Senator McGuire’s legislation to guarantee medically necessary treatment for severe mental health conditions passes key committee

Thursday, April 28, 2022

Sacramento, CA – California is facing a mental health crisis. Thousands of residents struggle with mental health conditions across the state and for a variety of reasons, many don’t have access to treatment which can lead to increased risk of unemployment, homelessness, suicide, and substance abuse. 

A mental health condition that can most impact a person’s ability to live a normal life is when a person experiences an episode of psychosis. Psychosis is a severe mental disorder where thoughts and perceptions are so impaired that the individual loses touch with reality. Early psychosis is often confusing and frightening for the person experiencing it and difficult for their family to understand. Research suggests that three out of every 100 people will have an episode at some point in their lives.

The most effective and only evidence-based treatment for the condition is the Coordinated Specialty Care (CSC) model, which creates a personalized treatment plan with wrap-around services, such as access to guaranteed/longer term mental health care, access to housing, and assistance with educational and vocational goals. The problem is, most private pay insurance companies and health plans don’t provide this type of treatment.

Senate Majority Leader Mike McGuire’s bill, SB 1337, would ensure that California’s insurance companies and health plans cover CSC as a treatment for early psychosis by January 1, 2023. Currently, many young patients who experience early psychosis are not being treated with the CSC model, which research shows can help patients live healthy, functional lives.

“Early psychosis is a heartbreaking condition that impacts far too many young Californians and those who love and care for them,” Senator McGuire said. “We know what needs to be done – guarantee access to mental health care. Coordinated Specialty Care can literally save a person’s life. It’s beyond time for insurers to step up. Withholding this medically necessary care to those suffering from this traumatic disease is truly appalling and we can change this with this bill.” 

SB 1337 was approved Wednesday in the Senate Health Committee with a 9-0 vote.

In the CSC model, a team that includes a primary care physician, psychiatrist, and case manager work to provide evidence-based treatment for mental health conditions, including education, family and peer support, and medication. Studies found that people who engaged with CSC programs experienced greater improvement in their symptoms, stayed in treatment longer, and were more likely to stay in school or employed than those who received sub-standard mental health care.

CSC not only results in better outcomes for the individual, their families and communities, benefiting society as a whole, but it’s also cost effective. For every $1 spent on care delivered in the CSC model, there is a $6.50 ROI in improved health and productivity.

“SB 1337 is the missing piece in California’s mental health parity law,” explains McGuire. “We owe all Californians the right to a healthy and prosperous life. Medically necessary treatment­­­ — that’s covered by insurance — is a must.”