ARE YOU READY? THE JOINT HEARING
WILL COME TO ORDER AT THIS TIME.
GOOD MORNING. UH TO OUR MEMBERS
AND GUESTS. UM. IT'S IMPORTANT
UM AS ALWAYS, THAT WE MAINTAIN
DECORUM DURING THE HEARING AS A
COURSE AS CUSTOMARY AND ANY
INDIVIDUAL WHO IS DISRUPTIVE MAY
BE REMOVED. UH, FROM THE HEARING
ROOM. FOR TODAY'S HEARING. EACH
PANELIST WILL PROVIDE THEIR
TESTIMONY AS LISTED ON THE
AGENDA PRIOR TO TAKING ANY
PUBLIC COMMENT. ONCE WE HAVE
HEARD ALL THE TESTIMONY, WE WILL
HAVE PUBLIC COMMENT PERIOD FOR
THOSE WHO WISH TO PROVIDE
REMARKS ON THE TOPIC OF TODAY'S
AGENDA. IT IS INDEED AN HONOR TO
HAVE THIS JOINT HEARING. UH,
WITH, UH, SENATOR WIENER AS WE
BEGIN TO MAKE SURE THAT WE MAKE
IT CLEAR. I JUST BECAUSE WE HAVE
MADE SOME, UH, HISTORIC, UH,
DECISIONS WHEN IT COMES TO OUR
MENTAL HEALTH SYSTEM. THAT DOES
NOT MEAN IT IS THE END OF THE
DISCUSSION. IT MEANS THAT WE
STILL HAVE WORK TO DO. AND OUR
WORK WILL NOT STOP. UNTIL UM OUR
POPULATION IS STABILIZED AND
THEY ARE RECEIVING QUALITY AND
TIMELY SERVICES THAT MEETS, UH
THEIR INDIVIDUAL NEEDS. UH,
THEREFORE WE WILL CONTINUE TO
MEET WITH STAKEHOLDERS, UH, MEET
WITH THOSE WHO HAVE LIVED
EXPERIENCES SO THAT WE CAN
CONTINUE TO MAKE SURE UH, THAT
WE ARE MAKING, UH, GETTING THE
FEEDBACK NECESSARY ON WHAT'S
HAPPENING ON THE GROUND. BUT
THEY'RE MOST IMPORTANTLY, UH,
THAT WE DO, UH, THAT WE DO
SOMETHING THAT WE DON'T DO
USUALLY AND THAT IS, UH, ONCE WE
HAVE MADE A BIG DECISIONS IN
TERMS OF ANY ISSUE, WE ARE NOT
JUST CHECKING OFF THIS BOX AND
MOVING ON. WE ARE GOING TO MAKE
SURE THAT WE CONTINUE TO CHECK
ON THIS PROGRESS. AND BASED UPON
WHAT HAPPENS ON THE GROUND,
ENSURE THAT WE CONTINUE TO MAKE
THOSE CORRECTIONS AS NECESSARY.
UH, SO AT THIS TIME, I WILL HAND
IT OVER TO, UH, MY COLLEAGUE,
SENATOR WEINER FOR HIS REMARKS.
UH, THANK YOU. UM UH, SOME
MEMBER JACKSON. UM IT'S UH,
GREAT TO BE ABLE TO, UH,
COLLABORATE, UH, BETWEEN OUR TWO
HOUSES BECAUSE MENTAL HEALTH
TREATMENT ACCESS IS, UH, AN
INCREDIBLY HIGH PRIORITY IN THE
SET IN THE ASSEMBLY FOR THE
GOVERNOR, UH, AND FOR THE PEOPLE
OF CALIFORNIA FOR MANY, MANY,
MANY YEARS, UH, MENTAL HEALTH
WAS TREATED AS A SECONDARY. UH,
FRANKLY, AS A PERSONAL, UH,
FAILING, UH, IF WE THINK ABOUT
HOW MANY TIMES IN LIFE WHEN
SOMEONE HAS BEEN SUFFERING FROM
ANXIETY OR DEPRESSION OR TRAUMA,
UH, THE REACTION BY SOCIETY IS
SOMETIMES JUST SNAP OUT OF IT.
UH, JUST BE STRONG. JUST GET A
GRIP, UH AND AS IF IT WERE A
PERSONAL FAILURE, UH, WHEN WE
KNOW THAT A DISEASE OF THE BRAIN
IS NÓ DIFFERENT THAN A DISEASE.
OF OTHER PARTS OF THE BODY. UH
AND WE WOULD NEVER TELL SOMEONE
WITH CANCER OR HEART DISEASE TO
SNAP OUT OF IT. THAT IS
COMPLETELY ILLOGICAL, AND IT'S
ALSO A LOGICAL TO HAVE THAT
REACTION FOR SOMEONE WHO'S
SUFFERING FROM A BEHAVIORAL
HEALTH. PROBLEM. SO WE HAVE BEEN
WORKING VERY HARD FOR YEARS IN
THE LEGISLATURE TO EXPAND ACCESS
TO MENTAL HEALTH TREATMENT. UH,
WE HAVE PAST GROUNDBREAKING LAWS
TO FORCE INSURANCE COMPANIES TO
COVER MORE MENTAL HEALTH AND
ADDICTION TREATMENTS. WE HAVE
EXPANDED RESOURCES, UH, WITHIN
ME AND ELSEWHERE TO MAKE SURE
PEOPLE CAN ACCESS. UH, TREATMENT
. WE HAVE STRENGTH AND
CONSERVATORSHIP LAWS SO THAT
PEOPLE WHO CANNOT MAKE DECISIONS
FOR THEMSELVES. CAN RECEIVE THE
CARE THAT THEY NEED IN ORDER TO
GET THEIR LIVES BACK. UM AND WE
HAVE MADE HUGE INVESTMENTS, UH,
IN EXPANDING THE MENTAL HEALTH
WORKFORCE, A WORKFORCE THAT IS
UH, DOES NOT HAVE ENOUGH
PROFESSIONALS. IN TO BEGIN WITH
A WORKFORCE THAT IS INCREASINGLY
BURNED OUT, UH, DUE TO HEAVY
CASELOADS AND INADEQUATE, UH,
PAY. UH AND SO WE MADE SOME, UH,
I THINK VERY SMART INVESTMENTS A
FEW YEARS AGO TO TRY TO SHORE UP
THE WORKFORCE THAT WE HAVE AND
CREATE MORE PATHWAYS FOR PEOPLE
TO ENTER. UH, THAT, UH,
WORKFORCE AND SO TODAY, UH,
WE'RE GONNA RECEIVE. UH, SOME, I
THINK REALLY INFORMATIVE UPDATES
ABOUT WHERE WE ARE IN TERMS OF
WORKFORCE IN TERMS OF TREATMENT
ACCESS. AND I'M REALLY LOOKING
FORWARD TO THE DISCUSSION. UH
TODAY, UH AND AS WE, UH,
CONTINUE TO PASS STRONG PRO
MENTAL HEALTH TREATMENT, UH, PRO
ADDICTION TREATMENT, UH, PUBLIC
POLICY. THANK YOU. THANK YOU
VERY MUCH. UH, SENATOR, UM,
COLLEAGUES. ARE ANYONE ANY HE
MARKS A Tð THIS TIME. UM OK,
WELL, WE WILL, UM, HEAR FROM
EXPERTS ABOUT TRAINING
SPECIFICALLY PRIMARY CARE
PHYSICIANS AND TRUSTED COMMUNITY
MEMBERS ABOUT EXPANDING
BEHAVIORAL, HEALTH CARE, D¯ÚI
DELIVERY AND CREATIVE APPROACHES
TO RETAINING AND ATTRACTING, UH,
CLINICIANS. AND SO IF THE FIRST
PANEL WILL COME UP AND SENATOR
WEINER, YOU CAN LEAD US OFF. UH,
THANK YOU, UM, SO OUR FIRST
PANEL HAS TO DO WITH PROGRESS
IN, UH, WORKFORCE DEVELOPMENT.
THE MENTAL HEALTH SPACE. UH SO I
WANNA, UM FIRST, UH, WELCOME,
DOCTOR, JANET, UH KAUFMAN, WHO
IS A COO DIRECTOR FOR POLICY
PROGRAMS AT U èC S¼ F INSTITUTE
FOR HEALTH POLICY STUDIES AND CO
DIRECTOR OF THE MASTER OF
SCIENCE AND HEALTH POLICY AND
LAW PROGRAM. UM, AND, UH SO
WE'LL START. THERE AND THEN OUR
I ALSO JUST NOTE THAT, UH, THE
OTHER SPEAKERS IN THIS PANEL YOU
CAN ALL UH, COME UP. UH, IS, UH
UH ROBERT MCCARRON, THE DIRECTOR
OF, UM THE U èC I TRAIN NEW
TRAINERS. PRIMARY CARE
PSYCHIATRY, UH, FELLOWSHIP. UH
AND THEN, UH, MYRA ANGELUS
HERNANDEZ, THE BEHAVIORAL HEALTH
PROGRAMS MANAGER AT VÆ, èC. Y
COMPROMISO, UH SO WE'LL HEAR
FROM OUR SPEAKERS IN THAT ORDER.
THANK YOU.
WELL I THANK YOU VERY MUCH.
SENATOR WEINER, UH, ASSEMBLY
MEMBER, JACKSON AND ALL THE
MEMBERS OF THE COMMITTEE. IT'S A
PLEASURE TO BE WITH YOU, UH,
TODAY AND I SEE YES, WE'VE GOT
THE SLIDES, UH UP, SO REALLY
APPRECIATE BEING WITH YOU. UM
I'M GONNA TRY TO DO TWO THINGS
IN MY TEST AND MY FIRST VERY
QUICKLY. JUST A LITTLE BIT OF,
UH, LEVEL SETTING AND BACKGROUND
AND CONTEXT. THEN I'M GONNA GIVE
YOU SORT OF A FRAMEWORK ABOUT
HOW WE MIGHT THINK ABOUT
BEHAVIORAL HEALTH WORKFORCE
DEVELOPMENT AND THEN CITE A
COUPLE OF UM, BEFORE I TURN IT
OVER TO MY COLLEAGUES WHO I KNOW
ARE GOING TO TALK ABOUT SOME
EXAMPLES OF PROGRAMS IN GREATER
DETAIL. NEXT SLIDE, PLEASE. SO
WHY DOES BEHAVIORAL HEALTH
WORKFORCE MATTERS? WELL, I THINK
SENATOR WEINER AND ASSEMBLY
MEMBER JACKSON HAVE, YOU KNOW
HAVE, UH, INDICATED THAT BUT,
YOU KNOW, JUST TO EMPHASIZE
DEMAND FOR BEHAVIORAL HEALTH
SERVICES GREW, UH, DURING THE 20
TENS AND ACCELERATED DURING THE
COVID-19 PANDEMIC, PARTICULARLY
AMONG YOUNG PEOPLE, AND SO YOU
KNOW, DEMAND IS INCREASING AND,
YOU KNOW CALIFORNIANS HAD. BIG
CHALLENGES IN ACCESSING
BEHAVIORAL HEALTH BEFORE THE
PANDEMIC, AND I THINK IT'S FAIR
TO SAY THAT THOSE CHALLENGES
HAVE BECOME GREATER, AND WE HAVE
MANY CALIFORNIANS WHO HAVE UNMET
NEED FOR BEHAVIORAL HEALTH
SERVICES. WE ALSO HAVE SOME
AREAS OF THE STATE THAT HAVE
SHORTAGES OF BEHAVIORAL HEALTH
PROFESSIONALS, PARTICULARLY THE
INLAND EMPIRE, WHICH ASSEMBLY
MEMBER JACKSON REPRESENTS. AND
THE CENTRAL VALLEY THAT ASSEMBLY
MEMBER ARAMBULA REPRESENTS, AND
WE ALSO KNOW THAT THE RACE,
ETHNICITY AND LANGUAGES SPOKEN
BY HERO HEALTH PROFESSIONALS DO
NOT MATCH CALIFORNIA'S
POPULATION AND LANGUAGE BEING
PARTICULARLY IMPORTANT FOR
BEHAVIORAL HEALTH BECAUSE SO
MUCH OF BEHAVIORAL HEALTH
TREATMENT INVOLVES FORMING
DEVELOPING TRUST. YOUR PROVIDERS
IN BEING ABLE TO SPEAK CANDIDLY
AND OPENLY ABOUT YOUR CHALLENGES
AND TO HAVE A PROVIDER WHO
UNDERSTANDS YOUR LANGUAGE, YOUR
CULTURAL CONTEXT, THE WAY IN
WHICH YOU THINK ABOUT YOUR
MENTAL HEALTH AND SUBSTANCE USE
NEEDS NEXT SLIDE. JUST REALLY
QUICKLY. YOU KNOW WHO
CONSTITUTES THE BEHAVIORAL
HEALTH WORKFORCE? WELL, I THINK
WE OFTEN THINK ABOUT THE FOLKS
IN THE MIDDLE. UH, OVAL HERE,
BEHAVIORAL HEALTH PROFESSIONALS
AND PARAPROFESSIONALS,
PSYCHIATRISTS, PSYCHOLOGISTS,
SOCIAL WORKERS, MARRIAGE AND
FAMILY THERAPIST, PEER
PROVIDERS. THOSE FOLKS ARE
TREMENDOUSLY IMPORTANT. IT'S
ALSO IMPORTANT TO NOTE THAT OUR
PRIMARY CARE CLINICIANS PROVIDE
A LOT OF BEHAVIORAL HEALTH
SERVICES A PARTICULARLY TO THOSE
FOLKS WITH MILD AND MODERATE,
UH, MENTAL ILLNESS, AND THEY'RE
ALSO INCREASINGLY CALLED UPON TO
CARE FOR FOLKS WHO HAVE
SUBSTANCE USE DISORDERS AND THEN
OVER ON THE RIGHT FIRST
RESPONDERS ARE POLICE OR
FIREFIGHTERS OR PARAMEDICS. EM
Tð S¼. THESE ARE THE FOLKS WHO
RESPOND WHEN 911 IS CALLED AND
OFTEN MEET FOLKS WITH BEHAVIORAL
HEALTH NEEDS WHEN THEY ARE IN
CRISIS. AND THEY ARE IN THE MOST
DIRE NEED OF HELP. UM I'M GONNA
SKIP THROUGH IN THE INTEREST OF
TIME SOME SLIDES AND GET TO
NUMBER EIGHT. UH, BEHAVIOURAL
HEALTH WORKFORCE PIPELINE. UM,
AND SO THIS IS JUST A FRAMEWORK
TO THINK ABOUT THE DIFFERENT
LEVELS AT WHICH STATE AND OTHERS
COULD INTERVENE TO ADDRESS OUR
BEHAVIORAL HEALTH WORKFORCE
CHALLENGES AND BEGINNING IN Kò
TO 12 THROUGH UNDERGRADUATE TO
GRADUATE AND POSTGRADUATE
EDUCATION AND INTO PRACTICE, AND
I'M JUST GONNA IN MY TESTIMONY
THE REMAINDER OF MY TESTIMONY
HIGHLIGHT WHAT WE HAVE UP THERE
IN THE NORTHWEST QUADRANT CAREER
EXPLORATION FOR Kò TO 12 AND
THEN, UM, TALK IN THE SOUTHEAST
QUADRANT, ENHANCING THE
KNOWLEDGE AND SKILLS OF PRIMARY
CARE PROVIDERS. IF WE HAD MORE
TIME, I COULD TALK A LOT ABOUT
EVERYTHING ELSE ON THE SLIDE,
BUT I THINK, UM, JUST, UH, THESE
TWO I THINK, UH UH, DIAGONALS,
YOU KNOW, ARE IMPORTANT FOR TWO
ASPECTS. TWO REAL KEY ASPECTS OF
THE CHALLENGE. AND SO FOR A
CAREER EXPLORATION. I WANNA TALK
ABOUT A PROGRAM WE HAVE AT
UNIVERSITY OF CALIFORNIA CALLED
CHANGE S¼. F AND CAREER
EXPLORATION IS IMPORTANT. I
MEAN, THIS IS A TRITE BUT TRUE
SAYING YOU CAN'T BE WHAT YOU
CAN'T SEE. AND MANY OF OUR YOUNG
PEOPLE, PARTICULARLY OUR YOUNG
PEOPLE IN LOW INCOME MINORITIZED
COMMUNITIES DON'T HAVE A LOT OF
EXPERIENCE WITH BEHAVIORAL
HEALTH PROFESSIONALS. NOW THEY
PROBABLY HAVE SOME IDEA WHAT A
WHAT A DOCTOR IS AND WHAT A
NURSE IS. AND IF WE'RE LUCKY
THEY'VE BEEN TO A DENTIST OR A
DENTAL HYGIENIST HERE, BUT THEY
MAY NOT HAVE MUCH EXPOSURE TO
BEHAVIORAL HEALTH PROFESSIONALS
TO KNOW WHAT THEY DO AND TO KNOW
WHY. THAT MIGHT BE A CAREER PATH
OF INTEREST TO THEM. SO THAT'S
WHY THIS CAREER EXPLORATION AND
AS WELL AS MENTORSHIP AND
SUPPORT IS SO IMPORTANT, SO
CHANGES UP IS A PARTNERSHIP WITH
SAN FRANCISCO MAYOR LONDON
BREEDS OPPORTUNITIES FOR ALL
INITIATIVE, WHICH IS REALLY AN
OVERALL INITIATIVE FOR PAID WORK
BASED LEARNING AND MENTORING FOR
YOUNG PEOPLE FROM LOW INCOME AND
MINORITIZED COMMUNITIES IN SAN
FRANCISCO. AND SO THIS PROGRAM,
WHICH IS RUN OUT OF OUR
DEPARTMENT OF PSYCHIATRY AND
BEHAVIORAL HEALTH SERVICES,
PROVIDES PAID WORK BASED
LEARNING AND MENTORING TO YOUTH
AGE 13 TO 24 FROM DIVERSE
BACKGROUNDS. NOW IT'S A SMALL
PROGRAM. ONLY 15 PARTICIPANTS,
UH, TO DATE, BUT THOSE
PARTICIPANTS HAVE REALLY GOTTEN
MULTIPLE, YOU KNOW,
OPPORTUNITIES, UH, TO LEARN
ABOUT MENTAL HEALTH. UM BE
MENTORED BY FACULTY HAVE AN
EXPOSURE TO DIFFERENT, UH,
CAREER PATHS. UH, AND THREE OF
THEM THUS FAR HAVE BEEN HIRED BY
UCSF AFTER COMPLETING THE
PROGRAM. UH AND SO THEY'RE
WORKING IN SAYING CLINICAL
RESEARCH COORDINATOR POSITIONS
WHERE THEY'RE CONTINUING TO BE
EXPOSED TO CRUZ AND BEHAVIORAL
HEALTH AND BE MENTORED BY OUR
FACULTY AND STAFF. SO I THINK
THIS IS THE TYPE OF IDEA THAT
REALLY COULD BE TAKEN TO SCALE
AND THE PAID PIECE. OF COURSE. I
DON'T THINK I NEED TO TELL YOU,
BUT IT'S SO IMPORTANT FOR OUR
YOUNG PEOPLE FROM LOWER INCOME
COMMUNITIES. UM, THEY ARE.
FAMILIES ARE STRUGGLING,
PARTICULARLY IN PLACES LIKE SAN
FRANCISCO. I MEAN, ARE COST OF
LIVING IS HIGH ACROSS THE BOARD
IN IN CALIFORNIA, BUT IT'S
PARTICULARLY HIGH IN SAN
FRANCISCO. THEN THESE FAMILIES
YOU KNOW, FAMILIES HAVE LOWER
INCOME FAMILIES HAVE GREAT
DIFFICULTY ENABLING THEIR YOUNG
PEOPLE TO HAVE UNPAID
EXPERIENCES. THEY NEED TO AT
LEAST OFTEN, CERTAINLY AFTER OUT
OF HIGH SCHOOL SUPPORT
THEMSELVES. UM, SO NOW LET'S
TURN TO THE OTHER END OF THE
SPECTRUM. AND I WANT TO TALK
ABOUT THE UNIVERSITY OF
CALIFORNIA PSYCHIATRIC MENTAL
HEALTH NURSE PRACTITIONER
CERTIFICATE PROGRAM. ANYTHING WE
WANT TO THINK ABOUT. THIS IS A
PROGRAM THAT HELPS TO UPSKILL
AND ENHANCE THE ABILITY OF NURSE
PRACTITIONERS TO CARE FOR
PERSONS WITH MENTAL HEALTH AND
SUBSTANCE USE NEEDS. AND SO THIS
IS A PROGRAM FOR NURSE
PRACTITIONERS, NURSE MIDWIVES
AND OTHER ADVANCED PRACTICE
NURSES. SO PEOPLE WHO'VE ALREADY
HAVE COMPLETED THEIR EDUCATION
SAY TO BECOME A NURSE
PRACTITIONER AND I ALREADY
THEY'RE WORKING. SAY THEY'RE
WORKING IN A FAMILY, A FAMILY
COMMUNITY HEALTH CENTER. MAYBE
THEY'RE WORKING IN A PEDIATRIC
PRACTICE. UH INTERNAL MEDICINE
PRACTICE AND THE IDEA IS THAT
THEY CAN SPEND A YEAR UM
COMPLETING THE EDUCATION TO
BECOME A PSYCHIATRIC MENTAL
HEALTH NURSE PRACTITIONER ON TOP
OF THEIR EXISTING CREDENTIAL.
AND SO THIS IS A PARTNERSHIP
AMONG FALL FOR U èC. NURSING
SCHOOLS. I MEAN, IT'S A LITTLE
UNUSUAL, AND YOU SEE, WE TEND
TO, YOU KNOW, SOMETIMES HAVE OUR
OWN LITTLE FIEFDOMS AND
TERRITORIES. YOU'RE NODDING
BECAUSE THAT IS JUST THE REALITY
OF THE UNIVERSITY. AND SO THIS
IS REMARKABLE PARTNERSHIP AND AN
EXAMPLE OF WHAT I THINK WE HOPE
TO SEE WOULD LIKE TO SEE MORE OF
AND IT'S PREDOMINANTLY ONLINE.
THREE INTENSIVE IN PERSON
SESSIONS SO THAT FOLKS HAVE A
YOU KNOW, CAMARADERIE AND COHORT
WITH ONE YOU KNOW, WITH ONE
ANOTHER AND GET TO KNOW THEIR
FACULTY BETTER, BUT
INTENTIONALLY, MOSTLY ONLINE, SO
IT'S AVAILABLE TO PEOPLE
WHEREVER THEY ARE IN THE STATE.
SO IF YOU'RE UP IN MODOC COUNTY,
OR YOU'RE DOWN IN IMPERIAL
COUNTY, SOMEPLACE THAT'S DISTANT
FROM A U èC NURSING SCHOOL.
THIS IS AVAILABLE TO YOU. UM AND
THE CLINICAL TRAINING IS ACROSS
CALIFORNIA. SO YOU DO YOUR
DIDACTIC IN PERSON ONLINE, AND
THEN ALL YOUR CLINICAL TRAINING
IS ACROSS THE STATE. SO IT'S A
GREAT WAY TO UP SKILL PEOPLE WHO
ARE ALREADY SERVING SOME OF OUR
COMMUNITIES ACROSS THE STATE,
BUT PARTICULARLY OUR UNDERSERVED
COMMUNITIES TO BETTER BE ABLE TO
MEET NEEDS. UM IN CLOSING. YOU
KNOW, I'M A PROFESSOR. SO OF
COURSE I'VE GOT TO TELL YOU WHAT
I THINK SO THESE ARE JUST SOME
RECOMMENDATIONS. UM AND FIRST
OFF. I KNOW THIS IS A REALLY
TOUGH BUDGET YEAR, A VERY
DIFFICULT YEAR TO ASK FOR
ANYTHING, BUT I DO THINK IT'S
IMPORTANT TO NOT DELAY THE
DISTRIBUTION OF THE GENERAL FUND
AND MENTAL HEALTH SERVICES FUND
REVENUE THAT'S ALLOCATED FOR
BEHAVIORAL HEALTH WORKFORCE
DEVELOPMENT. I MEAN, THERE ARE A
LOT OF HARD CHOICES THAT ARE
GOING TO HAVE TO BE MADE, BUT
THEY CONSEQUENCES IN THIS CASE
TO DELAY. I THINK IT'S ALSO
IMPORTANT TO CONTINUE THE
SUPPORT FOR MEDI CAL
REIMBURSEMENT POLICIES THAT
FOSTER INNOVATIVE TEAM BASED
CARE. UM THE STATE ALREADY DID
THAT WITH THE, UM LEGISLATION IN
2020, THAT AUTHOR THAT CREATED
CERTIFICATION FOR PEER PROVIDERS
AND MEDICAL, I MEAN, THAT'S
EXACTLY THE KIND OF THING WE
SHOULD BE DOING AND I THINK WE
SHOULD SUPPORT THE BEHAVIORAL
HEALTH WORKFORCE DEVELOPMENT
PROVISIONS. A PROPOSITION ONE.
NOW I THINK THERE'S YOU KNOW,
UNDERSTANDABLY, DIFFERENCES OF
OPINION. SOME PARTS OF
PROPOSITION ONE. BUT I WOULD
HOPE THAT ALL OF US SEE THE
VALUE IN PUTTING MORE RESOURCES
INTO BEHAVIORAL HEALTH WORKFORCE
BECAUSE WE CAN'T EXPAND SERVICES
FACILITIES FOR PEOPLE WITHOUT
THE WORKFORCE TO CARE FOR THEM.
THANK YOU VERY MUCH. THANK YOU.
I WILL NOW GO TO, UH, ROBERT
MCCARRON. HEY, GOOD MORNING
SELECT COMMITTEE, CHAIRS AND
MEMBERS. THANKS FOR HAVING US
HERE AND THANKS FOR TAKING THE
TIME TO MEET WITH US AND LEARN
WITH US. UH MY NAME IS ROBERT
MCCARRON. I'M A PROFESSOR IN
INTERNAL MEDICINE AND PSYCHIATRY
. SO I TREAT CANCER AND DIABETES
AND STUFF LIKE THAT, BUT ALSO
PSYCHIATRIC CONDITIONS LIKE
DEPRESSION AND ANXIETY.
