Health chair to prioritize mental health, homelessness

State Sen. Susan Talamantes Eggman (D-Stockton), who was instrumental in passing Governor Gavin Newsom’s mental health care legislation last year, has been named head of the influential Senate Health Committee – a change that promises a more urgent focus on expanding mental health services and moving homeless people to housing and treatment.

Eggman, a licensed social worker, co-authored the new law that allows families, clinicians, first responders and others to ask a judge to impose government-funded treatment and services on people whose life was derailed by untreated psychotic disorders and substance abuse.

It was a victory for Newsom, who proposed the Community Assistance, Recovery and Empowerment Act, or CARE Court, as a powerful new tool to address the tens of thousands of people in California who are homeless or at risk of incarceration. due to untreated mental illness and addiction.

The measure has faced fierce opposition from disability and civil liberties groups worried about denying people the right to make decisions for themselves.

“We see real examples of people dying every day, and they are dying with their rights,” Eggman said in an interview with Kaiser Health News ahead of the date. “I think we need to take a step back and look at the larger public health issue. It’s a danger for everyone to live near needles or to have people digging under highways.

Senate Pro Tem Toni Atkins (D-San Diego) announced Eggman’s nomination Thursday night. Eggman replaces Dr. Richard Pan (D-Sacramento), who was fired last year after serving as president for five years. Pan, a pediatrician, had prioritized the state’s response to the COVID-19 pandemic and championed legislation that strengthened state laws on childhood vaccinations. These moves made him a hero among public health advocates, even as he faced taunts and physical threats from opponents.

The leadership change is expected to coincide with a Democratic health care agenda focused on two of the state’s thorniest and most intractable issues: homelessness and mental illness. According to federal data, California accounts for 30% of the nation’s homeless population, while it accounts for 12% of the US population. A recent Stanford study estimated that in 2020, approximately 25% of homeless adults in Los Angeles County suffered from a serious mental illness such as schizophrenia and 27% suffered from a substance use disorder. long-term.

Eggman will work with Assemblyman Jim Wood (D-Santa Rosa), who returns as chairman of the Assembly Health Committee. Although presidents may set different priorities, they must cooperate to get bills to the governor’s office.

Eggman takes the helm as California grapples with a projected $24 billion budget shortfall, which could force health care spending cuts. The tighter fiscal outlook is pushing politicians to shift from big “moonlight” ideas such as universal health care coverage to showing voters the progress of the state’s homelessness crisis, said David McCuan, chairman of the Sonoma State University Department of Political Science. Seven in 10 likely voters cite homelessness as a big issue, according to a recent statewide survey by the Public Policy Institute of California.

Eggman, 61, served eight years in the state Assembly before her election to the Senate in 2020. In 2015, she drafted California’s End-of-Life Option Act, which allowed terminally ill patients who meet specified conditions to obtain drugs to aid death. their doctor. His previous mental health work has included changing eligibility rules for outpatient treatment or guardianship, and trying to make it easier for community clinics to bill the government for mental health services.

She hasn’t announced her future plans, but she has about $70,000 in a campaign account for the lieutenant governor, as well as $175,000 on a voting committee to “fix the mental health system in California”.

Eggman said the CARE Court initiative seeks to strike a balance between civil rights and public health. She said she believes people should be in the least restrictive environment necessary for care, but when someone is a danger to themselves or the community there must be an option to restrain them. against his will. A Berkeley Institute of Governmental Studies poll released in October found that 76% of registered voters had a positive view of the law.

Sen. Tom Umberg (D-Orange), a co-author of the bill with Eggman, credited his behavioral health expertise and dedication to explaining the mechanics of the plan to fellow lawmakers. “I think she really helped put a face to it,” Umberg said.

But it will be difficult to show quick results. The measure will proceed in phases, with the first seven counties – Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus and Tuolumne – set to launch their efforts in October. The remaining 51 counties are expected to launch in 2024.

County governments remain concerned about a steady and sufficient flow of funding to cover the treatment and housing costs inherent in the plan.

California has allocated $57 million in start-up funds to counties to set up local CARE courts, but the state has not specified how much money will go to counties to operate them, Jacqueline Wong-Hernandez said. , deputy executive director of legislative affairs at the California State Association. counties.

Robin Kennedy is professor emeritus of social work at Sacramento State, where Eggman taught social work before being elected to the Assembly. Kennedy described Eggman as someone driven by data, an attentive listener to the needs of caregivers, and a leader willing to do the hard things. The two have known each other since Eggman began teaching in 2002.

“Most of us, when we become faculty, we just want to do our research and teach,” Kennedy said. “Susan had only been there two or three years and she was taking on leadership roles.”

She said Eggman’s view of mental health as a community issue, rather than just an individual concern, is controversial, but she’s willing to engage in difficult conversations and listen to all parties. Additionally, Kennedy added, “she’s not just going to do what Newsom tells her to do.”

Eggman and Wood are expected to oversee CalAIM, the Newsom administration’s sweeping overhaul of Medi-Cal, California’s Medicaid program for low-income residents. The effort is a multi-billion dollar experiment that aims to improve patient health by funneling money into social programs and keeping patients out of expensive institutions such as emergency departments, prisons, nursing homes and mental health crisis centers.

Wood said he thinks there are opportunities to improve the CalAIM initiative and watch for consolidation in the healthcare industry, which he says is driving up costs.

Eggman said she was also concerned about labor shortages in the healthcare sector and would be willing to resume a conversation about a higher minimum wage for hospital workers after negotiations broke down. of the past year between industry and workers.

But with just two years until she’s fired, Eggman said, her focus will be tightly framed around her area of ​​expertise: improving behavioral healthcare across California.

“In my final years,” she said, “I want to focus on my experience.”

This article was produced by KHN (Kaiser Health News), one of the three major operating programs of the KFF (Kaiser Family Foundation).


Los Angeles Times

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