Assembly Select Committee on California's Mental Health Crisis

And finally, Panel three will bring us the perspectives of community crisis centers and a local Police Department. Practitioners who respond directly to Californians in crisis. After all three panels are done presenting, we will take public comment from those who are here in the room with us.

So for those who are watching on the live stream and have comments to submit, please email them to my Legislative Director who's here today, Charmaine Mills.

It took a lot of time, work and heart to put this on, and I'm very grateful for her energy and coordinating this hearing today. My hope is that today's conversation helps us deepen our understanding of where we are, identify actionable solutions and strengthen partnerships across the state.

I also want to thank the staff and members of the public who help keep attention on mental health as a core priority for California. I'm thrilled that Assemblymember Chiavo is here today. She is one of our Committee Members as we are in an interim time when members are in their district.

Thank you to our panelists and our Chair who has had a laser focus on this issue throughout her tenure in the Legislature. I was very happy to come in with her as a colleague at the same time and have seen her leadership be really critical when it comes to our mental health crisis.

Tearing parents away from their children who are in the process of seeking citizenship and withdrawing critical support to the very youth who face the highest suicide rate. Our LGBTQ youth. California answers more 988 calls than any other state in the nation and nearly one fifth of all crisis calls nationwide.

I'm not going to talk about this because it's a little too much. But over the past several years, California has worked hard to build a crisis response system worthy of the people that we serve. We expanded mobile crisis teams.

According to a recent NPR interview, crisis counselors are now hearing from children as young as 9 and 10 years old because they don't know where else to turn. This is, as I said, not a partisan issue. It's a matter of life and death, and it's a public health imperative for us.

Thank you, Assemblymember Chiavo. You can see how this issue has touched us personally and emotions are very present. So with that, we'll begin with our first panel on state implementation updates. This panel will provide an overview of where California stands in building a coordinated, effective crisis response system.

I would have to say that over the 25 years that I've been working in this field, I can attest that I'm seeing changes that are being implemented on a daily basis in order to address the crisis that you just described.

CALHS plays a critical role in three areas in this overarching system of the Crisis Care Continuum really focused on coordination, accountability and transparency and community engagement.

CALHSS will continue to identify challenges, opportunities and solutions to improve California's crisis care continuum and I'm very pleased to be here today and to listen to all of the speakers and gather some of that information.

Those initiatives to date have invested nearly $14 billion in our behavioral health system and has really provided us a critical opportunity to create the crisis response system that Californians deserve, regardless of payer or insurance type. AB988 required our agency to establish an advisory body to develop the 988 crisis called the 988 Crisis Policy Advisory Group.

The plan also identifies four pillars of what we need to accomplish within all of those activities. First is equity.

And critically important, especially as I'm voicing the work that the advisory body did is to make sure that we have peer support in every element of our crisis system from preventing crisis to providing ongoing recovery supports. Cal HHS has several departments that were named as being responsible for implementing activities in the report.

We work closely with our partner who will also be on the panel today, the California Governor's Office of Emergency Services, who participated significantly in the advisory body and are responsible for the sustained interoperability between 988, 911 and other emergency services.

As I mentioned, I came before this Committee in 2022 to talk about that peak. At the same time, we were also getting ready to implement the Children and Youth Behavioral Health Initiative, which was critical in trying to address some of the needs of young people.

In addition, we have four different targeted campaigns for young people that are led by our California Department of Public Health. They are called Never a Bother, Take Time to Pause, Live Beyond, and collectively we've had over 4 billion impressions from those campaigns.

In response to that and eliminating that specialized press three option for young callers, we worked to enter into a contract with the Trevor Project to provide enhanced competency training from experts in this field to ensure and support our crisis centers in being able to meet the needs of LGBTQ youth.

We are continuing and actually launching some of that training in the new year.

You may be familiar with and round one of the BCHIP bond that was funded through Proposition 1 have collectively created, or I should say funded, not all of these, not all of These pieces of infrastructure obviously are built, yet they're under construction and or in the process of being under construction.

So we've created 13 crisis residential facilities, 23 crisis stabilization units, 14 sobering centers and the first round of Beechip most notably was focused on supporting the mobile crisis response infrastructure, knowing that we would be rolling out the MEDI Cal mobile crisis benefit. And we have either created OR enhanced over 485 mobile crisis teams.

And we all and and of those over 4,000 have identified Sud as being part of their personal recovery experience.

Thank you. Thank you so much. We were told that construction was over, and so I feel like I'm in the dentist's office and they're drilling your teeth and they're saying that, oh, wait just a little bit more. So hopefully that's where we are.

So we'll move on to our next speaker now, and ideally we can Keep comments to 10 minutes or less so we can get through the day. I let you go over because you're, you're the. The kickoff here. So thank you so much. So we'll now move on to Ivan Bhardwaj.

I'm the chief of the Medi Cal Behavioral Health Policy Division at the California Department of Healthcare Services. My team and I oversee the policy components of the specialty behavioral health plans. And we also oversee Medicaid adjacent initiatives like the Community Assistance, Recovery and Empowerment Act, Laura's Law, and of course, 988.

We work very closely with the departments that Ms. Welch had mentioned, but we work in particular very closely with the Health and Human Services Agency and the California Office of Emergency, Governor's Office of Emergency Services.

In administering the 988 network, we specifically contract with a third party administrator at the Advocates for Human Potential, and they in turn contract with the 11988 crisis centers that make up the network. And through these contracts, we Fund the 988 crisis centers.

And historically, there have been a host of different funding sources that have supported the 988 network, including the Mental Health Services Fund, which was from the Mental Health Services act, state General funds and also federal dollars such as the Community Mental Health Services Block granted a little closer. Okay, there we go.