ASSOCIATE DEAN IN THE MEDICAL
EDUCATION AT U èC I AND THE
DIRECTOR OF EDUCATION FOR THE
SUSAN SAMUEL INTEGRATIVE HEALTH
INSTITUTE. BUT HERE TO TALK TO
YOU IS DIRECTOR OF THE TRAIN NEW
TRAINERS. PRIMARY CARE
PSYCHIATRY FELLOWSHIP. I'M GONNA
START WITH THE PROBLEM, THOUGH.
IF THAT'S OK WITH YOU, UM ONE
OUT OF THREE OF US IN THIS ROOM.
WILL SUFFER FROM A SUBSTANCE USE
DISORDER CRIPPLING ALCOHOLISM,
FOR EXAMPLE. METH DEPENDENCY.
ONE OUT OF FIVE. CURRENTLY HAVE
A PSYCHIATRIC DISORDER AND IN
OUR LIFETIME HALF OF US WILL
STRUGGLE WITH THE PSYCHIATRIC
DISORDER. HOT OFF THE PRESS FROM
THE JOURNAL OF AMERICAN MEDICAL
ASSOCIATION, MATERNAL MENTAL
HEALTH. IS THE LEADING CAUSE.
THE LEADING CAUSE FOR PREGNANCY
RELATED DEATH IN THIS COUNTRY.
IT'S NOT GOOD. ONE OUT OF THREE
ADOLESCENTS REPORT SERIOUS
PSYCHOLOGICAL DISTRESS. AND
AMONG THIS GROUP IT'S A SECOND
LEAD. SUICIDE IS THE SECOND
LEADING CAUSE OF DEATH OPIOIDS.
THE NUMBER ONE CAUSE OF
ACCIDENTAL DEATHS AMONG GROWN
UPS IN THIS COUNTRY AND
DEPRESSION. AMONG THE NUMBER ONE
TOP DISABILITY, UH, COST FOR
DISABILITY WORLDWIDE, INCLUDING
THE STATE OF CALIFORNIA WHEN I'M
ON CALL IN THE EMERGENCY ROOM
THERE ARE PATIENTS WHO ARE
WAITING NOT NECESSARILY DAYS.
BUT IN TERMS OF A WEEK OR MORE,
AND THAT INCLUDES KIDS, SIX YEAR
OLD KIDS, EIGHT YEAR OLD KIDS,
NOT A GOOD THING FROM AN
OUTPATIENT PERSPECTIVE.
REFERRALS TAKE A LONG TIME, NOT
WEEKS. NOT WEEKS MONTHS, SEVERAL
MONTHS, ACTUALLY, AND PEOPLE ARE
SUFFERING AND AT RISK DURING
THAT TIME. SO HERE'S THE THING I
WANNA CONVEY TO YOU 70% OR, IN
SOME CASES, MORE. 70% OF OUR
WORKFORCE. OUR BEHAVIORAL HEALTH
CARE WORKFORCE IS NOT DELIVERED
BY PSYCHOLOGISTS OR SOCIAL
WORKERS OR EVEN FOLKS LIKE ME
PSYCHIATRISTS. DELIVERED BY
PRIMARY CARE PROVIDERS AND
EMERGENCY MEDICINE DOCS. AND
HERE'S THE PROBLEM WITH THAT.
MANY OF THEM DIDN'T GET THE
TRAINING. SO AS AN INTERNIST
WITH THREE YEARS IN RESIDENCY,
ZERO MINUTES ARE REQUIRED. ZERO
MINUTES ARE REQUIRED. OR
CLINICAL TRAINING AND
PSYCHIATRY. FOR P S¼ IN THE
STATE OF CALIFORNIA, TWO WEEKS
REQUIRED NOW WHEN WE GET OUT AND
GO AND PRACTICE 40 TO 50% OF OUR
DAY. IS WORKING WITH PATIENTS
WHO STRUGGLE STRUGGLE AND SUFFER
WITH ANXIETY, DEPRESSION,
SUBSTANCE USE DISORDERS. WE NEED
TO HELP THIS WORKFORCE BECAUSE
IN FACT THIS IS THE WORKFORCE.
UH, AS DOCTOR KAUFMAN ALLUDED
TO. THERE ARE MANY PEOPLE IN
DISCIPLINES INCLUDED IN THE
WORKFORCE. THE PRIMARY CARE
PROVIDERS, UH, ARE AT THE TOP OF
THAT LIST. SO IF WE CAN GO TO
THE NEXT SLIDE, PLEASE, UH U èC
IRVINE IS, I WOULD SAY ON THE
CUTTING EDGE OF INNOVATION AND
CREATING UNIQUE FELLOWSHIPS, UH,
THAT PROVIDE THIS TRAINING
NATIONWIDE. WE HELP THEM DO A
BETTER JOB OF WHAT THEY'RE
ALREADY DOING. WE'RE NOT
TEACHING THEM TO DO OTHER STUFF.
EVERY DAY. THEY'RE DOING THIS.
THEY'RE HELPING FOLKS WHO ARE
STRUGGLING WITH BEHAVIORAL
ISSUES. WE'RE HELPING THEM. DO
IT BETTER AND AS AN A BONUS, WE
TRAIN THEM. ON HOW TO TRAIN
OTHER PEOPLE IN THEIR CLINIC OR
THEIR REGION. SO WE'RE NOT JUST
SAYING, HEY, THIS IS GOOD STUFF.
LET'S LEARN IT. UH, WE'RE GOING
A LITTLE BIT FURTHER WITH THAT
NEXT SLIDE, PLEASE. SO WE HAVE
THREE DIFFERENT PROGRA MMES THAT
WE'VE RUN FOR SEVERAL YEARS. THE
PRIMARY CARE PSYCHIATRY
FELLOWSHIP, ALSO OUR CHILD,
ADOLESCENT OR PEDIATRIC
PSYCHIATRY, FELLOWSHIP AND OUR
NEWEST PRIMARY CARE, TRAINING
AND EDUCATION IN ADDICTION,
MEDICINE, OR P èC TEAM. NEXT
SLIDE, PLEASE. SO IN A NUTSHELL.
WHAT WE DO IS WE PROVIDE
TARGETED TRAINING. DURING NON
CLINIC HOURS. SO THESE FOLKS ARE
STILL WORKING AND SEEING
PATIENTS IN THE PRIMARY IN THE
BUSY PRIMARY CARE SETTING. WE'RE
TELLING THEM ABOUT COMMON
PSYCHIATRIC ISSUES WITH THE
FOCUS ON THREE THINGS. ONE IS
PREVENTION. IS HOW DO YOU
DIAGNOSE IT QUICKLY AND THREE IS
HOW DO YOU TREAT IT? HOW DO YOU
PARTNER WITH YOUR PATIENT TO
TREAT IT AND THESE ARE THE
THINGS WE FOCUS ON. WE HAVE
PUBLISHED OUTCOMES IN PEER
REVIEWED HIGH IMPACT MEDICAL
JOURNALS SHOWING THE FOLLOWING
NUMBER ONE EVIDENCE OF INCREASED
SIGNIFICANT INCREASES IN
KNOWLEDGE AND OVERALL, UH,
SUBJECT MATTER AFTER THEY
GRADUATE FROM THE PROGRAM NUMBER
TWO IS INCREASING SELF EFFICACY.
60% OF ER DOCS ARE BURNED OUT.
AS OF 2 2020 THREE DATA. WE SEE
THE SAME WITH EMERGENCY
MEDICINE, INTERNAL MEDICINE,
FAMILY MEDICINE, ETCETERA. SO
WE'RE ABLE TO SHOW THESE
FINDINGS. I'M ALSO HAPPY TO SAY
THAT WE'VE PARTNERED WITH INLAND
EMPIRE HEALTH PLAN TO LOOK AT
DATA SHOWING THAT OUR GRADUATES
ARE MORE LIKELY TO DIAGNOSE
EARLY DEPRESSION. AND TREAT WITH
THE ANTIDEPRESSANTS RELATIVE TO
THOSE WHO DIDN'T GO THROUGH OUR
PROGRAM IN MORENO VALLEY IN
INLAND EMPIRE. WE ALSO SHOW THAT
, UH, OUR GRADUATES ARE
PRESCRIBING MUCH LESS OPIOIDS
FOR TREATMENT OF CHRONIC PAIN
RELATIVE TO THOSE WHO DIDN'T GO
THROUGH OUR PROGRAM. COUPLE OF
THINGS JUST TO POINT OUT. OUR
FACULTY ARE UNIQUE IN THAT THEY
ARE PSYCHIATRISTS. ALSO ER DOCS
OR FAMILY, MEDICINE, DOCTORS OR
INTERNAL MEDICINE DOCTORS.
PEDIATRICIANS, RIGHT AND THE
THING THAT'S REALLY NEAT ABOUT
THIS AND THAT I WANNA CONVEY TO
YOU IS THAT WE DON'T STOP AFTER
ONE YEAR WE PROVIDE AT NÓ COST.
ONGOING CAREER LONG TRAINING. WE
KNOW THAT LEARNING SHOULDN'T
STOP. WE HAVE 1200 ALUMNI, AND
THEY CONTINUE TO LEARN WITH US,
HOPEFULLY FOR THE REST OF THEIR
CAREER XL, PLEASE. THIS IS AN
OVERVIEW ON HOW WE'VE BEEN
GROWING. WE WANT TO CONTINUE TO
GROW. UH HÌ Kò PROVIDED US
FUNDING IN IN 2021. AND WE'VE
USED MUCH OF THAT FUNDING
ALREADY. WHICH IS A GOOD THING
WE'VE TRAINED SO MANY CLINICIANS
, UM AND THERE'S MANY MORE THAT
WE WANNA CONTINUE TO TRAIN. SO
THESE ARE JUST SOME TOPICS THAT
WE COVER. I WANNA POINT A FEW
OUT PROVIDER WELLNESS. PROVIDER
WELLNESS. WE NEED TO MAKE SURE
THAT WE'RE TAKING CARE OF OUR
OWN. RIGHT. A LOT OF A LOT OF
OUR CLINICIANS ARE STRUGGLING.
THEY REALLY ARE. UH, IN THE
CHILD, ADOLESCENT PSYCHIATRY
REALM WE COVER. UH, A LOT OF
TOPICS. UH, SUBSTANCE USE
DISORDERS. ADOLESCENT BEHAVIORAL
, HEALTH, FAMILY FOCUSED CARE.
AND THEN, OF COURSE, WE COVER A
VERY COMPREHENSIVE OVERVIEW WHEN
IT COMES TO ADDICTION MEDICINE.
WE'VE BEEN LUCKY TO PARTNER WITH
THE STATE. THIS HAS BEEN
REPLICATED. KENTUCKY IS DOING
THIS. WE'RE WORKING WITH
TENNESSEE, UNITED ARAB EMIRATES
AND MANY OTHER MUNICIPALITIES.
WE PARTNER WITH MANY, UM HEALTH
PLANS LIKE L A CARE LIKE KAISER
LIKE ATLANTA, PART HEALTH PLAN
AND MANY, MANY OTHERS. WE'D LIKE
TO KEEP THIS GOING. WE'D LIKE TO
GROW. WE'D LIKE TO CONTINUE TO
TRAIN NEW TRAINERS IN THIS AREA.
I'LL END WITH THIS. 86% OF OUR
LEARNERS OF OUR ALUMNI COME FROM
DESIGNATED UNDERSERVED AREAS,
NOT JUST IN CALIFORNIA. BUT
NATIONWIDE. THIS IS A REPLICABLE
MODEL THAT COMES FROM US FROM
THE STATE OF CALIFORNIA. THANK
YOU SO MUCH. THANK YOU VERY MUCH
. UH NEXT, UH, I'D LIKE TO, UH,
WELCOME MYA. UM ANGELA
HERNANDEZ. THERE YOU GO. UM HØI.
THANK YOU FOR HAVING ME TODAY.
UM, MY NAME IS MAYA ANGELES. I
UM, A BEHAVIORAL HEALTH PROGRAM
MANAGER AT THE UN COMPROMISO.
I'M ALSO AMERICAN FAMILY
THERAPIST AND A DOCTOR IN
MARRIAGE AND FAMILY THERAPY
THERAPY. UM BUT I PRE PRIMARILY
WORK WITH VISION PROMIS, WHICH
IS AN ORGANIZATION THAT SUPPORTS
, UM, PROMO TORES, OR AS OTHER
PEOPLE MIGHT KNOW IT, UH,
COMMUNITY HEALTH WORKERS. UM AND
SO I RELATE TO A LOT OF WHAT
THEY YOU KNOW WHAT THEY'VE BEEN
SHARING AS A CLINICIAN. I
UNDERSTAND THE BURNOUT AND THE
FRUSTRATION WITH UM, BEING ABLE
TO PROVIDE SERVICES TO THE
COMMUNITY. UM HOWEVER WE WORK.
UM ORGANIZATION WORKS A VERY
UNIQUE UM. VERY UNIQUE WITH THE
PROMO TORE, UM, AS THEY ARE
COMMUNITY MEMBERS, AND THEY WORK
MORE AS LIKE LIAISONS AND
ADVOCATES FOR THE COMMUNITY. SO
ESSENTIALLY, UM, MY ROLE OR A
LOT OF US IN VÆ èC IS TO TRAIN
UH, THESE PROMO TOES TO BE ABLE
TO SUPPORT THE COMMUNITY. WHILE
THERE'S THAT, UM THE BRIDGE AND
WHERE THEY'RE ATTEMPTING TO GET
SERVICES. AND IT'S JUST TAKING,
UM A WHILE TO GET TO THAT POINT,
SO WE PROVIDE, UM, ANY TYPE OF
EDUCATION, MENTAL HEALTH? UM
ADDICTION WELL BEING TO BE ABLE
TO, UM ONE OF THE ONE OF THE, UH
THINGS FROM TO DO IS THEY ARE
NOW PROVIDING SUPPORT GROUPS AND
MEN MENTAL HEALTH, SO THEY'LL GO
TO THE COMMUNITY, UM, AND
PRIMARILY IN SPANISH. THEY'LL
PROVIDE ANY TYPE OF EDUCATION.
UM, WHETHER IT'S LIKE PARENTING
GROUPS. UM SOME TOPICS ARE LIKE
A ADDICTION ANXIETY, ANY TYPE OF
MENTAL HEALTH THAT THE COMMUNITY
IS NEEDING AT THE MOMENT. UM WE
TRAIN THEM, UH, WE SUPERVISE
THEM, AND, UM THEY WORK AS THAT
BRIDGE WHILE THEY GET THE
SERVICES. UM AND SO THERE'S JUST
BEEN A LOT OF LACK AT THE MOMENT
WITH LIKE FUNDING TO PROVIDE
GRANTS TO BE ABLE TO CONTINUE
TO, UM, PROVIDE THAT EDUCATION
TO THE PROMO TORRES, UM AND THEN
. AND HAVE A POWERPOINT SO I'M
KIND OF GOING BY THE ONE I HAVE
RIGHT NOW. UM SO THE PROMOTOR
WERE ESSENTIALLY WHAT THEY DO
IS, UM IT'S A PROMO COMMUNITY
AND THEN THE HEALTHCARE SO THEY
I KNOW THAT PERSON IN THE MIDDLE
WHO THEY GO TO THE COMMUNITY.
THEY LET US KNOW WHAT THE
COMMUNITY IS NEEDING. COME BACK
TO US, AND WE TRY TO PROVIDE ANY
TYPE OF SUPPORT. THEY CAN
CONTINUE TO DO THESE, UM,
SUPPORT GROUPS OR OTHER
ACTIVITIES TO SUPPORT THE
COMMUNITY. UM, ONE OF THE THINGS
THAT WE ARE SEEING IS THE, UM
JUST A FEW OF THE COMMITTEES
HAVING AT THE MOMENT WITH, UM,
BEING ABLE TO ACCEPT SERVICES. A
LOT OF THEM ARE, UM HISPANIC, SO
BEING ABLE TO UNDERSTAND THAT
MENTAL OR NORMALIZING MENTAL
HEALTH HAS BEEN A CHALLENGE
LATELY. UM SO WE DO WORK A LOT
WITH THE PROMO TORRES TO
DECREASE THE STIGMA OR HELP THEM
. UH UM, TEACH THE COMMUNITY TO
DECREASE THAT MENTAL HEALTH
STIGMA THAT THEY MIGHT HAVE, UM,
SO THAT'S SOME OF THE TRAINING
WE DO ALONG WITH, UM. UH, ALONG
WITH, UH WE ALSO HAVE A FEW
DEPARTMENTS. SO WE HAVE A
PROMOTER INSTITUTE WHERE WE'LL
TEACH HIM, UM HOW TO BE A
PROMOTER OR WORKFORCE TRAINING
FOR PROMO TOES, UM, TECHNICAL
ASSISTANCE SO THEY CAN
UNDERSTAND HOW TO BE ABLE TO GO
TO THE COMMUNITY. UM AND THEN WE
RECENTLY ADDED A LOT A LOT OF
LIKE MENTAL HEALTH AWARENESS.
MENTAL HEALTH TRAINING. UM AND
NOT JUST MENTAL HEALTH. ALSO
HEALTH ANY LIKE HEALTH. UM
ISSUES THAT THE COMMUNITY, UM,
STRUGGLING WITH SO WE, WE'RE
REALLY FOCUSING ON BEING ABLE TO
TRAIN THESE INDIVIDUALS, UM, SO
THEY CAN BE THAT LIKE YEAH.
BRIDGE. UM WHEN THEY'RE LACKING
WHEN THE COMMUNITY IS LACKING
SERVICES, UH OR SUPPORT TO BE
ABLE TO, UM, GET THOSE SERVICES
AND THEN A LOT OF ADVOCACY IS
WHAT WE'VE BEEN WORKING ON WITH
THE ROMO TORRES. UM SO WE DO, UM
, MANAGE A LOT OF PROJECTS, UM,
TO SUPPORT THEM, UM, BUT THAT'S
ESSENTIALLY WHAT VIC COMPROMISO
DOES IS WE GO TO UNDERPRIVILEGED
COMMUNITIES, UM. A LOT OF WE
TARGET A LOT OF HISPANIC OR
LATINO COMMUNITIES. BUT THERE'S
JUST OVERALL WHOMEVER IS OPEN
TO, UM, BE ABLE TO HEAR WHAT WE
OFFER. UH, WE TRAIN THESE PROMO
TOES OR, UH, COMMUNITY HEALTH
WORKERS, UM. SO THEY CAN GO AND
PROVIDE THAT INFORMATION TO THE
COMMUNITY. AND THEN WE, THEY
COME BACK, AND, UM WE SUPERVISE
THEM AS WELL. UM, SO THAT'S JUST
A LITTLE OF WHAT WE'RE DOING AT
THE MOMENT. THE TRAININGS THAT
WE'VE BEEN PROVIDING THEM WITH,
BUT MENTAL HEALTH HAS BEEN ONE
OF THE BIGGEST. I WANNA SAY IN
2023 WORKING WITH VISION THAT
BIGGEST CHALLENGES THAT WE'VE
SEEN WITH THE COMMUNITY, NOT
JUST WITH LIKE STIGMA, BUT ALSO
JUST BEING ABLE TO GET THE FUNDS
TO YOU KNOW, SERVE THE COMMITTEE
. UM, BUT THAT'S THAT'S KIND OF
WHAT HAPPENED. THANK YOU. THANK
YOU VERY MUCH. COLLEAGUES ARE
THERE ANY, UH, QUESTIONS? UH UM
SOME OF THEM ARE ABOUT KHAN. UM
THANK YOU. I WANNA THANK BOTH
CHAIRS FOR SETTING THIS UP, AND
FOR ALL OF YOU FOR BEING HERE,
IT'S OBVIOUSLY CRITICALLY
IMPORTANT, UM, CONVERSATION AS
THE STATISTICS THAT WERE CITED.
UM INDICATE AND OBVIOUSLY JUST
WHAT WE SEE EVERY DAY. UM SO I
FIRST OF ALL I WANNA START WITH
THE PRIMUS. I KNEW ABOUT THEM IN
THE SEXUAL REPRODUCTIVE HEALTH
SPACE, BUT IT'S SO CRITICAL TO
HAVE TRUSTED COMMUNITY MEMBERS
IN ALL HEALTHCARE SPACES. SO I
JUST WANT TO THANK YOU FOR THAT,
BECAUSE I THINK IT'S REALLY
BRILLIANT THAT YOU'RE DOING THAT
AND SHARING AND SPREADING THAT
KNOWLEDGE. UM I WANTED TO START
WITH SOME OF THIS WORK AROUND
PRIMARY CARE PHYSICIANS REALLY
AS OUR GATEWAY INTO, UM
BEHAVIORAL HEALTH SERVICES. SO
YOU KNOW, I HAVE THREE CHILDREN
AND AT MY POST NATAL
APPOINTMENT. FIRST THING THEY
DID WAS SCREENED ME. FOR, UM
BEHAVIORAL HEALTH CONCERNS AFTER
HAVING A BABY NOW IT NEVER
HAPPENED ONCE WHILE I WAS
PREGNANT, SO I THOUGHT YOUR
STATISTIC AROUND THE IMPACT OF
PREGNANT WOMEN PRENATALLY. THE
FACT THAT WE'RE NOT DOING THOSE
SCREENINGS IS REALLY FASCINATING
BECAUSE IT WAS PRETTY
STRAIGHTFORWARD, RIGHT? IT WAS A
SURVEY THAT WAS DONE. THEY COULD
IDENTIFY IF I HAD, UM, THE NEED
FOR CARE AND GAVE ME THAT CAR
MOVED ON, BUT I WANTED TO ASK
ABOUT THAT. ARE WE TRAINING IN
OTHER SPACES, RIGHT? I THINK IN
THE PEDIATRIC SPACE WE DO THOSE
SCREENINGS PERIODICALLY, BUT
WHEN I GO TO MY PRIMARY CARE
PHYSICIAN I'VE NEVER BEEN GIVEN
A SCREENING. SO I JUST WANTED TO
ASK ABOUT THAT. WELL, THERE
SHOULD BE SCREENING AND THERE
MIGHT BE TWO REASONS FOR NOT
GETTING SCREENING. THE FIRST IS
KNOWLEDGE. EXPERTISE IN THAT
SPECIFIC AREA, AND TWO IS TIME
YOU KNOW, IN CERTAIN PARTS OF
THE STATE. PRIMARY CARE
CLINICIANS GET ABOUT 7.5 TO 10
MINUTES PER PATIENT. WHEN YOU'RE
TRYING TO DEAL WITH DIABETES.
AND PAIN, ARTHRITIS AND
DEPRESSION. ALL A Tð THE SA ME
TIME. THERE'S JUST NOT ENOUGH
TIME. AND SO THOSE ARE TWO
THINGS I CAN THINK OF U S¼
PREVENTIVE SERVICES TASK FORCE
IS VERY CLEAR THAT THIS
SCREENING SHOULD BE DONE AND TO
GO FURTHER CARE SHOULD BE GIVEN.
IF THE SCREENING IS POSITIVE.
THAT'S A THIRD BARRIER. A THIRD
BARRIER IS RIGHT. YOU YOU'RE
WAITING 34 MONTHS SOMETIMES TO
SEE A PSYCHIATRIST. IF YOU DO
SCREEN POSITIVE, SO THOSE I
WOULD SAY WOULD BE THE THREE
BARRIERS. WE'RE WORKING ON THE
FIRST, WHICH IS HOW DO WE
PROVIDE EXPERTISE? BUILD
KNOWLEDGE IN THIS AREA? AND YOU
CITED WORKING WITH A BUNCH OF
HEALTH CARE SYSTEMS. UM, ARE YOU
WORKING WITH OUR FEDERAL
QUALIFIED HEALTH? CENTERS OR
SMALLER ONES. I KNOW THAT MINE
IN MY COMMUNITY IS TRYING TO
INTEGRATE BEHAVIORAL HEALTH INTO
THEIR PRIMARY CARE MODEL, BUT I
THINK THAT'S A REALLY IMPORTANT
PLACE TO GET FOLKS THAT ARE
UNDERSERVED ABOUT 50% OF OUR
LEARNERS COME FROM FQ, HÌ èC S¼
OR LOOK ALIKES AND THAT'S WITHIN
AND OUTSIDE CALIFORNIA. OK
THAT'S AWESOME. UM, AND I ALSO
WANTED TO, UM, DOCTOR KAUFMAN
MENTIONED OUR VERY DIFFICULT
BUDGET. UH, THIS YEAR, I THINK
THAT I WANNA TOUCH ON THE COST
SAVINGS THAT GOES ALONG WITH
ENSURING THAT WE TREAT PEOPLE
PREVENTATIVELY RATHER THAN
LETTING THEM GET INTO CRISIS
BECAUSE, AS YOU MENTIONED, THEY
END UP IN R ER S¼ THEY END UP
HOSPITALIZED AND IT IS MUCH MORE
DIFFICULT I CAN IMAGINE TO TREAT
FOLKS AT THAT POINT, UM, IN THE
BEHAVIORAL HEALTH SPECTRUM, AND
SO I THINK THESE PREVENTATIVE
SERVICES COULD REALLY BE A COST
SAVINGS TO US RATHER THAN A COST
IN THE LONG RUN. DID YOU WANNA
TOUCH ON THAT? UM, YES, I THINK
THAT IS AND AN EXCELLENT POINT
THAT WE KNOW THAT EARLY UH,
SCREENING, YOU KNOW, AND
DETECTION AND TREATMENT OF ANY
MENTAL ILLNESS CERTAINLY
IMPROVES THE QUALITY OF LIFE AND
WELL BEING, UH, OF THAT PERSON
AND OFTEN BY EXTENSION, UH,
THEIR FAMILY AND CERTAINLY WITH
SEVERE YOU KNOW, WITH WITH, UM,
LET'S SAY DEPRESSION, ANXIETY.
GETTING PROMPT TREATMENT CAN
ENABLE SOMEBODY TO STAY IN THE
WORKFORCE AND BE PRODUCTIVE. UM
WITH WITH SCHIZOPHRENIA, OTHER
MENTAL ILLNESSES. THOSE ARE
OBVIOUSLY MORE CHALLENGING, BUT
AGAIN, EARLY TREATMENT. CAN
REALLY MAKE A DIFFERENCE.
