The Capitol Weekly interview: Sen. Susan Eggman’s long battle for mental health reform

Widely regarded as the most knowledgeable and effective state legislator on mental health issues in the Legislature, Sen. Susan Talamantes Eggman (D-Stockton) is credited with major, bipartisan legislative accomplishments over nearly 12 years, first in the Assembly, now in the Senate, where she chairs the Senate Health Committee.

Despite bipartisan and often unanimous support, there has also been intense opposition, mainly from disability rights groups opposed to any kind of “involuntary” treatment and counties concerned about funding and deadlines. Two major Eggman bills are currently before the Legislature, in the final days of the legislative session, reportedly well on their way to passage and the governor’s desk, after facing procedural hurdles and last-minute amendments.

The Legislature adjourns on Sept. 14.

“She’s risen to meet every challenge no matter how daunting,” says veteran legislative advocate Randall Hagar, who represents psychiatrists and has helped write much of the state’s mental health legislation. “There’s no pretense or calculation with Susan. She has profound lived experience, lending her great credibility. And she’s a straight shooter, able to inspire others to see and believe in her vision.”

Eggman championed a major bill in 2020 to significantly strengthen the two-decades-old Laura’s Law (Assisted Outpatient Treatment or AOT). Named for Laura Wilcox, a 19-year-old college student working in a Nevada County mental health clinic who was gunned down in 2001 by a deranged mental patient whose family’s pleas for intervention were ignored by clinic officials, it is one of the few legal avenues for family members attempting to help mentally ill relatives.

Most states now have AOT programs, which have been increasingly successful in getting treatment for severely mentally ill people throughout the country, generally voluntarily. Treatment programs are overseen by civil rather than criminal courts, before someone ends up in jail or prison as a result of untreated mental illness.

Under the original law passed in 2002, counties could quietly “opt out” of Laura’s Law, as many did, with no public hearings. The 2020 Eggman legislation required hearings for counties to “opt out,” generating a flurry of contentious local public hearings that resulted in widespread adoption of AOT programs in California counties.

Partly based on Laura’s Law, the even broader Community Assistance, Recovery, and Empowerment (CARE) Act, co-authored by Eggman and Sen. Tom Umberg (D-Santa Ana) and strongly backed by Gov. Gavin Newsom, was passed last year. Unlike Laura’s Law, the CARE Act is required statewide, with financial sanctions for counties that fail to create programs. Newsom has made mental health reform – and substantial, related funding – a centerpiece of his administration.

Rolling out in eight California counties by the end of this year, statewide in 2024, the CARE Act requires counties to create a new system of civil courts to oversee intervention, treatment and housing for thousands of severely mentally ill Californians wandering the streets, cycling through hospital ER’s, or in jails and prisons ill-equipped to help them.

Newsom has said he does not plan to attempt major changes in the 1967 Lanterman-Petris-Short Act that has governed mental health care in California for more than 50 years. But Eggman has introduced many bills over the years to modify LPS’ strict restrictions, and most new programs are voluntary. Many have passed and been signed by the governor.

Eggman has repeatedly – and this year, apparently successfully – attempted to expand the extremely restrictive LPS definition of “grave disability,” which mental health advocates say prevents meaningful intervention and treatment, too often leaving people to die on the streets.

Expansion of the “grave disability” standard under Eggman’s SB 43 includes substance abuse, which often accompanies and exacerbates severe mental illness, as well as the inability to care for oneself. The measure is key to Eggman’s legislative package, with several co-authors and broad, bipartisan support.

Eggman has repeatedly – and this year, apparently successfully – attempted to expand the extremely restrictive LPS definition of “grave disability,” which mental health advocates say prevents meaningful intervention and treatment, too often leaving people to die on the streets.

While Newsom has not specifically stated his position on the bill, it is expected to pass and be signed by the governor. Intense, often behind-the-scenes negotiations – mainly over the timeline for implementation of the new standards – continued well into the chaotic final weeks of the legislative session. Ultimately, in last-minute amendments, the timeline for counties to adopt the expanded standards became “optional” in 2024, but mandatory by Jan. 1, 2026. Counties resisted earlier deadlines favored by advocates.