It's funded by the Samsung 988 grant and we've thus far deployed more than 270 static billboards and about 240 digital billboards. Actually, if you're on 16th and T, I think it is on my way in onto the office, I saw a 988 billboard. So they're located throughout here.

As I noted, it is required. We are also receiving federal enhanced match of the mobile crisis services benefits. So There is an 85% match where the centers for Medicare and Medicaid Services is covering the mobile crisis benefit.

So the 90 day crisis centers that are operated by those two counties dispatch mobile crisis services. And what we're doing is looking to understand what their protocols are, how they function, how can we mirror and replicate that to the rest of the the remaining 988 crisis centers?

And there's a lot of opportunity to make sure that there's a close system integration so that every 988 contact can basically potentially get a mobile crisis team that's being funded by Medi Cal. So that's the goal long term. And that is supported by the 988 implementation plan that Ms. Welch had earlier mentioned.

I do want to expand a little bit on our work with our counties. Like I said, there are two county operated 988 crisis centers. The remaining are supported by community based organizations.

And we are working really closely with counties to better understand how they are being funded, how our 980 crisis centers are being funded right now, and also being transparent on how we are funding our 90 day crisis centers. So we're not duplicating funding and allowing counties to really strategically Fund across the behavioral health continuum in their localities.

So one thing that's really exciting is our 988 referral resource directory, which is kind of a sophisticated tool that allows, that will allow 988 crisis counselors to be able to filter local resources so they would be able to see, hey, locally, is there what housing resources are available, what peer support services are available, you know what, you know what other crisis stabilization units are available, are there mobile crisis teams that are available?

But you know, I think, I think of a 98 is very much in the beginning stages. As Ms. Walsh had noted, it launched in July 2022.

All right, we're back and there's peace, so let's be grateful for that. So, thank you all for being flexible and being willing to pivot to another room. We'll now continue with our hearing, and thank you, Ivan, for enduring that noise and hopefully we can get your written statement testimony as well to add to our records.

Correct. Yes, thank you. Good morning, Chair Pellerin and Assemblymember Schiavo. Thank you for the opportunity to come provide an update about the California 988 system that we're building. California has made substantial progress in building a modern statewide 988 system that connects people in crisis to immediate help and strengthens the bridge between behavioral health and emergency response.

The other thing that we've accomplished is is validating the interoperability between the legacy 911 system and the 988 call system.

That's for legacy traffic on the legacy 911 system that's operational today and it requires the calls to be transferred through an analog interface that the call taker ends up being the prime mover in making that transfer. Going forward in the next gen 911 system, additional capabilities will be built in and that will allow that, that transfer process to be automated, so it doesn't rely as heavily on the human to type in the 10-digit phone number to make the transfer.

That's a feature set that I think we've heard from a lot of the frontline people that that would be valuable to them. So, that's being built into the product. As I mentioned, that's a 60-day pilot that's happening at the Buckaloo Center and that 60-day term recently came to a close at the end of November.

So, that's, you know, the high-level overview of what Cal OES involvement is. You know, as we've gone through this, we've built a backbone of a modern system. I think we have the network, the routing technology, the call handling platform and the governance structure. And we're developing these partnerships.

So, we'll continue to build that system out and deploy it when and where it's, it's desired. I think, you know, a lot of it has to do with you know, other opportunities that are on the market that the call centers might avail themselves of.

And then of course, you know, as we do this, we continue to work with our partners at Healthcare Services and make sure that whatever new material comes down, we're standing ready to be able to implement that as well. So with that, I think I'll close my remarks and I'm happy to answer any questions at the appropriate time.

Wonderful. Thank you so much. Just a quick question. We just were wondering whether you can text 911.

Yeah, so that is a feature that's available in the legacy 911 system and it's also being built into the next generation 911 system. So, that feature will be available and continue through into the new technology.

Thank you. We'll now move on to our last speaker for this panel and that is our President of the 988 California Consortium, Narges. You may begin.

Thank you so much for having us today.

In today's presentation, my hope is to give you a glimpse of what the work is like from the perspective of running a 988 center and also, the ways in which we have encountered the dynamics that we're encountering right now. I think the first and foremost is the number of help seekers reaching out has increased substantially.

And I have some slides coming up with the number, with the actual graphs of that. And these are our neighbors who are experiencing significant distress right now. I'm sure you're seeing this in your own districts. You're seeing this on your staff; you're seeing this in your house. Like, watching TV is stressful. People's economic well being feels threatened.

And we're glad that they're reaching out for help. I want them to be reaching out for help, but I also want to be able to show up for them when they reach out for help. And there are a couple dynamics that are resulting in not only there's been an increase in call volume, but our call lengths are getting longer.

Currently, the national standard for follow up, which changed just two years ago, states that anyone who's had any suicidal thoughts currently or in the last 24 hours should receive follow up care. That's an outbound contact from a center. Most centers in California are not able to offer follow up care at that level right now.

There are some additional things that are important. When we talk about key performance indicators, I think it's easy to kind of zone out. But the key performance indicators are about people getting quality care. Our key performance indicators are about picking up calls in a speedy fashion.

To put that in perspective, in 2023, in California, about 4,200 people died of suicide. And what if one of them had called us and didn't get through? And I think that's a reality that is hard to hold, so we often just talk about the metadata. But those individual calls are actually the world I live in.

Our partners are responsive. They put in a budget request, the budget comes through a couple months later. We hire a couple months later. By then, I'm nine months behind the call volume. And you know what? The call volume has grown again. So, it's not that our partners aren't being responsive.

