE DO WE GO
FROM HERE? WHAT ARE WE MISSING?
WHAT DO WE NEED TO CONTINUE TO
DO, UM, PASSED THIS LEGISLATIVE
YEAR AND MOVING FORWARD INTO THE
NEXT AND WHAT SHOULD WE BE
FOCUSING ON? WE WILL BE HEARING
FROM THE ADMINISTRATION AND THE
MENTAL HEALTH SERVICES OVERSIGHT
AND ACCOUNTABILITY COMMISSION.
AND WE HAVE INVITED
ORGANIZATIONS WHO REPRESENTS OF
VARIOUS GROUPS. WE HAVE HEARD
THE PUBLIC VERY CLEAR. WE MUST
ALSO FOCUS ON OUR API COMMUNITY
. OUR VETERANS AND OUR SENIORS.
AND TODAY WE WILL DO JUST THAT.
CALIFORNIA IS HOME TO ALMOST 40
MILLION PEOPLE WHO ARE SENIOR
CITIZENS MIDDLE TELL MILITARY
VETERANS OR MEMBERS OF THE A P I
COMMUNITY SO TODAY'S HEARING. WE
WILL TRY TO UNDERSTAND HOW THESE
GROUPS ARE IMPACTED BY MENTAL
HEALTH. ADDITIONALLY WE WILL
HEAR FROM THE CALIFORNIA UM,
CALIFORNIA AND HUMAN SERVICES
AGENCY AND THE MENTAL HEALTH
SERVICES OVERSIGHT
ACCOUNTABILITY COMMISSION, UM TO
MAKING SURE THAT WE WRAP IT UP.
UM, SUCCINCTLY HERE. UH THIS
SELECT COMMITTEE AGAIN WAS
CREATED TO ADDRESS THESE ISSUES
AND HELP FORMULATE POLICIES THAT
WILL BE EFFECTIVE IN BOTH NEAR
AND LONG TERM. TO HELP
CALIFORNIA'S LIVE I MEAN, MORE
JOYOUS AND MEANINGFUL LIFE. I AM
GRATEFUL TO MY COLLEAGUES WHO
HAVE JOINED THE SELECT
COMMITTEE. WE WILL NOW OPENING
UP FOR THEM TO MAKE THEIR
COMMENTS. ASSEMBLY MEMBER
PELLERIN THANK YOU. AND THANK
YOU TO OUR CHAIRED, UH,
ASSEMBLYMEMBER'S JACKSON FOR
PULLING US ALL TOGETHER AND
DOING THIS IMPORTANT WORK IN
THIS SPACE. UM SO I HAD AN
EXPERIENCE TODAY, WALKING INTO
THE CAPITOL EARLIER THIS
MORNING, A YOUNG GIRL WAS
OUTSIDE AND JUST SOBBING AND WAS
BEING COMFORTED BY ANOTHER
PERSON. AND I STOPPED AND ASKED
IF I COULD HELP IN ANY WAY IT
JUST REALLY IMPACTED ME AND SHE
SCREAMED OUT. SHE DID NOT WANT
TO LIVE. AND I THOUGHT, WOW, YOU
KNOW FOR A YOUNG PERSON. TO HAVE
THAT KIND OF A FEELING IN HER TO
BE ABLE TO SHOUT THAT OUT, AND
IT DEFINITELY IMPACTED ME AND
TRIGGERED ME. MY HUSBAND DIED BY
SUICIDE. UM, NOVEMBER 2018. AND
I WAS SO GLAD SHE HAD SOMEONE
THERE TO HELP HER AND I DIDN'T
WANT TO INVADE HER PERSONAL
SPACE MORE BUT IT MADE ME THINK
ABOUT OUR SYSTEM OF HEALTH OR
MENTAL HEALTH CARE AND HOW HARD
IT IS TO FIND. COUNSELORS HOW
HARD IT IS TO GET IN FOR AN
APPOINTMENT, HOW DIFFICULT IT IS
TO PAY FOR THOSE SERVICES AND
THE STIGMA THAT IT IS STILL
THERE FOR PEOPLE GOING THROUGH A
MENTAL HEALTH CRISIS. AND I'M
JUST SO GRATEFUL TO MY COLLEAGUE
HERE IN THE STATE ASSEMBLY
DOCTOR JACKSON FOR THE WORK HE'S
DONE IN HIS PERSONAL LIFE AND
THE WORK HE'S CARRYING OVER. UM,
NOW AS A STATE ASSEMBLY MEMBER,
AND HAPPY TO SEE MY COLLEAGUE
MARIE WALDRON HERE TODAY,
ASSEMBLYMEMBER'S, UM, BECAUSE
THIS IS SO CRITICALLY IMPORTANT
. WE ARE IN A PUBLIC HEALTH
CRISIS AND PEOPLE ARE SUFFERING.
EVERY SINGLE DAY, AND PEOPLE ARE
MAKING DECISIONS THAT MAY BE
THEIR LAST DECISION THAT THEY
EVER MAKE IN THIS EARTH AND WE
HAVE TO WORK TOGETHER. WE HAVE
TO LEAD WITH LOVE AND COMPASSION
, AND WE NEED TO FIND A PATH
FORWARD SO PEOPLE CAN GET THE
CARE THAT THEY NEED. SO THANK
YOU ALL FOR BEING HERE.
ASSEMBLYMEMBER'S WALDRON. THANK
YOU, MR CHAIR AND ALSO FOR
HAVING THIS SELECT COMMITTEE
THAT'S SO CRITICALLY IMPORTANT,
UM, THE DISCUSSION ABOUT STIGMA
, OF COURSE, IS TURN AMOUNT OF
HOW WE ADDRESS THE MENTAL HEALTH
CRISIS. UM FOR 11 YEARS I'VE
SERVED IN THE LEGISLATURE AND
WE'VE BEEN TALKING ABOUT MENTAL
HEALTH, ESPECIALLY STIGMA. AND
HOW DO WE REDUCE THAT? UM REALLY
BRINGING MENTAL HEALTH ISSUES
INTO THE MAINSTREAM CONVERSATION
IS ONE OF THE BEST WAYS TO KIND
OF STREAMLINE, UM, THAT
DISCUSSION AND TRY TO MAKE IT
LESS, UM, EMBARRASSING FOR
PEOPLE OR RESTRICTED FOR PEOPLE
TO COME FORWARD. UM WE NEED TO
HAVE THOSE CONVERSATIONS IN OUR
COMMUNITIES. IN OUR SCHOOLS IN
OUR HOMES. UM YOU KNOW THAT IT'S
A COMMONPLACE ISSUE. EVERYBODY
KNOWS SOMEONE WHO'S GOING
THROUGH A MENTAL HEALTH ISSUE
EVERYWHERE I GO IN MY DISTRICT
WHENEVER I SPEAK, I ALWAYS TALK
ABOUT WHAT WE'RE DOING IN THE
MENTAL HEALTH CAUCUS. WHAT'S
HAPPENING NOW WITH OUR MENTAL
HEALTH SELECT COMMITTEE. UM AND
ALL OF THE WORK THAT WE'VE BEEN
DOING IN THE LEGISLATURE FOR AS
LONG AS I'VE BEEN HERE AND
EARLIER AS WELL AS ALL THE
AMAZING WORK THAT OUR CLINICS
AND TREATMENT PROVIDERS ARE
DOING OUT IN IN OUR REGIONS, UM,
WE SHOULDN'T IT SHOULD NEVER
HAPPEN THAT SOMEONE SUFFERS IN
SILENCE. AND I THINK HAVING THE
CONVERSATION IS REALLY THE
CRITICAL STEPS. SO THANK YOU FOR
THIS MEETING AND I LOOK FORWARD
TO HEARING THE DISCUSSION. THANK
YOU. ASSEMBLYMEMBER'S BAUER CAN
THANK YOU, MR CHAIR. UM SO I
JUST WANT TO START BY THANKING
YOU, DR JACKSON FOR YOUR
LEADERSHIP. YOU KNOW, I REMEMBER
WALTER AND I HAVE BEEN AROUND
FOR A LITTLE WHILE LONGER THAN
ME. AND WHEN I GOT HERE, THERE
WASN'T MUCH LEADERSHIP IN THE
MENTAL HEALTH SPACE AND THAT HAS
REALLY CHANGED OVER THE LAST
FOUR YEARS. BUT YOUR, UM WORK
HERE AND YOU'RE JOINING US AND
ALSO SOME REMEMBER PELLERIN, UM
, YOU KNOW, BRINGING THIS ISSUE
TO THE FORE IS REALLY, REALLY
CRITICAL BECAUSE FOR TOO LONG,
IT WASN'T SOMETHING LEGISLATURE
SPENT MUCH OF ITS TIME OR ENERGY
TALKING ABOUT OR WORKING ON. AND
IT IS SOMETHING THAT EVERY ONE
OF OUR CONSTITUENTS, UM, LIVES
EVERY SINGLE DAY. AND SO YOU
KNOW, IN MY WORK IN THIS SPACE,
IT HAS BEEN AN ABSOLUTE
PRIVILEGE TO WORK IN A
BIPARTISAN WAY EVERY STEP OF THE
WAY, KNOWING THAT THIS IS NOT A
PARTISAN ISSUE. IT IS NOT ONE
THAT ONLY AFFECTS SOME OF US,
BUT IT ACTUALLY AFFECTS ALL OF
US. AND SO I REALLY WANT TO
THANK YOU FOR CONVENING THIS
COMMITTEE FOR ALL THE WORK THAT
YOU'VE ALREADY DONE, BUT I KNOW
THE WORK YOU WILL CONTINUE TO
DO. AND I JUST REALLY APPRECIATE
EVERYONE WHO'S HERE TODAY TO
HAVE THIS CONVERSATION BECAUSE
THE MORE WE TALK ABOUT IT, AND
THE MORE WE TALK ABOUT MENTAL
HEALTH AS HEALTH AS A HEALTH
CONCERN, AND SOMETHING THAT
NEEDS TO BE TREATED IN THE
HEALTHCARE SPACE, AND NOT IN THE
CRIMINAL JUSTICE SPACE, UM AND
NOT IN OTHER PLACES, BUT INSTEAD
IN THE SAME WAY THAT WE WOULD
TREAT OTHER ILLNESSES THAT WE
EXPERIENCE YOU KNOW, THE MORE
PEOPLE ARE WILLING TO COME
FORWARD AND HAVE CONVERSATIONS
AND GET THE CARE AND SUPPORT
THAT THEY DESERVE. AND SO IT'S
REALLY CONTINUES TO BE AN HONOR
TO WORK IN THIS SPACE AND TO DO
WHAT CALIFORNIANS ARE ASKING FOR
US TO DO, WHICH IS PROVIDE THEM
WITH FULL SERVICE, MENTAL HEALTH
CARE. AND SO I ALSO WANT TO
THANK OUR AGENCIES WHO ARE GOING
TO BE HERE TODAY. WHO I KNOW
HAVE A VISION FOR CALIFORNIA'S
MENTAL HEALTH SERVICES THAT IS
SO ROBUST AND COMPLETE AND
REALLY PROVIDES A FULL SPECTRUM
OF SERVICES TO INDIVIDUALS WHO
NEED THAT IN A HEALTHCARE
SETTING, AS IT SHOULD BE. THANK
YOU. THANK YOU VERY MUCH. WE
WILL NOW MOVE ON TO OUR FIRST
TWO PANELISTS THAT ARE HERE IN
PERSON. WE WILL START OFF WITH
SARAH SAROKIN FOR THE NATIONAL
UNION OF HEALTHCARE WORKERS, AND
THEN WE WILL ALSO INVITE JANET
FRANK, UM FROM THE CALIFORNIA
COMMISSION ON AGING. AND MS
SAROKIN. YOU CAN LEAD US OFF.
YOU CAN MAY BEGIN WHEN YOU'RE
READY. THANK YOU. SO I HAVE
WORKED AS A PSYCHOTHERAPIST IN
VARIOUS PUBLICLY FUNDED SETTINGS
THROUGHOUT THE STATE, ENDING
KAISER'S NAPA SOLANO AREA
CLINICS. THE WAY OUR HEALTHCARE
SYSTEM IS DESIGNED. MOST PEOPLE
GET MENTAL HEALTH CARE THROUGH
COMMERCIAL HEALTH PLANS AND
INSURERS. THESE PLANS AND
INSURERS HAVE BEEN FAILING TO
LIVE UP TO FEDERAL AND STATE
PATIENT ACCESS AND MENTAL HEALTH
PARITY LAWS. PATIENTS WHO HAVE
MEANS END UP PAYING OUT OF
POCKET FOR MENTAL HEALTH
TREATMENT WHEN THEY CANNOT FIND
AN AVAILABLE PROVIDER COVERED BY
THEIR INSURANCE. LEAVING THOSE
UNABLE TO AFFORD PRIVATE PAY
LEFT WITHOUT TREATMENT. THIS IS
IN EFFECT, A TWO TIER SYSTEM OF
HEALTHCARE AND SOCIAL JUSTICE
TRAVESTY IN MY SIX YEARS AS A
TRIAGE AND CRISIS THERAPIST AT
KAISER, I OBSERVED CHRONIC
PROBLEMS WITH ACCESS TO CARE AND
SYSTEMIC PROTOCOL USED TO HIDE
THESE PROBLEMS. WE WERE
INUNDATED ON A DAILY BASIS WITH
CALLS FROM PATIENTS AND THEIR
FAMILIES REPORTING WORSENING
CONDITIONS AND EXPERIENCING
CRISES ADMITS WEEKS AND MONTHS
LONG WAITS BETWEEN TREATMENT
APPOINTMENTS WHILE LANGUISHING
FOR MONTHS ON WAIT, LISTS FOR
TREATMENT AND WHEN UNABLE TO GET
CONNECTED TO TREATMENT AFTER
CALLING THROUGH LENGTHY LIST OF
PROVIDERS PATIENTS AT KAISER
CONTINUED TO BE FUNNELED INTO 30
MINUTES. TELEHEALTH ASSESSMENTS
PERFORMED ASSEMBLY LINE STYLE AS
AN ATTEMPT TO MEET APPOINTMENT,
TIMELINESS STANDARDS AND THE
LENGTHY WAIT TIMES THEY FACE FOR
THEIR FIRST TREATMENT
APPOINTMENTS ARE NOT TRACKED OR
REPORTED. ALSO PATIENTS ARE
ROUTINELY PLACED INTO
INAPPROPRIATE LEVELS OF CARE.
BECAUSE OF LACK OF AVAILABILITY
OF THE MEDICALLY NECESSARY CARE
NEEDED. FOR EXAMPLE, PATIENTS
ARE OFTEN FORCED INTO GROUP OR
BRIEF TREATMENTS WHEN THIS IS
NOT THE STANDARD OF CARE FOR
THEIR CONDITIONS, HEALTH PLANS
AND INSURERS CAN CONTINUE TO
DELAY AND DENY CARE BECAUSE
STATE REGULATORS HAVE NOT
EFFECTIVELY HELD THEM
ACCOUNTABLE. WE NEED TO TAKE
STOCK OF WHAT REGULATORY
ACTIVITIES WORK AND WHAT DOESN'T
AND GET MUCH MORE AGGRESSIVE AND
ENFORCING PARODY AND ACCESS
LAWS. WHILE INVESTIGATIONS BY
REGULATORS MOVE AT A GLACIAL
PACE AND RESULT IN LITTLE TO NO
CHANGE OF THE STATUS QUO.
PATIENTS ARE EXPERIENCING SEVERE
EMOTIONAL PAIN WORSEN PROGNOSIS
NEGATIVE IMPACTS TO THE ABILITY
TO FUNCTION AT WORK SCHOOL AND
HOME, INCREASED DISABILITY AND
WORSE. WE HAVE STRONG STATE LAWS
THAT WERE PASSED TO GUARANTEE
ACCESS TO TIMELY AND APPROPRIATE
MENTAL HEALTH CARE. SO IT IS
INEXCUSABLE THAT MANY
CALIFORNIANS AREN'T ABLE TO
ACCESS THAT CARE. HERE ARE JUST
TWO EXAMPLES OF THE PERVASIVE
AND WIDESPREAD NEGATIVE OUTCOMES
AND OUR CURRENT BEHAVIORAL
HEALTH DELIVERY SYSTEM DURING MY
SHORT TENURE SO FAR AT SOLANO
COUNTY BEHAVIORAL HEALTH, I
BECAME AWARE OF A CLIENT WHO
TRAGICALLY DIED BY SUICIDE AFTER
BEING UNABLE TO GET CONNECTED TO
AN AVAILABLE THERAPIST THROUGH
CAROLAN BEHAVIORAL HEALTH.
FORMALLY CALLED BEACON HEALTH
OPTIONS. A MANAGED CARE PLAN FOR
PARTNERSHIP MEDICAL MEMBERS IN
THE COUNTY. WHEN WORKING AT
KAISER. I SPOKE WITH A CLIENT
EXPERIENCING A SERIOUS MENTAL
ILLNESS WHO HAD BECOME HOMELESS
DUE TO THEIR UNDERTREATED AND
UNMANAGED SYMPTOMS. THE PUBLIC
OFTEN THINKS OF HOMELESSNESS AND
MENTAL HEALTH CRISIS AS TWO
SIDES OF THE SAME COIN. THAT IS,
IN MANY CASES TRUE. BUT THEY ARE
SYMPTOMS OF A BIGGER SOCIETAL
PROBLEM. WE CANNOT FOCUS MENTAL
HEALTH INTERVENTIONS ONLY ON THE
PATIENTS WHOSE CONDITIONS HAVE
DETERIORATED THAT FAR. WE NEED
TO INVEST IN PREVENTION BY
HOLDING OUR HEALTH PLANS
ACCOUNTABLE. A BEHAVIORAL HEALTH
WORKFORCE CRISIS ISN'T THE
PROBLEM HERE. THE PROBLEM IS,
CLINICIANS ARE ABANDONING,
PROVIDING CARE THROUGH THE
INSURANCE SYSTEM AND HEALTH
PLANS DUE TO POOR WORKING
CONDITIONS AND REIMBURSEMENT
RATES AND BECAUSE OF THE
BARRIERS TO GETTING ON INSURANCE
PANELS, GETTING REIMBURSED AND
PROVIDING CARE THAT DOESN'T
COMPROMISE THEIR TRAINING,
EDUCATION AND ETHICAL CODES. WE
ARE COMPLICIT AND MAINTAINING A
HEALTHCARE SYSTEM THAT HARMS
PEOPLE, FAMILIES AND OUR
COMMUNITIES. IF WE DON'T DO
EVERYTHING IN OUR POWER TO
ENSURE PATIENTS GET THE
HEALTHCARE TO WHICH THEY ARE
ENTITLED. WE NEED TO TAKE URGENT
ACTION TO IMPROVE THE
EFFECTIVENESS OF REGULATORY
ENFORCEMENT OR ELSE MENTAL
HEALTH TREATMENT WILL CONTINUE
TO BE INACCESSIBLE.
PSYCHOTHERAPISTS WILL CONTINUE
TO BE PUSHED OUT OF PROVIDING
CARE THROUGH HEALTH PLANS AND
INSURANCE, SYSTEMIC INEQUITIES
AND OUR HEALTH CARE SYSTEM WILL
CONTINUE TO BE REINFORCED AND
EVER INCREASING RATES OF
HOMELESSNESS, SUICIDE AND OTHER
NEGATIVE OUTCOMES WILL PERSIST.
THANK YOU VERY MUCH. WE WILL GO
OVER GO NEXT TO OUR NEXT STEP
PANELISTS, AND THEN AFTER THAT
WE'LL HAVE QUESTIONS OR COMMENTS
FROM COMMITTEE MEMBERS. GOOD
AFTERNOON. MY NAME IS JANET
FRANK AND I AM A COMMISSIONER ON
AGING AND ALSO A FACULTY
ASSOCIATE AT THE UCLA CENTER FOR
HEALTH POLICY RESEARCH. I RESIDE
IN MONTEREY, SO I'M ACTUALLY ONE
OF YOUR NEIGHBORS. IT IS MY
PLEASURE TO JOIN YOU TODAY AND
TALK ABOUT ONE OF THE
COMMISSION'S PRIORITY AREAS,
BEHAVIORAL HEALTH AND OLDER
ADULTS. STATE DATA CLEARLY,
DOCUMENTS THAT OLDER ADULTS ARE
SYSTEMATICALLY UNDERSERVED
ACROSS THE STATE, WITH ONLY 4%
IN NEED RECEIVING SERVICES.
THAT'S 96. YEAH. AND LESS THAN
2% OF MEDICAL ELIGIBLE OLDER
ADULTS RECEIVING EVEN ONE
SPECIALTY MENTAL HEALTH SERVICE.
MARGINALIZED GROUPS SUFFER
TRIPLE JEOPARDY. THEY ARE OLD.
THEY ARE POOR, AND THEY HAVE
EVEN POORER ACCESS. WHEN IT
COMES TO GETTING SERVICES, AND
THIS INCLUDES RACIAL AND ETHNIC
MINORITIES, IN ADDITION TO
SPECIAL GROUPS SUCH AS LGBT Q,
PLUS AND HOMELESS, OLDER ADULTS
, WHICH IS THE FASTEST GROWING
SUBSET OF HOMELESS POPULATION.
PRIOR TO RETIRING. I LED THE
OLDER ADULTS, SYSTEM OF CARE AND
MENTAL HEALTH STUDY THE FIRST
STUDY THAT ASSESSED HOW WELL
MENTAL HEALTH SERVICES SPONSORED
BY THE MENTAL HEALTH SERVICE ACT
WERE SERVING OLDER CALIFORNIANS
AND THAT'S DEFINED AS PEOPLE 60
OVER WITH SERIOUS MENTAL
ILLNESS. WE FOUND THERE ARE
SIGNIFICANT UNMET NEEDS AND
GEOGRAPHIC DISPARITIES. AND
SERVICES ACROSS THE STATE. THAT
FEW PROGRAMS OR OUTREACH EFFORTS
ARE TAILORED FOR THE COMPLEX
CARE NEEDS OF OLDER ADULTS. THAT
OUTCOME. MEASUREMENT AND DATA
ARE LIMITED AND VARIABLE BY
COUNTY. THERE ARE LEADERSHIP
GAPS AT THE STATE FOR OLDER
ADULT BEHAVIORAL HEALTH. THERE
IS, AS THE PREVIOUS SPEAKER
NOTED, LACK OF, UM PROVIDERS AND
LACK OF REPRESENTATIVE AND WELL
TRAINED PROVIDERS AS
RELATIONSHIP TO OLDER ADULTS.
