will know the following questions for discussion. first, what gaps do you see currently in the provision of mental health services for justice involved individuals, second, what federal resources and our policy changes are needed to support provision of mental health services for justice involved individuals. as you discuss these questions in your group, nico staff and partners will be i or table recording your response is. our next session will begin in ten minutes following a short video. and, again, thank you so much for coming. we really appreciate it. >> thank you, very much.

>> good afternoon everyone. it got quiet in here quickly. my name is captain margaret and i represent the fifth district in los angeles county. it is my pleasure to introduce the final part of our summit on mental health solutions. throughout today's discussion, we have highlighted both the challenges and >> throughout today's discussion, and we have highlighted both the challenges and opportunities before us as we work to mitigate these unprecedented crises. the things we've heard today on

the prevalence of mental illness in our nation, coincide with the fragmented behavioral health system that has left many communities without adequate access to community based care, and without a workforce. i know we can all relate to. that without a work force of services. counties, as frontline owners, and operators of care, are the lifeblood of behavioral health reform. the time to elevate innovative solutions to address this crisis is now. but we cannot, and we should not do it alone. it is critical that we take and all government approach to building a system of mental health of behavior health care in the united states working in partnership with federal and other inter governmental partners. which is why it is my great honor, to introduce our next speaker. secretary javier becerra, the 25th secretary of the u.s.

department of health and human services. secretary breast sarah is a former member of congress serving 12 terms in the u.s. house of representatives, before becoming the attorney general for the state of california. in both his previous roles you championed issues relating to help, security, patience safety, combatting the opioid crisis, and protecting health care access. secretary becerra has made one of his top priorities of hhs to strengthen our countries behavioral health. he's leading hhs to combat the growing mental health crisis of our country. particularly related to issues of substance abuse, youth mental health, and suicide. so, without further ado i would like to welcome the 25th secretary of the united states department of health and human services, secretary javier breast sarah. we >> thank you. we thank you very much. supervisor berger, fort thank

you very much for letting me join you. thanks for your friendship, thanks for letting me work with you on so many issues whether as a member of congress, certainly as the attorney general of california had a chance to do a lot of things together, and now. here i am excited to see that you want to launch in a way that is cohesive in within the counties to work with us because we want in. we want to work with you on this issue. we know at the end of the day that if we get resources, whether it's our same saw operations, are ministration for children and families, we have to work for you. and so, we want to do that as quickly as we can. we know we are going to deal with the states, but we know you all are the folks on the ground you have to make it happen. hopefully the state doesn't give too much money off before they send it off to you, right? i know the lingo. i have been there before. i've seen it. i am going to do this. i honestly would rather hear

your questions or your comments, we doesn't want your by. and i want you to know that we really want to do a partnership with you. if we are going to make a difference, and by the way, the president essentially mission and asked to do it differently. we are not going to get to parity on mental health just because the president said it. but the president has given us more money for mental health, and substance use it is shorter than the federal government has ever provided in the history of the country. >> here is a difficulty. it is not enough. as you know. and it goes very quickly. and covid has made things absolutely difficult. i don't know some of you saw the cdc report that just came out today or this week. a third of girls are saying that they contemplated suicide in this country. 15% of them said that they were forced to have sex. they are hurting. 90% of americans today say that their country is in a mental health crisis. we have got work to do.

we are trying to do some of it. 988, i think if you had all were involved in setting up the 988 lifeline within your region, and within your state, we will pump more than 20 times more money in 18 months than in the previous than the previous administration had before. why? because we knew it had a launch right and work. so, today, 90 88. if someone else that number, we dials anymore? if you use that number, text or chat, you are going to reach someone. not a busy signal, not be police on hold. but really reach someone. and the end result, we had about 1 million more people communicate through 988 in the first six months after our launch on july 16th 2022. then the previous years six months. that's good.

we but it is also bad and scary that 1 million more people actually reached out. what were they doing before? and so, we really have a lot to do. i'm not going to go into my notes because i told catherine that i would, as i said, turn to you for questions or comments. but i want to put something into context. because i know that this is what we are dealing with, that is why it is so important to get on board with you really quickly. especially those of you who are in rural counties. because the big counties, catherine and others, you guys have wherewithal. i know you don't have enough, but you've got muscle. the small counties and rural counties, it is tough. roughly one third of counties in the u.s. are without one single psychiatrist. there are fewer than 10,000 practicing child psychiatrists in the entire country. on average, it takes 11 years after the onset of mental health symptoms for someone to

