Behavioral health care legislation takes center stage at the State Capitol

California lawmakers placed an increased emphasis on expanding access to behavioral health services this year, particularly for California’s homeless individuals. Lawmakers introduced several bills this legislative session that would make changes to existing systems and implement new approaches.

Many of these proposals are in line with the 2022 Cal Cities State Action Agenda, which seeks to secure increased funding and resources to prevent homelessness and assist individuals experiencing homelessness. The Cal Cities Board of Directors also passed a new policy in May that supports expanded access to behavioral health services, especially for unhoused Californians, which paved the way for Cal Cities to advocate on the measures.

For unsheltered individuals with severe behavioral health needs, access to a comprehensive care system is essential to addressing their homelessness.

What is the CARE Court Program?

Earlier this year, Gov. Gavin Newsom proposed a new behavioral health program — Community Assistance, Recovery, and Empowerment (CARE) Court. SB 1338 (Umberg) reflects the Governor’s vision by outlining a civil court process that, if specific requirements are met, would connect individuals experiencing acute mental illnesses to a court-ordered care plan managed by a care team in the community. These care plans would include clinically prescribed, individualized interventions, along with supportive services, medication, and a housing plan.

Cal Cities has been closely following the CARE Court proposal and has taken a support if amended position. Cal Cities supports the concept of the CARE Court Program. However, as written, the bill does not allow for sufficient time or funding to implement the program throughout the state, jeopardizing the program’s success. Cal Cities is working with the Governor and lawmakers on amendments that would:

• Create a phased-in implementation plan for the CARE Court Program: A phased-in approach would allow local governments to better understand the challenges and costs that may accompany this program and allow for refinements to the concept as challenges arise.
• Ensure that the 2022-23 State Budget and future budgets include sufficient funding to support the program: It is essential that all new obligations for local governments are supported by sufficient funding to be successful, and that long-term funding is dedicated to the program.
• Require cities to be consulted in the formation of care plans in the event that cities are required to provide services or support: Cities’ voices are key as care plans could include implications for city programming and funding. Cities should have a platform to express concerns and share mitigating circumstances that would impair their ability to comply.

Lawmakers have started to outline funding for the program. Recently, the Governor announced $518.5 million in funding for the CARE Court Program in the form of grants for counties to help provide services and housing to those with severe mental illness or substance use disorders, including unhoused Californians.

This funding is part of a $2.2 billion package included in the 2021-22 budget for the Department of Health Care Services Behavioral Health Continuum Infrastructure Program, which seeks to construct, acquire, and expand behavioral health facilities, community-based care options, and mobile crisis infrastructure.

Additionally, the Governor’s proposed May Budget Revision included $65 million to implement the CARE Court Program. This funding was not included in the Legislature’s preliminary 2022-23 budget, which set aside funding for future appropriations for the CARE Court Program following additional discussions about the details of SB 1338.  

SB 1338 passed the Assembly Judiciary Committee on June 21 by a 9 to 1 vote. However, the measure will likely be amended as it continues to move through the Legislature. Cal Cities will review these changes and advocate in support of amendments to ensure the successful implementation of this new program.

Modernizing California's existing behavioral health care system

Additionally, several measures moving through the Legislature seek to better coordinate existing programs to improve patient outcomes. Cal Cities is supporting an eight-bill legislative package put forward by Senator Susan Eggman that focuses on improving the conservatorship process while also increasing access to statewide data about the behavioral health care system to ensure tangible results.

Collectively, SB 929, SB 970, SB 1154, and SB 1238 would increase data collection to help behavioral health agencies better understand the outcomes of involuntary holds, the services provided, waiting periods to receive care, current and projected behavioral health care infrastructure, and service needs. This information would allow the behavioral health care system to be analyzed holistically and improve outcomes going forward.

The other measures included in this package — SB 965, SB 1035, SB 1227, and SB 1416 — would identify changes to the conservatorship process and expand treatment options that can be clinically tailored to address each patient's needs. While this package identifies changes to the conservatorship process, Cal Cities recognizes that there needs to be a concurrent, continued emphasis on preserving a patient's independence and civil liberties and preventing unnecessary conservatorships.

For more information about Cal Cities' advocacy efforts on these bills, please contact Legislative Affairs Lobbyist Caroline Cirrincione.