One of Eggman’s most controversial measures this year is SB 326 (the Behavioral Health Modernization Act)  to update the landmark Mental Health Services Act (MHSA), the so-called “millionaire’s tax” passed in 2004 as Proposition 63. Despite strong support, it continued to face major hurdles in the waning days of the legislative session, and vocal opposition from disability rights groups and counties concerned about funding.

The legislation is tied to a proposed $4.68 billion bond measure, the Behavioral Health Infrastructure Bond Act, AB 531 by Assemblywoman Jacqui Irwin, D-Thousand Oaks, co-authored by Eggman. Both bills are central to Gov. Newsom’s efforts to address California’s growing mental health, homelessness and substance abuse crisis, and are expected to be combined as a single measure, Proposition 1, targeted for the March ballot.

A licensed clinical social worker with a PhD in social work, Eggman, 62, is a tenured professor of Social Work at California State University, Sacramento. A longtime community activist, she was the first Latina and the first lesbian to be elected to the Stockton City Council in 2006, in a surprise upset victory following a tough campaign replete with rank homophobia.

She was born in Castro Valley, and raised in Turlock, Stanislaus County, where her family owned a small almond orchard and apiary (bee-keeping). Her interest in mental health issues developed while working at a psychiatric facility during her senior year at Turlock High School. After graduating, and from a family of veterans, she joined the U.S. Army at 18, training as a medic. After four years in the Army, she earned a Bachelor’s degree in Psychology and a Master’s in Social Work at California State University, Stanislaus, later completing a PhD in Social Work at Portland State University.

She wrote her doctoral dissertation on end-of-life care for Latinos. Her mother was her research assistant, and Eggman worked as a medical social worker with patients in hospice care at the University of Oregon Hospital (now Oregon Health and Science University, a trauma center and teaching hospital). She started her PhD program in 1997, when Oregon’s landmark end-of-life bill – the Death with Dignity Act – was taking effect.

Eggman was teaching at Sacramento State when she won a seat in the California State Assembly in 2012. Among her major bills during eight years in the Assembly was California’s 2015 End of Life Option Act, which for the first time gave terminally ill patients the right to end their lives. She was easily elected to the Senate in 2020.

And she is true to her three-generation family roots in agriculture and natural resources, serving on the Senate committees on Natural Resources and Water, and Energy, Utilities and Communication, and authoring a 2018 bill while in the Assembly to provide funding for solar energy in disadvantaged communities.

She lives in Stockton with her partner of more than 30 years, Renee Hall (they were married in 2014) and their 15-year-old daughter Eme.

Eggman is termed out of the Senate next year. She plans to continue her mental health advocacy and perhaps return to teaching at Sacramento State, or possibly run for statewide office.

Editor’s Note: Sen. Eggman was interviewed on Aug. 15 in her state Capitol office by Sacramento journalist Sigrid Bathen. The interview has been lightly edited for clarity:

CW: In the final weeks of the current legislative session, two of your major mental health bills are pending final approval, both with bipartisan, often unanimous support. One of the most controversial measures is SB 326, to update the Mental Health Services Act (MHSA), the so-called “millionaire’s tax” passed in 2004 as Prop. 63. Despite strong support, it has faced major hurdles, and opposition from counties and disability rights groups. It is tied to a proposed $4.68 billion bond measure which is central to Gov. Newsom’s ongoing efforts to address California’s growing mental health and homelessness crisis. Comment?

Eggman: We have been working with all of the stakeholders in this (SB 326), trying to get it right, and one of the things we have repeatedly said – and Dr. Ghaly (state Health and Human Services Director Dr. Mark Ghaly) has been very firm on this – if you can show us what is not going to be funded, we can have a conversation.

Oftentimes, there is fear about things not getting funding, but when you really look at it, the funding may be in a different “bucket.” We are prioritizing people with higher needs.

CW: MHSA has been in place for nearly two decades, raising billions for mental health, but with persistent concerns about accountability, how the money has been spent, whether it is reaching those who most need help, how the counties are – or are not – managing this huge funding stream. How will that change with SB 326?  