seek treatment. can you imagine if you broke your bone and you had to wait 11 years before you got it set? we'd never let that happen. we'd never let an insurer or providers say, we don't reimburse for that. or, we don't have providers in our network to deal with that. we would never let that happen. but you go in and say, my daughter are suffering from severe mental depression. it could be awhile before she gets referred to somebody. we are trying to change that. we are trying to make it so that the mental health is held period. we love to say that, you don't have to you don't have to get referred to especially a behavioral health services. our primary care physician should be able to do the at least initial intake of anyone coming in for a health care issue. whether it is a physical challenge, or mental health challenge. you should not find that your

family care doctor says, gosh, i don't really deal with that. let me refer you to your psychiatrist, psychologist. it is going to take about three months. but let me refer you while your child is hurting right now. and so, we are going to move. that is why we moved a 988. that is why we are fortunate the president wasn't willing to give us over $5 million. again, in 2020 i think the budget was $22 million. to get this going. but, remember. 9-8-8 is not a national hotline. it is a state based hotline. that we are standing out. we stood up the text and chat features because we figured all bunch of young folks are gonna call. they want to. chat and sure enough, we have seen about 1000, 400% increase in the people, mostly young, people who are communicating through the chat feature. we got work to do. when the second largest killer

of kids 10 to 14 is suicide. what is a ten year old doing thinking, i have to commit suicide. at ten years of age. where are we gone so wrong that a child has enough brainpower to say, i think i need to terminate this life. how do you know at ten years of age what you've gone through life? that you can survive. we have work to do. we are going to go out there and we're gonna do some stuff. we want to partner with. you and i'm going to partner with catherine, because ella, you can't. miss >> he tries to miss me, but he can't. >> no, i love going back. comb but, i want to speak principally to those of you who are in counties where resources aren't is easy. where it is harder to get there. we want to be there with you. we may not be able to solve all the issues, but we would like to get there because if the suicide rates are tough in l.a. county, i guarantee you in rural america they are higher.

and so, we can act. we can do it together. i look forward to working with. you let me stop it to be of any thoughts or questions. >> first of all, good from your lips to the governor's ear, i think we would all agree with that. but here in this, room you've got across section from both large and small. and it really does represent the heart and soul of counties across the nation. and so, i can tell you all, having had the honor of working with you when you are congressman and as attorney general, those are not empty promises he is making in terms of reaching at. and i know that he walks and talks it. but the first question i think does read into what you are doing to bring counties into at, to help inform the development of the roadmap for behavioral health. integration, released last fall. you and other hhs agency officials went on a national tour to strengthen mental health. to hear directly from local communities about their innovations and challenges relate it to be a real health. during this tour, you had an opportunity to visit with

several counties across the nation, including los angeles county, san diego county, washington d.c., suffolk county in new york, and montgomery county in maryland just to name a few. what were your biggest takeaways from this tour in terms of best practices, and innovations, and what were some of the most common challenges experienced by communities that you and your team heard. >> the thing that hit me most was that people don't believe we are listening. and they want to speak. at first, they don't. because they don't think you're paying attention. they don't see something that will happen. it won't be fruitful, so they close-up. but when they finally see that you really are interested, they to open up. i remember in philadelphia, a child at a youth crisis center. we met with a number of families. among the families was a young girl with her mother. she had just lost, this past

summer, her brother who had been murdered. and he was trying to get young men through his nonprofit organization off the streets and out of gun violence. and she was having a really tough time coping with his loss because he was your idol. in fact, she was wearing a t-shirt with his picture on it. and she wouldn't talk during most of the session. and then finally, when i asked her about the t-shirt, she started to talk about her brother. but by the time we ended, she was telling me that she felt inspired to follow her brother's footsteps and try to keep his nonprofit going. and so, it doesn't take much. they want to be heard. but what i think one of the things i learned really well is, listen. because people don't believe you are listening. the other thing of course is a resource. we put out about two and a half billion dollars by the way, in the last two years. for behavioral health.

two and a half billion. do you even feel it? i mean, that is how quickly it evaporates. that is how quickly folks are sucking it up and using it. some of it went to workforce resilience because of just the tenacity of people. but the burnout that is occurring, some of it went to youth mental health. some of it went to substance use disorder, because chances are that you are very connected in many cases, especially with the homeless. and, so we are getting out there. it is not going to cover everyone. and, again, you all have the authorities. health care is a state province. it is not a federal province. we can get at the game because we bring money to the table. and we are going to continue to do that. but we need your help. and we want to know what you are doing that work so that we can try to spread the word about what the best practices are. >> thank you for that. the second question is, what are the biggest challenges for achieving integrative, equitable, accessible health

