Assembly Select Committee on California's Mental Health Crisis

Okay. Can you hear me? Okay. So far, so good. All right. Well, good morning, and I apologize for the construction noise. We got amazing sergeants here trying to work up a plan B for us. But as you all know, in life, things unexpectedly happen and we have to figure out and navigate our way through them.

Charmaine, put a bag over here. We could hand those out. Maybe Brianna could pass them around. One of my co workers in Santa Cruz crochets these little hearts with an affirmation on it. And it's called the Little Heart Project, to spread positive vibes and energy to people, making sure they know about the 988 emergency number.

So something that might help you during this time, the noise, we could just caress that little heart. But good morning to everyone. I want to thank you all for joining us today for this information informational hearing of the Assembly Select Committee on California's Mental Health Crisis.

I especially want to thank our panelists and Members of the public who are here in person and tuning in remotely. Today we're focusing on one of the most important components of California's mental health system, the 988 Suicide and Crisis Lifeline, and the broader network of crisis response that surrounds it.

While California has a longer history of the suicide crisis hotline, AB988, led by Assemblymember Bauer Cahan and the Steinberg Institute in 2022 strengthened and modernized that system into what we now know as the 988 lifeline.

As many of us know, 988 was launched with the promise of offering people a simple, memorable number to call during their most vulnerable moments of crisis. This morning's hearing is an opportunity to take stock of where we are, what gaps remain, and what steps the Legislature and our state partners can take to strengthen the 988 ecosystem.

Panel one will begin with updates from our state partners at the California Health and Human Services Agency, the Department of Healthcare Services, the Governor's Office of Emergency Services, and the 988 California Consortium. They'll walk us through statewide data call answer rates, Medi, Cal Behavioral health integration, and the foundational infrastructure needed to build a reliable response system.

At the state level, Panel 2 will turn to our county and community partners to hear how implementation is working at the at the local level, we'll hear from the County Behavioral Health Directors Association, Santa Clara County's Behavioral Health Services Department, and the Mental Health Association of San Francisco about what's working, where coordination is lagging, and what resources and workforce supports are most urgently needed.

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.

And her email is charmaine, [email protected] and I want to take this opportunity to thank her for coordinating this panel today.

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.

We know that every delay, every unanswered call, every missed handoff can have life or death consequences. We also know that when the system works and calls are answered quickly and mobile teams are available, lives are saved. I'm somebody in my life who's had a personal encounter with this tragedy of our mental health system.

In November of 2018, my husband of 25 years died by suicide. And I totally, completely understand and I, my family since then have used this 988 number and it's been a lifeline for us as well. And I want to thank again our panelists for being here and for the essential work that you do.

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.

Not everybody is able to be here, but this hearing is being recorded and they and some may be streaming in and watching in their districts as well. So this information will get out to our other Members of our Committee. And with that, I want to invite Assemblymember Chiavo to make some opening remarks.

Thank you. Good to see you. Good morning. Well, the noise is testing our mental health this morning, but thank you everyone for being here. This is such a critical issue and I'm really grateful. I want to echo thank you to Charmaine for pulling this together.

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.

And so grateful that she's highlighting the challenges that we continue to face in our communities. You know, so this morning, we're here really around a shared purpose and with shared weight on our our shoulders. The stability of California's 988 suicide and crisis line is for so many Californians. They reach out in their darkest hour.

And we know it's under real threat right now. That what is unfolding at the federal level is not a distant policy debate, but it's something that touches families in every corner of this state. And we know when it comes to our mental health crisis, it does not discriminate based on your politics or your party.

This is something that touches everyone in every community. Too often this Administration has responded to crisis not with relief, but with a decision that deepens people's suffering and like stripping food assistance away from families whose livelihoods are depending on it.

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.

And in Los Angeles County, where I represent, suicide is now the third leading cause of death for our youth. That statistic isn't just a number. It's shocking, it's terrifying. And it represents whole classrooms of children. An empty chair in a class that a friend will miss forever.

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.

We've strengthened Medi Cal's behavioral health services, and through Prop 1, we have also committed to building more treatment and more housing for those who need it the most. Unfortunately, our ability to sustain this progress is at real risk, and I know that we'll discuss some of that today.

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.

When the 988 system weakens, calls don't just go unanswered. Children are pushed into systems never designed to respond to emotional or psychological pain. They land in 911 operations, emergency departments, or at the hands of law enforcement. And we know what happens when this happens.

Psychiatric holds, emergency room visits increase, more avoidable tragedies happen, and tragically, more lives are lost. My hope is that today our discussion gives us clarity and urgency and the path to safeguard California's suicide crisis response system. And I'll leave the rest of my comments for later. Thank you.

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'd like to welcome to the front table here Stephanie Welch, who's our Deputy Secretary of Behavioral Health from the California Health and Human Services Agency, Ivan Bhardwaj, the chief of the Medi Cal behind Behavioral Health Policy Division with the Department of Healthcare Services, Steve Yarbrough, Deputy Director of Public Safety Communications at the Governor's Office of Emergency Services, and Narjus Zohori Dielen, President of the 988 California Consortium.

You may begin when you're ready. Thank you.

Good morning, Chair Pellerin and Assemblymember Schiavo. I just want to thank you for sharing your personal experience. I think it is more than critical that we keep in mind the people that we serve every day in the work that we do.

And I really appreciate the opening comments making sure that we are upholding our mission to serve every California who every Californian who is vulnerable.

I do want to start today by really lifting up that we have made a significant amount of progress in the last five years and much of it has been through the support of the Legislature.

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.

I believe the last time I addressed this Select Committee was in 2022 and I wanted to share a couple of things that we have been working on since then in order to address this growing crisis.

First and foremost, it has been an an honor and quite a privilege and responsibility to support and lead in our agency are both crisis care continuum planning work as well as the development of the AB988 five year implementation plan that we did that work in 2024 and submitted it to the Legislature earlier this year in January of 2025.

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.

Both the Crisis Care Continuum plan and the five year 90 day implementation plan focus not just on developing the capacity to respond and stabilize crisis, but also to provide transitions to on care and critically important to the points made at the opening comments to preventing crisis in the first place.

Nobody should have to wait until they are in crisis to get access to help.

The experience of crisis itself is traumatizing, it's avoidable, and it is an experience that is not carried equally Black, Indigenous and communities of color, younger and older individuals, people who identify as LGBTQ veterans, justice impacted populations and people experiencing homelessness carry the heaviest burdens as individuals with the highest risk of suicide and or are most likely to be reliant on crisis services to receive behavioral health treatment.

Our role in this system really was solidified with AB988, which is the Miles Hall Lifeline and Suicide Prevention act, authored by Assemblymember Bauer Cahan and signed into law in 2022. That particular plan was developed with the knowledge that there were significant other behavioral health initiatives that were being implemented throughout this Administration with the support of the Legislature.

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.

And that group was responsible for developing the five year plan. And as I mentioned, that plan was submitted earlier this year and I did want to take an opportunity since I don't believe that we've ever presented to the Legislature about some of the elements of that plan.

It really is a blueprint for the crisis system we want to build over the course of the next five years. So the plan was developed over a year long process. It involved numerous individuals organizations.

We had seven public meetings, 21 public meetings of of work group Members, 13 focus groups, nearly 100 interviews to develop the plan itself and host it. And we also hosted several subcontracted events in order to reach groups like Native Americans to learn more about what they felt was needed to better address their needs.

The plan identifies four goals to achieve over five years through 16 recommendations and 65 implementation activities broadly, those four goals are to increase public awareness and trust in 988 and utilizing behavioral health crisis services to establish systems inclusive of technology, policies and practices to support help seekers to have access to appropriate call, chat and text to support the 988 system in delivering high quality response and to integrate 988 into the continuum and increase coordination with ongoing behavioral health services.

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

That means prioritizing equity in the way in which we provide crisis services to be cognizant and focused on understanding the elevated risk of behavioral health crisis for those who experience discrimination and prejudice those who need adaptive or tailored services due to a physical, intellectual or developmental disability and others who have unique cultural or linguistic needs.

Another pillar is to have sustainable funding to continue to support a robust crisis system and that includes making sure that our behavioral health transformation investments are looking at addressing crisis and also continuing to pursue pursue behavioral health parity enforcement. Another pillar is data and metrics.

That's to make sure that we have data standards in our crisis system so that we can monitor who's utilizing it and we can invest our resources in that way.

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.

