Assembly Select Committee on California's Mental Health Crisis

Testing. All right, thank you very much. Good evening. Good evening, everyone. We are going to call the Select Committee on California's mental health crisis to order. It is indeed a pleasure to be here in the beautiful City of Los Gatos and want to thank the leadership of my colleague and dear friend, Assemblymember Pellerin, who also serves as the Vice Chair and also so excited to have the Senator with us as well, to be able to participate.

The Select Committee on California's mental health crisis was meant to ensure that we talk about this issue with the urgency that it deserves. And that is, California is in a mental health crisis and we must treat it as so because we know what California can do when it declares something a crisis. Nothing. zero boy, I don't like hearing my own voice.

Nothing stands in California's way when we have a crisis, and we must act with the same ingenuity and aggressiveness as we have done many crisis before. We are pleased to be at Los Gatos Town hall. We, of course, have people here in attendance in the public, but also we want to make sure people know that they can also view this on live stream on the Assembly's website.

Assembly CA Gov todayevents public comment will occur after the conclusion of expert panelist testimony and all Members questions to the panelists. After all Members questions to the panelists have concluded, public comments shall last 30 minutes and each Member of the public shall have 1 minute to register their comments.

Let me just say that this Select Committee is not just an exercise of addressing the moments of the day, but to many of the panelists or many of the Members of this Select Committee, for us, is deeply personal. On my way here in preparation yesterday, on my way on the freeway, I was notified that my brother passed due to mental illness and addiction and homelessness. And as I was going throughout on our various events, I was planning my brother's funeral.

And so this is not an exercise for someone who has a master's degree and a Doctor's degree in social work. The system still failed my family. And so we have got to get this right.

And although we have done a lot this year, when it comes to mental health reform and other great things and other things that's left for the voters to decide on, when it comes to the Mental Health Services act, the key question we will always ask every time is, are we doing everything that we can? Not just are we doing something, but are we doing everything that we can? And we will not rest until we can say yes to that question. So I want to hand it over for a few comments from my distinguished Vice Chair, assemblymember Gail Pellerin, to say a few words.

Thank you. Thank you to the Dr. Corey Jackson, our chair of this Committee. I'm so sorry for your loss. It is truly tragic. And thank you to our Senator, Dave Cortese, for being here today. And thank all of you for coming here tonight to listen to this Select Committee on California's mental health crisis, because, as our chair said, we are in a mental health crisis. I also want to thank our legislative audiovisual team.

I can't believe how much work you guys put into making sure that this hearing gets televised. And I'm thrilled to have you here in the 20 eigth Assembly District in Los Gados. I also want to personally thank the town manager, Laurel Privetti, and the staff here at the town hall and the Los Gatos town council for being so accommodating and allowing us to use this beautiful space. I also want to give a shout out to. Don't walk away, Hannah.

Give a shout out to Hannah Barnes, who put a lot of work and time and effort into this hearing today. You did amazing. She's our field representative over in San Jose, and also Ashley Labar is my Chief of Staff. And Nina Schwang is here, who's the field rep. And Lizette Jones. So happy to have team Pellerin here in the room. And as some of you know, my family has been profoundly impacted by mental health. And it was a struggle for years.

And as Dr. Jackson said, as somebody who has resources and access to resources and knows who to call when there's a problem in a crisis. It was extremely hard to navigate our mental health system to get the care, the quality care that my family needed in a time of crisis. My husband of 25 years died by suicide five years ago this November. It never gets any easier to talk about it. But he is somebody who could not ask for help.

He just had everything available to him, but he just reached a place that was just so hopeless and he was so depressed that he saw no way out from this world but to end his life.

And we have to ask ourselves why people are making those decisions, especially when we talk about our 10 to 18 year olds that are dying by suicide at alarming rates, kids as young as 23 and four showing up with mental health conditions, our senior population that have gone through this pandemic with all of us and certainly suffered from that isolation and mental health impacts everybody. I mean, how many people here in the room have had somebody in their lives with a mental health.

That's why we're here. We're here to talk about this important issue, to make sure that we get these vital services to people who need it, that we build the workforce that we need to deliver these services, that we expand upon our 988 emergency mental health hotline. So we not only have someone to call, but someone to show up and someplace to go.

Nearly one in seven California adults experience a mental illness, and one in 26 have a serious mental illness that makes it difficult to carry out daily activities. And in 2021, Santa Clara County lost 154 neighbors to suicide. So we know that mental health care is a crucial step towards healing from a mental illness. But barriers to accessing this care and the affordability of the care is a huge issue that we need to resolve.

So I want to thank our panelists who are here today for lending their time to this important issue, to educate us. We're here to listen and to learn and to take this information and to go back to Sacramento and fight like hell to make sure that mental health gets the resources it needs so we can heal as a state. Thank you.

Thank you, Assembly Member. This community is so lucky to have a Senator as Senator Cortese. There's 120 Members of the Legislature, and when you're a new Member, you have to go through half the year to really beat your other colleagues on the other house. And I started listening to him in a hearing. I said, who's this guy? Man, he's tackling some great issues, and he seems so unassuming sometimes.

But, man, this man is representing this community that is definitely setting the example for many of us new in the Legislature. So, Senator Cortese, would you like to say a few words?

Yes, thank you. Thank you very much for that, Mr. Chair, and to the Vice Chair, thanks for the invitation to be here. I know Members of our case, you're wondering, a couple of people raised their eyebrows. They saw me coming in because they know me here from Santa Clara County, and Members of the delegation here from Santa Clara County were invited to participate. And I didn't want to miss the opportunity to be here and see what else I can learn, what we can know.

I speak for myself and everyone else. Listening to my two colleagues here, the sense of ongoing grief that we share with you and anyone else who's been impacted to that degree by mental health symptoms that couldn't be checked or treated in their own families, it's palpable. It's very real to all of us. And my condolences, of course, to your recent losses.

I think one thing I want to share is, as a Member of the Board of Supervisors, I think it became fairly apparent that I have had my own lived experiences with a large extended family in terms of impact and trying to navigate the system and so forth. And other Members of the Board of Supervisors, again, without getting specific, were able to draw on their own experiences.

And that informs public policy to the extent that you can take that and what you've seen and what you've struggled with and what you've learned, and then pull that together with the expertise of those who really spend their lives trying to get us to a place where we can mitigate the impacts of mental health. And we know we can get better, and we know people can get better, and we know that science will get better. We know all of that.

But I think that combination of lived experience for those of us who are honored to be in these policy positions and blessed to be in these policy positions with the kind of expertise we're going to hear from today is just really important. And that's why I'm here. I'll note that I'm a Member of the Senate mental health and addiction. Select me on mental health and addiction with Senator Wiener chairs. And I've been a Member for the last couple of years of the mental Health Oversight Commission for the state. So I'm very much invested in the work. Thank you again.

Thank you very much, Senator. We were going to start off with our first panel in terms of addressing gaps in care, and we're so excited to be able to hear from the behavioral Health Contractors Association, the Maternal Outreach, Mood services, or moms, program at El Camino Health, and the Santa Cruz chapter of the California Association of Marriage and Family Therapists. We're going to have each of them introduce themselves and when they present their testimony. And, sir, first we'll start off with the Behavioral Health Contractors Association.

Thank you. Good evening. I'm Elisa Koff-Ginsborg with the Behavioral Health Contractors Association, a Santa Clara County wide network of community based nonprofit organizations providing mental health, substance use and transitional housing services to children, adults and adolescents. Santa Clara County's contract providers represent 90% of the safety net service system. Thank you for the opportunity to speak with you. I will focus my remarks on CalAIM, but urge the Committee to devote a future meeting to the impact of the modernization of MHSA.

It may shore up some services, but at the same time it creates gaps in care. Changes under calame and the behavioral health payment reform represent the most seismic shifts to safety net behavioral health systems in over half a century. Counties around the state are dealing with this transition in a variety of ways.

The experience of providers in Santa Clara County offers both a cautionary tale as well as an example of how to stabilize a system on the verge of collapse, the system that serves the most vulnerable children, adolescents, adults on medical, who have faced enormous barriers to accessing care, including racism. Santa Clara County adopted systemwide rates for all providers in July 2023. As context, we were provided among the highest rates in the State of any county.

The rates implemented reimburse contract providers between 54% to 72% of the rates the county is receiving for the services provided. Programs deemed intensive were provided a 10% rate differential to accommodate for necessary but nonreimbursable services. The payment structure does not differentiate between populations served, levels of care, of community based care required or non billable required activities. It treats all outpatient and all intensive programs as if they were functionally the same, which, as I'm sure you all know, they are not.

A service provided to a client who comes to an office is very different than the same service provided to someone who is engaged in the encampment in which they live. Looking back, one can see the development of a perfect storm. Since July, rushed implementation due to state delays and challenges updating electronic health records and billing systems led to very limited visibility into the impact of payment reform during the first quarter of this year.

By the time the data became available in the fourth month, it was clear the service system was in jeopardy. The majority of agencies are facing significant losses and desperately sought support for the county in order to survive long enough to build a new system that incentivizes efficiency and quality care. In some cases, the rates were not sufficient to cover the costs, but in addition, the shift in billing from by the minute to CPT procedure codes resulted in a loss of 10 to 20% of billing revenue.

That further impact limited the effectiveness of the rates. Our county is implementing a strategy that could serve as a model for other counties. The county just on Tuesday passed a report offering outpatient mental health providers additional fiscal support to cover any operating losses for the rest of the fiscal year and providing grants to agencies that successfully transition.

This will allow us to stabilize the system as we collaboratively seek to develop a county payment model that will not have disastrous unintended consequences which are built into the current county payment models. Across the state, some providers also experienced an unintended consequence of Calam implementation, a dramatic drop in referrals. Up to 30% of the youth sent to a call Center for screening were referred to managed care plans, which were not prepared for the sudden influx.

Referring pediatricians and county staff raised concerns that the screening tools lacked questions on eating disorders and gender dysphoria. DHCS has since issued further guidance that allows a medical provider to refer directly. This represents the varied circumstances, the type that we need to be alert to, particularly as we grapple with the findings of the recent state audit finding children enrolled in medi Cal face challenges accessing behavioral health care.