care is the ability to build a diverse and qualified workforce. which really is the backbone needed to strengthen the capacity of our local systems to care. what are some of the strategies that your agency is currently employing, and we're working to implement this challenge to ensure that local behavioral health systems can attract and retain, and i say retained because many of them are burning out, a strong workforce years to come? >> we put out about a year and a half ago about 105, 100 and $3 million for workforce resilience. and we put many conditions on it. what we said is, you want to do it to increase salary, to give people more training, to give people some time off. you use it, but to protect your workforce so they don't leave you. we are going to do some things like that where we see success. a couple of other things we are doing, we are trying to take some of the national, public

health service corps scholarships that we provided to folks that want to go into the health care field, principally medicine, but now we have broadened. it nursing, and other allied health professionals. and if you commit to you about five years of service, my son-in-law just finished. he's now in his first five years of service of the pediatrician. he had his entire four years of medical school paid. by the federal government. but now he is committed to five years of giving service in underserved community in the country. we are expanding a number of public service thoughts that we have available in the health workforce. we are trying to do a better job of getting some of these graduate medical education residency slots directed into communities that don't have enough of them because, studies have shown, if you start your teaching, medical education residency program in a

particular community, there's a real strong chance you are going to stay there after you finish and not leave. and that is a great way to get assets, medical health care assets, to state a community. by directing them to these places. i will say, forgive me this may sound political, very tough right now to get butting ob/gyn's to go into some of these states that are now making a very difficult for women who are seeking abortions. my wife's of maternal fetal medicine specialists. she's a high-risk ob/gyn. and she's already telling me, yeah we are hearing. stories of medical students who are who want to go to ob/gyn are not interested in going to some of the states anymore. what do you do for the half of the population in those states that, regardless of what your loss on abortion say, need health care? i mean, come on. let's figure that out real quickly. and so, we've got real challenges ahead of us. >> amen to that. the conversation around

workforce is also critical to the work that local communities are doing to build comprehensive care facilities, and to better respond to individuals that are in crisis. the launch of the 9-8-8 suicide and crisis lifeline last july, prompted many counties to implement or redesigned our reese crisis response infrastructure, looking to innovate and volatile like that cahoots or ccbhc's, and other co-responder models it's a roadmap. how has hhs invested in local efforts, and particularly county efforts, to better respond to behavioral health crises, and what opportunities are there in programs like medicaid, for a long term support? >> so, let me just focus and keep the answer brief, on the ccbhc. 's certified community behavioral health centers. you don't have one yet, get it. these are crisis centers 24/7. federal government pumping in money. so that we can provide

behavioral health services and a more intense way, in a more consistent constant way. here is that catch. right now there are about eight states that have funding for ccbhc's. they were pilot programs that were started by, i know that senator debbie -- out of michigan was a big champion of this along with former senator, oh gosh. we roy blunt. missouri. senator blunt. senator blunt and senator stabenow were by worked bipartisanly to get funding into start these out. because they had seen some local programs, and they were working really well in capturing people. not just saving them, but getting them in to a productive life. last year, they provided more funding to go beyond the eight

states, to add an additional eight states. yet in there are before de gaulle discussion. these are magic. because you are getting real services in, and you are getting the federal government to get a bump in money to make it happen. and so, i urge you to really look at the ccbhc's, because they have proven very successful in capturing people who are hurting and making it so you have saving a lot of money down the road in the process of providing health care. >> yeah. and i can say that we have definitely capitalized on the ccp age sees, and i've stood up. i think we have for now in l.a. county. and i would tell, you if you want to come out. open invitation to come out dolly county and see how it works. but it has been a game-changer. especially for first responders, but also for families with no place else to go. so, ensuring broad coverage for behavioral mental health is another key component of achieving integrative behavioral care. counties are particularly

invested in sharing ensuring that all residents have access to quality and affordable mental health services. how is hhs working to advance middle of parity? >> so, we continue to urge congress to send down the resources. we are probably going to have a tough time this year getting more resources down to the local governments. in, fact i'm just hoping that we can keep our head above water for this coming fiscal year. but what we are trying to do, as i just mentioned, is we are trying to cede the programs that show innovation and success. because our dollars don't go far enough to get to everyone who needs help within your counties. but we can try to elevate those programs that are working really well. so, as i said, we can highlight them and shop around his best practices. and then hopefully encourage some of your members in the

house and in the senate you come together to support further funding as they did for ccbhc's. the president last year in his state of the union made it very clear, we are taking this to the next level. his budget, take a look at his budget from last year. it went way beyond what any presidents budget had ever committed for behavioral. you will see, once again he's making that commitment. but the president's budget is just a blueprint and it is ultimately up to congress what they found. and, so with your help, maybe we can continue to get out there and support some of these innovative programs that are showing real success. fantastic, we touched on medicaid, and i want to personally express my appreciation to you. administrator brooks, was her and her -- groundbreaking approval of california's 11:15 medicaid waiver that will assist us in connecting medicaid beneficiaries reneged entering their communities to vital behavioral and mental health