They include the Department of Healthcare Services, the Department of Public Health, the Department of Managed Healthcare Services, and the Emergency Medical Services Authority.

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.

We continue to facilitate extensive and necessary coordinations between our departments as well as other state agency agencies and we will be reconvening the 988 Policy Advisory Group in January because our first report to the Legislature on the status of the implementation of the five Year Plan is due by the end of next year.

So with that I just wanted to provide a quick update and share a few things where I think we have some silver linings of progress. In 2023, the number of young people in California age 15 to 24 who died by suicide declined by 8%. This was at a historic peak in 2021.

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.

We launched free coaching services with qualified behavioral health wellness coaches via two digital platforms, one called Bright Life for Kids, which is for the younger children, and Saluna for Young Adults. As of September of This year, roughly 420,000 children, youth and families are using both of these tools.

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.

We have also, despite very challenging budget times in the last fiscal year plus, we're able to provide $5 million in ongoing support to the Calhope Peer Warm Line and we are able to provide funding for the Older Adult friendship line in 2026.

It's critical to continue to focus on these efforts so that we are collectively, in addition to our work with 988, preventing additional crisis Responding to crisis I'm going to defer and you'll get a lot of details from my colleague here from DHCS on the work that we're doing with the 988 crisis centers, but I wanted to share to your point.

We were also terribly dismayed, I don't know how else to put it, by the actions that the Federal Government took in their relationship with the Trevor Project, which is a nonprofit suicide prevention advocacy organization that provides 24. 7 crisis support services, research and advocacy for LGBTQ youth.

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.

Second, we are also doing some national research in partnership with DHCS because in order to really understand all of our different crisis teams and systems, we have many different ones throughout our entire very large state and we want to figure out exactly which ones we have where and what are their focuses on.

Also wanted to provide some update in the stabilizing crisis area. Our Behavioral Health Continuum Infrastructure Program, which we lovingly call BCHIP.

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 lastly, and I think this is what's really important, particularly in our role at Health and Human Services is to really also think about supporting access to ongoing care. We know that many individuals who are at most risk of crisis are individuals who did not get adequate treatment after an initial crisis.

And so again as I lifted up the Children and Youth Behavioral Health Initiative was in many ways a response to the crisis that we had. That was the Covid 19, Covid induced crisis.

And so the Children Youth Behavioral Health Initiative has increased access to school link behavioral health services by establishing a sustainable reimbursement through and through health insurance. That's our our fee schedule. Also as of September of this year we currently have over 7,500 individuals who have obtained their MEDI Cal Peer support Specialist certification.

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

I mention that because it's very important to us in our work around implementing the five year plan for 988 to focus on the fact that we also need to have the capacity to respond to people who are experiencing crisis who are living with a primary substance use challenge or disorder.

And lastly, we've certified over 3,000 wellness coaches to support children, youth and famil. So what's. I was so blessed to not have that in the background. I am almost done. I do want to report some exciting things that we're working on right now that are on the horizon.

Our Department of Managed Healthcare issues guidance to health plans with directions for reimbursement for mobile crisis services and also have been working to assist counties with provider disputes. It's really important to make sure that we are making sure that our commercially covered individuals are reaching these services and being reimbursed.

And probably most exciting due today are the public comments on our proposed CDPH Prop 1 population based prevention work. And in that proposal there is a proposal to have a comprehensive public awareness campaign for 988 beginning in 2027. The planning will start in 2026.

There are training and technical assistance components of that larger campaign and a grant program to award community based organizations and tribes resources to support 988 implementation. We stand committed to improving the crisis care continuum. It is, again, an absolute hallmark of the work that this Administration has done with the Legislature to transform behavioral health.

We have a lot of work that we need to do, and we look forward to continuing to do that. So thank you very much and I'm happy to answer any questions.

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.

And thank you so much for the presentation and thank you for your efforts to step in and fund that gap with the Trevor project, because that is so critically important that everyone gets the services they need, and that's particularly important for our LGBTQ youth.

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.

Thank you. Thank you. What an honor it is to be here with you Assembly Members Pellerin and Shiavo. And it sounds like the construction got started just in time for me to be here. So grateful for that. But anyway, my name is Ivan.

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.

And with respect to 988, we have a large focus on Administration of the network. So that means contracting and funding the network. And we work very closely. We do not do this independently.

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.

The Community Mental Health Services Block Grant. And then also we currently have two primary funding sources that support the 988 network. One is federal, that's from the Substance Abuse and Mental Health Services Administration. It's the 988 grant. It's the second iteration of it and it's running from September 2023 through September 2026.

It's $20 million per year for a total of $60 million. And this is, as far as we know, the last iteration of the grant. So as far as we understand, this grant sunsets in September 2026, at which point we'll have to shift to sole focus on the AB988 fund. I think it stopped. Yes. Oh, okay.

So you know, the 988 Fund is sustained by a surcharge that Cal OES administers. And you know, in addition to to contracting and funding the 90 day crisis centers, we also provide technical assistance, operational oversight and quality improvement through our third party administrator.

We also are responsible for ensuring that 988 crisis centers meet specific national standards as set forth by the Substance Abuse and Mental Health Services Administration. That includes things like ensuring there's the appropriate accreditation in place, that the risks protocols are followed, that every 988.

Every member that contacts the 988 line receives standardized suicide screening, that 988 counselors have a meet a basic threshold for training requirements in taking 988 calls, responding to chats, responding to texts. And in addition to administering the 988 network, we also oversee a 988 media campaign. So. So we're promoting awareness of 988.

There's a lot of folks I always ask, whenever I see people, I always ask, hey, have you heard of 988? A lot of people surprisingly have still not heard of it. So what we're doing is kind of increasing awareness.

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.

There is a specific focus on adult and young adult men. As we are probably all aware, there's a four times increased rate of suicide among men than There is women, so we really put a focus on that.

So in addition to kind of covering the Administration, I also wanted to just cover some of the overlaps with Medi Cal reimbursement. And to be clear, 988 is not a Medi Cal program. As I said, it is funded by, you know, currently a SAMHSA grant and also the 988 Fund.

But we do have Medi Cal benefits that complement and work very closely with 988. And so that includes the mobile crisis services benefit. That is a statewide benefit that is currently available in 53 counties. And we are currently working to expand it to make sure that all counties are implementing the mobile crisis services benefit.

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.

And importantly, just to give you kind of a, kind of an understanding of how much mobile crisis services are costing the state right now or basically being claimed for. It's $88 million we've received in claims from January 2024 through March 2025. And the Federal Government because of the federal enhanced match is covering $70 million of it.

We are covering $18 million through State General Fund. And so while there is a pathway in the 988 statute that can support mobile crisis services, the surcharge is not at a level at this time to be able to support a statewide mobile crisis implementation, you know, really at scale.

I do want to note that we have been working to integrate mobile Crisis Services. And 988, this is Work that is, you know, very much ongoing. We have two crisis centers that are currently county operated that includes Sand, Clara and Kern counties. And so there is a really a close relationship and integration there.

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 of course, we have to tailor our best practices to make sure that they are responsible to the local need of each 988 crisis center and of each county. I also want to note that, like I said, this is ongoing work.

And so what we're doing in partnership with the California Health and Human Services Agency is really working to build out that integration between 988 and mobile crisis. In some ways, we're in the infancy of that.

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.

I also want to note that we are developing resources that will help support, support 988 crisis centers locally.

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?

So that is really forthcoming and we're really excited to be able to develop that in partnership with our third party administrator. We're just developing a host of other resources as well. We've developed school guides, we've developed a crisis stabilization toolkit and the work remains ongoing.

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.

There is a lot of work ahead of us and I'm really excited to be able to kind of implement, expand and really professionalize the 988 network so that it is responsive to every individual that contacts the 988 line. So with that I just want to thank you for your time and the opportunity to share regarding our work.

Thank you. You managed that challenge very well. Speaking with the construction, we're checking on a room we are going to get to move. There's stuff that's there so they have to clean it up and get it ready for us. So.

It's ready.

Okay, it is ready. So we're going to go ahead and recess this hearing, gather our things and move up to the fourth floor. Room 437. What? 447. 447 sorry.

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.

And we'll now move on to Steve Yarbrough. He's with the Deputy Director of Public Safety Communications.

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.

Over the past two years, we've moved this project from concept to implementation, building out the technological foundation, establishing governance structures, and aligning the system with our partners.

The approach that California has taken is to build this partnership or build the system based on a partnership with our partners at the Department of Health Care Services and the Health and Human Services Agency. One of the first things we established was the governance structure for this project, and that's the 988 Technical Advisory Board.