CERTAINLY FROM SOMEBODY THE
LIKELIHOOD THAT SOMEONE, UH,
WILL END UP HOMELESS AND
CERTAINLY WITH ADDICTION, YOU
KNOW IF WE CAN IDEALLY PREVENT
TO START WITH, BUT IF NOT, UH,
TREAT, UM, WHERE AND WHEN? MORE
AND MORE MEDICATION ASSISTED
THERAPIES ARE AVAILABLE THAT YES
. I THINK IN THE LONG RUN, IT
DEFINITELY DOES MAKE A
DIFFERENCE TO INVEST IN THE
WORKFORCE SO THAT PEOPLE WHO
HAVE MENTAL HEALTH NEEDS HAVE
PROMPT ACCESS TO TREATMENT.
WELL, THANK YOU ALL. I THINK
THIS REALLY IMPORTANT AND I
REALLY APPRECIATE THIS FOCUS ON
OUR PRIMARY CARE PHYSICIANS. UM
I SHARE THE SELECT COMMITTEE
REPRODUCTIVE HEALTH AND WE JUST
HAD A HEARING ON MENOPAUSE, AND
ONE OF THE THINGS THAT WE WERE
LEARNING ABOUT IS THAT MANY OF
THE WOMEN WHO GO INTO MENOPAUSE
THAT HAVE MENTAL HEALTH NEEDS
ARE TREATED WITH THE WRONG KIND
OF TREATMENT. BECAUSE AT THAT
POINT IN YOUR JOURNEY, YOU NEED
DIFFERENT KINDS OF TREATMENT.
AND SO THE MORE PEOPLE
UNDERSTAND AROUND BEHAVIORAL
HEALTH AT DIFFERENT POINTS IN
THE PATIENT'S LIFE, I THINK THE
BETTER OFF THE SHE WILL BE, AND
I THINK THE TRAINING YOU'RE
GIVING IS SO CRITICAL TO GET
MORE PEOPLE THE CARE THEY NEED,
BECAUSE, UM, JUST RECENTLY I WAS
TALKING TO ONE OF MY SCHOOL
DISTRICTS THAT CITED A
STAGGERING NUMBER OF 5150 PER
WEEK COMING OUT OF THE SCHOOL
DISTRICTS. AND SO AS YOU SAID,
IT'S RIGHT NOW IT'S A
FIREFIGHTERS WHO I KNOW WE'RE
GONNA HEAR FROM. IT'S OUR SCHOOL
PROFESSIONALS WHO ARE AT THE
FRONT LINE OF THIS AND WE REALLY
NEED TO BE GETTING OUR HEALTH
CARE PROFESSIONALS IN THE GAME
IN A MORE MEANINGFUL WAY. SO
THANK YOU. THANK YOU SOMETHING.
REMEMBER RALA. AND THEN AS SOME
OF THEM EUR I THANK YOU, MR
CHAIR. I'M I'M GOING TO BEGIN
WITH THE IMPORTANCE OF MAKING
SURE THAT WE HAVE A DIVERSIFIED
WORKFORCE AND EXPANDING ACCESS
TO MANY BEYOND THE MEDICAL
DOCTORS. THE Dð S¼ TO INCLUDE
OUR NURSE PRACTITIONERS, OUR
PHYSICIANS, ASSISTANTS, OUR
COMMUNITY HEALTH WORKERS, AND
YES, OUR TORO MAAS. AND SO I
WANTED TO FOLLOW UP M KAUFMAN ON
A COMMENT YOU MADE THAT JUST
RESONATES SO MUCH WITH ME. YOU
CAN'T BE WHAT YOU CAN'T SEE.
HAVING A GRANDFATHER ZACHARIAS,
WHO NEVER LEARNED TO READ. IT'S
HARD FOR SO MANY OF US TO
ENVISION OURSELVES AS THE FUTURE
PROVIDERS OF TOMORROW. AND SO WE
HAVE TO FIGURE OUT HOW TO BREAK
DOWN SOME OF THOSE BARRIERS AND
THERE ARE CONSEQUENCES TOWARDS
THE DECISIONS WE MAKE WITHIN
THIS BUDGET THAT DON'T ALLOW US
TO CONTINUE TO DIVERSIFY OUR
WORKFORCE AND TO ADDRESS OUR
LANGUAGE AND CULTURAL
COMPETENCIES THAT WE NEED WITHIN
THE PROVIDERS OF TOMORROW. AND
SO I WAS DRAWN TOWARDS YOUR
POINT THAT LATINX ARE
UNDERREPRESENTED IN ALL LICENSED
BEHAVIORAL HEALTH PROFESSIONS.
ALL IS A POWERFUL WORD AND SHOWS
A REAL NEED FOR US TO MAKE SURE
THAT WE'RE CONTINUING TO MAKE
THOSE INVESTMENTS THAT I WANTED
TO FIGURE OUT IF OUR BEHAVIORAL
HEALTH WORKFORCE PIPELINE IS
TIED INTO OUR HEALTH PROFESSION
PATHWAY PROGRAM. A RE WE ABLE TO
WITH A NEW PRO THAT HÌ Kò IS
ESTABLISHING, ENSURING THAT
WE'RE OPENING UP THOSE AVENUES
FOR PIPELINES FOR THOSE WITHIN
THE BEHAVIORAL HEALTH WORKFORCE
AS MY FIRST QUESTION AND THEN
FOR DOCTOR MCCARRON, IF I COULD.
I WANTED TO FOLLOW UP AS IT
SEEMED THAT YOU SAID YOU HAD
FUNDING FROM HK THAT WAS ONE
TIME IN NATURE. WHEN DOES THAT
FUNDING EXPIRE? AND DO YOU
BELIEVE THAT WE'RE DONE NEEDING
TO TRAIN NEW TRAINERS, OR IS
THERE A NEED FOR CONTINUED
FUNDING FROM US TO MAKE SURE
THAT WE'RE, UM, PROVIDING THAT
INFORMATION? UH SO THANK YOU,
SENATOR ABLA. UM MY
UNDERSTANDING IS THAT THE
PATHWAYS PROGRAMS ARE INTENDED
TO EXPOSE YOUNG PEOPLE TO A WIDE
RANGE OF CAREERS. UM I, I WANNA
BE CAREFUL ON THE SPEC. YOU
KNOW, IF SOMEONE FROM HÌ Kò IS
HERE, I THINK THEY'LL HAVE MORE
MORE DETAILS, BUT I THINK, UH,
THAT IS THE GOAL. AND CERTAINLY
I THINK THAT'S THAT'S VERY
IMPORTANT. UH THAT, UM THOSE
PATHWAY PROGRAMS EXPOSE YOUNG
PEOPLE TO BEHAVIORAL HEALTH
CAREERS, UH, AMONG OTHERS,
BECAUSE THAT IT IS, I THINK FOR
WHOLE HEALTH SO IMPORTANT, AND I
MEAN WE HAVE FANTASTIC. YOU KNOW
, THE DOCTORS ACADEMY IN YOUR
AREA FANTASTIC PROGRAM FOR
PREPARING PEOPLE TO BE
PHYSICIANS, INCLUDING
PSYCHIATRISTS. UM, WE NEED EVEN
MORE OF THAT TYPE OF PROGRAM. UH
TO ENCOURAGE OUR YOUNG PEOPLE
FROM OUR LOW INCOME LATINX BLACK
AND I SHOULD SAY SOUTHEAST ASIA
ASIAN COMMUNITIES AS WELL.
BEHAVIORAL HEALTH. I WANNA
REALLY RESONATE THERE THAT IN
SOME HEALTH CARE HEALTH
PROFESSIONS. UM, WE HAVE LARGE
NUMBERS OF FOLKS FROM VARIOUS,
UH, ASIAN ETHNIC GROUPS. BUT
WHEN WE LOOK AT BEHAVIORAL
HEALTH PARTICULARLY WHEN WE LOOK
AT, SAY, OUR MASTER'S LEVEL
CLINICIANS AND OUR SUBSTANCE USE
WHAT MEAN MEANING SOCIAL WORKERS
, MARRIAGE AND FAMILY THERAPIST
AND WE LOOK AT SUBSTANCE USE
PROVIDERS. WE REALLY DON'T HAVE
THE SAME REPRESENTATION YET. WE
KNOW FROM LOOKING AT THE DATA
THAT MANY FOLKS FROM MANY AS
MANY PEOPLE FROM A FROM ASIAN
PACIFIC ISLANDER BACKGROUNDS,
YOU KNOW, STRUGGLE AND SUFFER
WITH SUBSTANCE USE AND MENTAL
ILLNESS, JUST LIKE OTHER ETHNIC
GROUPS. AND SO WE REALLY NEED A
WORKFORCE IN BEHAVIORAL HEALTH
THAT FULLY REFLECTS THE
POPULATION. RAMBLA. THANKS FOR
YOUR QUESTION. UM WELL, JUST TO
BE CANDID. MY CONCERN IS NOT
RECEIVING THE FUNDS THAT WERE
ALLOCATED TO US A YEAR AND A
HALF AGO. SO THAT'S THE CONCERN
WITH THE BUDGET ISSUES. UM AND
SO THIS WAS TIMELY. I WHEN I
WHEN I WAS INVITED TO COME HERE,
I, I DIDN'T REALIZE THAT MEANT
THAT YOU KNOW THAT THAT'S AN
ISSUE AND THAT THE DEFICIT IS
INCREASED, SEEMINGLY OVER THE
LAST, UH, MONTH OR SO, UM, OUR
FUNDING. IT'S A FIVE YEAR SO
IT'S FIVE YEAR FUNDING. BUT AS I
MENTIONED EARLIER, WE'VE BEEN SO
SUCCESSFUL IN TRAINING SO MANY
PEOPLE, UH, THAT YEAR WE RUN OUT
OF OUR FUNDING FOR TO TRAIN
FOLKS IN IN OUR IN OUR CHILD
ADOLESCENT PSYCHIATRY, PEDIATRIC
PSYCHIATRY PROGRAM. THE ANSWER
TO YOUR OTHER QUESTION. UH AND
I'M BIASED. I'LL SAY BUT MOST
DEFINITELY, UH, I SEE THIS AS A
10 TO 12 YEAR PLAN TO TRAIN UP.
UH AND IN ADDITION OFF OFF OFF
OFF OF THE ANY FUNDING THAT I'M
RECEIVING, I'M WORKING CLOSELY
WITH A èC GME, THE NATIONAL
ORGANIZATION THAT OVERSEES
RESIDENTS AND FELLOWSHIPS TO TRY
AND CHANGE AT A NATIONAL LEVEL.
THE RESIDENCY TRAINING SO YOU
MAY NOT NEED Tð N Tð IN 10
YEARS RIGHT? AND SO THE TRAINING
WILL TAKE PLACE DURING FAMILY
MEDICINE OR RESIDENCY, INTERNAL
MEDICINE, RESIDENCY. PEDIATRIC
RESIDENCY, ETCETERA. THANK YOU.
AND I WOULD JUST ELEVATE THAT
WE'RE IN A CRISIS RIGHT NOW.
THAT REQUIRES US TO CONTINUE TO
MAKE THOSE INVESTMENTS AND IT'S
ONLY GOTTEN WORSE OVER THE LAST
COUPLE OF YEARS. AND SO THE
ORIGINAL LEGISLATIVE INTENT WAS
FOR US TO MAKE SURE THAT THOSE
PROFESSION PATHWAY PROGRAMS WERE
DIVERSIFYING AND IS EXPANSIVE AS
WE COULD, AS WELL AS THAT THIS
FUNDING WOULD EVENTUALLY GO
TOWARDS TRAINING THOSE NEW
TRAINERS AND WE HAVE SUCH A NEED
FOR IT THAT I BELIEVE WE SHOULD
CONTINUE TO MAKE SURE THOSE
DOLLARS. THANK YOU. THANK YOU,
MR CHAIR. THANK YOU. AND THANK
YOU SO MUCH FOR YOUR TESTIMONY
AND BEING HERE TODAY. UM I, UH
YES, WE'RE IN A MENTAL HEALTH
CRISIS AND WE NEED MORE EXPERTS
LIKE LIKE YOU HAVING YOUR VOICES
HEARD, UM, FROM PERSONAL
EXPERIENCE WITH MY FAMILY. I'VE
BEEN THROUGH THIS MENTAL HEALTH
JOURNEY AND IT'S COMPLICATED TO
NAVIGATE. UH EVEN WHEN YOU HAVE
CONNECTIONS, AND YOU KNOW, FOLKS
, AND SO, I, I UNDERSTAND
THERE'S A HUGE WORKFORCE, UH,
NEED AND FACILITY NEED HERE IN
THE STATE OF CALIFORNIA. DO WE
HAVE NUMBERS ON THAT ON ON WHAT?
OUR TARGETS ARE AND WHAT OUR
NEEDS ARE. UM I THANK YOU.
ASSEMBLY MEMBER. LET ME FOLLOW
UP WITH YOU ON SPECIFICS, BUT I,
UH WE'VE CERTAINLY DONE WORK ON
THAT AND PROVIDE IT. BUT I THINK
WE'RE WE'RE TALKING, YOU KNOW,
LOOKING OVER THE NEXT, YOU KNOW,
DECADE I WANNA SAY YOU KNOW
SOMETHING AROUND THE
NEIGHBORHOOD OF 4000 MORE, UH,
PSYCHIATRIST. I WANNA SAY 15 TO
20,000 MORE. UH, MÀ, YOU KNOW
THE, UH SOCIAL WORKERS MENTAL,
UH, SOCIAL WORKERS, MARRIAGE AND
FAMILY THERAPIST. UM YOU KNOW,
AND HÌ Kò Ó IS DOING SOME WORK
TO COME UP WITH UPDATED
ESTIMATES AND PROJECTIONS. FOR
THAT, AND I SHOULD SAY, I THINK
IT IS IMPORTANT. AND I THINK
MAYBE YOU AGREE IMPORTANT AS
TRAIN THE TRAINER AND ALL OF
THIS WORK TO ENHANCE THE ABILITY
OF OUR PRIMARY CARE PROVIDERS
TO, UM, CARE FOR THOSE WITH
BEHAVIORAL HEALTH NEEDS. WE ALSO
NEED TO INVEST IN TRAINING
PSYCHIATRISTS SO THAT THEY CAN
BE THE TRAINERS AND SO THAT THEY
CAN BE AVAILABLE TO COACH
PRIMARY CARE PROVIDERS AND ALSO
TO REALLY CARE FOR THOSE FOLKS
WITH SCHIZOPHRENIA AND OTHER
REALLY COMPLEX DISORDERS THAT
REALLY REQUIRE A LEVEL KNOWLEDGE
AND SKILL. AND UM, YOU KNOW,
WE'VE DONE GREAT WORK IN
CALIFORNIA OVER THE LAST DECADE
OR SO IN INCREASING OUR FUNDING
FOR PRIMARY CARE, RESIDENCY
PROGRAMS WE HAVEN'T DONE AS GOOD
A JOB IN FUNDING FOR PSYCHIATRY
PROGRAMS AND AGAIN. YES THIS IS
A TOUGH BUDGET YEAR TO MAKE
INVESTMENTS. BUT AGAIN IF WE
REALLY WANT TO, UM SOLVE THIS
BEHAVIORAL HEALTH WORKFORCE
CRISIS AND IMPROVE ACCESS. WE
NEED TO BE THINKING OF INVESTING
IN PSYCHIATRY JUST AS MUCH AS WE
ABSOLUTELY POSITIVELY NEED TO BE
THINKING ABOUT INVESTING IN
TRAINING, COMMUNITY HEALTH
WORKERS AND PEER PROVIDERS
BECAUSE IT IT YOU KNOW, IT TAKES
A VILLAGE. TO CARE FOR ALL OF US
WITH BEHAVIORAL HEALTH NEEDS. I
THINK MY BEST GUESS IS IN MY
LIFETIME. WE WON'T COME CLOSE.
AND THAT'S THE REALITY. IT'S
JUST A MATTER OF NUMBERS, BUT IT
IT GOES BEYOND WHAT'S HAPPENING
IN CALIFORNIA. IT'S A NATIONAL
ISSUE AND FUNDING FOR RESIDENTS
AND FELLOWS IS JUST DIFFICULT
FOR SO MANY REASONS. UM, SO I
THINK IT'S IMPORTANT TO TRAIN UP
THE WORKFORCE THAT'S DOING THIS
STUFF NOW AS BEST WE CAN, AND,
UH AND DO A BETTER JOB OF THAT,
ACTUALLY, SO, UM, BUT THANK YOU
FOR YOUR QUESTION. I. I
UNDERSTAND AND THEN AND THEN I
THINK IT'S SO IMPORTANT WHEN
SOMEBODY DOES COME INTO A
FACILITY FOR SOMETHING ELSE THAT
MIGHT BE PHYSICAL HEALTH RELATED
TO ALSO DO THAT IMPORTANT
SCREENING ON BEHAVIORAL HEALTH.
I HAVE A BILL A 492 THAT WOULD
DO THAT WITH ANYBODY GOING IN
AND SEEKING REPRODUCTIVE HEALTH
SERVICES. THEY WOULD ALSO BE
SCREENED FOR BEHAVIORAL HEALTH
AND THEN REFERRED OUT FOR THAT
KIND OF TREATMENT IF NEEDED. AND
UM I MEAN, IT'S JUST SO
CRITICALLY IMPORTANT. WE DO
EVERYTHING POSSIBLE. I KNOW THAT
, UM IF I WERE DIAGNOSED WITH
CANCER, I WOULD UM, IMMEDIATELY
BE ABLE TO GET INTO A DOCTOR
IMMEDIATELY GET TREATMENT. UH,
MY INSURANCE COVERS EVERYTHING.
UM BUT WHEN I HAVE A MENTAL
HEALTH CRISIS, THAT'S NOT THE
CASE AND I HAVE TO STRUGGLE AND
TRY TO FIND SOMEBODY TO SEE ME
OR SEE MY FAMILY. AND AS YOU
SAID, IT'S MONTHS OUT SOMETIME
AND THEN YOU PRIVATE PAY AND
THEN HAVE TO SEEK REIMBURSEMENT
ON THAT. SO YOU KNOW JUST I HOPE
IN MY LIFETIME. WE GET SOME
PARITY HERE BETWEEN PHYSICAL AND
MENTAL HEALTH CARE AND ANY IDEAS
ON HOW WE CAN IMPROVE THAT.
WELL, WE HAVE THE FEDERAL LAW
AND THE STATE LAW. I THINK IT'S
ALL ABOUT ENFORCING THAT RIGHT.
AND SO I THINK, UH, SOCIAL
WORKERS, PSYCHOLOGISTS,
PSYCHIATRISTS, ALL CLINICIANS
SHOULD BE ENCOURAGING THEIR
PATIENTS TO UH, TALK TO THEIR
LEGISLATORS AND, YOU KNOW, REACH
OUT TO THE RIGHT PEOPLE AND SAY,
LISTEN, HERE'S WHAT'S HAPPENING
TO ME. AND UH, I THINK IT'S ALL
ABOUT ENFORCEMENT RIGHT NOW TO
TRY AND MAKE SURE WE CAN DO THE
BEST TO ENFORCE THESE LAWS. AND
I THINK IF I'D HAD, YES
ENFORCEMENT AND ALSO YOU KNOW
WORKFORCE, UH, DEVELOPMENT UH,
AS WELL SO THAT WE HAVE ENOUGH
FOLKS AND PARTICULARLY, I THINK
ONE OF THE CHALLENGES IN
BEHAVIORAL HEALTH COMPARED TO
SAY, PRIMARY CARE, AS WE DO HAVE
A NUMBER OF PROVIDERS THAT ARE
IN PRIVATE PAY. THAT MAY NOT
ACCEPT, YOU KNOW, LET ALONE
COMMERCIAL INSURANCE, LET ALONE
UH MEDI CAL AND I. I DON'T KNOW
THAT I HAVE A GOOD ANSWER. I
MEAN, SOME OF IT IS IN IS
ENFORCEMENT. SOME OF IT IS
REIMBURSEMENT. IT'S A COMPLEX
PROBLEM, BUT IT MAKE IT. I THINK
THAT MUCH MORE CHALLENGING IN
BEHAVIORAL HEALTH RELATIVE TO
SAY PRIMARY CARE OR CANCER CARE.
COLLEAGUES. ANY OTHER QUESTIONS.
YEAH, SENATOR PAI. THANK YOU, MR
CHAIR AND BEING A GOOD CHAIR. UM
I KNOW YOU'RE MOVING THE AGENDA
ALONG INSTEAD OF SPEAKING SO
MUCH YOURSELF YOURSELF, BUT I
WANTED TO GIVE THE CHAIR. UM A
PLUG FOR, UM, HOLDING A PRIOR
HEARING. UH, THAT I PARTICIPATED
IN, UM YOU KNOW, TALKING ABOUT
THIS VERY ISSUE OF
REIMBURSEMENT. UM, UTILIZATION
REVIEW HIS UM, VERY IMPORTANT
LEGISLATION, I THINK WAS S¼ B
885 A COUPLE OF YEARS 855 A
COUPLE OF YEARS AGO. UM WE HAVE
INTRODUCED ADDITIONAL
LEGISLATION AGAIN THIS YEAR. S¼
B 999. UM. THE TWO THINGS I'D
I'D LIKE TO HEAR A MORE SPECIFIC
REACTION ON IS YOU KNOW WHAT
YOUR EXPERIENCES WITH
UTILIZATION REVIEW DENIALS. UM
WHAT YOU SEE WITH THAT IF YOU'RE
SEEING, UH, THE SAME TYPES OF
THINGS WITH CERTAIN UM UM, WITH
CERTAIN REIMBURSEMENT. UM
CARRIERS AND PROVIDERS THAT, UM,
SEEM TO BE KIND OF OFF THE
CHARTS IN TERMS OF A PERCENTAGE
OF DENIALS OR SHORT TERM.
REDUCTIONS IN CARE BASED ON
TERMINATION OF INSURANCE
COVERAGE. AND THE SECOND THING
IS, I'LL JUST KIND OF ASK YOU A
COMPOUND QUESTION. IT'S A IT'S A
LITTLE BIT OF A SLIGHTLY
DIFFERENT SUBJECT IN TERMS OF
MOBILIZING PEOPLE. I VERY MUCH
APPRECIATE WHAT YOU JUST SAID,
HAVING SPENT AN AWFUL LOT OF
TIME. UM IN THE FIELD, UM, AS A
COUNTY SUPERVISOR PRIOR TO THIS
AS A BIG CITY, UM, VICE MAYOR.
WORKING WITH PEOPLE IN RECOVERY.
WE. WE ON THE ONE HAND, YOU
KNOW, ENCOURAGE THEM TO BE ALI.
UM, EVEN THROUGH OUR 12 STEP
PROGRAMS THROUGH THROUGH THOSE
WHEREVER THOSE PROGRAMS ARE ON
THE OUTSIDE IN PRISON EVERYWHERE
ELSE, UH, TO BE ANONYMOUS. UH,
AND YOU KNOW, IN EFFECT NOT TO
COME FORWARD AND TO PROTECT THE
ANONYMITY OF THEIR THEIR PEERS
WHO WHO ARE IN THESE SITUATIONS.
UM HOW DO YOU HOW DO YOU SEE US
MOBILIZING? YOU KNOW, AFTER
DECADES OF TRADITION YOU KNOW, I
THINK IT'S NOT I. I WILL SAY I.
I DON'T THINK IT'S I THINK IT'S
BEYOND STIGMA. I THINK WE'VE
ACTUALLY SORT OF TAUGHT THIS AS
AS A WAY TO ENCOURAGE PEOPLE TO
SEEK HELP. LOOK IT'LL BE
ANONYMOUS. OBVIOUSLY IN THE
HEALTH CARE SIDE, WE HAVE HIPAA
AND IN OTHER WAYS OF DOING THAT,
BUT IT SEEMS VERY DIFFICULT. II.
I BELIEVE IF THAT WASN'T THE
CASE. YOU KNOW, THIS CHAMBERS
WOULD BE FULL OF PEOPLE WHO YOU
KNOW ARE, UM YOU KNOW, IN
RECOVERY OR SEEKING RECOVERY,
YOU KNOW, TELLING THEIR STORIES
BECAUSE THAT'S THAT'S WHAT
PEOPLE IN RECOVERY DO. THEY TELL
THEIR STORIES, BUT WE'RE WE'RE
NOT SEEING THAT WE DON'T SEE
THAT THIS YEAR. WE DON'T SEE IT
AT A PRIOR HEARINGS. UM ANY ANY
COMMENT ON EITHER OF THOSE
THINGS? THANK YOU, MR CHAIR.
WELL, I'LL JUST MENTION I JUST
REALLY BRIEFLY, I WE ARE
EXPERIENCING ON A ON A REGULAR
ROUTINE BASIS DENIALS. AND IT
AFFECTS OUR PATIENTS. I'LL JUST
GIVE YOU ONE EXAMPLE. THIS IS A
VERY NICE WOMAN WHO I'VE SEEN
FOR YEARS SUFFERING FROM
PROFOUND DEPRESSION, CRIPPLING
DEPRESSION, AND IT TOOK US A
YEAR AND A HALF. TO GET. UM A
PROCEDURE CALLED Tð M S¼ TRAINS.
CRANIAL MAGNETIC STIMULATION
PROVED A YEAR AND A HALF. DURING
THAT TIME SHE ATTEMPTED SUICIDE
TWICE. UM AND THIS IS PERVASIVE.
THAT'S JUST ONE EXAMPLE. I WILL
SAY THAT THE CHANGES THE BOLD
STEPS THAT THE STATE HAS TAKEN
THAT ALL OF YOU HAVE TAKEN TO
MOVE THE HISTORIC MENTAL HEALTH
CHANGES. HAS CHANGED. THE WAY WE
SEE MENTAL HEALTH IN THE STATE
OF CALIFORNIA. I BELIEVE AND I
ALSO BELIEVE THAT IT'S CHANGED
THE WAY CLINICIANS SEE MENTAL
HEALTH. SO ALL GOOD AND I THINK
THOSE LEGISLATIVE AND FUNDING
CHANGES. UH I'LL I'LL BE A
DIFFICULT NOW, PARTICULARLY WITH
THE BUDGET, I THINK ARE
IMPORTANT AND RESULT IN A
DIFFERENT VIEWPOINT. UH, FOR HOW
WE SEE BEHAVIORAL HEALTH. OK, UM
UH, I SHOULD NOT EVERYONE HAS TO
RESPOND. WE'RE GONNA NEED TO
MOVE ON. SO IF THERE'S ANYTHING
EARNING ANSWER FEEL FREE. BUT
NOT EVERYONE HAS TO RESPOND TO
EVERY QUESTION. OR ANYTHING. OR.
