California lawmakers are considering a bill that could help build a workforce of people living with mental illness to help guide others in need of services toward care.
When Eric Bailey landed in a San Diego hospital after a mental health crisis in 2013, he says he was at the end of his rope.
“At the moment of being ready to discharge, I had zero idea what I was doing,” he said. “I had no vehicle there at the time, my wife was leaving me, I’d lost my job, I was losing my apartment as well.”
Bailey didn’t know where to go. Then a stranger approached him and told him he’d been in that same psychiatric ward, and that he could help.
“I was very grateful for that,” Bailey said. “At that moment, I realized that there was something that I could do for myself as I was released from the hospital.”
That stranger was a peer support worker — someone who draws on lived experience with mental illness to guide others — and he pointed Bailey toward more resources.
Advocates say these workers are a vital, and often life-saving, component of the state’s behavioral health provider network. But many aren’t certified, which means their services aren’t Medicaid-reimbursable.
SB 10 from state Senator Jim Beall (D-San Jose) could fix that. The bill would require the Department of Health Care Services to establish a certification in four categories: peer, parent, transition-age youth and family support specialists. The department would define the practice guidelines for each specialist, including required training, continued education and a code of ethics.
There are roughly 6,000 peer support workers all over California, according to the Steinberg Institute, a nonprofit focused on mental health policy that’s sponsoring the bill. They say California is one of only two states that don’t have a certification process in place or in the works.
Former Gov. Jerry Brown vetoed an identical bill last year, stating a certification program would be too costly. A fiscal analysis from the prior bill found a certification program would cost DHCS approximately $2 million in the first year, with an ongoing cost of $3.8 million annually.
Under the new bill, the department would be able to use funds from Prop 63 — the Mental Health Services Act — to develop and administer the program.
Current Gov. Gavin Newsom has stressed additional investments in the state’s mental health provider network.
A statewide certification is required for states to bill for peer support services through Medicaid. As of 2016, 41 states and the District of Columbia were receiving federal reimbursement for the services provided by peer support specialists, according to the U.S. Government Accountability Office. In California, peer providers are helping Medi-Cal patients at the expense of counties.
Supporters of the bill say in addition to the cost-saving component, building up a workforce of certified peers is a key step in addressing the state’s severe mental health provider shortage.
“We need to have client and family driven practices,” said Adrienne Shilton, Government Affairs director for the Steinberg Institute. “We need to have the state recognize these individuals as professionals, as part of an interdisciplinary team, bringing them up to the standards that other licensed professionals have in California.”
Research has shown peer support can alleviate patient symptoms and reduce hospitalizations. In California, peers are already leading support groups, accompanying patients to appointments and serving as mental health liaisons in hospitals. The new bill prohibits them from diagnosing an illness, prescribing medication or providing clinical services.
Eric Bailey now works for Sacramento’s chapter of the National Alliance on Mental Illness, using his lived experience with bipolar disorder to help connect people suffering from mental health issues to the care they need.
He says sometimes people need to speak to someone who isn’t a doctor or a therapist. He describes his role as “defrosting” people who aren’t quite ready to enter the mental health system.
“There’s a lot of that angst and animosity toward doctor’s offices and all of that,” he said. “I felt like I couldn’t convey my status, my symptoms, my feelings effectively to someone who hadn’t similarly felt those things or been in a position to have experienced those acute moments of distress or suicidal thoughts or extreme depression or extreme mania. I couldn’t help them realize what it was like to be me.”