That board meets quarterly, and the most recent board meeting was just before Thanksgiving, November 20th. It continues to meet, and in that way we can coordinate the planning, the technology implementation, ensure that there's a statewide programmatic alignment between all of the stakeholders.

The structure keeps our partners, the call centers, and the state agencies and system vendors all working together from the same operational roadmap and make sure that the stakeholders and the public have an opportunity for engagement in that process. I'll now move on to touch on where we are with the system update.

So far, the statewide network has been built out, and we've installed infrastructure for the network in each of the 11 lifeline crisis centers. That includes server racks, network ingress points, secure cloud connectivity, and creating the statewide transport layer for the call traffic that comes in.

This transport layer is the foundation that allows us to route calls back and forth between 911 and 988 as needed. And that's, of course, based on the county or zip code of origin and allows those calls to move back and forth either way.

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.

So, that's a technology upgrade that's coming in the next gen 911 call routing.

That, that next gen call routing has been validated in our laboratory environment and it's currently being proved out in a live environment at the Buckaloo Center in Marin County.

They're under a 60 day pilot project right there where they're working through that the proving out the capability in the real environment and then also getting to the point where text messages can be treated the same way.

So, calls on the next gen system and then text shortly following that are being handled that way at that one location. Simultaneously, the call handling system and the customer relationship management interface for that system.

Through our partner, a system vendor that we've contracted with, we've developed this cloud call handling system and customer relationship management system that allows the call taker to have access to and provide data input on the the caller who's calling in.

So, it'll help expedite processing the request in such a way that there's additional context, if this person has called before, that's integrated into the call taking system. And so, in that way, we're advancing the capability of the call taking system.

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.

We've since extended that so we can gather more information and continue with the, the text part of it. We would like to do some more development work and, and build that out, so the pilot will be extended to allow for more development.

And what, what that will allow us to do is at the end of that pilot period then that will give a great opportunity for all of the other call centers to be able to evaluate how, how the product worked for Buckaloo and then decide, make an informed decision, as to whether or not they would like to implement it in any of the other call centers.

So, the last piece I wanted to touch on is it's been mentioned before that Cal OES is the agency who administers the surcharge rate that generates the revenue.

So, that's another piece of the puzzle that we perform on an annual basis. In the October time frame, October 1st of every year, we submit the rates for the coming calendar year, what that will—and that's designed to match up with the amount of revenue that's been approved and appropriated in the, in the final budget act.

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.

But we wanted to make sure that we had at least this particular solution in place for their ability to evaluate that and choose it if they wanted it.

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.

Can someone let me know how the slides work? Okay. Well, appreciate the time to be here this morning and share about the work that the California 988 centers are doing. Really grateful to, I think, be part of a system that has such a clear vision for 988 implementation.

And I will say that the centers have been involved and wholeheartedly agree with the vision that was shared by our colleagues here today. Next. Here's a map of our coverage areas for the California 988 centers. We formed a consortium in 2023 because we wanted to formalize the relationships we've had for decades.

And we saw this as an opportunity to really bring our expertise in the field of suicide prevention to the table at a time there was both policy and implementation work happening statewide. Many of California's 988 centers have been running crisis lines since the 60s with the start of the peer support work.

And most of us have been part of the National Suicide Prevention Lifeline since its inception in 2005. So, this is work that we hold dearly, and we see our responsibility to our communities and the trust that we have built with our communities as a really key part of 988 implementation.

Our partners at the HCS shared about increasing knowledge, and I think knowledge plus trust equals action. And the trust is where I think the 988 centers have done a good job in our respective communities. Next slide, please.

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 there's a direct linkage between economic well being and crises. We've seen that in the past during the recession. We also have been exposed to ICE raids in our communities, to changing immigration policy, to our LGBTQ young people being targeted. And all of this is really contributing to people's sense of wanting to reach out for help.

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.

And some of that is because the acuity of calls has gone up. So, that means there's more callers who are more suicidal or in a heightened state of crisis. Those calls take longer to de-escalate, to safety plan with. There's also the matter of follow up care and linkage.

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.

We are mostly doing follow up care for medium to high-risk callers, which was the previous standard, due to the sheer volume of outbound calls required and the resources needed to meet the follow up needs. And I think follow up is really important.

We take pride in the fact that less than 2% of our calls are ending in an in-person response. We think of the crisis contact that people make to us as an intervention itself. The goal is not the next thing; the goal is for that intervention to be complete.

And in order for that to work, we need to be able to offer adequate follow up to our callers and stay on the line with them as long as possible. Next slide please.

Some of the other dynamics that we're holding as people running crisis centers, as Ivan mentioned, is the SAMHSA funds running out but there's also local implementation in terms of Proposition 1. Most of our centers have MHSA dollars that help our prevention and outreach programs that are not necessarily 988 picking up the calls.

But there are supplemental to our 988 work. And a lot of those programs, because of their prevention nature, are slotted to run out or that funding is in danger. So, that's a dynamic that the centers are holding right now. So, I imagine our reliance as a system on the AB 988 is going to increase moving forward.

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.

It's about having a high in-state answer rate which helps us connect people to appropriate resources. Using the system that AHP is creating for resource and referrals, we're going to be able to connect people to those mobile crisis teams that are coming on board to those crisis stabilization units that Stephanie talked about.

But if we're not able to answer our calls in California, other states aren't going to be able to do that. So, it's really important for us to keep our calls in California and have our centers responding to those calls. And the last thing is missed calls.

Missed calls are people who are going to lose trust in the system. If you call 988 and no one picks up, are you going to call 988 again? That's a big deal. Like, that's literally what keeps us up at night. Like, you know, at my center, 10;00 PM to 2:00 AM are our hottest time, like most high risk, most calls, and there's nothing else available at that time.

Who's someone going to call if they can't get through on 988? And also, there's the practical matter of running a crisis center. With 988 becoming this big federal thing, there's much so many layers of regulations.

So, the regulation to be an accredited center has increased. The training standards, the quality assurance, the supervision standards have increased significantly. And I think all of that is actually, in the long term, positive for the consumer. But in the short term, it requires a significant shift in the way we have historically operated our centers. Next slide, please.

This slide here shows the October call volume, a call and text and chat volume, so we call it contacts, for all three combined in California in October the last five years. I hope—it doesn't even require me to say anything. Right? It just goes up. So, the orange is text and chat, and the blue is calls.

So, they're both going up. Calls are going up more. And next slide, please. I zoomed in on the last 12 months here, just to give you a sense. And this is directly pulled from the 988 national dashboard. So, this is not my slide. So, a couple things to help you understand.

The gray is important because those are our missed calls. And in the last three months, each month we've missed between 4,600 and 4,900 calls. So, those are people who called 988 and their calls didn't get through. Those are not people who flowed out of state. The flow to backup is the tiny red mark.

Those are people who waited, and they hung up because they didn't get someone. And I just want to hold them. Like, I think it's really impressive that we're answering so many calls in California. Highest call volume, you said it. But it's also really worrisome that we're missing almost 5,000 calls a month.

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.

And just in the past 12 months, just because charts aren't always easily readable, this is a 40% increase in call volume, just so you are aware.

And I think the only way for us to not constantly be chasing the call volume is to plan for it to grow, is to acknowledge that it's been growing for five years straight. It's going to keep growing. Let's plan for it to grow and build the capacity for it, because currently, we see it growing.

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.

I feel the behavioral health continuum getting stronger, like literally. And if people aren't coming to my center or going to centers in California, I can't connect them to that behavioral health continuum. And therefore, there's a gap that I want us to hold.

Texts and chats I think threw a wrench in our planning because an average text or chat takes 43 minutes instead of the 12 minutes that a call takes. You know, I think it makes sense the moment I say it, but it also surprised, I think, our partners.

Many of us had had text in chat but it was at a much smaller scale before 988.

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.

Just in terms of baseline funding, currently, Cal OES receives a higher percentage of the AB 988 funds for the technology infrastructure than the centers do for the implementation of the 988 services. And from where we are sitting, it feels that our partners at HHS and DHCs don't have the funding they need to truly make this five-year implementation plan.

Like we have so many goals and we're not even picking up the phone all the time, like it's really hard to imagine that leap without major investment. And the last thing I will say is like the infrastructure and technology, Steve spoke to it, there has been major delays.

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.