services and advancing their release. this approval is a critical step and reducing the overwhelming rate of substance use disorder and mental illness and our local jails. as well as correlating rates of recidivism. what additional steps is h h s taking to build a bridge to community based care for justice involved individuals who may be on federal programs such as medicaid, chip, or medicare? >> catherine, you know this, but for those who haven't heard we are now trying to help some of those individuals who are just justice involved. we know are on the verge of leaving the incarceration system. and making it back into the community. rather than wait for them to land out there and not to have anything to turn to, we are trying to see if we can qualify them for medicaid before they leave the doors of those institutions. and if they qualify then right away they are getting the healthy need to keep them on,

whether it is their meds or just to make sure that they are getting the services they would otherwise qualify for. because a lot of these folks don't even know that they qualify for these services in that incident justice in itself. that they have done their time, they get ready to come out, we should try to be there to make sure they don't fall. and ultimately we save a ton of money when we do something like that. so we will continue to do efforts like that to try to catch folks. i was going to mention something else but it left my head. >> it comes back, interrupt me. given all that we have discussed today with meeting the needs of the vulnerable populations such as youth and justice involved individuals. and taking into consideration some of the proverbial issues surrounding our efforts to strengthen our nations behavioral health systems. such as static collection, and technology adoption. it is clear these efforts will require a collaborative work of both inter and intra governmental partners. how are you and health and

human services working with other federal agencies to advance the goals on the road map. and what where you partnering with counties and other forms of local government on this work? >> so my answer will come after i mention two things before you leave my head. my first is that i remember i wanted to say on the last subject, it is that medicaid, housing, food, remind me of that i forgot again. the second, see, the second one is leaving, but the question was on, on, are we, how are we working with other federal agencies to advance the goals that have the roadmap. and in what way are you partnering with counties and other forms of local government on this work? >> did you agreements. get use agreements and medicaid. waivers, okay, those two. but how are we working? we are where i have told my

team that i was in congress for a long time. and i would hear people come out to me, a lot of the stakeholders. administration isn't doing enough, can you push, them get more resources? when i became a.g. i heard about cases where we are not doing enough to get things done. we are not enforcing. and so at the end of the day, you are on the ground, you have to deliver. you have no choice because if you don't deliver they are gonna end up on your door anyhow somewhere else. whether it is the e.r. roaming the streets. you told me about an individual that was lying on the streets naked. you, know needed services and wasn't getting it. anyways, what we are trying to do is we are trying to let you know where we are going. so for example, when we decided that we are gonna pull down the public health emergency, it has been operational since, you know, march or so of 2020. lots of things are gonna happen, as you know, on medicaid for example. the winds down. we made very clear to the governors what is going to happen before made the announcement. we have been for months now

chatting with the governors of your various states. telling them that this is what is gonna happen once the public health emergency comes down. let's start working together, principally on something like medicaid where some 15 million or so people may lose their health coverage because they may come off medicaid roles. even though they may be eligible to stay on. so we are telegraphing. and one thing, as an attorney, i learned early on is that you need to make sure you put it in writing. so we make sure we communicate as often as possible in writing so this way you see what we are doing. and we are not doing, and what we cannot cannot help you with. what do you want more we will tell you if we can do more. but i figure, if i am in writing, no one can say that i didn't let you know what we are able to do. so we will work with you, we will try to be transparent. and we will try to let you know how far we can reach. and that is a commitment i make to you as leaders in your counties throughout the country. if i can go back into data you secure humans. how we can be helpful, you know

that i don't have the authority through the cdc, and i think dr. williams was here, dr. walensky does not have the authority to ask the various jurisdictions who are in this room who collect all of this health data that made it possible for us to track covid. we don't have any ability to get that data. without your voluntary agreement. i can't tell you how many places did not want to voluntarily agree to give us that data. we would be blind in so many parts of the country today where covid was hitting what communities needed, but for the fact that the public health emergency gave us a particular authority. to go beyond, to go extra legally into areas because of the public health emergency. and required. most of those jurisdictions have done a very good job of providing thus the data, but now that the public health emergency is going away. we are gonna lose sight of a

