What does mental health care look like in California?

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On Monday President Trump said that better health mental health -- not gun control -- is behind the key to preventing mass shootings such as the recent tragedy in Texas.

Trump said the shooter, 26-year-old Devin Patrick Kelley, was a "deranged" man who should have received treatment.

In California, nearly one in six adults has a mental health need and one in 20 suffers from a serious mental illness that impacts their daily life, according to the California Health Care Foundation.

In 2014, the Affordable Care Act (ACA) required that all health insurance plans offered in the individual and small-group markets provide a package of items and services, known as essential health benefits. Mental health and substance use disorder services, including behavioral health treatment, were included as one of the ten essential health benefits under the ACA. The requirement also includes the plans for Medicaid recipients who gained coverage under the ACA's expansion of Medicaid.

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Medicaid is the single largest payer of mental health and addiction treatment services in the nation, paying 25 percent of all mental health and 20 percent of all addiction care, according to USA Today.

The addition of the benefit builds on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) provision to expand mental health and substance use disorder benefits and federal parity protections to an estimated 62 million Americans. The law requires most health care plans to cover preventative services such as depression screenings for adults and behavioral assessments for children, at no extra cost. Also, plans can no longer deny coverage or charge you more if you have a pre-existing mental health condition.

While mental health services are available through private medical insurers, for individuals who are uninsured or who lack extensive coverage, public mental health programs may be the only option. 

The California Department of Health Care Services (DHCS) works with the County Behavioral Health Directors Association (CBHDA) to help state residents receive the mental health help they need.

Public mental help services are available through county health departments. All county mental health departments have 24/7 hotlines for local residents seeking assistance in a crisis and to access local mental health program, according to the DHCS. 

Anyone seeking help can call the hotline or walk-in to a county mental health office during business hours. If it's an emergency, crisis workers are available either over the phone or in-person if a friend or family member is concerned a loved one is in danger of harming themselves or others. 

If there is no immediate danger, people should talk with their health care professional who can help provide referrals to mental health specialist. 

Sacramento County has a Mental Health Access Team that provides over-the-phone assessments and referrals. The team helps direct people to Mental Health Medi-Cal Service Providers, Prevention & Early Intervention Service Providers, and Crisis Respite Service Providers. Sacramento County also provides a "Warm Line" people can call if they just need a listening ear and also have a local 24-Hour Suicide Prevention Hotline, as well as access to the National Suicide Prevention Lifeline (1-800-273-TALK).

The county also provides a Community Support Team which helps connect people to community resources available for their needs. 

If a person is suffering from a mental illness but wants to seek employment, California's Mental Health Cooperative Program assists people with severe psychiatric disabilities enter or re-enter their community workforce. The county and the Department of Rehabilitation work together to help people with mental illness find specialized jobs that are appropriate for their needs.

California also has laws for involuntary psychiatric commitments, also known as "court-mandated treatment", for individuals with severe mental conditions who are too ill to seek help voluntarily. To qualify for mandated treatment in a hospital or another inpatient facility a person must be a danger to themselves or others, or must be unable to provide basic personal needs for food, shelter and clothing, according to the Treatment Advocacy Center.

"Laura's Law" -- or AB 1421 -- is a California law that provides community-based, mandated assisted outpatient treatment to individuals unable to access mental help due to an illness. A person must meet the legal criteria, which includes having a condition likely to substantially deteriorate and who is likely to need treatment to prevent meeting inpatient standard. Laura's Law typically applies to individuals who are in and out of jail, hospitals and homelessness.

In order to be legal, counties must implement the law as the state doesn't require counties to adopt it. Currently Yolo County and Placer County have the law in place, but Sacramento County does not.

Although state laws shape the way mental health care is delivered, nearly all financial and administrative responsibility for delivering these services rests on counties, according to the California Health Care Foundation.

This is why programs and service availability vary from county to county. Usually mental health care funding is "disconnected" from the rest of California's public health system, making the approach to receiving health care different for individuals with mental health conditions.

In 2004, Proposition 63 -- also known as the Mental Health Services Act (MHSA) -- passed, imposing a one percent tax on seven-figure incomes to be used to develop and expand mental health care services. However, since the law went into effect, the state has not been able to provide hard evidence or statistics on how the revenue is being used, according to a 2016 Orange County Register report.