It's just the system is growing at a pace that's outpacing all of us. Next slide please. This one is our text and chat volume in California. The red is texts and chats that flowed out of state and the dark blue is the text and chats that we were able to answer in California.

Our current in-state answer rate is the highest it's been, at 43%. So, most texts and chats from Californians are going out of state. Again, this is making it hard for us to utilize the amazing behavioral health continuum that Stephanie talked about. I feel it. I've been running a crisis center for 13 years.

And I think in order for all California centers to have 24/7 text and chat capacity, which they currently don't, there is a need for a major one-time investment or maybe like a two-year plan of how do we get from 43% answer rate to 100%? Next slide. And this is my last slide.

These are some of the barriers that we're currently holding. The AB 988 search funds are just plain insufficient to meet the growing need and to help us expand to the degree that we need to.

The goal was for all centers to be using this unified platform by July 1, 2024, and we're just noting that it makes it harder to do the work the way that is being envisioned in California right now when the infrastructure that was supposed to be part of that implementation is not in place.

And part of that is even technology reimbursement. Our centers are mostly community based agencies and when we hire folks, we buy them computers to do this work. None of us are yet to be reimbursed by Cal OES for that. Some of us have been waiting nine months to be reimbursed.

Yeah. So, to address that, I think it's helpful to look at it from two different perspectives. One is the, the per line surcharge is, did go down this year, but the funding is still there to meet whatever has been appropriated in the final budget act. So, the funding didn't go down, the surcharge went down.

And so, once we determine the revenue need, then it's a math calculation based on the number of lines that we get from the carriers. They tell us you have about 45 million lines of service, and so, you divide the revenue need across those lines of service to get the surcharge.

But it seems like we've identified funding gaps, right, that you know, you paid for computers you haven't been reimbursed for. So, is there enough money that's being appropriated? I mean, do we need to address that? And what happens if CAL HSS and OES disagree about how to invest those revenues?

But I think my colleagues at HHS or DHCS would know more about what happens behind the scenes because we are not at those tables.

Just a point of clarification that might be helpful. I know it was for me when I was trying to understand this process and I'll use specific years. So, we're currently in budget year '25-'26. That budget gets approved July 1st, 2025.

But that is technically one of the challenges is that we are on a fiscal year budget setting process and the rate setting is on an annual process. There are other mechanisms that we can use to right size that. But again, if we do new things, it would have to be through the budget process.

Some of the new things that were mentioned by the crisis summit.

I mean, this is. This is a problem. We hear a lot that are, you know, a lot of what we do in funding our budget is year by year. And it means that there's not the kind of reliability or the forward planning that organizations need. And it's frustrating. And I think it's also by design because.

And so, you know, I do think that this is an area where we really need to prioritize and make sure that we're planning for that.

I'm really encouraged with what the State of our, you know, coordination amongst our, our agencies is right now. And I have hope that it will continue that way and, in fact, get better as we go along.

I would concur that there was Insight in the drafters of AB988 to ensure that the two bodies that are responsible for overseeing the implementation of the growth of this 988 system are on each other's boards. But I would also offer, there are. It's almost like a whole network and series of meetings that, that we staff.

It's true with the work that we do around addressing housing and homelessness as a health care intervention. So it's part of the philosophy. And so I do think that structurally it's helpful. We've also created a project charter together to kind of delineate roles and responsibilities.

We're developing new muscles in working with a consortium. And I'll give an example. You know, we were developing a methodology at DHCS, a funding methodology. And there was an important kind of milestone for us where we determined, you know, what, we could do this in isolation.

We could share it with our fellow departments and then we could roll out the funding methodology and just give the crisis centers the funding that we think that they need. But importantly, we actually engaged with the crisis centers. We wanted to tell, hey, what's wrong with this methodology? What's going right with it?

And so I think working with the crisis centers, I think that's an ongoing partnership that we're kind of working to further develop. And I'm really excited about that part.

Just one other quick question, and I don't know if it's appropriate for this panel or maybe a future one too, but do we, what data do we collect and what do we know about people who are calling 988? What do we know about what are the biggest issues that they are facing?

Currently the data collection is obviously based on the content of the call. And as you can imagine, it's hard to collect, for example, like demographic information when someone is in crisis. We do have some demographic information and because we have such a large sample size, I do think the information we have is meaningful.

So sometimes part of the presenting problem is someone's identity. Sometimes part of the presenting problem is someone's immigration status.

Okay, and just one last question. So what does Cal OES do to collaborate with the call centers?

And that's how we came to the conclusion that we needed to include the contact resource management segment to the product where that gathers information over, you know, multiple calls that would be helpful to the call taker.

You saw the trend line of the number of calls, but the severity I think you also mentioned, or the acuity I think is the term you used. And so as that changes, then that will drive additional changes in technology and in feature sets that need to be built into the product.

So it isn't a build it once and then you're done kind of thing. It's build the initial product and then iterate to make it better and better over time. And in order to do that, we have to maintain that, you know, touch point with the frontline operators.

So that's, you know, and when I say operator, I'm talking about the people operating on the front line, you know, because that's, you know, where the rubber meets the road. So that's what we're doing and I think we want to continue doing that.

And from the call center's perspective, is that system meeting your needs or do you have suggestions for improvements?

Sometimes it feels like the feedback is a one way street, which is where feedback is collected repeatedly in an iterative process. But the result of the feedback or how was it implemented is not reflected back to the centers. So the centers aren't really sure what is happening with the feedback that's being being given.

So I think the intention was there, but often on the ground it doesn't feel like we're at the table as a partner. It feels like we're being managed like a vendor.

