California Psychiatric Association Advocacy Day

This year, I had the distinct honor of being flown to Sacramento to participate in the California Psychiatric Association’s Advocacy Day. I went as a representative of Los Angeles psychiatrists and the Southern California Psychiatric Society (SCPS) with the goal to advocate for mental health.

In Sacramento, we were briefed on the bills that are currently being sponsored by the California Psychiatric Association (CPA). There are three main bills; two assembly bills (AB) sponsored by Assemblymember Susan Eggman and one senate bill (SB) sponsored by Senator Josh Newman.

According to the National Association of Counties, 64 percent of people in jail have a mental illness. Furthermore, 15 percent of male inmates and 31 percent of female inmates have what can be classified as a severe mental illness. AB 720 would allow for the involuntary medication of people in jail with a mental illness who are awaiting adjudication (i.e. sentencing). Of note, this law would only allow for involuntary treatment of people who are deemed to be dangerous to others, dangerous to themselves, or gravely disabled (as in not being able to care for their own food, clothing, or shelter usually due to a psychotic illness). This bill would not allow for involuntary medication of people with mild mental illness.

Already, law allows for inmates who have been sentenced to be medicated involuntarily; AB 720 would expand the scope of this law to include inmates who have yet to be sentenced. As a psychiatrist, it is clear to me that treating mental illness is of utmost importance. This bill has the potential to reduce harm to the inmate themselves, other inmates, and staff, and to reduce suffering by actively and effectively treating severe mental illness.

AB 1136 was the second bill on which we were briefed. This bill would mandate that the California Department of Public Health apply for federal funding under the 21st Century Cures Act for the creation of a web-based psychiatric bed registry. This registry would include inpatient psychiatric beds, crisis stabilization units, residential community mental health facilities, and residential substance use disorder treatment facilities. Currently, when patients come to an emergency department in an acute psychiatric crisis, social workers have to cold-call dozens of facilities to find out bed availability and if a particular patient would be appropriate. A bed registry that could be updated in real-time would greatly increase the efficiency of this process.

The third and final bill has to do with mental health parity. Mental health parity refers to the fight to end discrimination toward people with mental illness through ensuring equal access to treatment (i.e. the same types of benefits for mental illness as other medical illnesses). This takes the form of ensuring similar copays, similar numbers of doctor visits, and similar numbers of days in the hospital. SB 347 makes certain that regardless if the Affordable Care Act is repealed, the California Department of Insurance may continue to enforce mental health parity laws.

After being briefed on the three bills, I was paired with a senior psychiatrist (Dr. William Arroyo, president of CPA) and other resident-fellow members from the Los Angeles area. Together, we went to the State Capitol Building and met with Assemblyman Nazarian and Senator Bob Hertzberg’s Chief of Staff Diane Griffiths to discuss the importance of the three bills.

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Participating in CPA Advocacy day was an eye-opening experience on both the complicated nature of mental health policy in California and the relevance of the CPA and the SCPS in influencing that policy. I feel honored to be part of the wonderful team of psychiatrists who fight for mental health parity and increased access to care for all people.

If these topics interest you, I encourage you to reach out to your local California legislator to advocate for their support on these important topics.

 

Go Outside, It’s Good for You

Everyone knows that spending time outside is “good for you,” but how many of us know exactly how much time we need to spend outside, or what type of outside areas (beaches, forests, or parks) would achieve the most health benefits?

As urban areas attempt to incorporate more green space (think the High Line in New York City), public health experts are attempting to nail down the characteristics of these areas that have the most population-wide benefit.  A recent study published in Nature examined the relationship between the duration of exposure to green space and public health outcomes such as mental health, physical health, and social health.

The study found that with 30 minutes per week spent in a green area people had reduced rates of depression. This was dose-dependent up to 1 hour and 15 minutes (meaning that increased durations were associated with decreased depression). The mental health benefits were present regardless of the intensity of the green space (i.e. low versus high vegetation complexity). This article estimated there would be a 7% reduction in depression prevalence for the population if every person achieved this minimum time.

The point here is short and sweet; get outside and spend some time in a green space (however you define it). It’s good for you!

Eagle's Nest

Photo taken during a time spent outside hiking in Topanga Canyon to Eagle Rock. Link to trail here, highly recommended!


As an aside, I found the idea that vegetation complexity could influence the magnitude of mental health benefits pretty fascinating. Apparently, vegetation complexity may mediate this through increased feelings of restoration (i.e. higher levels of plant, butterfly, and bird species richness have been shown to enhance a person’s feeling of restoration 1) and by possible parasympathetic nervous system activation (which lowers your blood pressure and heart rate) which may decrease your experience of stress 2. Other fun facts, “more people tend to visit public green spaces with moderate levels of vegetation cover (rather than high or low), and vegetation is also likely to influence the perception of safety of an area.” That’s enough nerdiness for today, until next time!