Eggman: I think both myself and the governor are pretty unabashed in saying we are making those with the greatest need a higher priority for all of this taxpayer money, and all other [state and local programs] need to be utilized before we go to MHSA money, in order to be able to focus on those with the higher needs. . . We need to be sure that the counties aren’t automatically using MHSA money when there are other sources of funding.

CW: Mental health funding is notoriously complex, and opaque, with multiple funding streams and inconsistent follow-up, data collection, accountability. How has recent legislation improved – or will improve – the existing system?

Eggman: There are more federal and private dollars available than historically. . .The treatments have evolved. Newer medications are much more effective. Most kids are on some kind of insurance plan and/or on Medi-Cal, which now reimburses for a lot of things they did not before, so we want to be sure the counties aren’t just automatically using MHSA money, when you can pull in federal dollars, private dollars for a lot more than we have historically been doing.

CW: How have the state’s ongoing Cal-AIM reforms (California Advancing and Innovating Medi-Cal), a multi-year state program to improve Medi-Cal services, and coordinate with other services, been incorporated into mental health reform?

Eggman: Cal-AIM is a major component of this, and we would be remiss not to discuss the importance of programs such as Cal-AIM, CARE Court and SB 43 [to expand the definition of grave disability]. It just makes perfect sense to talk about a re-do of MHSA, as that is a major funding and care stream. Add CARE Court to the continuum of care, the Cal-AIM re-do, it makes much more sense to talk about the re-do of MHSA.

CW: Although most mental health funding is state and federal, the counties are responsible for providing mental health care at the local level. But county behavioral/mental health departments – and influential statewide advocacy associations of counties and local mental health directors – are often criticized for “foot-dragging,” opposing reforms, and bureaucratic delays in implementation of state-mandated programs. Comment?

Eggman: I think anytime we change systems, it’s hard, especially in something as big and complex as the behavioral health system in a state with 40 million people. There were articles in the 1980s about Lanterman-Petris-Short (LPS), and about grave disability, and how, “oh my God, we got it so wrong.” We could already see the growing number of people on the streets, coming from the state hospitals, but there was no thought about housing.

CW: As the state hospitals were closing in the 1960s and ‘70s, the Lanterman Act, by Frank Lanterman, a co-author of LPS, helped to create a statewide Regional Center system of care for developmentally disabled residents discharged from state hospitals. No such system was created for the mentally ill population, leading to the crisis we see today on the streets, in hospital ER’s, jails and prisons. That Regional Center system provides statewide placement and treatment options, which many advocates say should be the model for a similar system to house and treat mentally ill people.

Eggman: That’s what we’re talking about with the bond portion of [SB 326 and AB 531], to build out those villages and cottages that should have been built a long time ago, but never were. (Editor’s Note: The two bills are expected to be combined as Proposition 1, for the March ballot).

There will always be those among us who will need supportive care, who are not going to be able to live totally independently. As you said, we have accepted that with the developmentally disabled community. We have not accepted it as well with the mental health community.

I think anytime we change systems, it’s hard, especially in something as big and complex as the behavioral health system in a state with 40 million people.

CW: Then you factor in substance abuse, which often accompanies – and exacerbates – severe mental illness. . .The importance of treating “dual diagnosis” (mental illness and substance abuse) was poorly acknowledged in mental health care for decades, and that disconnect persists today.

Eggman: When the initial LPS law was created, there was a provision for substance abuse, but only for alcoholism. Why not include a more broad definition of substance abuse? Which is what we’re trying to do now with SB 43, for people who are found to be gravely disabled by severe substance abuse, such as the severe psychosis often induced by methamphetamine. And in SB 326, we say explicitly that you can also use that funding for substance abuse in addition to mental health.

CW: You have been instrumental in strengthening provisions of Laura’s Law, the 2002 legislation  that provided one of the few avenues for family members to get help for severely mentally ill relatives, but originally allowed counties to “opt out” – quietly, without public discussion. Partly based on the civil-court system created in Laura’s Law (by then-Assemblywoman Helen Thomson, D-Davis), counties are required to establish CARE Courts, and there are financial sanctions if counties fail to comply with the law.