And so today is my first day ever being in this capacity, in this setting. So I'm very grateful for that. And if I cry, please forgive me. zero, we're just going to do this right now. Okay. So I want to thank you again. My name is April Gambra.

I serve as the clinical Deputy Director for mental health and substance use services in Lake County, California in the behavioral Health Department. We're a small rural county and in that we wear many hats. I am no exception.

So some of my early responsibilities and contributors included drafting and implementing California's First Department of Healthcare Services approved implementation plan for the mobile crisis. As a small county, I'm very proud of that. We saw an opportunity with the support and we seized it very wholeheartedly, full force. So I come today with two messages.

Second, from the perspective of small rural county, the way 988 is currently structured and funded does not yet allow for us to fully realize some of the promise of the mobile crisis response. So in Lake County, our 988 calls are handled by an out of county call center.

I, by the way, I've learned so much today about this system of care. Very grateful for that. Often our callers roll over to a phone tree that spans into other many counties and to staff who do not know our geography. Our local risk factors or the realities of our emergency or social service systems and strains.

It's a matter of roles and responsibilities. We refer to community members to our 988. We refer community Members to our 988 centers when appropriate, but have no way of knowing how, when or why. Our 988 centers are sending individuals in need to Lake County Mobile Crisis. We would very much like to bridge this gap.

Our local first responders know that Lake County does not have a locked 24 hour psychiatric facility. Our frontier county is too small to keep those kinds of resources afloat. They know our single low barrier shelter is often full, but that a call to a specific local hotel may secure temporary shelter on a promise to pay.

Something that I consider to be very unique is that one of our mobile crisis team members can call and just based on a promise to pay, we're able to get somebody out on the streets if we needed to.

They understand that roughly 60 mile radius around Clear Lake where cell phone service and power can be intermittent and completely unavailable at times. They know how to shape I'm sorry and how that shapes what is safe and realistic. When planning a collaborative response.

They recognize the difference between a call from a remote rural property, possibly unreported cultivation or manufacturing and a call from a small in town apartment where neighbors are already alarmed. Our mobile crisis response team is made up of local peers with lived experience of mental health, substance use and justice involvement.

They have the ability to build trust with individuals in crisis that is unparalleled. With repeated partnership and success, our mobile crisis team has built trust with local law enforcement, fire emergency medical services, Child Welfare Services and adult protective services with and with our local hospitals.

When first responders see a call coming in from Lake County Behavioral Health mobile crisis team, they know that we are reaching out because there is a significant concern or need to protect lives and others, not because we want law enforcement to take over the situation, which in my experience in the past before recently has been the situation.

The trust is the product of years of working side by side in a close knit community with this local model, a workforce that is largely peer led, staffed by people whose families live in Lake County for generations, we have seen powerful outcomes. In 2024 alone, our mobile crisis team received more than 8,000 calls.

Over that same period, we saw measurable reductions in law enforcement, initiated 5150 holds as well as increased access to temporary housing for 63 individuals in a group of people who had been circling through emergency response for close to a decade.

They trust that when they give their last name, someone on the other end of the phone will understand their history behind it.

Not in a judgmental way, but in a way that the but as a neighbor who has walked alongside their family for years in our community looking ahead, these outcomes are very much in the spirit of what this body envisioned. With the development of 988 and the emphasis of mobile crisis teams and peers.

From where we sit, the remaining challenge is making sure that future funding and policy structures truly support county led mobile crisis in not just in concept. Although the statute allows for it, County Behavior Health mobile crisis teams are still unable to access the 988 surcharge to support and sustain these compelling outcomes.

Although medical pays for each mobile crisis response funding is still inadequate. Commercial plans typically still do not reimburse counties, although we are working with regulators to turn that around. In addition, medical pays by encounter which is challenging and a less populous county such as Lake as startup funding from behavioral health crisis care was utilized.

Those investments have absolutely paid off in the saving lives and the stability that our community has experienced. What we are learning now is a couple of years into the implementation is that sustainable high quality crisis response in rural counties require ongoing flexible funding for the pieces of work that are not neatly reimbursable but are absolutely essential.

So hardware and technology that keeps the pace that we just learned for heard from oes. You know it was really great to have that money up front to purchase the computers, the monitors, the technology, the equipment. But those things age out very quickly and we don't have the local funds to be able to replace them.

Having a vehicle that could go the distance and be able to get off road like that would be very much appreciated. We also don't have an Ada American Disabilities act accessible van capable of telepsychiatry. Those are things that we really feel would be imperative to being able to serve our community.

And so the thought of being able to help somebody but not help their animal, whether it be transport them safely inside of a vehicle, they decline our services. And it's something as simple as that. So my request today is that you continue to refine in the implementation of 988.

What began with a handful of staff and volunteers has evolved into one of the 12 certified 988 crisis centers in California and just one of the two county operated centers statewide. The history of our program reflects the shifting political and funding landscape around suicide and crisis crisis prevention and intervention.

We conducted our first volunteer training in March 1981. By the late 1980s, more than 100 volunteers were supporting our mission. At one time, calls were routed to volunteers homes during the wee hours of the morning. We've evolved significantly since this time while still maintaining the unwavering commitment of that early inception.

We became accredited by the American Association of Suicidology in 2012 and joined the National Suicide Prevention Lifeline Network in 2017 which positioned our program to transition when 988 launched in 2022. The launch of 988 has fundamentally transformed crisis response in our county.

Our average speed is 7.9 seconds under the 20 second requirement. Our hang up and disconnect rate meets the 5% standard. We did not begin 988 implementation with meeting these standards in their entirety and with exceeding to such a degree, but we have consistently made progress year over year and I hope to continue to do so.

