On March 20th, the California Nurses Association joined Asm. Matt Haney (D – San Francisco) outside of St. Mary’s Medical Center in San Francisco to welcome the introduction of Assembly Bill 1001. The bill would create standards and procedures for hospitals to ensure staffing levels are available to immediately respond to behavioral health emergencies in all units.
“California is experiencing a mental health and addiction crisis and the first place people come to get help is our hospitals,” Haney said during the event. “But our hospitals often don’t have the appropriate staff or standards to care for these patients—that hurts both the patients and the already overworked staff. Instead of treating people with mental health and addiction issues, we’re pushing them back onto the street.”
According to the California Department of Health Care Access and Information, patients with behavioral health diagnoses represented one-third of inpatient hospitalizations and one-fifth of emergency department visits in 2020. That year, mood disorders, anxiety disorders, and alcohol-related disorders were the most common reasons for emergency department visits and inpatient hospitalizations. For over two-thirds of encounters where a behavioral health diagnosis was involved, the department estimated that Medi-Cal and Medicare were the sources of payment.
AB 1001 would create hospital standards that make sure appropriate staff are trained and available to respond to patients who are experiencing behavioral health emergencies. The bill would establish the Behavioral Health Emergency Response and Training Fund, which would provide grants to new programs. The fund would also support existing programs that increase staffing in general acute care hospitals of direct care staff trained in behavioral healthcare and behavioral health emergency services response and intervention.
“For too long, we have gone without appropriate staffing to meet the needs of patients who are facing a behavioral health emergency,” said Yvette Bassett, RN in the Emergency Department at St. Francis Hospital. “For patients who are suffering from an emergency, it could be a matter of life or death. Having an appropriately skilled behavioral health team would not only save the life of our patients, but also provide the necessary support for staff and nurses to appropriately care for the patient.”
Becker’s Hospital Review recently posted a report highlighting staffing issues across California that are impacting both behavioral and physical healthcare. The UCLA Medical Center in Los Angeles, for example, held a rally in early March over unsafe conditions for patients, including crowding emergency room hallways with beds. Within Santa Clara Valley’s three-hospital healthcare system, there have been significant levels of vacant nursing roles, although construction on a new child and adult behavioral health service center in the county is expected to be completed by the fall of 2025.
The bill states that by Jan. 1st, 2025, every general acute care hospital must adopt protocols and policies to respond to patients experiencing behavioral health emergencies. To do so, two registered nurses who have experience in providing psychiatric care must be available to provide behavioral health emergency services. The bill would enforce procedures to ensure the availability of behavioral health emergency services personnel in each patient care area at all times.
“We also need to invest in developing the workforce responsible for taking care of people with mental health and addiction emergencies,” Haney said. “This bill pulls on already existing dollars to fund a mental health and addiction staff training program to make sure there is knowledgeable staff in hospitals who know how to deescalate situations and take care of patients. If we don’t invest in this workforce, we’ll continue to see more nurses leaving the field and fewer patients getting the help they desperately need.”
AB 1001 would establish continual and annual training for behavioral health emergency services personnel to ensure adequacy in existing and new skills within psychiatric care, behavioral healthcare, and substance use treatment services. Annual training and education includes providing trauma-informed care and access to linguistically and culturally competent care. Under this bill, all hospital staff who must be present in a patient care area would also receive annual training and education to recognize patient interactions that require responses by emergency services personnel, and how to intervene.
The bill is waiting to be heard in the Assembly Committee on Health.