Policy Brief:
Understanding
California’s Recent
Behavioral Health
Reform Efforts
Attachment 3
Policy Brief: Understanding California’s Recent Behavioral Health Reform Efforts 2
INTRODUCTION
California is at a tipping point for mental health and substance use disorders, collectively known as behavioral health.
As this plan comes together, a working adult struggling with anxiety will be able to reliably depend on their employer sponsored health insurance to provide the services they need, a parent whose child is beginning to show early signs of a serious mental illness will be connected to early assessment and intensive treatment, and an unhoused neighbor struggling with co-occurring mental health and substance use disorders who has fallen through every crack in the system will have access to housing, treatment, and a path to recovery.
The truth is: We all struggle. At some point in our lives, we will all either have a challenge with mental health or substance use ourselves – or be supporting a parent, child, neighbor, friend, or coworker through their journey with behavioral health.
The weight of this crisis is not carried equally. Communities of color, people involved with the justice system, and those who are LGBTQ+ carry the heaviest burden.
Together we are developing a thoughtful set
of connected programs that provide tools to
help anybody, anywhere, anytime with their
unique behavioral health challenges.
This behavioral health plan pulls every lever
the government has at its disposal, from
setting a bold policy agenda, to creating and
implementing new initiatives, to simplifying and
streamlining programs, to enforcing laws and
regulations. As we continue this journey, some
changes will be immediate and visible, and
others will require more patience and time.
Because these challenges cannot wait, the Newsom Administration has invested a historic $10 billion in the full spectrum of behavioral health services, because all Californians are entitled to quality, culturally competent behavioral health services when, how, and where they need them.
Behavioral Health Continuum
Policy Brief: Understanding California’s Recent Behavioral Health Reform Efforts 3 Increasing Access by Building Workforce, Infrastructure Undergirding all of California’s behavioral health efforts are investments to build the pipeline of providers and the physical infrastructure needed for these services.
For behavioral health care to be truly accessible, services must be available when Californians need them. Providers must speak our language, look like us and come from our communities.
We also need brick-and-mortar spaces for care, to address historic gaps and to meet growing demand for services across the lifespan. So, California has set aside $2.2 billion to ensure care can be provided in the least restrictive settings and within the community through a wide range of options.
That’s why the Administration is investing
$1.4 billion to create tens of thousands of new behavioral health professionals – offering tuition assistance and loan forgiveness and funding training programs.
Prevention and
Early Intervention
It’s important to recognize that for many
Californians, there is still a stigma around
mental health and substance use challenges.
This is why it is important to both normalize the
conversation around behavioral health and
emphasize prevention.
In August 2022, the Administration announced a
Master Plan for Kids’ Mental Health, an integrated
multi-year effort uniting historic investments to
better serve the state’s diverse children, youth,
and families. At the core of the Master Plan is a
historic, five-year, $4.7 billion initiative that focuses on promoting mental, emotional, and behavioral
health and well-being; prevention and providing
services; support and screening; and addressing
inequities.
These efforts will increase access to a wide range
of mental health services in schools, allowing
schools to reach more students and provide
more counseling and mental health supports.
Schools are a critical access point for mental
health and substance use services, especially
for African American, Native American, Pacific
Islander, and LGBTQ+ students.
Critically, in response to the exponential
increase in overdoses, the state will soon launch
a $40.8 million education and awareness
campaign focused on opioids and fentanyl.
California is also investing more than
$80 million to increase overdose reversal
medication distribution to first responders,
law enforcement, community-based
organizations, middle and high schools, and
county agencies to reverse overdoses.
To further support the success of these
efforts, the state is investing $100 million in
a youth-led campaign to destigmatize the
conversation around youth mental health
and substance use struggles.
Policy Brief: Understanding California’s Recent Behavioral Health Reform Efforts 4 Outpatient Care
For all Californians to be able to access
behavioral health care when they need it,
the state is holding commercial plans, which
cover more than half of all Californians,
accountable and reforming Medi-Cal,
California’s Medicaid program.
On the commercial side, California has some
of the strongest behavioral health “parity”
requirements in the country, requiring coverage
of “medically necessary” services to treat
mental health and substance use disorders. The
treatment cannot be limited to short-term or
acute treatment.
To enforce these laws, the state has dedicated
$22 million over five years to conduct behavioral
health-focused investigations of commercial
health plans to make sure they are meeting
state law – and taking enforcement action
against those that are not. Californians are
paying health care premiums for behavioral
health care; they deserve access to it.
On the public side, Medi-Cal has vastly
expanded the use of telehealth, which made
behavioral health care far more accessible
for some.
And California is in the process of completely
reforming Medi-Cal behavioral health delivery
through numerous federal waivers, including
CalAIM and the proposed California
Behavioral Health Community-Based
Continuum Demonstration.
There will be a “no wrong door” approach
to ensure beneficiaries receive mental health
services regardless of where they seek care,
even if the beneficiary is ultimately transferred
somewhere else due to their level of impairment
and mental health needs.
Medi-Cal is also reforming how county behavioral
health systems are paid to reward better care and
quality of life for Medi-Cal beneficiaries.
