How California can access federal funds to solve its dangerous psychiatric bed shortage

Californians with mental illness are dying on the streets because of a statewide shortage of over 4,700 psychiatric beds, according to a new detailed report from the nonpartisan Rand Corporation. The need for inpatient beds in California is growing while the number of available beds remains unconscionably low.

Across the country, doctors and families of people with severe mental illness cannot access inpatient treatment when patients need it the most, leading to homelessness, inadequate treatment in emergency rooms, incarceration, higher suicide rates and an increased risk of dying on the streets.

This is especially true in California, where Mike Lehmkuhl died homeless in Sacramento because his family could not access care. Oceanside mother Rebecca Reinig could not access a bed for her son, Joey, after he was turned away from a hospital. Unfortunately, these types of stories are common.

Ironically, California has the nation’s largest mental health care provider; not a hospital or clinic, but a jail. People with the most debilitating forms of mental illness — including schizophrenia, bipolar disorder, schizoaffective disorder and other psychotic disorders — suffer the most. They are left to languish on the streets and in jails or prisons because the state and counties lack the resources to provide inpatient treatment.

To address this deadly bed shortage and access federal funds to pay for it, we must repeal a discriminatory federal law known as the “institutions for mental diseases” exclusion. This federal statute does not generally allow Medicaid funds to pay for inpatient psychiatric treatment.

While many people with mental health conditions can thrive with only outpatient treatment, people with severe mental illness need periodic inpatient treatment throughout their lives. The federal government is not currently paying its share of that cost, but California can change that.

Seven states and D.C. have already waived the IMD exclusion and accessed federal funds to help the most vulnerable. California should join those states and take advantage of federal funds to address its psychiatric bed shortage.

The California Department of Health Care Services has already declared publicly its intentions to apply for a Medicaid waiver and access funds to address the chronic bed shortage. But advocates for better mental health care must remain vigilant and ensure that the state follows through on its promise. Not only should the state seek an IMD waiver, but it should also ask the federal government for the broadest coverage possible for inpatient services.

While states are doing the work that the federal government refuses to do, Rep. Grace Napolitano, D-El Monte, is trying to change that. Joined by 10 California legislators, Napolitano has a bill before Congress to repeal the IMD exclusion.

Repeal of this discriminatory federal statute is the only permanent nationwide solution, but there’s no scheduled hearing for the bill, and its passage does not seem likely before this November’s midterm elections. Gov. Gavin Newsom’s Department of Health Care Services should not wait for Congress to fix California’s problems; it should act now to get a Medicaid waiver to circumvent the IMD exclusion.

If the Department of Health Care Services doesn’t act quickly, the California Legislature can hold the executive branch’s feet to the fire and mandate that the agency seeks an IMD exclusion waiver.

Whether the executive branch acts alone or the Legislature spurs it on, Californians with severe mental illnesses can’t wait any longer for the inpatient treatment that will stabilize them and open the possibility of long-term community-based care. If the state makes them wait, they will continue to die on the streets like Mike Lehmkuhl and Joseph Reinig.