BUT ALSO THERE ARE EVIDENCE
BASED, EFFECTIVE PROGRAMS AND
PROMISING PROGRAMS BENEFITING
OLDER CALIFORNIANS. AND I THINK
YOU MAY BE HEARING MORE ABOUT
THAT FROM TOBY EWING WHEN HE
PRESENTS AND FINALLY, OLDER
ADULTS BENEFIT MOST FROM AN
INTEGRATED SERVICE APPROACH. OUR
STUDY INCLUDED PEOPLE WITH LIVED
EXPERIENCE THAT PARTICIPATED IN
FOCUS GROUPS. AND MOST
PARTICIPANTS HAD SPENT A
LIFETIME AS LOW INCOME RESIDENTS
IN UNDERSERVED AREAS OF ABJECT
POVERTY AND VIOLENCE, A LIFETIME
OF EXPOSURE TO AND SURVIVAL
WITHIN THESE RAW REALITIES
BROUGHT FORTH A DEPTH OF INSIGHT
AND TRUTHS THAT WERE SHARED WITH
US IN THE MOST OPEN AND
COMPELLING MANNER. THE HOMELESS
GROUP, WHICH WAS PRIMARILY
AFRICAN AMERICANS CONSIDERED
CHURCH AND FAMILY AS PART OF
THEIR SERVICE AND SUPPORT
NETWORK, AND THEY MORE
FREQUENTLY DISCUSSED INDIVIDUAL
LEVEL TRAUMA IN THE CONTEXT OF
COLLECTIVE AND SOCIETAL TRAUMA
FRAMED IN HISTORICAL AND SOCIAL
FACTORS, SUCH AS RACISM. THE
HISTORY OF MEDICAL
EXPERIMENTATION, GENERATIONAL
POVERTY, LACK OF COMMUNITY
RESOURCES, VIOLENCE AND A
VARIETY OF DRUG EPIDEMICS JUST
SHARE WITH YOU SEVERAL QUOTES
FROM MEMBERS. QUOTE. I WAS JUST
SPEAKING AS FAR AS ME BEING A
BLACK MALE. THE OLDER ADULTS,
YOU KNOW, THEY CAME UP AND ALL
THEM TESTS THAT THEY TOOK IN
THAT STUFF THAT WAS SHOT IN THEM
AND THE STORIES THAT WAS TOLD SO
ME DEALING WITH DOCTORS. IT'S AN
ISSUE. SO ACTUALLY TALKING TO A
THERAPIST. YOU KNOW, A LOT OF
THERAPISTS JUST DON'T BE LOOKING
LIKE US. UNQUOTE. HERE'S ANOTHER
QUOTE. QUOTE I GOT THE ROYAL
RUNAROUND. SO I DON'T FIND THAT
THE COUNTY IS DOING ENOUGH. THEY
SAY THEY OFFER SERVICES BUT THEN
TO QUALIFY FOR THOSE SERVICES,
YOU HAVE TO BE WELL, YOU ALMOST
HAVE TO BE ON LIFE SUPPORT TO
GET SERVICES AND QUOTE. HOWEVER
MANY OF OUR GROUP MEMBERS
EXPRESSED APPRECIATION AND GREAT
BENEFITS FROM THE SERVICES
PROVIDED AS EVIDENCE FROM THIS
QUOTE FROM A WOMAN AND ONE OF
OUR SPANISH SPEAKING GROUPS.
QUOTE. I ALSO FEEL THAT THEY
HAVE HELPED ME A LOT AT LEAST
FOR A SHORT TIME. TWO YEARS TO
GET WHAT THE AMERICANS CALL
RECOVERY. RECOVERY. BUT IT WAS
VERY MUCH BECAUSE OF THEIR HELP
THEIR PRESENCE. YOU FEEL
MOTIVATED BY THE FACT THAT THEY
GO TO YOUR HOUSE THAT THEY ASK
YOU HOW YOU'RE FEELING. THEY
PUSHED ME. THEY MOTIVATE ME TO
KNOW THAT AND TO BE GRATEFUL FOR
THEM BECAUSE THEY COME SEE US IN
OUR HOMES, UNQUOTE. BASED ON OUR
STUDY DATA, AND I DO HAVE SOME
POLICY BRIEFS HERE THAT GO INTO
MUCH MORE DETAIL. BUT LET ME
JUST SUMMARIZE. WE HAVE A NUMBER
OF RECOMMENDATIONS. NUMBER ONE.
CREATE A DEPARTMENT OF HEALTH
CARE SERVICES LEADERSHIP
POSITION TO APPROVE TO IMPROVE
OLDER ADULTS SERVICE DELIVERY
AND TO FACILITATE WORKING
COLLABORATIVELY ACROSS STATE AND
COUNTY DEPARTMENTS. NUMBER TO
CONDUCT DEDICATED OUTREACH AND
DOCUMENT UNMET NEEDS AMONG OLDER
ADULTS. NUMBER. THREE PROMOTE
STANDARDIZED GERIATRIC TRAINING
OF PROVIDERS TO INCLUDE THE RICH
CULTURAL AND LINGUISTIC
DIFFERENCES, INCLUDING
GENERATIONAL COHORT, RACE,
ETHNICITY, GENDER IDENTIFICATION
AND SEXUAL ORIENTATION. NUMBER
FOUR INSTITUTE MANDATORY AND
STANDARDIZED DATA REPORTING
REQUIREMENTS AT THE STATE AND
LOCAL LEVELS FOR OLDER AGE
GROUPS. MANY REPORTS REALLY LUMP
OLDER ADULTS AS ADULTS, ANYBODY
27 AND OLDER, YOU KNOW, AFTER
TAE, THIS ISN'T HELPFUL. NUMBER
FIVE REVISED THE CURRENT FUNDING
FORMULA TO ENSURE THAT RURAL
COUNTIES ARE PROVIDED THE
NECESSARY FUNDING NEEDED TO
ADDRESS THE CRITICAL GEOGRAPHIC
DISPARITIES TO PROVIDE SERVICES
TO ALL ALL AGE GROUPS THAT ARE
IN NEED. AND FINALLY INCREASED
SERVICE INTEGRATION EFFORTS,
ESPECIALLY THE INTEGRATION OF
MEDICAL BEHAVIORAL HEALTH, AGING
SOCIAL SERVICES, HOUSING AND
TRANSPORTATION SERVICES.
INCLUDING AND CLOSING OLDER
ADULTS ARE SURVIVORS. THEY ARE
RESILIENT. AND THEY DESERVE
THEIR FAIR SHARE OF ALL TYPES OF
BEHAVIORAL HEALTH SERVICES,
INCLUDING PREVENTION AND EARLY
INTERVENTION. THANK YOU. THANK
YOU BOTH VERY MUCH QUESTIONS OR
COMMENTS FROM COMMITTEE MEMBERS.
THERE WAS A LOT THERE, SO I
DON'T KNOW. UM I JUST I DID
WANNA TALK. I WAS TRYING TO TAKE
NOTES. BUT YOU KNOW, WE DID PASS
THE PARODY LAWS AND YOU KNOW IT
STRUCK ME THAT YOU'RE SAYING
THAT YOU'RE NOT REALLY SEEING
THAT OUT THERE IN THE COMMUNITY
AND WHAT CAN BE DONE. Tð HMM.
AH, BASICALLY IMPROVE THE
ENFORCEMENT. IS IT MORE DATA
GATHERING OR IS IT MORE LIKE,
HOW CAN WE HELP? TO DO THAT.
YEAH. SO, UM. STATE REGULATORS,
LIKE GMHC SHOULD SHIFT AWAY FROM
COMPLAINT BASED ENFORCEMENT. UM
UH, IN MY EXPERIENCE A LARGE
MAJORITY OF PATIENTS WHO HAVE A
HARD TIME ACCESSING APPROPRIATE
AND TIMELY CARE DON'T GO THROUGH
THE GRIEVANCE PROCESS. UM AND
THAT THOSE PROCESSES UM, CAN BE
QUITE CHALLENGING, ESPECIALLY IF
YOU HAVE MENTAL HEALTH SYMPTOMS.
UM AND INSTEAD, REGULATORS NEED
TO TRACK ALL THE RELEVANT DATA
POINTS. THEY NEED TO ASSESS
WHETHER EVERY PATIENT IS
RECEIVING TIMELY AND APPROPRIATE
CARE REGULARLY SCRUTINIZED THOSE
PATIENT RECORDS AND AGGRESSIVELY
PUNISH VIOLATIONS IN A WAY THAT
INCENTIVIZES QUICK AND
MEANINGFUL ACTION. AS OF RIGHT
NOW, THERAPISTS LIKE MYSELF, UM
WERE PLACED IN JEOPARDY OF
LOSING OUR LICENSE. IF A PATIENT
DOESN'T GET THE CARE THAT THEY
NEED, UM, BUT THESE OUTPATIENT
SERVICE PROVIDERS ARE ONLY
REGULATED LIGHTLY, AND THAT
NEEDS TO CHANGE. ANY OTHER
MEMBERS. YES SIR. DR ARAMBULA.
I'LL BEGIN WITH MISS FRANK, IF I
CAN, UM I LOOK FORWARD TO THE
CONVERSATION THAT MR EWING WILL
HAVE LATER ABOUT EVIDENCE. UM UH
, PROGRAMS, EVIDENCE BASED
PROGRAMS AS WELL AS THE
PROMISING PROGRAMS, BUT I'M
HOPING YOU CAN SPEAK TO A FEW
WITH SPECIFICITY ON HOW WE CAN
ALSO ADDRESS THE GEOGRAPHICAL
DISPARITIES THAT YOU HAD
MENTIONED COMING FROM ONE OF
THOSE AREAS. I DO LIKE TO REMIND
OUR STATE THAT IS NOT ONE SIZE
FITS ALL MUST MEET. THE NEEDS OF
ALL CALIFORNIANS, WHICH REQUIRES
US TO MEET PEOPLE JUST CAME
BACK. SO I DIDN'T KNOW IF YOU
HAVE HERE AT LEAST TALK ABOUT
SOME OF THOSE PROGRAMS THAT HAVE
BEEN SHOWING PROMISE. YES AND
FIGURE OUT IF THOSE ARE SOME
THAT WE CAN TALK ABOUT SCALING.
HOW CAN I DIDN'T KNOW YOU DIDN'T
. I DIDN'T KNOW YOU WERE JUST A
MINUTE. THERE'S SOMEONE WHO
NEEDS TO MUTE THEMSELVES. THE
MARKET. IT'S RUSH HOUR. YOU KNOW
YOU TO HOPEFULLY TOMORROW
EVERYTHING WILL BE BETTER
BECAUSE WHEN SHE CAME, MODERATOR
, CAN YOU MOVE MUTE? THE LINES
START MAKING NOISE. BUT THEN SHE
DROPPED ME. THERE YOU GO. OKAY
SURE. UM WELL, ONE OF THE
PROGRAMS THAT HAS REALLY HAD A
LOT OF RESEARCH AROUND IT. UM IS
THE PEARLS PROGRAMS PROGRAMS FOR
ENRICHED AND REWARDING LIVES AND
THAT FOCUSES ON DEPRESSION. AND,
UM, IT IS CURRENTLY AND I THINK
THAT TOBY WILL PROBABLY TALK
ABOUT THIS. UM CURRENTLY, THE
MHS S¼ FUNDING HAS JUST PUT IN
$20 MILLION TO THE CALIFORNIA
DEPARTMENT OF AGING TO SCALE UP.
THOSE PROGRAMS AND TO BRING THEM
TO OTHER COMMUNITIES. AND, UM SO
THAT'S THAT'S ONE OF THEM. THERE
ARE SOME OTHER PROMISING
PROGRAMS THAT DON'T HAVE THAT
LEVEL OF RESEARCH. I MEAN,
THERE'S A NUMBER OF EVIDENCE
BASED PROGRAMS THAT HAVE BEEN
SHOWN TO REALLY BENEFIT OLDER
ADULTS AND PEARLS IS THE ONE
THAT COMES TO MIND RIGHT NOW,
AND THERE'S OTHER PROMISING
PROGRAMS THAT ARE REALLY MORE
LIKE DROP IN PROGRAMS WHERE THEY
HELP PEOPLE WITH JOB SKILLS AND
YOU KNOW ALL KINDS OF DIFFERENT
, MEANINGFUL AND PROVIDE
PURPOSE. THERE'S ANOTHER GREAT
ONE IN THE OAKLAND AREA THAT IS
ACTUALLY REACHING OUT TO
PREVIOUSLY HOMELESS PEOPLE AND
PROBABLY STILL, SOME ARE
CURRENTLY HOMELESS AND THEY ARE
CREATING AMBASSADORS. AND THIS
IS AGAIN AN MHS A FUNDED PROGRAM
AND THEY'RE CREATING AMBASSADORS
AND HELPING THEM BECOME
ADVOCATES AND SPEAKING. TO CITY
COUNCILS AND OTHER OTHER GROUPS
ON BEHALF OF HOMELESS PEOPLE AND
PEOPLE WITH MENTAL HEALTH
ILLNESSES. AND I ACTUALLY HAVE A
POLICY BRIEF THAT DESCRIBES WITH
A COMPENDIUM OF ALL THE
DIFFERENT, UM, PROMISING
PROGRAMS AND EVIDENCE BASED
PROGRAMS, WHICH I WOULD BE HAPPY
TO PROVIDE TO THE COMMITTEE GIVE
YOU THAT GIVE YOU THAT
INFORMATION FORWARD TO READING
THAT THROUGH WITH MORE DETAIL.
YEAH WE ALL KNOW THE EFFECT THAT
SOCIAL ISOLATION IS HAVING. YES
PARTICULARLY IN OUR ELDERLY
POPULATION. ABSOLUTELY. IT'S
IMPORTANT TO LISTEN TO WHICH
PROGRAMS ARE BEING THINK YOU'RE
GOING TO HEAR FROM FRIENDSHIP
LINES. I BELIEVE, YEAH. THAT'S
ANOTHER REALLY IMPORTANT
PROGRAM. BUT ALL ALL OF THESE
ANYTHING THAT HELPS CONNECT
PEOPLE I THINK PROVIDING
PROGRAMS AND WE WERE TALKING
ABOUT ACCESS. I THINK OLDER
ADULT ACCESS ISSUES REALLY BEGIN
WITH THE PLANNING PROCESS. SO
COUNTIES HAVE THESE PLANNING
MEETINGS WHERE THEY INVITE
PEOPLE TO COME IN. AND RESEARCH
HAS SHOWN THAT VETERANS AND
OLDER PEOPLE ARE THE LEAST
LIKELY TO ATTEND THOSE MEETINGS
. THEY THEN BASE THEIR PROGRAM
PLANNING FOR THE COUNTY ON THE
INPUT AT THOSE PLANNING MEETINGS
, SO RIGHT FROM THE VERY
BEGINNING YOU'VE GOT, YOU KNOW,
KIND OF A DEFICIT IN INPUT. AND
I THINK THAT ONE OF THE THINGS
THAT COULD BE DONE WOULD BEAT
YOU. OUTREACH. THROUGH SENIOR
CENTERS, COMMUNITY CENTERS, UM,
FOOD PROGRAMS, YOU KNOW,
DIFFERENT KINDS OF THINGS LIKE
THAT, WHERE THEY KNOW OLDER
PEOPLE WILL BE AND TRY TO REALLY
GAIN SOME INSIGHT WITH OLDER
PEOPLE, UM, FOR ABOUT THEIR
NEEDS, BECAUSE THIS IS THE GROUP
, ESPECIALLY RIGHT NOW. THEY
CAME UP BY THE BOOTSTRAPS.
TREMENDOUS STIGMA. DON'T WANT TO
ASK FOR HELP. YOU'VE SEEN THE
NUMBERS OF SUICIDE, ESPECIALLY
IN THE NORTHERN RURAL COUNTIES,
YOU KNOW, DOUBLE DIGITS. UM AND
SO THERE'S JUST A LOT GOING ON.
THAT COULD BE BENEFICIAL. YEAH.
THANK YOU, MR CHAIR CHAIR. YEAH
GO AHEAD. ASSEMBLYMEMBER'S
PELLERIN. YES SO YOUR STATISTIC
REALLY SHOCKED ME THAT ONLY 4%
ARE GETTING SERVICES. YES YOU
SAY THE BARRIER IS JUST THAT THE
STIGMA IS THAT THE ACCESS TO
PROVIDERS? IS THAT MONEY? IS
THAT ALL THE ABOVE? YES SO, UM,
I BELIEVE THAT PEOPLE THAT
PROBABLY HAVE THE MOST ACCESS
ARE THE DUALLY ELIGIBLE. AND
THEY AND PEOPLE TEND TO KIND OF
DIP IN AND OUT THAT ELIGIBILITY
. SO HAVING CONSISTENT, UM,
BENEFITS IS AN ISSUE. FOR PEOPLE
THAT HAVE MEDICARE ONLY AH, THAT
IS ALSO AN ISSUE BECAUSE EVEN
THOUGH THEY MAY HAVE A BENEFIT,
THEY CANNOT FIND A PROVIDER THAT
TAKES MEDICARE. AND SO THAT IS A
HUGE ACCESS ISSUE. UM, ALSO. THE
UH, FACT THAT, UM THERE'S A
NUMBER OF PEOPLE THAT NEED
PRETTY INTENSE IN A WAY CASE
FINDING TO BE ABLE TO GET THEM
INTO SERVICES. YOU KNOW, THEY'RE
RELUCTANT TO SAY THEY HAVE A
MENTAL HEALTH PROBLEM. THERE'S A
LOT OF STIGMA INVOLVED, AND SO
THERE NEEDS TO BE, UH,
RELATIONSHIPS BUILT. I THINK THE
CREMATORIES AND THE DIFFERENT
PURE COUNSELING PROGRAMS ARE
REALLY BENEFICIAL WHEN IT COMES
TO THAT KIND OF OUTREACH AND
CONNECTION. SO THERE'S JUST A
LOT OF VARIOUS ISSUES AND FACE
IT. YOU KNOW, A LOT OF PROGRAMS
DON'T RELATE TO THE NEEDS OF
OLDER, OLDER ADULTS. MANY
COUNTIES LUMP OLDER ADULTS IN
WITH ALL OF THEIR ADULT
PROGRAMMING. VERY FEW COUNTIES.
UM YOU KNOW, MAYBE ABOUT A THIRD
ACROSS THE STATE RIGHT NOW HAVE
AN OLDER ADULT SYSTEM OF CARE
WHERE THEY HAVE TAILORED, UM,
SERVICE IS REALLY GETTING TO THE
TO THE MEAT OF WHAT THE NEEDS
ARE OF OLDER ADULTS. AND I THINK
ALSO INTEGRATED CARE WOULD BE
VERY BENEFICIAL AND THERE'S A
LOT OF GREAT MODELS HAVE
INTEGRATED CARE PROGRAMS WHERE
THEY HAVE BEHAVIORAL HEALTH
WHERE THEY HAVE PHYSICAL HEALTH,
MEDICAL CARE, OR THEY HAVE
MEDICAL CARE WHERE THEY HAVE
BEHAVIORAL HEALTH. SO IF YOU
COME INTO YOUR DOCTOR MUCH MORE
LIKELY TO GO IN TO SEE YOUR
DOCTOR, AND THEY CAN IDENTIFY
THIS BECAUSE THEY'VE BEEN
TRAINED TO THEY CAN LINK YOU UP
RIGHT THERE IN THE OFFICE WITH
SOMEBODY AND GET YOU STARTED ON
ON YOUR TREATMENT AND RECOVERY,
AND WHEN YOU SAY HAVING A
SEPARATE CARE FOR OLDER ADULTS
WHAT'S THAT DEFINITION
PROGRAMMATIC, SEPARATE KINDS OF
PROGRAMS. SO THAT'S 60 65. WHAT?
WHAT'S THAT IN THE MENTAL HEALTH
FIELD AT 60 OVER BUT FOR
MEDICARE, OBVIOUSLY AT 65 AND
OLDER? YES, FOR THAT BENEFIT,
YEAH. THANK YOU. THANK YOU FOR
YOUR LEADERSHIP. ALL OF YOU.
ABSOLUTELY MISS SORORITY, AND
I'M HOLD ON, OBVIOUSLY, UM. MANY
OF THE, UM THOUGHTS IN REGARDS
TO HAVING A LIFE SUPPORT SYSTEM
INSTEAD OF A HEALTH SYSTEM. UH
IT IS SOMETHING SIMPLY. WE'VE
GOT TO FIX. AND. HOW CAN WE
TRANSFORM OUR HEALTH SYSTEM IS
IN MANY CASES, THE ONLY THING
THAT COMMUNITIES HEALTH IS A
HOSPITAL. YET THE HOSPITALS ARE
NOT AS REALLY EQUIPPED WITH THE
MENTAL HEALTH SERVICES THAT ARE
NECESSARY. TO BE ABLE TO UM UM
ADEQUATELY SERVE THE VARIOUS
NEEDS. UM, OF OUR POPULATION. UM
I'M REMINDED OF, YOU KNOW, MANY
OF US ARE ALWAYS TRAINED IN
MENTAL HEALTH. FIRST AID. BUT
TOO MANY TIMES. PEOPLE THINK
THAT THAT'S ALL THERE IS. RIGHT?
WHAT IS NECESSARY. OBVIOUSLY
THERE'S A NUMBER OF PROPOSALS.
THERE'S A NUMBER OF THINGS IN
THE BUDGET TO BEGIN TO BUILD OUT
OUR BEHAVIORAL HEALTH SYSTEM.
WHAT ARE SOME THINGS THAT YOU
STILL SEE IS LACKING THAT WE CAN
BEGIN TO LEGISLATE ON FOR NEXT
YEAR. NOW I AM JUST A CLINICIAN
SO THAT SOME OF OUR A LOT OF
THAT INFORMATION WOULD PROBABLY
BE SOMETHING THAT NUH W COULD
PROVIDE YOU BUT IN, UM MY
EXPERIENCE, UM UH, MANY
PSYCHOTHERAPISTS CHOOSE TO
PRACTICE IN A WAY WHERE THEY
TAKE PRIVATE PAY, SO THEY
BASICALLY SEE THE MOST
PRIVILEGED PEOPLE WHO CAN AFFORD
PRIVATE PAY, UM, IN ORDER TO
MAKE A LIVING, UM, INSURANCE IN
SOME CASES, INSURANCE RATES.
REIMBURSEMENT RATES FOR
THERAPISTS HAVEN'T BEEN RAISED
IN A DECADE OR MORE. UM AND, UM
, GIVEN THE, UM HIGH DEMAND FOR
MENTAL HEALTH SERVICES, IT IS,
UM, CONFUSING TO ME. WHY, UM
THESE INSURANCE COMPANIES AND
COMMERCIAL HEALTH PLANS. DON'T
TRY TO ATTRACT AND RETAIN
PSYCHOTHERAPIST BY. COMPENSATING
A FAIR AND LIVING WAGE FOR THEM.
THANK YOU VERY MUCH. WE WANT TO
THANK OUR TWO PANELISTS FOR
BEING HERE. UM AND WE WILL TAKE
OUR NEXT TO THANK YOU ALL VERY
MUCH. UM OUR NEXT ONE. WE WILL
MOVE TO SWARTZ TO PLOW SHARES.