Our staff and volunteers work very hard to meet these standards because they know that timely and effective help can save lives. The feedback we receive tells a story better than any data point and I'll read you a couple fairly tear jerking quotes. One caller said, you saved my life.

We also have continued through partnership with our local law enforcement agencies, the PERT program which pairs a clinician with a team of law enforcement officers to respond to mental health crisis calls that are routed through 911. Additionally, we have a mobile response support team that provides targeted crisis intervention for youth and their families.

Between 8 and 10% of our 90 day calls result in a referral to mobile crisis services. Last fiscal year we made 6,539 referrals among all of our mobile crisis response teams.

Our staff in the wake of the discontinuation of the Option 3 through the Trevor Project, our staff completed training from the Transgender, Gender Variant and Intersex Justice Project, state mandated crisis intervention training and specialized sessions from community organizations in our area like Kaminar's Youth Space and our own County Q Corner.

In FY25 our 988 center received $2.4 million for for the 12 months in funding from Vibrant, our national 988 Fund administrator. Just our 17 direct positions cost our Department $2.6 million to operate and we know that as we are working we currently have 4911 transfer protocols with our 14911 call centers in the county.

We will need additional staff time to expand, text and chat, develop and implement more 911 transfer protocols and to continue to reduce those missed calls. Santa Clara County remains deeply committed to this work.

We are facing immense funding challenges in the upcoming fiscal year and the implementation of Prop 1, while it brings certain opportunities, also limits our ability to use what is now called MHSA funding for this purpose.

Over four decades we've demonstrated our ability to adapt, innovate and deliver excellent crisis services even as demand has grown and funding has fluctuated. Historically, we've built partnerships across our community, trained hundreds of volunteers and created a seamless continuum of crisis care.

We cannot do this alone though the success of 988 and the continued expansion will depend on sustained state investment that truly reflects the scope of need and the cost of providing really quality services. So thank you for your time and consideration and I'm happy to answer any questions.

I mean I, So, so the Warmline's been around since 2014 and I'm going to talk a little bit today about like my experience with it and also the history of the warmline, which is it's kind of a before and after in a way because we, we had a really robust service built up through the middle of this last fiscal year and then our funding changed a lot from this last budget which is affecting our ability to provide the service.

But yeah, I'm somebody, I've been clean and sober for like 30 years. So I'm one of the SUD, you know, folks and I come to this work through like 12 step recovery and I never like as much as like my mental health got better when I got clean and sober years ago.

But I still kind of didn't address it and I was in denial around it. And I feel like one of the biggest things that we try to provide is to destigmatize mental health. And I've heard some of that for sure here today where it's folks, maybe this is the first place they call looking for help.

And I think our training is really great as well. But yeah, what we offer is really based. It's based on the lived experience of our counselors. And the. Up here on the slide there's a little picture of a boiling pot.

We've been in the state budget since 2019, and I feel like we were really well placed then for when the pandemic started in 2020 and we were able to expand and we became. We answered the CalHope calls as well, devoted to pandemic conditions and just information about that and fears about that.

And I'll talk more about that as we go through, but it's meant we've had to reduce our services. So this is. This slide is more information about what makes how the warmline fits into the continuum of care.

You know, suicide is one of those subjects that most of us, for many reasons, and we just don't have experience with it really. And I'm sorry for your loss as well to learn about that. But so we're trying to normalize all that, really normalize those conversations so that it's like.

I mean, it's like people get, they get arrested and then, oh, you have mental health issues. Okay, so. And we see, we see a lot of that locally in our own. But see, the sheriff there in Cook county as well, is aware of that and has created services to, to address that as well, but.

The other thing I want to mention too is like we saw a huge increase, I think in relation to—some of it was the wildfires in California earlier in the year. Also, with the current Federal Administration, our heaviest months were like May and June before we had to cut back.

We also have a team of behavioral health navigators who can help folks that aren't in the specialty mental health Medi-Cal system and need access to services, as an outcome of the call.

And then, for access to mobile crisis services, we have of a decision tree, I think you call it, to decide when someone needs a field response—should it go to our mobile crisis team, or should it go to our trust or MRSS teams? But importantly, those teams actually do their own dispatch.

988, the platform itself doesn't have the capability to dispatch, and our team of volunteers and staff aren't trained to do the dispatch, nor do they have the ability to know where folks are located in the moment. So, MCRT, our county operated team, does its own dispatch simply with the clinicians on staff.

And law enforcement will divert, so they will contact our mobile crisis team. We've established that relationship, but we haven't been real successful in bridging the gap between our 988 call centers and our local mobile crisis teams.

Well, we're, we're a pre-crisis line.

Right, right. So, you're.

But we do, we do make a lot of referrals as well, and we have a system for that. We have a great database that I think includes a lot of the other services that, the same—probably a lot of the same services that 988 refers folks to as well.

I think the biggest concern that we get are folks, from my own personal experience, it's like they're isolated and they're isolated plus they need housing, plus they need a job, plus they need—they've got a relationship issue or whatever it is.

So, you know, how is the workforce capacity? What can we do to ensure that we are fully staffing these programs?

Well, for us it's a matter of funding. As I said, the grant funding does not fully cover our costs. We supplement with MHSA dollars right now. Our ability to do that in the future is going to be much more limited. And so, we're kind of at a holding still position. You heard me mention...what you call extra help staff.

Those are vacant positions that we temporarily hire into because of the uncertainty in our budget.

And then for us—thank you. For us, the ability to be able to access some of the surcharges associated with 988 to be able to staff some of the critical things that we've identified I think are very important for us.