So, these are some of the practical things that are in our way of doing this work, but I do think at its core, the AB 988 vision that California has is one that the whole country should be jumping on. So, really grateful to work part of the system. Thank you.

Thank you so much. This has been some really powerful presentations and very enlightening. You know, so I mean just one question here as far as that surcharge is concerned, because I heard the surcharge is going down. So, are we going to continue to see the same level of funding or it sounds like we need additional funding?

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.

The reason that is because the way we calculate the surcharge every year is we start off by what's approved in the final budget act and then we say how much do we have remaining in the fund from last year? So, what's our fund balance? We subtract that from the appropriated amount. That's the revenue need.

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.

This particular year, it went down from 8 cents to 5 cents because there was a fund balance of, you know, sufficient magnitude to offset that.

So, it still gathered the revenue necessary for all of the appropriated expenditures, but it just didn't have to have as much taken from the, the, the users of the telephone lines out there this year.

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?

Well, so from Cal OES's perspective, you know, we don't necessarily have an opinion on how it's invested. I think we take as an input to our process what the Legislature and the Administration have approved in the budget act as our guide as to how to spend that money.

But what we'll do is calculate the per line surcharge necessary to meet that funding need. So, when it comes to figuring that part out, I'm happy to increase the surcharge rate to meet whatever approval comes in the next budget cycle.

So, the model that we use to calculate the surcharge rate will adapt to whatever number is approved in the budget.

So, I'm curious what Narges's thoughts are on that answer.

I think the centers are kind of pretty removed from the budget process itself. We often meet with the HCS regarding kind of what our immediate needs are, but we have never been part of the actual budget process.

And I think our hope is actually that we would be part of that budget process and we could truly do this like three-year projection of what does it take to do this work plus implement the 988 5-year plan.

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.

Seems to me that the—oh, sorry, I got a new phone. I don't even know how to use it. Okay.

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.

It is that budget that determines the rate that is set in October of that year for an annual process. So, one of the challenges that we have is that we have a six-month gap. And so, I appreciate very much the crisis centers coming and saying that we have these future needs for consideration for future budget processes.

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.

Because then you can figure out how much money you have the next year.

But I think it does a huge disservice because it means, you know, there's a lot of starts and stops and inefficiencies that come out of having that kind of a system where you're just using year by year and having to maybe start and stop programs or not able to take advantage of forward planning that could actually be more efficient and save money.

And so, you know, I think it would benefit us to be creative and think of at least the kind of minimum budget that we expect to happen for multiple years and be able to allow for some kind of planning based on that. I know that, you know, our budget this year is going to have a deficit.

Next year is probably going to have a deficit. We're not looking at great budgets the next few years. So that all makes it a little bit more difficult. But, you know, this is something that is going to grow whether we plan to budget for it or not.

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.

And so because there's kind of multiple agencies involved in this, I'm curious if there are ways in which you think coordination works well, ways in which coordination needs to be maybe improved, or are there, you know, are there responsibilities that don't solidly fall clearly within an agency and that can create issues? Or does it.

Is it all tied up in a neat little bow? I don't know.

I'll offer this to start us off. I think what has worked well or is working well is the.

When I have our partners on the technical advisory board, and then reciprocally, I'm invited to participate in the programmatic board that they're rebooting here in January and again later on in next year, I think that's the kind of coordination, you know, amongst state agencies that tends to get the best results. And so I'm.

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.

We are lucky enough to have a 90 day project Director that's housed with an agency who can. Dr. Bui can spend a significant amount of time focusing not just on the coordination with Cal oes, but really importantly for us, the coordination between our various different departments that have a critical role to play.

So, you know, we all are full and have lots of duties and responsibilities, but it is really a commitment that we have at CALHSS to focus on that coordination. It's true with 988, it's true with some of our other behavioral health initiatives.

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.

And there also is some clarification of roles and responsibilities in the actual five year implementation plan, which I made a note to make sure that I get to everybody on this Committee when I get back to my office so that we can lift that up and I don't know. Ivan, please share.

Yes, I think restarting the 988 workgroup is gonna be a real benchmark for us and bringing in a host of different stakeholders together to think through the future of the 988 network. I think that's a major step. I will say that I think the partnership is.

We're getting better to be better partners together between OEs, HHS, CDPH, all the other departments. And I think Importantly, it's the 988 consortium, which is new and working closely with them. Because the most important aspect of 988 is the 988 crisis centers themselves. And so, you know, we're creating new muscles.

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 we met over kind of a series of several weeks to further develop the methodology and not just meet, but actually listen and implement changes that we think make the methodology and ultimately the funding for the crisis centers more effective.

I think that there is a real need to develop that kind of a funding roadmap where we're not just looking at the next three years, for example, the next year, the next three years, we're looking at the next five years, the next 10 years. And one of the challenges that we've had is projecting contact volume.

And I think what we need to do is get ahead of it, like Narges is saying, and building out capacity so that we have room to grow. Right. We're not just kind of constantly struggling to keep up.

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?

I know there was discussion of housing assistance or other. Is it economic? Are there other things going on? What do we know about that?

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.

However, we are not asking every single caller like their age. But you mentioned earlier that we do get some littler kids calling these days and they do often share. They're pretty nervous, right. So we have callers who share their information because it's part of of the presenting problem sometimes.

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

But I will say in more recent years, people are also really hesitant to actually share any identifying information with us because they're hypervigilant about what happens to that information and whether that information could be used to track them in some way. And we are obviously reassuring that their information is HIPAA protected and things like that.

But during times of distress, I think people Also become hyper vigilant about what does it mean to share the thing that makes me most vulnerable right now, be it their immigration status, be it that they're working multiple jobs or their parents see them a certain way.

So the data collection, it's not in a way that is like every single contact is getting the same collection. What we do get is the degree of risk on every call reported by the caller or texter at the onset and the end of the call.

So in that sense we are able to know the efficacy of the system and that people are De escalated as a result of reaching out to us. But the other data that we have is not universal.

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

Well, I think part of the collaboration up to this point has been involving, involved with our technical advisory board. But also we've sent our staff out to the frontline call centers to speak to them and understand what would be beneficial in the product that we're developing for them.

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.

And so building some of those features into the system is an outcropping of that relationship going out and actually talking to the frontline people who are operating, you know, out there.

Because like when it comes right down to it, and I think this echoes the sentiment that NAR just mentioned a moment ago, is like that's really, you know, where the mission is happening is at the call center.

And so making sure that whatever the business requirements are at that end point has to be the key thing that factors into the technical development that goes on for building the system.

And so getting that feedback loop and not just, and it's not just a one time feedback, it has to be an ongoing because the mission is going to evolve as time goes on.

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 we do that in a couple of venues, formally in our governance bodies, but also having people, you know, on a, on a regular basis go out, visit the center, see what's happening, you know, on the ground, as it were, so that we can understand what they go through and how we could design a solution that would be beneficial.

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

I would think there's room for improvement in our collaboration with Cal oes. I think so. Some of the challenges has been in terms of who the lead is. There's been some turnover, which is understandable. But I think the feedback loop that Steve is mentioning could be strengthened.

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.

And there was a request maybe a year or so ago for monthly check ins between Cal oes, the centers and nga, which is the third party kind of contractor. And those meetings I think have happened two or three times and the rest of them have gotten canceled.

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.

All right, that's good to know. I would love to spend a lot more time on this, but I'm going to keep us on task here and move to our next panel. Thank you so much. And there's definitely going to be some follow up with all of you, so thank you. Thank you.

So we'll now move on to our second panel which will focus on county level coordination and workforce training. This panel will highlight how counties, call centers and community organizations are working together to integrate 988 with mobile crisis teams, local behavioral health services and ongoing care.

And with us today is April Giambra with the County Behavioral Health Directors Association. Megan Wheelehan with the Santa Clara County Behavioral Health Services Department. Good to see you. And Peter Murphy with the Mental Health Association of San Francisco.

And they will share what they are seeing at the local level, including what's working where the system is strained and. And what resources and training are needed to strengthen crisis response in our communities. So thank you all so much for being here. And we'll start with April.

Oh my goodness. Good morning, everybody. Sorry. Good morning. Chair and Members of the Committee, I just wanted to thank you for an opportunity today to speak. This arena is not a comfortable one for me. I am a peer, someone with locked, lots of lived experience.

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.

In addition to my administrative role, I am the county alcohol and drug administrator, A social worker who still provides direct services. A substance use disorder counselor who again still provides direct services. I'm a peer support specialist supervisor. Any person with lived experience, a former recipient of our services, a former foster youth unhoused in our community.

