URGENT UPDATE + CTA RE: #AB665 – minors: consent to mental health services bill

Houston (Sacramento). We have a problem….

Assembly Bill 665 is 2023’s Senate Bill 866. Let me say that again and clarify: the rage and panic you felt for SB866 – Wiener’s bill that would have reduced the age of consent for vaccines to 12 – is the same rage and panic you should feel for “Assemblywoman Wendy Carrillo’s” (Senator Wiener’s) AB665. It’s unconstitutional, it’s illegal, it’s dangerous and cruel, and it’s California’s largest step to emancipating minors. Despite this, it flew through the Assembly and is on its way to flying through the Senate and must be stopped.

HOW DID THIS HAPPEN?

I honestly believe we were bamboozled and distracted by Assemblywoman Aguiar-Curry’s second or third attempt to mandate the HPV vaccine via AB659, and we are overwhelmed by the craziness of our World, but either way, the time to act is now.

WHAT IS AB665?

CLAIMED PURPOSE OF AB665

According to Assemblywoman Wendy Carrillo (D, AD52, Los Angeles, Glendale) – and seconded by co-author Senator Scott Wiener (D, 11), neither of whom have kids – AB665 was created to, “Remov[e] barriers to mental health access for young people who are Medi-Cal recipients and destigmatizing mental health,” by “allow[ing] Medi-Cal youth recipients to receive self-consenting mental health services as is policy with private health insurance.” In a statement to the press upon her announcement of the bill, Assemblywoman Carrillo explained:

In California, four in ten children receive Medi-Cal, for communities of color, 61% of African American children, 59% of Latino children, and 38% of Native and Indigenous children are Medi-Cal recipients… AB 665 is about making sure all young people, regardless if they have private health insurance or are Medi-Cal recipients, have access to mental health resources.’

In 2010, Governor Arnold Schwartzenegger signed SB 543 (Leno), “the Mental Health Services for At-Risk Youth Act” into law, allowing young people aged 12 and above to consent to receiving mental health care. However, young people who were Medi-Cal recipients were left out of that expansion…

In 2020, less than 19% of teenagers with Medi-Cal coverage received adequate depression screenings and follow-up care, despite nearly one in three Californian adolescents exhibiting symptoms of severe psychological distress. These findings underscore the urgent need for legislation like AB 665.” [Emphasis added] [1].

Based upon these statements, the Bill was brought to give predominantly minority and immigrant children who are Medi-Cal recipients access to mental health services. At the time of writing this rebuttal in May 2023, there are over 1.3 million children enrolled in Medi-Cal in the state of California. [2]

A plain reading of the actual text of AB665, however, reveals that its purpose is not to “expand access” to mental health services to minority and immigrant children who are Medi-Cal recipients, but to remove current legal requirements stated in Family Code, section 6924 that ensure that only those children who are a extreme risk to themselves or others, or the victim of incest or abuse, are permitted to “self-consent” out of their parents’/guardians’ custody and control and into a residential shelter. [3] Additionally – and seemingly out of nowhere given Assemblywoman Carrillo’s statements about her bill – AB665 appears to be a bill about protecting the LGBQT+ community, instead of immigrants and minorities as initially claimed. It also – shockingly [or not] makes zero mention of expanding insurance coverage. Underscoring this reality is the fact that the bill was not assigned to the Assembly Appropriations Committee, which reviews all bills with any fiscal impact after passage by a policy committee, and is not currently referred to the Senate Appropriations Committee, either.

ACTUAL PURPOSE OF AB665

The preamble of AB665 admits that the purpose of the bill is to remove guardrails currently in place and legally required to ensure that only those children that a professional independently determines are at risk of serious bodily injury or death are able to leave their parents’/guardians’ custody without their parents’ knowledge or consent and into residential shelters. The preamble states:

This bill would align the existing laws by removing the additional requirement that, in order to consent to mental health treatment or counseling on an outpatient basis, or to residential shelter services, the minor must present a danger of serious physical or mental harm to themselves or to others, or be the alleged victim of incest or child abuse.

This bill would also align the existing laws by requiring the professional person treating or counseling the minor to consult with the minor before determining whether involvement of the minor’s parent or guardian would be inappropriate. [Emphasis added].

As you can see, there is zero mention of insurance coverage or payments even in the introductory paragraphs of the bill. Rather, AB665 – by its own admission – seeks to remove the requirements that (1) a child be in serious danger before checking into a government-run residential shelter without his or her parents’/guardians’ knowledge or consent, or (2) a professional person conduct an independent investigation to determine that involving the parent/guardian in the child’s mental health care is inappropriate.