Why can't, and why can't you access them?

So, access the, the?

Law enforcement cannot transfer to that numbrer, so they call one of our deputy directors at 3am in the morning for us to call and then dispatch our team. There is a system like a networking technology issue that we don't have the capacity to lift up the infrastructure to fix, from what I understand.

Yeah. Is that, right—is that why they're doing all this tech, beta testing, new system process? Does anyone in the room know the answer to this? No? Okay, well, we're crossing our fingers on that.

I've been invited to sit as part of the 988 National Committee, one of the committees for a small frontier county, and so, I'm hopeful that I'll get to advocate for some of these technical—technological—issues at that level.

So, sorry, just really want to understand this. So, you would like it to work that 988 calls come to your crisis line. You operate both the mobile unit and a crisis line.

But they're going to the Police Department?

Yes.

Yeah.

That are not getting through to you. So, how does that, how does, are they—do you have a recording saying if you can't reach us, call 988, or how does that go? Probably to 988, or what do you think happens?

We're not doing that. But, but I think 988 will probably see an increase anyway, and, and when folks do get through, we make suggestions. I mean, there are, there are possibly other warm lines. I mean we might say 988, but it's really kind of a different service, you know, I mean, it really is.

And where are these calls coming from? Just the San Francisco area?

All over the state.

All over the state. Okay, that sounds like us. This is just San Francisco.

So, we see ourselves, I mean, we can be a resource for rural areas that maybe don't have as much access. And we have, I mean, I feel like everybody agrees, like this is a really great service, you know, and it's just a matter of going, you know, going the extra mile to just ensure that it works, I mean, that it can continue to be available.

Dr. Le Ondra Clark Harvey from the California Behavioral Health Association, Sandri Kramer of Didi Hirsch Mental Health Services, and Janae Schallert of the Elk Grove Police Department. So, we appreciate you all being here and appreciate your insight and the real time challenges and opportunities to ensure timely, compassionate crisis response through 988 services.

Do we—hang on one sec. Okay, try to speak again here. Not hearing you.

There we go.

And so, as a nonprofit, you're excited for stable funding, but that funding is barely going to, if even, be able to keep up with the call growth as well as was pointed out that we're still not even handling half of our text and chat in state.

And so, I think we still have a long ways to go to build up the 988 structure to become what we hope it could be. It was great to hear other people speak to this nation state level. So, I'm excited that those—that's happening. Our primary partners are really county behavioral health.

Historically, we've gotten prevention dollars and a big part of 988 is getting the word out that it's there. We see that the number keep going up and I think they keep going up because simply the word keeps spreading.

It is remarkable how many people, when you say 988 don't know what you're talking about, which tells us that that still needs to happen. We go into a lot of schools, into a lot of community groups, to just get out word about mental health responsiveness, awareness, destigmatization, and 988.

The other part of our partnerships with counties and with local providers, that's really important, is around their crisis lines. And so, counties set up, as Santa Clara said, their access line are ways in which their behavioral health department can be contacted for crisis. We're contracted with each of those department, each of the counties, to provide those services.

We have an interesting arrangement where we provide mobile crisis for Santa Cruz County and so, we work with ourselves to deploy those services and then we work in partnership with other agencies for San Benito and Monterey. But both of those we've really had to develop sitting at the table, working out the protocols, working out how we talk.

And I just want to give kind of a second-floor goal here, which I know the state has talked about it at visioning levels, ultimately, mobile crisis is really expensive, and counties just don't have any funding coming up for that, while the Medi-Cal enhancements have helped on the Medi-Cal side.

We are in conversations with both Monterey and Santa Cruz and Santa Cruz has been kind of visionary in setting up our contract with the high that at some point, 988 would actually be doing the dispatch. Why that's important is for two reasons. One, it reduces costs. 988 has to have its own dispatch.

When you have 988 handing off to mobile crisis, your caller is going through a double assessment experience, which really isn't good on the client visitor end because you're asking them to do things twice and you don't get a continuity of that handover.

We have an intensive outpatient program for clients who are actively suicidal that uses the CAMS protocol, Collaborative Assessment Management of Suicidality, which is a model program that helps people who are actively suicidal. So, again, for 988 to be effective, it's really going to need to work closely with providers. But there's a big—there's a big challenge there that we've really been wrestling with because we're asking a lot of the 988 responders or counselors, responders of the counselors, if we're getting to the second floor integrated services part because they're going to need to be trained on a lot more pieces and be able to do a lot more things.

The...crisis I spoke to. The other piece that's really exciting part, the state's actually sponsoring some consultation for counties to really look at their 911 dispatch protocol. So, I'm learning a lot about this. But each county or each 911 provider has a dispatch protocol.

And so, what we're really looking at is branching where 988 and mobile crisis for this matter are part of that protocol. And we've started some work in Santa Cruz County, which is really exciting, where the police and fire are looking at that 911 protocol and trying to integrate in mobile crisis and integrate in 988.

One of these second floor things that I call it which is—it's two part. One, it's the ability to have a mobile—to have a mental health response to a mental health crisis which 988 is sort of challenged with, and it's relying on law enforcement.

And then, the other part is to decrease the cost to law enforcement so that you can have more cost-effective response reducing police costs. So, when this integration actually happens, there's potential funding or funding savings there.

We currently have funding where we're just chasing being able to answer our calls with the hope that we'll be able to handle the text and chat in state where we don't have to send out to other states.

Getting everything handled in state, in county, in local environments is going to be critical to have the real continuum of care. I want to speak briefly to kind of how it's not working in terms of the funding. My understanding, per Cal OES—I love your question, Assemblymember Pellerin.

