California Lawmaker Pushes for More Mental Health Professionals in Hospitals

By Jonathan Springston, Editor, Relias Media

A California lawmaker has proposed legislation that would require hospitals to make available appropriately trained psychiatric healthcare professionals to immediately respond to hospital patients outside psychiatric units.

If AB 1001 becomes law, hospitals would have to create minimum staffing requirements, response times, and data management and reporting standards to ensure appropriate staff is available and trained to respond to patients experiencing behavioral health emergencies.

National Nurses United (NNU), a large union and professional association for registered nurses, expressed support for AB 1001 when they rallied recently in San Francisco. “California is experiencing a mental health and addiction crisis and the first place people come to get help is our hospitals,” said State Rep. Matt Haney, D-San Francisco, author of AB 1001. “But our hospitals often don’t have the appropriate staff or standards to care for these patients — that hurts both the patients and the already overworked staff. Instead of treating people with mental health and addiction issues, we’re pushing them back onto the street.”

During the worst of the COVID-19 pandemic, 40% of adults reported symptoms of anxiety and depression, up from 11% pre-pandemic. Almost 60% of patients receive mental health treatment from primary care providers. In California, in 2020, patients with behavioral health diagnoses accounted for one-third of all inpatient hospitalizations and one-fifth of all ED visits.

But even before the pandemic started, the number of therapists, psychologists, psychiatrists, social workers, and other available appropriate professionals was dwindling. In 2018, the authors of a research paper estimated the psychiatrist workforce will contract through 2024 to a projected low of 38,821, which is equal to a shortage of between 14,280 and 31,091 psychiatrists.

A short-term fix is telemedicine, but trained professionals on site are essential. “For patients who are suffering from an emergency, it could be a matter of life or death,” said Yvette Bassett, a registered nurse in the emergency room at Saint Francis Hospital, who spoke during the recent NNU rally. “Having an appropriately skilled behavioral health team would not only save the life of our patients, but also provide the necessary support for staff and nurses to appropriately care for the patient.”

In the long term, The American Association of Directors of Psychiatric Residency Training Directors suggests creating and expanding residencies and fellowships; indeed, recent data suggest there is no lack of interest among young medical professionals.

But who will pay for all of this? In June 2022, President Joe Biden signed into law the Bipartisan Safer Communities Act, which is designed to provide funding to strengthen the training pipeline and expand other mental health resources. Along with funds from the American Rescue Plan, the Biden administration is using resources to expand Certified Community Behavioral Health Clinics. These sites are designed to provide mental health and substance use disorder treatment services 24 hours a day, seven days a week.

In California, AB 1001 would establish the Behavioral Health Emergency Response and Training Fund. “This bill pulls on already existing dollars to fund a mental health and addiction staff training program to make sure there is knowledgeable staff in hospitals who know how to de-escalate situations and take care of patients,” Haney explained. “If we don’t invest in this workforce, we’ll continue to see more nurses leaving the field and fewer patients getting the help they desperately need.”

For more on this and related subjects, be sure to read the latest issues of ED Management, Healthcare Risk Management, Hospital Case Management, and Hospital Employee Health.