RIGHT UM, YES. GO AHEAD. I
ACTUALLY WANNA, UM, GIVE MY
PERSPECTIVE AS A CLINICIAN. IF
THAT'S OK, SO PRIOR TO WORKING
WITH VION FOR LIKE A DECADE, I
WORKED IN REHABILITATION CENTERS
. SO I HAVE A LOT OF EXPERIENCE
WITH, UM, JUST INSURANCE AND ALL
THAT, AND TO JUST KIND OF AS A
CLINICIAN. UM ONE OF THE THINGS
I SAW WAS JUST A CONSTANT, UM
LACK OF MOTIVATION. THERE WAS
WHEN INSURANCE WOULD CUT
PATIENTS OFF THAT REALLY NEEDED
THAT SUPPORT. AND JUST AS YOU
KNOW, COLLEAGUES STATED, LIKE
THERE WAS SO MANY TIMES WHERE I
HAD CLIENTS WHO, FORTUNATELY, UM
, WHETHER IT WAS OVERDOSE OR ANY
TYPE OF SUICIDE IT IT JUST
HAPPENED FOR THE YOU KNOW,
CLIENTS WERE JUST CUT OFF FROM
ONE DAY TO ANOTHER. UM, AND AS A
CLINICIAN THAT THAT ALSO WHICH
IS ONE OF THE REASONS WHY I
DECIDED TO LEAVE THE POPULATION
BECAUSE IT WAS VERY, UM,
FRUSTRATING TO NOT BE ABLE TO
REALLY DO SOMETHING TO GIVE THE
SUPPORT FOR THOSE PEOPLE THAT
REALLY, REALLY NEEDED IT AND
WANTED IT. UM BUT THAT'S JUST MY
PERSPECTIVE AS A CLINICIAN, UM
AND I IT WAS JUST A PATTERN. I
WORKED ON MANY REHABS, AND IT
WAS ALWAYS YOU KNOW, PRETTY MUCH
THE SAME, BUT IT'S JUST MY
PERSPECTIVE OF THE RIGHT? UM,
UH, SOME OF THEM, WALDRON. YES.
THANK YOU, UM. I APPRECIATE
THAT. WE'RE HAVING THIS HEARING
IN THE FIRST PLACE. IT'S VERY
IMPORTANT, ESPECIALLY HERE IN
CALIFORNIA. UM I WAS WONDERING
YOUR THOUGHTS ON WHEN WE LOOK AT
BEHAVIORAL HEALTH TREATMENT
OPTIONS. WHAT'S OFFERED OR
WHAT'S COVERED. IT REALLY
DEPENDS ON WHAT COUNTY YOU LIVE
IN. UM YOU KNOW, JUST THE WAY
THAT WE FUND THINGS JUST THE WAY
THROUGH THE COUNTY SYSTEMS AND
EVERYTHING L, A COUNTY CAN OFFER
PATIENTS VERY DIFFERENT SERVICES
OR OPTIONS THAN, SAY, LAEN
COUNTY OR MODA COUNTY. UM I
REPRESENT A DISTRICT IN SOUTHERN
CALIFORNIA. THAT'S VERY RURAL.
WE HAVE 18 TRIBAL GOVERNMENTS,
UM, ACCESS TO MENTAL OR
BEHAVIORAL HEALTH. IS DEFICIENT,
OBVIOUSLY, UM. HOW COME AND JUST
YOUR THOUGHTS ON HOW CAN WE DEAL
WITH THIS DISPARITY BETWEEN WHAT
COUNTY YOU LIVE IN? UH WHAT
OPTIONS OR COVERAGE IS AVAILABLE
? HOW WE CAN GET MORE, UH,
ACCESSIBILITY IN THE RURAL
AREAS. AND DO YOU THINK PROP ONE
. UM HOW CAN THAT ADDRESS SINCE
WE'RE TAKING THE FUNDING BACK?
IT. WILL WE BE ABLE TO MAYBE
DEAL WITH THAT ISSUE? I N SOME
REGARDS. JUST YOUR THOUGHTS ON
THAT. OK, WELL. YOU KNOW, FOR
ILL OR FOR GOOD IN CALIFORNIA.
WE SORT OF HAVE THIS PATTERN OF
DEVOLVING RESPONSIBILITIES TO
COUNTIES. AND GIVING COUNTIES A
LATITUDE. THIS IS NOT JUST
BEHAVIORAL HEALTH. UM SO, I. I
THINK THAT THE MOTIVATION BEHIND
THE PROVISIONS OF PROP ONE OF
HAVING SOME MORE MONEY AT THE
STATE LEVEL IS GOOD, AND
HOPEFULLY THAT WILL RESULT IN
SOME MORE STANDARDIZATION, UH
ACROSS, UH, COUNTIES. UM BUT I
THINK THAT'S A THAT'S A POOL IN
JUST ACROSS THE BOARD IN
CALIFORNIA. THAT'S SOMETHING WE
NEED TO GRAPPLE WITH IS HOW MUCH
WHETHER IT AND IT DOESN'T IT'S
NOT, YOU KNOW WHETHER IT'S
MEDICAL ENROLLMENT, WHETHER IT'S
CORRECTIONS, HOW MUCH DO WE WANT
TO DEVOLVE US OR OUR COUNTIES
WHO ARE VERY DIFFERENT FROM ONE
ANOTHER VERSUS AT AT A STATE
LEVEL? UM, AND I THINK THE, UH
I'M JUST REALITY IN RURAL AREAS
AS WE FACE A WORK, YOU KNOW A
DEFICIT IN WORKFORCE. UM AND
MANY OF OUR FOLKS IN COMMUNITIES
LIKE YOURS ARE EITHER UNINSURED
OR DEPENDENT ON ME AND THAT, YOU
KNOW, CONFIRMS AND MAKES IT THAT
MUCH HARDER. MEET THEIR NEEDS.
GREAT. UM. GREAT. WELL THANK YOU
SO MUCH. WE REALLY APPRECIATE
IT. AND WE WILL NOW MOVE TO OUR,
UH SECOND PANEL. UH, REGARDING,
UH, COMMUNITY ENGAGEMENT WE'VE
NOW HEARD FROM EXPERTS ON, UH
PROGRESS AND THE CHALLENGES
AROUND THE BEHAVIORAL HEALTH
WORKFORCE. UH, SO NOW WE WANNA
TALK ABOUT CURRENT PROGRAMS AND
PILOT PROGRAMS THAT ARE IN
PROGRESS AROUND THE STATE THE
VARIOUS WAYS THAT THEY CAN
CONTRIBUTE TO ADDRESSING THE
MENTAL HEALTH CRISIS. UH, THESE,
UH NEXT, PANELISTS HAVE A STRONG
COMMITMENT TO HEALTH CARE
JUSTICE AND CAN SPEAK MORE ABOUT
HOW COLLABORATING AND PEER TO
PEER SUPPORT CAN BE
TRANSFORMATIONAL IN SERVING
COMMUNITIES. UH, SO, UH, WE HAVE
THREE SPEAKERS, UH BRET FELDMAN,
DIRECTOR AND CO FOUNDER OF U, S¼
èC, UH, STREET MEDICINE. UM,
UH, DAVE, UH, G A LOT. UH, THE
CO CHAIR OF THE FIREFIGHTER,
BEHAVIOURAL HEALTH TASK FORCE.
UH, èC PF, CALIFORNIA
PROFESSIONAL FIREFIGHTERS
SEVENTH DISTRICT VICE PRESIDENT
AND PRESIDENT OF THE, UH OF L, A
COUNTY FIREFIGHTERS LOCAL 1014.
I'M SORRY IF I MISPRONOUNCED
YOUR NAME GOT A GOOD, UM,
SENSITIVE SINCE MY NA ME GETS
MISPRONOUNCED ALL THE TIME. UH
AND FINALLY, DOCTOR, UH, VIVAL,
UM BON VÀ. DID I PRONOUNCE THAT
CORRECTLY? PA. YEAH, THAT'S
PERFECT. OK GREAT. GOT IT SECOND
TIME, UH, A PHYSICIAN WITH
ADVANTAGE, HEALTH CARE SERVICES.
UM SO WHY DON'T WE GO AND THAT
ORDER THAT I LISTED? YOU WILL
START. UH, WITH UH, BRET
FELDMAN. GREAT HØI. MY NAME IS
BRAD FELDMAN. AND THANK YOU,
SENATOR WEINER AND THE COMMITTEE
FOR ALLOWING ME TO COME AND TALK
TO YOU TODAY ABOUT WHAT'S GOING
WELL IN THE WORLD OF BEHAVIOR,
HEALTH CARE AND CARE FOR OUR
NEIGHBORS EXPERIENCING
UNSHELTERED HOMELESSNESS. WHAT'S
GOING WELL AS STREET MEDICINE,
WHICH IS DEFINED AS THE DIRECT
DELIVERY OF HEALTH CARE TO
PEOPLE WHO ARE UNSHELTERED,
WHICH IS 75% OF OUR HOMELESS
POPULATION IN THEIR LIVED
ENVIRONMENT. I'VE BEEN
PRACTICING STREET MEDICINE SINCE
2007 AND NOW SERVE AS THE
DIRECTOR FOR STREET MEDICINE AT
U S¼ èC. WE PROVIDE ABOUT
10,000 OFFICE VISITS A YEAR
EXCEPT OUR OFFICES ARE UNDER THE
BRIDGES. UH, WE ALSO HOST THE
CALIFORNIA STREET MEDICINE
COLLABORATIVE, WHICH IS OUR
STATEWIDE ORGANIZATION WE HAVE
ABOUT 100 AND 30 ORGANIZATIONAL
MEMBERS AND HAVE A PRETTY
EXTENSIVE WORKFORCE DEVELOPMENT
AND EDUCATION ARM, WHICH TRAINS
AND EQUIPS OTHERS ACROSS THE
STATE. UH AND REALLY ACROSS THE
COUNTRY TO DO THIS WORK. BUT THE
REASON WHY I'M HERE TODAY AND
THE REASON WHY STREET MEDICINE
NEEDS TO EXIST IS BECAUSE PEOPLE
EXPERIENCING UNSHELTERED
HOMELESSNESS CAN'T ACCESS HEALTH
CARE THE WAY THE REST OF US DO.
AND SO YOU START WITH EXTREME
POVERTY PLUS SOCIAL ISOLATION.
THEN YOU ADD SEVERE AND
UNTREATED PHYSICAL DISABILITIES,
SUBSTANCE USE DISORDERS AND
MENTAL ILLNESS AND THEN YOU TOP
IT OFF WITH A WITH A HEALTH CARE
SYSTEM THAT WAS NEVER DESIGNED
TO SERVE THEM IN THE FIRST
PLACE. IN CALIFORNIA. WE'VE DONE
A GREAT JOB OF MAKING SURE FOLKS
ARE INSURED BETWEEN 60 80% OF
THE PEOPLE WERE INSURED, BUT
ONLY 7% ARE ACTUALLY ABLE TO
ACCESS THEIR P èC P AND ONLY 3%
ARE ACTUALLY ABLE TO BE SEEN BY
BEHAVIORAL HEALTH CARE. AND SO
IN RESPONSE AND RECOGNITION OF
THEIR SACRED HUMANITY, WE GO TO
THE PEOPLE FIRST TO DELIVER AN
UNDERSTANDING, LOVE AND THEN THE
SAME QUALITY OF CARE ON THE
STREET THAT YOU'D EXPECT IN A
BRICK AND MORTAR CLINIC. OUR
TEAMS ARE MADE UP OF DOCTORS. P
A S¼, NURSE PRACTITIONERS,
NURSES, SOCIAL WORKERS AND MANY
OTHERS, BUT THE BACKBONE OF THE
TEAMS ARE A COMMUNITY HEALTH
WORKERS, THE PEOPLE WITH LIVED
EXPERTISE IN HOMELESSNESS WHO
ACT AS OUR STREET GUIDES AND
MAKE SURE THAT WE DON'T LOSE
ANYBODY. BUT WE ALSO KNOW THAT
HEALTH CARE IS MORE THAN AN
OFFICE VISIT. EVEN IF THAT
OFFICE IS LITERALLY ON THE
STREET, SO WE DISPENSE
MEDICATIONS. DRAW LABS DO
ULTRASOUND E Kò G S¼ ALL IN THE
PATIENTS LIVED ENVIRONMENT. AND
THIS APPROACH IS DISTINCTLY
DIFFERENT FROM MOBILE MEDICINE.
OR R, VÆ MEDICINE WHERE YOU PARK
THE R VÆ. PEOPLE LEAVE THEIR
ENCAMPMENT EVEN IF THEY'RE
WORRIED ABOUT EVERYTHING BEING
STOLEN TO GO TO THE R VÆ.
INSTEAD WE GO TO THE PEOPLE WITH
, UH, PICKUP TRUCKS AND
BACKPACKS AND DELIVER CARE IN
THEIR ENVIRONMENT WHERE THEY
FEEL MOST COMFORTABLE. AND AT U
S¼ èC. WE'VE HAD VERY GOOD
RESULTS DOING IT THIS WAY. FOR
EXAMPLE, WE'VE SHOWN WE CAN
DECREASE HOSPITALIZATION BY 70.
BUT AS IT RESULTS RES, UH,
RELATES DIRECTLY TO BEHAVIORAL
HEALTH. BECAUSE THAT'S THE
CHARGE OF THIS COMMITTEE. THERE
ARE THREE CONTINUUM WHERE WE, UH
, SERVE AS THAT. THAT KEYSTONE
THAT STABILIZING UM, PEACE
WITHIN THE CONTINUUM. THE FIRST
ONE IS JUST ACCESS TO BEHAVIOR.
HEALTH CARE, UM, WHICH YOU
ALREADY HEARD A LOT ABOUT. AND
SO LAST YEAR WE PUBLISHED THE
CALIFORNIA STREET MEDICINE
LANDSCAPE ANALYSIS, WHICH SHOWED
70 TO 80% OF OUR PROGRAMS ARE
DIAGNOSING AND TREATING. MENTAL
HEALTH CONDITIONS. WE'VE HAD TO
TRAIN OURSELVES UP TO PRACTICE
AT THE VERY TOP OF OUR SCOPE OF
PRACTICE AS PRIMARY CARE. AND
THE REASON IS BECAUSE IN THAT
SAME REPORT IF YOU ADD UP THE
TOTAL NUMBER OF STREET
PSYCHIATRISTS IN THE STATE, YOU
GET FIVE F Tð E S¼. BUT WE'VE
ACTUALLY HAD GOOD RESULTS IN
DOING IT THIS WAY. FOR EXAMPLE,
WE PREFER TO USE LONG ACTING
INJECTABLE ANTIPSYCHOTICS. I
GIVE ONE INJECTION THAT LASTS
FOR A MONTH. IT'S NEVER LOST OR
STOLEN OR TRADED OR DEGRADED BY
THE ELEMENTS. IT'S JUST IN
THERE. AND SO USING THAT
TREATMENT, FOR EXAMPLE, I
REMEMBER GIVING BULLET HIS FIRST
INJECTION BEHIND, UH UH, CARL'S
JUNIOR FOR HIS SCHIZOPHRENIA,
AND IN A FEW MONTHS I LOOK
FORWARD TO WATCHING HIM GRADUATE
AS A DRUG AND ALCOHOL COUNSELOR
TO GO BACK TO THE COMMUNITY TO
SERVE. I REMEMBER GIVING JOSE
HIS FIRST INJECTION, ALSO FOR
SCHIZOPHRENIA OUTSIDE OF HIS
BROKEN DOWN COROLLA, WHERE HE
LIVED WITH HIS FAMILY AND TWO
LITTLE GIRLS. UM, AND AFTER THE
TREATMENT, HE WAS ABLE TO
ORGANIZE HIMSELF ENOUGH TO
COMPLETE HOUSING PAPERWORK. UM,
REGISTER HIS GIRLS FOR SCHOOL.
AND ONE OF THE HAPPIEST DAYS, UM
, WAS SEEING LI LITTLE AMELIA,
WHO AT THE AGE OF NINE WENT TO
SCHOOL FOR THE FIRST TIME. I
REMEMBER HER, LEAVING HER HER
COROLLA GOING TO SCHOOL, AND SHE
WAS SO PROUD OF HERSELF, BUT I
THINK EVEN MORE PROUD OF HER
DADDY. UM THE SECOND, UM, AREA
WHERE WE SERVE AS THAT
CORNERSTONE IS IN HOUSING SINCE
2018 AT U S¼ èC WE'VE HOUSE
BETWEEN 30 40% OF EVERYBODY WE
SEE AND THE REASON IS BECAUSE
MEDICINE IS SEEN AS AN
INSTRUMENT OF PEACE WHERE WE CAN
BUILD THESE TRUSTING
RELATIONSHIPS QUICKLY START
TREATMENT IMMEDIATELY AND THEN
REFER TO HOUSING AND WHILE
THEY'RE WAITING FIVE MONTHS, SIX
MONTHS A YEAR FOR HOUSING, WE
CONTINUE TO FOLLOW THEM SO THAT
WHEN HOUSING DOES COME THROUGH
NUMBER ONE, WE KNOW WHERE THEY
ARE. WE HAVEN'T LOST THEM AND
NUMBER TWO. THEIR PHYSICAL
HEALTH IS IMPROVED. PSYCHIATRIC
CONDITIONS ARE IMPROVED. THEY'RE
USING LESS DRUGS AND HOUSING IS
MORE LIKELY TO BE SUCCESSFUL.
AND THEN FINALLY AS OUR ROLE IN
CRISIS PREVENTION AND POST
CRISIS MANAGEMENT. VERSUS
PREVENTION, BECAUSE IF THEY'RE
BEING TREATED FOR PSYCHOSIS WITH
ANTIPSYCHOTICS IF THEY'RE USING
LESS DRUGS OR LESS LIKELY TO
HAVE A CRISIS IF THEY DO HAVE A
CRISIS WHEN CRISIS COMES, IF
THEY DECIDE NOT TO TRANSPORT WE
COME ON SITE AND TAKE OVER CARE.
IF THEY DO, TAKE HIM TO THE
HOSPITAL. WE ALSO GO TO THE
HOSPITAL AND THEN FOLLOW THEM ON
THE STREET TO CONTINUE CARE TO
PREVENT THE NEXT CRISIS. AND SO
RIGHT NOW WE'RE AT THIS REALLY
CRITICAL POINT IN OUR HISTORY OF
STREET MEDICINE WHERE WE'RE
TRANSITIONING FROM THIS ROBIN
HOOD, UH, GRASSROOTS MOVEMENT
INTO MAINSTREAM HEALTH CARE, AND
WE'VE GOTTEN TREMENDOUS SUPPORT
FROM THE ADMINISTRATION FROM A
LOT OF YOU IN THE LEGISLATURE
AND FROM Dð HÌ èC S¼ TO THE
POINT THAT WE NOW HAVE 57
PROGRAMS ACROSS THE STATE WITH
ANOTHER 20 IN DEVELOPMENT IN 34
DIFFERENT COUNTIES. SO THIS IS
NOT JUST, UH, I IN THE BIG
CITIES. AND SO MOVING FORWARD AS
WE'RE THINKING ABOUT LEGISLATION
, THE GOAL WOULD BE TO MAKE IT
THAT ANYBODY WANTING TO GO TO
THE STREET TO DELIVER CARE IS
ABLE TO DO SO WITHOUT
BUREAUCRATIC BARRIERS BECAUSE
THERE NEEDS TO BE MORE OF US TO
GO TO THE PEOPLE WITH LOVE AND
SOLIDARITY. THANK YOU VERY MUCH.
THANK YOU, UH, THAT IS A GREAT
TRANSITION INTO ME SPEAKING TO
YOU, UM, BECAUSE I ALSO PRACTICE
STREET MEDICINE AND, UH, ONE OF
THE GREATEST THINGS ABOUT COMING
TO WORKSHOPS. HEARINGS LIKE THIS
IS WE'RE GONNA GO, UH, TALK
OUTSIDE OF THIS ROOM BECAUSE WE
SHARE A COMMON DISTRICT AND MANY
WAYS THAT WE CAN, UH, PULL OUR
RESOURCES TO ASSIST AND HELP
EACH OTHER, UM, RIGHT ON THE
VERY STREETS THAT YOU KNOW HE'S
WORKING ON AND THAT I'M WORKING
ON. SO UH, THANK YOU FOR THE
OPPORTUNITY TO COME HERE AND
GIVE YOU SOME TESTIMONY. UM
THANK YOU FOR THIS NOT ONLY
BIPARTISAN, BUT BOTH SIDES OF
THE AISLE. UM COMMITTEE, UH, WHO
IS TACKLING PROBABLY ONE OF THE
GREATEST ISSUES IN FRONT OF US
RIGHT NOW, UM, IN OUR SOCIETY.
AND WITH THAT, UM MY NAME IS
DAVE GELATI. AND I'M A FIRE
CAPTAIN. I STARTED OUT IN
LAKESIDE FIRE DEPARTMENT DOWN IN
SO I REMEMBER WALDRON'S DISTRICT
FOR 5.5 YEARS AND I'VE BEEN WITH
L A COUNTY FIRE FOR 30 YEARS. I
WAS A PARAMEDIC FOR 12.5 OF
THOSE YEARS. UM AND I SUPERVISE
PARAMEDICS, UM, IN ONE OF THE
HARDEST HIT AND UNDERSERVED
AREAS IN L, A COUNTY THAT'S THE
FLORENCE FIRESTONE, UH, WATTS,
WILLOWBROOK AREAS, AND, UH, WE
DEAL WITH CRISES THAT WE'RE
TALKING ABOUT HERE, UH, DAILY? I
ALSO CHAIR THE CALIFORNIA TASK
FORCE ON BEHAVIORAL HEALTH. I
COCH IT, UM WITH, UH, KRISTIN
THOMPSON. SHE'S UH OUT OF
NEWPORT BEACH FIRE DEPARTMENT.
SHE'S ACTUALLY A NURSE, AND, UH,
SHE IS AN EXTREMELY AMAZING, UH
UM, CO CHAIR FOR OUR COMMITTEE.
AND OUR COMMITTEE IS, UH, MADE
UP OF BOTH LABOR AND MANAGEMENT,
WHICH I THINK IS SUPER KEY.
BECAUSE IF YOU DON'T GET BUY IN
FROM THE CHIEFS IF YOU DON'T GET
A BUDGET ALLOCATIONS TO DO WHAT
WE NEED TO DO EVERY BIT AS MUCH
AS THE UNION, PUSHING IT ON
BEHALF OF THE FIREFIGHTERS AND
PARAMEDICS IN THE STREETS, AND
THEN WE DON'T, UH, GET THINGS
DONE. UM I'M HONORED TO TALK TO
YOU ABOUT, UM, A MICROCOSM OF
BEHAVIORAL HEALTH THAT I HOPE
GIVES YOU A VIEW INTO WHAT'S
RIGHT. HOW IT CAN WORK. NOT ONLY
FOR FIREFIGHTERS IN THE EXAMPLE
I'M GOING TO GIVE YOU BUT ALSO
HOW THAT TRANSLATES, UH, DOWN
ONTO THE STREETS IF WE HAD
SIMILAR PROGRAMS, REALLY
BOLSTERING UP THE TESTIMONY OF
EVERYBODY COMING HERE TODAY
ABOUT GETTING MORE CLINICIANS
ABOUT GETTING ACCESS ABOUT
EDUCATION AND ABOUT SERVICE
DELIVERY, SO THAT WE'RE NOT JUST
TAKING PATIENTS TO THE EMERGENCY
ROOM, UH, WHEN THEY NEED WE CARE
OR ACTUALLY CARE IN THE STREETS
DEALING WITH BEHAVIOR, HEALTH
AND DRUG ADDICTION. SO, UH, HOW
DID THE TASK FORCE COME ABOUT?
IN 2016. WE HAD A TWO YEARS
WHERE, UH, THE LEADING CAUSE OF
DEATH FOR FIREFIGHTERS.
OUTPACING ALL OTHER COMBINED
CAUSES OF DEATH. CANCER HEART
ATTACKS, TRAUMATIC INJURY, UM
VEHICLE ACCIDENTS RESPONDING ON
THE WAY THE FIRES ALL THE THINGS
YOU SEE ON Tð VÆ THE NUMBER ONE
CAUSE OF DEATH FOR MY MEMBERS.
WAS SUICIDE. AND THAT WAS A WAKE
UP MOMENT FOR US AND A WAKE UP
MOMENT. UH FOR ME, AND THAT'S
WHY I, ALONG WITH MY COLLEAGUES
GOT INVOLVED IN THE CALIFORNIA
TASK FORCE ON BEHAVIORAL HEALTH.
AND, UH, WHAT HAVE WE DONE? UM
FIRST YOU HEARD A LOT ABOUT IT.
WE HAD TO BREAK DOWN. STIGMA UM,
LET ME TELL YOU ABOUT
FIREFIGHTERS AND WE'RE TOUGH.
WERE HARD. WE DON'T WANNA ASK
FOR HELP. AND, UH I THINK THAT
GOES FOR PROBABLY EVERYBODY IN
THE ROOM HERE. YOU HEARD SOME
NUMBERS EARLIER TODAY, AND I
SAID, WOW. ONE IN 31 IN FIVE. I
GO. WELL, WHO IS IT? AND WHO
WANTS TO RAISE THEIR HAND AND
SAY I HAVE MENTAL HEALTH ISSUES.
YOU KNOW WHO DOES NOBODY AND SO
WE NEED TO BREAK DOWN THE STIGMA
OF ACCESSING BEHAVIORAL HEALTH.