So, we're actually starting to develop a community but really going to die on the vine if we don't get the money that's necessary for the training, for the integration, for the other services. So yeah

You got a lot of heads nodding in here. Thank you. Thank you. You have a lot of heads nodding in here. Appreciate your comments. We'll now move on to Le Ondra Clark Harvey, who's with the California Behavioral Health Association. So, you may begin.

And while it's important as part of this hearing to discuss the mechanics of the crisis services framework for the State of California, it's also equally important to discuss the boots on the ground, the people that are providing the services, and those that they are providing services to.

So, I'm here to share the impact of these constraints on the centers that we represent. So, as a colleague from 988 California shared so eloquently earlier, for decades, these call centers have offered something that no other model has been able to sustain at scale—consistent, trauma-informed, reliable crisis de-escalation.

The mention of these facts aren't to imbue any criticism, but rather to illustrate that 988 call centers have remained one of the stabilizing forces in crisis care for decades. Their outcomes speak incredibly clearly.

The absence of reimbursement has forced centers to absorb expenses they were never intended to. Third, as mentioned earlier, call centers recently received notice of an almost 50% reduction in rates. This decision was made without including 988 call centers in the process, In the discussions regarding budget.

Yes. There you are. Hello. Welcome.

Okay. And I'm going to.

We can hear. We can hear you. And there's less echo. Thank you.

Okay, perfect. I am honored to represent my agency, which is one of the largest 988 centers in the country, and speak here specifically about 911 diversion. Thank you so much for having me. So, I'm going to dive right in and going to talk about what 911 diversion is. So, basically, 911 diversion is a program. Can you guys, I'm so sorry, can you—are you seeing the 911 diversion slide?

It's basically a program that redirects certain types of suicide, substance use, and mental health crisis related calls away from 911 and a likely law enforcement response and then towards a 988 crisis center to give a trade crisis counselor the opportunity to support the person in crisis or their loved ones and provide compassionate care and help de- escalate the crisis, which is often done entirely over the phone.

Aside from the fact that this has been a passion project of mine for many, many years, but I'll try not to divert into too much storytelling there. You have already heard several people talk here today how important it is to get the right response at the right time and at the level that it is needed.

And that kind of begs the question if anyone experiencing a suicide or other type of behavioral health crisis is best served by a law enforcement response and whether an in person response is actually needed at all.

If you think about it, if you or a loved one is experiencing a severe emotional crisis, severe enough where you end up calling 911, that's a very emotionally charged and intense situation. You need somebody to show compassion and care and listen to you and allow you to speak about your pain.

But what you most often will get when calling 911 are flashing lights and sirens and nosy neighbors, and sometimes you end up with large ambulance bills or hospital bills, which perhaps can even add to your crisis. And we also know that suicide risk often goes up after being released from hospital.

And then, finally, we know that there has been a growing prevalence of disengagement policies amongst police departments, not just in California, but nationwide.

And therefore, disengagement policies sort of like try to ward that off to begin with, because the moment they knock down that door for the person who is not willing to engage with them, they own that situation, and that can have all kinds of consequences that nobody is really looking for either. Right?

We just have different scopes, but we have the same goal, which is helping people in need, in the behavioral health crisis. And so, identifying the right response means better outcomes for all. Right? That's kind of what we're all looking for together.

There is an urgent need for 988 and 911 centers throughout California to work together, because again, both are needed at various times to provide true whole person care or crisis care on that response continuum, right? That's what's so important. And this collaboration is happening throughout California but are hampered by certain things.

If they are in a structure or a bridge or overpass, just in a large structure in a public area, that's a public safety concern. If they have a weapon, such as a firearm or a knife, and are in public and others are present, also public safety concern.

And finally, if they have a weapon or maybe not in public, but there's other people present inside their residence and could therefore be at risk.

So, those are the types of calls that while we get those kinds of calls all the time on the 988 line directly, if these people are calling 911 first, those should require an in-person response.

We also noticed some unexpected demographic differences that we really did not expect to see. So, first of all, age—so, I'm comparing a 911 diversion callers with 988. We see more older folks calling us or reaching us through 911 diversion.

Again, it shows us what we need to do in terms of our outreach focused outreach efforts. And then, finally, in race and ethnicity, we see more than twice as many African American callers come through 911 diversion and significantly more Hispanic callers come through 911 diversion. Again, giving us really great insight into mental health equity, like where do we need to be, where do we need to go to show people there is another number you can call for emergencies besides 911.

And if you could wrap up your thoughts, that would be wonderful. Thank you.

Yes.

Thank you.

Yes, I'm going—I'm actually getting to my last point. So, talking about a crisis response continuum of care, just what we have been talking about and been hearing about all day today, there's still a few things that are missing. So, what does it really take to have a successful 911 to 988 diversion program? There's a few points here.

First of all, we need better technology interoperability. You've heard before that Cal OES has been working on this platform and that they're piloting it with Buckle U, but the problem is that it misses a lot of functionality for us and so it's not where it needs to be yet.

We constantly need to address dispatch hesitancy to make sure that dispatchers feel safe and backed up by leadership to send calls from this batch over to 988. We also know that those 988 calls, I call it 911 to 988 diversion.

So, that's an important thing to be aware of. It takes a lot of follow up, qualitative outcomes, evaluation. We're working on a commute. We're working on a USC research evaluation project, as well as building out a community advisory board for this. All of this to say there's a lot more gaps that need closing.

It can be incredibly traumatic. Oftentimes, people do need that intervention. So, if they do need that intervention, we obviously want to get them to the right place to ensure that they're safe and sound in the community.