AND THAT IS MICHAEL BLACKER, WHO
IS JOINING US VIA PHONE. MR
BLACKER, ARE YOU WITH US, AND
WE'LL GIVE THEM OPPORTUNITY TO
BE ON MUTED HERE.
MR BLECKER, ARE YOU WITH US?
YEAH. OKAY MR BLACKER. THEY'VE
REQUESTED FOR YOU TO AN MUTE SO
YOU CAN MUTE YOURSELF.
DO THEY KNOW HOW TO AMUSE
THEMSELVES. THE SUN WILL COME
THEM. LIKE YEAH. NOTHING I COULD
DO BESIDES. OKAY THEN WE WILL
MOVE ON TO, UM, DR KWACHA FROM
THE ASIAN HEALTH SERVICES.
DOCTOR, ARE YOU WITH US?
IT LOOKS LIKE THIS IS ONE OF
THOSE TECHNOLOGY DAYS.
OAN AT ALL YESTERDAY.
WE'LL WAIT JUST A FEW MINUTES
UNTIL THEY CAN TAKE CARE OF THE
TECHNOLOGY HERE.
YEAH. YEAH. YOU JUST HAVE TO BE
ON. YEAH. UNFORTUNATELY. YEAH,
WE HAVE. THEY JUST HAVE TO YEAH,
THAT ONE.
YEAH. SO THEY CAN BUT THEY IN
HERE.
YEAH. SO.
WHILE WE'RE TRYING TO FIGURE OUT
OUR OTHER PANELISTS FOR THIS
PANEL, WE CAN MOVE ON TO THE
SECOND PANEL, WHICH IS WHERE WE
GO ON FROM HERE. UM AND SO.
LET'S BRING UP OUR. TWO
PANELISTS HERE. AND WITH US FOR
OUR SECOND PANEL, WE HAVE THE
CALIFORNIA HEALTH AND HUMAN
SERVICES AGENCY. WITH MELISSA
STAFFORD JONES AND THE
CALIFORNIA HEALTH AND HUMAN
SERVICES AGENCY, STEPHANIE
WELSH. DEPUTY SECRETARY
BEHAVIORAL HEALTH. UM AND THEN,
OF COURSE, TOBY EWING, UH, THE
EXECUTIVE DIRECTOR OF THE MENTAL
HEALTH SERVICES OVERSIGHT AND
ACCOUNTABILITY COMMISSION. WE
WANT TO WELCOME THEM WITH US. UH
UM AND WE HAVE HAD, UM, HOURS OF
TESTIMONY FROM PARTICULAR GROUPS
. UM, VARIOUS, UM RACIAL, ETHNIC
GROUPS AGING DISABILITY
COMMUNITY TO HEAR THEIR SPECIFIC
EXPERIENCES. UM DEALING WITH THE
MENTAL HEALTH. IN THEIR
COMMUNITIES. AND IT IS OUR HOPE
THAT, UM, NUMBER ONE. OF COURSE.
WHAT ARE WE ALREADY DOING? THE
EXECUTIVE SUMMARY IS A LOT. UM
BUT BUT THEN. UM WHERE DO WE
HAVE LOOKING FORWARD TO FOR NEXT
YEAR? WHAT SHOULD WE BE GEARING
UP FOR? RIGHT? UM, BECAUSE WE
KNOW THIS WORK IS GOING TO TAKE
SOME TIME. UM SO WE'RE LOOKING
FORWARD TO SOME OF THE HEARING
SOME OF THOSE AS WELL. WE WILL
BEGIN. WITH THE PROBABLY MISS
WELCH. AND THEN WE WILL MOVE ON
TO MISS STAFFORD JONES AND THEN
MR EWING. GREAT GOOD AFTERNOON.
HONORABLE CHAIR. DR. JACKSON I
GOT TO MEET ASSEMBLY MEMBER PELT
PELLERIN. AND THE ELEVATOR ON MY
WAY UP THIS AFTERNOON. SO UM AND
, UM I HAVE HAD THE OPPORTUNITY
TO HEAR YOU SPEAK LAST WEEK OR I
THINK THAT WAS LAST WEEK AT THE
STATE OF REFORM, AND I THINK YOU
ACTUALLY ALSO CAME TO OUR CARE
COURT PRESENTATION, SO IT'S
REALLY NICE TO SEE YOU AS WELL.
UM SO MY NAME IS STEPHANIE WELCH
ON THE DEPUTY SECRETARY OF
BEHAVIORAL HEALTH FOR OUR HEALTH
AND HUMAN SERVICES AGENCY, AND
IN THAT ROLE, MY JOB IS TO
SUPPORT OUR AGENCY AND ALL OF
OUR DEPARTMENTS AND BUILDING
EQUITABLE, ACCESSIBLE AND
AFFORDABLE BEHAVIORAL HEALTH
CARE FOR ALL CATTLE. CLIFF
ORANIENBURG. UM TODAY, I'M GOING
TO START WITH REALLY KIND OF AN
OVERVIEW OF KIND OF A VARIETY OF
DIFFERENT THINGS WE'RE DOING AND
THEN PASS IT OVER TO MY
COLLEAGUE MELISSA STAFFORD JONES
, WHO IS THE DIRECTOR OF OUR
CHILDREN AND YOUTH PAPER HEALTH
INITIATIVE, AND THAT IS A VERY
FUTURE AND FORWARD THINKING
INITIATIVE, WHICH I'M REALLY
EXCITED FOR HER TO SHARE SOME
DETAILS ABOUT, UM YOU HAVE HEARD
ME SAY THIS IN TESTIMONY BEFORE
AND I'M SURE YOU HEARD IT FROM
THE INDIVIDUALS WHO HAVE BEEN
COMING TO THE SELECT COMMITTEE
COMMITTEE HEARINGS THAT AT SOME
POINT IN OUR LIVES, WE ARE ALL
GOING TO BE CHALLENGED WITH A
MENTAL HEALTH OR SUBSTANCE USE,
UH, ISSUE OURSELVES. THERE WILL
BE CARING FOR A PARENT, A LOVED
ONE. A NEIGHBOR, A CO WORKER, A
FRIEND. WHO WILL BE ON THEIR OWN
JOURNEY. UM AND THIS JOURNEY
RANGES FROM EVERYTHING FROM
THOUGHTS OF SUICIDE, WHICH YOU
HEARD ABOUT, AND I APPRECIATE
YOU SHARING YOUR STORY OF
SUICIDE LOSS AND BEING A SUICIDE
LOSS SURVIVOR, UM TO INDIVIDUALS
WHO JUST ARE DEEPLY GRIEVING ARE
ISOLATED. UM AND ARE PARALYZED
BY GRIEF AND ANXIETY. UM AND THE
WAY TO THIS CRISIS, AS YOU HAVE
LIFTED UP IS MOST CERTAINLY NOT
EQUALLY CARRIED BLACK,
INDIGENOUS AND COMMUNITIES OF
COLOR, YOUNGER AND OLDER ADULTS
. PEOPLE WHO IDENTIFY AS LGBT Q.
PLUS VETERANS, PEOPLE WHO ARE
INVOLVED IN THE JUSTICE SYSTEM,
AND PEOPLE WHO ARE HOMELESS
CARRY THE DEEPEST BURDENS IN THE
HEAVIEST BURDENS. AND THIS IS
JUST A CLEAR THEME THAT I
APPRECIATE YOU LIFTING UP IN
THESE HEARINGS, UM SO WE ALL
HAVE MENTAL HEALTH. I'M ALSO A
SOCIAL WORKER. UM EVERYBODY HAS
MENTAL HEALTH. SOME OF US HAVE
MENTAL ILLNESS. VOLUNTEER THAT
CATEGORY. SOME PEOPLE HAVE
SERIOUS MENTAL ILLNESS. AND
WHILE MANY OF US MAY MISUSE
SUBSTANCES TO, UH, COPE WITH
STRESS AND PAIN, THERE ARE
OTHERS WHO ARE LIVING WITH
CHRONIC SUBSTANCE USE DISORDER
CONDITIONS POLICY, SUBSTANCE USE
DISORDER. AND MAYBE A MAY HAVE
HAD THESE CONDITIONS FOR SUCH A
LONG PERIOD OF TIME. THERE WERE
UNTREATED THAT THEY HAVE A LONG
TERM COGNITIVE AND PHYSICAL
IMPAIRMENT. BEHAVIORAL HEALTH
CHALLENGES ARE EXPERIENCED ON A
COMPLEX CONTINUUM FROM MILD TO
CHRONIC, JUST LIKE ANY OTHER
ILLNESS. IT'S SOMETHING THAT WE
JUST SIMPLY DON'T TALK ABOUT
ENOUGH AND WE, UM OVER SIMPLIFY
SOME OF THESE CONCEPTS WHEN WE
HAVE THESE CONVERSATIONS, AND I
FEEL VERY STRONGLY GOING FORWARD
, THAT WE CAN'T DO THAT. IF WE
REALLY WANT TO IMPROVE OUTCOMES
, WE HAVE TO BE VERY SPECIFIC TO
THE RESPONSE. UM AND THAT
RESPONSE AND WHAT THAT RESPONSE
SHOULD P IS BASED ON NEED, AND
BASED ON WHO THAT INDIVIDUAL IS?
TODAY I'M GOING TO TALK VERY
HIGH LEVEL ABOUT OUR APPROACH TO
COMPREHENSIVELY ADDRESSING THIS
MOMENT OF CRISIS IN WHICH I ALSO
THINK IS AN OPPORTUNITY AS WELL
AS TO LOOK TO, UM, REALLY
OVERALL, IMPROVE THE MENTAL
HEALTH AND WELL BEING OF OUR
STATE. UM HOW DO WE GET TO A
SYSTEM THAT REALLY CAN PREVENT
AND INTERVENE EARLY AND OFTEN?
SO THAT MENTAL HEALTH CHALLENGES
DO NOT MANIFEST INTO SERIOUS
MENTAL ILLNESS. AND IF IT DOES,
HOW DO WE ENSURE THAT THE
PRESENCE OF THAT SERIOUS ILLNESS
DOES NOT RESULT IN WHAT WE KNOW
ARE AVOIDABLE, TRAGIC OUTCOMES.
SO UM, SUICIDE OVERDOSE,
INCARCERATION, HOMELESSNESS.
SCHOOL FAILURE. I HAVE A LONG
LIST THAT I DON'T NEARLY NEED TO
GO THROUGH. UM I DID BRING AND
PERFECTLY I HAVE FOUR COPIES,
ACTUAL COPIES THAT I CAN LEAVE
BEHIND A POLICY BRIEF THAT WE
PUT TOGETHER EARLIER THIS SPRING
TO TRY TO SIMPLY THANK YOU
SIMPLY, UM, ORGANIZE SOME OF OUR
THOUGHTS IN OUR MAJOR. I WOULD
SAY NOT JUST INVESTMENTS BUT
TRULY INITIATIVES. UM WE REALLY
TRY TO LIFT UP IN A SIMPLE, EASY
TO DIGEST REPORT HOW WE ARE
TRYING TO GET AT ACHIEVING THESE
OUTCOMES GOING FORWARD AS YOU'VE
LIFTED UP IN THIS PARTICULAR
COMMITTEE. HOW INCREDIBLY
DEBILITATING STIGMA IS HOW
MISINFORMATION CAN LEAD PEOPLE
TO NOT GETTING HELP AND,
FRANKLY, HOW PEOPLE EXPERIENCE
DISCRIMINATION AND HOW THEY
ACCESS BEHAVIORAL HEALTH CARE.
WE HAVE SIGNIFICANT DELAYS IN
GETTING ACCESS TO TIMELY
TREATMENT. JUST WANT TO BE
TOTALLY HONEST ABOUT THAT. IT IS
A PROBLEM THAT NEEDS TO BE A
PRIORITY. WE HAVE SIGNIFICANT
DISPARITIES IN UTILIZING
SERVICES AMONGST BY PARK AND
LGBT COMMUNITIES, AND WE DO NOT
HAVE ENOUGH SERVICES THAT HELP
BRING ACCESS TO CULTURALLY
RESPONSIVE CARE. WE HAVE FAR TOO
MANY INDIVIDUALS LIVING WHO HAVE
MENTAL HEALTH AND SUBSTANCE USE
DISORDERS WHO ARE LIVING IN OUR
PRISONS AND OUR JAILS. I HAD TO
PULL SOME DATA FOR SOMETHING THE
OTHER DAY, AND I SAW THAT THIS
IS A TWO YEAR DATA LAG, BUT WE
HAD NEARLY 100,000 PEOPLE
INCARCERATED IN LOCAL JAILS WHO
RECEIVING MENTAL HEALTH
SERVICES. THAT IS AN ENORMOUS
AMOUNT OF PEOPLE. UM AND WE
REALLY HAVE TO INCREASE QUALITY
COMMUNITY PLACEMENTS. WE BELIEVE
IN THIS ADMINISTRATION THAT WE
NEED TO DO MORE TO MAKE SURE
THAT PEOPLE CAN NOT ONLY LIVE IN
THEIR COMMUNITIES EVEN IF THEY
HAVE A VERY SERIOUS CONDITION.
THEY CAN THRIVE IN THEIR
COMMUNITIES IN A HOME LIKE
ENVIRONMENT, WE OBVIOUSLY HAVE A
HOMELESSNESS CRISIS, BUT WE ALSO
HAVE INDIVIDUALS WHO ARE PART OF
ARC. UH BEHAVIORAL HEALTH SYSTEM
WHO ARE LIVING WITH DEEP HOUSING
INSECURITY. THEY ARE ON THE
BRINK OF HOMELESSNESS, BECAUSE,
UM, FOR WHATEVER REASON, THEY
HAVEN'T BEEN ABLE TO WORK.
THEY'RE EXPERIENCING POVERTY,
ETCETERA. UM AND THIS IS
PROBABLY MY FAVORITE GOAL THAT
IS OUTLINED IN THIS POLICY BRIEF
. WE MUST INCREASE THE
SATISFACTION. AND TRUST THAT
THAT PEOPLE HAVE THAT THEY ARE
GETTING A HIGH QUALITY SERVICE.
UM UH, THIS IS SOMETHING I'VE
SAID FOR MUCH OF MY CAREER, BUT
PEOPLE DON'T COME BACK TO GET
SOMETHING THAT DIDN'T WORK FOR
THEM. AND IN MANY CASES, WE MAY
NOT BE OFFERING PEOPLE WHAT THEY
WANT AND HAVE TO REALLY LOOK
DEEPLY INTO. UM HOW THAT IS
WORKING. NOW I WANT TO JUST MOVE
US TO THE NEXT SLIDE REAL
QUICKLY. HERE THE REPORT ITSELF
REALLY USES THIS KIND OF, UM
SIMPLIFIED, I WOULD SAY
VISUALIZATION OF THE BEHAVIORAL
HEALTH CONTINUUM. TO TALK ABOUT
WHERE OUR CURRENT INVESTMENTS
FIT IN. AND THIS IS A REALLY
IMPORTANT I WANT TO REALLY WANT
TO LIFT UP THAT AS PART OF THIS
VISUAL YOU SEE AT THE BOTTOM
KIND OF THE UNDERGIRDING OF ALL
OF OUR BEHAVIORAL HEALTH ISSUES
, WHICH ARE INVESTMENTS TO BUILD
THE PIPELINE OF PROVIDERS AND
PHYSICAL INFRASTRUCTURE THAT WE
NEED IN ORDER TO DELIVER CARE IN
EACH OF THESE VERY IMPORTANT
STATEMENTS. FOR ANYBODY WHO'S
EXPERIENCED A MENTAL HEALTH
CHALLENGE TO SOMEBODY WHO WAS
DIAGNOSED WITH A SERIOUS AND
PERSISTENT MENTAL ILLNESS WHO
MAY NEED ONGOING LONG TERM CARE
AND SUPPORT. SO IF I WERE JUST
TO KIND OF WALK, WALK THROUGH
THIS REAL QUICKLY, I CAN, UM
KIND OF HIGHLIGHT WHERE WE SEE
SOME OF THESE INVESTMENTS. FIRST
I WANTED TO BE SPECIFIC AND
RESPONDING TO THE QUESTION ON
THE AGENDA ABOUT OUR BEHAVIORAL
HEALTH WORKFORCE PIPELINE ISSUES
BEFORE I DO THAT, UM FIRST AND
FOREMOST IS REALLY THREE
STRATEGIES THAT WE HAVE BOTH IN
C Y B H I WORKFORCE INVESTMENTS.
AND THEN LAST YEAR WE WERE WE
WERE ABLE TO GET SOME ADDITIONAL
RESOURCES FOR THE OVERARCHING
KIND OF HEALTH AND HUMAN
SERVICES WORKFORCE, BUT FIRST WE
HAVE TO SUPPORT STUDENTS SEEKING
EDUCATION AND TRAINING AND MAKE
SURE THAT WE HAVE SCHOLARSHIP
PROGRAMS, NOT LOAN FORGIVENESS.
FULL SCHOLARSHIP PROGRAMS FROM
ENTRY LEVEL TO LICENSED CLINICAL
PROFESSIONALS. WE NEED STIPENDS
FOR MASTERS LEVEL SOCIAL WORK TO
POSTGRADUATE FELLOWSHIPS AND
LOAN REPAYMENT PROGRAMS FOR
THOSE PROFESSIONALS WHO CHOOSE
TO SERVE AND UNDERSERVED
COMMUNITIES. UM, I AM GETTING
CLOSE TO 50 STILL PAYING OFF MY
STUDENT LOANS FROM MY TIME IN
SOCIAL WORK SCHOOL. IT IS A
TREMENDOUS COMMITMENT AND
PERSONAL AND FINANCIAL
INVESTMENT. UM THAT IS VERY
TAXING ON OUR WORKFORCE. UM
SECOND, WE WANT TO EXPAND
EDUCATION AND TRAINING PROGRAMS
. UM AND WE HAVE TO HAVE A NEW
WAY OF DOING THIS. ONE OF MY
MOST EXCITED ABOUT OUR BUILDING
OF OUR CAPACITY FOR OUR EARN AND
LEARN APPRENTICESHIP PROGRAMS,
BUT WE'RE ALSO INVESTING IN
THINGS LIKE PSYCHIATRIC RESIDENT
SHE RESIDENTIAL PROGRAMS, UM,
SOMETHING THAT WE LEARNED IN OUR
PARTNERSHIPS WITH OUR LABOR
FOCUS, AND I CERTAINLY LEARNED
COMING OUT OF WORKING WITH THE
REENTRY POPULATION IS HOW IT WAS
ABSOLUTELY NECESSARY TO HAVE
THAT THAT, UH ON THE JOB
EXPERIENCE, BUT ALSO THAT
PAYCHECK IF YOU DON'T HAVE A
PAYCHECK WHILE YOU'RE HAVING
THAT ON THE JOB EXPERIENCE, YOU
CAN'T TAKE THAT JOB. IT'S JUST
NOT REALISTIC. SO I'M SUPER
EXCITED ABOUT THAT PROGRAM THAT
WE ARE BUILDING AND TO HAVE
ACTUALLY PUT OUT DOLLARS FOR
THAT PROGRAM ALREADY, AND
LASTLY, WE HAVE TO CREATE
PIPELINES LIKE THE HEALTH
PROFESSIONS PATHWAY PROGRAM THAT
RESOURCE ACTUAL ORGANIZATIONS
THAT GO OUT AND ENCOURAGE
STUDENTS FROM UNDER SEPP UNDER
REPRESENTED REGIONS OF THE STATE
AND DIVERSE BACKGROUNDS TO
PURSUE HEALTHCARE CAREERS AND DO
THIS THROUGH MENTORING,
INTERNSHIPS AND FELLOWSHIPS. SO
UM, I DO ALSO WANT TO LIFT UP
THAT THAT WE DO HAVE RESOURCES
THAT ARE GOING OUT THE DOOR FOR
THESE. THESE PROGRAMS RIGHT NOW,
FOR EXAMPLE, OUR HEALTHCARE
ACCESS AND INFORMATION
DEPARTMENT. IT'S STILL HARD TO
GET THAT TO ROLL OFF MY TONGUE
HAS AWARDED NEARLY $100 MILLION
IN TRAINING PROGRAMS THAT WILL
EXPAND TRAINING BY NEARLY 900
SOCIAL WORKERS. OVER 700,
PSYCHIATRIC, MENTAL HEALTH NURSE
PRACTITIONERS AND 45
PSYCHIATRIST. I THINK THAT'S
IMPORTANT BECAUSE IT SHOWS YOU
WHERE WE'RE BUILDING OUR SYSTEM
. UM I ALSO WANTED TO LIFT UP
THAT WE ARE FUNDING THREE NEW BS
W AND FOR NEW MSW PROGRAMS TO
NEW PSYCHIATRIC RESIDENCY
PROGRAMS AND THREE NEW
PSYCHIATRIC NURSE MENTAL HEALTH
PRACTITIONER PROGRAMS. UM UH.
AND AS I LOOK AT THIS CONTINUUM
, I ALWAYS WANTED TO LIFT UP
WHERE I SEE SOME OF THE MOST
EXCITING NEW ELEMENTS OF A WORK
FORCE FOR TOMORROW. UM WE CAN
SEE FUTURE WELLNESS COACH IS
PROVIDING PREVENTION AND EARLY
INTERVENTION SERVICES FOR OUR
SCHOOL AGE YOUTH, WHILE WE CAN
ALSO SEE PEER SUPPORT SPECIALIST
RIGHT THERE IN THE CRISIS
SECTION, JOIN OUR MOBILE CRISIS
TEAMS TO PROVIDE UM, UH,
BEHAVIORAL HEALTH CRISIS
RESPONSE THAT IS NOT BASED IN A
LAW ENFORCEMENT RESPONSE AND WE
CAN SEE OUR OUR NEW COMMUNITY
HEALTH WORKERS PROVIDING ONGOING
ONGOING SUPPORTIVE SERVICES SO
THAT PEOPLE WHO HAVE INTENSIVE
CARE NEEDS INCLUDING MEDICAL
CARE NEEDS AND OTHER NEEDS OF
THAT NATURE, UM, TO BE ABLE TO
LIVE. IN THE MOST LEAST
RESTRICTIVE AND MOST INTEGRATED
RESIDENTIAL SETTING IN THE
COMMUNITY AS POSSIBLE. UM SO THE
OTHER THING I WANT TO LIFT UP IS
THAT WE ARE, UM TEARING DOWN
SOME BARRIERS TO PROVIDE
SERVICES THAT MAY HAVE BEEN
HAPPENING IN IN INDIVIDUAL
COUNTIES OR COMMUNITIES BUT WERE
NOT ABLE TO SCALE STATEWIDE. UM
WE ARE IN THE PROCESS RIGHT NOW
OF IMPLEMENTING OUR CONTINGENCY
MANAGEMENT PROGRAM. IT BELONGS
ON THIS CONTINUUM. SO DOES
MEDICATED ASSISTED TREATMENT.