AND WE'VE DONE THAT WITH
FIREFIGHTERS BY, UH, WORKING TO
FORM NOT ONLY THIS TASK FORCE,
BUT, UM, WE HAVE PEER SUPPORT
TEAM. NOW THAT, UH, RUNS UP AND
DOWN THE STATE IN IN L, A COUNTY
WE HAVE OVER 250. UH, TRAINED
PEER SUPPORTERS. THESE ARE
FIREFIGHTERS, PARAMEDICS AND
NURSES FROM THE FIELD. SO IT'S
I'M LOOKING INTO MY BROTHER AND
MY SISTER'S EYES. WHO ALSO DOES
MY JOB, BUT THEY HAVE SOME
TRAINING IN HOW TO RECOGNIZE
SOME OF THE SYMPTOMS OF POST
TRAUMATIC STRESS AND CUMULATIVE
STRESS THAT I MIGHT BE HAVING AT
WORK AND PROBABLY ABOUT 10 TO
12% OF OUR MEMBERSHIP. AND I
HAVE 3500 MEMBERS PLUS FAMILY,
UH, THEY NEED PROFESSIONAL HELP.
THEY NEED PEER SUPPORTERS AND
THEY NEED WE CALL THEM
CULTURALLY COMPETENT CLINICIANS
AND I'M GONNA HIT ON THAT, TOO.
WE DO HAVE A HUGE SHORTAGE OF
CLINICIANS. TRAINING THAT YOU
HEARD TODAY TRAIN, THE TRAINER
AND THE RESOURCES AND YOU ASKED
HOW WE CAN GET CLINICIANS TO,
YOU KNOW, COME INTO THE FOLD AND
RAISE THEIR HANDS, IN MY OPINION
, HUMBLY, AND WE HAVE A HEALTH
INSURANCE PLAN THAT WE RUN FOR
L, A COUNTY FIRE VERSUS SELF
FUNDED INDEMNITY PLAN WITH
ANTHEM BLUE. WE NEGOTIATE AND
SET A LOT OF OUR OWN BENEFITS.
BUT WHAT WE'RE DOING IS WE'RE
OFFERING TO THE CLINICIANS. THAT
ARE THAT ARE TAKING OUR TRAINING
PROGRAM. IT'S THREE HOURS OF èC
E, AND THEY'RE ACTUALLY COMING
OUT AND RIDING ALONG WITH US TO
BECOME CULTURALLY COMPETENT FOR
MY WORKFORCE, FIREFIGHTERS SO
THEY KNOW HOW TO TALK TO MY
FIREFIGHTERS AND COUNSEL. MY
FIREFIGHTERS. WE'RE OFFERING
THEM BETTER THAN TABLE RATE.
WE'RE OFFERING THEM BETTER THAN
WORKERS, COMPRE, AND WE'RE
PAYING THEM IN 30 DAYS AND LET
ME TELL YOU WHAT HAPPENS. YOU
HAVE A LONG LINE OF CLINICIANS
SAYING I WANT TO TREAT
FIREFIGHTERS, SO THINK ABOUT
THAT AS WE WORK TO, UH, CLEAR
SOME OF THE ROADBLOCKS AND
HURDLES TO HAVE INSURANCE COVER,
UM, MENTAL HEALTH, BUT ALSO TO
RECRUIT CONDITIONS THAT WILL
TAKE THE TRAINING THAT YOU'RE
HEARING ABOUT HERE TODAY. GET
THAT TRAINING AND PART OF THAT
IS WE'RE GONNA TAKE CARE OF THEM
IN SO MANY WAYS. UM THE OTHER
REASON WHY I GOT INVOLVED IN
THIS WAS I HAD A FIRE CAPTAIN IN
HUNTINGTON PARK, WHO WAS A GOOD
FRIEND OF MINE. WE USED TO RIDE
THE BIKE EVERY MORNING AND I HAD
THE UNFORTUNATE EXPERIENCE OF
MOTIVATING ME OF HAVING TO JOIN
MY FIRE CHIEF AND GO TO HIS
HOUSE WITH HIS WIFE AND HIS
KIDS. AND OPEN THAT DOOR AND SEE
THE LOOK IN HER EYES. AS WE TOLD
HER, HER HUSBAND, WHO WAS ONE OF
THE TOP FIRE CAPTAINS ON OUR
DEPARTMENT, YOU WOULD HAVE NEVER
GUESSED IT WOULD HAVE BEEN HIM
THE EPITOME OF WHAT A FIRE
CAPTAIN SHOULD BE AND A
PARAMEDIC. HE HAD TAKEN HIS OWN
LIFE IN A WAREHOUSE BEHIND A
DUMPSTER IN VENTURA. AND THE
VENTURA FIREFIGHTERS WENT TO
HIGH SCHOOL WITH HIM AND THEY
KNEW HIM. AND I DECIDED AT THAT
MOMENT, JUST LIKE YOU. I'M NOT
GONNA GIVE UP ON THIS. NOT ONLY
FOR MY FIREFIGHTERS, BUT FOR THE
PUBLIC I SERVE. FOR SEVEN YEARS
INTO THIS BEHAVIORAL HEALTH TASK
FORCE, AND WE'VE COME A LONG
WAY. WE HAVE TO MAKE A HARD
DECISIONS ON FUNDING AND
ALLOCATIONS OF RESOURCES TO PUT
BEHAVIORAL HEALTH INTO THE FIRE
SERVICE. BUT I'M GONNA TELL YOU
THAT WITH OUR PEER SUPPORT
PROGRAM, OUR CULTURALLY
COMPETENT CLINICIANS, UM WE HAVE
BEEN ABLE TO REDUCE THE
DEPRESSION, THE ANXIETY, THE
SUICIDES AND THE ISSUES IN, UH,
THE FIRE SERVICE DRAMATICALLY.
AND THIS CAN ALSO BE A MODEL
THAT YOU USE OUT ON THE STREETS.
UM I TOLD YOU WHERE I WORK, AND
I CAN TELL YOU, UM WE ARE ALSO
PART OF A PILOT PROGRAM IN THE
STATE FOR PEOPLE THAT WE TREAT
TO USE TELEHEALTH. AND TO USE
WHAT ESSENTIALLY WOULD BE LIKE
FACETIME. BUT IT'S HIPAA
COMPLIANT, TELEHEALTH AND WE
HAVE, UH, THREE DOCTORS ON THE
L, A COUNTY FIRE DEPARTMENT. WE
HAVE NURSE PRACTITIONERS AND WE
HAVE A CONNECTION WITH OUR
PARAMEDICS, AND WE'LL GO OUT AND
DIAGNOSE THAT SOMEBODY, IN FACT
CAN BE CLEARED MEDICALLY. AND
DOES NOT NEED TO GO TO THE
EMERGENCY ROOM AND WE TAKE THEM
TO A MENTAL HEALTH TREATMENT
FACILITY. AND WE HAVE SEEN A
DRAMATIC REDUCTION IN THE REPEAT
CALLS TO 911. WE'VE SEEN A
DRAMATIC REDUCTION IN THE
EXPENSE OF FIREFIGHTERS,
PARAMEDICS GOING OUT IN THE
FIELD AND TREATING THESE PEOPLE
SOMETIMES THREE 45 TIMES A DAY,
AND JUST RECENTLY, I HAD A YOUNG
WOMAN WHO'S A SINGLE MOTHER WITH
THREE KIDS LIVING IN A MOTOR
HOME ON MY STREETS, AND WE GOT
HER INTO NEXUS, UH, OVER IN
MARTIN LUTHER KING HOSPITAL
THROUGH THIS PROGRAM, AND SHE
CAME BACK TO OUR FIRE STATION
AND BROUGHT COOKIES AND SAID, UM
, I JUST WANTED TO THANK YOU.
BECAUSE WHERE YOU GOT ME IN THE
TREATMENT I GOT AND GETTING BACK
ON MY MEDICINES AND HAVING
ACCESS TO CARE THINGS BEING
DELIVERED TO HER HOUSE. SHE IS
UP AND RUNNING IN AN APARTMENT
WITH HER THREE KIDS, AND, UH,
THAT IS AN EXAMPLE OF HOW IT CAN
WORK WHEN WE DO IT RIGHT AND WE
FIGHT HURDLES TO BE ABLE TO DO
THAT, RIGHT? SO I ENCOURAGE YOU
TO CLEAR THE WAY FOR US TO BE
ABLE TO USE OUTSIDE THE BOX
PROGRA MMES LIKE THAT. UM I'LL
JUST GO AHEAD AND CLOSE RIGHT
THERE BY SAYING, UM,
FIREFIGHTERS, YOU KNOW, WE WERE
TAKING OUR OWN LIVES. AT A RATE
HIGHER THAN ALL OTHER. ALL OTHER
CAUSES OF DEATH, AND IT IT IT
WAS THE MOMENT WHEN WE DECIDED
TO FORM THE TASK FORCE AND TREAT
MENTAL HEALTH DIFFERENTLY TO
BREAK DOWN STIGMA TO CLEAR
ACCESS TO PROVIDE RESOURCES.
LIKE YOUR HEARING HERE TODAY TO
OUR FIREFIGHTERS, AND WE HAVE
DRAMATICALLY REDUCED SUICIDES
AND OR DEPRESSION AND ANXIETY,
AND, UH RELATING TO THAT THE
PEOPLE THAT WE TREAT IN THE
STREETS IF WE WERE TO HAVE
PROGRAMS LIKE YOU'RE HEARING TO
HERE TODAY THAT MIRROR WHAT
WE'RE DOING FOR FIREFIGHTERS.
YOU CAN SEE A DRAMATIC REDUCTION
IN THE BEHAVIORAL HEALTH ISSUES
IN THE STREET AND PROBABLY
RELATED COSTS ASSOCIATED WITH
IT. THANK YOU. THANK YOU. I.
GOOD AFTERNOON. UH, THANK YOU
GUYS FOR THE OPPORTUNITY TO
SPEAK IN FRONT OF THE COMMITTEE
AND SHARE WITH YOU THE WORK THAT
ADVANTAGE HAS BEEN DOING OVER
THE LAST DECADE OR SO, UH,
SUPPORTING THE AT MOST AT RISK
PATIENTS IN OUR STATE. UH, MY
NAME IS VIMO BON VIA NATIVE
CALIFORNIAN. WENT TO UNDERGRAD
AT U èC L, A GRADUATE SCHOOL AT
U, S¼ èC, AND I SPENT THE
BETTER PART OF MY CAREER FOCUSED
ON CREATING SOLUTIONS WITH STATE
AGENCIES TO GET CARE DELIVERED
TO PATIENTS WITH BEHAVIOURAL
HEALTH ISSUES. UM I'M EXCITED TO
SPEAK TO YOU ALL ABOUT. LAST
MILE SOLUTIONS THAT WILL ENSURE
THAT THE DOLLARS THAT YOU GUYS
ARE ALLOCATING FOR PATIENTS WITH
BEHAVIORAL HEALTH, UM, ARE
MAXIMIZED AND PATIENTS GET THE
BEST CARE POSSIBLE. ADVANTAGE UH
, HEALTH CARE SERVICES IS
DEDICATED TO IMPROVING THE
HEALTH AND WELLNESS OF OUR
COMMUNITIES THROUGH INTEGRATED
PHARMACY SOLUTIONS ANCHORED IN
CLINICAL CARE. UM AND IT'S
DESIGNED TO OPTIMIZE OUTCOMES,
SUPPORT, ACHIEVEMENT AND POPULAR
AND MANAGED POP POPULATION.
HEALTH MANAGEMENT GOALS. UM, AS
A HIGH TOUCH PROVIDER. UH, WE
HAVE A SUITE OF PATIENT CENTRIC,
COMMUNITY BASED SERVICES
DESIGNED TO ADDRESS UH,
MEDICATION ACCESS ADHERENCE,
YAPS, UM, AND WORK THROUGH
SOCIAL DETERMINANTS OF CARE TO
MAKE SURE THAT PATIENTS GET THE
RIGHT CARE AT THE RIGHT PLACE AT
THE RIGHT TIME. UH, TO DATE
WE'VE SERVED ABOUT 100,000 MEDIC
BENEFICIARIES THAT DEAL WITH
SUBSTANCE USE DISORDERS AND
BEHAVIORAL HEALTH ISSUES AND
ABOUT 10,000 ROLES. UH, THE WAY
WE DO. THIS IS THROUGH SOMETHING
CALLED ENHANCE MEDICATION
MANAGEMENT SERVICES, WHERE YOU
TAKE AN INTEGRATED TEAM.
BENEFITS PLANNER, SOCIAL WORKER
CASE WORKER NURSE AND PHARMACY,
PHARMACY AND CLINICAL PHARMACIST
, UM TO SUPPORT UH, PATIENTS
THAT REQUIRE CARE VERSUS A CORE
PHARMACY SERVICE, WHICH IS JUST
A TECHNICIAN FILLING THE
MEDICATION AND A PHARMACIST
DISPENSING THE MEDICATION. A
GREAT EXAMPLE OF THIS WAS IN
2016. WE MET WITH THE PAROLE
DEPARTMENT, UM, AT THE DOWNTOWN
LOS ANGELES, UM, OFFICE, WHICH
IS THEIR LARGEST PRO, UH, UNIT
AND WE LAUNCHED A. A PILOT.
WHERE UM, WE UNDERSTOOD THE GAPS
THAT THE PAROLE DEPARTMENT HAD,
AND THE GAPS KIND OF ARE THE
GAPS WE IDENTIFIED WERE THAT
PATIENTS GENERALLY WERE NOT ABLE
TO ACCESS SERVICES IN GENERAL.
AND BECAUSE OF THAT, UM SOCIAL
WORKERS, CASE WORKERS AND OTHERS
THAT WORKED IN THE PAROLE
SETTING WERE UNABLE TO, UM,
REALLY FOCUS AND MOVE FORWARD
CARE DELIVERY. UH SO ONE OF THE
THINGS THAT YOU KNOW HAPPENED
THROUGH THAT, UM PILOT WAS
UNDERSTANDING. WHAT THE SOCIAL
WORKERS AND PROS FELT WAS
DIFFICULT WHEN RECEIVING CARE.
AND WE WERE ABLE TO INTERVIEW
THOUSANDS OF PAROLEES. AND MANY
MANY SOCIAL WORKERS ACROSS THE
STATE. AND THE GOAL OF THE
PROGRAM WAS TO CREATE SOMETHING
THAT WAS VERY PATIENT FACING. HE
STIGMATIZED CARE. BECAME REALLY
REPEATABLE, BECAUSE IF YOU'VE
EVER DEALT WITH PEOPLE WITH
BEHAVIORAL HEALTH ISSUES THEY
NEED CONSISTENCY WHEN THEY COME
BACK AND TRY TO ACCESS CARE. AND
A FEEDBACK LOOP. SO THAT THE
CARE TEAM THAT WAS SUPPORTING
THE PATIENT. HAD THE ABILITY TO
KNOW WHERE THE PATIENT WAS IN
THEIR CARE CYCLE, PARTICULARLY
WHAT THEIR MEDICATIONS AND THE
BIGGEST BENEFICIARY, I THINK WAS
A SECURITY SIDE OF THE HOUSE.
UM, THE PALE AGENTS AND SUCH
BECAUSE THEY WERE ABLE TO
UNDERSTAND THAT THEIR PATIENTS.
LIKE MY COL COLLEAGUE STATED
EARLIER, HAD A LONG ACTING
INJECTABLE AND KNEW THAT THEY
WERE ON MEDICATION FOR 30 60 90
DAYS. AND THROUGH OUR LEARNINGS,
WE REALIZED THAT YOU KNOW ONE OF
THE PILLARS OF THE QUADRUPLE
AIM, WHICH IS TO REDUCE
CAREGIVER BURDEN WAS PROBABLY
THE MOST IMPORTANT IN THE PALE
SETTING. UM. MANY OF THE SOCIAL
WORKERS INDICATED TO US THAT 5%
OF THEIR PANEL. PICK UP 50% OF
THEIR TOTAL TIME. THEY WERE NOT
ABLE TO SPEND TIME WITH THEIR
ENTIRE PANEL BECAUSE THEY WERE
MANAGING 5150 RISKS, AND THEY
WERE NOT ABLE TO KIND OF
NAVIGATE THROUGH, UM SOME OF
THOSE ACTIVITIES WITHOUT ADVANCE
NOTICE AND EXPOSURE. SO WE CAME
UP WITH A WAY TO INDICATE BY UM.
BY KIND OF INCARCERATION STATUS.
WHICH PATIENTS WERE DUE FOR
WHAT? TREATMENT WHILE AHEAD OF
TIME SO THAT THEY CAN BE
SCHEDULED, AND THINGS COULD BE
DONE IN ADVANCE AND WHAT WE
LEARNED ABOUT THE PRO PAROLEES
WAS THAT THEY WERE MANAGING
SOCIAL DETERMINANTS THAT WE
OFTEN KIND OF UNDERSTAND, RIGHT.
YOU KNOW, FOOD, INSECURITY,
TRANSPORTATION, THE ABILITY TO
ACCESS. UM YOU KNOW, ACCESS CARE
. BUT THEN THERE WERE OTHER
SOCIAL DETERMINANTS THAT WE
DON'T THINK ABOUT IE WHEN WE
FIRST ON BOARDED THE 1ST 1000
ROLLS IN THE LOS ANGELES
DISTRICT. NORTH OF 50% NEVER HAD
A MEDICATION FILLED AND WHEN WE
ASKED THEM WHY THEY WOULD STATE
YOU KNOW THE MEDICATIONS WERE
SENT INTO A GANG TERRITORY WHERE
I WASN'T GONNA GO PICK UP MY
MEDICATION. AND THINGS THAT WE
JUST DON'T THINK ABOUT AS NORMAL
EVERY DAY. CITIZENS. SO WE HAD
TO WORK ON FIGURING OUT HOW TO
DECONSTRUCT THOSE CHALLENGES AND
ENSURE THAT THEY WERE ABLE TO
GET ACCESS TO CARE IN A WAY THAT
YOU KNOW WAS CONSUMABLE BY THEM
AND REDUCED. TOTAL CAREGIVER
BURDEN SO THAT THE PAROLE AGENTS
ACE WORKERS, SOCIAL WORKERS AND
M Dð S¼ WERE ABLE TO
SUCCESSFULLY DO THEIR DO THEIR
JOBS. ULTIMATELY WE FOUND THAT
WITH AN INTEGRATED SYSTEM, WE
WERE ABLE TO GET PEOPLE COMING
OUT OF PALE ON NINE POINT POINT
THREE MONTHS OF CONSECUTIVE CARE
, AND WHEN TRANSITION TO THE
NEXT SIDE OF CARE, WE GOT THEM
ON 14 MONTHS OF CONSECUTIVE
CARE. GREAT SAVINGS TO THE
SYSTEM. GREAT SAVINGS TO THE
PAYER ME. AND A LOT OF SECONDARY
BENEFITS, YOU KNOW, UH,
REDUCTION OF PETTY THEFT. SPREAD
OF COMMUNICABLE DISEASES. UM.
AND ULTIMATELY, UM, YOU KNOW,
JUST TO SAFER ENVIRONMENT TO
KIND OF EXIST IN FOR US. YOU
KNOW, THE LACK OF REIMBURSEMENT
MEANT THAT THIS PROJECT WAS A
LABOR OF LOVE FOR ORGANIZATION.
IT'S BEEN SELF FUNDED SINCE 2016
AND WE CONTINUE TO FUND IT
BECAUSE WE'VE TOUCHED SO MANY
PAROLEES OVER THE YEARS, UM BUT
TO SCALE PROGRAMS LIKE THIS AND
PROGRAMS THAT DRIVE PEOPLE TO
THE LAST MILE. ARE REALLY
IMPORTANT. AND I THINK THAT WHAT
WE'VE DONE AND WHAT THE
COMMITTEE HERE HAS DONE, YOU
KNOW, PASSING CALIFORNIA,
MEDICAID, PRE, UH, RELEASE
COVERAGE. IT'S AMAZING. I MEAN,
IT'S A REALLY, REALLY IMPORTANT
FIRST STEP. AND YOU HAVE TO
COMMEND IT. THE CONCERNS THAT WE
HAVE IS, YOU KNOW OUR THAT YOU
HAVE, YOU KNOW? FACILITIES LIKE
TWIN TOWERS, WHICH IS OFTEN
REFERRED TO AS THE LARGEST
MENTAL HEALTH FACILITY IN THE
COUNTRY. UM MANY OF THE PATIENTS
MANY OF THE PATIENTS WHILE
INCARCERATED, ARE GETTING ACCESS
THROUGH Dð G S¼ TO LE. I S¼ AND
OTHER THERAPIES THAT WORK. BUT
WHEN THEY'RE DISCHARGED THERE'S
NÓ SOFT HAND OFF. I THINK
ULTIMATELY AS PART OF OUR
RESPONSIBILITY. WE HAVE TO. KIND
OF ENCOURAGE THESE FACILITIES IN
THE COMMUNITY PARTNERS THE
COMMUNICATE AND MAYBE HAVE A
WORKFLOW TO ENSURE THAT THESE
PATIENTS STAY ON THE THERAPIES
THAT ALLOW EVERYONE DOWNSTREAM
THAT WE'RE FUNDING CASE WORKERS,
SOCIAL WORKERS M Dð S¼ THE
OPPORTUNITY TO REALLY SUCCEED AT
THEIR RESPONSIBILITIES BECAUSE
OUR TEAM LOOKS AT THE PROBLEM WE
HAVE IN BEHAVIORAL HEALTH AS A
QUADRATIC EQUATION WITH ALL
VARIABLES NÓ CONSTANTS. AND IF
WE CAN GET ONE OF THE MAJOR
CONSTANTS, LET'S CALL IT
MEDICATION DELIVERY. CONSISTENT
THEN EVERYTHING ELSE STARTS TO
FIGURE ITSELF OUT, AND YOU HAVE
A REAL SHOT IN THE FIELD OF
MAKING SURE THAT EACH SUBSEQUENT
OPPORTUNITY TO COMMUNICATE WITH
THAT PERSON. MATTERS. AND
ULTIMATELY, YOU KNOW, I TOOK
THIS OPPORTUNITY TO SPEAK TO YOU
TO EVERYONE HERE TODAY BECAUSE I
LOOK AT MY ORGANIZATION AND
EVERYTHING THAT EVERYONE HERE IS
DOING AS WE ARE EMPATHY,
EXTENDERS. THEY'RE HUMAN BEINGS
THAT DO THE WORK EVERY DAY ON IN
THE FIELD. THEY CARE. THEY'RE
OVERBURDENED. THEY DO MORE WORK
THAN THEY POSSIBLY CAN DO, AND
IT'S UP TO US TO IN. POWER THEM
TO HAVE MORE TIME SO THAT THEY
CAN TOUCH MORE LIVES. THIS
HISTORIC FUNDING THAT'S FLOWING
THROUGH THE SYSTEM RIGHT NOW
COULD REALLY BE INCREDIBLY
IMPACTFUL. IF THAT LAST MILE IS
CONSIDERED, AND WE'RE ABLE TO
PULL THE PATIENT THROUGH THAT
LAST MILE SO THAT THE CHANGE
THAT WE ALL. HOPE TO HAPPEN
STARTS TO BE REALIZED. SO THAT'S
WHAT YOU KNOW THAT'S WHAT
ADVANTAGE DOES AND THANK YOU FOR
YOUR TIME. THANK YOU SO MUCH.
AND BEFORE WE GET THE QUESTION,
I JUST WANNA SORT OF COMMENT ON
ONE THEME THAT IS RUNNING
THROUGH BOTH OF THESE PANELS.
AND I THINK IT IS JUST SO CLEAR
IS THAT IN IN CALIFORNIA IS SORT
OF AT THE EXTREME END. HERE WE
NEED MUCH MORE FLEXIBILITY IN
ALLOWING PEOPLE TO PROVIDE
SUPPORT AND CARE FOR PEOPLE
STRUGGLING WITH BEHAVIORAL
HEALTH. UH CHALLENGES. UM WE GET
SO CAUGHT UP WITH RIGID SCOPE OF
PRACTICE ISSUES AND, UH,
REIMBURSEMENT ISSUES. FOR UM,
YOU KNOW, PEER SUPPORT, ET
CETERA. UH, AND IT'S ALWAYS A
HUGE FIGHT. I HAD A MENTAL
HEALTH WORKFORCE BILL. UM COUPLE
YEARS AGO, IT ENDED UP UM. NOT
PASSING. WE DIDN'T NEED IT
BECAUSE SO MUCH GOT INCORPORATED
INTO THE BUDGET, BUT THE ONE
PIECE THAT WE WERE GOING TO MOVE
FORWARD WAS, UH, HAVING YOU SEE,
DO A SCOPE OF PRACTICE. STUDY
AROUND MENTAL HEALTH WORKFORCE,
JUST A STUDY AND IT CAUSED A
MEGA UPROAR THAT WE WERE EVEN
ASKING THE QUESTION AND ASKING
FOR A STUDY. UM AND I, UM YOU
KNOW, AND I RESPECT A LOT OF
THE, UH, GROUPS. THESE ARE MAJOR
GROUPS. I WORK WITH A LOT. I
HAVE GREAT RESPECT FOR THEM, BUT
IT JUST IS A REFLECTION OF HOW
HENCE THE SITUATION IS AROUND
SCOPE OF PRACTICE AND LICENSURE
REQUIREMENTS, AND THERE IS SO
MUCH WORK TO GO AROUND. PEOPLE
DON'T NEED TO BE TERRITORIAL
HERE THERE IS PROFOUNDLY
EXPONENTIALLY MORE WORK THAN WE
HAVE THE PROFESSIONALS TO
PROVIDE. SO WE NEED TO ALLOW
PEOPLE TO THE FULL SCOPE OF
THEIR TRAINING. WE NEED TO RELAX
SOME OF THESE JURISDICTIONAL
BOUNDARIES, AND I KNOW SOME
PEOPLE GET UPSET WHEN I SAY THAT
, UM AND WE NEED TO ALLOW MORE
TYPES OF PEOPLE TO PROVIDE THIS
TREATMENT. UM I IN THE FIELD, UH
, AAA, AND WE NEED TO DO THAT
QUICKLY. I. I WAS JUST, UH AND
THEN I'LL STOP. I GO ON FOR A
WHILE ABOUT THIS, UM, A FRIEND
OF MINE WHO I'VE KNOWN FOR A
LONG TIME. HE, UM, HE LIVED IN
SAN FRANCISCO THEN. LEFT SAN
FRANCISCO, UM, TO GET TO BECOME
A PSYCHOLOGIST. HE WENT I. I
CAN'T REMEMBER WHERE IN THE
COUNTRY HE WENT. IT WAS IN
PENNSYLVANIA. I THINK, AND HE
GOT HIS. HE BECAME A LICENSED
PSYCHOLOGIST IN PENNSYLVANIA AND
HE WANTED TO COME BACK. TO SAN
FRANCISCO TO WORK AS A
PSYCHOLOGIST. HE DIDN'T BECAUSE
THE BARRIERS TO TRANSFERRING IN
AND OUT OF STATE LICENSE FOR A
PSYCHOLOGIST WERE HE WOULD HAVE
HAD TO RETAKE LIKE A THIRD OR A
HALF. OF THE EXACT SAME COURSES
THAT HE TOOK IN PENNSYLVANIA. IN
ORDER TO DO THAT IT IT'S
OUTRAGEOUS AND WE JUST LOST A
PSYCHOLOGIST. BECAUSE OF THAT,
AND THAT PLAYS OUT OVER AND OVER
AGAIN. UH SO WE NEED TO DO
THINGS, UH, DIFFERENTLY. UM SO
QUESTIONS OR COMMENTS ANYONE?
