State Senator Susan Talamantes Eggman (D-Stockton), who was instrumental in passing mental health legislation Governor Gavin Newsom signed into law last year, has been named to lead the influential Senate health care committee, a change that promises a more urgent focus on expanding mental health services and moving the homeless into housing and treatment.
Eggman, a licensed social worker, co-authored the new law that allows families, doctors, first responders and others to petition a judge to mandate government-funded treatment and services for people whose lives have been derailed from untreated psychotic disorders and substance use.
It was a victory for Newsom, who proposed the Community Assistance, Recovery and Empowerment Act, or CARE Court, as a powerful new tool to address the tens of thousands of people in California who are homeless or at risk of incarceration due to disease untreated mental health and addiction.
The measure has met stiff opposition from civil liberties and disability groups concerned about depriving people of the right to make decisions for themselves.
“We see real-world examples of people dying every single day and dying with their rights,” Eggman said in an interview with Kaiser Health News ahead of the appointment. “I think we need to take a small step back and look at the larger public health issue. It is a danger for everyone to live around the needles or have people hiding under the highways.
Senate Pro Tem Toni Atkins (D-San Diego) announced Eggman’s nomination Thursday night. Eggman replaces Dr. Richard Pan (D-Sacramento), who was fired last year after serving as president for five years. Pan, a pediatrician, had prioritized the state’s response to the COVID-19 pandemic and supported legislation tightening state childhood vaccination laws. Those moves made him a hero among public health advocates, even as he faced name-calling and physical threats from opponents.
The leadership change is expected to coincide with a Democratic health care agenda focused on two of the state’s thorniest and most intractable issues: homelessness and mental illness. According to federal data, California accounts for 30% of the nation’s homeless population, while making up 12% of the US population. A recent Stanford study estimated that in 2020, approximately 25% of homeless adults in Los Angeles County had a serious mental illness such as schizophrenia, and 27% had long-term substance use disorder.
Eggman will work with Assemblyman Jim Wood (D-Santa Rosa), who will return as chairman of the Assembly Health Committee. While presidents may set different priorities, they must work together to get the bills to the governor’s desk.
Eggman takes the helm as California grapples with a projected $24 billion budget deficit, which could force reductions in health care spending. Tighter financial prospects are causing politicians to shift from big “moonshot” ideas like universal health coverage to showing voters progress on the state’s homeless crisis, said David McCuan, chair of Sonoma State’s political science department university. Seven out of 10 likely voters cite homelessness as a big problem, according to a recent statewide survey by the Public Policy Institute of California.
Eggman, 61, served eight years in the state Assembly before her election to the Senate in 2020. In 2015, she authored California’s End of Life Option Act, which allowed terminally ill people who meet certain conditions to get drugs that help die from their doctor. Her past work on mental health has included changing eligibility rules for outpatient treatment or advocacy and trying to make it easier for community clinics to bill the government for mental health services.
He hasn’t announced his future plans, but he has about $70,000 in a campaign bill for lieutenant governor, as well as $175,000 in a campaign measure committee to “fix California’s mental health system.”
Eggman said the CARE Court initiative seeks to strike a balance between civil rights and public health. He said he believes people should be in the least restrictive environment needed for care, but that when someone is a danger to themselves or to the community, there must be an option to hold them against their will. A Berkeley Institute of Governmental Studies poll released in October found that 76 percent of registered voters had a positive opinion of the law.
Sen. Tom Umberg (D-Orange), who co-authored the bill with Eggman, credited his behavioral health expertise and dedication to explaining the plan’s mechanics to fellow lawmakers. “I think he really helped put a face on it,” Umberg said.
But it will be difficult to show quick results. The measure will roll out in phases, with the top seven counties — Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus and Tuolumne — set to launch their efforts in October. The remaining 51 counties are expected to launch in 2024.
County governments remain concerned about a steady and sufficient flow of funding to cover the costs of care and housing under the plan.
California has allocated $57 million in seed money for counties to establish local CARE courts, but the state has not specified how much money will flow to counties to keep them running, said Jacqueline Wong-Hernandez, deputy executive director of legislative affairs at the California State Assn. of the Counties.
Robin Kennedy is a professor emeritus of social work at Sacramento State, where Eggman taught social work before being elected to the Assembly. Kennedy described Eggman as someone driven by data, a listener attuned to the needs of healthcare professionals, and a leader willing to do the hard stuff. The two have known each other since Eggman began teaching in 2002.
“Most of us, when we become faculty members, just want to do our research and teach,” Kennedy said. “Susan had only been there for two or three years and she was taking leadership roles.”
She said Eggman’s view of mental health as a community issue, rather than just an individual concern, is controversial, but that she is willing to have difficult conversations and listen to all sides. Plus, Kennedy added, “she’s not just going to do what Newsom tells her to do.”
Eggman and Wood are expected to provide oversight for CalAIM, the Newsom administration’s sweeping overhaul of Medi-Cal, California’s Medicaid program for low-income residents. The effort is a multibillion-dollar experiment that aims to improve patient health by funneling money into social programs and keeping patients out of expensive institutions like emergency departments, prisons, nursing homes and mental health crisis centers.
Wood said he believes there are opportunities to improve the CalAIM initiative and to monitor consolidation in the healthcare sector, which he says drives up costs.
Eggman said she was also concerned about workforce shortages in the healthcare sector and would be willing to revisit a conversation about a higher minimum wage for hospital workers after last year’s negotiations between industry and labor collapsed.
But with just two years left before she’s fired, Eggman said, her focus will be closely framed around her area of expertise: improving behavioral health care across California.
“In my later years,” he said, “I want to focus on where my experience is.”
This article was manufactured by KHN (Kaiser Health News), one of the three major operational programs of the KFF (Kaiser Family Foundation).