DIETETIC SERVICES. UM ARE
BEHAVIORAL HEALTH INTEGRATION IN
SCHOOLS? BUT ALSO SERVICES FOR
PEOPLE WHO HAVE MORE COMPLEX
PROBLEMS LIKE A SORT OF
COMMUNITY TREATMENT. AND VERY
IMPORTANTLY, IMAGINE, YOU'LL
PROBABLY HEAR ABOUT THIS TO, UH
, SPECIALTY CARE FOR FIRST
EPISODE PSYCHOSIS. WE WILL BE
PURSUING MAKING THAT A MEDICAL
BENEFIT. UM, WE'RE DOING JAIL IN
REACH STRATEGIES AND DECREE AND
HAVE A PROJECT AS PART OF OUR
FUTURE WAIVER TO DECREASE LENGTH
OF STAYS IN HOSPITAL EMERGENCY
DEPARTMENTS. WE'RE ADDING
SUPPORTIVE EMPLOYMENT,
RECOGNIZING IT'S NOT JUST ABOUT
CREATING A LIVABLE WAGES,
CREATING ABOUT MEANING, UM AND
SUPPORTING PEOPLE TO HAVE THEIR
DREAMS, NO MATTER WHAT HEALTH
CONDITIONS THEY HAVE SO EXCITED
ABOUT THE SUPPORT OF EMPLOYMENT
PIECE AND ALSO ADDING ENHANCED
CARE MANAGEMENT IS I'M SURE
YOU'VE HEARD ABOUT AND COMMUNITY
SUPPORTS. IN THE CONTINUUM. UH
WHEN I STARTED 20 PLUS YEARS
AGO, THESE ARE NOT THINGS THAT
ANYBODY COULD GET. UM THESE WERE
NOT SERVICES THAT WERE AVAILABLE
. UM AND SO I THINK WE'RE REALLY
HOPING TO SCALE THESE THINGS. UM
SO THAT EVERY CALIFORNIAN
INCLUDING POTENTIALLY, YOU KNOW,
REGARDLESS OF PEAR IS GOING TO
HAVE ACCESS TO THESE PARTICULAR
SERVICES. I JUST WANT TO ADD
BEFORE I TURN IT OVER TO MY
COLLEAGUE HERE. I HAVE BEEN
QUITE A BIT OF A BROKEN RECORD
ABOUT THIS. BUT SINCE THIS
PARTICULAR SELECT COMMITTEE IS
ABOUT CRISIS, I JUST WANTED TO
SHARE THAT THE VERY BEST WAY TO
PREVENT CRISIS IS TO INCREASE
ACCESS. Tð EQUITABLE, AFFORDABLE
OUTPATIENT CARE, AND THAT
INCLUDES MAKING SURE THAT ARE
HIGH RISK AND VULNERABLE
POPULATIONS WITH HIGH NEEDS ARE
SAFELY HOUSED AND THAT THEY HAVE
ACCESS TO ONGOING SHIRT
SUPPORTIVE SERVICE. THAT ALSO
MEANS THAT WE OFTEN STABILIZE
SOMEONE IN CRISIS, BUT THERE IS
NO IMMEDIATE FOLLOW UP CARE. WE
HAVE TO RESOLVE THAT. UM AND
THAT SHOULD BE SOMETHING THAT
EVERYBODY GETS. REGARDLESS OF
YOU HAVE COMMERCIAL INSURANCE OR
MEDICAL UM, TODAY, OUR COMMUNITY
BEHAVIORAL HEALTH INFRASTRUCTURE
PROGRAM HAS AWARDED FUNDS TO
CREATE 88 NEW OUTPATIENT
FACILITIES THAT WILL INCREASE
CAPACITY TO SERVE OVER 200,000
PEOPLE ARE 200,000 SLOTS. WE'VE
ADDED 65 RESIDENTIAL FACILITIES
OR AWARDED FUNDS TO BUILD 65
RESIDENTIAL FACILITIES OVER $1.2
BILLION HAS ALREADY BEEN, UH,
AWARDED. AND WE ARE, I THINK A
WEEK OR TWO AWAY FROM THE NEXT
ROUND OF AWARDS, WHICH WILL
FOCUS ON CRISIS SERVICES, AND WE
HAVE $430 MILLION THAT WE WILL
BE AWARDING THIS MONTH TO BUILD
THOSE CRISIS SERVICES AND
SYSTEMS OF CARE. I WANT TO
ACKNOWLEDGE FOR YOU AND FOR
ANYONE WHO'S WATCHING AND
LISTENING, UM, THAT CALIFORNIANS
ARE RIGHTFUL, RIGHTFULLY
FRUSTRATED WITH OUR CURRENT
SYSTEM. UM BUT I DO BELIEVE WE
ARE MAKING PROGRESS. AND I DO
BELIEVE IT IS A LONG ROAD AHEAD
. UM BUT I AM VERY HOPEFUL THAT
THE HORIZON IS POSITIVE, AND I
THINK ONE OF THOSE SHINING
POSITIVITY OR PIECES OF
POSITIVITY IS REALLY, UM, THE
CHILDREN AND YOUTH BEHAVIORAL
HEALTH INITIATIVE. AND SO I'D
LIKE TO TURN IT TO DIRECTOR
STAFFORD JONES TO PROVIDE AN
UPDATE ON THAT PARTICULAR
PROGRAM. THANK YOU, STEPHANIE.
GOOD AFTERNOON CHAIR. JACKSON
AND MEMBERS OF THE COMMITTEE.
THANK YOU FOR THE OPPORTUNITY TO
BE HERE TO DISCUSS THIS CRITICAL
ISSUE OF WHERE DO WE GO FROM
HERE AND FOR ME TO BE ABLE TO
SHARE SOME OF THE WORK THAT IS
UNDERWAY TO REIMAGINE THE
ECOSYSTEM OF SERVICES AND
SUPPORTS FOR THE BEHAVIORAL
HEALTH OF OUR CHILDREN AND
YOUTH. THROUGH THE CHILDREN
YOUTH BEHAVIORAL HEALTH
INITIATIVE, OR C Y B H, I WITH
THE LEADERSHIP AND COMMITMENT TO
SOLUTIONS FROM THE LEGISLATURE
AND THE GOVERNOR THROUGH HIS
MASTER PLAN FOR KIDS. MENTAL
HEALTH. CALIFORNIA IS IN THE
PROCESS OF IMPLEMENTING A
MULTIPRONGED APPROACH TO CREATE
A SYSTEM THAT IS MORE
COORDINATED YOUTH CENTERED,
EQUITABLE AND WELL BEING AND
PREVENTION ORIENTED. THE C Y B H
I IS FOCUSED ON THE SYSTEMIC
CHANGE IS NEEDED TO IMPROVE
BEHAVIORAL HEALTH ACCESS AND
OUTCOMES FOR CHILDREN AND YOUTH.
AND WE HAVE HEARD LOUD AND CLEAR
FROM OUR PARTNERS THAT SIMPLY
DOING MORE OF HOW SYSTEMS AND
SERVICES OPERATE. TODAY IS NOT
GOOD ENOUGH AND WILL NOT BE
EFFECTIVE IN BUILDING THE
SYSTEMS AND SERVICES, YOUTH AND
FAMILIES NEED FOR MENTAL HEALTH
AND WELL BEING. PARTNERS
EMPHASIZED THE NEED FOR
FUNDAMENTAL TRANSFORMATIONAL
CHANGE. AND HERE'S A FEW OF THE
WAYS THAT THAT WE ARE WORKING ON
THAT AND THAT THAT HAS COME UP.
ONE IS THAT SYSTEMS ARE SILOED
AND THE LACK OF COORDINATION
GETS IN THE WAY OF CHILDREN AND
FAMILIES GETTING THE SERVICES
THAT THEY NEED. AND THAT'S WHY
I'M MEETING KIDS WHERE THEY ARE
IS A STRONG FOCUS IN THE
CHILDREN AND YOUTH BEHAVIORAL
HEALTH INITIATIVE, SO BUILDING
COLLABORATION AND INTEGRATION
ACROSS EDUCATION AND HEALTH
SYSTEMS IS CENTRAL TO THE WORK
OF CBB H I. WHEN YOU ASK THE
QUESTION, WHERE DO WE GO FROM
HERE? I THINK WHERE WE'RE TRYING
TO HEAD WITH THIS WORK IS WHERE,
UM, SCHOOLS ARE JUST A CENTRAL
ACCESS POINT FOR A RANGE OF
SUPPORTS AND SERVICES FOR
SOCIAL, EMOTIONAL WELL BEING AND
BEHAVIORAL HEALTH FOR CHILDREN
AND YOUTH. THAT IT'S EASILY
ACCESSIBLE AND EASILY NAVIGABLE
FOR OUR YOUTH AND FAMILIES. AND
WE KNOW THAT SCHOOLS UTILIZE
REALLY A TIERED SYSTEM OF
SUPPORT ALL THE WAY FROM
UNIVERSAL SUPPORTS FOCUSED ON
PREVENTION AND WELL BEING FOR
ALL STUDENTS UP TO A THIRD TIER
OF REALLY THINKING ABOUT
CHILDREN YOUTH THAT MAY NEED ONE
ON ONE CLINICAL THERAPEUTIC
SERVICES AND THROUGH THE C Y B
H. I WERE SCHOOLS, BEHAVIORAL
HEALTH PROVIDERS, COMMUNITY
BASED PROVIDERS AND
ORGANIZATIONS AND PARTNERS
HEALTH PLANS. WE'RE REALLY
WORKING TO SUPPORT THEM AND
WORKING TOGETHER AND COORDINATE
THEIR EFFORTS SO THAT WE CAN
CREATE THIS ECOSYSTEM WHERE YOU
CAN ACCESS GREATER SERVICES
THROUGH SCHOOL BASED AND
SCHOOLING TO SETTINGS WERE ALSO
WORKING AT THE OVERALL STATE
INITIATIVE LEVEL, FOR EXAMPLE,
REALLY THINKING ABOUT HOW WORK
THAT'S HAPPENING IN EDUCATION IN
K THROUGH 12 EDUCATION FOR
COMMUNITY SCHOOLS AND THE
COMMUNITY SCHOOLS FRAMEWORK. CAN
BE IMPLEMENTED IN A COORDINATED
WAY WITH THE CHILDREN AND YOUTH
BEHAVIORAL HEALTH INITIATIVE SO
REALLY TRYING TO WORK ON THAT
INTEGRATION BETWEEN EDUCATION
AND HEALTH. LAST YEAR. THE
CHILDREN AND YOUTH BEHAVIORAL
HEALTH INITIATIVE MET WITH 600
YOUTH AND FAMILIES AND NEARLY 50
CONVENING AROUND THE STATE TO
LISTEN TO WHAT THEY WANT AND
NEED IN TERMS OF SUPPORTING
THEIR MENTAL HEALTH AND WELL
BEING AND WHAT A REIMAGINED
ECOSYSTEM OF BEHAVIORAL HEALTH
SHOULD LOOK LIKE. AND I WANTED
TO SHARE WITH YOU SOME OF THE
THINGS THAT THEY REALLY
HIGHLIGHTED FOR US THAT ARE
DRIVING THE WHERE ARE WE GOING
WITH THIS WORK IN THE C Y B H I
ONE IS THAT A SYSTEM THAT
RECOGNIZES AND INCORPORATES THAT
CULTURE IS HEALING. THAT
RETHINKS WHAT TREATMENT IS WHAT
IT LOOKS LIKE WHO PROVIDES IT,
INCLUDING A FOCUS ON COMMUNITY,
SAFE SPACES AND EXPANSION OF NON
CLINICAL SERVICES AND PEER TO
PEER SERVICES. A SYSTEM THAT
YOUTH AND FAMILIES CAN NAVIGATE
EVEN WHEN THEY ARE STRUGGLING.
UH YOU TOLD US THEY WANT PLACES
TO BE TO CREATE AND CONNECT,
INCLUDING IN THE OUTDOORS.
THEY'RE LOOKING FOR COMMUNITY
CENTERS, PARKS, MENTORS. THEY
YOUTH RECOGNIZE THAT WE NEED
SYSTEMS THAT TAKE CARE OF ADULTS
SO ADULTS CAN CARE FOR CHILDREN.
THAT YOUTH AND COMMUNITIES HAVE
INFORMATION AND RESOURCES FOR
SELF DETERMINATION. I MEAN, YOU
HEARD THIS FROM DEPUTY SECRETARY
WELSH AND WE HEARD, FOR EXAMPLE
, IN ONE GROUP WITH A GROUP OF
YOUTH WHO TALKED ABOUT THE
SCHOOL WELLNESS CENTERS THAT
THEY HAVE ON THEIR SCHOOL CAMPUS
. AND THEY SAID, YOU KNOW, THE
FIRST PERSON WHEN WE WALK IN THE
DOOR THAT WE WANT TO SEE IS NOT
NECESSARILY A THERAPIST. WE
MIGHT. WE MIGHT NEED A THERAPIST
. WE MIGHT WANT ONE. WE MIGHT
GET TO THAT POINT. BUT THE FIRST
PERSON WE WANT TO SEE SOMEBODY
WHO SORT OF LOOKS LIKE US COMES
FROM OUR COMMUNITIES. MAYBE A
LITTLE CLOSER IN AGE SORT OF
LIKE A NEAR PIER. THAT'S THAT'S
WHO THEY TOLD US. THEY WANTED TO
SEE FIRST. I'M YOU HAVE ASKED
THAT WE HAVE A REPRESENTATIVE
WORKFORCE. AND THAT HISTORIC AND
CURRENT HARMS FROM OUR SYSTEMS
ARE ACKNOWLEDGED, AND THAT HOPE
AND TRUST CAN BE BUILT. YOU'VE
ALSO TALKED ABOUT, UM AND THIS
HAS COME UP IN A NUMBER OF
FORUMS AND I KNOW THAT BECAUSE
OF DEPUTY SECRETARY WELCH'S
COMMENTS, THEY REALLY WANT A
SYSTEM THAT IS COMPASSIONATE.
THAT IS FULL OF LOVE. I HAD ONE
PERSON SAY TO ME, WE REALLY
SHOULD CALL THIS THE LOVE
INITIATIVE THAT EVERY CHILD IN
CALIFORNIA KNOWS THEIR LOVED.
THAT THEY HAVE AT LEAST ONE
CARING, CONSISTENT ADULTS IN
THEIR LIVES BECAUSE WE KNOW HOW
CRITICALLY IMPORTANT THAT IS
LIFELONG FOR MENTAL HEALTH AND
WELL BEING. I JUST EVERY ONE OF
OUR KIDS SHOULD HAVE THAT. UM
AND THOUGH ALL YOUTH CAN
EXPERIENCE MENTAL HEALTH
CHALLENGES, UM AS WAS TALKED
ABOUT, AND AS WE KNOW, THE
COMMITTEE HAS DISCUSSED AND
STUDIED EXTENSIVELY. WE DO KNOW
THAT SOME GROUPS OF YOUTH ARE
DISPROPORTIONATELY IMPACTED AND
ALSO FACED GREATER STRUCTURAL
AND SYSTEMIC BARRIERS BOTH TO
ACCESS INTO THE KINDS OF THINGS
THAT SUPPORT WELL BEING WAS
TALKING WITH SOMEBODY EARLIER
TODAY, LIKE THINGS LIKE
ACTIVITIES, WHETHER THAT BE
SPORTS OR OTHER KINDS OF
ACTIVITIES. AND WE KNOW THAT OUR
BIPAC YOUTH ARE LGBTQ, PLUS
YOUTH, OUR YOUTH FROM LOW INCOME
FAMILIES AND UNDERSERVED
COMMUNITIES ARE HAVE FACED
GREATER INEQUITIES IN TERMS OF
BEHAVIORAL HEALTH. AND SO WE ARE
SPECIFICALLY WORKING ON IN THE
PLANNING, THE DESIGN AND THE
IMPLEMENTATION OF THE CHILDREN
AND YOUTH BEHAVIORAL HEALTH
INITIATIVE TO ADDRESS THOSE
THINGS SO YOU CAN SEE IN THIS
CHART OF THE DIFFERENT WORK
STREAMS THAT ARE IN THE
INITIATIVE, FOR EXAMPLE, IN THE
SCALING OF EVIDENCE BASED IN
COMMUNITY TO FIND EVIDENCE
PRACTICES. WE'RE LOOKING
SPECIFICALLY ABOUT HOW WE
ADVANCE RACIAL EQUITY IN THE
CONTEXT OF THAT SCALING IN THE
TARGETED YOUTH SUICIDE
PREVENTION AND OUTREACH CAMPAIGN
, IT IS LOOKING SPECIFICALLY AT
WHAT GROUPS OF YOUTH ARE AT
HIGHEST RISK FOR SUICIDE AND
THINKING ABOUT WHAT MESSAGES.
WHAT MESSENGERS WHAT TRUSTED
PARTNERS WILL SPECIFICALLY
ADDRESS THEIR CONCERNS THEIR
COMMUNITY'S NEEDS. UM AND
THINKING ABOUT ALL OF THE
INVESTMENTS IN THE WORKFORCE
THROUGH THE ABOUT HOW DO WE
REALLY CREATE A MORE DIVERSE
REPRESENTATIVE WORKFORCE SO THAT
WE CAN INCREASE EQUITY IN THE
SYSTEM? ALSO WHILE WORKING
ACROSS THE ENTIRE CONTINUUM OF
CARE IN THE C Y B H I. THERE'S A
VERY STRONG FOCUS ON BUILDING A
MORE PREVENTION AND WELL BEING
ORIENTED SYSTEM. WE HEAR
CONSISTENTLY FROM OUR PARTNERS
FROM PRACTITIONERS FROM YOUTH
AND FAMILY THAN THEMSELVES. I'M
THAT VERY OFTEN. WE COULD HAVE
INTERVENED EARLIER THAT WE
MISSED OPPORTUNITIES TO REACH
CHILDREN AND YOUTH BEFORE
CONDITIONS WERE EXACERBATED AND
BEFORE SUFFERING WAS EVEN
GREATER. UM AND SO WHEREVER WE
HAVE THAT OPPORTUNITY, WHERE IS
IT THAT WE CAN BUILD SYSTEM
SYSTEMS AND COORDINATED
APPROACHES THAT WILL ALLOW FOR
THAT EARLIER INTERVENTION. YOU'D
HAVE TOLD US. THEY ARE TIRED OF
HEARING THAT THEY'RE NOT SICK
ENOUGH TO BE ABLE TO ACCESS
SERVICES AND THAT THEY WANT US
TO STOP WAITING UNTIL THEY ARE
IN CRISIS TO PROVIDE SUPPORTS.
SO WE ARE ACTIVELY AND
CONCRETELY MOVING FORWARD TOWARD
THAT VISION THROUGH THE WORK OF
THE CHILDREN YOUTH BEHAVIORAL
HEALTH INITIATIVE IN FOUR KEY
FOCUS AREAS, WORKFORCE BUILDING
ECOSYSTEM INFRASTRUCTURE,
FOCUSING ON COVERAGE AND
FOCUSING ON PUBLIC AWARENESS AND
REDUCING STIGMA, AND I WANT TO
JUST SHARE A FEW EXAMPLES OF
SOME OF THE WORK THAT'S
HAPPENING. TO MOVE US TOWARDS
THAT FUTURE STATE OF WHAT WE
WANT AND NEED FOR ALL OF
CALIFORNIA'S CHILDREN IN TERMS
OF SUPPORTING THEIR BEHAVIORAL
HEALTH. DEPUTY SECRETARY WELSH
ALREADY NOTED SOME OF THE
INVESTMENTS IN WORKFORCE I
WANTED TO JUST LIFT UP TWO
ADDITIONAL ONES. ONE IS THAT AS
PART OF THE C Y B H I, IN
ADDITION TO THE HEALTH
PROFESSIONS PATHWAY PROGRAM
GRANT SHE MENTIONED WHICH ARE
ALSO PARTLY FUNDED BY C Y B H, I
THE DEPARTMENT OF HEALTH CARE,
ACCESS AND INFORMATION ALSO HAS
A $25 MILLION PROGRAM TO
IMPLEMENT THE YOUTH MENTAL
HEALTH ACADEMY, WHICH IS TO
SUPPORT EARLY CAREER DEVELOPMENT
FOR 2500 CULTURALLY DIVERSE
CALIFORNIA HIGH SCHOOL STUDENTS
WITH AN INTEREST IN BEHAVIORAL
HEALTH CAREERS. AND ALSO THIS
SUMMER, THE OFFICE OF THE
CALIFORNIA SURGEON GENERAL
ROLANDO FREE, ONLINE
PROFESSIONAL TRAINING THAT IS
DESIGNED TO HELP EARLY CARE AS
WELL AS K THROUGH 12 EDUCATION
PERSONNEL TO RESPOND TO TRAUMA
AND STRESS IN CHILDREN WHEN THE
TRAINING HAS TWO MAIN GOALS WHEN
IT'S JUST INCREASED AWARENESS OF
THE IMPACT OF STRESS AND TRAUMA
ON CHILDREN'S DEVELOPMENT AND
LEARNING BUT IT'S ALSO TO
PROVIDE STRATEGIES TO RESPOND
WITH TRAUMA, INFORMED PRINCIPLES
IN ORDER TO HELP CREATE THE
CONDITIONS THAT REALLY SUPPORT
LEARNING ENVIRONMENTS FOR OUR
CHILDREN. IN TERMS OF THE SECOND
CATEGORY RELATED TO BEHAVIORAL
HEALTH SYSTEM INFRASTRUCTURE.
THE STUDENT BEHAVIORAL HEALTH
INCENTIVE PROGRAM IS SUPPORTING
PARTNERSHIPS BETWEEN MEDICAL
MANAGED CARE HEALTH PLANS.
SCHOOLS AND COUNTY BEHAVIORAL
HEALTH DEPARTMENTS TO WORK
TOGETHER IN A COORDINATED WAY TO
INCREASE ACCESS TO SCHOOL BASED
BEHAVIORAL HEALTH SERVICES WITH
A STRONG FOCUS ON PREVENTION,
WELLNESS AND TIER ONE SUPPORTS,
AND WE'VE HEARD FROM OUR
PARTNERS THAT IN ADDITION TO
THOSE INTERVENTIONS, THE
PARTNERSHIPS THEMSELVES ARE A
CRITICAL OUTCOME OF THIS
INVESTMENT BECAUSE THOSE
RELATIONSHIPS AND THAT
COLLABORATION IS A CRITICAL
FOUNDATION TO BUILDING A MORE
COORDINATED SYSTEM AND TO
ADDRESSING THOSE SILOS THAT WE
KNOW WE HAVE. UM AS DEPUTY
SECRETARY WELSH MENTIONED AS
PART OF BUILDING THE BRICKS AND
MORTAR INFRASTRUCTURE. THERE
WERE ALSO SPECIFIC INVESTMENTS
OF $480 MILLION RELATED TO
CHILDREN AND YOUTH SERVICES TO
ADDRESS GAPS. WE KNOW WE HAVE
THERE. A NEW VIRTUAL SERVICES
PLATFORM WILL PROVIDE
INFORMATION RESOURCES AND SELF
MANAGEMENT TOOLS WILL ALSO
PROVIDE ACCESS TO ONLINE
COACHING AND MODERATED, PEER
SUPPORTS AND LINKAGES TO
COMMUNITY BASED SERVICES WHEN
ONGOING SERVICES ARE NEEDED FOR
BOTH YOUTH AND PARENTS, AND
THAT'S UNDER DEVELOPMENT, AND IT
WILL LAUNCH IN JANUARY OF 2024.