lot of data. there are some 64 jurisdictions in the country. states, territories, travel governments that we deal with. when it comes to health care data. 51 of them have already signed voluntary data use agreements with us that correspond to the types of agreements we had under covid. we are hoping the other 13 will sign off. and by the way part of it isn't so much politics, it is state laws in those particular states that deal with privacy issues, for example. for them to be able to release some of that data. without that data, you know, as they say, that inputs, bad outputs. we cannot to afford to give you wrong information as you all decide where to put your money, so we really would appreciate it if you can help us make sure in your states that our signing these voluntary data use agreements that we can continue to share, share valuable data about health for our

communities. the last thing i wanted to mention then was the on medicaid. and now after remember what i wanted to say. forgive me, i turned 65 just to the other day. >> i am right behind you. >> it has been a long day. >> medicaid, 11:50 another waivers. on the issue, how are we trying to take it to the next level and help you all with housing and health care? california just got a waiver, there are several states that have applied for waivers. we have said already, food is medicine. food is medicine, and if food is medicine, and we are in the business of keeping americans healthy, then we can get involved in making sure that there is good food available for families that qualify for medicaid. so guess what? today's state of oregon has a program where they are going to start launching an effort to provide healthy foods to communities that have been howie's had access to it.

and they are going to do it right. they get to use your medicaid money to pay for that. housing, california just did a waiver that is going to let them show that unhoused individuals are usually unhealthy individuals. and if we want to keep people healthy than we should keep them housed. so we are trying to move into the space where we are gonna say a medicaid dollar can be used to keep someone healthy, which could be support for housing. we just have to show accountability. so we will demand from anyone who asks for this waiver, stay in your counties, show us that you use this dollar in a way that actually improved or expanded health care for the medicaid population. and if you do, who is going to complain? congress? taxpayers? if we are getting bang for the buck. but you have to prove it. because otherwise if i can't go back with catherine's data, and show that we had success, then i am done, i want to be able to do it again. so we are gonna do as much as we can to help you.

we have taken off the blinders and allowed us to look at health care only as medicine and so forth. in fact, i hope we get to the point where we no longer look at our health care system as a illness care system, but a wellness care system where we move to keep people well from the beginning, not a treating illness at the end. my mom said it best, better to prevent than remediate, thank you. >> i will say on 11:15 waiver, i would encourage you all even from a county, because we did our waver in the first, we talked about this in the beginning, l.a. county driven. it was revenue neutral because we showed people coming into our emergency room costing us more because they were coming in for chronic illnesses so we were able to redirect federal dollars to our outpatient. and show a cost savings. so i would encourage you all to look into the 11:15 waiver especially today. because there are ways to show with housing, housing them is gonna save the federal government money as much as about the person.

it is also about saving money. so we are running out of time but i just want to thank you for being here. secretary. let's give him a big round of applause. >> thank you all. >> i have to say, as we close to the, someone would like to emphasize that our work to create effective change in our communities for the better is really just beginning. i opened our discussion talking about the value of partnership as we work to find solutions. for building a better behavioral health system. i am certain that my colleagues and fellow county officials in this room will continue the great work that they are doing with partners across sectors. and on all levels of government. to innovatively address the challenges we have laid forth today. which is why i am beyond excited to be able to share with you all today that nato is announcing the launch of its commission on mental health and

well-being. yep. i am excited to be able to announce it with you here, secretary, i am clearly east to join county executive dal konstantin and ten other county leaders from across the united states in the formation of this commission where we will lead the nation in the development of policy and programmatic reprimanded mendacious that all of government. to address systemic issues contributing to the ongoing mental health crisis. but we cannot do it alone. we need all of your input. your voices and your ideas to drive this work forward. everybody is a part of this commission. and most of all we will need the support of our inter governmental partners, especially at the federal level. so i would like to say thank you to the officials that took part in today's discussion, which i think was very incredible at all levels of government. and to thank you all for making

the mental health and well-being of all americans a priority. and i want to thank you for being here today, i know it has been a long day for you. but it has been a long day for all of us. but i know how important this is. so i look forward to seeing and working with each and every one of you. as we move this forward so we build a system that is going to address what is truly a crisis in this country. mental health and substance abuse. so with that, thank, you mister secretary. >> thank you, and thank you denise for allowing me to be here. >> yeah. thank you. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2023]

tonight the ceo of moderna testifying on the increase in price for the companies covid-19 vaccine. before the senate health committee. watch the entire hearing at 9 pm eastern, on c-span two. it is also available on c-span now, our free mobile video app. or online at c-span dot org. >> there are a lot of places to get political information. but only at c-span do you get it straight from the source. no matter where you are from, or where you stand on the issues, c-span is america's network. unfiltered, unbiased, word for word, if it happens here or here or here or anywhere that matters. america is watching on c-span. powered by cable. transportation secretary pete buttigieg talked