About one in six adults in California currently experience mental health challenges, while at the same time, rates of depression in adolescents have also increased. Health industry leaders banned together at the 2023 Northern California State of Reform Health Policy Conference to discuss the increasing need for behavioral healthcare, and the work their organizations are currently doing to tackle the ongoing behavioral health crisis.
Karen Larsen, LMFT, CEO of the Steinberg Institute, shared how the institute—which focuses on public policy issues pertaining to mental health and substance use—has been working to increase access to behavioral healthcare.
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“One of the ways that the Steinberg Institute has attempted to improve access to care and quality of care was through a bill of a few years ago—Senate Bill 855—which is a parity bill,” Larsen said. “Essentially, this bill forces the private insurance companies to cover behavioral health conditions, to provide services for behavioral health at a rate that is commensurate with how they cover physical health.”
Sponsored by the Steinberg Institute, the bill was introduced to the legislature, and was later signed into law by the governor in 2020. SB 855 requires insurance companies to cover all mental health or substance use-related services that are deemed necessary by a physician.
While the years-old bill has allowed for a greater number of Californians to receive insurance coverage for these services, more recent barriers to care involve workforce shortages and building an ideal crisis response system.
Sandrine Pirard, MD, PhD, chief medical officer for Carelon Behavioral Health’s west region stated that to build the ideal crisis system, caretakers must first look at the person in crisis to create a person-centered approach, and have the finances to implement a continuum of care. Pirard highlighted the importance of data sharing so that all providers at all points on the continuum of care have access to the same information.
“It’s great to set up a crisis system, but we know that we need a mechanism for us to sustain it,” Pirard said. “Ideally what we want—the system must be payor-blind and available to the entire community regardless of age, income level, insurance status, and for that we really need kind of a system where all that funding coming from insurance, coming from the state, has been integrated and really helping supporting the crisis system.”
WellSpace Health is a federally qualified health center which sees about 1,400 patients per day, according to CEO Jonathan Porteus, PhD. The facility also hosts a 988 crisis center, which serves 16 to 22 individuals daily.
“The current system tends to overly disempower people and create self-stigma,” Porteus said, adding that people experiencing distress are told that they cannot help themselves, while the greatest step for an individual experiencing a crisis is to be an active participant in their change.
“The current system funnels people to jail or the emergency department. There are no alternative destinations.”
With the implementation of the 988 Suicide & Crisis Lifeline, Porteus sees a greater transition away from law enforcement response and jailing, towards receiving centers that have more intimate connections into the care continuum.
Porteus said WellSpace Health is pushing a “first responder” model in the rural areas they serve. First responders return to base at the end of their shift and provide the name and phone number of the persons they were concerned about during their shift, and the hotline reaches out.
“It’s actually pretty simple to call people,” Porteus said. “Then if we call people every day for 30 days, they learn the tools to solve their issue or how to reach out to help.”
Porteus said individuals experiencing crises don’t need acute inpatient care settings where they are forced to give up their basic rights, but rather they require a safe place where they can be taken in and handled with care.