Eggman: Yes, $1,000 a day. . .

CW: How is the CARE Act rollout progressing – in eight counties by the end of this year, the rest of the state next year? The state Health and Human Services agency is coordinating a series of statewide CARE Act “working groups,” involving a wide range of mental health providers and advocates, legal experts, many others.   

Eggman: We have the working groups, which are ongoing [to implement the CARE Act], but we’re not there yet.

CW: Much of your mental health legislation in recent years has gone through the policy committees and both houses of the Legislature with unanimous or near-unanimous bipartisan support. But until recently, some, including a measure last year to expand grave disability standards, were blocked by committee chairs and never heard by the full committee, over concerns about “involuntary” treatment.

Eggman: There were a few abstentions but we didn’t have any no votes this year on SB 43 in any policy committee or on the floor. (Editor’s Note: SB 43 now includes amendments that counties can “opt out” in 2024, but must do so publicly, and the new standards must be adopted statewide by Jan. 1, 2026).

CW: Historically, LPS reform measures have often failed over the years in the Legislature, which tends to regard LPS as the “third rail” of mental health policy in California. Why is the grave disability definition so important in getting severely mentally ill people off the streets and into treatment? And why has that been so difficult to do? The governor has said he decided not to attempt to change LPS because of the volatile nature of LPS debate.

Eggman: I don’t think he (Newsom) thought we could do it before. Sometimes you have to dream and other times you have to try to do what is politically possible. But SB 43 is a major reform.

CW: In the Assembly, but not in the Senate, committee chairs could block a bill by refusing to hear it, which is what happened to your bill last year to expand the definition of grave disability under LPS. While the bill had wide support, it was blocked by the chair toward the end of the legislative process, which happened to other bills despite broad bipartisan support.

Eggman: That’s correct. We couldn’t get a hearing before the former Assembly Judiciary chair on the grave disability bill. A lot of my mental health bills couldn’t get a hearing before the former Judiciary chair (Assemblyman Mark Stone (D-Santa Cruz), since retired, who opposed any “involuntary” treatment).

CW: New Assembly Speaker Robert Rivas reportedly plans a different approach than the previous speaker, Anthony Rendon, playing a more active role in determining the legislative agenda in the Assembly.

Eggman: I approached him very early-on, before the transition. I said this is very important to me, where are you going to be? And he expressed nothing but support.

CW: LPS was passed following decades of controversy over state mental hospitals, where mentally and developmentally disabled individuals could be detained indefinitely without consent and little treatment. Those concerns about “forced” treatment remain the principal opposition to LPS reform today. The community care that was to replace the hospitals never happened, a direct precursor to the crisis on our streets today. Comment?

Sometimes you have to dream and other times you have to try to do what is politically possible. But SB 43 is a major reform.

Eggman: Everyone would agree, voluntary treatment is best. I never argue with that. This whole idea of “forced” treatment, is not correct, there are many legal protections in the CARE Act. If you’re unable to provide for your own self-protection, your medical care, and you’re suffering and don’t even know that you are ill, then it is only compassionate and humane to provide treatment until you can make the right decisions.

People die every single day. This heat wave we’re having right now, people will die, because they don’t understand that it’s too hot and they shouldn’t be outside. And they don’t have other options, or hydration, they have infections, get dehydrated. People will die. . .It goes on and on and on. . ..

If you ask average Californians, legislators, as I have, they agree that the current system isn’t working.

CW: Should there be a re-thinking of the role of state hospitals? Some provided important programs, treatment, although most were closed in the 1960s and 1970s.

Eggman: The hospitals had recreational activities, they had community, food, shelter. . .Our state hospitals are now basically only treating those deemed [criminally insane] or incompetent to stand trial.