AND ALSO THE HIV IS WORKING TO
SUPPORT AND STRENGTHEN SOCIAL
EMOTIONAL LEARNING IN SCHOOLS,
INCLUDING THROUGH ADDITIONAL
INVESTMENTS IN THE BUDGET LAST
YEAR SUPPORTING, UM WELL BEING
MINDFULNESS AND RESILIENCE IN
OUR CHILDREN YOU THROUGH
PARTNERSHIPS BETWEEN THE HEALTH
SYSTEM AND SCHOOLS. IN TERMS OF
COVERAGE IN JANUARY OF THIS
YEAR, WE ADDED THE NEW DIETETIC
SERVICES BENEFIT IN THE MEDICAL
PROGRAM. UM THIS IS A REALLY
CRITICAL BENEFIT WHEN WE THINK
ABOUT SORT OF THE FUTURE STATE
BECAUSE IT RECOGNIZES THE
IMPORTANCE OF TREATING AND
ADDRESSING THE NEEDS THAT BOTH
THE DEVELOPMENT AND THE
BEHAVIORAL HEALTH NEEDS OF A
CHILD BUT ALSO THEIR PARENTS OR
CAREGIVER. AND REALLY THINKING
ABOUT HOW WE SUPPORT THEM
PROVIDE THEM SERVICES.
COORDINATE EFFORTS PROVIDE
HOLISTIC RESOURCES AS A DIET
ABOUT THAT DIETETIC SERVICES
MODEL OF REALLY THINKING
HOLISTICALLY. WE ARE ALSO
PUTTING IN PLACE A NEW SYSTEM TO
PROVIDE ONGOING RESOURCES TO
SCHOOLS, BOTH T K THROUGH 12 AND
HIGHER EDUCATION FOR FUNDING FOR
STUDENT BEHAVIORAL HEALTH
SERVICES. IT IS A FEE SCHEDULE
THAT WILL PROVIDE SCHOOLS WITH
REIMBURSEMENT FROM BOTH MEDICAL
MANAGED CARE PLANS AND
COMMERCIAL HEALTH PLANS FOR
SCHOOLING, BEHAVIORAL HEALTH
SERVICES, AND I KNOW THIS
PARTICULAR COMPONENT CAN SOUND
VERY SORT OF TECHNICAL AND MAYBE
EVEN A LITTLE BIT, UM, DRY AND
BORING, BUT I THINK IT IS. ONE
OF THE MOST IMPORTANT PIECES
THAT IS ABOUT BUILDING THAT
INFRASTRUCTURE OF THE SYSTEM TO
PROVIDE ONGOING RESOURCES FOR
SCHOOLING. BEHAVIORAL HEALTH
SERVICES WHERE WE KNOW KIDS ARE
MEETING THEM WHERE THEY ARE, IF
THE SERVICE IS THERE, AND THE
FUNDING IS THEIR ON GOING TO
PROVIDE IT. IT'S A WAY TO REALLY
BUILD THIS ONGOING APPROACH TO
INCREASING ACCESS AND IMPROVING
OUTCOMES. AND THEN IN THE FOURTH
CATEGORY RELATED TO PUBLIC
AWARENESS AND REDUCING STIGMA.
WE HAVE A SERIES OF CAMPAIGNS,
OUTREACH EFFORTS AND PUBLIC
INFORMATION RESOURCES THAT ARE
AIMING TO REDUCE STIGMA TO
INCREASE UNDERSTANDING IN
CULTURALLY RELEVANT AND
APPROPRIATE WAYS THAT IT'S OKAY
TO NOT BE OKAY. AND TO ASK FOR
HELP AND SUPPORT. AND TO
INCREASE AWARENESS OF THE WAYS
THAT YOUTH THEMSELVES AND THE
ADULTS IN THEIR LIVES CAN
SUPPORT THEM WITH THEIR MENTAL
HEALTH, WELL BEING AND
RESILIENCE. UM I WAS HAD THE
OPPORTUNITY TO VISIT A COMMUNITY
SCHOOL A COUPLE OF WEEKS AGO,
AND WE HAD A CHANCE TO MEET WITH
SOME PARENTS. AND THERE WAS A
MOM WHO TALKED ABOUT ACTUALLY,
I'M THE VIEWS OF MENTAL HEALTH
IN HER COMMUNITY AND IN HER
CULTURE AND THE HESITATION SHE
HAD ABOUT, UM THINKING ABOUT
WHAT KIND OF SERVICES HER CHILD
MIGHT NEED, AND SHE TALKED ABOUT
HOW THE WORK THE SCHOOL HAS BEEN
DOING WITH ITS PARTNERS AS A
NUMBER OF BEHAVIORAL HEALTH
PROVIDER PARTNERS ON THE CAMPUS
, THE WAY IN WHICH THEY ARE JUST
CONTINUALLY RAISING MENTAL
HEALTH FOR STUDENTS AS JUST A
REGULAR PART OF THE WORK OF THE
SCHOOL AND THE WORK OF THE
COMMUNITY TOGETHER. WHETHER
THAT'S IN NEWSLETTERS AT PARENT
MEETINGS IN EMAIL BLAST THEY
SENT IN EVERYTHING THEY DO AS IF
IT'S FOOD OVER IF IT'S HEALTHY
FOOD AND WATER, UM REALLY THAT
THAT WAS STARTING TO CHANGE HER
EXPERIENCE OF STIGMA AND HOW
IMPORTANT IT WAS IN A TRUSTED
SETTING OF THE SCHOOL TO BE
DOING THAT WORK. SO THANK YOU
FOR THE OPPORTUNITY TO TALK
ABOUT WHERE WE ARE GOING
TOGETHER TOWARD A REIMAGINED
SYSTEM THAT SUPPORTS OUR YOUNG
PEOPLE'S BEHAVIORAL HEALTH AND
WELL BEING SO THEY CAN THRIVE.
THANK YOU. MR EWING. THANKS VERY
MUCH, MR CHAIR AND MEMBERS. I
APPRECIATE THE CHANCE TO JOIN
YOU TODAY AND TO JOIN MY
COLLEAGUES, YOU KNOW THAT THE
ADMINISTRATION IS REALLY
PURSUING A HISTORIC INITIATIVE.
IN AND AS DEPUTY SECRETARY WELSH
OUTLINED UM YOU DON'T HAVE TO
HAVE BEEN HERE VERY LONG TO
REMEMBER A TIME WHEN NONE OF
THIS WAS WAS POSSIBLE, RIGHT
THAT THAT WE HAD DREAMED ABOUT
SOME OF THESE OPPORTUNITIES. AND
TO SEE IT HAPPEN. THE WAY IT'S
HAPPENING IS REALLY HEARTENING.
I APPRECIATE THE CHANCE TO TALK
ABOUT THE QUESTION, PUT ON THE
AGENDA AND THANK YOU TO YOUR
STAFF FOR THE WORK AND PUTTING
THIS TOGETHER AROUND JUST
SAYING, WHERE DO WE GO FROM
HERE? UM I HAVE A COUPLE OF
HANDOUTS, THE IN ORDER TO
RESPOND TO THAT QUESTION. I
WANTED TO JUST DO A SHORT WALK
THROUGH OF. THE ORIGIN STORY OF
THE MENTAL HEALTH SERVICES ACT,
UM AND IT'S IMPORTANT TO
RECOGNIZE THAT UNLIKE IN OTHER
AREAS OF HEALTH CARE IN OTHER
AREAS OF HEALTH. MORE BROADLY,
UH, HISTORICALLY, CALIFORNIA HAS
RATIONED ACCESS TO CARE THE
COMMENTS THAT YOU HEARD EARLIER
OR ABOUT A DIAGNOSIS SHOULD NOT
BE THE DETERMINING FACTOR OF
WHETHER OR NOT WE GET OUR FOOT
IN THE DOOR, RIGHT? AND WE DON'T
HAVE THAT CONVERSATION IN IN
MUCH BROADER AREAS OF HEALTH
CARE. RIGHT. WE REALLY LEAD WITH
A PREVENTION LENS. IN THE MENTAL
HEALTH SPACE. HISTORICALLY WE
HAVE NOT BEEN INVESTING IN
PREVENTION EARLY INTERVENTION
BECAUSE WE HAVE HAD SUCH
RESOURCE LIMITATIONS BUT ALSO
LIMITATIONS AND HOW WE THINK
ABOUT WHAT CONSTITUTES MENTAL
HEALTH. RIGHT THIS THIS NARROW
LENS OF A CLINICAL RESPONSE
RATHER THAN THIS BROAD LANDS
AROUND WELL BEING AS DEPUTY
SECRETARY TALKED ABOUT. UM UH,
MENTAL HEALTH VERSUS MENTAL
ILLNESS. IT REALLY HAS BEEN AN
ILLNESS DRIVEN MODEL THAT WE'VE
HAD IN THE STATE OF CALIFORNIA
FOR DECADES. AND UM, I ALSO WANT
TO PUT ON THE TABLE AND THIS IS
KEY IS REALLY WEAK PUBLIC
COMMITMENT TO MENTAL HEALTH. THE
STIGMA COMMENTS THAT THAT YOU
KNOW WHEN WE TALK WHEN, WHEN THE
COMMISSION TASKED WITH YOUNG
PEOPLE AS WELL, WE HEAR MUCH THE
SAME. THESE ARE ALL CHANGING, UM
, AS WE SPEAK IN CALIFORNIA
COVID PANDEMIC. GENERATIONAL
SHIFTS HAVE REALLY AND THE
MENTAL HEALTH SERVICES ACT HAVE
REALLY BEGIN TO REORIENT THIS
FRAMEWORK AROUND CALIFORNIA'S
MENTAL HEALTH SYSTEM AND THE
ORIGIN STORY OF THE MENTAL
HEALTH SERVICES ACT REALLY
FOCUSES ON THAT ISSUE OF
RATIONING CARE. LIMITED
INVESTMENT, TOO LIMITED TO NO
INVESTMENT IN PREVENTION, EARLY
INTERVENTION WEEK PUBLIC
COMMITMENT THAT PUBLIC SUPPORT
THAT POLITICAL CAPITAL AND
REALLY, NO STRATEGY AROUND
CONTINUOUS IMPROVEMENT. AND
AGAIN. I'M NOT. THAT'S NOT
COMMENTS ABOUT THE SYSTEM WE
HAVE RIGHT NOW. THE WORK THAT'S
HAPPENING ADMINISTRATION. THIS
IS THE ORIGIN OF THE MIDDLE
HEALTH SERVICES ACTUALLY LOOK
BACK 15 20 YEARS AGO. THE MENTAL
HEALTH SERVICES ACTORS REALLY
ENVISIONED AS A COUNTERWEIGHT TO
MEDICAL BECAUSE THOSE RULES WERE
IN PLACE FOR VERY GOOD REASON AT
THE TIME THAT IT WAS ABOUT
DEVELOPING A COMMUNITY DRIVEN
SYSTEM, STRONG REQUIREMENTS FOR
COMMUNITY ENGAGEMENT WITH
RECOGNIZES THAT WHAT'S HAPPENING
IN TRINITY IS GOING TO BE
DIFFERENT THAN WHAT'S HAPPENING
IN ALAMEDA. RIGHT UM, VERY MUCH
RECOVERY FOCUSED VERY MUCH, UM,
WITH THIS MANDATE FOR PREVENTION
RIGHT WITH A MANDATE FOR EARLY
INTERVENTION, A MANDATE FOR
INNOVATION. THERE ARE SPECIFIC
ELEMENTS OF THE MENTAL HEALTH
SERVICES ACT THAT SET ASIDE
DOLLARS THAT CAN ONLY BE SPENT
ON PREVENTION AND EARLY
INTERVENTION. AND I USE THAT AS
THIS REFERENCE TO A
COUNTERWEIGHT TO MEDICAL VERY
MUCH APPRECIATE THE WORK THAT
THE DEPARTMENT HEALTHCARE
SERVICES DOING THE
ADMINISTRATION MORE BROADLY, IS
DOING TO REORIENT SOME OF THE
REIMBURSEMENT STRATEGIES TO
RECOGNIZE THE OPPORTUNITIES
AROUND THINGS LIKE DIABETIC CARE
RIGHT, WHICH CAN SUPPORT EARLY
INTERVENTION STRATEGIES.
OPPORTUNITIES IN MEDICAL TO
SUPPORT PREVENTION IN TERMS OF
THE REIMBURSEMENT MECHANISMS
THAT WE HAVE UM AND THE MENTAL
HEALTH SERVICES ACT ALSO CALLED
OUT EXPLICITLY DISPARITY. SO
COMMENTS ABOUT THIS, THIS
MEMBERS OF OUR COMMUNITIES WHO
HAVE THE HEAVIEST BURDEN THE
HEAVIEST LIFT THE GREATEST
NEEDS. THERE'S THEY'RE SUPPOSED
TO BE AN EQUITY PERSPECTIVE
BUILT INTO THIS STRATEGY AROUND
COMMUNITY DRIVEN. WE'RE NOT AS
FAR ALONG AS WE'D LIKE TO BE,
BUT BUT IN TERMS OF THIS ORIGIN
STORY THE MENTAL HEALTH SERVICES
ACT REALLY WAS DESIGNED TO T UP
AND CALL OUT EMPHASIZE AND
ELEVATE THOSE THOSE KEY ISSUES
AND, UM AND I WANT TO POINT OUT
THAT, UM, UNLIKE SOME OF OUR
MORE TRADITIONAL FUNDING STREAMS
, IT EMBRACES THIS IDEA OF IT.
WHAT OF A WHATEVER IT TAKES
APPROACH. RIGHT IN FACT, UNDER
STATE RULES. UH COUNTIES ARE
REQUIRED TO DEDICATE THE
MAJORITY OF THEIR IMAGES SAY
SERVICE FUNDS FOR WHATEVER IT
TAKES APPROACH WITH A SPECIFIC
EMPHASIS ON ADDRESSING
HOMELESSNESS, INCARCERATION AND
HOSPITALIZATION. THESE THESE
NEGATIVE OUTCOMES RIGHT THAT ARE
THE CONSEQUENCE OF INADEQUATE
ACCESS TO CARE THAT IS ALIGNED
WITH MY NEEDS. SO THE COMMENTS
OF DEPUTY SECRETARY WHO TALKED
ABOUT PEOPLE MAY NOT RETURN TO
SERVICES BECAUSE THEY DON'T SEE
THE VALUE OR THEMSELVES AND THE
SERVICES THAT THAT THEY'RE
RECEIVING, AND SO DAMAGES SAY IT
WAS REALLY TRYING, AND I THINK
IT IS BEING SUCCESSFUL IN MANY
WAYS TO CHANGE THAT PERCEPTION
AROUND WHAT WE CAN AND SHOULD BE
DOING WITH THE RESOURCES WE
HAVE, AND THAT REQUIRES A HIGH
LEVEL OF FLEXIBILITY. AND IT AND
IT CREATES A DEFINITION EMBEDDED
IN THE PREVENTION AND
INTERVENTION LANGUAGE OF MENTAL
HEALTH THAT IS MUCH CLOSER TO A
DEFINITION OF WELL BEING SO
HOUSING, EMPLOYMENT, EDUCATIONAL
SUCCESS PERSONAL AND COMMUNITY
SAFETY, AVOIDING THE CRIMINAL
JUSTICE SYSTEM, FOR EXAMPLE,
FAMILY CONNECTEDNESS, AVOIDING
THE CHILD WELFARE SYSTEM.
AVOIDING PREMATURE DEATH BECAUSE
OF SUICIDE OR BECAUSE OF UNMET
NEEDS AND AVOIDING SUFFERING. IT
REALLY PUTS OUT THIS, UM,
ASSERTIVE, EXPANSIVE STATEMENT
ABOUT WHAT WE'RE TRYING TO
ACCOMPLISH. RATHER THAN WHAT
WE'RE TRYING TO RESPOND TO. AND
SO THE MENTAL HEALTH SERVICES
ACT, SO THE ORIGIN STORY THERE
IS TO REALLY REFRAME THE
CONVERSATION. AWAY FROM A, UM, A
SYSTEM THAT LOOKED AT HOW MUCH
MONEY WE HAD. AND HOW DO WE
DIVVY IT UP AMONG COMPETING
NEEDS AND INSTEAD REPLACE IT
WITH A STRATEGY THAT SAYS, HOW
DO WE WORK UPSTREAM? HOW DO WE
ENGAGE THE COMMUNITY? HOW DO WE
BUILD TRUST AND RESPONSIVENESS?
HOW DO WE GET CREATIVE? AND HOW
DO WE INSPIRE PUBLIC ENGAGEMENT
AND UNDERSTANDING TO REALLY
TACKLE SOME OF THE MOST PRESSING
CHALLENGES THAT CUT ACROSS THE
MOST EXPENSIVE, MOST DEVASTATING
OUTCOMES FOR INDIVIDUALS,
FAMILIES AND COMMUNITIES,
HOMELESSNESS? INCARCERATION.
CHILD WELFARE INVOLVEMENT TASKS
THAT HAVE NOT TRADITIONALLY BEEN
THE PURVIEW OF OUR TRADITIONAL
BEHAVIORAL HEALTH INFRASTRUCTURE
. SO CONVERSATIONS WITH COUNTY
BE HER HEALTH DIRECTORS WHO SAY,
WELL, THAT'S ACTUALLY NOT MY JOB
, FOR EXAMPLE, AND SO I
MENTIONED THAT BECAUSE IT IT IS
A DISRUPTIVE ACT. IT WAS
DESIGNED TO SAY THE SYSTEM WE
HAD AT THAT TIME THE SYSTEM WE
HAVE TODAY IN TERMS OF THE
FINANCING. AND WORKFORCE AND OUR
APPROACH THE SILOED NATURE OF
OUR APPROACH TO MENTAL HEALTH
SERVICES ACT. ITS ORIGIN STORY
IS TO BE A DISRUPTIVE ACT. WE'VE
BEEN WORKING, AND SO THE HANDOUT
THE SECOND HAND OUT THAT YOU
HAVE. I GAVE THEM ALL AWAY, SO I
DON'T HAVE ONE FORGOT TO GET MY
HANDS, OKAY? HIS UM, UH, YOU
KNOW, HIGHLIGHTS SOME OF THE
EFFORTS THAT WE'RE DOING, AND
I'LL JUST VERY QUICKLY JUST, YOU
KNOW, POINT OUT. WE'VE BEEN
WORKING TO IMPLEMENT THAT VISION
IN EARLY PSYCHOSIS SINCE
SEQUENTIAL INTERCEPTS AROUND
CRIMINAL JUSTICE. AND THIS IS
NOT ALL IN THIS HANDOUT. THIS
HANDOUT IS REALLY JUST DESIGNED
TO FOCUS ON UPSTREAM
OPPORTUNITIES, TAKING THOSE
THREE MOST EXPENSIVE, OFTEN MOST
NEGATIVE OUTCOMES. FROM FROM A
SYSTEM PERSPECTIVE OF
HOMELESSNESS, HOSPITALIZATION,
INCARCERATION AND TALK ABOUT THE
UPSTREAM EFFORTS THAT THAT ARE
NECESSARY. IF WE WANT TO BE
EFFECTIVE, WE NEED TO MAKE SURE
THAT THAT THE, UM THE
INTERVENTION THAT IS JUST BEFORE
SOMEONE IS LIVING ON THE STREETS
OR RETURNING TO THE STREETS OR
JAIL OR HOSPITAL IS A FULL
SERVICE PARTNERSHIP. HOW DO WE
DO THAT? THE BEST WE CAN WE
REALLY APPRECIATE THAT IN THE
GOVERNOR'S MODERNIZATION
PROPOSAL, HE IS HIGHLIGHTING THE
IMPACT OF FULL SERVICE
PARTNERSHIPS. UM BEFORE THAT, IN
THE COMMISSION'S WORK IS EARLY
PSYCHOSIS THAT THE RESEARCH THAT
WE'VE BEEN ABLE TO DO WITH OUR
PARTNERS AT UC DAVIS, UCSF AND
STANFORD IS THAT ABOUT 10% OF
CALIFORNIANS HAVE ACCESS TO MOST
EFFECTIVE CARE. IN THE EARLY
ONSET OF PSYCHOSIS. AND IF WE
JUST AND JUST LIKE OTHER ASPECTS
OF HEALTH CARE IF WE CAN
INTERVENE EARLY IN SOME
COUNTRIES, THEY'VE ESTABLISHED
EXPLICIT GOALS THAT 100% OF
THEIR RESIDENTS WILL HAVE ACCESS
TO EFFECTIVE CARE WITHIN TWO
WEEKS. HAVE THEIR FIRST EPISODE
OF PSYCHOSIS, THE AVERAGE ACCESS
TO CARE. THE DELAY IN THE UNITED
STATES IS 18 MONTHS. AND THE
RESEARCH SHOWS. AND IT IS
SURPRISING THAT THIS THAT WE
THAT WE HAVE TO SORT OF
REINFORCED. THIS IS THAT IF WE
INTERVENE EARLY, WE CAN ACTUALLY
SUPPORT AN INDIVIDUAL'S ABILITY
TO LIVE INDEPENDENTLY TO MANAGE
PSYCHOSIS, EVEN SCHIZOPHRENIA AS
A CHRONIC CONDITION. UM AND SO
THAT EARLY PSYCHOSIS
INTERVENTION IS WHAT WE NEED TO
DO IN ORDER TO REDUCE RELIANCE
ON A FULL SERVICE PARTNERSHIP AS
AN ITSELF AND EFFECTIVE BUT
EXPENSIVE INTERVENTION IN OUR
YOUTH. DROP IN WORK ACTUALLY IS,
HOW DO WE CREATE AN ENVIRONMENT
WHERE YOUNG PEOPLE FEEL SAFE?