UH, SOME OF THEM A RE. I SO, UH,
THANK YOU. FOR ALL THE WORK YOU
DO OUT THERE. IT'S SO CRITICALLY
IMPORTANT. AND UM, ONE OF THE
MOTIVATING FACTORS FOR ME TO RUN
FOR STATE ASSEMBLY WAS TO BE A
VOICE, UM, AND A FACE AROUND
MENTAL HEALTH. MY HUSBAND I'M 25
YEARS DIED BY SUICIDE NOVEMBER
OF 2018. SUCCESSFUL ATTORNEY HAD
EVERYTHING GOING FOR HIM IN THE
CARE OF A PSYCHIATRIST AND JUST
GAVE UP. AND THE IMPACTS OF THAT
ARE TREMENDOUS. AND I'M UM, YOU
KNOW, GRATEFUL FOR THIS HEARING
TODAY. I'M I'M GRATEFUL FOR THE
WORK WE'VE DONE AROUND 988 AS
WELL. AND HAVING THAT EMERGENCY
HOTLINE, UH, WHERE SOMEONE CAN
CALL IN THE EVENT OF A CRISIS,
BUT WE STILL DON'T REALLY HAVE
THE MECHANISM AS FAR AS SOMEBODY
TO COME TO THEIR HOUSE. YOU
KNOW, THE MOBILE MENTAL HEALTH
HEALTH CARE, I THINK IS SO
CRITICALLY IMPORTANT AS WELL AND
THEN PLACES FOR THEM TO GO TO
GET THE TREATMENT THAT THEY NEED
, BUT THE WORK WE NEED TO DO
AROUND REMOVING THE STIGMA IS SO
CRITICALLY IMPORTANT THAT WE
NEED TO BE TALKING ABOUT THIS.
AND UM, THE WORK YOU'RE DOING
OUT THERE IS JUST SO INCREDIBLY
IMPORTANT AND, UM, DO YOU DO YOU
INTERACT WITH THE 988 SYSTEM AT
ALL? I'M JUST CURIOUS ABOUT HOW
THAT HELPS IN YOUR PROFESSION.
WE DO I HAVE THE L, A COUNTY
BOARD OF SUPERVISORS, THE FIVE
MOST POWERFUL WOMEN IN THE
WORLD, ARGUABLY ALL FIVE OF MY
FRIENDS AND, UH AND I KNOW MY
PLACE. I WORK HARD FOR THEM, UM,
I INTEGRATE WITH THEM. UM IN HOW
THE 988 SYSTEM IS GOING TO BE
ROLLED OUT, BUT ALSO UP HERE AT
THE STATE. WHEN LEGISLATIVELY WE
LOOK AT HOW WE DEFINE THAT I
HAVE PUBLIC SAFETY DISPATCHERS,
BY THE WAY, UM, THEY'RE NOT PART
OF THE POST TRAUMATIC STRESS
BILL FOR FIREFIGHTERS,
LIFEGUARDS EM Tð S¼ AND
PARAMEDICS. UM I WANNA THANK
EVERYBODY HERE. WE DO HAVE A
STUDY THAT WE'RE GOING TO DO TO
TRY TO BRING THEM IN. BUT CAN
YOU IMAGINE TAKING THE PHONE
CALL AND WE BROUGHT IN TESTIMONY
WITH ONE OF MY PUBLIC SAFETY
DISPATCHERS ABOUT A SUICIDE, UH,
THAT WAS COMPLETED IN THE
DESERT. ON THE OTHER END OF A
PHONE AND ZERO HELP FOR HER. UM
WE NOW HAVE A SYSTEM WHERE WE
CAN HELP HER IN L A COUNTY.
WE'RE PUSHING THAT, BUT, YEAH,
WE DO INTERACT WITH 988. AND
THEN LET ME GIVE YOU ANOTHER
PERSPECTIVE THAT I'LL JUST KIND
OF BLOW YOU AWAY A LITTLE. UM,
I'M I N MY 36TH YEAR AS A
FIREFIGHTER, A PARAMEDIC AND A
CAPTAIN NOW MY SON. IS THREE
YEARS ON WITH L, A COUNTY FIRE
DEPARTMENT. HE WORKS ONE STATION
AWAY FROM ME. WE TEACH
BEHAVIOURAL HEALTH AND BREAKING
DOWN STIGMA AND ACCESSING
PROACTIVE CARE WHICH, BY THE WAY
, PROACTIVE MENTAL HEALTH. I'M
GONNA LEAVE THIS OUT. THERE IS
THE CHEAPEST FORM OF MEDICINE
THAT YOU ALL CAN PUT IN THE
SERVICE REACTIVE CRISIS CARE IS
EXPENSIVE. AND THAT'S TRUE. I N
THE WORK COMP SYSTEM, BUT IT'S
ALSO TRUE IN THE EM S¼ SYSTEM
OUT IN THE HOSPITALS, UM AND SO
ALONG THOSE LINES, I ASKED HIM
THE OTHER DAY. HEY CAN YOU GO TO
DINNER WITH ME? LET'S GO HANG
OUT. YOU KNOW HE'S OLD ENOUGH TO
GO HAVE A BEER AND A STEAK WITH
ME OR A PIECE OF SWORDFISH. AND
I SAID, UH, CAN YOU GO WITH ME
AND HE SAID, OH, I CAN'T I HAVE
MY QUARTERLY TELEHEALTH. ONLINE
TELEHEALTH MENTAL CHECK IN
APPOINTMENT TONIGHT. I CAN'T GO
AND I SAID, OH, THEN HE LOOKED
AT ME AND HE'S SMART, AND HE
SAID, YOU KNOW, THE UNION
PROVIDES THIS BENEFIT RIGHT AND
I GO. OF COURSE I KNOW THAT AND
HE SAID WELL. YOU TAKE ADVANTAGE
OF IT, DON'T YOU? THEY TEACH U
S¼ IN THE TOWER. AND OF COURSE,
HE SAW IT ON MY FACE. I HAD
NEVER TAKEN ADVANTAGE OF AND HE
SAYS I'M GONNA SIGN YOU UP
TOMORROW AND YOU'RE GONNA BE
AGAIN DOING WHAT I'M DOING AND
WHAT YOU'RE TEACHING, AND HE
BROKE DOWN STIGMA WITH ME.
STIGMA WITH ME. SO I DO A
QUARTERLY CHECK IN NOW. SO WE'VE
COME A LONG WAY. I THINK IN THE
STREETS WHEN YOU LOOK AT STREET
MEDICINE WHEN YOU LOOK AT
TRAINING CLINICIANS THROUGH ANY
TYPES OF PROGRAMS WHERE WE CAN
ACTUALLY BREAK DOWN, STIGMA BY,
UH AND SOMEBODY SAID YOU CAN'T
BE IT IF YOU CAN'T SEE IT. I
ALSO THINK IF YOU CAN'T SEE IT,
THEN YOU DON'T KNOW REALLY
WHAT'S GOING ON OUT IN THE
STREETS AND BREAKING DOWN STIGMA
HAS TO DO WITH GETTING PEOPLE
THAT CAN TALK TO PEOPLE THAT ARE
IN THESE SITUATIONS. AND BRING
THEM OUT OF THE CRACKS. UM AND
I'M GONNA TELL YOU PEOPLE ARE
DYING WITH THEIR RIGHTS PINNED
TO THEIR CHEST IN MY DISTRICT,
OK? THEY'RE LIVING AT STANDARDS
LESS THAN WILD ANIMALS IN THE
STREETS I WORK ON AND IF WE
DON'T DO SOMETHING DIFFERENT,
I'M SO ECSTATIC TO HEAR SENATOR
WEINER LEAVE THE CHARGE ON
SAYING WE GOTTA GET OUTSIDE THE
BOX. WE GOTTA DO SOMETHING
DIFFERENT. WHOEVER HEARD OF
STREET MEDICINE BEFORE. COMING
OUT, AND I WAS JUST TALKING
EARLIER. WE HAVE INDIVIDUALS
THAT LIVE ALONG THE METRO BLUE
LINE IN MY DISTRICT A TON OF
THEM. AND, UH, I'VE BEEN ABLE TO
WORK WITH. I DIDN'T KNOW OF
STREET MEDICINE, BUT CLINICIANS
THAT CAME OUT AND BROUGHT
PRESCRIPTIONS TO PEOPLE THAT ARE
CHALLENGED BEHAVIORAL ON THE
STREETS IN ADDICTION AND
DIFFERENT THINGS LIKE THAT. AND
ACTUALLY, ONCE THEY GOT THEIR
MEDICINES, THEY'RE NOT LEAVING.
THE TRAIN, UH, TRACKS BUT THEY
BECOME FUNCTIONAL. THEY CAN EAT.
THEY CAN TAKE CARE OF THEMSELVES
CLEAN THEMSELVES IN THAT
ENVIRONMENT, SO I THINK THAT
SPEAKS TO GETTING OUTSIDE THE
BOX. AND UH, ANYTHING WE CAN DO
TO BREAK DOWN THOSE BARRIERS
WILL HELP DELIVER THE CARE THAT
YOU'VE HEARD HERE TODAY. THANK
YOU SO MUCH FOR BRINGING UP
PROACTIV CARE THAT'S ABSOLUTELY
ESSENTIAL TO GETTING US TO OUR
GOALS AND HAVING THE PREVENTION
AND STARTING THEM YOUNG IN OUR
SCHOOLS WITH OUR KIDS. SOME
MEMORABLE KHAN AND THEN SOME,
WALTER. THANK YOU, SENATOR.
THANK YOU GUYS. ALL FOR BEING
HERE AND FOR THE SERVICES. YOU
PROVIDE, UM TO PEOPLE WHERE THEY
NEED IT MOST. I LOVE THE WAY YOU
FRAMED. UM YOU KNOW, MEETING
PEOPLE WHERE THEY A RE WITH
EMPATHY, ALL OF YOU. IT'S REALLY
SO CRITICAL THAT WE THINK ABOUT
THIS THAT WAY. AND I THINK YOU
KNOW WHEN I WAS YOUNG PEOPLE
DIED BY SUICIDE AND SILENCE.
PEOPLE DIDN'T TALK ABOUT IT. AND
THE FACT THAT WE'RE ALL HERE
TALKING ABOUT, YOU KNOW, PEOPLE
DYING ON OUR STREETS. UM AND
ELSEWHERE IS SO CRITICAL TO
MAKING SURE THAT WE SOLVE THIS
PROBLEM. UM SO ONE OF THE THINGS
I THINK THAT ASSEMBLY MEMBER
PELLER AND TOUCHED ON WHICH IS
REALLY CRITICAL IS THAT WE NEED
PEOPLE WHO ARE OUT THERE IN OUR
COMMUNITIES SERVING PEOPLE IN A
MENTAL HEALTH CAPACITY, AND I
THINK YOU KNOW WHETHER IT'S OUR
PHYSICIANS OR PHARMACISTS OR OUR
FIREFIGHTERS. YOU GUYS ARE ALL
UM YOU GUYS ARE OUT THERE
MEETING PEOPLE WHERE THEY ARE,
UH, ONE OF MY FIRE DEPARTMENTS
WORKED VERY CLOSELY WITH OUR
POLICE DEPARTMENT TO SAY, YOU
KNOW, WE'D HAD A COUPLE
INCIDENTS WHERE UM FORCE WAS
USED WITH PEOPLE IN MENTAL
HEALTH CRISIS AND THE POLICE ARE
THE FIRST TO SAY. THEY DO NOT
WANT TO BE THE ONES RESPONDING
IN A MENTAL HEALTH CRISIS, THEY
DON'T THEY ARE TRAINED. THEY
DON'T KNOW HOW TO DO IT, AND
THEY DON'T WANT TO DO IT. UM BUT
THEY ARE CURRENTLY THE ONLY
PEOPLE WHO ARE AVAILABLE TO
ANSWER THOSE CALLS. AND I KNOW
THAT OUR FIRE DEPARTMENTS ARE
REALLY STEPPING UP IN THAT WAY.
AND SO ONE OF MY DEPARTMENTS
ACTUALLY INSTITUTED A TRAINING
PROGRAM FOR THEIR EM S¼ FOLKS TO
MAKE SURE THAT WHEN THEY WENT
OUT ON THESE MENTAL HEALTH CALLS
THAT THEY COULD BE THE ONES WHO
RESPOND TO WHEN THEY RESPONDED.
THEY DID SO WITH ADEQUATE
TRAINING, AND SO I WANTED TO
TOUCH ON THAT, BECAUSE I THINK
YOU KNOW YOU'RE TALKING A LOT
CHIEF ABOUT, UM BEING THE ONES
WHO SERVE FOLKS ON THE STREETS
IN MENTAL HEALTH CRISIS, BUT I
THINK IT'S ALSO REALLY CRITICAL
TO TALK ABOUT HOW WE'RE TRAINING
UP. FIREFIGHTERS AND OUR EM S¼
FOLKS TO DO THAT, BECAUSE IT
ISN'T I BELIEVE A PART OF THE
FIRE ACADEMY TO LEARN HOW TO
TREAT PEOPLE IN MENTAL HEALTH
CRISIS. SO CAN YOU TOUCH ON WHAT
L A COUNTY IS DOING IN THAT
REGARD? WELL, UM THERE'S A
THERE'S A LOT THAT WE'RE DOING,
BUT WITH OUR RECRUIT
FIREFIGHTERS AND THEN IN OUR
TRAINING IN THE FIELD, UM I RAN
PROBABLY 20 TO 30 CALLS A SHIFT.
ON THE STREETS OF FLORENCE
FIRESTONE WS A BUSY SHOOTING
STABBINGS, CAR CRASHES,
DIABETICS, HEART ATTACKS, TAKE
YOUR PICK CANCER. BUT AT LEAST A
QUARTER 5 TO 7 OF MY CALLS PER
DAY. OUR MENTAL HEALTH COSTS.
ADDICTION. UM SOMETIMES THEY
JUST SEND THE ENGINE OUT, NOT
THE PARAMEDICS BECAUSE THE
DISPATCHER IS ABLE TO ASCERTAIN
THAT WE'RE NOT IN A CRISIS THAT
REQUIRES THE PARAMEDICS SO WE
CAN KEEP THE PARAMEDICS READY TO
GO SOMEWHERE ELSE AND WE GET
TRAINING ON HOW TO DEAL, UH,
WITH PATIENTS FROM A PSYCHIATRIC
POINT OF VIEW, THE OTHER THING
I'M GOING TO GIVE A LITTLE SHOUT
OUT FOR LAW ENFORCEMENT THERE'S
A LOT TO DO TO CLEAN UP. YOU
KNOW A LOT THAT'S GOING ON. BUT
MY LAW ENFORCEMENT BROTHERS AND
SISTERS, MANY OF WHOM COME FROM
MY DISTRICT UM, THEY HAVE MET
TEAMS AND PET TEAMS NOW AND WHEN
WE GET THEM OUT, UM, ONE OF THE
GREATEST TOOLS THAT WE HAVE IS
5150. WE USE IT AND WE'RE TRYING
NOT TO. WE TRY TO TALK TO THE
PATIENTS AND BRING RESOURCES
LIKE YOU'VE HEARD HERE TODAY
INTO THE PICTURE. AND OFTTIMES.
WE CAN DO THAT AND VOLUNTARILY
GET THEM TO NOT GO TO THE
EMERGENCY ROOM, CLEAR THEM VIA
TELEHEALTH AND TAKE THEM TO A
MENTAL HEALTH FACILITY OR TAKE
THEM TO A LOCATION WHERE I CAN
HOOK THEM UP WITH THREE JUSTICE.
UM AND SO WE'RE GETTING THAT
TRAINING AND LEARNING HOW TO DO
IT. THE MET TEAMS AND THE PET
TEAMS. THOSE ARE THROUGH THE LAW
ENFORCEMENT, UM, ENTITIES AND
THEY'VE DONE PRETTY GOOD WORK
WHEN THEY GET OUT ON SCENE. BUT
JUST FRANKLY, THE CALL VOLUME IS
TOO LARGE. LIKE EVERYTHING ELSE.
THERE'S JUST NOT ENOUGH
RESOURCES. YEAH. AND I WILL SAY,
UM, YOU KNOW, I CARRIED THE 98
BILL, AND I LIKE COUNTY IS WHAT
REALLY LEADING IN MANY WAYS AND
MENTAL HEALTH CRISIS RESPONSE,
SO I THINK IT'S GREAT. YOU'RE
HERE TO REALLY SHARE WHAT I LIKE
COUNTY IS DOING BECAUSE I THINK
THERE'S A LOT HAPPENING IN L A
THAT WE SHOULD RE REPLICATING
THROUGHOUT THE STATE. UM AND,
YES, MY LAW ENFORCEMENT AGENCIES
THAT HAVE THOSE TEAMS. THEY'RE
NOT EVEN ON 24 7 BECAUSE THEY
JUST DON'T HAVE THE RESOURCES TO
DO THAT RIGHT. AND MENTAL HEALTH
CRISIS DOESN'T GO TO SLEEP AT
NIGHT. UM SO I REALLY APPRECIATE
IT. I THINK YOU KNOW, I
MENTIONED IT EARLIER, BUT THE
STATISTICS AROUND THIS ARE JUST
SO STAGGERING. I WAS JUST
REVIEWING THE CDC DATA ON YOUTH.
MENTAL HEALTH CRISIS AND 20% OF
KIDS ARE THINKING ABOUT SUICIDE
AND 10% OF KIDS ARE ATTEMPTING
SUICIDE, ACCORDING TO THE CDC.
SO IT IS JUST STAGGERING. HOW
MANY PEOPLE ARE SUFFERING
AMONGST US, AND, UM, WE NEED TO
DO MORE, AND WE NEED TO MAKE
SURE THAT EVERYBODY WHO IS IN
THE MIDST OF PEOPLE WHO ARE
SUFFERING IS THERE TO SUPPORT
THEM AND GET THEM. SARAH THEY
NEED SO I WANT TO THANK ALL OF
YOU FOR BEING A PARTNER IN THAT.
GREAT SOME REMEMBER WALDRON AND
THEN SENATOR ALLEN. SENATOR
CORTESI. THANK YOU. I'LL JUST
TOUCH ON TWO THINGS REALLY
QUICK. UM THE FIREFIGHTER ISSUE.
THE FIRST RESPONDERS IS REALLY
CRITICAL ONE. MY SON IS AN EMT
FIREFIGHTER WITH CAL FIRE AND
YOU KNOW, I WORRY ALL THE TIME
ABOUT THAT TYPE OF THING. THEY
GO FROM ONE CALL TO THE OTHER.
THERE'S NO TIME IN BETWEEN THE
ADDRESS IT, UM AND I THINK THE
MORE YOU KNOW ORGANIZATIONS LIKE
THE CALIFORNIA TASK FORCE AND
BEHAVIORAL HEALTH THAT YOU'RE
WORKING WITH, UM THE COREY
IVERSON FOUNDATION WHEN COREY
IVERSON, THE FIREFIGHTER FROM MY
DISTRICT THAT DIED IN THE THOMAS
FIRE, UM, YOU KNOW, HIS WIFE IS
WORKING ON THAT SO CRITICALLY
IMPORTANT TO RAISE AWARENESS. OF
UM, REDUCING THE STIGMA LETTING
FOLKS KNOW THEY'RE NOT ALONE.
COMMUNICATION ASPECTS OF IT ARE
HUGE, AND THE STRONG SUPPORT
SYSTEMS ARE CRITICAL. UM BUT I
ALSO WANTED TO MENTION THAT I'VE
WORKED FOR MANY YEARS IN THE
INCARCERATED SPACE. AND THE LACK
OF SUPPORT AND TREATMENTS.
ACCESSIBILITY WHEN PEOPLE LEAVE
PRISON. IS STAGGERING AND ALL
THE WORK I'VE TRIED TO DO
THROUGH THE YEARS HAS BEEN ON
THAT REENTRY SIDE OF THINGS. UM
AHEAD TO BUILD THIS YEAR THAT
COULDN'T GET THROUGH A PROBES
BECAUSE IT COSTS MONEY. BUT
BASICALLY I WANTED TO SET UP A
DEPARTMENT THAT FOCUSED DIRECTLY
ON REENTRY SERVICES. AND BECAUSE
OF THE BUDGET ISSUES LIKE CAN'T
EVEN BE LOOKED AT. WE'RE TRYING
TO HIRE A INDIVIDUAL WHO WHO
WILL JUST FOCUS ON THAT? BECAUSE
I THINK IT'S SO CRITICALLY
IMPORTANT WITH THE MENTAL HEALTH
ISSUES BEHAVIORAL HEALTH THAT WE
CAN REDUCE RECIDIVISM AND BY A
SUBSTANTIAL AMOUNT OF WE SUPPORT
PEOPLE WHEN THEY LEAVE PRISON
INSTEAD OF JUST LEAVING THEM TO
MAYBE HOPE THAT THEY CAN ACCESS
A SERVICE THAT'S AVAILABLE. UM
YOU KNOW, WE'VE TRIED TO DO
INCENTIVES FOR JUSTICE INVOLVED
PERSONS TO STAY INTO TREATMENT.
REDUCING THEIR PAROLE TIME AND
THE OTHER END. THE LONGER THEY
STAY ON, UM FUNDING INTO COUNTY
JAIL SO THEY CAN GET SERVICES.
THEY'RE, UM MY BILL WAS
ACTUALLY, UM THE 90 DAY
ENROLLMENT INTO MEDICAL PRIOR TO
RELEASE FROM PRISON. UM THAT WAS
ROLLED INTO THE BUDGET AND TO
CALIMA AND STILL HAS NOT BEEN
IMPLEMENTED. UM CMS SUPPORTED
THAT THE FEDERAL SIDE FIRST
STATE IN THE NATION, AND WE NEED
TO MAKE SURE WE'RE ACCOUNTABLE
THAT WE CAN ACTUALLY GET THAT,
UM TO HAPPEN BECAUSE IT WILL BE
REALLY IMPORTANT, TOO.
STREAMLINE UM FOLKS COMING OUT
OF PRISON. THEY ACTUALLY HAVE
SOMEONE ALREADY AVAILABLE IN
MEDICAID MEDICAL THAT THEY CAN
ACCESS TREATMENT. BOTH FOR
BEHAVIORAL HEALTH. YOU KNOW,
SUBSTANCE USE AND ALSO MENTAL
HEALTH. SO. THANK YOU. SO, UM,
REMEMBER SENATOR ALLEN? WELL,
FIRST OF ALL, THANK YOU. THANK
YOU FOR THIS GREAT HEARING.
THANK YOU FOR THE DISCUSSIONS,
AND I LOVE YOUR STORY. UM DAVID,
ABOUT YOUR INTERACTION WITH THAT
MEMBER OF THE DEPARTMENT. HE WAS
CALLING YOU OUT. WE'RE NOT
TAKING ADVANTAGE OF THE SERVICE
AT THE IT'S A GREAT STORY, AND I
THINK IT'S SOMETHING JUST
RELATES TO THE VERY THEIR
HUMANNESS OF THIS AS WE ALL TRY
TO UM, NAVIGATE OUR INTERACTION
WITH THIS WITH THIS SYSTEM AND
ALL THE SUPPORTS THAT ARE OUT
THERE BUT THAT ARE OFTENTIMES.
UM YOU KNOW, FOR WHATEVER REASON
WERE NOT AS INCLINED TO ACCESS.
UM I WANTED TO JUST ASK ONE
QUESTION. UM, SPECIFICALLY TO
BRETT, YOU KNOW. UM IT'S MY
UNDERSTANDING THAT CALIFORNIA'S
CURRENT POLICY ONLY ALLOWS FOR
COUNTIES COUNTIES. TO PROVIDE
SERVICES TO THOSE WHO ARE
EXPERIENCING SEVERE MENTAL
ILLNESS. AND, UM SO CAN YOU GIVE
US A SENSE OF HOW, UM YOU KNOW,
IN LOS ANGELES AND MAYBE MAYBE
MR GIAMATTI CAN SPEAK TO THIS OR
I'M DR VALUE AS WELL. BUT BUT
SPECIFICALLY TO LOS ANGELES HOW
THE COUNTY IS MEETING THOSE
NEEDS AND WHAT SORT OF GAPS THAT
WE SHOULD WORK ON TO ENSURE
NETWORK ADEQUACY FOR FOLKS WITH
SECURITY. NOW THE ILLNESS AND
YOU KNOW. I MEAN, I GUESS STREET
MEDICINE TEAMS SUCH AS YOURS.
EVEN IF YOU HAVE A PSYCHIATRIST,
YOU'RE NOT ALLOWED TO PROVIDE
DIRECT SERVICES. AND SO COULD
YOU WALK US THROUGH THAT? THE
RATIONALE BEHIND IT, WHETHER WE
OUGHT TO LOOK AT CHANGES IN THAT
DIRECTION AND I LOVE TO HEAR
ABOUT IT. YEAH, THANK YOU. IF
THERE'S ONE THING THAT I'D LIKE
TO GET IT WOULD BE THAT PLACES
LIKE LIKE, YOU KNOW, VENISON AND
CLINIC AND I'M JUST THINKING
ABOUT, YOU KNOW, UM, WESTSIDE
FAMILY HEALTH CENTER, ANYWAY.