I don’t think we’re going to change anything overnight, but I do think with all the reforms, [that] eventually the burden upon closing the state hospitals will change, and we will open up more capacity for more current treatment, to help people earlier, before they get so sick or hurt other people. Like the young man in Davis. Clearly, this young man just spiraled down, in front of everybody. And killed two people. (Editor’s Note: Carlos Dominguez, charged with murdering two Davis residents and attempting to kill a third, has been declared Incompetent to Stand Trial and is awaiting court-ordered mental competency treatment.)

CW: Family members attempting to get help for mentally ill relatives – often adult children – say they have been historically ignored in policy debates, although that is changing as family members organize and demonstrate, demanding inclusion and recognition of their roles as default caregivers, advocates, with no support or even acknowledgement. Comment?

Eggman: The narratives, and the telling of family stories, have always been powerful. We hear from Disability Rights, and they’re always speaking for people who are not there with them, for the most part. Family members I think speak from a reality-focused place. As we’ve let our mental health system spiral out of control, there are more and more of those who have experience with somebody who is very ill, and/or have experience with a family member who has struggled to get somebody help, and there just don’t seem to be any avenues. The saturation of those kinds of stories make people think, oh, yeah. . .

CW: How does your background as a social worker and college professor – and family member (your aunt, who died on the streets of San Francisco) – inform your work as a legislator?

Eggman: I think all of those things make me the human being that I am, and that’s a lot of years of experience to bring to the process, and the workplace – because this is a workplace – and to be as successful as I can to make the greatest good. I term out next year, and I know I have an expiration date on me, and I want to get as much done in order to leave the system in a much better place than it was. I have experience, it would be a sin for me not to use every ounce of energy I have to make as much of a difference as I can, to improve the lives of people all across the country.

I don’t think we’re going to change anything overnight, but I do think with all the reforms, [that] eventually the burden upon closing the state hospitals will change, and we will open up more capacity for more current treatment, to help people earlier, before they get so sick or hurt other people.

CW: What has been the biggest obstacle to advancing meaningful mental health legislation? And what has your approach been to gain broad bipartisan support?

Eggman: I think for me it’s been tenacity, and building relationships. As a social worker, I have to ask myself every day, am I in service, through relationships, to reach that  higher level? If you’re not working for a good, and in service, and you’re not maintaining and sustaining all the relationships that you need to maintain, then you’re not going to make progress. That’s something I’ve always tried to focus on. Because in sustaining and maintaining relationships, we can go far together. The [progress] on mental health issues is a testament to that.

CW: Has it become easier over the years to convince other legislators to adopt mental health reforms?

Eggman: It’s been a very bipartisan journey, and these are relationships I’ve been nurturing for years.

CW: And you bake bread for colleagues.

Eggman: Yes, I bake bread, unabashedly!

CW: What are your future plans?

Eggman: That’s a big question. I will continue to do mental health advocacy. My plan right now is probably to go back to Sacramento State and teach. As you said, I’ve developed a statewide reputation, maybe somebody will have other things for me to do too.

CW: I understand you have a campaign committee for lieutenant governor?

Eggman: Yes. I want to keep my options open.

CW: What do you do to take care of herself after the stresses of work, other than your famous bread-making? 

Eggman: I like audiobooks, I like to cook. I try to get outside, nature really sustains me. We just did a week-long RV trip. I fish. I just took up golfing. Something to get me outside. If I’m outside doing something active, my brain can rest. I have a hard time sometimes shutting off. . .

CW: You have deep personal and professional ties in the San Joaquin Valley, in Stockton, where you live. How is your family?

Eggman: My spouse struggles mightily with health issues – a spinal cancer that resulted in neurologic after-effects, so I’m pretty much a fulltime caregiver too. Every day is a different adventure.

CW: Do you have home health care, or do you care for her yourself.

Eggman: I do it all.

And today, I took our daughter to the first day of her sophomore year in high school!

Editor’s Note: Sigrid Bathen is an award-winning journalist who taught journalism at Sacramento State for 32 years. She is a former Sacramento Bee reporter who has covered mental-health issues for several publications and health care, education and state government for Capitol Weekly since 2005. Her web site is www.sigridbathen.com. She can be reached at mailto:[email protected].