Exit Interview: State Senator Jim Beall on fighting for mental health change
Termed-out San Jose leader talks about his years in state legislature and the politics of mental health
Jim Beall was 28 years old when he was elected to the San Jose Council. Forty years later, he’s ending his political career after 14 years in the California legislature, the last eight of them in the Senate.
Beall has made mental health issues one of his primary areas of focus. He was a founding member of the Senate’s Mental Health Caucus and served as its chair. And he has introduced dozens of mental health-related pieces of legislation over the years.
Probably none of them were more important than two measures he co-authored this year (both of them sponsored by the Steinberg Institute). SB 855 strengthens the obligation of private health insurers to cover mental health conditions. SB 803 establishes a process for training and certifying peer support specialists — people who have personal experience recovering from mental illness or substance disorder — so they can support and coach people going through similar experiences.
Similar measures have failed to pass the legislature or been vetoed by the governor in previous years. This time, both measures passed and were signed into law by Governor Gavin Newsom, who saluted Beall’s work during a September bill-signing ceremony.
Beall sat down for an exit interview via Zoom to discuss mental health issues and lessons he’s learned over the years. It has been edited for length and clarity.
Looking at your history, I realized you’ve spent 40 straight years in elected office — City Council, Board of Supervisors, and 14 years in the legislature. Did you ever lose an election?
Once I lost an assembly election. At the last minute, they needed somebody to run against Chuck Quackenbush for Assembly. I almost beat him — got within 1.5%. So I’m 20–1.
And what’s your scorecard on mental health legislation?
About 50–50. About half of them were approved.
Why has mental health been such an important issue for you?
When I was a city councilman in San Jose in the ’80s and ’90s, I worked in a lot of distressed areas and I saw the substance abuse, mental health and depression. And literally, nothing was done about it. There wasn’t a public response. When I joined the board of supervisors, I focused on mental health as uncharted territory. I started reading up and found that the academic research was decades ahead of public policy. We worked hard in the area of mental health and public health. We were the first county to establish a children’s health care initiative to fund health care for all children, including undocumented children. When I started in the legislature, I had the impression that mental health may be a bipartisan issue that both sides could agree on in terms of improving health but also saving a lot of money. Not taking care of people is very expensive in the long run.
So what’s your pitch for early investment?
For 75% of people that have mental health problems, those problems begin when they’re children. Treating them at the earliest possible stage is a public health policy that would save huge amounts of money. It now cost $125,000 a year to take care of somebody incarcerated in a state prison that has serious mental illness. One lesson I learned is to look at your cost drivers, the things that cost the most, and attack those things from a policy standpoint. Drive down your caseload and keep people out of the emergency room and the expensive parts of the healthcare system by doing prevention.
Like wearing a mask in the time of COVID?
Jim Beall: Right. In mental health, we’re running around with no masks. We’re breathing on each other and not wearing masks. Studies done by the UCLA School of Health Policy show that only about 14% of the public in California believe they receive adequate mental health care.
How many other illnesses have 86% of people thinking they’re not being cared for?
We’re at the bottom of the pit, and incrementalism doesn’t work. If you’re going to try to solve the problem, you have to do things bigger, and bigger issues politically are harder to do.
Other bills aimed at achieving parity were killed or vetoed in the past. Yet this year, SB 855 passed and was signed by the governor, as were several other mental health bills. What changed?
We have a new governor. Gavin Newsom is the only governor that has ever talked about mental health. Previous governors — their policy was dominated by people tied to the insurance companies. Even today, the insurance companies are the biggest lobbyists, they give a lot of money to political action committees. There is no political action committee for people that have mental health problems.
What impact do you think 855 can have and what will it take for its potential to be realized?
The governor has to say: “I want full enforcement of these statutes, and I’m going to put money in the budget to enforce this.” Governor Newsom decided he wanted to focus on mental health. But we need a mental health expert inside the governor’s office, and we need the governor himself to be a leader.
“Gavin’s got to take a step forward on this subject. He can have profound influence on mental health and substance abuse issues in our state. He said he was going to and I know he got delayed by COVID. He’s got to step forward.”
Otherwise, we’re just going to see more and more people in the Medi-Cal system, more homeless, more people in our criminal justice system, more families having mental illness and drug and alcohol problems, resulting in kids going into foster care. We’re spending a hell of a lot of money by not taking care of the problem. So why don’t we spend some money on taking care of the problem and save money in doing so?
The problem is that the money you save may be several years down the road, and everyone’s always thinking about this year’s budget, especially with the pandemic.
I don’t agree with that. I think (if you invest) in services right now, you’re gonna immediately move people away from homelessness, reduce child welfare costs. You can reduce acuity almost immediately if you have good mental health treatment at the earliest stages. I think you can get results in one year and probably huge results in three years, within the term of office of a governor — if the governor doesn’t delay. Of course, COVID is making the situation worse. I propose the governor create a COVID mental health task force and immediately hire a mental health czar to direct this effort. Because the result is going to be more people with mental illness, more depression, higher acuity, more suicides, more overdoses.