SORRY YEAH, NO, NO. IF THERE'S
IF, AS IT RELATES TO BEHAVIOR
HEALTH IF THERE'S ONE THING THAT
WOULD HELP, IT WOULD BE CHANGING
THAT. AND THE REASON IS BECAUSE
UM AND I MENTIONED IN THE
BEGINNING WE RUN THE CALIFORNIA
STUDY MEDICINE COLLABORATIVE
WITH 130 ORGANIZATIONS, SO WE
HAVE A SENSE OF WHAT'S GOING ON
ACROSS THE STATE. IN ADDITION TO
L, A AND SO BUT IN L, A
SPECIFICALLY WHERE WE HAVE THE
MH, WHICH IS. PRETTY LIKE
PROBABLY THE MOST EXTENSIVE DMH.
I WOULD GUESS. THEY HAVE HOW
THEY ADDRESS PEOPLE EXPERIENCING
, UH, UNSHELTERED. HOMELESSNESS
IS WITH THEIR HOME TEAMS. AND
THEY FOCUS MOSTLY ON, UH
CONSERVING FOLKS. AND SO IF
YOU'RE NOT READY TO BE CONSERVED
, THERE'S NOT A WAY TO PROVIDE
ONGOING CARE. UM AND THEY'RE
ONLY AND EACH TEAM ONLY TAKES
CARE OF A VERY SMALL AMOUNT OF
PEOPLE. AND SO THE VAST MAJORITY
ARE NOT BEING SERVED AT ALL. UM
WHICH IS WHY OUR TEAMS ARE
PROVIDING THE HIGHEST LEVEL OF
CARE THAT WE CAN PROVIDE. UM AND
SO WE IN IN ONE OF OUR STATEWIDE
MEETINGS, WE WERE TALKING ABOUT
HOW SOME OF US, INCLUDING USC,
BUT OTHERS EMPLOYEE
PSYCHIATRISTS. UM AND USE THEM
TO HELP US WITH OUR MOST SEVERE
PATIENTS MAKE A DIAGNOSIS AND A
TREATMENT PLAN. BUT THEN IT'S
CARRIED OUT BY THE REST OF THE
OF THE PRIMARY CARE TEAM. UM BUT
FOLKS AREN'T WILLING TO HIRE
MORE BECAUSE THEY CAN'T GET
REIMBURSED FOR IT. SO WE REALLY
NEED TO OPEN UP THE DOOR FOR
ANYBODY WANTING TO PROVIDE
PSYCHIATRIC SERVICES ON THE
STREET TO BE ABLE TO DO SO. SO
CAN YOU WALK ME THROUGH WHY THE
RULES ARE THE WAY THEY ARE. DO
YOUR BEST UNDERSTANDING. MY BEST
UNDERSTANDING AND I DO STREET
MEDICINE, SO I'M NOT, UH, WRITE
AN EXPERT IN THIS STUFF, BUT MY
BEST UNDERSTANDING IT WAS THE,
UM THAT THERE'S SOMETHING IN
PLACE. MAYBE IT'S THAT MH ESSAY
THAT MAKES IT THAT THAT PUT THE
COUNTIES IN CHARGE OF THIS AND
SO THE COUNTIES CAN BUILD FOR
SERIOUS MENTAL ILLNESS, BUT ONLY
THE COUNTIES AND SO FOR THE REST
OF US THAT WANT TO PROVIDE CARE
THAT WE ARE PROVIDING CARE FOR
THE SAME. UH DIAGNOSES BUT CAN'T
GET REIMBURSED FOR IT. AND CAN
YOU BE? YOU CAN'T ACT AS A AS A
CONTRACTOR, AGENT OR A SERVICE
OR TO THE COUNTIES AND GET
REIMBURSED THROUGH THE COUNTIES.
SO IF HAPPENS IN SO MANY OTHER
CONTEXT. SO WE'VE TALKED ABOUT
THAT WITH DIFFERENT COUNTIES
ACROSS THE STATE, AND IT COMES
DOWN TO THERE HAVING TROUBLE
FUNDING THEIR OWN STUFF. UM AND
YOU KNOW, SUBCONTRACTING WITH US
WOULD MEAN WE WOULD HAVE TO
SHARE THE SAME POT OF MONEY. IS
THAT YOUR UNDERSTANDING AS WELL,
MR GILARDI? SIMILAR EARLY. WE
HAVE THIS ALTERNATIVE TRANSPORT
DESTINATION PILOT PROGRAM, SAN
FRANCISCO WAS FIRST DEPARTMENT
IN THE NATION TO TRY IT. WE HAVE
NURSE PRACTITIONERS AND
PARAMEDICS ON HER RIGS OR
DOCTORS, MEDICAL DOCTORS. WE
HAVE THREE MEDICAL DOCTORS ON
OUR DEPARTMENT. WE'RE FORTUNATE
IN THAT WAY. AND OUR WHOLE
PROGRAM. IT'S FUNDED BY OUR
DEPARTMENT. EVEN THOUGH THE
COUNTIES COULD REIMBURSE THERE'S
NO IN YOUR COUNTY, A COUNTY
DEPARTMENT, BUT WHAT WE ARE
DOING AND I THINK OPENING
EVERYBODY'S EYES, TOO, IS WHEN
YOU LOOK AT MEDICARE AND HMM.
BUILDING THAT WE CAN GET
FEDERALLY. UM YOU KNOW, IF YOU
HAD A MEDICAL ISSUE IN THE
FIELD, WE CAN GET REIMBURSED FOR
THAT CALL. WHY ARE WE NOT
GETTING REIMBURSED? THROUGH
MEDICARE FOR A MENTAL HEALTH.
CALL. THAT WE TAKE A PATIENT TO
AN ALTERNATIVE TRANSPORT
DESTINATION OR TO A CLINIC WHERE
THEY CAN GET THE CARE THAT'S
DIFFERENT THAN THE EMERGENCY
ROOM. WE ONLY GET IT IF WE GO TO
THE EMERGENCY ROOM, BREAKING
DOWN BARRIERS ON HOW WE ACTUALLY
RUN THE CALLS. THE FOLLOW UP TO
THAT IS HOW WE CAN GET FUNDING
AND PAYMENT FOR THAT. IS IT TOO?
WE'VE BEEN SPENDING A TON OF
MONEY FROM THE STATE ON
HOMELESS, HOMELESSNESS, HOMELESS
SERVICES. THERE'S NOT ENOUGH
MONEY. I MEAN, WHAT WHAT? WHAT
ARE SOME OF THE RECENT? WHAT IS
IT? $15 BILLION OF 13 TO $15
BILLION RECENT ALLOCATIONS FROM
THE STATE. NONE OF IS IT ANY OF
IT GOING TO THIS SERVICES AND UM
WHY WHAT'S STOPPING EVERYONE
FROM HAVING ADEQUATE FUNDING TO
ADDRESS THESE CHALLENGES? YEAH
SO FOR STREET MEDICINE, UM AND
IN PARTICULAR A LOT OF OUR
PROGRAMS, SO WHEN I STARTED, UH,
THIS PROGRAM IN 2018 WE WERE THE
SECOND IN LOS ANGELES AND THE
SIXTH IN THE STATE. NOW THERE'S
AT LEAST 14 IN LOS ANGELES AND
57 IN THE STATE. AND MOST OF
THAT GROWTH HAS BEEN BECAUSE OF
A LOT OF THE FUNDING THAT THAT
WAS MADE AVAILABLE FROM, UH, D.
H C S, AND IT WAS KIND OF IT WAS
SHORT TERM CAPACITY BUILDING
FUNDING A LOT OF IT LIKE A CHEP
HOUSING AND HOMELESS INCENTIVE
PROGRAM IS DUE TO EXPIRE IN
ABOUT A YEAR AND A HALF. AND SO
WE'RE WORKING AS QUICKLY AS WE
CAN TO GET CONTRACTS IN PLACE
WITH THE MANAGED CARE
ORGANIZATIONS SO THAT WE DON'T
HIT THIS CLIFF AND HAVE TO THINK
ABOUT, YOU KNOW, NOT TREATING
THE PEOPLE THAT THAT ALL THESE
PROGRAMS HAVE BEEN TREATING, AND
SO WE'VE BEEN TRYING TO
NEGOTIATE WITH THE PLANS. UM THE
RATES HAVEN'T THAT MOST OF THEM
ARE JUST OFFERING STANDARD RATES
AND THERE'S A NUMBER OF REASONS
IF YOU'RE INTERESTED IN WHY THE
EQUITABLE THING TO DO WOULD BE
FIRST STREET MEDICINE TO GET
REIMBURSE MORE? UM SO THAT'S THE
THAT'S EVERYTHING WITHIN
MEDICAL. BUT THEN THERE'S ALL
THIS STUFF THAT WE DO OUTSIDE OF
MEDICAL. SO FOR EXAMPLE, THE
CRISIS RESPONSE STUFF MEDICAL IS
WHEN YOU GO TO AN INDIVIDUAL WHO
HOLDS INSURANCE IN A SPECIFIC
PLAN THAT YOU HAVE A CONTRACT
WITH THAT YOU'RE WILLING TO
BUILD. BUT UH, CRISIS CALL
DOESN'T FUNCTION LIKE THAT. AND
SO PRESUMABLY, IT SHOULD BE
FUNDED OUT OF THESE COLLECTIVE.
AND PRETTY ROBUST STATE FUNDING
EFFORTS. AYE. THROUGH THE
COUNTIES AND LOCALS AND. YEAH I
THINK SO. BECAUSE UM, YOU CAN'T.
UH ASK A STREET MEDICINE TEAM
WHO RELIED JUST LIKE YOU CAN'T
ASK A CLINIC WHO'S RELYING ON
BILLING FOR MANAGED CARE TO
RESPOND TO PEOPLE THAT THERE UH,
NOT, YOU KNOW, UNDER CONTRACT
WITH AND SO THAT'S WHAT WE WOULD
BE DOING IN ST MEDICINE, WHICH
WE ACTUALLY DO NOW, BUT IT'S NOT
A SUSTAINABLE MODEL. IDEALLY
THERE'D BE SOMEONE WHO GOES AND
TRIES TO MAKE SURE WE'RE
COLLECTING WHATEVER WE CAN FROM
THE FEDERAL GOVERNMENT TO HELP
AT LEAST OFFSET SOME OF THE
MEDIC, YOU KNOW. MEDICAID
RELATED COSTS OR MEDICARE. UM.
GEE, OKAY, WELL, UH. IT DOES
SEEM, IS THAT SEE THIS SEEMS
LIKE AN AREA THAT NEEDS SOME
WORK ON OUR SIDE. AND YET, MR
JOHNNY, I'D LOVE TO HEAR
SOMETHING REAL QUICK AND I KNOW
WE'RE SHORT ON TIME, BUT I THINK
GETTING, UM THE SERVICES WERE
TALKING ABOUT HERE, WHICH HAS
SENATOR WEINER SAID, IS THERE
NOT IN THE BOX? IF I WERE TO GO
OUT AND RUN A CALL AND TAKE THAT
MENTALLY A PATIENT WITH ALL THE
ISSUES THAT COULD BE TREATED BY
THE STREET MEDICINE OR
ALTERNATIVE TRANSPORT
DESTINATION, AND I TAKE THEM TO
THE EMERGENCY ROOM. I GET FULL
REIMBURSEMENT. WHERE'S THE
INCENTIVE TO REACH OUT TO THE
STREET MEDICINE HAVE THEM ON THE
ROLES. WHERE IS THE INCENTIVE TO
NOT TAKE THEM TO THE EMERGENCY
ROOM AND GET THEM TO THE
ALTERNATIVE TRANSPORT
DESTINATIONS? MENTAL HEALTH
FACILITIES, DRUG ADDICTION
CENTERS WHEN IN REALITY IF WE'RE
DOING THESE THINGS THAT WE'RE
TALKING ABOUT HERE TODAY. WE
WILL NOT HAVE THE COST OF THE
EMERGENCY SERVICES RESPONDING TO
THEM AND TAKING THEM TO THE
EMERGENCY ROOM. THINK ABOUT THE
OFFSET THAT'S THERE. AND I THINK
WE'RE GOING TO HAVE TO GET
OUTSIDE THE BOX LIKE THE SENATOR
SAID TO SAY WE'RE GOING TO
APPROVE SOME PROGRAMS THAT
AREN'T IN THE BOX. AND WE'RE
GONNA GET REIMBURSEMENT FOR IT.
AND THEN LET'S STUDY WHAT WORKS
AND WHAT DOESN'T AND MAKE SURE
THAT WE KEEP FUNDING. WHAT'S
WORKING. YEAH. AND IF I CAN JUST
ADD ONE MORE IMPORTANT THING
THERE AT A DISTINCT DISADVANTAGE
, BECAUSE RIGHT NOW WHEN THEY
GET, UM, CALLED TO A CRISIS
RESPONSE, THERE'S TWO OPTIONS
NUMBER ONE. THIS IS NOT A
CRISIS, IN WHICH CASE THEY LEAVE
THE PERSON. THERE BUT SOMETHING
PROBABLY PROMPTED THE CALL. UM
OR IT IS A CRISIS IN WHICH CASE
THEY TRANSPORT THEM. THE
HOSPITAL KEEPS THEM FOR ONE DAY
OR THREE DAYS, AND THEN THEY GO
BACK OUT ONTO THE STREET. AND
BOTH RESULT IN THE PERSON BACK
OUT ONTO THE STREET WITHOUT
RELIABLE CONNECTION TO CARE. AND
SO THAT'S THAT'S REALLY STREET
MEDICINES ROLE IS THEY WOULD
REFER TO US AND WE WOULD
CONTINUE CARE. WE'RE GOING TO
HAVE TO MOVE QUICKLY BECAUSE
OKAY, I JUST I LOVE TO WORK ON
THIS. WE THE ASSEMBLY GOES INTO
SESSION AT ONCE. YEAH, THANK
YOU. UM, GENEROSITY. WELL, I CAN
BE VERY QUICK. I JUST HELLO,
PRESIDENT SALEH. IT'S NICE TO
SEE YOU. I JUST SAT WANTED TO
SAY TO MY COLLEAGUES REALLY THAT
I HAVE SB 1180. WHICH DEALS WITH
THIS ISSUE AND ALLOWS MEDICAL
REIMBURSEMENT FOR AMBULANCES TO
DROP OFF THAT ALTERNATE SITES
THERE ARE MORE APPROPRIATE FOR
MENTAL HEALTH AND BEHAVIORAL
HEALTH SERVICES. SO ANY OF YOU
WHO WOULD LIKE TO SIGN ONTO THAT
BILL WITH ME CO AUTHOR LOVE TO
HAVE YOU JUST JUST HOLLER AT ME.
LET MY OFFICE KNOW THERE'S NO
WAY TO STOP THE REVOLVING DOOR
NATURE OF THIS IF WE JUST DROP
PEOPLE OFF AT THE EMERGENCY
ROOM, MY HUSBAND RUNS THE LOCAL
EMERGENCY ROOM IN SACRAMENTO.
ALL HE CAN DO IS HOLD THEM FOR A
LITTLE WHILE AND THEN RELEASE
THEM AND THEN YOU CAN BRING THEM
BACK IF WE REALLY WANT TO STOP
THAT AND BE EFFECTIVE AND WE
NEED MORE THAN 988, WE NEED MORE
THAN STREET MEDICINE. WE NEED
LONGER TERM SERVICE PROVISION.
AND PEOPLE WHO WRITE OUT A PLAN
FOR SUCCESS. AND THERE IS NO
REASON WHY FIREFIGHTERS WOULD
DROP SOMEBODY OFF WHEN THEY
CAN'T BE REIMBURSED FOR THAT
CALL. IT'S NOT A FAIR THING TO
ASK THEM TO DO, ALTHOUGH MANY OF
THEM ARE DOING IT. MANY OF THEM
ARE SACRAMENTO, I KNOW IS DOING
THAT. I'M SURE ELLA IS TOO. BUT
IT IS NOT A SUSTAINABLE PROGRAM.
AND THERE'S NO REASON FOR IT TO
FUNCTION THAT WAY. SO THANK YOU
ALL VERY MUCH FOR YOUR WORK. AND
I'M HONORED TO CARRY THAT BILL
AND I WOULD LOVE TO HAVE ANY OF
YOU SIGN ON. THANK YOU, SENATOR.
AND THE FINAL QUESTIONS OR
COMMENTS? YES, SENATOR COURTESY.
THANK YOU, MR CHAIR. JUST
QUESTION FOR MR FILMING IN. YOU
KNOW, A SHORT ANSWER IS FINE, IF
IT'S TOO COMPLEX YOU KNOW, FOR
TODAY'S HEARING, WE COULD TALK
AFTERWARDS AND CONNECT WITH MY
OFFICE. BUT UM. YOU KNOW WE WERE
DOING BELLY MEDICAL CENTER TO
BECAUSE THE SECOND LARGEST
PUBLIC HEALTH AND HOSPITAL
SYSTEM IN THE STATE IN MY COUNTY
IN MY DISTRICT. AND WHY WAS THE
COUNTY SUPERVISOR? BACK IN 2014
WE WERE DOING IN THE LARGEST
ENCAMPMENTS. WHAT? YOU'RE
CALLING STREET MEDICINE. NOW, I
THINK FROM AND I. PARTICIPATED
IN THAT, YOU KNOW, AS AN
OBSERVER AND SHADOWING WHAT WAS
GOING ON. THE HEARTBREAKING
THING WAS THAT WE WOULD GET
FOLKS, UM. LIKE YOU'RE
DESCRIBING INTO PATIENT POSITION
RELATIONSHIP ON A FIRST NAME
BASIS WHERE THEY WOULD BE
VISITED IN THEIR TENSOR. LARGE
ENCAMPMENTS LIKE THE SO CALLED
JUNGLE. WE GET HIM ON THE EPIC
SYSTEM. UM WHO WOULD HAVE A FILE
ON THEM, AND THEN THEY'D BE
SWEPT. UM AND ALL OF A SUDDEN
WE'VE GOT NO CONTACT AGAIN AND
THAT THAT HAS BEEN A RECURRING
ISSUE. IN THE 10 YEARS SINCE
2014 WHEN WE FIRST STARTED DOING
THAT, HOW DO YOU DEAL WITH THAT?
YEAH, IT IS A HUGE ISSUE, AND
THERE WAS JUST A STUDY PUBLISHED
THAT IT ACTUALLY INCREASES
MORTALITY WHENEVER THERE'S A
SWEEP. UM A NUMBER OF THINGS,
ONE. THAT'S THIRD PART OF THE
WORK OF THE COMMUNITY HEALTH
WORKERS. AS WE DO IT, WE CALL IT
A HOMELESS ADVANCED DIRECTIVE
WHERE WE ASKED THEM. IF YOU WERE
TO MOVE WHERE TWO PLACES YOU'D
BE. UM, AND THEN, UH AND THEN
ALSO WE TRY AND FIGURE OUT WHAT
THEIR DAILY ROUTINE IS. JUST
LIKE JUST LIKE YOU AND I. THEY
HAVE A DAILY ROUTINE. SO IF
THEIR ENCAMPMENT GETS MOVED, BUT
I KNOW THAT THEY'RE GOING TO
PANHANDLE ON A CERTAIN CORNER AT
NOON. I'LL JUST MEET HIM THERE
AT NOON. WE STILL SOMETIMES YOU
CAN'T FIND FOLKS, BUT IT HELPS.
THANK YOU. THANK YOU VERY MUCH.
OKAY WE'LL GO TO OUR FINAL. UH,
PANEL. UM. AND DO YOU WANT TO
CALL THAT? YEP OUR NEXT PANEL.
OUR FINAL PANEL IS NEW
DEVELOPMENTS. PROMISE IS PROMISE
OF THE PIPELINE PANEL. UM WE
APPRECIATE EVERYONE AND WE WOULD
LIKE TO CALL THE NEXT PANEL UP.
AH MISS COMPA RAMIREZ. AH! UH,
AND MISS. UH CLARK HARVEY. AND
ARE YOU MAY BEGIN WHEN YOU'RE
READY. THANK YOU. APPRECIATE
YOU, MR CHAIR. THANK YOU SO MUCH
TO ALL OF THE MEMBERS HERE TODAY
WE WILL, IN THE ESSENCE OF TIME.
BE BRIEF. UM, GOOD AFTERNOON.
SALLY CAMPER RAMIREZ HERE ON
BEHALF OF CALIFORNIA LIFE
SCIENCES. WE SERVE AS A TRADE
ASSOCIATION FOR THE COMPANIES
AND RESEARCH INSTITUTIONS THAT
ARE DOING THE INNOVATIVE WORK IN
THE MENTAL HEALTH SPACE. UM
THANK YOU AGAIN FOR THE
OPPORTUNITY TO PROVIDE COMMENTS
HERE TODAY. UM, WE'VE HEARD FROM
OUR PRIOR SPEAKERS. ABOUT THE
CHALLENGES SURROUNDING MENTAL
HEALTH AND THE SEVERE SCOPE OF
THE PROBLEM. RESEARCH IN THIS
FIELD IS EQUALLY CHALLENGING.
THE BRAIN IS COMPLICATED AND
KNOWING HOW TO ADDRESS MANY OF
OUR MENTAL HEALTH CHALLENGES
WITHOUT ADVERSE SIDE EFFECTS HAS
STYMIED RESEARCHERS AND
FRUSTRATED PATIENTS. FOR YEARS.
WE HEARD A COUPLE OF PRIOR
SPEAKERS TALK ABOUT THE STIGMA
AROUND MENTAL ILLNESS IS
OFTENTIMES NOT TAKEN A SERIOUS
AS PHYSICAL ILLNESSES AND IN
MANY CULTURES. MENTAL HEALTH IS
STILL VERY MUCH TABOO, MAKING IT
DIFFICULT FOR THOSE SUFFERING
FROM IT TO GET THE HELP THEY
NEED. HOWEVER WE DO HAVE SOME
LOT OF PROMISING, UM, TECHNOLOGY
THROUGH THE PIPELINE. WE'RE
OPTIMISTIC THAT THERE ARE NEW
PRODUCTS THAT ARE BEING YIELDED.
THAT CAN CHANGE THE LIVES OF
PATIENTS SUFFERING FROM A
VARIETY OF MENTAL HEALTH
CONDITIONS, SO I WANT TO JUST
DIVE BRIEFLY INTO WHAT THIS
INDUSTRY IS SEEING AND WHAT'S
COMING DOWN THE PIPELINE. WE'RE
SEEING A LOT OF SIGNIFICANT
PROGRESS IN THIS SPACE. OVER THE
PAST DECADE, BIOTECH COMPANIES
HAVE MADE TREMENDOUS STRIDES
TOWARD UNDERSTANDING MENTAL
ILLNESSES AND DEVELOPING
INNOVATIVE TREATMENTS. BY
LEVERAGING A GROWING SCIENTIFIC
UNDERSTANDING OF THE BRAIN.
RESEARCHERS ARE DEVELOPING NEW
TREATMENTS AND BRINGING
THERAPEUTIC ADVANCES FOR
PATIENTS WHO ARE NOT HELPED BY
CURRENT STANDARDS OF CARE. ARE
THOSE EXPERIENCING NEGATIVE SIDE
EFFECTS. SO, FOR INSTANCE, WE
CURRENTLY HAVE APPROXIMATELY 160
MEDICINES THAT ARE IN
DEVELOPMENT THAT ARE TARGETING
COMMON MENTAL ILLNESSES, ALL OF
WHICH ARE IN CLINICAL TRIALS ARE
AWAITING REVIEW BY THE FDA. WE
HEARD SOME ASTONISHING FACTS
EARLIER. SOME OF THE NUMBERS WE
HAVE 54 MEDICATIONS THAT ARE
CURRENTLY IN THE PIPELINE FOR
DEPRESSION, WHICH AFFECTS ABOUT
8.4% OF ADULTS AND 17% OF
ADOLESCENTS IN THE U. S WE HAVE
35 IN THE PIPELINE FOR
SCHIZOPHRENIA 35 FOR ANXIETY
DISORDERS, WHICH WE KNOW THAT
MORE THAN A THIRD OF ADULTS IN
THE U. S AND UM MANY ADOLESCENTS
EXPERIENCE ANXIETY DURING THEIR
LIFETIME. WE HAVE 33 FOR
SUBSTANCE ABUSE DISORDERS. 13
FOR BIPOLAR EIGHT FOR ATTENTION
DEFICIT HYPERACTIVITY DISORDER,
80 HD, WHICH IS ONE OF THE MOST
COMMON CHILDHOOD DISORDERS
AFFECTING A COMBINED NEARLY 20%
OF CHILDREN AND ADOLESCENTS IN
THE U. S NOW, AS MENTIONED
EARLIER. AND DR MCCARRON TALKED
ABOUT CALIFORNIA BEING A LEADER.
UM AND WE ARE AS WELL WHEN IT
COMES TO NEUROLOGIC,
NEUROLOGICAL RESEARCH AND
UNDERSTANDING. UM THE BRAIN IS
KEY TO UNDERSTANDING MENTAL
HEALTH DISORDERS. SO WE'RE GLAD
THAT IN CALIFORNIA WE'RE VERY,
VERY PROUD THAT WE HAVE OVER 60
COMPANIES THAT ARE WORKING ON
LATER STAGE MENTAL HEALTH
MEDICATIONS. FOR THESE
CONDITIONS. UM ONE OF OUR MEMBER
COMPANIES IN SAN DIEGO IS
INVESTING $2 BILLION AND THEN
YOU FACILITY THEY HAVE OVER
600,000 SQUARE FEET OF LAB SPACE
OR WORKING ON YOUR SCIENCE,
RESEARCH AND DEVELOPMENT. WE
HAVE COMPANIES WORKING FOR ON
DEVELOPING MEDICATIONS FOR
CONDITIONS THAT HAVE NEVER BEEN
TREATED BEFORE, LIKE AN ADONIA,
WHICH IS THE INABILITY TO FEEL
JOY OR PLEASURE. UM AND THERE'S
A STRONG FOCUS ON QUALITY OF
LIFE, WHICH I REALLY WANT TO
POINT TO. BECAUSE REALLY WHAT
WE'VE SEEN. IN THE LAST FEW
YEARS. WE'VE SEEN MEDICATIONS
THAT REALLY ARE GAME CHANGERS IN
THE QUALITY OF LIFE FOR
PATIENTS. SO, FOR EXAMPLE, WE'VE
SEEN LONG ACTING INJECTABLES
WHICH HAVE COME IN AND INSTEAD
OF HAVING TO DO LIKE ORAL
TREATMENTS ARE HAVING TO GO IN
TO THE TO THE HOSPITAL TO THE
CARE FACILITY. UH EVERY DAY OR
WEEKLY MONTHLY. THESE
MEDICATIONS NOW THROUGH THE
INJECTABLES CAN BE DONE LIKE
EVERY THREE MONTHS, FOR EXAMPLE.
