Newsom Campaign Responds to NAMI Questionnaire on Mental Health
Lieutenant Governor Newsom responds to the
NAMI California Candidate Questionnaire
Lieutenant Governor Newsom’s response (download pdf version)
QUESTION ONE: The mental health system in California is complex and communication across the system is often fragmented. Given this reality, and within our current systems of care, many families struggle to connect their loved ones living with mental illness to appropriate services quickly and without undue burden. If elected governor, what strategies would you promote to help families better understand the mental health care system and more quickly and easily access services for their loved ones living with mental illness?
In any given year, one in four families in California deal with a mental health condition and our mental health care system falls short, not for lack of funding. We’ve done the right thing in this state: Thanks to the vision of then-Assembly member Darrell Steinberg (now Mayor of Sacramento), we passed a millionaire’s tax in 2004 that now funnels more than $2 billion a year into services. We fall short because we lack the bold leadership and strategic vision necessary to bring the most advanced forms of care to scale across the state. We lack the political will necessary to elevate brain illness as a top-tier priority. We lack the unity and fervor needed to rally the medical and research communities around an unyielding search for ever-better diagnosis and treatment.
We must ensure that Californians have quick and easy access to mental health services, especially through access to affordable health insurance. Even with the expansion of Medi-Cal and the availability of significant subsidies to help low and middle income families purchase coverage through the state exchange, millions of working Californians will remain uninsured as the price of coverage remains prohibitive, especially for those living in high cost areas. We can create a more efficient, effective, and comprehensive health care system that works for patients and providers alike, available regardless of one’s ability to pay, pre-existing medical conditions, or immigration status, and including coverage not only for physical, but also mental and behavioral health issues.
QUESTION TWO: 70 percent of youth in juvenile justice systems have at least one mental health condition. 20 percent of adolescents ages 13–18 (approximately 615,000 teens in California in 2016) experience a severe mental disorder at some point during these years. For children and adolescents ages 8–15, the estimate is 13 percent – only half of whom receive mental health services. In other words, in 2016 of the 530,000 California children and teens ages 8 – 13 with a serious mental disorder, 265,000 children received care while 265,000 children did not. Describe your strategy for increasing access among children, youth, and young adults to treatment, services, and supports that promote resiliency and recovery.
These are stunning statistics, and underscore why, as a state, we need to find ways to infuse more resources into prevention and early intervention – and why we must be more strategic and directed in how we spend those dollars.
We know that 50 percent of mental illness manifests by age 14 and 75 percent by age 25. We also know that depression and suicide rates are climbing among adolescents and young adults. There are several strategies my administration will pursue to target and reach these groups:
1. Standardize and scale up early screening for childhood trauma and adverse childhood experiences that research tells us are a likely precursor to mental illness. (i.e. ACES research) This needs to be a routine aspect of pediatric care.
2. Work with counties and our university and research communities to expand access to programs that provide effective early intervention in psychosis-related illness and serious mood disorders. Our goal must be for every family to have access to these services, regardless of ZIP code.
3. Invest in our public schools by ensuring every campus has timely access to licensed mental health professionals, and that staff are trained in identifying early signs and symptoms of mental illness and directing families to appropriate care.
4. Ensure every public college in the state adopts comprehensive strategies for raising awareness of symptoms of mental illness, identifying students at risk, and providing support services. In addition, we will call on every college to implement evidence-based suicide prevention policies.
QUESTION THREE: Many individuals defer seeking mental health treatment because of the stigma that exists around mental illness. As governor, in what ways would you use your platform and voice to help reduce the stigma associated with mental illness?
We will amplify efforts to eliminate the stigma that keeps too many people from reaching out for the care they need. My administration will join efforts to end discrimination in the workplace, encouraging leave policies that mirror those in place for other types of illness and training employers how to accommodate someone living with a brain illness in the workplace so that they have the support they need to live a life with meaning and make a contribution to society. We’ll invest in public service campaigns and outreach to educate our communities and normalize discussion of brain illness.
As Governor, I will embrace the mantra that there is no health without brain health. We will usher in the next era of care, and emerge a stronger, healthier California.
QUESTION FOUR: Communities of color and other underserved groups like the LGBTQIA population have historically faced additional barriers to accessing mental health care. How can the state of California create more inclusive systems of care and ensure that all persons with mental health care needs are receiving access to critical treatment and services?
There is a basic lack of cultural competency in our health care system. We must increase training for medical care providers so that these groups not only feel comfortable in accessing health care services, but even more importantly, so that doctors, nurses and other health care providers know how to meet the unique medical needs of the community.
Communities of color and the LGBTQIA community face higher rates of violence, discrimination, and stigma. They face issues that are often excluded from the traditional mental health model.
