Guest Opinion: Investing in behavioral health for all

  • by David Chiu
  • Wednesday April 7, 2021
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Assemblyman David Chiu. Photo: Courtesy Assemblyman Chiu's office
Assemblyman David Chiu. Photo: Courtesy Assemblyman Chiu's office

At just past the one-year mark of COVID-19, we have seen the devastating consequences of the pandemic in every aspect of society. One of the most troubling impacts of the health crisis has been its toll on behavioral health, particularly with regard to substance abuse.

A recent Kaiser Family Foundation study found four in 10 adults reported symptoms of anxiety or depression during the pandemic, compared to one in 10 adults who reported such symptoms prior to COVID-19. These mental health impacts have been acutely felt by our LGBTQ communities. According to a Center for American Progress study, 69% of LGBTQ people reported feelings of nervousness or anxiety because of the pandemic; 60% felt "down, depressed, hopeless, or had difficulty falling/staying asleep," and 54% reported feeling unable to stop or control their worrying.

The pandemic's strain on our mental health has exacerbated the experience of those grappling with substance abuse. The same Kaiser study found 13% of adults reporting new or increased substance use due to coronavirus-related stress. Pandemic-induced challenges can lead them down a lethal path, as reflected by the alarming rise in overdoses. For those with a substance use disorder, the pandemic diminished their ability to get critical clinical treatment. Last year, 669 San Franciscans died from overdoses — a 59% increase from the prior year.

Even before the health crisis, California and San Francisco have only been able to treat a small fraction of those with substance use issues. In the past year, about 2.7 million Californians had a diagnosable substance use disorder, yet only one in 10 of these individuals received treatment. The shortage of counselors and clinicians who work in the substance use field has been a major factor in the explosion of the opioid and behavioral health crises.

California has lagged the nation in our percentage of qualified counselors and other substance use treatment providers. Less than 20,000 alcoholism and substance use counselors are currently certified in California, and fewer than 700 of the state's nearly 140,000 licensed physicians maintain a substance use specialty certification. Substance use treatment providers regularly cite the "lack of qualified staff" as their primary concern.

Despite intense needs, the substance use disorder workforce has been underfunded for years. While Californians approved Proposition 63 in 2004 to provide funding for behavioral health, its funding cannot be spent on substance use disorder-specific services. Last year's state budget included $50 million in additional funding for mental health workforce development, but had no allotment for the substance use disorder workforce. At a time when overdoses are spiking, behavioral health care providers are seeing budgets shrink: 61% of community behavioral healthcare organizations reported cutting at least one program due to the pandemic, while nearly all organizations reduced operations.

To address these glaring issues, I recently introduced Assembly Bill 666 (a number I did not choose) to boost the substance use disorder workforce pipeline and increase the capacity of California's treatment programs. This effort would provide tuition assistance for students in behavioral health related fields and fee waivers for testing and other certification expenses. If it becomes law, AB 666 would add over 1,000 certified behavioral health workers to California's workforce in the short term, and also require a statewide analysis of substance use disorder workforce needs to plan for the long term.

AB 666 would also address the reality that California's behavioral workforce currently fails to reflect the linguistic, ethnic, and cultural backgrounds of the state's population, by providing grants to diversify the workforce and build a more culturally competent field. This is critical when substance use disorders have become increasingly prevalent among our state's most vulnerable communities. We know that LGBTQ+ adolescents are 90% more likely to use substances, and that a majority of our chronically homeless residents — including the 40% of homeless youth who are LGBTQ+ — struggle with substance use.

While substance use disorders have long been a persistent challenge in our community, the pandemic has shown a spotlight on our society's lack of capacity to treat those who are suffering. By passing AB 666, we can provide much-needed healing for those in dire need and can also turn the corner on the opioid crisis.

In the meantime, critical organizations in San Francisco — including HealthRIGHT 360, PRC, the San Francisco LGBT Community Center, the San Francisco AIDS Foundation, and many others — provide culturally competent, clinical treatment to our LGBTQ+ communities and beyond. If you are able, please support the life-saving work they are doing.

Assemblyman David Chiu, a straight ally, represents San Francisco's 17th District. He contributes op-eds on a quarterly basis to the Bay Area Reporter.

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