UM WHERE WE'VE REALLY SEEN THIS,
AND I KNOW THAT THERE HAS BEEN
SOME CONVERSATION AROUND.
MATERNAL MENTAL HEALTH AND JUST
HOW PREVALENT THAT'S BEEN. UM
WE'RE VERY PROUD THAT ONE OF OUR
MEMBER COMPANIES JUST IN OUR IN
AUGUST OF LAST YEAR, ANNOUNCED
THE FIRST ORAL MEDICATION FOR
ADULTS WITH POSTPARTUM
DEPRESSION. UM THE DRUG TURIN
ALONE WAS APPROVED BY THE FDA.
YEAH IT'S A 14 DAY TREATMENT.
THAT'S ORAL. UM WHICH IS AGAIN
JUST A GAME CHANGER COMPARED TO
WHAT WE'RE WE'VE BEEN IN THE
PAST. UM POSTPARTUM MEDICATION
HAS BEEN OFF LABEL MEDICATIONS.
IT'S BEEN MONTHS AND MONTHS AT
THE EARLIEST. YOU'D START TO SEE
CHANGES ISN'T ABOUT SIX WEEKS
BUT COULD TAKE MONTHS TO REALLY
SEE SOME SOME CHANGE. AND SO FOR
MOTHERS WHO ARE NURSING, YOU
KNOW THEY'D HAVE TO STOP
NURSING. COMPLETELY JUST OUT OF
OPTIONS. AND WITH THE TREATMENT
LIKE THIS, IT'S 14 DAYS. IT'S
ORAL. IT'S SHORT WOMEN CAN CAN
RESUME NURSING AFTERWARDS. THEY
SO WISH, SO JUST REALLY SOME
SIGNIFICANT CHANGES AND WHAT
WE'RE SEEING. UM AGAIN SOME SOME
STATS THAT WERE MENTIONED
EARLIER ALREADY AROUND MENTAL
HEALTH, SO I WON'T WILL SKIP
THAT IN THE ESSENCE OF TIME, BUT
WANTED TO FLAG THAT WE'RE ALSO
LOOKING BEYOND TRADITIONAL
PHARMACOLOGY, AND WE'RE TRYING
TO REALLY MEET PEOPLE WHERE THEY
ARE WITH MAJOR INVESTMENTS IN
PRESCRIPTION DIGITAL
THERAPEUTICS. THESE DIGITAL
APPLICATIONS ARE APPROVED
THROUGH THE FDA. THEY'RE
SUPPORTED BY REAL WORLD CLINICAL
EVIDENCE. JUST LIKE ANY OTHER
DRUG THAT GOES THROUGH THE FDA
APPROVAL PROCESS. UM WHEN THESE
ARE SOFTWARE BASED THERAPIES
THAT ARE USED TO TREAT AND
MANAGE A BROAD SPECTRUM OF
DISEASES AND DISORDERS, THEY CAN
IMPROVE PATIENT HEALTH REDUCE
THE COST OF HEALTH CARE, WHICH
WAS TALKED ABOUT EARLIER,
ESPECIALLY IN THIS SPACE. WE'RE
ALSO UTILIZING AI. WE'VE HEARD A
LOT ABOUT A I AS FAR AS YOU
KNOW, LIKE, THE CHAP, GPT AND
OTHERS, BUT WE HAVE SO MUCH OF
THIS IN THE HEALTHCARE SPACE AND
IT'S BEEN AROUND A I HAS BEEN
AROUND SINCE THE EIGHTIES IN THE
HEALTHCARE SPACE, AND WE'RE
EXCITED TO SEE THAT A LOT OF OUR
RESEARCH INSTITUTIONS ARE REALLY
UTILIZING IT TO UNDERSTAND THE
BRAIN BETTER THAN EVER AND TO
REALLY GET INTO THE Y. BEHIND A
LOT OF THESE MENTAL HEALTH
DISORDER, SO WE'RE VERY EXCITED
TO WHAT THE PROMISE OF A I CAN
REALLY LEAD TO IN MENTAL HEALTH
SPACE. UM SOME OF THE STATE
INVESTMENTS WERE I MENTIONED
EARLIER. I KNOW. UM MISS
FARRAKHAN'S BILL WAS DISCUSSED
WITH 988. WE WERE EXCITED TO SEE
THAT WE'VE SEEN WE'RE JUST
HARDENED OVERALL THAT OVER THE
PAST 10 YEARS OR SO WE'VE SEEN
SIGNIFICANT INVESTMENTS. UM AND
THEN, MORE RECENTLY, THE
GOVERNOR'S MENTAL HEALTH
MOVEMENT, HELPING TO BUILD
NEARLY 25,000 BEDS IN UNITS
NEARLY 46,000 TREATMENT SLOTS,
INCLUDING INPATIENT OUTPATIENT
AND COUNSELING. UM $5 BILLION TO
TRAIN AND SUPPORT. WE TALKED
ABOUT HEALTH CARE WORKERS
EARLIER 65,000 HEALTHCARE
WORKERS OVER THE NEXT FIVE YEARS
. UM, SO ALL OF THIS, COUPLED
WITH WHAT WE'RE SEEING COMING UP
WITH PROP ONE. WE'RE HOPING THAT
ALL OF THESE INVESTMENTS AND
MENTAL HEALTH SERVICES WILL ONLY
CONTINUE TO ADDRESS PREVENTION,
EARLY INTERVENTION, THE
TECHNOLOGY AND TRAINING THAT WE
NEED. SO WITH THAT, UM I'LL JUST
STAY. OUR BIOTECH AND RESEARCH
INSTITUTIONS ARE COMMITTED TO
ADDRESSING THE STIGMA OF MENTAL
HEALTH AND ILLNESS AND
RESEARCHING AND DEVELOPING
MEDICINES TO IMPROVE THE HEALTH
AND WELL BEING. OF THOSE
STRUGGLING WITH THESE ILLNESSES.
THE TREATMENTS AND DEVELOPMENT
TODAY REPRESENT THE CONTINUED
COMMITMENT OF OUR INDUSTRY TO
ADVANCE NEW THERAPIES FOR A WIDE
RANGE OF MENTAL MENTAL ILLNESSES
IN THE DIVERSE PATIENT
POPULATIONS IMPACTED BY THEM. SO
THAT CONCLUDES MY REMARKS. THANK
YOU. ALRIGHT I HAVE 10 SECONDS.
YEAH, LOVED. PLEASE DO HOLD ON A
FEW MINUTES. SO GREETINGS, MR
CHAIR AND THE MEMBERS WHO HAVE
STAYED. I KNOW YOU HAVE A BUSY
SCHEDULE IN PLACES TO GO, BUT I
APPRECIATE YOUR COMMITMENT TO
HEARING US THROUGH. I'M DR
LEANDRO CLARK. HARVEY I'M A
PSYCHOLOGIST BY TRADE. I'M THE
CEO OF THE CALIFORNIA COUNCIL OF
COMMUNITY BEHAVIORAL HOLIDAY
AGENCIES, WHERE STATE ADVOCACY
GROUP FOR BEHAVIORAL HEALTH
CLINICS ACROSS THE STATE AND ALL
OF YOUR DISTRICTS. AND I'M ALSO
THE EXECUTIVE DIRECTOR OF THE
CALIFORNIA ACCESS COALITION,
WHICH IS A DIVERSE GROUP OF
PATIENT ADVOCATES AND
PHARMACEUTICAL INDUSTRY REPS.
AND WE JOINED TOGETHER TO
ADVOCATE FOR ACCESS TO
BEHAVIORAL HEALTH MEDICATION AND
TREATMENT. SO BEING A LEADER OF
THESE GROUPS ALLOWS ME TO HAVE A
UNIQUE VANTAGE POINT ON THE
PULSE OF THE SPECTRUM OF
BEHAVIORAL HEALTH CARE FROM
CLIENTS TO PROVIDERS AND
CLINICS. Tð NOVEL TREATMENTS
THAT MY COLLEAGUE JUST POST
SPOKE ABOUT YET MY EDUCATION. MY
CLINICAL TRAINING AND RESEARCH
DID NOT PREPARE ME FOR THE
BREAST CANCER DIAGNOSIS THAT I
RECEIVED AT THE HEIGHT OF THE
PANDEMIC IN 2020. THIS
EXPERIENCES HAS ALLOWED ME TO
ALLOWED ME. EXCUSE ME, TWO MORE
INTIMATELY UNDERSTAND THE
INTERSECTION OF PHYSICAL AND
BEHAVIORAL HEALTH. THE HOLES IN
THE SYSTEM OF CARE AND
POSSIBILITIES FOR CHANGE. I
CONSIDERED MYSELF TO BE A
PROFESSIONAL ADVOCATE YET I
STILL CAN'T FIGURE OUT MY
INSURANCE BILLS. MY COLLEAGUE TO
MY LEFT DISCUSSED SOME EXCITING
OPPORTUNITIES FOR ADVANCES AND
MEDICATION TREATMENT, CURRENTLY
SAID ON SAMSON'S MENTAL HEALTH,
MATERNAL MATERNAL MENTAL HEALTH
TASK FORCE, AND DR MCCARRON
HIGHLIGHTED IT EARLIER. THERE IS
A LOT OF ENERGY AROUND NEW
MEDICATIONS AND ALSO LIFTING UP
COMMUNITY PRACTICES THAT WORK
THE THINGS THAT WE ALREADY HAVE
IN OUR TOOLKIT. AND THAT'S WHAT
I'M GOING TO FOCUS ON IN MY LAST
FIVE SECONDS OF TESTIMONY. SO
THERE ARE MANY OPPORTUNITIES TO
BOLSTER EXISTING TREATMENT.
MODALITIES AND PROGRAMS IN YOUR
DISTRICT, AS WAS WELL
ILLUSTRATED EARLIER. THESE ARE
THE LOW HANGING FRUIT, IN MY
OPINION, AND THESE APPROACHES TO
CARE, CULTURALLY SENSITIVE AND
THUS EFFECTIVE. THEY JUST NEED
TO BE FUNDED. AND SKILLED UP.
I'M GOING TO SHARE A FEW OF THEM
THAT ALREADY EXIST. 988 IT WAS
MENTIONED EARLIER. SO TBH
REPRESENTS ABOUT A THIRD OF THE
CALL CENTERS WHO DO AN EXCELLENT
JOB, BUT THEIR STAFF IS HIGHLY
CONSISTED OF VOLUNTEER
WORKFORCE. THAT'S THE PROBLEM.
WE CANNOT SUSTAIN OPERATIONS
THROUGHOUT THE STATE WITH THE
GROWING MENTAL HEALTH AND AS A
RESULT OF THE PANDEMIC WITH
VOLUNTEERS AT THE CALL CENTERS.
THIS CERTIFIED COMMUNITY
BEHAVIORAL HEALTH CLINIC MODELS
IS SOMETHING THAT WE ALL NEED TO
BE PAYING ATTENTION TO. THIS IS
A PROGRAM WHERE WE HAVE FEDERAL
FUNDS TO SUPPORT THE EXPANSION
OF SERVICES. BASICALLY CLINICS
IN YORK RESPECTIVE DISTRICTS ARE
GETTING A MILLION DOLLARS TO
EXPAND SERVICES. THAT'S A GREAT
THING, BUT CALIFORNIA HAS NOT
SIGNED ON TO THE DEMONSTRATION
WAIVER, MEANING THAT THEY'RE
COMMITTING COMMITTED TO
SUPPORTING THESE CLINICS. AND
ACTUALLY BEING THE ADMINISTRATOR
OF FUNDS. SO WE HAVE THE FEDERAL
GOVERNMENT GIVING FUNDS DIRECTLY
TO CLINICS AND THE CLINICS ARE
BOLSTERING THESE PROGRAMS AND
SERVING MORE PEOPLE WITHOUT A
PROMISE OF CONTINUATION. WHAT IF
THEY DON'T GET GRANTED THE FUNDS
NEXT YEAR? WHAT DOES THAT MEAN
FOR CARE IN YOUR DISTRICT? TELL
HER HEALTH. IT'S NOT NOVEL. IT'S
BEEN AROUND FOREVER, AND OUR
ASSOCIATION HAS BEEN ADVOCATING
FOR YEARS FOR FLEXIBILITIES AND
RELAXING ALL OF THE REGULATIONS
AND WE'VE BEEN, YOU KNOW, MET
WITH A LOT OF PUSHBACK. WE'RE
VERY CAREFUL STRAIGHT HERE. BUT
WHEN THE PANDEMIC HIT ALL THAT
WENT OUT THE WINDOW AND IT WAS
ALLOWED WONDERFULLY AND IT WAS
SUCCESSFUL. BUT SINCE THEN WE'VE
GONE BACK TO BUSINESS AS USUAL,
SO WE HAVE PAYMENT DISPARITIES
AND MULTIPLE BARRIERS FOR OUT OF
STATE PRACTITIONERS, AND DR
KAUFMAN DISCUSSED THE WORKFORCE
CHALLENGES EARLIER. I'LL MOVE ON
TO DIGITAL THERAPEUTICS USING
TECHNOLOGY APPS TO PROVIDE
INCENTIVES FOR MEETING TREATMENT
GOALS. IT'S PROMISING AND OUR
STATE I HAVE TO GIVE THEM CREDIT
IS UTILIZING ONE OF THESE
PROGRAMS FOR SUBSTANCE USE
DISORDER TREATMENT, SO THAT'S
VERY, UM EXCITING AND SOMETHING
THAT WE HAVE TO CONTINUE TO
FOLLOW. I'LL MENTION AS MY
COLLEAGUE DID AS WELL.
ARTIFICIAL INTELLIGENCE. THESE
TECHNOLOGIES ARE DESIGNED TO BE
EXTENSIONS. EXTENSIONS OF THE
HUMAN MIND. THAT'S SCARY, BUT WE
HAVE TO MAKE SURE THAT WE'RE
TRACKING THAT. WE'RE MAKING SURE
THAT THESE ARE ADEQUATE AND
APPROPRIATE. THEY REALLY CAN
HELP PROMOTE EFFICIENCY AND
LIMIT ADMINISTRATIVE BURDEN. AND
I'LL GIVE YOU AN EXAMPLE AT C B.
H A ONE OF OUR BUSINESS MEMBERS
IS PIONEERING AN APP THAT WILL
TRANSCRIBE AND ANALYZE THERAPY
NOTES AND CAPTURE PATTERNS AND
CLIENTS. BEHAVIORS TO HELP
PREDICT STEPPED SYMPTOM
OCCURRENCES, RECURRENCES AND
POTENTIAL CRISES THEY CAN
ACTUALLY PREDICT IF THIS PERSON
MAY POTENTIALLY HAVE THIS
DISORDER OR ACT IN THIS WAY. IT
IS SCARY. IT IS NEW. IT IS REAL.
WE HAVE TO BE ABLE TO MAKE SURE
THAT WHAT'S HAPPENING IS SAFE.
SO WHAT ARE THE BARRIERS RIGHT?
WELL AS CHAIR WIENER SHARED
EARLIER REGULATION, SO STRINGENT
LICENSE, RECIPROCITY LAWS AND
POOR AND UNEVEN REIMBURSEMENT
RATES FOR SERVICES HAPPENING ALL
OVER THE STATE AND IMPACTING THE
ABILITY FOR THESE LOW FRIEND
HANGING FRUIT INTERVENTIONS TO
BE EXERCISED. WE HAVE TWO
MEMBERS THAT HAVE TELE
PSYCHIATRY BUSINESSES. THEY
CAN'T GET THEIR PROVIDERS THEIR
VIRTUAL PROVIDERS TO PROVIDE
SERVICES IN CALIFORNIA BECAUSE
OF REGULATIONS. WE HAVE ANOTHER
WHO IS, UM MORE INCENTIVIZED TO
SERVE NON MEDICAL PATIENTS
BECAUSE REIMBURSEMENT RATES ARE
SO DESPERATE SO THERE'S ALSO
MANY PROMISING THERAPIES AND
TREATMENT MODALITIES ON THE
HORIZON, WHICH I'LL SUMMARIZE
SHORTLY. ONE IS PSYCHEDELICS. 30
STATES HAVE INTRODUCED
LEGISLATION AND TWO STATES HAVE
PASSED LAWS VIA BALLOT MEASURES
RECENTLY GOVERNING THE USE OF
PSYCHEDELICS. CALIFORNIA JUST
SAW LEGISLATION LAST YEAR FROM
ONE OF OUR CHAIRS CHAIR WIENER.
MOBILE APPS IS SOMETHING ELSE
THAT WE HAVE TO PAY ATTENTION TO
GIVEN THE GLOBAL SHORTAGE OF
PSYCHIATRISTS AND THE LACK OF
MENTAL HEALTH CARE AND ACCESS IN
RURAL REGION HAVE EMERGED AS A
VIABLE TOOL TO BRIDGE THE MENTAL
HEALTH TREATMENT GAP. FOR
EXAMPLE, 60% OF PEOPLE WHO OWN A
SMARTPHONE HAVE DOWNLOADED AT
LEAST ONE HEALTH APP. THERE ARE
OVER 300,000 HEALTH APPS ON THE
MARKET. AND I'M HEARING THAT
EVERY DAY THERE'S 200 POPPING
UP. MORE THAN 15,000 OF THESE
APPS RELATE TO MENTAL HEALTH,
BUT ONLY 20% OF THESE APPS ARE
CREATED IN CONSULTATION WITH THE
BEHAVIORAL HEALTH SPECIALIST. SO
WE HAVE PEOPLE THAT ARE GREAT
HAVING GREAT BUSINESS VENTURES
BUT NOT NECESSARILY HAVING THE
TECHNIQUE THAT'S NEEDED TO BE
ABLE TO CREATE APPS THAT ARE
GOING TO IMPACT INDIVIDUALS WHO
NEED HELP. I'LL SKIP AHEAD TO
CLOSE OUT, BUT I THINK IT'S
REALLY WHETHER IT'S SCALING UP
THE WORKFORCE OR RELAXING
TELEHEALTH REGULATIONS. STATE
GOVERNMENT REALLY HAS AN
OPPORTUNITY HERE TO PROVIDE
OVERSIGHT AND INFLUENCE ON WHAT
IS AVAILABLE AND HOW IT'S
DELIVERED. SO AS ALWAYS, C B H A
AND THE ACCESS COALITION MEMBERS
ARE HERE TO PROVIDE TECHNICAL
ASSISTANCE AND PARTNER WITH ALL
OF YOU. THANK YOU FOR THE TIME.
THANK YOU VERY MUCH COLLEAGUES
ANY QUESTIONS OR COMMENTS AT
THIS TIME FOR THIS PANEL? SAYING
THAT WE REALLY WANT TO THANK YOU
OBVIOUSLY WAS ALSO GOING TO BE
IMPORTANT AS PLEASE, UM, PROVIDE
YOUR TESTIMONY TO THE STAFF
YOU'VE BEEN IN CONTACT WITH SO
WE CAN MAKE SURE THAT IT GETS TO
ALL OF OUR MEMBERS, AND
PARTICULARLY, WHAT HAS BEEN
HELPFUL IS ALSO SOME OF THE MORE
THINGS THAT WE'RE STARTING TO
SEE IN TERMS OF THE FUTURE. THE
INNOVATIONS. THAT ARE COMING UP.
IS THAT SOME POINT AGAIN? WE'RE
TRYING TO SAY WHAT IS THE NEXT
STEP HERE? RIGHT WE HAVE DONE.
WE HAVE MADE SOME PROGRESS, BUT
WE KNOW THAT WE'RE, UH, WE STILL
HAVE A LONG WAY TO GO TO BE
QUITE HONEST. WHEN YOU STILL
CONTINUE TO LOOK AT WHAT'S
HAPPENING ON THE GROUND. THE
FIGURES WE CONTINUE TO SEE, UM
AND SO WE WANT TO THANK YOU. BUT
PLEASE MAKE SURE AND FOR ALL
PANELISTS, PLEASE MAKE SURE THAT
WE RECEIVE YOUR TESTIMONY SO
THAT WE CAN DIGEST IT FURTHER
AND BE ABLE TO HOPEFULLY TAKE IT
INTO SOME WORK AND CONTINUED
LEGISLATIVE RECOMMENDATIONS.
THANK YOU SO MUCH FOR ALL OF OUR
PANELIST. HMM NOW WE WILL NOW
MOVE ON TO ANYONE WANTING TO
PROVIDE PUBLIC COMMENT. YOU'RE
EXCUSED IF YOU WOULD LIKE, YEAH.
PLEASE COME ON UP. STATE YOUR
NAME AND AFFILIATION. AND WE ASK
THAT YOU PLEASE KEEP YOUR
COMMENTS VERY SUCCINCT. YOU GOT
IT. HI IT'S CLARE CONLAN HERE
FOR BIO COM. CALIFORNIA
REPRESENTING R 1800 MEMBERS
ACROSS THE STATE, INCLUDING
BIOTECHNOLOGY, PHARMACEUTICAL,
MEDICAL DEVICE, GENOMICS
DIAGNOSTIC COMPANIES, AS WELL AS
RESEARCH UNIVERSITIES AND
INSTITUTES. MEDICATION ACCESS IS
AN IMPORTANT TOOL FOR PEOPLE
EXPERIENCING. SERIOUS MENTAL
ILLNESS DELAYS TO TREATMENT
BECAUSE OF UTILIZATION
MANAGEMENT CAN HAVE COSTLY
CONSEQUENCES, BOTH FOR THE
STATE. AND THE PATIENTS. AND SO
I'M HERE TO ECHO THE COMMENTS OF
THE PATIENT ADVOCACY GROUPS AND
UNIVERSITY FOLKS. THANK YOU.
THANK YOU. GOOD AFTERNOON TARGET
. THE EASTMAN WITH THE STEINBERG
INSTITUTE REALLY APPRECIATE THE
CONVERSATION TODAY. I WAS SO
HELPFUL AND JUST REALLY WANTED
TO BRIEFLY HIGHLIGHT THE
IMPORTANCE OF THE WORK FORCE
DISCUSSION THROUGHOUT TODAY'S
HEARING AND HIGHLIGHT ONE PIECE
OF INFORMATION THAT WAS ASKED
FOR DURING THE HEARING AROUND
WHAT OUR NEEDS ARE AROUND
WORKFORCE. THE STEINBERG
INSTITUTE HAS RECENTLY LEVERAGED
FEDERAL BUREAU OF LABOR
STATISTICS TO ESTIMATE WHAT ARE
LONG TERM WORKFORCE NEEDS AND
BEHAVIORAL HEALTH WILL BE WE
ESTIMATED ABOUT 375,000
PROFESSIONALS ACROSS THE
DIFFERENT TYPES OF OCCUPATIONS
OR ABOUT 32,000 PEOPLE PER YEAR,
SO THAT'S QUITE A BIT OF WORK
AHEAD OF US AND LOOK FORWARD TO
PARTNERING ON THAT. THANK YOU.
PLEASE MAKE SURE THAT WE GET
THAT INFORMATION TO MYSELF AND
SENATOR WEINER'S OFFICE, PLEASE.
THANK YOU. THANK YOU ANY OTHER
PUBLIC COMMENT AT THIS TIME?
SEEING NONE. I WANT TO AGAIN.
THANK ALL THE PANELISTS. I WANT
TO. THANK, UM MY COLLEAGUE,
SENATOR WIENER FOR PARTICIPATING
AND WORKING TOGETHER AND
ACTUALLY BEING THE LEADER OF
THIS JOINT HEARING. OBVIOUSLY
I'M AS WE GET CLOSER TO A LOT OF
THINGS GOING ON. WE'RE BEING
PULLED IN MULTIPLE DIRECTIONS.
BUT NO MATTER HOW BUSY THINGS
GET WE WANT TO MAKE SURE THAT
THE PUBLIC AND EVERYONE INVOLVED
UNDERSTANDS THEN AND THIS MENTAL
HEALTH JOURNEY THAT WE'RE ALL ON
, UM, MARY MAINS A TOP PRIORITY.
I WANT TO THANK MY COLLEAGUES
FOR PARTICIPATING. UM AND IT'S
VERY IMPORTANT TO KNOW. I MEAN,
98% OF, UH, BOTH THE SENATE AND
THE ASSEMBLY SELECT COMMITTEES
HAVE PARTICIPATED AT SOME TIME
HERE. UM UNDER ALSO RECOGNIZING
THE IMPORTANCE OF THIS ISSUE,
AND MOST IMPORTANTLY, WHY I WANT
TO THINK, UM, THE STAFF UM,
PARTICULARLY SENATOR WIENER
STAFF FOR DOING A LOT OF THE
HEAVY LIFTING. UM OF COURSE. UH
MY STAFF FOR, UM, HELPING TO
HURT US. THOSE OF US WHO ARE
CATS, AND SO I WANT TO THANK
THEM VERY WELL. AGAIN WE WILL
CONTINUE TO ENGAGE ON THIS ISSUE
. WE WILL CONTINUE TO MAKING
SURE THAT WE HAVE FURTHER
DISCUSSIONS AND PARTICULARLY
ENSURING THAT WE DO ALL THAT WE
CAN TO MAKE SURE THAT WE
CONTINUE TO MOVE FORWARD AND WE
DON'T GO BACKWARDS. ESPECIALLY
AS WE GO THROUGH THIS VERY
CHALLENGING BUDGET TÌM SO AT
THIS TIME, THANK YOU VERY MUCH,
AND WE WILL ADJOURN THIS
HEARING.