How has the perception of mental health by elected officials and the public changed?
People are recognizing that mental health is an ongoing chronic illness, not a social issue, that criminal justice approaches don’t work and that early intervention and treatment is a successful model. There’s more insight about genetics, about childhood trauma. The combination of predisposition from your genetics and from your environment and life. If you have a lot of abuse in your family, you’re going to have predispositions later in life to have serious mental health problems. And adverse childhood experiences don’t lead to just mental health problems, they lead to problems in all the health areas.
I see signs that mental health has crept out of the shadows. There’s less stigma, people are more willing to talk about it. The Mental Health Services Act (MHSA) has provided increased funding. Yet the number of severely mentally ill people living on the streets or lingering in their parents’ basements is exploding. What are we doing wrong?
I dispute the idea that public investment in mental health has increased. MHSA provides a couple billion dollars a year. The state (in 2011) took away the Department of Mental Health. You can say that public spending has gone up, possibly, for mental health in the Medi-Cal system. But why is that the case? Because the private, employer-based insurance model is not working for mental health, so people with mental health problems lose their jobs, become disabled. Then they go on Medi-Cal, which covers their mental illness and care. By that time, (their condition has worsened). And the cost is higher. The state hasn’t enforced mental health parity with private insurance companies. That’s what SB 855 attempts to address.
Do you think the Newsom administration will strongly enforce the new parity laws? And what kinds of strategies do you think the insurance industry will follow?
Insurers insist on controlling the utilization management of caseloads, and they’re still fighting the medical necessity criteria. They don’t mind paying fines. They’re multi-billion-dollar companies. If you mandate that everybody have private insurance — and that’s a state law in California now — why can’t you mandate that insurers include adequate mental health treatment? Otherwise, you’re just giving them a ton of money. The governor needs to take a policy stand on this. And he may. During his campaign, he met with the Mental Health Coalition and he said he was going to do a lot of work on mental health. We want him to implement his thoughts. He can’t drift away from those things.
What kinds of changes would you like to see in crisis response, shifting from police to mental-health response?
Law enforcement people don’t like to be the safety net for mental illness. They’d rather have people handled by the mental health system. We passed SB 29 four years ago that required mental health training for all law enforcement in de-escalation techniques.
Many people fear that police training alone won’t be enough.
I agree with that. You can’t have a police officer be a mental health clinician. You need a mental health response as opposed to police response for behavioral health problems. I think our crisis 5150 law should be looked at in the future too. They ought to recognize different levels of acuity, more residential facilities that can deal with different kinds of mental health problems. We should have crisis programs for kids and we should involve the family more with crisis intervention. Family members can participate more in what I call the circle of support that is needed for somebody with mental illness.
What are some other major priorities?
Racial and ethnic disparities in the mental health system. With COVID, unemployment has attacked the Latinx and Black communities and women who had to leave their jobs to take care of the kids. Society is changing because of the pandemic and we have to recalibrate. California needs to be more strategic in its approach to these issues. Right now, we’re shackled by our budget process. We go through this short-term, month-by-month approach and don’t look at the long-term strategies that would reduce acuity, reduce caseloads, get costs under control. The legislature needs to do more research. But the term limit law cut the Legislative Analyst’s Office by over 100 staff people that were doing analytical work. It’s given lobbyists more power. We do hundreds and hundreds of minor bills that don’t have big impacts. It lets the lobbyists bill their clients to lobby for or against the bills. Everybody makes a lot of money. It’s time to do things a little differently. The majority of legislators — Republican or Democrat, liberal, moderate conservative — believe this is a problem.
We need a more comprehensive system for health care that includes strong mental health and prevention for children. We put in the budget some money for youth drop in centers, where kids can just drop in and talk to someone. It’s worked in countries like Australia. We don’t call it mental illness, we say if you feel sad and want to talk to somebody, this is a safe place.
What’s next for you, and do you have any parting words for your fellow elected officials?
Jim Beall: I hope to be involved in mental health issues for the rest of my life, and I’ll be writing and suggesting and pushing on the subject.
Gavin’s got to take a step forward on this subject. He can have profound influence on mental health and substance abuse issues in our state. He said he was going to and I know he got delayed by COVID. But he’s got to step forward.
I’ve seen polls that ask would you be more inclined or less inclined to support somebody that wants stronger mental health and substance abuse treatment programs in California. And almost nobody opposes that. Everybody — Republicans, Democrats, independents — they all want more programs. I think there’s a potent vote out there for stronger mental health programs that politicians should pay attention to. And if they don’t, it could cost them.