HOW DO WE DESIGN THE SERVICE
DELIVERY SYSTEM THAT PEOPLE THAT
YOUNG PEOPLE WHO ARE VERY
RELUCTANT TO ACCESS MEDICAL
CARE? IN THE FIRST PLACE? THEY
ACTUALLY FEELS WELCOMING AND
WARM THAT LOVE THAT SENSE OF
BELONGINGNESS SO THAT IF THEY
DID ELOPED SYMPTOMS. THEY
HAVEN'T TRUSTED PLACE TO TURN TO
FOR SUPPORT BEFORE THEY NEED IT
. IT MAY BE THAT OUR YOUTH DROP
IN WORK MAY NEED TO BE WHAT WE
CAN REFER TO AS A LOSS LEADER
RIGHT? IT MAY NOT PAY FOR ITSELF
AT THE IMMEDIATE CARE, BUT IF
DOING THAT HELPS US ENSURE THAT
YOUNG PEOPLE, UM AS THEY AGE AS
THEY PROGRESS, WHERE THE
GREATEST LIKELIHOOD OF
DEVELOPING A MENTAL ILLNESS
HAPPENS IN THOSE LATE TEENS,
EARLY TRANSITION AGE EARLY ADULT
TRANSITION AGE. YOUTH YEARS IF
WE CAN MAKE SURE THAT WE'VE
BUILT THE TRUST AND THE CAPACITY
AND THE WELCOMING FOR SOMEONE
WHO DOES DEVELOP THOSE SYMPTOMS
AND CAN CREATE THAT PATHWAY TO
CARE IN A HIGHLY EFFECTIVE
MANNER, THAT'S WHAT IT'S GOING
TO TAKE. TO GET FROM 18 MONTHS
TO TWO WEEKS. RIGHT BUT IT DOES
AND BEFORE THAT, EVEN AS LISTED
HERE IS OUR IS THE SCHOOL MENTAL
HEALTH WORK THAT WE APPRECIATE.
THE COMMISSION IS PART OF THE
BROADER C Y B H I INITIATIVE IN
THE MIDDLE OF STUDENT SERVICES
WORK, WHICH IS REALLY ABOUT
BUILDING OUT THE PARTNERSHIPS
THAT THE ADMINISTRATION, THE
DEPARTMENT, HEALTHCARE SERVICES
, AND OTHERS ARE DOING THE MUCH
HEAVIER LIFT AROUND THE
FINANCING AND THE STRATEGY AND
THE WORKFORCE IN THE
PROGRAMMING. WHAT WHAT WORD?
WHAT? WE'RE SUPPORT. WE'RE
LEANING IN ON AND SUPPORTING IS
BUILDING OUT THE PARTNERSHIPS SO
THAT OUR SCHOOLS AND OUR COUNTY
BEHAVIOR HEALTH DEPARTMENTS
REALLY ARE WORKING TOGETHER IN
WAYS THAT THEY'RE RECOGNIZING
THAT THE CROSS SECTION ALLERGY
THAT THE OPPORTUNITY INTEGRATE
EDUCATIONAL OUTCOMES IMPROVED
AND BEHAVIORAL HEALTH NEEDS ARE
MET. BEHAVIORAL HEALTH MADE, UM
, SERVICES IMPROVE WHEN THEY'RE
DELIVERED WHERE CHILDREN ARE
WHICH IS IN SCHOOL, AND SO IT'S
AN ACCESS POINT. OUR SCHOOL
MENTAL HEALTH STRATEGY IS NOT
ADEQUATE BECAUSE NOT ALL YOUTH
FEEL THAT SCHOOLS ARE SAFE,
WELCOMING PLACES. AND AS WE WANT
, MANY YOUNG PEOPLE ACTUALLY
GRADUATE AND SAID THEY MOVE ON,
AND SO WE NEED A STRONG SCHOOL
BASED AND A STRONG, STRONG,
COMMUNITY BASED STRATEGY. AND SO
I SHARED THAT WITH YOU. JUST TO
HIGHLIGHT SOME OF THE WORK THAT
WE'RE DOING. TO REALLY, UM
OPERATIONALIZED THE VISION OF
THE MENTAL HEALTH SERVICES ACT
IN EARLY PSYCHOSIS ARE
SEQUENTIAL INTERCEPT MODEL ON
CRIMINAL JUSTICE IS NOT ON HERE
. STRENGTHENING FULL SERVICE
PARTNERSHIPS IS I WANT TO
APPRECIATE COMMISSIONER FRANK
CALLING OUT THE INVESTMENTS THAT
THE COMMISSION HAS RECENTLY MADE
IN PARTNERSHIP WITH THE
DEPARTMENT OF AGING AROUND
SERVING THE NEEDS OF OLDER
ADULTS. THAT IS THAT IS NOT IN
HERE, EITHER. UM WHAT WE'RE
REALLY DOING THERE IS USING SOME
LIMITED MENTAL HEALTH WELLNESS
ACT FUNDS TO INCENTIVIZE AND
EXPANSION OF EFFECTIVE SERVICES
AS COMMUNITIES LEARN ABOUT
WHAT'S WORKING OFTEN THROUGH
MENTAL HEALTH SERVICES,
INNOVATION FUNDS WE WANT TO HELP
SCALE HELP DISSEMINATE THOSE
LEARNINGS IN WAYS THAT OTHER
COMMUNITIES CAN BENEFIT FROM THE
LEARNINGS. AND SO COMMISSIONER
FRANK HIGHLIGHTED THAT AND WE
APPRECIATE THAT. UM WE'RE REALLY
WORKING TO IMPROVE UNDERSTANDING
OF PREVENTION AND EARLY
INTERVENTION WE WILL HAVE IN THE
NEXT 10 DAYS. I'M TOLD THAT A
HARD COPY OF A PREVENTION REPORT
THAT WE RECENTLY DID, UM, IT'S
DESIGNED TO SUPPORT THIS
CONVERSATION AROUND THE
EXPANSIVE OPPORTUNITIES WE HAVE
FOR PREVENTION, UM, WHEN WE HAVE
CONVERSATIONS WITH WITH FOLKS IN
THE IN THE HEALTH FIELD UM,
THERE'S NO QUESTION THAT
PREVENTION IS THE RIGHT THING TO
DO WHEN WE HAVE CONVERSATIONS
WITH FOLKS IN THE BEHAVIORAL
HEALTH FIELD. IT'S NOT ALWAYS
CLEAR THERE IS NOT THAT
CONSISTENT PUBLIC AGREEMENT,
PUBLIC UNDERSTANDING AND PUBLIC
SUPPORT FOR PREVENTION AS A
STRATEGY. RIGHT UM, I ROUTINELY
GET ASKED TO SPEAK TO PSYCHIATRY
FELLOWS DURING TYPICALLY THE
THIRD OR FOURTH YEAR OF THEIR
RESIDENCY, AND I'LL ASK THEM TO
TALK ABOUT THE TRAINING THEY
RECEIVE AROUND PREVENTION. FOLKS
AT THE TOP END, AND IF WE
COMPARE THE CONVERSATIONS YOU
CAN HAVE WITH THE CARDIOLOGIST
OR AN ONCOLOGIST ABOUT
PREVENTION OPPORTUNITIES IN
THEIR SPACE, THEIR WORLDS APART.
WE DON'T ENGAGE THAT THERE IS
NOT EVEN AGREEMENT OVER WHETHER
OR NOT WE CAN PREVENT PSYCHOSIS.
RIGHT, UM UH, 40 OR 50 YEARS AGO
THAT MAY HAVE BEEN THE CASE WHEN
IT CAME TO CANCER. BUT THAT'S
NOT TRUE TODAY AND IT DOESN'T
MEAN WE CAN PREVENT ALL CANCERS.
BUT WE HAVE VERY AGGRESSIVE
PUBLIC AWARENESS, PUBLIC HEALTH
EDUCATION CAMPAIGNS AND
STRATEGIES TO HELP PEOPLE
UNDERSTAND WHAT PREVENTION MEANS
AND TO LIVE THEIR LIVES AND TO
MAKE SMART DECISIONS. PUT
SUNSCREEN ON IN THE MORNING.
RIGHT VERSUS BEGINNING OUR OUR
RESPONSE TO SKIN CANCER THROUGH
THE LENS OF STAGE THREE, STAGE
FOUR RIGHT? AND SO MY EARLIER
COMMENT ABOUT, UM, RATIONING
ACCESS TO CARE AND BEHAVIORAL
HEALTH. UM WE HAVE. WE HAVE MADE
TREMENDOUS PROGRESS AND WHAT
YOU'VE HEARD TODAY, UM, THROUGH
THE WORK OF THE ADMINISTRATION
IS INCREDIBLY, UM, HEARTWARMING
THAT WE HAVE MADE THE PROGRESS
BUT BUT AT THE SAME TIME FROM A
BROAD PUBLIC UNDERSTANDING OF
WHAT PREVENTION MEANS IN THE
BEHAVIORAL HEALTH SPACE, WE HAVE
A WAYS TO GO. UM THE QUESTION
WAS, YOU KNOW WHAT ARE THE
LARGEST BARRIERS TO THE SUCCESS
OF THE MIDDLE HEALTH SERVICES
ACT? AND I, IT IS THAT PUBLIC
UNDERSTANDING AND SHARED VISION.
THAT WE FIND OFTEN GETS IN THE
WAY AS WE THINK ABOUT WHAT WE'RE
TRYING TO ACCOMPLISH AND HOW WE
GET THERE. THAT THE, UM IN THE
PREVENTION SPACE THE WORK THAT
WE'VE DONE IN PREVENTION. IT IS
VERY CONSISTENT WITH WHAT YOU'VE
HEARD. IT IS ABOUT PARKS AND
WALKABLE COMMUNITIES AND
HEALTHY, HEALTHY BEHAVIORS.
GETTING ENOUGH SLEEP SLEEP IS A
HUGE FACTOR. IN UNDERSTANDING
DRIVERS OF MENTAL ILLNESS. YET
WE DON'T PRIORITIZE THAT WE
DON'T TALK ABOUT THAT, UM, WE
PUT TREMENDOUS EMPHASIS IN OUR K
12. UM CURRICULUM OVER THE
COURSE OF A YOUNG PERSON'S LIFE
AROUND PHYSICAL HEALTH, PHYSICAL
DEVELOPMENT, HEALTHY EATING
EXERCISE, RIGHT? WE REQUIRE
CHILDREN TO TAKE P E. YOU KNOW
THROUGHOUT THAT THAT YOU KNOW
FROM KINDERGARTEN THROUGH 12TH
GRADE MAY NOT BE A REQUIREMENT
IN KINDERGARTEN, BUT WE'VE JUST
BUILT INTO OUR SCHOOLS AND
UNDERSTANDING OF PHYSICAL
HEALTH. WE HAVE NOT YET
LEVERAGED. EDUCATIONAL ARKHAM
ARE FULL RANGE OF OPPORTUNITIES
IN OUR EDUCATIONAL SYSTEMS AND
IN OUR WORKPLACES. TO UNDERSTAND
DRIVERS OF STRESS DRIVERS OF
TRAUMA, IMPACTS OF STRESS AND
TRAUMA AND THE OPPORTUNITIES FOR
RESILIENCY. SO UM, PUBLIC SHARED
VISION IN PUBLIC UNDERSTANDING
ABOUT WHERE WE'RE TRYING TO GET
TO IS A KEY BARRIER THAT IS
IMPEDING OUR ABILITY TO HAVE
CONVERSATIONS WITH A MUCH
BROADER ARRAY OF PARTNERS.
AROUND HOW WE CAN IMPROVE
BEHAVIORAL HEALTH, PUBLIC HEALTH
OUTCOMES. SOME OF OUR BEST
ADVOCATES IN COMMUNITIES ARE IN
OUR LIBRARIES. BECAUSE LIBRARIES
LIKE SCHOOLS FOR YOUNG PEOPLE
ARE OFTEN CONSIDERED SAFE SPACES
FOR ALL RESIDENTS AND LIBRARIES
AS A TRUSTED SPACE ALSO CAN BE A
COMMUNITY CENTER. SO UM, BUT WE
DON'T HISTORICALLY THINK OF OUR
LIBRARIES AS AS BEHAVIORAL
HEALTH PARTNERS WHEN THEY VERY
MUCH CAN BE. WE'VE ACTUALLY HAD
SOME INNOVATIONS, UH, LED BY
COUNTIES WHO HAVE REALLY
PARTNERED WITH THEIR LIBRARIES.
WE'RE SEEING REALLY CREATIVE, UH
, PARTNERSHIPS BETWEEN
BEHAVIORAL HEALTH DEPARTMENTS
AND UM, AND THE FIRE RESPONSE
SYSTEM IN SOME COMMUNITIES
BECAUSE IN RURAL COMMUNITIES,
THE FOLKS WHO ARE OFTEN MOST
TRUSTED TO KNOCK ON YOUR DOOR IS
THE FIRE SERVICE AND SO IN IN
SOME AREAS OF EASTERN SAN DIEGO,
IT IS A PARTNERSHIP BETWEEN CAL
FIRE AND SOME OF THE HEALTH
DISTRICTS THAT ARE ACTUALLY
BRINGING HEALTHCARE AND TALKING
ABOUT PREVENTION AND EARLY
INTERVENTION WITH RESIDENTS WHO
WOULDN'T TRUST ANY OTHER
GOVERNMENT CAR TO DRIVE UP THEIR
DRIVEWAY AND KNOCK ON THE DOOR,
SO SHARED VISION. SECOND IT
WOULD BE THIS OUR ABILITY TO
RECOGNIZE WHERE WE HAVE FALLEN
SHORT. AND THE OPPORTUNITIES IN
FRONT OF US. UM IF WE LOOK AT
THE OUTCOMES THAT WE ARE
ACHIEVING IN CALIFORNIA IN JUST
ABOUT ANY AREA, UM, WE ARE NOT
TOP OF THE PACK IN TERMS OF THE
OUTCOMES THAT WE WOULD ACHIEVE.
UM SUICIDE LEADING CAUSE OF
DEATH FOR US, I THINK NUMBER TWO
FOR YOUNG PEOPLE. RIGHT SHAMEFUL
, UM, PENETRATION RATE FOR
SCREENING AND ISSUE NEAR AND
DEAR TO YOU, MR CHAIR. UM UH,
YOU KNOW, EVEN THOUGH THE LAW
ENVISIONS UNIVERSAL SCREENING
UNDER MPS, DT WERE NOT THERE.
WHERE WE'VE FALLEN FAR SHORT, UM
LOTS OF AREAS WHERE AND I'LL YOU
KNOW, HAVE AN EXAMPLE OF EARLY
PSYCHOSIS. THE VAST MAJORITY
WILL NOT GET WHAT IS EFFECTIVE
CARE AND COMMERCIAL INSURANCE
WON'T PAY FOR IT. BUT THERE IS
THE WE DID NOT BECAUSE WE DON'T
HAVE THAT THAT PUBLIC
UNDERSTANDING OF THE ACTUAL
PREVALENCE RATES. UH THAT IT'S
EASY FOR US TO SORT OF SET ASIDE
THESE INADEQUACIES OR FAILURES
AND NOT REALLY? MOVE YOU KNOW,
BRING THE COMMUNITY TOGETHER TO
DRIVE THE KIND OF CHANGE THAT WE
NEED TO CHANGE. IN THE LAST
THING I WOULD SAY IS THE
STRATEGY TO GET THERE. AND, UM,
YOU KNOW, THROUGHOUT ALL OF
THESE IS THIS RECORD MUST BE
THIS RECOGNITION OF DISPARITIES.
RIGHT. WE HAVE TO PUT THAT FRONT
AND CENTER UM, IN TERMS OF OUR
COMMUNITY ENGAGEMENT WORK IN
TERMS OF OUR UNDERSTANDINGS OF
THE IMPACTS IN TERMS OF THE COST
EFFECTIVENESS OF SERVICES. WE
HAVE TO RECOGNIZE THAT THAT, UH,
FOR YEARS WE HAVE LED OUR MENTAL
HEALTH SYSTEM THROUGH A 911 LAW
ENFORCEMENT RESPONSE. WE'RE
STILL SEEING THAT TODAY. I THINK
MANY OF THE OF THE PROPOSALS
THAT THAT THE LEGISLATURE HAS
AUTHORIZED AND APPROVED AND THE
GOVERNOR HAS LED ON AND THE TEAM
SITTING NEXT TO ME. HAVE REALLY
CHAMPION IS IN RECOGNITION THAT
WE NEED TO DO A BETTER JOB AND
WE CAN AND WE ARE DOING A BETTER
JOB. BUT BUT THE STRATEGY TO GET
THERE NEEDS TO BE NEEDS TO
RECOGNIZE FINANCE. UM MANY OF
THE FUNDS THAT ARE BEING
RELEASED OR ONE TIME FUNDS. IT'S
VERY DIFFICULT TO LEVERAGE ONE
TIME FUNDS FOR LONG TERM CHANGE
. SO THE WORK THAT'S HAPPENING
IN MEDICAL THE WORK THAT'S
HAPPENING IN THE GOVERNOR'S
PROPOSAL UNDER C Y B H I AND
MODERNIZATION TO LOOK PAST
PUBLIC FINANCE AND TOWARDS
COMMERCIAL INSURANCE IS
NECESSARY AND INCREDIBLY
WELCOMED. UM PROGRAMMATIC
APPROACHES TH I S AND INCREDIBLE
MAKING AN INCREDIBLE INVESTMENT
IN SCALING AFFECTED PRACTICES,
AND WE NEED TO DO THAT ACROSS
THE BOARD, INCLUDING FOR ADULTS,
INCLUDING FOR OLDER ADULTS, AS
COMMISSIONER, FRANK POINTED OUT
THE DATA. WE'RE STILL STRUGGLING
ON THE DATA AND ANALYTICS. IT IS
TOO HARD. FOR US TO ANSWER EVEN
THE BASIC QUESTIONS. AND AGAIN
IF WE COMPARE THAT TO HEALTH
CARE OVERALL, THAT THE
DISCREPANCY BETWEEN WHERE WE ARE
ON THE DATA AND ANALYTICS AND
OVERALL HEALTH CARE VERSUS
BEHAVIORAL HEALTH IS SHAMEFUL.
UM I MENTIONED EXPANSIVE
PARTNERSHIPS WORKFORCE VERY MUCH
A MISMATCH BETWEEN THE WORKFORCE
WE HAVE AND THE IMMENSE NEEDS
THAT WE HAVE AND AGAIN TO SEE
WHY BH I THROUGH THE
MODERNIZATION PROPOSAL AND TWO
OTHERS THAT ADMINISTRATION
LEGISLATURE HAVE BEEN MAKING
TREMENDOUS INVESTMENTS. WE HAVE
A WAY TO GO. IT'S GOING TO TAKE
US A LITTLE WHILE TO CATCH UP.
UM AND LAST, I WOULD SAY IS THIS
THE STRATEGY TO GET THEIR NEEDS
TO INCLUDE THIS CONTINUOUS
IMPROVEMENT. THE MENTAL HEALTH
SERVICES ACT HAS THAT BUILT IN
TODAY UNDER THE INNOVATION
COMPONENT, AND SO WE WELCOME THE
OPPORTUNITY TO WORK WITH THE
ADMINISTRATION AND THE
LEGISLATURE UNDER THE
MODERNIZATION PROPOSAL TO
PRESERVE THE ABILITY TO SUPPORT
COUNTIES TO IMPROVE THEIR
SYSTEMS. AS PART OF AN EXPECTED
A MANDATORY ELEMENT DOESN'T HAVE
TO BE MANDATORY IN A STATUTORY
SENSE, BUT BUT AS AN EXPECT
EXPECTATION THAT OUR SYSTEM WILL
IMPROVE OVER TIME. UM THERE ARE
OTHER THINGS THAT THAT I JUST
WANT TO SHIFT A LITTLE BIT TO
THE TO THE GOVERNOR'S
MODERNIZATION PROPOSAL. UM, THE
COMMISSION HAS BEEN WORKING AND
WE REALLY APPRECIATE AND RESPECT
THE CALL TO ACT TO THE ACTUAL
INTEGRATION OF MENTAL HEALTH AND
SUBSTANCE USE DISORDER SERVICES
SO THAT WE HAVE A BEHAVIORAL
HEALTH MODEL, WHICH IS NECESSARY
BECAUSE IT'S JUST SO DIFFICULT
TO SEPARATE OUT THESE NEEDS AND
THE REALITY IS THAT SUD UM
SERVICES ARE MENTAL HEALTH
SERVICES, AND SO I REALLY
APPRECIATE THE GOVERNOR'S
LEADERSHIP ON THAT. UM OF COURSE
I WOULD BE REMISS IF I DIDN'T
HIGHLIGHT THAT THE COMMISSION IS
VERY INTERESTED IN THIS
CONVERSATION ABOUT MOVING THE
COMMISSION UNDER THE AGENCY.
IT'S THE COMMISSION APPRECIATES
ITS INDEPENDENCE AND ABILITY TO,
UM YOU KNOW, REALLY WORK IN A
DYNAMIC WAY THAT THAT IS, UM
ABLE TO INFORM AND SHAPE AND
SORT OF LOOK AROUND THE CORNER,
AND I THINK WE'VE BEEN ABLE TO
DO THAT. AND I WORKFORCE MENTAL
HEALTH. WE HAVE A CURRENT. I'M
SORRY. WORKPLACE MENTAL HEALTH.
WE HAVE A CURRENT PROJECT ON
FIREARM VIOLENCE, AND I'LL SHARE
WITH YOU THAT ONE OF OUR TEAM
YESTERDAY HAD AN EXPERIENCE OF
HER DAUGHTER'S SCHOOL IN A IN A
LOCKDOWN BECAUSE OF A CREDIBLE
SCHOOL SHOOTER SITUATION. IT WAS
A SOCIAL MEDIA LAW ENFORCEMENT
WAS INVOLVED. AND OUR TEAM
MEMBER SHARED THAT SHE DID NOT
FULLY UNDERSTAND. WHY THE
COMMISSION WAS PURSUING A
FIREARM VIOLENCE PROJECT UNTIL
YESTERDAY, WHEN SHE GOT A PHONE
CALL THAT THERE WAS A CREDIBLE
THREAT ON HER DAUGHTER'S SCHOOL.
AND SO, UM THIS IS AN EXAMPLE OF
BEING A SMALL ENTITY THAT CAN BE
PRETTY NIMBLE AND DYNAMIC DOES
NOT HAVE THE CHALLENGE THAT MY
COLLEAGUES HAVE OF RUNNING
MASSIVE SYSTEMS AND PROGRAMS AND
THAT THAT NIMBLENESS THAT
INDEPENDENCE ALLOWS US TO TACKLE
ISSUES AND BRING THEM BACK TO
THE ADMINISTRATION TO THE
LEGISLATURE, UM, WITH GUIDANCE
ON HOW THE STATE MIGHT BENEFIT
FROM THE LEARNING THAT WE CAN
DO. THANK YOU VERY MUCH FOR THE
CHANCE TO BE HERE. UM YOU KNOW,
WE'RE REALLY THE IMAGES SAY IN
THE COMMISSIONER REALLY DESIGNED
TO DRIVE TRANSFORMATIONAL CHANGE
TO IMPROVE OUTCOMES TO LOWER
COSTS TO DO THAT, THROUGH A
COMMUNITY DRIVEN APPROACH THAT
IS RECOVERING PREVENTION
ORIENTED. AND RECOGNIZES THAT WE
HAVE TO DO A BETTER JOB MAKING
SURE THAT WE IMPROVE OUTCOMES,
PARTICULARLY FOR THOSE
COMMUNITIES THAT ARE LEAST WELL
SERVED. I'M HAPPY TO ANSWER ANY
QUESTIONS YOU MIGHT HAVE.
