Scott Wiener Takes Helm of California Senate Mental Health Caucus

With pandemic magnifying need, San Francisco Democrat sees ‘enormous momentum for aggressive mental health legislation’

Democrat Scott Wiener of San Francisco is the new chair of the Mental Health Caucus in the California Senate, where he has served since 2016. An activist since high school, Wiener says his own experiences with homophobia and anti-Semitism have made him sensitive to the plight of people who are left behind.

Last year, working with the Steinberg Institute and The Kennedy Forum, Wiener authored a sweeping bill, SB 855, that strengthened California’s parity laws to require health insurers to pay for mental health services on the same basis as physical health. The bill was signed by Governor Newsom and went into effect on January 1, 2021.

We sat down via Zoom for an interview, which has been edited for length and clarity.

Your interest in mental health issues and LGBTQ issues suggests a lot of empathy for people who have historically been marginalized. Where did that come from?

I come from two communities that have been victimized over time. I grew up Jewish in a very non-Jewish area in New Jersey. We experienced a lot of anti-Semitism. I was called ‘kike’ and other names many times. I learned early on about the history of the Jewish community — about pogroms and the Holocaust, and that we as a community were never safe. I also learned about the Jewish community’s history of fighting for civil rights with Black people. In my family, it was clear that you had to stick up for yourself, and for others being persecuted.

I wasn’t out in high school, but I knew I was gay. People made a lot of homophobic remarks, and I always knew that if I were to come out in high school, I would be physically in danger. I came out when I was 20, in college. It was during the virulently homophobic Reagan administration, at the height of the horrors around HIV-AIDS. There was no treatment, and gay men and others were dying at outrageous rates. I got engaged in working around HIV and moved on to other aspects of our community. The challenges I’ve had pale in comparison to what others have had to deal with. I acknowledge my own privilege — as a white man and also having accepting parents and a wonderful family. But I’ve had enough personal experience and windows into other people’s experiences to know that we all have a responsibility to fight for people who are being harmed and victimized.

You got involved in politics, including the election between Jesse Helms and Harvey Gantt when you were a law student at Duke University in North Carolina. What impression did that make?

Growing up, I knew how racist and homophobic Jesse Helms was. Then I was in North Carolina in 1990 and he was up for reelection, challenged by Harvey Gantt, the Black mayor of Charlotte. Doing campaigning, I heard racist remarks about Gantt. Harvey was ahead in every poll from beginning to end. At the end, Helms ran overtly racist commercials. And he won. It was horrifying to see those commercials and know people were lying to pollsters, not saying they would vote for Helms, but then voting for him in the booth. Sort of a precursor to Donald Trump.

How did these experiences inform your work and priorities today?

I’ve been around long enough to see a lot of people suffering and not getting the help they need, particularly in marginalized communities where people are less likely to have their health problems diagnosed. So many people have experienced trauma, and it doesn’t get treated. I’ve seen the extreme harm that untreated mental health issues cause in people living on our streets and people who are housed. The system is so broken that people who have these illnesses are unable to access treatment. We need to change that and do whatever we can to make sure people suffering from mental health issues, from addiction, are able to get the care they need. I’m passionate about that.

Mental health issues have flown under the radar for a long time — it’s been hard to build support for policy change. Is that changing?

I think there is enormous momentum in the legislature for aggressive mental health legislation. We saw that with SB 855. At the beginning, I wasn’t sure if it was going to pass because of opposition from the insurance industry. But it pretty much flew through. We did some negotiating, but we got it through in very strong form, with large majorities in both houses. It was an easy case to make to my colleagues that mental health treatment was already a problem and COVID was making it worse. Marie Waldron and some other Republicans were supportive. If SB 855 can have that experience, we can do that with other legislation.

The pandemic has led to big increases in calls to crisis lines, and levels of depression, anxiety, and suicide have spiked. How should the state address these issues?

Our healthcare system is so fragmented, and that impacts all sorts of health issues, particularly mental health. We don’t have nearly enough mental health workers. It needs to be a priority to get more people into the field — psychiatrists, psychologists, social workers, therapists. Insurance companies have strong incentives to not provide as much treatment as people need. And there are still outdated perceptions about mental health or addiction: “Just snap out of it. Get yourself into a better headspace. Just stop using meth. Don’t be depressed anymore.” Like it’s a mood thing as opposed to a physical problem, a chemical problem. It’s really no different than having an autoimmune disease or cancer. It’s a disease. It needs treatment.

