video. thank you for coming. we appreciate it. >> thank you very much. [applause] >> 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 opportunities before us as we work to mitigate these unprecedented crisis. the staggering statistics we have heard today on the prevalence of mental illness in our nation coincides with the fragmented behavioral health system that has left many communities without adequate access to community-based care and without a workforce to support such services. counties as frontline innovators of systems 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 should

not do it alone. it is critical we take an all government approach to building a better system of behavioral health care in the united states , working in partnership with federal and other intergovernmental partners. which is why it is my great honor to introduce our next speaker. secretary javier becerra, the secretary of the u.s. department of health and human services. secretary becerra is a former member of congress, serving 12 terms in the u.s. house of representatives before becoming the attorney general of the state of california. in both his previous roles, he championed issues related to health, security, patient safety , combating the opioid crisis and protecting health care access. secretary becerra has made one of his top priorities to strengthen our country's behavioral health.

he is leaving hhs to combat the growing mental health crisis in our country, particularly related to the issues of substance abuse, youth mental health and suicide. without further ado, i would like to welcome the 25th secretary of the department of health and human services, javier becerra. [applause] >> thank you very much. thank you very much for letting me join you. thanks for your friendship. thanks for letting me work with you on so many issues. certainly as the attorney general of california, we had a chance to do a lot of things together. i am excited to see you will want to launch in a way that is cohesive within the counties to work with us because we want in. we want to be with you on this issue. we know if we get resources, new authorities, our administration

for children and families, we have got to work through you. we want to do that as quickly as we can. we know we are going to deal with the states, but you are the folks on the ground that have to make it happen. hopefully the state does not skim too much money off before they handed to you. i have been there before. i have seen it. i honestly would rather hear your questions or comments because i want to buy in. i want you to know that we really want to do a partnership with you. the president essentially commissioned us 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 abuse disorders in the federal government has ever provided in the history of the country. [applause] here is the difficulty, it is not enough. it goes very quickly.

covid has made things absolutely difficult. i don't know if some of you saw the cdc report that came out this week, one third of girls are saying they have contemplated suicide. 15% of them say they were forced to have sex. they are hurting. 90% of americans today say our country is in a mental health crisis. we have got work to do. we are trying to do some of that. 988, i think you if you were involved at all in setting up the lifeline within your region, within your state. we pumped more than 20 times more in, in 18 months, than any previous administration. why? because we know how to launch right. today, if someone dials 988 -- i am old-fashioned. who dials anymore?

you can use that number and you are going to reach someone. not a busy signal, not placed on hold. the end result, we had about one million more people communicate through 988 in the first six months of our launch on july 16, 2022 than the previous years. that is good. [applause] but it is also bad and scary that one million more people actually reached out. what were they doing before? i am not going to go into my notes because i told the captain i would turn to you for questions and comments, but i want to give some context. i know this is what we are dealing with. that is why it is important to get on board. especially those of you in rural counties. the big counties, you guys have the wherewithal. you've got muscle.

small counties, 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 psychologists 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 had to wait 11 years before you got it set? we would never let that happen. we would never let an insurer say, we don't reimburse for that. or, we don't have providers in our network. we would never. but you would go in and say, my daughter is suffering from severe mental depression. it could be a while before she gets to somebody. we are trying to make it so that mental health is health, period.

[applause] we love to say that you don't have to get referred to a specialist to get behavioral health services. our primary care physicians should be able to do at least the 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 your family care doctor says, i don't really deal with that. let me refer you to your psychiatrist or psychologist. that could take three months, but let me refer you while your child is hurting right now. we are going to move. that is why we moved on 988. we are fortunate the president was able to give us over $500 million. in 2020, i think the budget was $2 million. 988 is not a national hotline. it is a state based hotline.

that we are standing up. we stood up the text and chat features because we figured a bunch of young folks are not going to call. sure enough, we have seen a 400% increase in the number of young people communicating through the text and chat feature. we have got work to do. the second largest killer of kids 10-14 is suicide. we have work to do. what is a 10-year-old doing thinking, i have to commit suicide? where have 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 10 years of age what you have gone through that you can't survive? we have work to do. we are going to do some stuff. we want to partner with you.

i want to partner with catherine because -- you cannot miss. >> he tries but he can't. >> i love going back home. i want to speak principally to those of you in counties where resources are not as easy. 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 of suicide rates are tough and l.a. county, in rural america they are higher. we can act. we can do which together. let me stop to see if you have questions. >> from your lips to the governor's ear. here in this room, you've got a cross section of both large and small and it does represent the heart and soul of counties across the nation.