QUESTIONS OR COMMENTS FROM MY
COLLEAGUES. SOMETHING MY
PROPELLER IN AND THEN
ASSEMBLYMEMBER'S WALDRON. WELL
I'M SUPER EXCITED ABOUT THE
PREVENTION REPORT COMING OUT,
AND I REALLY THINK I LOVE THAT
FOCUS OF LOOKING AT THE
PREVENTION OF MENTAL HEALTH YOU
TALKED ABOUT, UM, SLEEP
DEFINITELY AND BEING OUTSIDE AND
CAN YOU GIVE ME SOME OTHER IDEAS
ON WHAT YOU HAVE, LIKE? GIVE US
A LITTLE PREVIEW? WHAT TO EXPECT
IN THAT REPORT? WELL IN, UM THE
GOOD NEWS IS IT WON'T BE
SHOCKING TO YOU BECAUSE IT IS A
PUBLIC HEALTH APPROACH. RIGHT
AND BUT WHAT IT REALLY DOES. IT
JUST REMINDS US THAT IF WE THINK
EXPANSIVELY ABOUT PREVENTION, WE
HAVE TREMENDOUS RESOURCES OUT
THERE. IT IS ABOUT CONNECTEDNESS
AND SO AS AS WAS MENTIONED
EARLIER WITH OLDER CALIFORNIANS
, YOU KNOW, MY MOTHER LIVED
ISOLATED FOR 20 YEARS FOLLOWING
THE DEATH OF MY STEPFATHER, AND
ULTIMATELY SHE DEVELOPED
ALCOHOLISM AND BECAUSE OF THAT,
SHE FELL BROKE HER LEG WITH INTO
REHAB CENTER GOT COVID AND
PASSED AWAY. HER ISOLATION LED
TO HER DEATH. SO YOU KNOW, WE
KNOW THIS. WE HAVE KNOWN THIS
FOR A LONG TIME. WE HAVEN'T
NECESSARILY USE THAT LENS TO
THINK ABOUT BEHAVIORAL HEALTH,
THOUGH, RIGHT WHEN, UM, WHEN WE
TALK WITH PUBLIC OFFICIALS ABOUT
SORT OF THEIR PURVIEW, AND WE
TALKED TO PUBLIC HEALTH OFFICERS
. THEY SPEAK VERY BROADLY ABOUT
POPULATION HEALTH. RIGHT IN IN
THE BEHAVIORAL HEALTH SPACE. WE
HAVEN'T QUITE CROSS THAT PUBLIC
SECTOR FINANCE COMMERCIAL
FINANCE THINGS THAT AREN'T
FINANCED. RIGHT AND SO, UM, SO,
UH, THE REPORT IS ONLINE WILL
BRING YOU A HARD COPY BECAUSE
IT'S PRETTY AND IT'S EASY AND
YOU CAN CARRY IT AROUND. UM BUT
, UM, WHAT WE'RE TRYING TO DO
WITH THAT REPORT IS FACILITATE
THIS EXACT CONVERSATION. MOVE
AWAY FROM WHAT SHOULD CALIFORNIA
BE PAYING FOR WITH A LIMITED
PUBLIC MENTAL HEALTH DOLLAR
INSTEAD? HOW SHOULD WE BE
THINKING ABOUT PREVENTION? AND
HOW CAN WE LEVERAGE ALL OF THE
RESOURCES WE HAVE? INCLUDING OUR
PARKS? DESIGN YOU KNOW, WALKABLE
CITIES JUST LIKE WE'VE DONE WITH
PHYSICAL HEALTH. HOW DO WE
CREATE, SO IT'S EDUCATION? IT'S
TALKING TO EACH OTHER ABOUT UM,
NOT BEING AFRAID TO TALK ABOUT
OUR OWN DIAGNOSIS AND THE
EXPERIENCES THAT WE'VE HAD. ONE
OF THE THINGS THAT I'VE BEEN
ADVOCATING FOR IS POSTING THAT
988 NUMBER ON IN EVERY PUBLIC
RESTROOM JUST TO NORMALIZE THE
FACT THAT IT'S OKAY. YOU'RE NOT
OKAY AND THAT THIS IS SOMETHING
THAT WE'RE ALL EXPERIENCING, AND
THERE'S A QUICK RESOURCE THAT
YOU CAN CALL OR TEXT TO GET HELP
, AND HOPEFULLY WE'LL SEE THAT
SOMEDAY IN OUR STATE CAPITAL.
GOOD IDEA. ASSEMBLYMEMBER'S
WALDRON. NO, UM. THANK YOU FOR
ALL THE INFORMATION AS A LOT,
AND WE KNOW AS WE WORK IN THIS
SPACE THAT THERE'S JUST SO MANY
DIFFERENT LEVELS OF ISSUES AND
CONCERNS, UM I SPENT THE LAST 10
YEARS WORKING, UM, BASICALLY IN
THE INCARCERATED SPACE AND VERY
INTERESTED IN TRYING TO GET MORE
SERVICES INTO PRISONS AND JAILS,
UM, DEALING WITH GENERATIONAL
TRAUMAS AND HOW WE ADDRESS THAT
, UM, EVERY TIME YOU KNOW, I TRY
TO WORK ON CERTAIN THINGS WE
ALWAYS HEAR. OH, IT'S ALREADY
BEING DONE ALREADY DOING IT. WE
HAVE THE SERVICES ALREADY. BUT
YET, YOU KNOW, WE CLEARLY SEE
THAT WHAT THEY RESULTS OF OUR
JUST HOW MANY PEOPLE WERE
INCARCERATING AND THE OUTCOMES
YOU KNOW, AND RECIDIVISM RATES
THAT WE'RE NOT SUCCEEDING. UM
LAST YEAR, WE WERE ABLE TO GET
$10 MILLION FOR A GRANT PROGRAM
FOR COUNTIES TO APPLY FOR
SERVICES FOR MENTAL HEALTH AND
SUBSTANCE USE IN THE COUNTY JAIL
SYSTEMS. 10 MILLION FOR A STATE
THE SIZE OF CALIFORNIA IS NOT
REALLY ENOUGH, BUT IT'S A GOOD
START. YEAH YEAH. CMS JUST THIS
FEBRUARY APPROVED ALLOWING
PEOPLE WHO ARE INCARCERATED IN
PRISONS TO BE ABLE TO ACCESS
MEDICAL SERVICES 90 DAYS PRIOR
TO RELEASE WHICH WILL HELP THE
CONTINUITY OF TREATMENT WHEN
THEY ARE RELEASED. UM AND ALSO A
PROGRAM FOUR YEARS AGO. THAT I
WORKED ON. ACTUALLY THAT WOULD
INCENTIVIZE PEOPLE WHEN THEY ARE
RELEASED TO STAY IN A MENTAL
HEALTH OR SUBSTANCE USE PROGRAM
, AND IT DEALS WITH PAROLE
INCENTIVES. BUT THERE'S JUST SO
MANY MORE THINGS, AND EVERY TIME
WE COME TO DEAL WITH IT, WE
ALWAYS HEAR ABOUT THE WORKFORCE
SHORTAGE AND YOU KNOW, HOW DO WE
GET MORE TREATMENT PROVIDERS? SO
YOU KNOW WHEN WE LOOK AT THE
BEHAVIORAL HEALTH PIPELINE, HOW
DO WE ADDRESS THAT? WORKFORCE.
YOU KNOW, SHORTAGE AND DILEMMA
THAT WE HAVE. UM BECAUSE, YOU
KNOW, WE HAVE GREAT IDEAS AND
EVERYTHING, AND WE NEED FUNDING
FOR, BUT IF WE DON'T HAVE THE
PEOPLE THAT CAN DO THE TREATMENT
YEAH, FOLKS, GO, NOT ADDS TO THE
DELAYS OF PEOPLE GETTING INTO
TREATMENT. YEAH. LOT THERE. UM I
ACTUALLY WANT TO START BECAUSE,
UM, ONE OF MY PASSION
POPULATIONS THAT I WORK WITH ARE
ALSO PEOPLE WHO HAVE JUSTICE
IMPACTED AND SO I THINK I CANNOT
. IT'S ACTUALLY A GREAT EXAMPLE
. WE TALKED ABOUT EARLY
PSYCHOSIS. I HOPE WE COME AWAY
FROM TODAY'S HEARING,
RECOGNIZING THAT THERE ARE SO
MANY SYSTEMS THAT HAVE A ROLE TO
PLAY, WHETHER THAT IS IMPROVING
SOMEONE'S MENTAL HEALTH OR
TREATING THEIR MENTAL ILLNESS.
AND I THINK, UM, WHAT WE WERE
ABLE TO ACCOMPLISH AS THE FIRST
STATE IN THE NATION. WE HAD AN
OPPORTUNITY TO MEET WITH SOME
CMS FOLKS. THE DIRECTOR OF CMS,
TAKE HIM DOWN TO THE L. A COUNTY
JAIL AND TALK ABOUT HOW IS THIS
GOING TO WORK? YOU KNOW, TURNING
ON MEDICAL 90 DAYS BEFORE? UH,
SOMEBODY LEAVES WHERE YOU KNOW
IT'S GOING TO BE COMPLICATED,
BUT IT TRULY COULD BE LIFE
CHANGING FOR PEOPLE WHO ARE HOW
UNFORTUNATELY THERE ARE
INCARCERATED. BUT FOR MANY, THEY
HAVE BEEN ENGAGED. AS I
MENTIONED. WE'VE GOT 100,000
PEOPLE IN THE STATE. TO
CALIFORNIA RECEIVING MENTAL
HEALTH TREATMENT IN JAILS. TODAY
SO HOW DO WE KEEP THAT? THAT
GOING AND MAKING SURE THAT UM WE
HAVE THE HOUSING PLACEMENTS
TREATMENT SLOTS, ETCETERA. BUT
IT'S A GREAT EXAMPLE OF HOW I
DON'T THINK OUR MEDICAID SYSTEM
CAN DO THINGS LIKE DELIVER PARKS
, AND IT WASN'T DESIGNED TO DO
THAT. BUT IT WAS DESIGNED TO
TREAT SOMEBODY WHO HAS A
DIAGNOSED, UH, DISORDER THAT IS
RESPONSIVE TO A COURSE OF
TREATMENT. UM AND IT WAS
DESIGNED TO MAKE SURE THAT
PEOPLE GET THEIR JUSTIN RIGHT
FULL BENEFIT THAT THEY DESERVE
SO THAT THEY CAN GET ON THE PATH
TO RECOVERY, SO WE HAVE TO USE
EACH OF OUR DOLLARS BASICALLY,
AND EACH OF OUR SYSTEMS WE HAVE
12 DEPARTMENTS, FIVE OFFICES
WITHIN OUR HEALTH AND HUMAN
SERVICE. IS I LOVE WE TALKED
ABOUT THE POPULATION BASED
APPROACH. WE NEED TO HAVE A
STRONG, STRONG PARTNERSHIP WITH
PUBLIC HEALTH, UM, IN DOING
PREVENTION, WORK IT. WE CAN'T
RELY ON THE MEDICAID SYSTEM TO
DO ALL OF OUR PREVENTION WORKS.
THAT'S NOT WHAT WE'RE WHAT WE'RE
TRYING TO DO, BUT, UM, WHEN
THERE IS AN APPROPRIATE TIME,
LIKE WITH FIRST BREAKER EARLY
PSYCHOSIS WHERE WE CAN PUSH CMS
AND SAY, HEY, WE WANT THIS TO BE
SOMETHING YOU PAY FOR IN
MEDICAL, OR WE WANT YOU TO PAY
FOR COMMUNITY HEALTH WORKERS. UM
THOSE ARE THOSE ARE OUR
STRATEGIES THAT COLLECTIVELY WE
HAVE TO DO TOGETHER SO THAT
EVERY FUNDING SOURCE IS ABLE TO
ADDRESS ALL ACROSS THE CONTINUUM
FROM HEALTH TO SEVERE ILLNESS.
UM AND I HOPE THAT THIS IS AN
OPPORTUNITY TO DO THIS WORK,
WHETHER IT BE THROUGH THE WHAT?
WE'RE LEARNING WITH THE CHILDREN
NEWSPAPER HEALTH INITIATIVE.
WHAT WE'RE LEARNING WITH AS WE
PUSH MEDICAID TO. IT'S VERY,
VERY FURTHEST COMFORT LEVEL, SO
TO SPEAK, BECAUSE YOU KNOW IT IS
ESSENTIALLY STILL A SICK CARE
SYSTEM. UM AND SO, BUT LET'S DO
WHATEVER WE CAN WITH IT BECAUSE
WE GET A FEDERAL DOLLAR AND
LET'S LOOK AT HOW WE DO OTHER
THINGS AS WELL. ON THE WORKFORCE
PIECE. WHAT I CAN SAY IS IN
PARTLY BECAUSE I ALREADY
PERSONALLY SHARED WE HAVE TO
FIGURE OUT HOW TO SUPPORT PEOPLE
BEFORE THEY GO TO SCHOOL. PEOPLE
UNFORTUNATELY, ARE NOT GOING TO
MAKE THE CHOICE TO NOT ONLY GO
INTO BEHAVIORAL HEALTH CAREERS
BUT POTENTIALLY TAKE ON A
SIGNIFICANT AMOUNT OF BURDEN OF
DEBT UPFRONT WHEN THEY DON'T
NECESSARILY KNOW IF THEY'RE
GOING TO BE ABLE TO PAY THAT
DEBT OFF, AND SO WHAT I'VE HEARD
FROM YOUNG PEOPLE IN PARTICULAR
. EVEN WHEN I MENTOR PEOPLE,
THEY ASKED ME. SHOULD I GO
BECOME A SOCIAL WORKER? OKAY,
I'M ALWAYS GONNA SAY GO BECOME A
SOCIAL WORKER. AND I'M NOT JUST
SAYING THAT, BUT DO IT WITH YOUR
EYES WIDE OPEN. MAKE SURE THAT
YOU DO YOUR HOMEWORK AND THAT
YOU, UM LOOK THROUGH ALL THE
OPPORTUNITIES THAT ARE AVAILABLE
TO YOU BECAUSE I'M VERY HOPEFUL
IN THE COURSE OF THE NEXT TWO
YEARS THAT WE AS A STATE ALONE
ARE GOING TO HAVE A VARIETY OF
DIFFERENT OPTIONS. FOR YOUNG
PEOPLE TO COME AND EVEN PEOPLE
WHO WANT TO GET INTO THIS FIELD
BECAUSE I DON'T WANT TO GIVE UP
ON THE FACT THAT THIS IS AN
INCREDIBLY REWARDING FIELD. I
LOVE WHAT I DO. I FEEL BLESSED
AND HONORED THAT I GET TO HAVE
THIS REWARDING JOB EVERY DAY, NO
MATTER HOW CHALLENGING IT IS,
AND I DON'T KNOW IF WE TELL THAT
STORY ENOUGH TO OTHER PEOPLE
ABOUT THE REWARDS OF GOING INTO
THIS CAREER, BUT WE DO HAVE TO
MAKE SURE THAT WE'RE NOT MAKING
PEOPLE INCURRING HUGE DEBT. TO
THEN HAVE US HELP PAY THEM OFF
IN THE FUTURE. I THINK WE REALLY
HAVE TO SUPPORT THEM THROUGH THE
ENTIRE PROCESS. AND SO I DON'T
KNOW IF THAT ANSWERS YOUR
QUESTION IT IS. IT IS. PROBABLY
OUR MOST THAT AND THE LACK OF
ACTUAL FACILITIES AND FRANKLY
FACILITIES AND I INCLUDE IN THAT
, UM, AMPLE AND AFFORDABLE AND
STABLE HOUSING. THAT IS WILLING
, GETTING BACK TO STIGMA TO LOVE
AND CARE FOR PEOPLE IN OUR
COMMUNITIES AND SO ANYTHING THAT
WE CAN DO TO MAKE SURE THAT
EVERYBODY NO MATTER UM WHAT YOUR
MENTAL HEALTH STATUS IS THAT YOU
BELONG IN CALIFORNIA AND WE HAVE
A HOME FOR YOU HERE, AND WE'RE
GOING TO FIND A PLACE FOR YOU TO
BE IS IT IS A MESSAGE THAT WE
CAN ALL GET BEHIND. IF I MAY SAY
NEVER, WALDRON, THANK YOU FOR
THE EMPHASIS ON ON THE CRIMINAL
JUSTICE SYSTEM, AND, UM YOU
KNOW, PART OF THE ORIGIN STORY
OF MENTAL HEALTH SERVICES ACT
WAS RECOGNIZING THAT THAT IS
THAT IS THE ONLY SYSTEM THAT, UM
, ACCEPTS EVERYONE. 24 7, RIGHT
. I MEAN, OUR OUR HOSPITAL. OUR
EMERGENCY DEPARTMENTS DO AS WELL
BUT FOR SHORT TERM RIGHT KINDS
OF INTERVENTIONS. UM I WOULD SAY
NOT ONLY DO WE HAVE TO ADDRESS
THE WORKFORCE ISSUE THAT DEPUTY
SECRETARY WELSH IS HIGHLIGHTING,
BUT WE ALSO HAVE TO GET BETTER
AT UNDERSTANDING WHY SO MANY
PEOPLE WITH MENTAL HEALTH NEEDS
ARE IN THOSE SITUATIONS IN THE
FIRST PLACE. WHEN WE'VE LOOKED
AT THIS HISTORICALLY THROUGH THE
LENS OF PEOPLE WHO ARE IN A
HOSPITAL. WITH ACTUALLY DESIGNED
SYSTEMS INTERVENTIONS TO PREVENT
HOSPITALIZATION. AND THE FIRST
THING THAT HAPPENS WHEN SOMEONE
IS HOSPITALIZED AS A
CONVERSATION ABOUT DISCHARGE
PLANNING. DAY ONE PEOPLE ARE
STARTING TO WORK AROUND WHAT'S
GOING TO TAKE TO GET YOU OUT OF
HERE. WE DON'T HAVE THAT
APPROACH. THERE ARE ACTIVITIES
ACTIONS CIRCUMSTANCES BEHAVIORS
THAT RESULT IN PEOPLE BEING
INVOLVED WITH THE CRIMINAL
JUSTICE SYSTEM. WE HAVEN'T
NECESSARILY ROLLED UP PERSONAL
AVES AS AGGRESSIVELY AS WE CAN
ASK OURSELVES. IF THE FOLKS WHO
ARE IN THAT SYSTEM IF THAT IS
THE BEST PLACE FOR THEM TO BE
GIVEN WHAT'S HAPPENING IN THEIR
LIVES AND WHAT'S HAPPENING AND
THEIR OWN BEHAVIOR. SO WERE SOME
OF THE DATA COMING OUT OF THE
DEPARTMENT STATE HOSPITALS
SHOWING THAT BEFORE FOLKS ARE
CHARGED WITH A FELONY. THEY WERE
ARRESTED 12 TO 15 TIMES FOR
MISDEMEANOR BUT GOT NO COMMUNITY
BASED CARE. SO IS THE
INTERVENTION IMPROVED ACCESS TO
CARE FOR FOLKS WHO ARE AT HIGH
RISK. AND CAN WE ACTUALLY ALLOW
CRIMINAL JUSTICE RESOURCES TO BE
SPENT MORE EFFECTIVELY THAN
PEOPLE WHO REALLY NEED TO BE
THERE AND MAKE SURE THAT THEY
HAVE EFFECTIVE SERVICES AND ARE
THERE IS THERE? IS THERE A
PERCENTAGE OF THAT POPULATION
WHO ACTUALLY SHOULD BE BETTER
SERVED IN THE COMMUNITY AND AS A
CONSEQUENCE OF THAT, ABLE TO TAP
INTO THAT FEDERAL DOLLAR MORE
EFFECTIVELY OR EVEN THE
COMMERCIAL INSURANCE DOLLAR MORE
EFFECTIVELY? AND SO I THINK
WE'VE MADE A LOT OF STRIDES IN
THAT SPACE, BUT WE HAVE
ADDITIONAL OPPORTUNITIES TO
BETTER UNDERSTAND THE PROBLEM TO
TAKE IT APART AND PUT IN PLACE
INTERVENTIONS THAT ACTUALLY
ALLOW US TO MAKE SURE THAT WE'RE
GETTING THE BEST BANG FOR THE
DOLLAR IN TERMS OF THE
INTERVENTION THAT IS THERE IT
MAY ON THE SHORT TERM FEEL LIKE
IT'S CHEAPER TO CALL THE POLICE
AND, YOU KNOW, HAVE SOMEONE
ARRESTED AND THEY GET CHARGED
AND THEY MOVE THROUGH THAT
SYSTEM. BUT IN THE LONG TERM, IT
MAY BE FAR MORE EXPENSIVE. THEN
SO IF THE IF THE EQUIVALENT IS
INSTITUTIONAL CARE ON HEALTHCARE
, UM WE DON'T WE DON'T LET THAT
HAPPEN, RIGHT? WE PUT IN PLACE,
YOU KNOW, AS YOU SAW IN THE
CONTINUUM DIAGRAM, UM, THAT WAS
PUT ON THE BOARD, RIGHT? WE HAVE
NOT NECESSARILY DONE
INTERVENTIONS, INCLUDING THAT
WHAT'S KNOWN AS THE SEQUENTIAL
INTERCEPT MODEL TO MAKE SURE
THAT WE CREATE LOTS OF OFF
RAMPS. JUSTICE INVOLVEMENT.
DEPUTY SECRETARY WELSH FORMERLY
WAS THE EXECUTIVE DIRECTOR OF
THE COUNCIL ON CRIMINAL JUSTICE
AND BEHAVIORAL HEALTH AND HAS
REALLY LED FOR MANY YEARS. THESE
EFFORTS TO MAKE THAT HAPPEN, AND
WE'D BE HAPPY TO TALK WITH YOU
ABOUT SOME ADDITIONAL
OPPORTUNITIES. THIS HAS BEEN
SUCH AN A WRENCHING ENRICHING
CONVERSATION. UM. WE KEEP ON
RUNNING INTO THE ISSUES OF
DELAYS IN RECEIVING SERVICES.
AND NO MATTER UM, WENT DOOR
SOMEONE GOES THROUGH, THERE
SEEMS TO ALWAYS BE A DELAY. IN
ONE WAY OR ANOTHER, WHETHER IT'S
BECAUSE HEALTH PLANS ARE NOT
COVERING IT, WHETHER YOU KNOW,
THERE'S PREAUTHORIZATION ISSUES
, WHETHER THERE IS JUST NOT THE
RIGHT PEOPLE WHO ARE TRAINED IN
THE RIGHT TYPE OF INTERVENTION
FOR THAT PARTICULAR DIAGNOSIS.