Other outpatient benefits available under
Medi-Cal will include:
Assertive Community Treatment (ACT) and
Forensic Assertive Community Treatment
(FACT). ACT offers a wide range of medical
and social services to people living with
serious mental illness. Provided by a
multidisciplinary team, the services are
provided 24/7 for as long as needed and
wherever they are needed. FACT builds on
this model and adjusts based on criminal
justice issues.
Contingency Management, which
promotes healthy behaviors through
positive reinforcement (such as gift cards)
for people living with stimulant use disorder
who reduce or eliminate their stimulant use.
Medication Assisted Treatment, which is the
use of medication along with counseling
to treat substance use disorders. This
program is being expanded to increase
access to treatment and reduce opioid
overdose deaths with a special focus on
underserved communities, including youth,
rural areas and American Indian and
Alaska Native tribal communities.
Crisis Care
Sometimes, of course, people have more urgent
needs than can be covered by outpatient
services, which is why California is building a
robust system of crisis care.
During the pandemic, the state created the
successful CalHOPE program, a crisis line
and online platform to address stress and
anxiety. It offers free outreach, individual and
group crisis counseling and support. Since its
inception, more than 1.3 million Californians
have used CalHOPE services.
The state is also investing to build out crisis call
center capacity to support the transition to
988, which is an alternative to 911 when people
are experiencing a mental health crisis. It’s
an unprecedented opportunity to improve
behavioral health crisis prevention, response,
and stabilization. The easy-to-remember, threedigit number is available 24/7, 365 days per year and provides access to crisis counseling, often
in several languages and via text or online chat.
Policy Brief: Understanding California’s Recent Behavioral Health Reform Efforts 5 In addition, Medi-Cal beneficiaries will be
eligible for mobile crisis services, communitybased de-escalation and relief for individuals experiencing a behavioral health crisis wherever
they are, including at home, work, school, or in
the community. The benefit is meant to reduce
unnecessary law enforcement involvement and
ER visits for people in crisis.
Inpatient Care
There are times when the best setting for
someone’s care is in a hospital or residential
setting, so California is not only building more
infrastructure to make sure those beds are
available, but also improving that care.
CalAIM and CalBH-CBC will enhance care in
psychiatric hospitals and residential settings by
ensuring that patients’ physical, mental and
substance use conditions are treated and that
patients are only kept in inpatient care until they
can transition to community-based care.
Beneficiaries will also receive support before
discharge from inpatient and residential
treatment and will be supported during the
transition and connected to community-based
services and supports, including housing support.
Another form of inpatient care takes place at State
Hospitals, which increasingly provide inpatient
care for people facing felony charges and found
incompetent to stand trial due to a serious mental
illness, the majority of whom are also homeless.
California is investing more than $600 million in new
resources to ensure these individuals get access to
treatment quickly and to create options to safely
support community-based care and housing
stability and reduce recidivism.
Supportive Care
California is also providing a range of supports
to help people with the most extensive needs
get the help they need to care for their mental
illness and/or substance use disorder. These
services include:
The CARE Act, a compassionate civil
court process that provides care to the
most severely ill based on evidence that
many people can stabilize, begin healing,
and exit homelessness in less restrictive,
community-based care that prevents more
restrictive conservatorships or incarceration.
Behavioral Health Bridge Housing, which
will provide $1.5 billion to create and fund
new clinically enhanced housing settings
for people experiencing homelessness who
have complex behavioral health conditions.
Justice-involved initiatives under CalAIM.
California is the first state in the nation to
offer a targeted set of Medicaid services
to youth and adults in state prisons, county
jails, and youth correctional facilities for up
to 90 days prior to release to assist people
leaving incarceration connect to the
physical and behavioral health services
they need prior to release.
Enhanced care management will be
available to help Medi-Cal enrollees with
the highest needs. It will meet beneficiaries
wherever they are – on the street, in a
shelter, in their doctor’s office, or at home.
Beneficiaries will have a single lead
care manager who will coordinate care
among the physical, behavioral, dental,
developmental, and social services delivery
systems, making it easier for them to get the
right care at the right time.
Rent and transitional housing under CalAIM
to provide up to six months of rent or
temporary housing for beneficiaries who
are homeless or at risk of homelessness after
receiving treatment in an institutional setting.
Community supports including housing
deposits, short-term post-hospitalization
housing, recuperative care, and
sobering centers.
Supported employment services to help
Medi-Cal beneficiaries find and keep
employment so they have income to
maintain housing.
Policy Brief: Understanding California’s Recent Behavioral Health Reform Efforts 6
CONCLUSION
Over time, this plan will lead California to a behavioral health system that:
Reduces misinformation, stigma and discrimination and increases knowledge, acceptance and support for care;
Reduces the delay from the onset of symptoms to treatment and increases ongoing engagement in care;
Reduces disparities in utilizing services among BIPOC and LGBTQ+ communities and increases access to culturally responsive care;
Reduces the proportion of individuals with mental health and substance use disorders in prisons and jail and increases high-quality community care placements; Reduces the risk of homelessness and housing insecurity and increases educational and employment opportunities; and
Reduces disappointment and frustration and increases satisfaction and trust in the quality of services received.