Q&A: Sen. Eggman discusses new behavioral health bill package and mental health conservatorships

Sen. Susan Talamantes Eggman (D–Stockton) has been representing California’s fifth Senate District since 2020. She currently serves as Chair of the Senate Budget Subcommittee on Health and Human Services, and is a member of the Senate Health Committee. 

In this Q&A, Eggman discusses her advocacy for modernizing the state’s behavioral health system, especially regarding mental health conservatorships, as well as other key pieces of legislation included in her recently introduced behavioral health bill package.

 

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State of Reform: What are your health policy priorities for this legislative session?

Sen. Susan Eggman: “My priority for this legislative session has really been a focus on mental health and seeing what we can do to repair the mental health care system. In the Budget Subcommittee on Health and Human Services … we’re working hard to get the budget out. As the crisis that we’ve seen on our streets has continued to increase … I really try to focus this year on … [really looking] across the entire continuum of care at the spectrum of all the places where people can fall out of our system, and see if we can make repairs to really improve outcomes for people’s lives.

One of the things that we’ve really seen during the pandemic is the importance of our public health system, and the lack of funding and attention that it has received. So we’re really looking at public health and increasing the amount of funds that go down, both at the state level, and then down to our locals. We are looking at expanding health care for all and I think the budget is really going to double down and try to get that across all demographics by this year. I know the Governor’s plan was to do it, but to put it out I think we’re gonna see what we can do to get it done now.

The [federal government] has paid a significant portion of copays and premiums for the Affordable Care Act in the last couple of years, and we’re really looking at a potential cliff for people if the state doesn’t pick up, so we’re also looking at what we can do to make sure that there’s no disruption to care for people as we go into the next year. We’re always looking at ways to evolve our child welfare system, especially as we’ve had a lot of concerns about it as it relates to foster families and some of the drop offs of their funding.

Of course, there’s CalAIM. A lot of it is really about access … [in] the increasing work we’re doing with our plans to increase the amount of things that plans can pay for and really trying to hold systems accountable at all levels, counties, and the plans, and our locals or nonprofits.”

SOR: You recently introduced a behavioral health bill package. What bills are most important, and how do you expect them to impact Californians and the behavioral health system?

SE: “Working with the Steinberg Institute on the Mental Health Services Act (MHSA), I think it’s a good place to start. The MHSA provides a lot of money for our county level behavioral health providers. How do we really focus on best practices and outcomes and make those things more trackable? How do we also look at more opportunities to use some of the funding for stability and housing?

Another one of the [important] bills kind of goes under the radar. What we think is really important is a bed registry. Right now, if somebody goes to a hospital or a police station to be put on a psychiatric hold, in order to find a bed for them, people are still having to get on the phone and look through papers to physically call health care facilities to see if they have an open bed. We have worked for a couple of years now … so that if you have someone who needs a placement you can easily look online, to be able to figure out where there’s a bed … to best be able to expedite folks out of our emergency rooms and into the appropriate level of care for treatment. 

We hear a lot from cities that mayors get blamed for issues they see on the streets and people not getting care, but the counties are responsible for that. So setting up much like a [Council of Governments], which is already in development, [the bill] would add another component of looking at behavioral health needs from a regional perspective. Two of my counties have gotten together on [this] so we just think this will be another additive way to get everybody at the table.

The one that gets the most attention is modernizing what it means to be “gravely disabled” when you’re evaluating somebody under [mental health conservatorships]. We want to add the ability to care for oneself and make your own medical decisions. If your psychiatric condition has rendered you incapable of making decisions to provide for your medical care, that should be included in the addition of just basic food, clothing and shelter.

We’ve been moving steadily through committees so far. This week, I believe we’ll have all of our bills through our house of origin, and going into Judiciary, I think this week is going to get us through the rest of the way. And then we can get on to the Assembly with good momentum. Again, [we have a] good coalition as the bills are becoming stronger through each committee they go through.”

SOR: You’ve been an advocate for the treatment of unhoused individuals with severe mental illnesses and addiction. There’s been opposition to the bill regarding court-ordered treatment for these individuals–how have you responded and how will you continue to respond to the opposition to this bill?

SE: “We are going to continue to work with the opposition. We have always had some pushback with those who are very concerned about civil liberties, as we all are. And that is why, especially in the CARE court, it is to try to keep people in the lowest level of care and to have earlier intervention with psychotic behavior. Any clinician or any service provider will tell you that the earlier that you can intervene, the more likely it is to be able to help that person return to a higher level of stability and functioning. So the longer people languish without care on the streets, the worse their chances for positive outcomes are. We want to get people out of jails–our jails and our prisons should not be our biggest psychiatric facilities. So I think part of it is just kind of being able to talk about this as it is one more tool in the toolbox.”

SOR: Why is it so important to address behavioral health in California right now?

SE: “I think for everything there is a season. We created our [mental health conservatorship] laws in the 1960s. A lot has changed since then. We know a lot more now, our treatments are a lot better now. We shouldn’t be trying to deal with the problems of today with laws and rules that haven’t haven’t had much update since the 1960s. We’re facing an unprecedented amount of funds coming into our system, and I think there’s only so long you can send … billions of dollars down to the service providers without trying different things to be able to impact people’s lives in a more positive way. I think any Californian you talk to right now would say we have a crisis on our hands as it relates to mental health issues. And again, that small nexus that exists around homelessness and mental health, they are two separate issues a lot of times, but there is a Venn diagram on which those things intersect. The time is now, our resources are ready, our laws are ready to be updated. I think advocates realize that hospital systems are asking for it, law enforcement is asking for it, and families are asking for it.”

This interview has been edited for clarity and length.