When we had this shift happen in our county, the available specialty mental health providers were not able to easily shift to serving clients under managed care due to drastically different rates, and I think one of the speakers will speak more to that later in the panel. While this Committee is focused on mental health, substance use services are often intertwined and face similar transitions.

In our county, the substance use treatment system was developed using a cost reimbursement model that augmented drug medical the sector is facing a shift to fee for service for the first time and current rates that are not sufficient to maintain services. For example, outreach and prevention services are important tools which practitioners use to engage and enroll children but are not Medi-Cal billable.

A major challenge facing adult service providers is whether they will have sufficient client volume to cover their costs because many clients do not engage in services and there are high no show rates for appointments. Again, our plan could serve as a model for stabilization. The county is continuing cost reimbursement through all of the fiscal year coupled with grants to Fund client outreach and engagement as providers prepare to shift to fee for service. Thus far, I've spoken about short term measures for stabilization.

They allow us to focus on the hard work of determining fiscally viable rates that incentivize client driven services while meeting objectives of calam and payment reform. The current methodology of one rate for the entire system poses a long term danger, as it could drive providers out of the programs which do not cover the costs. The communities our Members serve often have good reason for mistrust of institutions and live in underserved areas.

Lacking transportation, our Members succeed working through trusted communities and going into streets, homes, and schools when needed. A payment reform model based on one size fits all clinic based models of care will drive these unique and culturally competent cbos out of business, create gaps in service, and worse, the outcomes will reflect that a more nuanced reimbursement structure so that each program level of care is fiscally viable and providers can determine their program mix based on community and system rather than financial drivers, is needed.

Early guidance from CalMHSA suggested a tiered approach and we hope to partner with Santa Clara County to develop sustainable rates and that our colleagues in other counties will be able to do the same thing. The shift of reimbursement rates being tied to the qualifications of Clinicians on a per unit basis could result in demand increasing for fully licensed staff Members in order for programs to sustain their operation. They were scarce pre pandemic and are even more scarce now.

Outpatient providers will have a hard time sustaining operations, which are largely composed of peers or paraprofessionals, those without degrees but with a great deal of experience, given that their reimbursement rates are lower. The most critical resource in our behavioral health system is our workforce. The intensity of working in the specialty behavioral health system puts our workforce at higher risk of burnout. The pandemic decimated an already dwindling workforce, followed by CalAIM's ambitious payment reform proposal.

Learning new billing systems, EHR modifications, multiple changes has stressed an already stressed workforce. Behavioral health employees have more options than ever to choose from. CBOs are historically at the lower end of salaries, and other alternatives have less documentation. While CalAIM has reduced documentation, the extent is not close to the amount needed. Our state associations are working to address this with legislative proposals and work with the Administration.

As long as providers spend more time doing unnecessary paperwork than treating clients in need, we'll have both a workforce crisis and a behavioral health crisis. Finally, it's critical to keep investing in workforce development. The existing efforts are making a difference but need to be brought to scale commensurate with the problem. My colleagues are finding great results from the mentored internship program, and locally, Palo Alto University was funded for an innovative contract that funds 50 current California county employees to earn their mental health counseling degree.

Thank you so much for holding this important hearing and for your individual leadership on these critical issues. I hope that you'll consider all Members of the behavioral health Contractors Association as a resource as we grapple with the ongoing changes in this system and providing critical services to those in need. Thank you.

Thank you so much. Next, we'll move on to the Maternal Outreach Mood services program at El Camino Health. Welcome.

Thank you. My name is Nicole Tarui. I'm a reproductive psychiatrist and the medical Director of the Maternal Outreach Mood Services program at El Camino Health. Chair Jackson Vice Chair Pellerin Senator Cortese, thank you so much for having me this evening, and I also wanted to express my appreciation for you sharing your personal stories about how mental illness has touched each of you. I appreciate the invitation to speak with you, and I look forward to answering any questions that you have after my remarks.

Before I start to address some of the gaps that patients experience, I'd like to briefly explain the role that El Camino health plays as a service provider. So Members of the Committee and the public have this context. We have some slides to refer to also. As a healthcare district hospital, El Camino Health has made a multi decade commitment to providing high quality mental health and addiction services.

When we think of patients, we focus on high quality outcomes, personalized and specialized treatment that is the most appropriate, and offering services that cover much of the continuum of care. As part of our treatment philosophy, we seek to care for similar patient populations together as this supports improved clinical outcomes. As an example of this, I work in the Inpatient Women's specialty unit, which offers treatment for women experiencing perinatal conditions.

I'm also the medical Director of the MOMS program and mostly work with pregnant and postpartum patients experiencing mental health conditions. We are an open system, and this means that we work with a variety of community mental health Clinicians, full time and part time employees, as well as independent contractors. These individuals represent a wide range of clinical roles such as psychiatrists, psychiatric nurses, clinical therapists, and occupational therapists. We also accept a wide range of insurance plans.

El Camino Health's mental health and addiction services Clinicians provide support for our two emergency departments, and this is often the setting where patients with acute behavioral health needs are identified. Patients who may be imminently suicidal or experiencing acute psychosis or mania, where they pose a safety risk, utilize acute hospitalization. These hospital stays are designed for stabilization and safety. Step down to lower acuity settings and follow up care is critical to ensure the best outcomes for the patients.

Partial hospitalization programs are typically five days out of the week, six to 8 hours per day, and cover group therapy, individual therapy, as well as psychiatric medication management. Intensive outpatient programs are typically three to five days of the week for at least 3 hours per day. The focus is on group work to help patients develop additional skills for managing symptoms.

The outpatient level of care is the level where a patient may see a psychiatrist periodically for medication management or therapy, or another licensed clinician for therapy, depending on their symptoms. In this slide, you can see many of the conditions and patient populations that El Camino health treats. Before diving into some of the gaps that I see as a medical Director and practicing psychiatrists, I'd like to underscore the complexity of the system, limited funding, and the challenge of enacting change.

I greatly appreciate the Committee's work in holding hearings like today's in order to learn more about what we experience as on the ground providers in behavioral health. The spirit of my remarks tonight is to share gaps that I and my colleagues at El Camino Health experience, as well as potential policy ideas that could make it easier to sustainably offer high quality, specialized behavioral health services for all Californians.

As you see on this slide, a main gap is access to the right level of care for the patient. Patients get delayed from being discharged from the acute inpatient psychiatric unit, where there is a shortage of beds at lower acuity levels of care. For example, residential treatment is a level of care for patients who are unable to live at home while receiving care. To make this point more concrete, typically acute inpatient psychiatric units are intended for short stays, typically seven to 10 days in duration.

In the past several years, we've experienced one out of 15 acute inpatient psychiatric patients with stays at or longer than 30 days who weren't able to be discharged due to capacity shortages at other levels of care. This means that these occupied inpatient psychiatric beds weren't available for those who truly needed them. Another gap is that patients get taken to the emergency Department for psychiatric services because they or their families are not able to access lower intensity services to stabilize symptoms.

Lastly, patient access for some programs can be more limited, for example, not all outpatient programs except Medi Cal due to reimbursement and administrative challenges. Another gap is screening and linking patients to quality outpatient services, which can be preventative. Patients experience challenges being screened and identified when they have mild or moderate mental health symptoms, and patients can face inadequate networks, which make it difficult to have timely access to outpatient clinicians. In many cases, patients will resort to paying out of pocket or foregoing treatment altogether.

And for many patients, this often results in worsening mental health symptoms that require stabilization and higher levels of care, for example, in the emergency Department or inpatient setting. Another gap is adequate reimbursement. Health plans don't always differentiate reimbursement based on specialization, so, for example, a specialized program like the mom's program or my specialization and additional training, reproductive psychiatry is often not reimbursed at a higher rate than more General programs.

When health plans determine usual and customary reimbursement rates, this methodology may not always incorporate all of the providers who are out of network or only accepting cash. If this occurs, usual and customary reimbursement rates may be depressed below the true level of operating behavioral health services. On the inpatient side, medikl rates don't cover costs, and reimbursement typically drops to an administrative rate once a patient has deemed eligible for discharge to a lower intensity setting such as residential level of care, even if that bed isn't available.

I'd like to further explain the administrative rate issue on the inpatient side. For a patient, medical only covers a portion of the hospital costs per day. With an administrative rate, medical reimbursement drops more than 50% while the hospital costs remain the same. Another gap is recognition of quality benefits from specialized training and care. The shortage of mental health and addiction services at all levels of care means that patients can end up in whichever program has availability rather than the best program for them as a patient.

For example, the MOMS program is a rare program that focuses on perinatal and postpartum moms, and there's a limited number of perinatal psychiatrists. We're one out of five programs in the State of California and the only one in the Bay Area. Inpatient reimbursement typically is at a single rate, which doesn't vary based on the acuity of the patient. So, for example, it won't delineate between a patient experiencing depression or a postpartum mom experiencing psychosis who's requiring one to one assistance for treatment.

This payment structure can be a disincentive for operating more focused and specialized programs which could achieve the best clinical outcomes for patients. Some potential policy ideas. The first is to incentivize and offer greater financial support for focused and specialized programs when needed for certain patient populations, for example, perinatal psychiatric care and acute inpatient behavioral health services that are integrated with other acute care clinical services.

The second is to maintain Medi Cal reimbursement for inpatient care when a patient is eligible to be discharged but must wait due to limited availability in other clinical settings. And lastly, is to hold health plans accountable to ensure that the usual and customary reimbursement rates are structured to reflect the market and true cost of operating behavioral health services. Chair Jackson Vice Chair, Pellerin Senator Cortese, thank you again for the opportunity to address you and for holding this important field hearing.

I'd also like to thank and to acknowledge the many dedicated behavioral health professionals in the State of California, in the county behavioral health departments, as well as Clinicians who deliver these critical health services every day. Thank you.

Thank you very much for that. Now we will have the Santa Cruz chapter of the California Association of Marriage and Family Therapists welcome.

Hi. Thank you so much for having me. And Dr. Jackson, I'm so sorry for your loss. And Assembly Member Pellerin, I've known for a while about your husband and I really feel for you and how hard that is for how long. Thank you. Also to my co panelists. You guys were awesome. Those are really on point comments and there's so much overlap, even though I'm in private practice, there's so much overlap in the concerns that we all deal with you probably at a more intensive level.