My administration will engage community groups that work with underserved populations to brainstorm how they can partner with counties to improve trust levels and access to care. There are best practices that could be scaled up. We will expand access to telehealth and other technologies to ensure people can get mental health services in a language they understand. And we will support efforts to break through stigma that can make it more difficult to reach out for necessary care.
I am committed to ensuring key staff in my administration are focused on this area and promoting proposals that will make positive change.
QUESTION FIVE: Access to permanent, decent, affordable housing, and supportive services is critical for individuals living with severe mental illness. Describe how you would promote a supportive housing system across the continuum of care for consumers living with a mental illness.
As a mayor, I was acutely aware of the many ways untreated mental illness tore at the fabric of community. We moved over 12,000 folks off the streets and into housing with supportive services. Yet still, more than 7,500 people live homeless in San Francisco, and research indicates about a third of them are dealing with untreated mental illness. Across the state, 134,000 people are living on the streets, a third of them suffering with progressed stages of mental illness.
I am committed to supporting Californians experiencing or facing homelessness. As Governor, I will appoint a State Homelessness Secretary to oversee an Interagency Council on Homelessness – because we need statewide leadership laser-focused on this problem. We will fund in-reach services at state prisons to prevent inmates from being released into homelessness, bolster the Housing Disability Assistance Program to provide SSI Advocacy services for chronically homeless adults, and expand social services, healthcare, including mental health, bridge housing, and permanent supportive housing. We’ve been “managing” this problem for too long; it’s time to solve it.
In addition, if voters pass Proposition 2 in November, my administration will work with counties to ensure they are receiving the support they need to fulfill the promise of the No Place Like Home program.
QUESTION SIX: Families, individuals, law enforcement, and others rely on emergency departments to provide timely, competent, and compassionate medical care during a psychiatric emergency. How will you ensure that all payers, including counties, support parity and access to these and other mental health services?
We must ensure mental health parity in all senses of the word. All people seeking mental health services should be met with culturally competent, inclusive, and welcoming care. We must also ensure that mental health is treated with the same priority as physical health. Parity in treatment is only effective if we have parity in access. Much too often people are faced with long wait times, complicated bureaucracy, and issues with insurance
At the state level, we must do a better job of scaling up best practices in crisis care. Several counties are having success with emergency room models tailored specifically to people in psychiatric crisis. These are proving effective, humane and cost-effective, and should be available in every county.
In addition, we will dedicate legal resources to ensuring California is fully enforcing parity laws and targeting insurers that discriminate against mental illness through pricing strategies, service limitations and provider restrictions.
QUESTION SEVEN: While treating individuals at the lowest possible level of care is considered a best healthcare practice, there is a statewide deficit of acute psychiatric hospital beds for those needing a higher level of care. If elected governor, what would be your stance on building hospital infrastructure for those with acute psychiatric needs?
We will expand the options available for inpatient care. Since 1995, we’ve witnessed the closure of 44 psychiatric facilities and the 2800 beds that come with them. As hospitals eliminated psychiatric units, the number of acute psychiatric beds per capita fell by 40 percent in California during that time. Rather than lead the nation in this critical aspect of care, we fall well below the national average. My administration will direct both funding and political capital into the effort to revitalize the acute-care system at the community level, pushing through the zoning issues and discrimination that often serve as obstacles to building specialized facilities.
QUESTION EIGHT: NAMI California believes that mental health systems should have the ultimate responsibility for treating all people with serious mental illness and that this responsibility should never be shifted onto the criminal justice system. Unfortunately, in many areas of the state, criminal justice facilities are the number one provider of mental health services. As an example, the largest provider of psychiatric services in the United States is Los Angeles County Jail with a daily average of ~4,700 inmates having serious psychiatric disorders. If elected governor, what strategies would you support to keep people living with mental illness out of jail? What policies would you support for persons who are incarcerated and living with mental illness? What strategies would you support to assist recently released persons living with mental illness get back on their feet and avoid re-arrest?
We will give law enforcement and courts the training and programs they need. Gaps in our treatment system mean that law enforcement officers are often the first responders for someone experiencing a mental health crisis. Meanwhile, state correctional officers and jail staff are dealing with tens of thousands of inmates who have been diagnosed with mental illness. It’s a reality that can prove debilitating for both law enforcement and the inmates in need of treatment.
Over time, increased investment in early prevention and intervention will help relieve some of this pressure, but we need a more immediate response. My administration will build on existing training for law enforcement officers, dedicating additional resources to instruction in how to de-escalate encounters with people with a mental health issue. We will scale up alternative sentencing options, including successful models of mental health and drug courts. And we will increase resources for specialized mental health units in our prisons and jails, as well as transitional housing that provides support and treatment upon release.