HR 107
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Date of Hearing: June 25, 2024
ASSEMBLY COMMITTEE ON HEALTH
Mia Bonta, Chair
HR 107 (Waldron) – As Introduced June 12, 2024
SUBJECT: Behavioral Health Care.
SUMMARY: Urges the state of California to address established practices and investments by
creating a statewide minimum standard for behavioral health (BH) care that emphasizes
prevention and early intervention. Proposes this minimum standard of care to give equal access
to a variety of interrelated elements of prevention and care, regardless of where individuals
reside and who insures them. States that to be successful in addressing the BH crisis, strategies
must mirror those made in primary health care, where the goal is prevent BH conditions and
detect early warning signs as soon as possible. States the concept of “flipping the triangle” in
mental health (MH) care seeks to invert the existing model, by prioritizing early prevention
rather than crisis management, establishing a baseline for prevention and early intervention,
identifying gaps in service, and ensuring equitable access and consistent quality of care across
counties and across plans. Resolves that the Assembly recognizes the importance of “flipping the
triangle” in the MH care model. Makes findings and declarations about the prevalence of BH
conditions in California and California’s investment in reactive responses to BH challenges
rather than prevention and intervention.
FISCAL EFFECT: None.
COMMENTS:
1) PURPOSE OF THIS RESOLUTION. According to the author, California faces a MH
crisis, with one in seven adults experiencing BH challenges, and two-thirds not receiving
treatment. The author continues that this resolution calls to “flip the triangle” of resource
allocation in BH care, by prioritizing prevention and early intervention, ensuring equitable
access to treatment. The author argues that a proactive approach reduces the need for acute
care, overall improving health outcomes. The author concludes that by establishing a
statewide minimum standard, this resolution seeks to create a more effective and fair BH care
system for all Californians.
2) BACKGROUND.
a) Prevalence of MH disorders in California. A 2022 publication from the California
Health Care Foundation (CHCF), entitled “Mental Health in California” reported that
nearly one in seven California adults experiences a mental illness, and one in 26 has a
serious MH condition that makes it difficult to carry out daily activities. One in 14
children has an emotional disturbance that limits functioning in family, school, or
community activities. According to the report, the prevalence of serious mental illness
varies by income, with the highest rates in adults and children in families with incomes
below 100% of the federal poverty level. Despite major investments and policy shifts to
bolster MH treatment in recent years, close to two-thirds of adults with a mental illness
and two-thirds of adolescents with major depressive episodes reported that they didn’t
receive any treatment. These barriers to care are an issue of equity. A 2019 survey by the
Substance Abuse and Mental Health Services Administration found nearly 5 million, or
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16%, of Black Americans reported having a mental illness. However, only one in three
Black adults who needs MH care receives it. Similarly, a 2021 study by the University of
California Los Angeles Center for Health Policy Research found that almost half of
Latino adults who had a perceived need for MH services experienced an unmet need for
care.
b) Prevalence of Substance Use Disorder (SUD) in California. A 2022 publication from
CHCF, entitled “Substance Use in California: Prevalence and Treatment” reported that
substance use in California is widespread with over half of Californians over age 12
reporting using alcohol in the past month and 20% reporting using marijuana in the past
year. According to the report, 9% of Californians have met the criteria for a SUD within
the last year. While the health care system is moving toward acknowledging SUDs as a
chronic illness, only about 10% of people with an SUD within the last year received
treatment. Overdose deaths from both opioids and psychostimulants (such as
amphetamines), are soaring. This issue, compounded by the increased availability of
fentanyl, has resulted in a 10-fold increase in fentanyl related deaths between 2015 and
2019. The California Department of Public Health’s Opioid Overdose Dashboard
reported 7,385 deaths related to “any” opioid overdose in 2022, with 6,473 (87.7%) of
those deaths fentanyl related.
c) Modernizing California’s MH System. In March 2023, Governor Newsom announced
in his plan to modernize California’s MH system. With the passage of Proposition 1 on
the March 2024 ballot, several new initiatives will be undertaken to:
i) Build thousands of new BH beds in state-of-the-art residential settings to house
Californians with mental illness and substance use disorders, which could serve over
10,000 people every year in residential-style settings that have on-site services,
including some locked facility beds;
ii) Provide more funding specifically for housing for homeless veterans;
iii) Recast the Mental Health Services Act as the BH Services Act (BHSA). leading to
approximately $1 billion every year in local assistance for housing and residential
services for people experiencing mental illness and substance use disorders, and
allowing BHSA funds to serve people with substance use disorders; and,
iv) Include new accountability and oversight measures for counties to improve
performance.
d) “Flip the Triangle.” According to a National Institutes of Health study “Flip the
Triangle: using quality improvement methods to embed a positive behaviour support
approach on a medium secure forensic ward for men with intellectual disabilities” the
“flip the triangle” quality improvement project aimed to develop a model of care and
culture in London’s Shoreditch Ward by flipping the attention and effort of staff to
increase focus on positive and proactive interventions to manage and prevent challenging
behaviors before they occur. The project team reported a 95% increase in positive and
proactive interventions. The project team reported this shift had a significantly positive
impact on the ward culture and the care of patients with intellectual disabilities and
recommended the approach to be shared with other services.
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REGISTERED SUPPORT / OPPOSITION:
Support
None on file.
Opposition
None on file.
Analysis Prepared by: Riana King / HEALTH / (916) 319-2097