So I'm here primarily to talk about what keeps us from taking insurance and medical. I've been a licensed clinician since 2006. I was the past President of Santa Cruz camped. I'm on the legislative Committee for state camped, which is the big organization of marriage and family therapists in California. There are so many aspects to this. It was kind of hard to even nail, reduce them down.

And I put out some queries to other Members of the Santa Cruz camp area to see what they had to say about what their experiences have been taking insurance, not taking insurance, and how they make their decisions. There's one thing that starts sort of at the beginning, and I think it was your program that addressed some of that, which is that the cost of graduate school is so prohibitive that we lose almost all people of color.

We lose almost everybody who is poor because you cannot afford to go and you come out with huge student loans. And we have very few public school settings for gaining that training and education. Then once we do that, we then have 3000 hours of, in counties like mine, almost always unpaid labor that you have to put in before you can get licensed. And we lose a lot of people to those hours as well.

If I was in tech so I could afford to kind of put myself through all of that, so many colleagues can't. They also get interruptions for having pregnancies, for caring for sick family Members, for all the things that come up in life, they end up not getting licensed. And they also still have the burden of these big student loans. So we do a lot of catch up afterwards.

And that is a really big factor in how people can and can't accept insurance, how they can and can't go into public practice. We, once you have your license in hand, you still have to wait for many insurance plans for two years before you can accept any insurance. By the time you've done those two years, there's a gap that happens in those two years. You do not get reimbursed.

And we do need to have some of those reimbursements start at the beginning, right after you either during the hours that you're gaining while you're in graduate school or right afterward, as soon as you're licensed, that you start to be able to be reimbursed. It's that they won't take you on their panels for the first two years is usually what happens.

And so by the time you get through those two years, you already have, hopefully, an established practice that you're working from and then trying to get continuity of care through insurance panels for your clients who are already existing. It's a nightmare. It just takes so many hours of work to try to get onto a panel.

Once you're on a panel, you have to agree to accept all the clients that they not numbers wise, but if they want to send you more clients, you have to agree to accept them. But you don't necessarily have the room to or the ability to because the reimbursement rates are so Low. So those things are all sort of the backdrop for why people have a really hard time, really looking at from the beginning of their careers how to accept insurance or not.

A lot of people go into county work, agency work, et cetera. But if you're burdened by a gigantic student loan, you can't afford to. So you also can't afford the rates that Medi Cal pays, in part because if you're a solo practitioner, you have to handle all your billing yourself or hire a billing service to do that. When you're dealing with straight up billing, it's not that big of an issue.

But so many times we have challenges with insurance companies where you don't get paid, you don't get paid on time. They challenge all kinds of different aspects of it. You always negotiate them with them. I personally have a billing service that I use simply. I could do them on my own billing. I just cannot deal with the number of hours it takes to deal with problems. It's so expensive and it's prohibitive to me. And also, I hate that stuff.

And many therapists, partly we don't take Medi Cal because the paperwork is so like, I personally have opted, and I know a number of people opt to see people pro bono rather than work with Medi Cal, that it is less expensive to just see people for free and eat that hour than it is to fight with Medi Cal, to get the paperwork, to go through all of the different things that you have to go through, to go through the audits, to go through every different aspect that you have to go through.

It's not worth it to us. And Medi Cal requires more paperwork than most insurance companies do. And many insurance companies still require quite a bit of paperwork. We also have problems around reimbursement rates is a big one. Santa Cruz County, I don't know if it still is, but for many years was considered a rural county. So we're reimbursed at rural rates. We might be partly a rural county, but we are so expensive.

It is just a terribly expensive place to live and to try to set up a practice and to be reimbursed at a big chunk below what we would get if we worked in the Bay Area is a real challenge for people. One of the things that happens with insurance companies is have, for obvious reasons, if you bill under false pretenses, if you do anything, they can take the money back. But so many times the clawbacks happen for really minuscule reasons.

Paperwork, not doing a little bit of paperwork. There are all kinds of situations in which you can get clawbacks, and that's the insurance company taking that money out of the money that they were going to pay you for something else. So you're already dealing with a low rate of reimbursement, and then on top of that, you get that money sucked right back out of your bank account.

The work it takes to fight those callbacks is sometimes also prohibitive, sometimes just worth it to just like, okay, I'm not going to deal with this one. I can't afford to not work those billable hours in order to deal with the paperwork of this one. So you just let them go. One of the things that we all would like to have is cost of living increases to actually happen for us. There's a combination of we don't get cost of living increases.

It's incredibly hard to find anybody at the insurance company who will talk with you and help you through that process. There's no transparency about it. There's very little transparency at any level about what you're going to be reimbursed by insurance companies. So if you want to be on a panel, you don't have very much negotiating room and you're a solo person, so you can't negotiate as a group. Right. We're not allowed to for antitrust reasons.

We have to negotiate on our own for each different insurance company that we want to be on. I myself have not had an increase in rates in more than a decade, but my cost of operating has gone up considerably over a decade, and there's no really good mechanisms for getting those rates to increase. It would be great if there were.

Some of the stuff that has come up for people when I was talking with them are a revamping of the ways that interns are paid, which is a problem. We have a lot of interns, we who have been doing this for a while, like to supervise interns, and we can get their hours through, but the ways that we have to work the internship hours is too long to explain. And some of you might already know how some of this works.

It is a pain in the neck. And so people are all inventing their different ways to make the interns be able to get paid. So revamping that, changing the tenure requirement in public practice for student loan forgiveness, to expand it so that more people can have that student loan forgiveness for other work that they do besides in title one schools, besides in county work, besides in the really high needs places. So much of what we do is high needs all the time, especially during the pandemic.

I'm sure you guys dealt with this, but the influx of kids just this year, I probably took maybe 20 calls a week, 10 to 20 calls a week, people looking for service. And almost all of those were for children. And we just don't have the capacity for it. I am assuming that's my bell there. So in some. There are so many blocks to us taking insurance. And people would be really willing to.

If the situation were simplified, if we weren't negotiating with each individual insurance panel, if we had rates that could be. That were transparent, and if the process of going through school were not so expensive that it puts people at a disadvantage to start with. Thank you very much for your time. Thank you for working on this. Thank you both.

Thank you, palace. So very much. Colleagues, any questions?

Yeah, I'm just trying to navigate through. So on to the county behavioral health group. What can we do? This sounds like a horrible situation you're facing. And what can we do to help and ease that fiscal cliff that I feel like you're on? Well.

You know, I think it's really focusing on the client and the services they need and determining how we are going to pay for services based on what's needed and build the fiscal model that way so that if someone needs a service that involves more time or driving, that it can be provided and doesn't have to be offset.

With building an organization that has programs that are winners and those that are losers that we really need to look at diversifying the rates and matching them to the cost that goes into the different specific services. I think the state and the counties and the providers need to realize that large changes require a lot of partnership and that there's expertise and legitimate concerns that get raised that need to be heeded.

What looks right on paper in terms of rates or processes and what we think of as, okay, this is managed care. It needs to work not just on paper, but it needs to work when serving populations that require a lot of intense services.

Definitely have a lot of work to do there. Thank you. I didn't understand, really what clawbacks are. What is that?

Clawback is when an insurance company has paid you for services and then they go through their process and when they're adjusting, they realize that there's some reason or another, there are many of them, that they are not going to accept the amount what they paid you. So they'll deny the service retroactively. And then they take that money back out of your bank account after they've already paid you. After they've already paid you. Yes. It's really fun. Super fun.

Wow.

Yeah. And agencies and stuff can get much bigger clawbacks or stepping forward, that you have deductions made from the amount that they're going to pay you. But, yeah, that's how clawbacks work for us.

One I've been thinking about is, like you were saying that for you to get coverage by an insurance plan, you have to go and apply to that one, and then if you want a different one, you got to apply to that one. And we're all familiar with the common app, right. For people applying for University enrollments, would that be something that.

It seems like it would be so helpful to have something like that and to have some transparency around it and then to be able to see what the different insurance companies are willing to pay for and not pay for a common app would be ideal.

Okay, good work on that.

Thank you.

Thank you. And I think I toured your facility. Right. Where's Dr. John Cowan? Yeah, yeah, I did. I toured that. Right. Yeah. It's incredible what you're doing there for moms. And we just learned today about how critically important it is for us to address the new moms that have depression and are trying to get their lives together. And we heard a startling statistic today that it's like suicide is like, the number one cause of death for them. And you have an amazing facility, though, that allows the moms to be there with their infants as well. So thank you for everything you're doing. What's the bed facility that you have? How many beds do you have there?

So for the inpatient side, we average between six to eight beds. So that unit is directly connected to our mom's program. And as you can imagine, a mom in crisis may fluctuate over time. So having that seamless care actually is quite critical for many of these patients.

And just the difficulty in getting them to move on to lower acuity care, you were saying?

Right. So the unique thing about El Camino health is that we have access to the only inpatient perinatal unit in the West Coast, and that is physically on campus where our mom's program is located. So when a mom may be having more acute symptoms, she can go straight into inpatient from our program, and then when she's stabilized, directly back to us. So it's completely seamless.

Well, thank you for everything you're doing there.

Thank you, Senator Cortese.

Thank you, Mr. Chair. I'm wondering, I guess, particularly from Ms. Paganelli, where I think maybe you see it more, but I'd certainly be open to hearing from anyone, what kind of experience you have with utilization review itself from the private insurers.

So that I understand clawback almost sounds like sort of the worst case in some ways, but we hear constantly from constituents here in the county who find their way to our office, especially in areas like you serve, in areas like we're dealing with today, mental health and addiction, that they're either denied right from the get go and they have to go through an appeals process, which can literally be deadly for folks because it's such a lengthy process, or they're approved.

They're approved to go from a provider standpoint to begin treatment, and then basically told after 15 days, you should be fine. Now, essentially, that's the message. And we've heard that on the Senate side in our House in testimony as well, not just from providers. We also hear pushback on that, and we think the numbers with some insurers are as high as 87% in denial. That's a real number that came up in testimony.

I wouldn't put that out if I didn't have that on the record in a prior hearing. Let me just let you answer. Maybe not everyone in this room understands what kind of a challenge that is. I do want to say Senator Wiener, a couple of years ago, actually, just before I got to the Senate in 2019, passed a Bill. I want to say it's Senate Bill 855 or 885.