So I have, I have traveled the gamut, if you will. I also serve as an on call clinician for our mobile crisis team. We are, I regularly cover shifts. We're both myself and another dispatcher, one of two cover and fill the calls.

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.

The hope that I can sit, that I hope can sit together comfortably. First, 988 is a critical and often life saving resource. Lake County is sincerely grateful for the opportunity, the vision, the advocacy and the funding that has brought this lifeline into being. So thank you.

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.

In our limited experience there have been some calls, many of which have been routed through law enforcement. And despite coming into our local crisis centers. Thank you. Today we are no closer to having 988 call routed to our mobile crisis center. There is still work to be done. This is not a matter of technology.

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.

There are very real ways that 988 has helped our residents and has completed, complemented rather than replaced our services. For callers who are not in acute behavioral health crisis but need someone to talk to, 988 has been a valuable source.

When individuals call our local crisis line and decline mobile response, 988 can offer a listening ear text based connection. For several of our reoccurring deaf beneficiaries. This has been their lifeline.

We as a mobile crisis unit managing a county run mobile crisis team, we don't have many of those capabilities and 988has really served a few of our Members who have gone for many years not supported. So in that regards, very much appreciated.

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 know which food pantry still has groceries and the they know which food pantry still has groceries that day and where the nearest self help meeting is so they can attend an AA or NA meeting.

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.

Now I was listening to those other numbers and that's pretty impressive. There are a lot of utilizers of 988 so very grateful for that. But in Lake County we received 8,000 calls and was dispatched into the community nearly 2,000 times.

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.

Nearly one in three are now placed in permanent housing and still engaged in behavioral health and or substance use services. People in our community call our crisis line because they know who exactly it is they're going to answer.

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.

The CCMU grant was very instrumental and we very much appreciated that. That's actually how we were able to get it up off the ground very quickly. With the funding shifts from Proposition 1 counties and the ability to Fund the operations are dwindling from our vantage point.

This means that counties are being asked to build and sustain 24/7, 2 person mobile crisis teams and the infrastructure around them.

While the key source of earmarked funding associated with 988 does not consistently reach county run mobile crisis units and does not always help when insurance coverage breaks down in practice, we are deeply grateful for the early state and federal investments that allowed us to launch mobile crisis and upfront local match, purchase unmarked vehicles and implement safety outcome tracking tools.

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.

Outreach funding, stigma reduction outreach funding for stigma reduction in education, long term outreach and stigma reduction to change beliefs around government ran crisis lines or crisis centers and the fear that calling will automatically mean hospitalization, police involvement or lack of support. We would like to change that. Technology funding hardware and software.

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.

And our systems are growing. Mobile crisis vehicles that can withstand unpaved roads. In our small rural frontier county we have a lot of unpaved roads. Access can happen in the middle of the night, 2am in the morning where there's no lights, no cell phone service.

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 something as simple and profound as being able to safely transport pets. In Lake County is a significant portion of a portion of people offered help in crisis. Basically what I'm saying is that the majority of people in Lake County have animals that's how they they've supported themselves, they're their comfort.

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.

You keep small rural counties like Lake in the center of your consideration while you explore ways to ensure that 988 related funding streams more directly.

Support county operated mobile crisis teams consistent with the original vision of 988 to have in person response Improve the state's oversight of 988 call centers to ensure the counties are clear about what we expect from our 988 call centers in terms of collaboration and to ensure that their services are well integrated into our local crisis response.

Address the gaps that cover when services are theoretically reimbursable by medical or commercial insurance but in practice claims are denied or not reliably paid. Maintain and grow flexible fundings that allows counties to invest in outreach, infrastructure, vehicles, technology and the other request that I had mentioned, Lake County.

Sincerely Thankful for 988 the legislators, departments, advocates and partners who brought this to us point and for CBHDA's going ongoing work to help counties make this system real and on the ground. The Medi Cal mobile crisis benefit has already saved lives in Lake County and strengthens our local partnerships with first responders.

Our story is a system of one in motion. Any rural county that is ready to fulfill and realize the promise that it was envisioned with the creation of 988. Thank you again for your time and your continued commitment to serving those.

Thank you so much. Appreciate that and thanks for all your lived experience. That really gives you a lot of insight into what you're doing today. So thank you. We'll now move on to Megan and and Charmaine is keeping time. So when you hear the little beep it's time 10 minutes.

So if you could kind of wrap up at that point that'd be great. Thank you.

Okay, great. You could give me a wave at 8 and I'll know. Excuse me. Good morning Chair Committee Members. I'm here today representing the County of Santa Clara. I'm the Deputy Director for their Behavioral Health Services Department. We want to share our experience implementing the 988 Suicide and Crisis lifeline.

And of course to emphasize the critical importance of sustained funding for this life saving service. Santa Clara County has been at the forefront of suicide prevention and Crisis intervention since 1980 when we established our Suicide and Crisis Services program.

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.

Even as we know that 988 needs ongoing publicity to increase awareness of the resource, the implementation has increased the call volumes in our services. In FY21 22 before 988, we handled 18,217 calls routed from the National Suicide Prevention Lifeline. Just one year after launch in FY22 23, that number jumped to 24,497, a 34% increase.

This fiscal year we are on Track to answer 31,372 calls, which is an incredible 72% increase compared to pre 988 levels. In July 2023 we launched Crisis text and chat support services which operate eight hours a day, seven days a week.

We now handle more than 3,000 text and chat conversations annually with what we know we need to grow to meet the growing demand for digital crisis support, particularly for youth and underserved populations.

Through our grant, our program must meet rigorous performance standards as discussed by previous panelists and I'm proud to report that Santa Clara County consistently meets or exceeds every benchmark. Our answer rate is 92% exceeding the required 90%. Our flow out rate is just 3%, well below the 5% threshold.

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.

I was going to commit tonight because I thought there was no other way, but you made me not want to. You saved me. Another person shared, I've never reached out before this, but now talking to 988 feels like one of the only times I do not feel completely and utterly alone in our county.

988 is not a standalone service. It is the front door to a comprehensive crisis response system. Santa Clara County operates a continuum of mobile crisis services that cover the entire county 24 hours a day.

That continuum consists of four programs, a county staff mobile crisis response team that has 18 Clinicians that respond to crisis in the field and provide support and consultation to law enforcement. Through an MHSA Innovation Grant that ends in early 2026.

We started a community mobile response team called Trust, which is for Trusted Response Urgent Support Team that provides De escalation and connection to services as an alternative to calling law enforcement.

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.

When DHCS developed the Mobile Crisis Benefit, we were among the first counties to implement that benefit to help cover the cost of the mobile crisis services we were already providing at that time.

And while we continue to work towards maximizing medi Cal billing and work towards attempting to Bill commercial insurance for the roughly 20% of people that we know have commercial insurance, say a good percentage of the people that we serve will not tell us what kind of insurance they have, which is another challenge.

But our experience billing commercial plans for other unique services we provide like methadone, tells us that the reimbursement is slow and paltry. We need a centralized approach to holding commercial payers accountable for the care that they are paid to provide. 988 is an important but not singular door to our mobile crisis response services.

Referrals to mobile Crisis come from 911 law enforcement and through our Behavioral Health Access Call Center. Similarly, while the availability of mobile crisis response is an important resource and referral for 988 call centers, most of our calls are resolved over the phone through skilled and caring responses to the caller's distress.

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.

Remarkably though, if you look at a per month basis, only 15 to 20 calls out of the 5,500 calls we answer every month go to a mobile crisis response team which shows that people in crisis having access to trained supporters can effectively De escalate most situations and connect people to appropriate care without law enforcement involvement.

As our program has continued to evolve to meet the needs of the community and requirements of our funders, so is our staffing model. We currently maintain a team of 17 coded staff positions, 11 extra help employees and 65 active volunteers.

This blend of professional staff and trained volunteers allow us to provide culturally responsive person centered crisis support around the clock. We've also heavily invested in training to ensure that our services are culturally responsive and gender affirming.

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.

We're currently implementing planning to implement the training from the Trevor Project, which we're so excited is coming out to enhance our support for LGBTQ youth in crisis. As others are discussing, there is an urgent need for sustained, stable funding for 988 services.

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.

Thank you very much. Thank you for the work you do. We'll now move on to our other panelists here. Peter Murphy, who's an outreach manager with the Mental Health Association of San Francisco. Thanks for being here.

