Video & highlights from “5 Slides: Mental Health Access and the Safety Net”

On Wednesday, State of Reform held our “5 Slides: Mental Health Access and the Safety Net” virtual convening with Michelle Doty Cabrera, Executive Director of the County Behavioral Health Directors Association of California, David Bond, Behavioral Health Executive at Blue Shield of California Promise Health Plan, and Alex Briscoe, Principal of the California Children’s Trust.



During the convening, the three leaders discussed the issue and importance of access to mental health services and the connection to the safety net that serves those in highest need in California.

Doty Cabrera kicked off the 5 slides conversation with a slide detailing the underinvestment in the public behavioral health safety net.



The smallest bar represents funding streams not applied to Medi-Cal beneficiaries. The next highest bar is what county behavioral health receives in terms of Medi-Cal beneficiaries.

“Prior to the pandemic we were receiving approximately $9 billion total to serve Medi-Cal, uninsured, as well as privately insured individuals. Post-pandemic, while spending in Medi-Cal overall went up in this year’s budget negotiation, we…still are going to see losses heading into next year,” said Doty Cabrera.

Doty Cabrera says the cost of this underinvestment shows up in an over-representation of people with serious mental illness who are incarcerated and who are homeless. It also shows up outside of Medi-Cal in involuntary treatment and institutionalization.

“We definitely need to fund our priorities and invest far more in lifting up the capacity of our public safety net to meet these needs that is more important now than ever.”

Bond presented on what has become one of the biggest storylines to come out of the COVID-19 pandemic – the increased utilization of telehealth services. For those pursuing therapy appointments or mild-to-moderate benefit psychiatry, Blue Shield of California Promise Health Plan saw a jump from about 4% of sessions being delivered via telehealth in January and February to nearly 80% by May and June.

“I think we’re heading toward a new normal in a post-COVID world where people are going to continue to want behavioral health access through telephone or through electronic access,” said Bond.

He says they’ve found providers are becoming more comfortable offering telehealth services, are experiencing less burnout, and that individuals receiving telehealth services are experiencing a different level of comfort in being able to engage from home.

Moving forward, Bond says there will need to be more science-informed decision making regarding what telehealth will looking like post-pandemic.

The conversation concluded with the three speakers reflecting on the potential upcoming behavioral health challenges stemming from the pandemic.



In response to this projection from the Washington State Department of Health, Briscoe says he fears that the reality of the situation will be even worse.

“What isn’t stated here is 400 years of structural racism and the stabilization of poverty that our nation is only just beginning to come to grips with and that our mental health system structurally ignores,” said Briscoe.

He says structural racism is seen in the mental health system through the requirement of a diagnosis as a prerequisite for care and through a largely white delivery team.

“When I look at this chart, I see yes, our mental health system was struggling to acknowledge the fundamental impact of race and class on social and emotional welfare. That our medical model was already straining to respond. That less than 5% of children statewide were getting anything at all, regardless of whether it was good or timely, and that we were already in a state of complete and total crisis before we disconnected children from the social networks and the communities that they rely on.”

The full video of the conversation is available above.