I apologize on the number, the so called parity Bill, saying you don't do that with a physical injury. You can't do that with a behavioral health or mental health injury. But the rulemaking on that and playing it out, four years later, we're back there at the table, he and I, saying we don't think we're getting parity. And I just want to hear if we're right or wrong about that.

You're definitely not getting parity. Parity, for those of you who don't know what it is, is treating significant mental health illnesses the same as you would treat a physical health illness. So giving coverage, making sure people have the care that they need throughout the time that they are affected by that. On the URs, I used to do URs, but I'm out of touch about how some of them work.

Part of why I don't do very much insurance work is actually because URs are a pain in the neck. And again, they take so many hours that you can do other stuff. But I will go back to Campton and ask them. They'll have those numbers, the state will, to give more information about those.

It is really challenging to try to get people the services that they need when you're dealing with an insurance company, and then most people don't have the kind of money it takes to get those services out of pocket.

So it's a serious challenge, let me just say. I appreciate that. And any post hearing information you can get to us will be great. I talked to a local provider here who's getting a lot of referrals from the county, who told me that one of the county, we know the health plan is actually one of the most difficult to get past utilization review, which was kind of shocking to me because a county affiliated plan, which is in effect then pushing the indigent, pushing the caseload right back to the county, to the taxpayer cost. Right.

So the shift would be from the insurance plan back over to the public side, if you think of it that way. Lastly, it's starting to occur to me my predecessors work, Senator Bill, Senator Weiner's work. And then we introduced a Bill, Senate Bill 999, that tried to modify and accelerate utilization review and get better results out of it was fine in both houses. Got vetoed. Proud to say, one of my only vetoes, but also disappointed in that.

But I'm starting to think that even the parody, sort of offhand definition that we use is not good enough because people will often say, even in hearings like this, you wouldn't treat a broken leg like that. But you can't really compare a broken leg to the disease that people are facing. That may require much more intensive treatment for much longer periods of time than a broken leg ever would. So it's really something more like parity plus that I think we need, and we'll try to get there. But thank you for responding.

Just add something from the inpatient side where this typically comes up when a patient is hospitalized, there is a process where the insurance is kind of taking a look at what's going on, and there's an extraordinary amount of pressure to get patients out as quickly as possible.

And some of the issues around that is that there may not actually be an appropriate level of care to step that patient down, as I was mentioning before, is that there may not be that residential bed or an opening in a program, and yet we're getting pressure from the insurance company to discharge the patient.

The second issue is that when there is a denial and say, for example, I do a peer to peer with the insurance company and they deny my request for more days, the hospital then eats that cost because I'm not comfortable sending somebody out and putting them out on the street when they're not ready. So ultimately, the hospital then has to compensate for that.

So the shift is occurring again, basically.

Exactly.

From something that people think. I'm talking again about private insurers that premiums are being paid for, and instead of getting the full benefit of the bargain, a significant part of that cost is being picked up either by private hospitals or public systems.

Exactly.

Thank you. Thank you, Mr. Chair.

Thank you, Senator. There's been a lot of talk about rates, and then, of course, I sit on Assembly Subcommitee one on health and Human Services, and we spent a lot of time about the MCO tax, about the hope that that will begin to help raise the rates in terms of medical reimbursements. Number one, are your statements taking that into account, or are you saying that we spent all that work? For now, we're still behind the ball. You're in a safe place. That's true. Yeah.

I think we're just starting to see what those rates will look like. The disparity between specialty mental health rates and the managed care rates are still really great, I think, even when that's taken into account. So you do continue to, I think, make it more difficult to more smoothly serve all the, serve clients throughout the continuum of services.

Personally, I haven't seen a change yet, and I think that there has also been frequent delays in terms of reimbursement. And so there's been, gosh, a period of time where there was like a six month gap in which I didn't see any reimbursements, and that's still kind of ongoing. So I can't actually give you a specific answer as to if I've seen improvements because of the delays around payment.

I'm not directly affected by those, but I will say to the delays in payment, especially from medical and sometimes from insurance, this is one of the things that just kept coming up over and over, months and months of not getting paid and three months for one person, six months. But it was a really common feedback about that and the delays. If you're in private practice, you don't have any money to operate your business.

We've heard that. Number one, we've heard clearly that we will work on a hearing to talk about the Mental Health Services act reform, but I think also we'll probably do include the MCO tax on that. Obviously, it hasn't taken effect yet, but we know that we should be, and we're going to have to find out exactly the schedule of when those rates will be enacted.

But our hope as a Legislature is that we will begin to see those rates least as we know how much those rates have been neglectful over the years. Right. So we look forward to continue to hear, hearing back from you once those things begin to take effect. Okay, colleagues, anything else before we move on to the next panel?

Thank you so much.

Thank you all so very much. Really appreciate it.

Thank you.

We will move on to our next panel, which is diversified youth mental health services. And we are so happy to have counseling and support services for youth, momentum for health, as well as the Santa Clara County Office of Education. And we'll actually start off with our County Superintendent of Schools, followed by Momentum for Health and then counseling and supportive services for youth. Welcome.

There we go. Thank you so much, Dr. Jackson and Assembly Member Pellerin for inviting me this evening to be here. And also a lot of gratitude to Senator Cortese as well. Thank you for prioritizing this hearing and providing space for us to talk about the needs of our young people and some of the observations we have had, including some of the successes and potentially some of the needs that might lend themselves to policy.

So I wanted to start by sharing a little bit of our observations about how great the need is amongst our youth. As many as 75% of youth have self reported experiencing depression, anxiety or feelings of hopelessness. We've also been hearing from many experts and some of our own observations indicate that it could take many years for students and youth to recover from some of the impacts of the Covid-19 pandemic.

We are seeing increasing levels of crisis need amongst our students, a crisis level need for care, increased suicide rates, chronic absenteeism at the highest rates we've ever seen, and adverse childhood experiences that are leading to post traumatic stress and a lot of other needs showing up in the classroom and our school campuses.

We've also seen significant investments that have really enabled us to expand services and we recognize that there is an essential need to sustain these efforts as it will take many years for our young people to recover. I wanted to mention some of the strength of our partnerships in Santa Clara County that have allowed us to implement some models that are yielding benefits.

In Santa Clara County, we established a consortium of the County Office of Education, plus our 31 school districts, our county behavioral health services Department and a number of community based organizations. Through this work, we've been able to expand school based behavioral health services, increased access to school based services, and implemented a wellness center model.

Our wellness center model has certain core components, including that we have personnel that staff the wellness centers, including a specialist who's licensed or credentialed, and a liaison who has a background in working in behavioral health and has an associate's or bachelor's level degree. We are successfully implementing this model on elementary, middle and high school campuses throughout the county. It is furthering our efforts at destigmatization, which we know many of our children and their families say is incredibly important.

And the wellness centers are increasing access because they are open and available to students before, during and after school. This is part of our county wide approach to school based health and wellness and I did want to start also by sharing a data point. Currently just looking at the Wellness centers operated by the County Office of Education on School District campuses throughout the county. We started in our first year with four. We're up to 19.

Since August of 2022, we have had 21,713 wellness center visits, again indicating the high need, and we've served over almost 3000 students. When we identify how students made their way into the wellness centers, 82% are self referred so the students themselves make that request. Sustainable funding is key to this effort into this expansion, and I was asked to speak about how we utilize a variety of funding sources.

Currently, we are funding this effort through a variety of one time grants, including community school partnership program grants, the Mental Health Services school based services act, the SB Hip program, a couple of small federal grants and grants from nonprofits and foundations, as well as donations.

Sustainable funding is going to be key to the sustainability and expansion of the wellness centers, and we are working directly with our school districts to create these sustainability plans, looking at different layers of funding as well as advocating for some changes in the way that certain funding mechanisms are implemented to make them more accessible for schools. Also, I wanted to share that community engagement is really important at the wellness centers and including our students.

So one of our programs is our student wellness advisory group that has students representing ages 14 to 21 from throughout the county, and the student Wellness advisory group is critical to the implementation, and they provide input on everything related to the wellness center implementation, including how they have advocated for nontraditional types of therapies and indicating that talk therapy is not always the most effective strategy for many of our young people.

Our wellness centers have also served a critical role in helping at getting early intervention and even prevention access to address potential early onset or prior to onset of more serious mental health and illness needs. Our wellness center approach is based on evidence and research, and we know that from this research, children are 21 times more likely to get the behavioral health services they need when they're accessible on a school campus.

Research also shows that integrating social emotional learning and behavioral health into the curriculum and into the school culture significantly reduces stigma amongst students and families, as well as supporting staff in better accessing the support for young people and school based mental health services can significantly reduce school disciplinary action by providing a more therapeutic and more appropriate support service to students in need can also reduce referrals into the criminal justice system and reduce school dropout rates.

And teachers are really encouraged to use wellness centers as an alternative to really try to address the self regulation needs of students. And through this model, we are also looking at curriculum early intervention tools at self regulation, addressing needs immediately when they occur, including addressing young people who may have anxiety, depression, and school aversion, and we have found success with this model.

I also wanted to share a little bit about some of the disparities and some of the concerns that we have related to our current implementation. One of the initial disparities that we need to consider are the varied rates of medical eligible students amongst districts and across the county where some communities have much higher rates of medical eligible students, others with less but still significant needs.

There are also quite a few disparities related to the ability to have school based personnel available to meet the needs of students, including variations around personnel type, staffing levels, and the types of credentials and other things that different funding sources require in order for the school to be reimbursed. We have great anticipation about the universal fee schedule and how that is going to be very enabling in terms of the ability for schools to seek reimbursement for services that are provided.

However, the universal fee schedule, which is slated to start in January, will start with a very small cohort of LEAs across the state and there will be wide variations in readiness and infrastructure for LEAs across the state to actually utilize the fee schedule.

We want to make heavy investments in this space because we do think it will be enabling, but we need to sustain the one time funding that's been made available to build out this infrastructure and need to be aware that there may be ongoing need, an additional year or two in order for all leas to be in a State of readiness to participate.

Variations in funding are also a barrier and create these disparities as many of the possible funding sources currently available to schools to build infrastructure and to expand services are one time competitive grants, and not all LEAs have the infrastructure to even pursue those grants. Lastly, I wanted to mention the LEA billing option program and some of the onerous audit and billing process requirements, very similar to what you heard on the initial panel.