Hello. Hello. Good morning. Thank you very much for having me here. I want to say thank you to Chair Pellerin and Assemblymember Schiavo. And yeah, I'm Peter Murphy. I'm the outreach manager for the Mental Health Association in San Francisco and I'm here today to talk about the California Peer Run warmline and we have a few slides.

I'm going to probably talk a little bit first. I think it's really great that we can be here because we're not like officially part of the 988 system, but we are part of what I would call like the continuum of care. And I'm, I identify as a, as a peer, like was mentioned earlier.

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.

I was a counselor on the phone lines as well. The line started in 2014. I was on the lines from 2015 through about 2019 and then now I've been the outreach manager since then. And I've seen the value of the work.

I've seen the value of the line and we are distinct from 988, but we perform a service that I think is really essential and we're trying to make our case, I guess, for why it's really a necessary service like 988 is and how we can work together.

So I think I'll go to our slides now so I don't get in trouble for not using them. But. Oops, let's see did the old. So first we want to talk about just what is a warm line and how is it different, say from 988 or a suicide prevention line?

And everybody on our staff, everyone that answers the calls identifies as a peer and we consider ourselves non emergency but we do what we call warm handoffs to 988. So you know, we don't expect the callers and 988 refers folks to us as well if they get somebody.

It's kind of a triage, you know, system or prioritizing who needs the most help. And we don't expect the callers to really know the difference. You know, I mean some of them call our line, they call 988 looking for support as well, depending on their level of crisis at the moment.

And I'm really proud of the training that we do with the new peer certification, relatively new over the last few years. Everybody that's on our. That joins our warmline as a counselor or as an administrator now is. Is peer trained. And if, if they're not, then they're working towards that pure certification. So.

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.

You know, was sort of the idea like, you know, as the crisis gets more difficult, you know, and spills over into sort of the boiling point, we're trying to De escalate that to make it to help the person to be able to tolerate what's going on and understand what's going on. And we make a lot of referrals.

We have a really great referral system and as I mentioned, we make direct contacts with 988. If somebody's on our line and we feel like they really need. They're at a high risk for suicide, then we can directly transfer them to 988 through the technology.

When I was on the phone lines, we had these offices in downtown San Francisco. That's still where our offices are, but now everything is done remotely so we got our first state funding.

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 so we've been in the budget three times. So the time after that was in 2022 and. And our funding increased. We were able to create this really robust service. And unfortunately, this last time we received enough funding, basically, it really got scaled back.

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.

We say it's all trauma informed, so we kind of assume anybody calling in, and sometimes somebody can't really express what's going on even. But we try to, as we say, meet the folks where they're at.

Sometimes folks call and it's just like I tell callers, just like, no problem is too small because we're trying to encourage them to call in. Unlike, say, 988, it's a crisis situation. And so they're triaging, they're prioritizing differently. But I feel like, yeah, we really work well together.

We do a lot of suicide prevention training as well as part of our training, in the sense that because we get a lot of callers that are hopeless, I mean, I've been there myself. When I was drinking, it was like, maybe my solution is to hurt myself, you know, and. And we run into that a fair bit.

And so long as someone isn't at a high risk, you know, they're not. They don't have the means, let's say, and all that. If it's just like ideation and wanting to talk about it, then it's a really great place to have that conversation.

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, yeah, the first time I got help was in the ER, you know, it wasn't like. And I wanted to mention too, this is maybe kind of a random fact, but like, the biggest. The biggest supplier of mental health resources in Cook county in Illinois is the correctional system, you know, and that makes no sense, right?

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.

So, why this matters for California. So, we also see ourselves as a cost saving device. I mean, we do surveys of our callers and around 15% of our callers have talked about that if they didn't call into us, they'd be in the ER, they'd be calling their psychiatrist, they might hurt themselves.

And we've equated that, in terms of ER visits, to around a savings of around $95 million a year. So, that's just one aspect of the cost savings to the community. You know, they say $1 of prevention can amount to like $5, $6 of care that you don't need.

So, this kind of summarizes what's happened to us most recently. So, we had, we had a Spanish language warm line, which we basically had to eliminate because of the changes in this year's fiscal—this year's budget starting the fiscal year in July. So, that's been eliminated for now.

We were operating a warm line federation, which was warm line—smaller warm lines from around the state that we were able to support, and we're no longer able to do that. And we've also had to cut back our hours. So, we were 24/7. Now, we're Monday through Friday, basically 7:00 AM to 11:00 PM, and so, my information's up there, and also, our phone line.

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 were getting 40,000 contacts a month and we're hardly able to keep up with that. Now, we're able to handle roughly around 8 or 9,000 a month. So, we've got people calling in that are like, well, I guess the warm line doesn't exist anymore. I mean, we do, but it's a skeleton.

And I would love to explore ways that we can work more closely with 988 in a more official kind of way, but I'm also just really glad to be here to meet everyone that's here and I really appreciate your time. So, thank you.

Thank you so much. Yeah, this is also a great networking opportunity to connect everybody and thank the three of you so much for the work you're doing in your communities. It's so critically important. Couple questions.

So, what are the protocols for how 988 connects people to local behavioral health services, mobile crisis teams, or emergency services at the local level?

I can tell you what's happening in our county. So, I think because 988 is operated by our county behavioral health department, they transfer calls to our access line when someone is a Medi-Cal beneficiary, needs access to specialty mental health services.

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.

Trust, the innovation program, which is fully funded by innovation funds right now, has its own call center that does dispatch through kind of a cool platform that we were able to implement with the grant funding, the CCMU Grant. And then, our MRSS team similarly has its own call center, those are contractor operated, that do the actual dispatch of it.

But there are decision trees so that 988 operators know when to seek that field response and which team to use for the field response.

So, for Lake County, we—currently, it is my understanding that when a call comes in our 988 center, it goes directly to law enforcement. They—we have un—we have not been successful to have those calls connected to our mobile crisis to team, which has been part of the problem.

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.

From you on that?

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.

And so, and with the Pandemic, I mean, which I still feel like we're, you know, we're still in it in a way, you know, and it's just had this tremendous effect. And so, the idea of isolation and how we, how do we provide that connection but also provide referrals and yeah.

Thank you. I'm hearing a lot too about workforce needs and I just want to put a shout out to all the volunteers. I hear about what, 65 I heard, yeah. That's incredible to have that many people willing to volunteer their time for this purpose to help people in a mental health crisis.

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?

The surcharge.

The surcharges. From what I, from what I understand, we're not able to bill up. There's not a mechanism for them to draw down to us. They go to, I believe the 988 resources, but not to the local mobile crisis.

Okay. And this problem of 988 calls going to law enforcement. So, is law enforcement identified as the 988 provider in Lake County? How is that, how is that happening?

So, it has been, we've had small rural areas struggle with routing phone calls numbers, crisis lines, and it has been an ongoing problems between our call over—even previously when we had after hours calls, it would be difficult for them to be able to access.

So, with the mobile crisis benefit, we did lift up the crisis toll free number. That has been successful, but for some reason, from what I understand, there are challenges with transferring to a transfer number. So, the system itself they cannot transfer to we use the cell phone, and so, they transfer to law enforcement.

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.

So, is this—are the first panelists still here? Cal OES still here? I hope Cal OES is listening because that is a mess. That's a terrible mess.

It has—we've worked with...and other entities over the years who have been a great support, but it has been challenging. I can only imagine for them how difficult it has been for these types of technology reasons.

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.

And so, just to say—and it's so important to get that rural county perspective compared to a larger county like Santa Clara County, because there's different needs here. So, we got to make sure that everyone in California will get the services they need. Thanks.

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.

Yes.

And the call should be coming to your crisis line?

Yes.

But they're going to the Police Department?

Yes.

I mean, I don't know why they can't just change the number that they direct a call to. I don't know. Is it more complicated than that? But I think we should figure it out.

Okay. Okay. Well, let's make a call to Cal OES after this. Okay, sorry.

I agree.

Okay. So, can you—when you're talking about, Peter, you were getting close to 40,000 calls and now you're doing around 8 or 9,000?

Yeah.

So, that's like 30,000 people or calls—calls at least.

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 I think that's important to realize. But we do have a, yeah, recording that's, that's like, you may experience delays, we apologize, and this kind of thing, and we refer them to the website and folks can leave a message and we try to get back to them, but.

But yeah, our staff is just not what it was at all. So, our staffing, we're gonna go back, we're coming back with a budget ask for this upcoming cycle, and I'd love to talk to you both about that when there's time.

