Senator Wiener Introduces Legislation to Strengthen Timely Care for Mental Health and Substance Use Disorders

Sacramento - Senator Scott Wiener (D-San Francisco) introduced SB 221, which would require health plans and insurers to provide patients with timely follow-up care for mental health issues and substance use disorders. California’s current law requires that Health Maintenance Organizations (HMOs) and insurers provide initial care for patients within ten business days following enrollment. But, under current interpretation of the law, health plans and insurers are not required to provide timely subsequent care for patients after an initial appointment. This loophole means that those suffering from mental health issues (from depression and anxiety to schizophrenia) and addiction may not be given adequate mental health care that they need to get better, or even a second appointment. With significant delays in accessing mental health care, we have seen a number of tragic suicides. In Santa Rosa, Elizabeth Brown and Barbara Ragan, took their own lives after facing long delays in accessing care. Mental health care and substance use disorder treatment is urgent and necessary, and people should have timely access to it before they go into crisis and their situations escalate.

SB 221 will establish clear timely access standards for HMOs who operate under Department of Managed Health Care (DMHC) and health insurers who fall under the jurisdiction of the California Department of Insurance (CDI), requiring them to provide follow-up appointments and other forms of care within ten business days, unless a provider believes a longer gap is appropriate. 

In the California Health Care Foundation's most recent survey of Californians’ health care priorities, 52% of those who tried to make a mental health appointment believe they waited longer than was reasonable to get one. 

With COVID-19 exacerbating an already dire mental health and substance use crisis facing our country, timely access to mental health care is more important than ever. National survey data shows that the rate of anxiety and depression has tripled over the last year, and a recent CDC study found that an astounding one in four people age 18 to 24 has seriously considered suicide in the past 30 days. Additionally, substance use and overdose deaths are on the rise nationally since the beginning of the pandemic, and San Francisco has seen a record number of overdose deaths. In San Francisco, overdose deaths outpaced COVID-19 deaths by a margin of three to one. 

SB 221 is sponsored by the National Union of Healthcare Workers (NUHW), which represents more than 4,000 mental health and substance use disorder clinicians in California.

“Mental healthcare is critically important to the health and well-being of our communities,” said Senator Wiener. “If you break a leg, you can expect to receive immediate follow-up care – no one with health insurance would be told they have to wait six months to get a cast removed because no providers were available. Yet, that’s exactly how we currently treat mental health and substance use disorder treatment. If we’re serious about access to mental health treatment — as we absolutely must be — we need to ensure timely access to care. SB 221 will do so.”

“This legislation would close the biggest loophole that still allows insurers to deny Californians timely and appropriate mental health and substance use disorder care,” said Sal Rosselli, president of the National Union of Healthcare Workers. “Californians with mental illness and substance use disorders who need ongoing care are seeing their conditions worsen because there is no firm standard in place to ensure they will get timely access to follow-up appointments. Senator Wiener's bill will fix that.”

“People can get better as long as they’re given an opportunity,” said Chelsie Martinez, who for several years had to wait four-to-eight weeks for individual therapy through Kaiser Permanente in Santa Rosa. “I had therapists who couldn't remember my name because they hadn't been able to see me for so long. I tried to end my life more than once, and I was contemplating trying again before I was able to start paying out-of-pocket for weekly private therapy appointments. This bill will save lives by ensuring that people who need follow-up appointments get them in time.”

“We need firm timely access standards for follow-up appointments," said Kenneth Rogers, a psychologist with Kaiser Permanente in Sacramento. "Even before the pandemic, I couldn't see my patients as frequently as they needed to have effective treatment, and now wait times have grown to 10 weeks. That doesn’t work for patients, and it doesn’t work for therapists trying to provide quality patient care.”