And very few schools actually use this mechanism because of the onerous policies in our state in terms of the way it's implemented and how even years after a school district has received funding that they're required to pay funds back for usually very minor reasons. Thank you.

Thank you. Now we will move on to Momentum for Health.

Good evening. Good evening. Chair Jackson, Vice Chair Pellerin and Senator Cortese, thank you very much for the opportunity to be here tonight to be on this panel and with my distinguished colleagues. It's always good to be with Mary Ann Dewan. Before I start the prepared text, I just want to say how grateful I am, Dr. Jackson and Vice Chair Pellerin, for your personal statements. And you too, Dave. I feel like. Dr. Jackson, I feel like I have to ask you if it's okay. Your brother's name?

His name is Derek.

The work we all do, what we're talking about tonight, it feels that Derek is connected to what we're talking about tonight directly, and I want to be able to say his name and to provide these comments sort of in memory of Derek.

Again, my name is David Mineta. For the last eight years, I've had the privilege of being President and CEO of Momentum for Health. Before momentum, I served five years in the Obama White House as a Senate confirmed appointee in the White House Drug Policy office. But more importantly, I'm a consumer of services, and I want to thank my friends from El Camino Health for helping our family when we needed it most, and it's good to be in this room, in this community.

Momentum is a comprehensive, community based behavioral health nonprofit agency that serves youth and adults. Youth for the next two weeks, we have both mental health and substance disorder services. We have outpatient residential and crisis services. We're a union shop represented by SCU 521 and we all work really hard to pay our staff well and provide good benefits. All of this to stay on mission, serving the behavioral health needs of our community's most acute and complex behavioral health conditions.

Momentum is but one community based nonprofit among a strong network of 30 agencies, nearly all Members of the local Behavioral Health Contractors Association. You heard our amazing Executive Director, Elisa Koff-Ginsborg on panel one. I fear that my comments I could just say ditto to what Elisa said. She says it better than all of us all the time.

That said, I'd ask my behavioral health BHCA colleagues, many of them in the room, to stand up because I want to thank them for what they do every day. Data. We go into data a lot. I think I'll spare you some more data issues and data talking about data, but we are living in a time of unprecedented increases demand for better behavioral health services. But it's also a time of equally unprecedented focus by all levels of government, Fed, state and local.

In my 30 years in the field, I don't recall a time when mental health and substance use disorder has garnered so much attention. At the same time, by all three levels of government, the policy attention is great, but the policies must be developed in coordination with the end users and providers. Measurable client improvements are the only thing that ultimately matters. It's our mission at North Star.

I'd like to provide several examples from Momentum's own experience, as well as some ideas from provider partners here in the room. CalAIM implementation varies across the state since July 1 2023 with the implementation of CalAIM, our agency has experienced severe financial duress, so much so that we made the difficult decision to close programs and reduce our service offerings during a community wide behavioral health crisis. I'm a social worker, too, and this is antithetical to the profession.

What concerns me is that our program closures were preventable. It reminds me a bit of California's deinstitutionalization efforts of the 1970s, as pointed out by our Chief Medical Officer, Dr. Shafali Miller, when the state decided five decades ago to moving clients from state hospitals back to voluntary placements in their community was an absolutely laudable goal. But as we know now, the efforts were under resource and poorly implemented.

The shift under CalAIM payment reform is also laudable and could move specialty behavioral health services in a very important direction. But my worry is that it too is under resourced and poorly implemented. The consequences of our system of care could be devastating. Momentum is closing six programs serving over 650 clients. On the day that we said we were going to close those programs affecting 85 staff overall in a year, that's 1500 clients.

Four programs in the higher end of the outpatient system serving the neediest in our public health system, which is not an accident, but it's not like this is happening in a county that does not prioritize behavioral health. Santa Clara County supported behavioral health before, decades before it was popular. Senator Cortese was a supervisor here, leading that charge for many years. I believe Santa Clara County has one of the state's better public health behavioral health systems.

Our county Board of Supervisors know more about behavioral health issues as individuals and as a group than I would wager any board in California. Our new county Administration is extremely supportive of behavioral health and along with the behavioral Leadership group leadership of the Department, they all work well with our provider community to create a comprehensive and strong system of care. And yet, even in this situation, we are perilously close to getting it wrong.

I truly believe at its core this is about an inadequate pass through rate for specific specialty levels of care. As the board President of CBHA Statewide Association of Behavioral Health Agencies, I hear CalAIM implementation issues statewide. It seems to me that in counties that had a higher pass through rate providers for providers, there are fewer system wide problems. In Santa Clara County, 16 to 17 agencies reporting running deficits that we cannot make up in this fiscal year.

Revenue loss for some of us is running above 20% two days ago, all to the credit of the partnership between the Board of Supervisors, county Administration and providers, a system lifeline was extended to cover the initial losses that we were experiencing. This literally saved our behavioral health system. We now have some breathing room to address the structural issues around the CalAIM transition, but it was the interaction between electeds, county Administration and providers that saved that system.

I would suggest this cautionary tale to the rest of the counties throughout the state. The results, when we don't get it right, are catastrophic, as highlighted by my colleague Dr. Marina Post's written statement to the Select Committee submitted online. My colleagues Don Taylor from Civic clinic here tonight, Ryan Eisenberg from Children's Health Council highlight that access and equity need to need to remain our priority through Calam.

No wrongdoer approach has simply moved the door mild to moderates to managed care, receiving what used to be specialty mental health care. There are new referral flows and the clients ultimately may not access those services. My colleagues Chris Raboa from Rebecca's Children's Services and Matt Kamen from Seneca family of agencies pointed out how rates and rate structures limit the services in variable ways.

Programs at great risk like our community based services that many of them that we are closing right now, literally, we're doing this now with rates now based on credential and higher rates for folks with higher education levels. There's some disincentive to build and implement community based programs that should be utilizing peers and paraprofessionals that provide much of the direct service. This conflicts with our efforts to better integrate staff with live experience and direct ties to our communities to provide clients with culturally responsive services.

It also highlights what Elisa was saying about the workforce crisis. We are in it up to our eyeballs. This is absolutely the perfect storm that gets ever more perfect every day. Ultimately, my faith is in the good folks around our proverbial community table right now, and this is evidenced by our work of the Board of Supervisors two days ago. But we are not out of the danger yet. We are implementing multiple significant behavioral policies nearly simultaneously. We all need to work together. And again, thank you very much for coming to Santa Clara County and listening to us tonight.

Thank you very much. Next we will have the counseling and supportive services for youth.

Thank you.

Good to see you.

Good to see you again. Thank you Dr. Jackson, Assemblymember Pellerin and Senator Cortese for listening to us tonight. And I thank all my colleagues in the room that are sharing the challenges that you've heard. My name is - Marico Sayoc. I'm the Executive Director of Counseling and Support Services for Youth. We are a nonprofit that began in 2009 because three students died at the high school across the street and those families and that school community did not know where to turn.

And so many of my colleagues have shared the many services that are available through the county and through other nonprofits. What I hope to share to you is why school based is so vital, because the preventative work that is needed and that is being provided early. This is a child in a family's first touch to mental health support.

And if we are able to provide professional, qualified, compassionate therapists, it opens the door so that they know there is never a harm in asking for help, which is what all of us so deeply want. We want to destigmatize mental health. What I fear is that if nonprofits such as ours rely on medical, rely on insurance, the preventative work cannot get done. And you've already heard why. And so what will we lose?

You will lose the ability of placing therapists that love to be with children on campuses. They're not there to look for what can we Bill? But they're there to look for children who just need someone to check in on them. That's not billable. They are looking for supporting teachers and the staff that are in crisis themselves. That's not billable. The one on one counseling that many students need, sometimes it takes three to four sessions before you can create a diagnosis.

Those three to four sessions are not billable. You're missing the classroom presentations. You're missing the group counseling. You're missing the parents that are coming to campuses crying because they don't know what's wrong. They don't know what questions to ask. They don't know how to navigate the system. And so when you place school based counselors on campuses, you're giving families the ability to ask for help because they can't navigate the system.

And unfortunately, we don't have enough therapists that can help provide the system of care that we need. So we want to divert them from getting to the clinics, from getting to the hospitals. And then if they are necessary to have that care, you want a reentry so that when they come back to campus, they don't go through a cycle and downward spike spiral that we're seeing so often.

And so as a nonprofit, we're just sharing that there are so much resources that are available help us figure out how to utilize our talents so that we can continue to help the children and families and not necessarily get focused on the billing cycles and the medical paperwork that's often necessary just to provide that 15 minutes of care. And so you've heard so much of what, the prepared testimony I was going to share with you today about the challenges and the gaps.

And I'm hopeful that together we can put our heads together to really think about, well, what tools do we have? What barriers can we break, and ultimately, what can we do? So we provide multilingual culturally competent therapists into the hands of our families, into the hands of the people that need it so that we can, 10 years from now, hopefully even sooner, come back to this table and show the successes we've been able to make by pulling together. For your pulling together this hearing today, and I thank you very much for doing that.

Colleagues questions.

I was asked by one of my staff Members earlier whether or not these kinds of hearings have an objective of informing new legislation or just providing public comment or some other purpose. What's the real purpose? Or all the above. And I think it's all the above personally.

But when I see these kinds of hearings, Select Committee hearings, informational hearings, and we can't vote today on a Bill or on a budget item today, but on the Cal aim I've heard before I got here, we received a lot of what you said through correspondence and communications, Mr. Manetta. But if you were shaping legislation now or what we would call budget play, a budget ask, what would that look like today? And I asked really?

Because it seems to me the best solution to this is assuming we could get everyone to agree up at the state capitol, is to get the solution from all of you.

Yeah. Thank you, Senator. So I just want to point out a couple of colleagues that have been doing amazing work for us in this county, Anna Aaron O'Brien and Rachel Montoya from community Solutions. Aaron's a CEO. Rachel's a CFO. I'm trying to channel both of them right now. I think it would have been, one would have been a minimum pass through rate, and the pass through rate to the states, to the counties down to the provider would have been over 80%, if not 100%, pass through.

