Lawmaker pushing mental health reform: It’s ‘more needed than ever’

During the first week of school closures in San Jose, state Sen. Jim Beall's office received more than a dozen phone calls from distressed parents and caregivers.

The problem: They couldn't get free lunches because school district rules required children be present to receive a meal. A grandmother caring for at least seven children couldn't fit them all in her car. One parent had a sick child who needed to stay at home, and another was unable to bring her child, who has disabilities, to wait in the drive-thru lunch line.

Beall's staff helped resolve their predicaments by calling the school districts and the schools to mediate. And while lunch line challenges alone might seem minor, Californians are contending with unexpected unemployment, social isolation and anxiety about the virus. All of those added stressors could lead to — or exacerbate — mental health problems as Californians cope with COVID-19, said the Democrat from San Jose.

As the chair of the Senate Select Committee on Mental Health, Beall is one of the most outspoken advocates for mental health in the state legislature. He believes Californians' mental health needs are more acute than ever and ought to be addressed — even in the face of deep state budget cuts.

"He's been a unique voice and champion who is not afraid to take an unpopular stand because it's the right thing to do," said Michelle Cabrera, executive director of the County Behavioral Health Directors Association of California. "We are in a precarious moment right now."

But whether state lawmakers will have the appetite — or funding — to enact mental health reform this year is unclear. The focus is unquestionably on responding to the novel coronavirus.

Gov. Gavin Newsom is scaling back his own plans to expand health care. His budget advisers told lawmakers on April 16 the state will spend at least $7 billion to respond to the pandemic. And state Senate President Pro Tem Toni Atkins has asked lawmakers to focus on bills related to the outbreak.

Beall talked to California Healthline's Samantha Young about why he believes mental health care must remain a priority. He and state Sen. Scott Wiener (D-San Francisco) have said they intend to pursue companion bills creating state parity laws, which would require health plans in California to provide mental health care benefits on par with medical benefits. Their previous attempts have failed, in part because of opposition from the health insurance industry.

Beall also wants the state to certify mental health peer-support specialists, people who rely on their own experiences to help others in treatment.

This interview has been edited for length and clarity.

Q: The state's response to the coronavirus has taken center stage. Are the mental health reforms you and others have advocated on hold for the year?

I think they are more needed than ever. People are very vulnerable under this kind of stress. Senior isolation is a big problem, and it's going to get worse and worse. The economy is distressed, people losing jobs causes a huge amount of stress, not being able to pay the rent, PTSD kicks in with veterans.

Q: How do you pay for mental health programs when there is so much competition in the budget to respond to the coronavirus?

Counties have Mental Health Services Act reserves to support existing services during a crisis like this pandemic. They are also receiving state and federal emergency funds. But it's never enough. We have to find a way to shift our priorities.

The homeless mentally ill population is highly susceptible to the virus. Prioritizing mental health spending is key to the success of a whole community.

Q: What are your priorities on mental health care?

Mental health has always been a segregated element of health care. It should be treated just like any other part of your body in terms of the health care system. It isn't. We've been trained in our minds to think of mental health as a social failing, not a real, legitimate health care issue. In fact, mental health is just like any other disease. If you don't treat it, it gets worse and worse.

So I believe mental health parity is very important because of that. And I have a philosophical belief that unless we require parity, it won't happen.

Q: The governor said the state can enforce the existing federal mental health parity law. Can you explain why you believe a state law is needed?

Right now with the staff the state has, they check health plans every three years. We want them to check every year and to do more vigorous checks. Real parity is how long it takes to get an appointment. How many months do I have to wait when they give me a referral to a doctor? Is the doctor able to take patients or is it just a doctor on a list?

Q: Your parity bill focuses on the treatment of substance abuse. Why is that an area that needs focus?

That's one of the main lagging things with parity. Substance abuse, just a decade ago, was thought of by most people as a human failing, not a medical issue. A lot of people still think that way.

Now, if a doctor sees a patient and the patient has addiction, the doctor says, "You know you're addicted to opioids and I've got to give you this prescription because we have to deal with your addiction. But I can't really do it right now because I have to submit the request to the insurance company and have them review and approve your medication." That can take a couple weeks, and in some cases they overrule it. What this bill says is if a doctor says that you're in need of care for a medical addiction and the doctor prescribes medication, the health plan cannot stop the doctor from prescribing the medication for you.

Q: Why is it in the state's interest to require insurance companies to cover mental health services equally?

When the insurance companies don't provide mental health services, people get sick. You know what happens when they get sick? They lose their jobs. When they lose their jobs, guess what happens. When they're unemployed, they go on Medi-Cal.

Not having good health insurance programs with mental health care costs the state a lot of money when people end up on the Medi-Cal system.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.