Healthcare leaders discuss behavioral health care and access – State of Reform

Currently about one in six adults in California experience mental health problems, while at the same time rates of depression in adolescents have also increased. Healthcare leaders gathered at the 2023 Northern California State Health Reform Policy Conference to discuss the growing need for behavioral health care and the work their organizations are currently doing to address the current behavioral health crisis .

Karen Larsen, LMFT, CEO of the Steinberg Institute, shared how the institute, which focuses on public policy issues related to mental health and substance use, has worked to increase access to behavioral health care.

One of the ways the Steinberg Institute has attempted to improve access to care and the quality of care was through a bill a few years agoSenate bill 855which is an equality bill, Larsen said. Essentially, this bill requires private insurance companies to cover behavioral health conditions, to provide behavioral health services at a rate commensurate with what they bill for physical health.

Sponsored by the Steinberg Institute, the bill was introduced to the legislature and was subsequently signed into law by the governor in 2020. SB 855 requires insurance companies to cover any mental health or substance use related services deemed necessary by the a doctor.

While the year-old bill allowed more Californians to receive insurance coverage for these services, the most recent barriers to assistance are workforce shortages and building an ideal crisis response system.

Sandrine Pirard, MD, PhD, chief medical officer for Carelon Behavioral Healths Western Region said that to build the ideal crisis system, caretakers must first look to the person in crisis to create a person-centered approach and have the finances to implement a continuum of care. Pirard emphasized the importance of data sharing so that all providers at all points of the continuum of care have access to the same information.

It’s great to create a crisis system, but we know we need a mechanism to sustain it, Pirard said. Ideally what we want, the system has to be payer-blind and available to the whole community regardless of age, income level, insurance status, and for that we really need some kind of system where all that funding coming from from the insurance, coming from the state, has been integrated and has really helped to support the crisis system.

WellSpace Health is a federally qualified health center that sees approximately 1,400 patients a day, according to CEO Jonathan Porteus, PhD. The facility also houses a 988 crisis center, which serves 16 to 22 people a day.

The current system tends to overly disempower people and create self-stigma, Porteus said, adding that people in distress are told they cannot help themselves, while the biggest step for an individual going through a crisis is actively participate in your change.

The current system funnels people to jail or the emergency room. There are no alternative destinations.

With the implementation of the 988 Suicide & Crisis Lifeline, Porteus sees a greater transition away from law enforcement and prison response, towards shelter centers that have more intimate connections in the continuum of care.

Porteus said WellSpace Health is promoting 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 people they were concerned about during their shift, and the hotline gets in touch with them.

It’s actually pretty simple to call people, Porteus said. So if we call people every day for 30 days, they learn tools to fix their problem or how to reach out for help.

Porteus said people in crisis do not need acute hospital care facilities where they are forced to give up their basic rights, but rather need a safe place where they can be welcomed and cared for.