the first question does read into what you are doing, to help them form the development -- you and other hhs officials went on to strengthen mental health, to hear about innovations and challenges related to health. los angeles county, san diego county, washington and montgomery county, what were your biggest takeaways from this poor? -- from this poor -- this tour? sec becerra: the thing we heard most was people don't believe we

are listening. if they don't think you are paying attention -- when they finally see that a child in a youth crisis center -- the young girl with her mother, she had lost the past summer her mother who had been murdered. she was having a really tough time coping. she was wearing a t-shirt with his teacher on it. when i asked her about the t-shirt, she started talking

about her brother. to follow and her brother's footsteps and keep the nonprofit going. one of the things i learned really well with listen. we put out about $2.5 billion in the last five years. that is how quickly it evaporates. some of it went to mental health -- some of it went to disorder.

we can get in the game because we bring money to the table. we need your help and we want to know what you are doing that works and what the best practices are. host: what are the biggest challenges for achieving an integrated effort? which really is the backbone needed to strengthen the capacity -- what are some strategies your agency is currently employing to ensure you can craft and retain -- and i say retain because many of them are burning out. sec becerra: we put out a year and a half ago about $103

million -- with many conditions on it. you want to do it to give people more training -- you want to protect them so they don't leave you. a couple of other things we are doing -- the public health service corps scholarship to provide folks who want to help, we have broadened it to nursing and other professions. about five years of service -- he had his entire four years of medical school paid. now he is giving service in an

underserved community. we are trying to do a better job with education residency slots. studies have shown if you start -- there is a real strong chance you are going to stay there after you finish and that is a great way to get assets -- this may sound political, it is very tough to get budding ob/gyn to go into the states that are making it very difficult for women seeking abortions. my wife is a high risk ob/gyn

and we are already hearing stories of medical students who want to go into ob/gyn and they are not interested in going to some of these states anymore. what do you do for half the populations of the state with whatever the laws are, they need health care. we have real challenges ahead of us. host: the conversation around workforce is critical to the work local communities are doing to build comprehensive care facilities and to better respond to individuals in crisis. the launch of the 988 suicide line prompted many counties to implement or redesign our crisis infrastructure, looking to innovative models and other co-responder models as 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 to let programs like medicaid for long-term support? sec becerra: let me focus and keep the answer brief. certified community behavioral health centers. you don't have one yet, get it. these are crisis centers, 20 47, federal government money -- 24/7, federal government money so we can find assistance in a constant way. here's the catch -- right now, there are about eight states that have funding for these. they were pilot programs started -- i know senator debbie stabenow out of michigan was a big champion along with former senator -- gosh -- roy blunt.

senator blunt and senator stabenow were partners to get funding in to 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 into a productive life. last year, they provided more funding to go beyond the eight states to add an additional eight states. get in there before the gold is gone. these are magic because you are getting real services and getting the federal government to pump in money to make it happen. so i urge you to look at these because they have proven very successful in capturing people who are hurting and make it so you end up saving a lot of money down the road in the process of providing health care. host: we have definitely

capitalized on the ccb hc's and i think we have for now in l.a. county. if you want to come out, you have an open invitation to come out to l.a. county. it has been a game changer for first responders. ensuring broad coverage is another key component for achieving integrated behavioral care. counties are particularly invested in ensuring all residents have access to quality and affordable health care services. how is hhs working to advance mental health security? sec becerra: we are probably going to have a tough time getting more resources out to local governments. we are hoping we can keep our head above water this coming fiscal year. what we are trying to do, as i

just mentioned, we are trying to cede the programs that show -- twoseed -- to seed the programs that are working well so we can highlight them and shop them around and hopefully encourage some of your members in the house and senate to come together to support further funding. the president last year in his state of the union made it very clear we are taking this to the next double. his budget went way beyond what any president's budget had committed for behavioral health. this year's budget, when it comes out, you will see once again he is making that commitment. the presidents budget is just a blueprint and with your help, maybe we continue to get out

there and support some of these in a -- some of these innovative program. host: we test on medicaid and i want to express my appreciation. administrator brooks and her colleagues at cms for the approval of the medicaid waivers that will assist us in connecting medicaid beneficiaries reentering communities to vital behavior of services in advance of their belief -- in advance of their release. what additional steps is hhs taking to build the bridge for community -- committee based care for individuals who may be on programs like medicaid, chip or medicare? sec becerra: you know this, but for those who have not heard, we are trying to help some of those

individuals who are just as involved who we know are on the verge of leaving the incarceration system and making it back into the community. rather than wait and wait for them to land out there and not have anything to turn to, we are trying to see if we can prequalify them for medicaid before they leave the doors of those institutions. if they qualify, right away, they are getting the help they need to keep them on their meds or just to make sure they are getting services they would otherwise qualify because a lot of these folks would not know they qualify for the services and that is an injustice in itself. they've done their time, they are getting ready to come out, we should try to be there to make sure they don't fall. ultimately, we save a ton of money when we do something like that. we will continue efforts like that -- i was going to mention something else but it left my head. host: given all we have