But if they don't need inpatient hospitalization, we'd like to provide those services in person and then also provide them to long term care, because obviously, 911 is not a perfect resource for long term care and we want to get them back to their providers who can provide follow up support after. We're also trying to reduce unnecessary incarcerations.

So, anytime there's a big kind of call out, there's generally a mental health component to it. People aren't thinking necessarily rationally, their judgment's impaired, their insights impaired, so when we have a mental health clinician responding to these high intensity calls, we can, one, provide insight to law enforcement officers.

So, if we could get more information when we're responding, we're going to have a safer and better response. So, even just like kind of working with that wording, identifying mental health need, what were the plan means intent, what are they saying?

I think this is kind of the style of policing. I think people are identifying that there are a lot of mental health calls when they do call 911, if there might be a safety component. So, police will be responding to some of these calls. Fortunately or unfortunately, they will be responding.

Once you're a licensed clinician, it's hard to get people to go kind of away from maybe like a private practice easier or could be a cushier gig to go in a police car responding to 911 calls and there could be danger and stuff. So, I think that is one part of it that we're definitely seeing. But it.

There's oftentimes with peers, clinicians, those two together. I think Sacramento just also offered one with the fire department. So, there's a variety of different mobile crises throughout. But the one I am most familiar with is the co-response embedded within law enforcement. Yeah, I think that's all I've got right now.

They were able to add us one, expand our hours a little bit, put us on, like, the hostage negotiation team. We're doing a lot of, like, the behavioral threat assessment.

I think it is the future of policing, but I don't think we're there yet, as a state.

I've had similar experience in seeing a shortage of the licensed clinicians and also shortage of hours that's not always available in those more critical hours when people are really in crisis.

And just, you know, I think that we're really in a crisis of funding. You know, I'm hearing that from everybody and you know, things are looking grim again this next fiscal year.

I think there's a lot of training on how police departments work as a general because we have to work as a team collaboratively. A lot of behavioral threat assessment training, crisis intervention training, and also training alongside of law enforcement and crisis intervention so we're also on the same page, speaking the same language as well.

My understanding that actual police officers get some level of mental health crisis training but it's maybe eight hours max?

Yeah, I think that is changing. I think a lot of academies are trying to do more long term crisis intervention training especially for like the younger officers. Some departments are trying to even go backwards and get that like 40 hour work week or 40 hour training.

Thank you, thank you. And I just want to thank the speakers on the Zoom as well. You gave us a lot of great information and really interested in what LA is doing there with their coordination efforts. So, thank you both speakers that are here. Thank you so much. Now, we're going to open it up to public comments.

Good afternoon, Chair Pellerin. Karen Vaccary, Mental Health America of California. We are a peer run organization. We appreciate this hearing. Thank you for holding it, all the great panels, and all of the work that went into coordinating it. My comments today relate to the peer perspective which wasn't necessarily reflected in the panels.

Yet because as we have heard, Prop 1 is diverting funding away from these upstream services, CBOs are losing funding for these vital services, and the services are being cut, we must prioritize funding for effective alternatives to hospitalization to ensure the success of 988 and we must also always consider non law enforcement and non-hospitalization crisis response services.

As previous speakers have shared, California is seeing increased call volumes to 98 call centers, with October 2025 as the highest on record for all California call centers.

As more Californians rely on 988, it is imperative that call centers are made aware of local mental health resources, particularly as these options may grow and evolve with the implementation of Prop 1 and other behavioral health transformation work like BH Connect.

Finally, we are concerned about the decreased funding for mobile crisis that California is likely to experience in 2027, when the enhanced 85% FMAP under the American Rescue Plan will expire. We ask that DHCS work with community partners to ensure these critical services can continue to be funded.

Thank you for your time and thank you for your dedication to this issue.

Hi there.

Good morning and afternoon, I guess. I just wanted to, like everyone else, thank you for convening this for the important work that 988 is doing. My name is Haley Ayers Ballou. I'm speaking on behalf of the Miles Hall Foundation, the namesake for the AB 988, the Miles Hall Lifeline and Suicide Prevention Act.

We're grateful for all of the work that you're doing and as many have said, there's still a lot of work to be done. For our key priorities that we'd like to discuss and have heard here, first, California must prioritize a mental health first response in practice and not just on paper.

Anyone in a physical, mental—physical, medical—emergency gets triaged, and we urge the Legislature and state agencies to ensure that 988 and 911 protocols enter the safety and clinical needs of the person first, behavioral health led responses, and that families have a meaningful way to indicate preferences such as a mental health team only.

Second, we need real accountability and strong state oversight across the entire crisis care continuum backed by public data dashboards.

So, just in closing, we'd like—the Miles Hall Foundation would ask you to carry forward the promise of AB 988 by making a mental health first person centered approach as the standard for crisis response, ensuring transparent data, clear accountability, and strong state oversight across the entire continuum of care, and embedding patients, families, and people with lived experience as true partners and decision makers in this work.

Thank you.

And Brianna's in the office, the, the audience here as well, taking notes and helping out and just, you know, I'm so incredibly grateful for all of you and the work that you're doing and just how mental health has profoundly impacted my life, my husband, my children, myself.

You know, we really need to do everything we can to remove the stigma, to get the funding it needs, get the attention it needs, and to work together. This is not a final discussion of this.

And just, you have my commitment that this next year, everything we've learned today is really going to help form our policy discussions, form what we're going to advocate in our budget, and look forward to more phone calls from us getting your ideas and your advocacy. So, thank you all so much for being here.

And with that, we're going to go ahead and adjourn this Select Committee. Thank you.