If that had passed through, and what I would tell, what I've told our county Administration, we wouldn't be having this conversation right now about closing programs. And if the state had actually mandated that to the counties, there are counties right now that the pass through rate was 40%. Their agencies in CBHA, they're going to leave those counties if that rate doesn't increase. And a lot of these counties can't afford to have a provider leave. They're the only provider. I don't know what happens after that.

That would be where I would start.

So, in effect, the rate structure just needs to be reworked. Is that fair enough?

I think the guidance, the rate structure that was set up, it seems like for all the different counties, I think you could argue, fair enough. It seemed mostly adequate. If it, if 100% had come through, 85%, again, we wouldn't be having those conversations. Those programs would be open. That 1500 clients, they wouldn't have felt any, seen any interruption in service.

So I think that, again, on the implementation side, there was a lot of planning and talk going into this somehow, again, we're on the verge of not implementing correctly, not making the right choices, and it has such severe catastrophic impact locally. I can't tell you how many letters we're getting from clients and their families right now about these closures.

Thank you. If I can, Mr. Chair. I just wanted to ask either of the other two witnesses what they think it would take to get what I think we all believe in. I know there was a tour earlier today of a great wellness center here on a school campus. We have those at the middle school level. We try to get legislation through. Sometimes it just requires the most simple of mental health referrals at each and every business.

For example, as far as their OSHA plan, I ran a Bill like that last year. The Bill got signed, but we had to take out the piece that required the wellness. Right. Too much became a California job killer Bill because of the fear of that. As if there's some expense to having something as simple as a plan that has a posted referral number. And we've certainly seen efforts on the school side at the state level, and I think everybody here is all for it.

You probably see a whole raft of aye votes in our voting history over the last couple of years on expanding mental health services and wellness centers and schools, but we're not. You got Prop 98 budget line in terms of folks wanting to know, wait a minute, we don't want the money to come out of that bucket. You've got fiscal tag appropriations issues. Any thoughts on how we can just expand the great work here?

I mean, obviously I'm disappointed at the business community not wanting to do what 7th graders are able to do in Santa Clara County. It's just the world we live in sometimes. But to be more positive and hopeful, especially you served in the local government, you're running a County Office of Education.

What do we need to do to just accelerate getting those wellness centers and the kids to where they can self regulate, they have a safe space and they can do peer referral and all these great things they're doing.

So I think there are a number of opportunities, things that we can do at the state level, and I alluded to a couple of them. So we were successful in getting some of the ideas around retooling the Lea billing option program and changing the administrative regulations around implementation. So I think having some ongoing oversight and working to make sure that those changes actually happen and then that there's infrastructure and support to help schools enroll and take advantage.

I also think that we've learned a lot from the SBHIP program. It was a short term implementation. I'd like to see some policy discussions about how do we make that more of a permanent relationship and how we take what the different learnings and how we work with the managed care organizations and others to sustain those efforts over time and build infrastructure and capacity with that existing model.

Another area is we know that the Behavioral Health Services act will be on the ballot and I think should that pass, and we're starting to implement that, there will also be a lot of need for oversight in Sacramento, the devil in the details, so to speak, and the implementation. It'll take I think years of developing regulations, providing training, communication, retooling the system to make the adjustments.

And I think along the way some preservation for some of the things that we've been talking about tonight, that not everything is billable, not everything is going to be crisis level, but still absolutely essential to meeting the needs of our children and families. So the prevention, the early intervention, thinking about investments in the whole child, the whole family, that then may also provide some cost saving measures down the road.

I know that's really hard for when we're in a current cycle of thinking about evidence and what the outcomes are to make decisions that on the backs of, well, we probably save money and save lives in the future. But the evidence is very clear and we have firsthand accounts as well as just implementation data that shows early intervention, prevention. Those types of programs are really essential.

The other piece is, as we think about opportunities, even if they are one time funding coming out of Sacramento, that we find a way to not make them competitive. It creates an incredible amount of inequity and disparity when a school district has to apply for a competitive grant to do something that we've identified as a high priority need in our schools and in our community.

And I'd really like to echo that non competitive what I share with my school. It actually doesn't have to be that complicated. If you placed a qualified therapist, that therapist is schooled and trained to work with children with very minimum. It's amazing what a trained therapist can do with sand and a playground. Sometimes we do as adults overcomplicate it when they just need a trained therapist to be on a campus in a reliable fashion, in a safe, comfortable environment.

And so I always want to encourage like we don't need to overcomplicate things. The other thing I want to mention is to talk about the disparity. We will continue to see well resourced schools provide mental health therapists while other schools continue to struggle. I can place five therapists at one school and then 5 miles away find someone for part time I have five schools where I am doing 100% of the fundraising.

And so we really need to look at how can we make sure that every school, regardless of zip code, has a qualified therapist that is available to assist students and families so that they don't always have to navigate a system that is not easy for them. And so anything we can do to remove that competitiveness and just place a qualified therapist on a campus will help ease the long term challenges and problems we will see in the future.

If I may, through the chair, just say in Santa Clara County some years ago, we, more than a dozen years ago, stood up a program that we call here school linked services, where the county itself has decided to take its MHSA money. And this was in the depths of the great Recession, so there was no General Fund money. I mean, we were telling folks we couldn't even find a $1,000 grant for them.

But the MHSA money was coming in in a big county to the tune where, thanks to the Administration and the push by myself and other, said, let's use that money to do exactly what you're talking about. The version of that county office has been instrumental in making sure that that rollout has happened and monitoring it. It's not very.

In very many other places that model, and a lot of counties don't use all their MHSA money, which I think has triggered some of the administration's response to wanting to put it on the ballot again and wanting to restructure things. One of the things that almost happened in the administration's first version was, in effect, the dramatic cutting of our ability and inflexibility in being able to use that MHSA money for youth mental health services.

And I know in this county there was some flexibility negotiated in what's going to go on the ballot, but there are resources like that. But how to scale that statewide is, I think, the question that's before us, it's not a question of political will in the Legislature. I'm pleased with the political will. I think you hit upon it, David, at all levels of government now, this is no longer item 25 on the list of priorities.

It's in the top three, and you need to be in the top three to get the kind of attention this needs. But now we got to figure out the implementation side of it. Anyway, thank you.

Thank you very much, Assembly Member.

I want to thank you all for your testimony today and your statements. It's really eye opening, and I 100% believe that we need to make prevention billable. We need to catch our kids, we needed to be doing screening at kindergarten and get them into a system and be able to provide care early on so it doesn't become a crisis later.

I want to just say I'm grateful to the Santa Clara County Board of Supervisors for filling in with the billing that's not coming in in time to keep services going. And I'm just devastated to hear about what's happening with momentum and leaving families without the programs that they become to rely on. Right. Because you said you had to cut how much? Six programs. And what's the amount of money that would be needed to keep? 10 million. And that's because of the delay in getting the CalAIMs money, or is it?

Yeah, it's a bunch of things. Because it's across different divisions. So it's in the substance use disorder division. It's in the adult, older adults and the children, youth and families. It's in the criminal justice. And they're all sort of different reasons, but I'd say they're all rate related because, again, I think if the password had been 85%, again, we wouldn't be having that conversation.

Yeah, absolutely.

I mean, I'm a social worker. I don't do math, but I got that math.

Like you said, this should be our number one priority to put the funding into mental health care, especially for our youth, because it will provide them the foundation they need to live a healthy life and will save money down the road, which I think is the difficult thing to quantify. As you were. So let's see. I had another question here. And then with CASSY. How many schools? Are you district wide or. No, you're not?

We're in San Mateo and Santa Clara County. No, we serve about 40 schools. I have about, unfortunately, 10 on a waitlist because, as you heard, there's a workforce shortage. And so trying to find trained therapists that know how to work with youth and are cognizant of how to be on a campus, it's difficult.

Is there a certain degree that's required for the people to be on these campuses, or is there some room for some changes there to make it perhaps like a two year degree versus a four year college degree?

Yeah, there's always room. Currently, CASSY employs postgraduate, so a master's level, MFTs or social workers. I know there's a lot of efforts to look at what we could do with associate or bachelor's level, and that's certainly something that we are looking at as well. But at this time, really, the cases we are seeing are so acute that we really do need trained clinicians that can handle a crisis from day one, because day one, you will have one to two already ready.

So we are at a stage, as many people have said, as a crisis. We've gotten here over multitude of years, and we need to look at all efforts to diversify workforce, to minimize the barriers we're creating, to provide care and to work together so that all of us who are continuing to struggle to find workforce can really utilize our strengths so that we're not competing, but really utilizing each other and our expertise when necessary. I refer out so often to many of my colleagues here.

We know what we're good at and we know what others are good at. And to leverage each other's strengths really is allowing us to really focus on making sure that those students and those families receive the adequate care that they need. Absolutely.

Thank you. And I know I've been very grateful to have the opportunity to tour the wellness center as we toured the high school today, and I've toured an elementary school now and the court school, and I just wish those were available when my kids were in school, because it's just vitally important for kids to have a place to go when they need a break, when they need to talk to somebody, when they're feeling the anxiety and the stress. So thank you for everything you're doing.

And we'll continue to work in Sacramento to make sure we can achieve these goals. And I think that collaboration between the locals, the state, and our Federal Governments is absolutely essential to get to where we need to go. So thank you.

Thank you for coming to our tours and also to all of you for recognizing that it is an all payer opportunity, that we really can't rely on the funding that is targeted for public school education to also Fund an entire whole system of mental health and wellness. We rely on our partners and community schools can't be a replacement for the safety net and that system. And yet we know that there is so much need and so much benefit from enhancing this continuum of care. And we do need to look at all possible payers as we're building out the system.

Thank you very much. I'm just trying to do a little check in. Is there anyone here who plans on doing any public comment? Can you just raise your hand? I just want to get a little. Great. All right. Just want to make sure we're staying on track here. I just had a few questions myself. Number one, of course we know we have community schools.

And you're right, it's more of a competitive type deal, but understanding that if we're going to truly make sure that schools are shifting from just being an education institution to a wellness institution, right, that we're going to have to do whatever we need to do to make sure that that's the type of support and the type of funding that all school districts can get in order to be able to transform their schools into what needs to happen. Are any of the districts within the county utilizing or being able to be awarded those community school grants?

Yes, we have a number of schools in Santa Clara County that were eligible and a small subset of those that were able to apply in the first round of funding. One of our learnings was that schools needed support and coordination with their application.