discussed when it comes to meeting needs and taking into consideration, see -- some of the issues surrounding our efforts to strengthen our nations behavioral health systems such as data collection and technologies options, it is clear this will require collaborative work of both inter-and intra-governmental partners. how are you and health and human services working with other agencies to advance the goals on the roadmap and in what way are you partnering with counties and other forms of local government on this work? sec becerra: my answer will come after i mention two things -- i remember -- medicaid housing, food, so remind me of that again -- the second one is leaving but the question was --

host: how are you working with other federal agencies to set roadmaps and what ways are you partnering with counties on this work? sec becerra: data use agreements and medicaid. i was in congress for a long time and i would hear people come up to me, stakeholders, can you push them, i've heard cases where we are not doing enough. at the end of the day, you have to deliver. you have no choice. if you don't deliver, they are going to end up on your door anyhow. whether it's the er -- you told me about an individual lying on

the streets naked and needed services and was not getting them. what we are trying to do is we are trying to let you know where we are going. lots of things are going to happen, on medicaid, for example . we made it clear to the governors what was going to happen before we made the announcement. we have been four months chatting with the governors of various states telling them this is what's going to happen once the public health emergency comes down. let's start working together, principally on something like medicaid were 15 million people are so may lose their health coverage because they may come off medicaid rolls even though they may be eligible to stay on. as an attorney, i learned early on, make sure you put it in writing. we need to make sure we communicate as often as possible in writing so you see what we are doing.

if you want more, we could do more but if i am in writing, you couldn't say i did not let you know what we were trying to do. we will try to let you know how far we can reach and that's the commitment i make to you with leaders in your counties throughout the country. to go back to data use agreements, how we can be helpful -- i don't have the authority through cdc -- dr. wolinsky does not have the authority to ask the various jurisdictions 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 may places did not want to voluntarily agree to give us that data. we would be blind in so many

parts of the country where covid was hitting, what communities needed, but for the fact the public health emergency gave us particular authorities to get extra authority and require it. most of those jurisdictions have done a very good job inviting the data but now that the public health is going away, we are going to lose sight of a lot of these. there are some 624 jurisdictions in the country, states, territories, travel governments that we deal with. 51 of them have signed voluntary data use agreements with us. we are hoping the other 13 will sign off. part of it is not so much politics, it is state laws in those particular states that there were privacy issues for

example. without that data, bad inputs, bad outputs. as you all decide where to put your money, we would appreciate it if you could help make sure your states are signing these voluntary data use agreement so we can continue to share valuable data about health for our community. the last thing i wanted to mention was medicaid. and i have to remember -- forgive me -- i turned 65 just the other day. the -- 1115 and other waivers -- how are we trying to take it to the next level? california just got a waiver.

we have said already, food is medicine. food is medicine. if food is medicine and we are in the business of making americans healthy, we can make sure there's good food available for families that qualify for medicaid. so, guess what? the state of oregon has a program where they are going to start launching an effort to provide healthy foods to communities that have not always had access to it and they are going to do it right and use the medicaid money to pay for it. housing, california just did a waiver that's going to let them show on housed individuals are using -- are usually unhealthy individuals. if we want to keep them healthy, we should keep them housed. we are going to a space we can say medicaid dollar is used to keep someone healthy which could mean support for housing. we just have to show accountability.

show us that you use this dollar in a way that improved or expanded health care for the medicaid population, and if you do, who is going to complain? if we are getting better bang for the buck, you've got to improve. if i can go back with catherine's data and show we did not have success, i couldn't do it again. we're going to do as much as we can to help you and we are going to be taking off the blinders that allowed us to look at health care only is medicine. in fact, i hope we get to the point where we no longer look at our health care system as an illness care system but a wellness care system where we look at keeping people well from the beginning, not treating illness at the end. my mom said it best -- better to prevent than remediate. host: i would encourage you all -- we did our waiver -- we

talked about this in the beginning -- l.a. county did and it was revenue neutral because we showed people coming into our emergency room were 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. i would encourage you all to look into the waivers especially today because there are ways to show housing is going to save the federal government money. we are running out of time but i want to thank you for being here, and let's give him a big round of applause. [applause] i have to say as we close out the summit, i would emphasize our work to create effective change in archimedes 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 my colleagues and fellow county officials in this room will continue the great work they are doing with partners across sectors and at 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 on its commission on mental health and well-being. [applause] and i'm excited to be able to announce that with you here, secretary. i'm pleased to join gal constantine and 10 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 recommendations at all level of government to address systemic issues can be into the ongoing mental health crisis. but we cannot do it alone.

we need all of your input. your voices and your ideas will drive this work forward. everyone is part of this. we will need the support of our intergovernmental 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 that 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. i look forward to seeing and working with each and every one of you as we move this forward to build a system that is going to address what is truly a crisis in this country -- mental health and substance abuse. with that, thank you, mr. secretary. sec becerra: and thank you for

allowing me to be here. [applause] [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]