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.

Well, exactly what you said. The ounce of prevention is so critically important to prevent the more expensive crisis down the road.

So yeah, we'd love to talk to you more.

Do you need to get going?

Yeah. Okay. Well, thank the three of you so much. We're going to go ahead and move on to our third and final panel. So, this panel is—brings us forward practitioner perspectives from those responding directly to individuals in crisis.

This panel will highlight what 988 response looks like on the ground and we'll hear from community-based providers and law enforcement crisis counselors to learn from their experiences of being dispatched. So, Bill McCabe of the Family Service center of the Central Coast is here with us. Come on down.

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.

And I believe we do have a couple people that are streaming in as well. So, I lost that list, but we'll find them. So. So, Bill, where is Bill on—Bill's on Zoom. Bill, we're going to start with you. So good to see you. Thank you. We're not hearing you. Is your—still not hearing.

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

Do you need this?

No. Either.

Thank you.

Still not hearing you. Just one sec.

There we go.

Yes. Let's do it louder. There we go. A little louder there. Thank you.

Okay, I'm talking still. All right, we good to go?

Yes, go ahead.

All right. I might have to turn down my volume.

Good to see you back here.

Yeah. Hello, I'm Bill McCabe. I'm the CEO of a Family Service Center and we're a nonprofit that does 988 providing for Santa Cruz, Monterey, San Benito counties, all of which are rural by population. And I'm here to just talk a little bit about the local systems we're creating and with our local set of providers and how that's going.

Thank you so much for having us. This program has been wonderful. I've learned a lot and it's been great to see the other providers and hear some of the other people speak. I just wanted to talk about maybe from the framework of first floor, second floor, as really other people have spoken. We're funded to answer the lines.

The fact that we're getting so many calls and so many people are being helped is a great achievement, but really that's just the—sorry, I tripped on...feedback. Okay, I fixed that. Really, that's a great achievement in that there's so many more people being helped than help before.

However, we also know that really for these services to be effective, they have to be interwoven with a lot of other services, so we have a true continuum of care that really helps people to get away from being, you know, crisis response.

And so, I want to talk about some of these second-tier things that are developing in our counties, which I think are really important and have some real challenges.

I want to underline some things that...said that as a call center and as a nonprofit, we recently got a 13-month contract which was huge since we've been getting small extensions and there's a little bump.

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.

In order for the continuum of services to work, we really need to get all the calls local so that then the people answering the phones are local, connect to the services which are local.

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.

And to the extent that crisis continuum, a continuum of care is going to be effective, that those partnerships have to be alive and well. And we're real thankful for having long histories of working with Santa Cruz, Monterey, and San Benito Behavioral Health, though there's different pieces to what we do together that are being challenged, I want to speak to.

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.

And with the recent Prop 1 cuts, it's really important to know 988 will be affected because a lot of the prevention dollars that were flowing through the county have been peeled off to be part of state responsibility and there's been no guidelines as to what that's going to look like. So, we need to be aware of that.

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.

And this really brings the integration. Getting 988 in the counties as part of the same system is really going to be essential, one of the central parts. I'm going to start paint these different pieces that all weave together as a web. But they're really built by, you know, partnership on partnership on partnership.

And we heard of Lake County's challenges because each one of these pieces takes work. And it's great to hear Santa Clara's model where, you know, they're doing it all internally but still sounds like they got a bunch of different parts that have to talk to each other. Mobile crisis.

Mobile crisis and 988 need to be developed together because ultimately, for us to be able to really prevent suicide, to have an active response that's mentally health competent, is to be able to have 988 and mobile crisis working together. And we've really built some good partnerships.

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.

So, these are services, the community at large that largely are unfunded, and the promise of insurance billing may or may not to fruition. And so, counties are left with these costs. The potential for 988 to do mobile crisis dispatch, I think is a real interesting idea.

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.

They go through an assessment protocol to figure out if they can handle that call on the phone or deployments made possible.

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.

So, really looking at the potential for 988 to be part and parcel with those efforts is going to be important. Just kind of checking on my list here. The other piece is services. You know, I just want to say that we've really been working on, we're a provider of a lot of counseling services, individual outpatient.

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.

There's a mechanism...spoke about follow ups and not being able to get enough follow ups, but the real work is getting a lot of dynamic, complex training to our call takers so that they can build the bridge to services themselves.

There's a real challenge in a crisis response situation where a person's in crisis, they can call 988, they can feel better, they go away. 10 days later, they're in crisis, they call, and the cycle continues, and we see a lot of that challenge.

And so, in building this integration of care, we're really working on how to get those clients into services. And we're really finding that the work there is for the call, the 988 call taker, to really be able to sell that bridge to services.

Not only do we have to have the back end where we have the services, we have the collaborations, but we really need an increase in training for our call takers, which we don't have funding for currently.

We're also providing survivor loss groups, groups for people who are survivors of suicide loss, and those are really important and powerful and I think really needs to be part and parcel with the 988 efforts, as well as we do loss response where we have, we actively go out into the field when there has been a suicide and support those communities. Again, these services being integrated with 988 are essential.

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.

So, when you call 911, you can get a direct dispatch to 988. The partnership with 911 and law enforcement particularly, but fire as well, is super important for 988 because it starts us to deliver this really important promise.

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.

And if you could wrap up. Yeah, we're over 10, so if you could wrap up your final thoughts that'd be great.

Okay, final thoughts. Sorry, having to turn down my mic. So, there's just—remains a great potential for 988 to be so much more than it is.

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.

Well, why are we lowering the tax if we don't get enough money to the call centers? And the reason, as I understand it, is Cal OES had a lot of money they didn't say spend and so, there's a lot of money sitting there that's not getting out. And so...just spoke eloquently to, we're not even part of the table.

We get allocations via Department of Health Care Services through HHS, through a contracted, you know, money handler. And we just get an amount given to us and we're happy to get it and we're happy that we got the money but it's not taking into factors any of these other things.

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.

Thank you. I will try my best to be brief and stay in my 10 minutes or less. Greetings, Chair Pellerin and Assemblymember Schiavo. I also want to thank your staff because they have supported this hearing and worked really, really well.

So, thank you for your accommodation and working so hard on this, and thank you for your moving remarks at the beginning of this hearing. I think that really grounds us in what we do and why we're here.

I am the Chief Executive Officer of the California Behavioral Health Association, but I'm also a psychologist and I've worked with many survivors and family members of those who have also died by suicide, so I know firsthand, I've seen the toll that this can take, that suicide, that trauma, can take on families, on individuals, on communities.

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.

With that said, our Association, the Behavioral Health Association, represents the most diverse network of behavioral health providers across the state. Our members support individuals and families across every region of California, from large metropolitan areas to rural and frontier communities, and they provide crisis response services every day to Californians in need.

Due to our representation of call centers and other crisis providers, in 2022, CBHA worked closely with the Steinberg Institute and the Kennedy Forum, who were the lead sponsors of AB 988, authored by Assemblymember Bauer-Kahan.

This carefully negotiated legislation, and boy, there were a lot of negotiations, was an attempt at having a comprehensive and modern framework for statewide crisis response. So, I have to say thank you to our state partners: HHS, OES, DHCS, CDPH, all the alphabets.

They have really shown leadership and implementation of 988 via the work of the 988 Policy Advisory Group, and we heard about this earlier and CBHA has a seat on this group. I'm very heartened to hear HHS share statistics about the decrease in suicide rates, particularly here in California, and also recognize the fiscal constraints.

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.

So, since AB 988's passage just a few years ago, competing crisis response have come and they've gone. Funding has shifted and leadership, as we heard earlier, across state agencies, in particular OES, has changed as well.

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.

Over 95% of crisis calls are resolved during the call itself, only 3% require mobile crisis intervention, and only 2% lead to the use of emergency services. This record reflects both the strength of 988 call centers and the essential role that they play in reducing strain on the emergency departments, law enforcement, and our 911 systems.

Now, despite this consistent performance and commitment, call centers report that they continue to face a number of urgent challenges that threatened sustainability. First, the more that 988 is it advertised, as we just heard, the more that volume increases across the state in terms of calls but staffing at centers struggle to meet this growing demand.

Without the ability to hire, train, and retain staff, call centers will not be able to keep pace with the expectations of the statewide crisis system. Meeting these needs requires predictable, sustainable investment in workforce. Second, call centers have not been fully reimbursed for technology costs for the past year, despite clear statutory requirements that these expenses be covered.