So a service that we provided out of our County Office of Education was to convene and provide technical assistance and support, and actually help design the readiness studies and doing the needs assessments in collaboration with the school so that they could actually make that application and receive funding. So we do have a small number of schools that are implementing wellness centers as part of their community school grant funding.

And one of the bills that I carried this year had to do with universal screenings for young people. And frankly, I can't believe how hard of a pushback I got for universal screenings. For a lot of reason, that sounded more like adult issues than young people issues, to put it nicely. Luckily, we were able to get a study funded to be able to find best practices of how school districts can implement universal screenings.

I say that because health centers are great, but it takes a young person to self identify themselves in many cases and then have the courage to go in. Hopefully there's no stigma tied to that. Hopefully there's not an adult stopping them to go, which are another issue to be able to receive services, or they are becoming a distraction in the classroom or things like that.

But what I'm most worried about are those students who know how to disappear in a classroom and who are suffering in silence. Many of them could have suicidal ideations. Many of them are dealing with subtype of trauma, but the way they deal with it is internal until there's a blow up that cannot be reversed. What can we do right now to do a better job of identifying people who may not exhibit external symptoms, but are just as capable of losing their lives themselves? Anyone? Go ahead.

As I mentioned, in 2009, we were created because three students across the street died that year. When we lose a student, and unfortunately, it has happened again and again. We often check our books and we check was that student, a client, and then there's always that initial leaf of, no, okay, we didn't do any wrong. Anything wrong. But I always then go back to staff and say, yeah, we did, because this child did not come to us. And so that's, again, where the preventative work. We're embedding a therapist in the school so that they are part of staff. They are walking the halls. They are checking in with students.

They are walking through classrooms explaining why mental health is so important, why asking for help, why checking in is so helpful, talking to teachers to share and psychoeducate, those are things that Medi Cal will never pay for yet are so crucial to build a team of supporters so that that child knows whether they go into the wellness center and check in with that therapist or they check in with a teacher or a coach or a custodian, those are the people that they need to know can ultimately lead them to the therapists and the Clinicians that can help them.

What we're seeing now, middle school boys, when you refer them, will not accept services. And so we're looking at innovative programs where we're coaching, we're working with coaches, we're working with custodians so that they could do some type of play therapy to build those relationships, to ease those pressures, because they are not accepting services yet. We know we cannot leave them behind.

And so, yes, we need to make sure that we continue to do what we can to reach out to every single student on that campus, regardless of whether they're smiling or crying.

Know one thing. I just would want to just emphasize something that Marico just said a lot the same word. It's relationships. School environments are target rich for relationship building every. And, you know, true to form, not to disparage government at all. Big fan of government. We can do a lot of good stuff in government as part of the Federal Government. We're here to help. I love going out and saying, we're from the Federal Government. We're here to help.

But reinventing what we know to be true, these are facts, and it feels like that's the thing that we do. Constantly tear something down. A few years later, somebody gets a bright idea, hey, we should do this. This we know. We already knew before we tried. It worked great. DA DA DA. Again, relationships in schools, whether they're custodians, bus drivers, whoever they are, teachers, obviously, that's who knows those kids. That's who knows those quiet kids, too. The kids who disappear. It's like, I know you.

I saw you. And we can train them to actually do it better. And again, I think those funds come in and it's how to break that time out in the curriculum is to take the staff and be able to do that. We did it before. That's the thing.

If I might just endorse your idea around the screenings. We've done some pilots with screening at like fifth grade and 6th grade level and have some experience with what worked well with that and maybe what some of even the barriers to service once you identify through a screener. Additionally, I think there are all these opportunities with the adults on campus with training and awareness sessions and ways in which we can notice and identify potential needs that create an invitation perhaps to screening or triage.

Also in the wellness centers, that is a component of the work that we do. So when students come in, they complete a really easy, brief survey. It gives us a hint of how they're showing up. And if needed, then the liaison can triage, and that can also lead to a more in depth assessment if needed. And then I also think there's a lot of opportunity around curriculum.

What we do in the classroom, the way that we promote curriculum across the school campus focused on wellness, helping young people, even self identify, destigmatizing, focusing on our mental health and wellness in similar ways that we educate around physical health and wellness can go a long way to addressing the concern that you raised.

Thank you all very much. I want to thank this panel very much for bending our ear, because there's going to be some very important things. I want to let you know that it is not too late. If you look on the agenda, there is an email on the agenda that also says, please send your written testimony to Lamont Gordon.

Just want to let you know if you get in any Bill ideas by January, the entire Select Committee will be taking those up to see which ones we might be able to introduce next year as well. So just know we're trying to provide even more direct access for your bills to be considered your ideas as well, so that we can make sure that we're doing things in a timely way.

And also so you know that we hear you and we want to make sure that we're presenting what is necessary on the ground. So thank you all very much for being here. Thank you.

Yeah, now we're going to do a public comment and we're going to do a. I think what we're going to do is we're going to use the. zero, never mind. All right. I was going to come up with my own idea. Okay. Improvise I was ready. And so, of course, we're going to give everyone 1 minute to briefly provide your comments, of course, so that we can make sure that we hear from those directly on the ground as well here.

So if you can begin lining up, and what we would like you to do is just to state your name, your affiliation, if you are affiliated with an organization, and then, of course, what city you may hail from. All right, please.

Good evening. My name is Sarah Rickler, and I live in Santa Cruz County. So I'm in Gail Pellerin's 20 eigth district. I know I only have 1 minute. I'm a retired public school teacher from Pajaro Valley unified. I'm bilingual in Spanish, and from my standpoint as a teacher, I had firsthand experience of hundreds of students who needed mental health counseling and referrals. And the amount of paperwork and barriers that we encountered as teachers to make referrals for mental health counseling was just enormous for my most critical students.

And I would say I probably had about three students who would get it per year or maybe semester. The intern would change every two months, so there was never any continuity. They would get to see someone for about 15 minutes once every two weeks or 15 minutes every week. These were high risk students. They saw violence in the home. They saw substance abuse. They had malnutrition. There were attendance issues. I can go on and on and on academic issues. The teachers are there to see it.

My background is in public health. I was just appalled at the lack of resources and the little amount that those interns were paid. So I'm also working with middle school students now and high school students as a tutor, and I see it with the pandemic. So I just wanted to say there are barriers in the school system for kids to get help.

Thank you very much. Next.

Hi, my name is Sharon McCorkle. I live in Boulder Creek, happy to be in Gale's district, and I am a retired school teacher, public school teacher. I taught science to high schoolers for 30 years. The last 13 years, I was in an alternative school. This was in Davis, where I happened to live at the time. We had a lot of at risk kids, and when we started having health providers on campus, mental health providers on campus, it made a world of difference.

It reduced the stigma of seeing somebody and the therapist. It was interns money saving. Sometimes we did have an actual therapist, and he'd go out and play basketball with the kids and be present at assemblies and things like that. And so having that person be a critical part of the staff and part of the students world is very important. The other thing I wanted to say before I run out of time is people with mental health.

People don't usually think of class size as being critical, but teachers that work with 35 kids, this is secondary schools turning over five times a day. You just can't get to know your kids and build the kind of relationships that you can. If you could even knock five kids off of that class, it's a huge amount of money, takes a lot of resources. But the more teachers and students have an opportunity to get to know each other, the more those referrals can be effective.

Thank you. Next. All right, well, this is mental health, not physical health.

Thank you, chair Jackson, and condolences for your loss. I'm sorry to hear that. Thank you so much for holding this. Sarah Bridge with the Association of California Healthcare districts. I get the distinct pleasure of representing the 77 healthcare districts throughout the state. Thank you for having El Camino participate on the panel. I think it's really important to hear from public providers that aren't just county providers.

Want to note that we are proud supporters of Proposition one and hope to see that be successful because we have significant challenges accessing the funding. Even though we are public providers on the ground providing that care because of the county pass through, typically those dollars don't funnel down and we're caring for the most vulnerable populations in the state. I wanted to also take the opportunity to answer your MCO question.

The MCO deal was historic, incredibly important, and will go a long way in addressing some of the systematic inequities that we've talked about today. However, we're not going to see that funding come down this year. We will see it come down next year and subsequent years. And then there's the ballot initiative, and certainly there are winners and losers. And I think it's going to be really important that the Legislature make a commitment to following through on how those dollars are allocated.

Additionally, I just note that there are all sorts of things that we can do outside of the budget process. I know we're in a budget deficit year, but there are things that we can do to utilize our existing workforce, leverage future workforces, and eliminate some statutory barriers that make it difficult for us to provide care. Thank you so much. Look forward to working with you more in Sacramento.

Thank you. Next.

Good evening. Thank you for having us. My name is Andrea Ranki. I'm from San Jose, and I'm also a nurse, and I have suffered with mental illness for about 17 years. So I've seen lots of changes happen. And last year, I was having problems with my heart, and I went to my psychiatrist and I told him, something's wrong. And I ended up getting an echo. And I had left ventricular hypertrophy of the heart from the medication that I was taking.

The provider told me if I was not suicidal or manic, he would not help me to get off of work so that I could use a bridge medication to help me get off of the other one. So I had to end up fundraising $30,000 to go to a private clinic in Florida to get off of a certain medication. And that was a lot to try to do while you're not doing well. And recently, I had to be hospitalized.

And most psych wards treat you inhumane and are traumatic to be on. And I had the pleasure to be on the unit. I don't even want to call it a psych Ward. The hospital unit at El Camino hospital surpasses any place that I've ever seen. They're phenomenal, they're seamless, they're excellent. Dr. Singh, who worked with me, she said, we don't just like our patients, we love them. And you can see that.

And so I just wanted to suggest that El Camino hospital be training other hospitals how to treat patients humanely and to decrease the traumatic effects of being in a hospital or a psych Ward. Thank you.

Thank you. Next.

Good evening. Thank you for the opportunity to speak on this important topic. My name is Kathleen Willie. I'm a local Los Gatos mom with kids in the local school district. I also work for the Los Gatos Union school district. So I see kids in elementary school and middle school most days. So I have seen the impact of the mental health on the kids from before the pandemic and after the pandemic.