LAST NIGHT. I WAS ACTUALLY
READING THROUGH SOME OF THE R UM
OUR MORALIST CHALLENGED FOSTER
CARE CHILDREN. AND HOW. THEIR
DELAY OF CARE IS HORRIBLE TO SAY
THE LEAST. BUT BUT ALSO THE FACT
THAT IT'S HARD TO FIND THE THOSE
CLINICIANS WHO MIGHT BE TRAINED
AND A SPECIFIC SERVICE THAT IS
NECESSARY. UM. I REMEMBER GOING
THROUGH WHEN I WAS DOING MY MSW.
I MEAN, EVEN THOUGH I WAS ON THE
COMMUNITY TRACKED. I STILL LEFT
WITH FIRST MENTAL HEALTH FIRST
AID CERTIFICATION. I STILL LEFT
WITH MOTIVATIONAL INTERVIEWING
CERTIFICATION, RIGHT? UM BUT.
FOR INSTANCE, YOU NEVER REALLY
HAD AN OPPORTUNITY. IT WASN'T
UNTIL I WAS IN A UH, IMAGES S¼
FUNDED PROGRAM THAT WE HAD
ACCESS TO UH HUH. SEE BITS
TRAINING. TO BE ABLE TO HELP
WITH THE YOUNG PEOPLE IN TRAUMA
IN A SCHOOL MODEL. WHAT CAN WE
DO TO DO A BETTER JOB THAT WHEN
PEOPLE ARE LEAVING OUR PROGRAMS
, PARTICULARLY THOSE THAT ARE
STATE FUNDED. ARE LEAVING WITH
THE TYPE OF TRAINING AND
CERTIFICATION NECESSARY TO BE
ABLE TO IMMEDIATELY GO INTO AND
PROVIDE SOME OF THESE MOST
CRITICAL NEEDED SERVICES, AS
OPPOSED. TO HAVING THEM HAVE TO
FIGURE IT OUT THEMSELVES AND
SIGN UP FOR A TRAINING
OPPORTUNITY. PAY FOR A
CERTIFICATION, RIGHT? HOW CAN WE
BETTER EQUIP OUR UPCOMING
CLINICIANS TO BE ABLE TO HANDLE
SOME OF THESE CRITICAL NEEDS. SO
UM, I HAVE A COUPLE OF THOUGHTS
ON THAT. I SPOKE OF THE EARN AND
LEARN MODEL VERY SPECIFIC TO
DEVELOPING OUR SUBSTANCE USE
DISORDER COUNSELORS, BUT I DO
THINK AND I HEAR THIS FROM OUR
COMMUNITY BASED ORGANIZATIONS,
AND OBVIOUSLY I ALSO HAD THOSE
PLACEMENTS MYSELF. AND I THINK,
UM, WE COULD DO MORE TO SUPPORT
THOSE ORGANIZATIONS TO HAVE THE
CAPACITY TO TRAIN YOUNG PEOPLE
WHILE THEY'RE DOING THEIR
CLINICAL HOURS OR EVEN JUST
GETTING THEIR HOURS WHILE
THEY'RE GETTING SAY LIKE THEY'RE
MSW OR THERE. THERE BE A OR OR
MASTER'S DEGREE SO THAT THEY'RE
IN. THEY'RE IN AN ENVIRONMENT
WHERE THEIR SUPERVISOR ACTUALLY
HAS AN OPPORTUNITY TO PROVIDE
THEM TRAINING, NOT JUST
SUPERVISION BUT TRAINING ON WHAT
WOULD BE AN EVIDENCE BASED
PRACTICE SO WELL. I CAN'T SPEAK
BECAUSE I WOULD HAVE TO GO BACK
TO OUR DEPARTMENT TO SEE IF
THERE'S ANY OPPORTUNITIES LIKE
THAT. I KNOW THAT WE'VE HAD SOME
DISCUSSIONS, INCLUDING WITH WITH
COUNTIES THAT ADMINISTER THEIR
LOCAL MHSC DOLLARS, BUT WE ARE
LOOKING AT WAYS IN WHICH WE CAN
MAKE SURE THAT OUR WORKFORCE,
EDUCATION AND TRAINING DOLLARS
THAT ARE A PART OF THE MENTAL
HEALTH SERVICES ACT CAN ALSO BE
USED TO REALLY, UM, CONTINUE TO
TRAIN THE EXISTING STAFF,
SPEAKING ABOUT WORKING WITH THE
CRIMINAL JUSTICE POPULATION OF,
UH YOU KNOW WHEN I GRADUATED
FROM FROM MY MSW PROGRAM. I
DON'T EVEN THINK I TOOK A CLASS
ON, UM, THAT TO BE HONEST WITH
YOU. I HAD AN INTEREST IN SUD.
SO I HAD TAKEN SOME OF THOSE
COURSES. AND SO, UM, YOU KNOW,
THAT WAS KIND OF WE NEED TO GO
BACK AND REALLY, UM, WORK WITH
OUR SCHOOLS TO MAKE SURE THAT
THEY'RE ALSO SUPPORTED TO
PROVIDE, YOU KNOW, REAL TIME
TRAINING ON WHAT ARE THE
EMERGING BEST PRACTICES IN THE
FIELD? AND WHAT ARE THE TARGET
POPULATIONS? I KNOW THAT THERE
THERE ARE SPECIALTIES IN
GERONTOLOGY AND SPECIALTIES AND
WORKING WITH VETERANS
SPECIALTIES IN WORKING WITH
REFUGEES AND MIGRANTS, BUT WE
ALSO NEED TO SPECIALIZE IN WHAT
THE ACTUAL SERVICES SO I DO
THINK THERE'S AN INTEREST AN
INCREDIBLE PARTNERSHIP WE CAN
HAVE. AND FRANKLY HOW DO WE ALSO
MAKE SURE THAT THOSE STUDENTS
AND YOUNG PEOPLE WHO ARE STILL
LEARNING? UM HAVE STRONG
SUPERVISION AND THAT WE DON'T
HAVE TO PULL SOMEBODY WHO NEEDS
TO BE DELIVERING DIRECT CARE A
WAY TO DO THAT SUPERVISION THAT
WE ACTUALLY SUPPORT OUR
COMMUNITY BASED ORGANIZATIONS
THAT ARE SPONSORING SO TO SPEAK
, UH, PEOPLE GETTING THEIR
CLINICAL HOURS TO ALSO HAVE THE
CAPACITY TO REALLY TRAIN THEM. I
THINK IT'S AN EXCELLENT
SUGGESTION, AND I WOULD I'M
GONNA TAKE IT BACK AND TALK TO
MY FOLKS ABOUT IT, PARTICULARLY
THE STATE BOARD, RIGHT THAT YOU
HAVE TO GO THROUGH TO GET YOUR,
UM UM YOUR LICENSING NUMBER TO
BE ABLE TO GET YOUR HOURS, RIGHT
? DO WE NEED TO STRENGTHEN SOME
OF THOSE REQUIREMENTS TO MAKING
SURE THAT YOU KNOW THERE'S
WHETHER IT'S NOT JUST HOURS BUT
ALSO SPECIFIC TRAININGS,
POSSIBLY UM, IS THERE
OPPORTUNITIES? UM THE
ORGANIZATION THAT I LEFT BEFORE
COMING HERE. UM LUCKILY WE WERE
ABLE TO USE P E I DOLLARS TO BE
ABLE TO HIRE A SUPERVISOR FOR
CLINICAL TRAINING RIGHT SO WE
CAN BUILD OUR OWN CLINICAL
DEPARTMENT TO BE ABLE TO DO
THAT. BUT I'M TELLING YOU,
RIGHT, THE NUMBER ONE HELPING
COMMUNITY BASED ORGANIZATIONS
AND OTHERS BE ABLE TO HAVE THE
TYPE OF FUNDING NECESSARY TO
BRING ON SOMEONE WITH SUCH HIGH
CERTIFICATIONS, RIGHT? UM AND OF
COURSE, WE KNOW HOW DEMANDING
THEY ARE ABOUT BUSINESS, ALMOST
A SPECIALTY TO BE ABLE TO, UM,
SUPERVISE SOMEONE. UH I'M
WONDERING, UH, LASTLY, I'M
WONDERING ABOUT. MAN THERE'S SO
MUCH, UM, THERE'S JUST SO MUCH,
BUT I THINK, UM OBVIOUSLY,
THERE'S STILL SOME MORE WORK TO
DO. AND YOU ALL HAVE A STRATEGIC
PLAN A MULTIYEAR PLAN AND
HOPEFULLY WE CAN MAKE SOME SPACE
IN THE FUTURE TAXES GO THROUGH
THAT MULTI YEAR PLAN SO PEOPLE
DON'T JUST THINK THAT THIS IS
WHAT WE'RE DOING, BUT THIS IS
NOT A PART THAT THIS IS A PART
OF A COORDINATED LONG TERM PLAN
OF BEING ABLE TO IMPLEMENT ONE
SYSTEM TO THE NEXT. UM, AND
THOSE TYPE OF THINGS RIGHT? UM
IS THERE ANY ADDITIONAL WORK
THAT WE CAN DO THAT WE'RE
THINKING ABOUT DOING WITH OUR,
UM HEALTH PLANS OUTSIDE OF JUST
MEDICAL AS WELL TO MAKING SURE
THAT WE'RE MORE UM SUPPORTIVE OF
BEHAVIORAL HEALTH SERVICES.
YEAH. UM SO I CERTAINLY WANT TO
RECOGNIZE THE PREVIOUS SPEAKER
WHO EXPRESSED, YOU KNOW, UM,
FRUSTRATIONS WITH, UM, ACCESS TO
COMMERCIAL. UH, ACCESS TO
BEHAVIOR HEALTH SERVICES
UNDERNEATH COMMERCIAL INSURANCE,
YOU KNOW? WE'RE PROBABLY ALL
HERE HAVE EMPLOYEE BASED
INSURANCE. WE PAY A PREMIUM FOR
THAT, AND WE HAVE A BEHAVIORAL
HEALTH BENEFIT IS PART OF THAT
AND WE ARE WORKING REALLY HARD
TO ENSURE THAT CALIFORNIANS GET
ACCESS TO IT. I UM, DO YOU WANT
TO SHARE A COUPLE OF YEARS AGO?
WE DID. WE DID RECEIVE SOME
RESOURCES FROM THE LEGISLATURE
FOR OUR DEPARTMENT OF MANAGED
CARE. TO DO COMPLIANCE REVIEWS.
I THINK I HAVE HEARD FROM SOME
OF OUR CONSTITUENTS STAKEHOLDERS
. YOU MAY EVEN HEAR SOME TODAY
THAT THAT PEOPLE FEEL LIKE WE'RE
NOT BEING FAST AND FURIOUS
ENOUGH. I DO WANT TO SAY,
THOUGH, IN THAT COMPLIANCE
REVIEW PROCESS OF 25 PLANS THAT
THERE WERE 24 PLANS THAT WERE
FOUND TO HAVE SOME SORT OF
COMPLIANCE ISSUE. UM AND SO, UH
, LIKE ALL THINGS THAT ARE
SIGNIFICANT SYSTEM CHANGE, WE'VE
GOT TO DO THINGS LIKE PAY
ATTENTION, BUT ALSO PROVIDE
TECHNICAL ASSISTANCE AND SUPPORT
AND MAKE SURE THAT WE'RE MAKING
SURE THAT POLICIES ARE GETTING
UPDATED THAT PEOPLE ARE
UNDERSTANDING HOW TO CHANGE AND
REVISED COST SHARING AGREEMENT.
SO I DON'T WANT TO SAY I
UNFORTUNATELY, LIKE I SAID,
BEFORE WE HAVE, WE DO HAVE A
ROAD AHEAD OF US, BUT WE DO HAVE
IN PLACE. ONE OF THE STRONGEST
PARODY LAWS IN THE COUNTRY. UM
AND WE ARE WORKING HARD TO MAKE
SURE THAT WE'RE PROVIDING
OVERSIGHT OF THAT AND THAT WE'RE
WORKING WITH OUR PLANS, WHO ARE
ALSO FRANKLY, STRUGGLING WITH
SOME OF THE SAME CHALLENGES THAT
WE HAVE HEARD BECAUSE OF JUST
THE HISTORIC LONG TERM STIGMA
AND DISCRIMINATION ASSOCIATED
WITH TREATING BEHAVIORAL HEALTH
CONDITIONS. UM THEY ALSO HAVE
WORKFORCE CHALLENGES. THEY ALSO
HAVE CHALLENGES OF, UM, NOT
HAVING THE RIGHT KINDS OF
INTERVENTIONS AVAILABLE AND,
FRANKLY, THE BIGGEST HURDLE THAT
I SEE IN, UM LOOKING AT THE CARE
THAT THEY'RE DELIVERING IS HOW
DO WE CREATE MORE OF WHAT YOU
ALL HAVE BEEN TALKING ABOUT A
SYSTEM THAT'S NOT JUST
NECESSARILY ABOUT YOU GET IN THE
DOOR BECAUSE YOU HAVE AN ILLNESS
, BUT WE'RE GOING TO WORK WITH
YOU TO MAKE SURE THAT YOU'RE IN
POWER TO NOT ONLY ASK FOR HELP,
BUT ALSO HAVE YOUR TOOLS AT YOUR
OWN DISPOSAL TO SUPPORT YOUR
MENTAL HEALTH AND WELL BEING, UM
, YOU KNOW, AND THAT'S MAYBE
MORE DOABLE FOR SOMEONE WHO IS
NOT EXPERIENCING A MORE SERIOUS
MENTAL ILLNESS. BUT FOR MANY OF
US, YOU KNOW, I STRUCK GO WITH
DEPRESSION AND ANXIETY. PROBABLY
LIKE MANY OTHER PEOPLE IN THIS
ROOM. I'M JUST REALLY OPEN ABOUT
IT. AND UM, I'VE LEARNED SOME
TOOLS. I HAVE SOME TOOLS FROM MY
PROVIDER TO SUPPORT ME. BUT, UM
WE HAVE TO EDUCATE THE WHOLE ALL
CALIFORNIANS TO ALSO ASK FOR
THAT. I DO. I UNDERSTAND HOW
FRUSTRATING IT MIGHT BE TO TAKE
THE EXTRA STEP TO FILE A
COMPLAINT AGAINST. UM UH, YOUR
YOUR PROVIDER FEELING LIKE YOU
DIDN'T GET ACCESS TO SOMETHING
THAT YOU DESERVE, BUT I REALLY
ENCOURAGE PEOPLE TO GO TO OUR
HELP CENTER TO FILE THOSE
COMPLAINTS IF THEY FEEL LIKE
THEY'RE NOT GETTING WHAT THEY
DESERVE, AND THE THING THAT I
THINK IN MY INTERACTIONS WITH
SOME OF THE WORK THAT MY
COLLEAGUES DO WITH YOUNGER
PEOPLE, I DON'T NECESSARILY GET
TO DO IT AS MUCH MYSELF IS. THIS
NEW GENERATION IS DEMANDING
ACCESS TO HIGH QUALITY CARE, AND
THEY DESERVE IT. AND THAT DEMAND
. I THINK WE'LL WE'LL CATAPULT
US TO SOME CHANGE, SO I'M REALLY
EXCITED ABOUT THE ENERGY AND
ACTION THAT YOUNG PEOPLE AND
THEIR FAMILIES ARE PUTTING
FORWARD AND SAYING NO. IT SAYS
RIGHT HERE IN MY BENEFIT PACKAGE
THAT I HAVE ACCESS TO
PSYCHOTHERAPY, AND I'M NOT
GETTING IT. AND SO, UM, WE WANT
TO HEAR FROM PEOPLE IF THEY'RE
NOT GETTING, UM THE CARE THAT
THEY NEED AND DESERVE, SO CAN I
PLEASE? I THINK THERE'S ALSO
WE'RE GOING TO HAVE AN
OPPORTUNITY TO LEARN ALONG THE
WAY FROM A LOT OF THE WORK
THAT'S HAPPENING, INCLUDING, FOR
EXAMPLE, THE FEE SCHEDULE FOR
SCHOOLING TO BEHAVIORAL HEALTH
SERVICES IN THE C Y B H I AS WE
TALKED ABOUT IT IS BOTH
COMMERCIAL PLANS AND MEDICAL
MANAGED CARE PLANS. UM IT DOES
NOT ALLOW FOR COPAYS OR PRIOR
AUTHORIZATION AS PART OF THE
STRUCTURE OF THE FEE SCHEDULE.
AND SO WHAT CAN WE LEARN FROM
THAT EXPERIENCE? WHAT SERVICES?
DO WE SEE CHILDREN ACCESSING
MORE BECAUSE OF THE NATURE OF
THAT FEE SCHEDULE. IF SOMETHING
ISN'T BEING USED AS MUCH AS WE
ANTICIPATE WHY IS THAT? WHAT ARE
STILL THE BARRIERS THAT ARE
THERE AND WE'RE VERY COMMITTED
IN THE C Y B H I WE HAVE AN
EVALUATION PLAN THAT IS VERY
COMMITTED TO LEARNING ALONG THE
AWAY AND NOT JUST THINKING ABOUT
AT THE END OF THE FIVE YEARS.
WHAT DID WE ACCOMPLISH AND
LEARN? AND SO I THINK THERE WILL
ALSO BE OPPORTUNITIES IN THIS
SPACE TO THINK ABOUT THIS MORE
HOLISTIC APPROACH ACROSS PAYERS
AND FROM THE DIFFERENT
INITIATIVES THAT ARE UNDER WAY.
WHAT CAN WE LEARN FROM THOSE AND
APPLY ACROSS THE SYSTEM? AND I
WOULD ADD TO THAT IS, UM YOU
KNOW THE REGULATORY MODEL. THE
COMPLIANCE MODEL IS A IS A
LIMITED MODEL. IT'S A CAT AND
MOUSE KIND OF GAME. CAN WE FIND
IT? CAN WE CATCH HIM? CAN WE
WRITE? UM AND I'M NOT SAYING WE
MOVE AWAY FROM THAT, BUT I THINK
WE MOVED BEYOND THAT. AND YOU
KNOW, THERE'S SO MANY ASPECTS OF
OUR LIVES WHERE QUALITY IS
DRIVEN BY SOMETHING OTHER THAN
WHETHER A GOVERNMENT AGENCY
INTERVENED AFTER THE FACT AND
DID AN INVESTIGATION AND FIVE
YEARS LATER IMPOSED A FINE. WE
HAVE TO HAVE THAT, BUT WE
HAVEN'T NECESSARILY PUT IN PLACE
THIS SIMILAR INVESTMENTS THAT
WE'VE SEEN ARE SUCCESSFUL IN
OTHER ASPECTS OF OUR LIVES, YOU
KNOW CERTIFICATION STANDARDS IN
TERMS OF THE QUALITY. YOU KNOW
WHEN PEOPLE ARE BUYING THE
SERVICE. RIGHT AND SO THE
COMMISSION HAS HAS A
RECOMMENDATION IN FRONT OF THE
LEGISLATION. THE GOVERNOR
THROUGH OUR MENTAL HEALTH IN THE
WORKPLACE IS THE STATE OF
CALIFORNIA IS A MAJOR EMPLOYER
AMONG THE LARGEST IN THE STATE
OUTSIDE OF THE FEDERAL
GOVERNMENT. PARTICULARLY IF YOU
INCLUDE OUR PUBLIC UNIVERSITIES
, RIGHT, AND THE PUBLIC SECTOR
IS THE LARGEST EMPLOYER AND AS
THE LARGEST EMPLOYER WHERE THE
LARGEST PAYER OF HEALTH CARE
BENEFITS. THROUGH THE
NEGOTIATIONS WITH PLAN PROVIDERS
AND SO IN ADDITION TO EXERCISING
YOUR LEGISLATIVE AUTHORITY TO
DESIGN A REGULATORY STRATEGY, WE
ALSO HAVE THE OPPORTUNITY. TO
JUST NEGOTIATE WHEN WE'RE PAYING
FOR IT OF WHAT THE STANDARDS ARE
FOR CARE AS A BUYER. AND SO YOU
KNOW, STRONGLY ENCOURAGED THIS
CONVERSATION TO BE MORE
EXPANSIVE ABOUT IF THE GOAL IS
TO IMPROVE ACCESS TO CARE, THE
QUALITY OF CARE IN THE OUTCOMES.
LET'S LET'S THINK MORE
EXPANSIVELY ABOUT THE TOOLS. WE
HAVE TO DRIVE THAT, RECOGNIZING
THAT WE ALSO HAVE TO HELP THE
PROVIDERS WHO THEMSELVES ARE
SORT OF TRAPPED IN THIS
WORKFORCE CHALLENGE. IN WAYS
THAT WE CAN ACTUALLY
INCENTIVIZED PROGRESS, INCLUDING
COMPENSATION. RIGHT WE CAN'T
PRETEND THAT THAT'S NOT A FACTOR
IN PEOPLE MAKING DECISIONS ABOUT
WHETHER OR NOT THEY'RE WILLING
TO WORK IN THE PUBLIC SECTOR
VERSUS, YOU KNOW, OR WILLING TO
WORK WITH A FORENSIC POPULATION
, FOR EXAMPLE, RIGHT AND IN
OTHER AREAS OF HEALTH HEALTH
CARE, WE ARE OFTEN WILLING TO
PAY MORE TO DO MORE COMPLICATED
WORK. IT'S NOT CLEAR THAT WE'VE
FULLY EXPLORED THOSE PATHWAYS.
IN THE BEHAVIORAL HEALTH SPACE.
I WANT TO THANK EVERYONE FOR
PARTICIPATING. UM, OBVIOUSLY, WE
UM. IN THE FUTURE. WANT TO
DEFINITELY TALK ABOUT MORE OF
THE BREAKING DOWN OF SILOS THAT
WE CONTINUE TO TALK ABOUT, AND
MAKE SURE THAT OUR SYSTEMS ARE
DESIGNED TO UM, SERVE THE UNIQUE
NEEDS OF OUR POPULATIONS AND
RESPOND ACCORDINGLY. UM BUT ALSO
OBVIOUSLY TO CONTINUE TO FIND
WAYS TO MOVE THE NEEDLE AND PUSH
THE BOUNDARIES WHEN IT COMES TO
MEETING THIS MOMENT, I
PARTICULARLY WANT TO APOLOGIZE
TO EXECUTIVE DIRECTOR BLACKER
SENIOR DIRECTOR SPENCER AND DR
QUAD SHOE WHERE THE VICTIMS OF
TECHNICAL DIFFICULTIES, BUT WE
PROMISE WE WILL MAKE SURE THAT
THEIR VOICES ARE HEARD IN THE
FUTURE BECAUSE THE POPULATIONS
THAT THEY REPRESENT ARE EQUALLY
AS IMPORTANT. UM UM, AND THIS
DISCUSSION, SO THANK YOU VERY
MUCH. I WANT TO THANK MY
COLLEAGUES FOR THEIR
PARTICIPATION, AND WE'RE LOOKING
FORWARD TO FUTURE DISCUSSIONS.
THANK YOU. THIS HEARING IS
ADJOURNED.