Technology is not an auxiliary part of 988 operations. It's a core component of call routing, data integration, quality monitoring, cybersecurity, and coordination with national systems. During AB 988 negotiations, call centers advocates, like CBHA and state partners, all agree that these costs would be reimbursed.

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.

As we heard earlier, they received the report. Some centers are already projecting immediate deficits that will affect staffing and call capacity. In addition to the state level issues, as prior—as a prior speaker shared—call centers are also reporting growing uncertainty about how 988 will be integrated into local planning efforts.

So, as counties are transitioning from the Mental Health Services Act to the Behavioral Health Services Act of 2026, some centers have received notice that counties may not renew their contracts. They cite that 988 funding is categorized as prevention, which is an optional use of BHSA funds.

So, despite the critical role that call centers play in the crisis continuum, they are at risk of being excluded from local county planning conversations. This issue is further complicated by the transition of certain prevention programs, including 988, to oversight by the Department of Public Health.

In its recently released Population Based Prevention Program Phase Two Guide, CDPH indicates that it will not begin issuing grants to community-based organizations until the '27-'28 fiscal year, and its grants will focus on outreach, not operational support. So, this creates a multiyear period in which call centers lack clarity about how they'll be integrated into crisis planning or supported.

Finally, these challenges represent a significant departure from the intent of AB 988. When the Bill was negotiated, the tiered rate structure was specifically designed to make call centers whole first before funds were distributed elsewhere. That principle was central to every conversation.

With technology reimbursements unpaid, rates reduced dramatically, and major decisions made without proper provider involvement, call centers are not being made whole. Instead, they're becoming increasingly underfunded and understaffed. This is the opposite of what California committed to when it set out to build a strong, locally anchored crisis system.

California has long been a leader in crisis response, and in its 988 call centers, they've saved countless lives. Call center staff want to continue this work. They want to innovate within the crisis continuum, and they also want to meet the needs of every caller who reaches out.

But to do so, they need clear commitments from state agencies, transparent decision making, rate structures that allow for sustainability, and full inclusion and planning efforts at the state and county levels.

So, we're urging the Legislature, Select Committee, and all involved agencies to provide sustainable rates, reimburse outstanding technology costs, clarify oversight structures, and recommit to the original tent of AB 988. Thank you for the opportunity to comment.

Thank you so much. That's incredible. Good information to have. We're now going back to the remote, I believe. Is that right? Okay. Sandri Kramer. She's the Senior Director of Training and Community Engagement at the Didi Hirsch Suicide Prevention Center. I don't see a picture.

I am here.

Yes. There you are. Hello. Welcome.

Great. Thank you. I actually am not sure—I need to share my slides. Can I just go ahead and do that?

Yes, go ahead.

Okay. And I'm going to.

Okay. All right. Well, I want to introduce myself first. My name is Sandra Kramer, and I am the Senior Director of Community Engagement for Didi Hirsch Suicide Prevention Center. And among other things, I oversee all crisis line training, community training and outreach, and our alternative crisis response program. Is there a way to eliminate the echo?

We're not sure. Hang on. We're going to lower the volume a little bit, so hopefully it removes the echo. Thank you.

Okay, thank you.

So, I've worked in the crisis line field for over—I want to make sure you guys are actually.

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?

Yes, we see the slide.

Okay, perfect.

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.

We will always do our best, very best, to connect these callers to appropriate resources in their community, of course, and our center, at least, all 911 diversion callers are offered a follow up call, regardless of acuity level. So, why am I here to talk about 911,988 diversion? Why is this so important?

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.

So, it's not always the best response for the person in crisis or their family members, but these types of calls also significantly impact our first responders, like law enforcement, ambulance personnel. They have to deal with these sometimes volatile situations, likely hampered by inability to provide the kind of support in that moment that is needed.

And they're human too. They have parents and siblings and children and friends and other loved ones who may struggle with suicidal times or mental health crises. This is not an easy call to tend to for any party involved.

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 these disengagement policies are kind of strategies that police departments use to save resources for where they really are needed the most and to avoid getting into situations where they're not necessarily funded or where they can provide the best support.

And sometimes we know this, a response can escalate a situation and find ourselves in suicide by cop situations—best to be avoided.

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?

So, 911 to 988 diversion can save lives and can go back to that idea of what we really need that's intended, which is the right response at the right time. Okay, so clearly there's a role for both crisis centers and an in-person law enforcement response.

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.

So, I just want to share with you that we have our program, one of the oldest programs, 911...in the country, which is with the Los Angeles Police Department. These are the eligibility criteria for our 911 diversion with them.

And they actually have provided significant Insight into the 988, 911 Interoperability Work Group that has been part of the 988 Implementation Plan as well. So, what you see here are the four points that would indicate that the call is not eligible to be transferred over to a 988 center. If they need medical attention.

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.

Now, I want to state right away that if we get these kinds of calls on 988 directly, our first response is not going to be we're going to get somebody to you. Our first response is still going to be tell me your story, tell me what's going on, and provide that compassion care.

So, a program with LAPD has been in place now for almost five years, which is amazing. Roughly 84% of all our diverted calls do not need any sort of emergency response or an immediate in person care. Right? That is less than the types that people that call 911 directly.

But again, we assume that there's a reason people call 911 expecting a response. So, we actually think that this makes sense, that these numbers are a little bit less than what we see on 988, yet you can see here how—how many—resources that saves and how much better the outcomes can be.

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.

That tells us a little bit about the level of outreach and education we still need to do about 988. You heard earlier this morning people talk about the fact how many people still have not heard about of 988 and my training and outreach team is out in the community all the time to change that.

And certainly, for all the demographics which are actually at the highest risk for suicide, we see more people calling—coming to us—through 911. Gender is also a significant difference. Roughly about almost a little bit less than 50% overall of all the calls that reach us through 988 are male, which is actually much better than it used to be because I've worked in this field for over 30 years. But with 911, roughly 70% of our callers are male. So, that's a significant difference.

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 need to make sure that there's some drive at the state level for leadership support from the police departments and sheriff's departments that we're working with. We need a lot more community outreach and education. I cannot tell you how many resources it actually takes to make a successful program.

They have a very small team, but it takes a lot of trainings, a lot of sit alongs, ride alongs, a lot of cross cultural pollination, lots of roll call visits, very frequent meetings and check ins.

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.

But it's not true to 988 because we need to set up specific lines for 911 calls to come to the right 988 center. Again, that's a technology issue, so they're not reaching us directly. And therefore, those numbers, which, with LAPD, we've over 6,700 calls so far, do not count towards our 988 number.

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.

But the most important one that you've heard already before is dedicated funder—funding—for 911 diversion to be a true success in California. I mean it is really pioneering. We really were one of the very first ones to do this, not just in our state, but nationwide, and LAPD is the largest police who has embraced this.

And that's what I want to talk about. So, thank you so much for listening.

Thank you so much for joining us today. Great slides that you had. Appreciate it. I will now move to our final panelist today and that is Janae Schallert with the Elk Grove Police Department.

Good afternoon. Thank you so much for having me. Yeah, so my name is Janae Schallert. I'm an LCSW at, or formerly at Elk Grove Police Department. So, licensed clinical social worker. I've been doing crisis response or crisis intervention response in the Sacramento area alongside of law enforcement for about five years.

So, initially, it was with Sacramento County Behavioral Health, and we had a partnership with local police departments. And then, I've been—or I was at—Elk Grove Police Department for a little over two years as I hired internally—hired clinicians internally.

So, a little bit about—let's talk just a little bit about how our response works, kind of more on the 911 side of it because that's when we're responding on a 911 side of it. So, how our program works is we are a co-response unit.

So, we have a licensed clinician alongside of police departments—or police officers—responding to 911 calls. So, how that looks is you have a clinician in a patrol car, in a black and white patrol car, alongside of a law enforcement officer who has additional training in crisis intervention and mental health.

We respond to 911 calls using a radio. So, we get dispatched via 911 to in progress emergencies and progress crimes. And we're not just kind of pigeonholed into obvious mental health calls. We'll call them like our welfare checks.

We go to active suicidal ideation, suicide attempts, domestic violence, shootings, stabbings, bad car accidents, child abuse, sexual abuse, basically anything and everything where we can identify a crisis. And people generally call 911 when they are in crisis.

So, how it kind of functions is we respond via 911 out into the community and our goals are to, one, reduce the crisis, stabilize the scene, ensure safety, the physical safety of whoever is involved, along with the emotional safety.