So I've heard a lot tonight about the increase in suicide and depression, and I think it's important to acknowledge the why. The lockdowns were really hard on our children. So it's hard to sit here as a mom and see how much your children missed with not some accountability of what happened. Our local, state, and federal response to Covid was disastrous. It was all wrong, and it was unnecessary. The school closures were 100% unnecessary.

You look at Sweden, for example, they decided to not close the schools, and they had a much better outcome. We had the worst COVID deaths globally, and we had some of the most draconian lockdown measures. So I'd just like to say I think we need to acknowledge the why. Thank you.

Thank you. Next.

Good evening. Chris Miller Lasquettes resident, proud constituent of Peller and Cortese. I was honored to have actually written the Bill language for Senate Bill 224, which mandated mental health instruction in California schools in 2021. It was introduced by Senator Portantino. Cortese was a co sponsor, which was great. It goes to superintendents ... comment of incorporating mental health instruction in schools. There was accompanying Bill 509 that unfortunately got through the Senate and Assembly was vetoed by the Governor in October.

509 would have added mental health instruction, mandated mental health instruction for elementary schools. So at this point in time, at this moment in time, mental health instruction is only required for schools that have a health course, and not all schools across the state have a health course, and it's not for elementary.

So I'm hoping that come this next legislative year, perhaps the Select Committee can look to have a potential Bill support, a Bill that would continue the work building on Senate Bill 224 mandated mental health instruction. Thank you.

Thank you.

Thank you so much for this vital conversation. My name is Chevakar. I am with Gail. I'm in Boulder Creek, California. I stand before you right now as a California nonprofit and corporate Executive consultant to the healthcare industry to prevent burnout and teach Clinicians in our VA hospitals how to treat mental health issues and complex PTSD.

First, but foremost, and to present our written testimony, which we emailed to you yesterday, my staff and I. But foremost, I am here as a daughter, a sister, and a wife who would have left my family bereaved as the two of you are due to suicide had it not been for a very simple self regulation technique that I learned when our mental health care system failed me.

That was developed at a research Institute 45 minutes up the road from here that is now deployed worldwide and is taught to children around the world. Had I learned that skill when I was seven years old, when my best friend was killed in gun violence, I would not have become a burden to the mental health care system.

Emotional literacy, and lack thereof, is a huge source of our mental health care crisis, and I want to expand the conversation to say, this is not a California mental health care crisis. This is a global health care crisis. I consulted this year to the G 20 and helped ratify a policy to lift social emotional learning in the G 20 countries of which the United States is a Member, on par with literacy and numeracy as foundational to all education and employment.

We have the opportunity to make simple self regulation skills like those evidence based, developed down the road available to children starting at the beginning as part of their reading, writing, arithmetic. And when we do that, California will be an example worldwide for how to transform this global crisis. Thank you.

Thank you.

Thank you for the time. Thank you. Panelists, I'm Don Taylor with Pacific Clinics, nonprofit, statewide and in the area. And a couple quick things on CalAIM. Just number one, to re emphasize access and equity is the center of CalAIM, and community based work is critical for success. So I think about where you and your seats can impact that. I think there's four areas from my perspective. The first is pushing for diversity of the specialized rates based on the need, as you heard from the panelists.

The second is insisting on consistency of rates across counties and the pass through rates to the providers. Simple example, locally, Santa Cruz County has a much smaller rate than Santa Clara County. Santa Cruz County. And in turn, their providers are greatly struggling right now, even more so than Santa Clara County. Third, enforcing of the parity laws is very significant. Significant. And then fourth, is continuing to keep advocating for mental health like you are. The crisis is real, and I appreciate the time. Thank you.

Thank you.

Thank you, Dr. Jackson, chair. Thank you, Vice Chair Pellerin and Senator Cortese for your public service, even in times of extreme personal losses. My name is Marina Post. I live in Los Altos. I'm honored to be a psychiatrist with the momentum for health youth outpatient programs for two more weeks while I say goodbye to all of my patients and they say goodbye to all of their treatment teams. Out of the 650 plus clients affected by the momentum closures, over 350 are in FSP programs.

Fsps provide life saving mental health care when other programs cannot. Many patients, including some of mine, cannot have this care anymore, anywhere. The frontline staff for fsps are a hardcore special forces type of case manager with a whatever it takes ethos. These staff are the ones saving lives by physically being with patients in their communities rather than in a clinic office. Soon, over 300 people with severe mental health struggles will be losing access to this life saving care. A primary medical equivalent would be our county losing 30% of our er beds. Thank you.

Thank you.

Hi, thank you so much for being here. I think I've been very moved by all of this. I'm by no means a mental health specialist. Anything. I'm a creative person and I want to piggyback on Mariko's comment. I'm the Executive Director of KCAT TV and radio here in Los Gatos. We're on the Los Gatos High School campus and Marika said something that just resonated me. I wasn't going to speak or anything, but she talked about innovative programming. I think the wellness centers are terrific.

I'm glad you toured it. Offer. I consider us wellness in a big way. I've been with KCF for nine years and we run these summer camp media programs to teach kids live TV and movies and all the media stuff. And I've noticed over the years more kids with mental issues and the world of autism have been coming to our camps and one of our biggest successes is podcasting for kids.

So when those kids come and they put on those headsets and they just talk and talk and talk, they don't even care if we record. And sometimes I send those recordings home to mom and dad so they're aware of issues. It's been so successful in my little opinion, I think thinking innovatively and sometimes we get too inside the box and I like to take it outside the box. So maybe innovative programming is another road or pathway. Thank you.

Thank you. Appreciate it.

Hi, Bruce Neustadter. Mostly I want to thank you for doing this and thank all the community based people for working their rear ends off. About probably over 35 years ago, I walked into a classroom to provide mental health, and a teacher principal was presenting me, and teacher asked, why do we need a therapist here anyway? We've moved past that.

And my experience in working in community based organizations and private practice, there's always an impediment and almost an implied lack of trust about how funding passes through if somehow that piece can be lifted. Where the community based organizations get the money, where we're not sitting there arguing about how much the pass through is and understanding that these critical services cost money. Appreciate it. Thank you.

Thank you.

Hi there. My name is Carrie Dunlay. I live here in Los Gatos. I have three grown children, and I don't remember a lot of this happening as I was growing up. So I think the lady that left and spoke earlier saying, we actually need to look at what are the causes? What's this crisis coming from? Right. Instead of trying to put all the solutions to fixing. I want to talk to you. I want to figure out what your problem is.

But I think there's bigger problems, like the pandemic. I think the kids have more power in the classroom than the teachers do. I have a friend who's a teacher's aide, and the stories she tells me are horrific of what the kids are allowed to do and the teachers have no power at all. Kids can spit on them, hit them, do whatever they want. And the teachers are reprimanded if they react to that. I mean, it's like it's flipped upside down. Kids are on their cell phones.

They're not socializing properly. There's so many problems that are underlying causing these mental illnesses. They're just disconnected. Anyway, I appreciate you being here, but I hope you look at the deeper reasons why it's all happening.

Thank you for being here.

Thank you.

This concludes our field hearing.

Snuck up on you a little bit there. Thank you all. I very much appreciate you having this conversation. My name is Kyle. I'm from open doors to future possibilities. We're a nonprofit in San Jose. We talked a lot about helping, working with kids, families, moms, and there's a lot of talk about overhaul and working with rates and insurance and trying to figure stuff out with medical calam, something that maybe we didn't touch upon that I'll bring up here. So open doors, future possibilities.

Our main goal is to make mental health services exportable, accessible. We do that $10 an hour for anybody coming in regardless of insurance. So those that don't have insurance, how does that get billed? How is that covered? In addition to veterans, a big factor with veterans is diagnoses help limit the percentage that they get back when they talk to the VA, if there's things like that in terms of their percentage and ratio that they get in return.

So just wanted to say that there's an opportunity, I think, to fill that gap with organizations that do provide services that kind of COVID that sort of niche as well. And just want to say again, thank you for your time and everything here.

Thank you, colleagues. Closing comments

I just want to say. I toured that facility as well, and that's incredible. I mean, really, it's just going to take a lot of creativity, a lot of collaboration, a lot of love and care for our fellow humans out there to do this important work, to get to where we need to go. And there's lots of gaps and lots of barriers that have been identified today.

And you have my promise and that I will be working on these and hopefully coming up with some solutions because mental health care is so vitally important. And thank you to Dave Mineta for naming Derek, and I really feel like his spirit is here and just kind of cements our resolve on how important this work is. So thank you all for being here.

Senator.

Again, thank you both for the invitation to be here and to participate. And I do take the responsibility now of making sure that this discussion, this conversation becomes fully part of the discussion and debate in the Senate as well. And thank you for your leadership, Mr. Chairman. To say the least, the understatement would be you would have been fully respected had you called off this hearing under the circumstances. And instead, you gave us the opportunity to do the hearing dedicated to your brothers.

So let's carry that spirit forward in the form of legislation and budget requests that really make a difference. I know we can all do that together. Thank you.

Thank you. We want to thank everyone, of course. We want to make sure that we thank all the staff from all of our offices who did all the logistics, made sure we were fed so we weren't cranky, make sure we got to where we needed to go on time, and so very much appreciate it.

I want to thank the panelists for making sure that we fully understand what's going on on the ground, the ramifications, and making sure that we continue to put faces to these policy discussions and so that we don't get separated from. These are real people's lives here. These are people being affected here. And so we really appreciate that as well. We want to thank DCO for being able to make sure that all the technology and everything is working appropriately.

And then, of course, I want to let everyone know just how appreciative I am with my colleagues for being here, for taking out the time and making sure that we give this the quality that it deserves. And, Madam Vice Chair, you know how much I appreciate you and feel about you and on this walk that we've done together this year and making sure that today was full of a lot of great stuff.

And I want to thank you and your staff for making all this happen for us so that we can do this here today. Also want to make sure that, you know, throughout the. Also throughout our day, we were also joined by Assembly Member Rebecca Barkayan, as well as Assembly Member Mark Berman, as well. And also Assembly Member Alex Lee would have been here, but he's out of town, and so we just missed each other. But thank you all very much.

But know this, we've taken notes, and hopefully you've seen just how serious we're taking this, that this is not an exercise for us, but this is a mission that we're on to making sure that we get this right. So thank you all very much for being here. Be safe. We are adjourned.