We need the insurance industry to see that. MediCal is a lot better than the private insurance industry, but there’s work to do there as well. There is so little support for teenagers, college-aged kids. Half of mental health issues arise by age 14 and three quarters arise by 24. Yet we’ve continually slashed services in public schools and colleges. Kids are left to suffer in silence. It puts enormous stress on teachers. We need to do a much better job intervening early, when teenagers and college age kids start showing symptoms — nip it in the bud so they don’t deteriorate.

So how do we get there? Is it a funding question? An implementation question?

It’s both, but at root, it’s a funding question. I hate to sound like that old guy, but when I was a kid, we had counselors and school nurses. They were always there. You could talk to them. Now a nurse may rotate between seven schools and is in your school half a day a week. There may or may not be counselors. We need to rebuild that infrastructure.

I remember, after the Great Recession, writing about the huge cuts in school counselors that happened in 2008, 2009. To what extent has that been rebuilt?

Some, but not a lot. I’ve worked with school nurses in San Francisco. They’re rotating to four, five, six schools.

How do you expect the insurance industry to respond to SB 855, now that it’s law? Are the Insurance Commissioner and Department of Managed Health Care ready to enforce it?

We don’t know yet how the on-the-ground rollout is happening. Insurance Commissioner Ricardo Lara put out a very strong directive. The Department of Managed Health Care put out draft regulations. I’m pleased with how the agencies are moving forward. There’s always a concern when you pass a law with a lot of opposition that the opponents might try to undermine it at the administrative level. That doesn’t seem to be happening yet. But I tell groups, especially of professionals, that we want to know if the insurance companies don’t follow the law.

Will the legislature have an oversight role?

I hope so. Oversight during COVID has been challenging. Our legislative capacity is constrained, so a lot has been focused on COVID-specific things like EDD or the prisons. I am interested in exercising my own oversight, and I know that Dr. (Richard) Pan (chair of the Senate Health Committee) is a strong supporter of this law. If we hear of problems, we’ll spring into action.

Let’s talk about SB 221, your bill to require timely mental health follow-up treatment. At Kaiser, therapists say it takes weeks to get a follow-up visit for clients. How big a problem is this?

In some ways, it’s a follow-up to SB 855. We can make sure coverage exists, but it doesn’t mean much if you have to wait weeks to get a follow-up appointment. We’ve heard from clients who get a quick first appointment as required by law, then wait 4, 6, 8 weeks and that doesn’t help. We want timely follow-up appointments so people can get better. We’ve heard about it at Kaiser, and other places too.

Back to workforce. You mentioned the need for more professionals. There’s also the potential to increase the number of peer support specialists and community health workers to help with pandemic recovery.

We made an investment a couple of years ago to reinvigorate the warm lines for people who don’t need a hospital but do need to talk to about their mental health challenges with people who are knowledgeable, and often have struggled themselves with mental health challenges. It’s a cost-effective way for people who need support but not full treatment. It’s a great model to supplement and take pressure off the formal treatment system.

There’s been talk at federal and state levels talk about a Health Corps of people to do contact tracing and provide social support, etc.

That’s critically important. It’s a win-win, especially as we rebuild after COVID. We need a lot more people working in different capacities. The economy is transitioning, and COVID has accelerated that. We could have New Deal-style investment and really expand that workforce, so people can retool and have a new career.

What are your other priorities?

I have several bills around substance use disorder, a bill to authorize medical reimbursement for a kind of behavioral therapy called contingency management, for meth and other stimulants. I have legislation to legalize safe (needle injection) sites so we can get people inside and safe and hopefully into recovery. And a bill to decriminalize psychedelics — there’s a lot of evidence of mental health treatment benefits. We’re working a lot in the addiction space.

Let’s talk about criminal justice. There’s a huge problem of untreated mental illness in jails and prisons, and of people becoming homeless after they’re released. Many struggle with mental health or substance use issues. What can the state do better?

We’ve not done a good enough job in terms of reentry. We pull people out, and we don’t give them support. When someone leaves prison, if we make sure they have a place to live, and access to health care supports, and a path towards getting a job — the chances of them reoffending plummet. If we don’t, they may become homeless, they may start using, their mental health issues may flare up. Then they’re likely to die or commit crimes again. We need to do more around reentry, particularly housing.