Giving the authors the benefit of the doubt, e.g. that despite tens of thousands of taxpayer dollars spent to fund innumerable debates around the language of the bill and numerous iterations thereof, these introductory paragraphs do not actually lay out the intended purpose of the bill and accidentally excluded mention of expanding Medi-Cal coverage, the actual language of the bill makes zero reference to insurance coverage for minors seeking mental healthcare without their parents’/guardians’ knowledge, consent, or involvement and only amends Family Code, section 6924, to strike the requirements currently in place that ensure only most at-risk children are able to leave home without their parents’/guardians’ knowledge, consent, or involvement. Specifically, AB665 seeks to strike the language in Section 6924 that requires (1) the child to be both mature and a danger to self or others, or the victim of abuse or incest, prior to participating in the care, and (2) the professional servicing the minor to conduct an investigation and form an independent, professional conclusion that involving the parent / guardian would be inappropriate. With AB665’s amendments, Family Code, section 6924, would read as follows:

(b) A minor who is 12 years of age or older may consent to mental health treatment or counseling on an outpatient basis, or to residential shelter services, if both of the following requirements are satisfied:

(1)The the minor, in the opinion of the attending professional person, is mature enough to participate intelligently in the outpatient services or residential shelter services.

(2)The minor (A) would present a danger of serious physical or mental harm to self or to others without the mental health treatment or counseling or residential shelter services, or (B) is the alleged victim of incest or child abuse.

(d) The mental health treatment or counseling of a minor authorized by this section shall include involvement of the minor’s parent or guardian unless, in the opinion of the professional person who is treating or counseling the minor, the professional person who is treating or counseling the minor, after consulting with the minor, determines that the involvement would be inappropriate. The professional person who is treating or counseling the minor shall state in the client record whether and when the person attempted to contact the minor’s parent or guardian, and whether the attempt to contact was successful or unsuccessful, or the reason why, in the professional person’s opinion, it would be inappropriate to contact the minor’s parent or guardian.

          Again, zero mention of insurance coverage anywhere. The only thing the amendments achieve are to remove guardrails currently in place, deemed by previous representatives as necessary to ensure that only the most vulnerable children are allowed to remove themselves from their parents’/guardians’ custody and control and only if there is a finding of abuse, incest or serious risk of harm or death.

THE TROJAN HORSE

AB665’s authors – Wiener and Carrillo – claim that by striking these safety measures, they are “aligning” the 1979 Family Code section with the later-in-time 2010 Health and Safety Code, section 124260, which allows a 12-year-old to receive mental health treatment or counseling if the professional finds the minor is mature enough to participate in the treatment or counseling services. There is no requirement that the child be a serious risk to themselves or others, or the victim of abuse or incest. The authors and proponents of AB665 claim that this is a “disparity” between Family Code, section 6924, and Health and Safety Code, section 124260 that needs to be “aligned”; however, section 124260 only reiterates and confirms California’s position and desire that all minors who are mature enough can consent to mental health treatment or counseling services, but only the ones who are mature, but also specifically pose an actual and serious risk to themselves or others, or the victims of abuse, can opt into residential shelter services.

This is in line with California’s “default position favor[ing] obtaining parental consent [and involvement], unless there are reasons for not informing [or involving] the parent.”[5] This is also consistent with statutory interpretation that the language of the bill later in time govern. It does. Section 124260’s language – which is the same as Section 6924’s – prevails: 12+ year olds who are mature enough can receive mental health and counseling services without their parents’ or guardians’ knowledge or consent. Section 124260 did not address and did not seek to modify the requirements stated in Section 6924 for when a minor can opt into a residential shelter. The two sections do not conflict and co-exist perfectly.

THE MOST GLARING DEFECT

What’s even more egregious than the bill’s total failure to actually address or “align” the insurance coverage “issue,” is the fact that Senator Wiener and Assemblywoman Carrillo ignore the only bill that addresses insurance coverage for minors seeking mental health services without their parents’/guardians’ knowledge or consent: Welfare and Institutions Code, section 14029.8. Section 14029.8 states one thing and one thing only:

Section 124260 of the Health and Safety Code shall not apply to the receipt of benefits under the Medi-Cal program.

This means that a minor enrolled in Medi-Cal cannot receive mental health treatment or counseling services under the Health and Safety Code without their parents’/guardians’ knowledge or consent, while a minor on private insurance can. However, the easiest, most direct, and effective way to rectify this discrepancy is:

• Authorize the treatment under Family Code, section 6924, and/oor
• Gut-and-amend AB665 to propose amendments to Welfare and Institutions Code, section 14029.8 to strike the word “not,” so the section would read:

Section 124260 of the Health and Safety Code shall apply to the receipt of benefits under the Medi-Cal program

With this revision, every minor in the state of California can receive, without their parents’/ guardians’ knowledge or consent, mental health treatment and counseling services, if they are mature enough, and residential shelter services, if they are mature enough and at risk, regardless of their health insurance coverage type. If this is truly Carrillo’s and Wiener’s goal, this would be the easiest, most direct, and only way to actually expand insurance coverage to all minors.

SO WHAT DO WE DO?

AB665 flew through the Assembly – its house of origin – and is making its way quickly through the Senate. If it makes it through the committees it is assigned to (Senate Judiciary, only (for now)) it will have to be voted on by all Senators on the Senate Floor and if it passes there, head to the Governor’s desk for signing into law, vetoing out of existence, or doing nothing and allowing it to become a law by default (“pocket veto”). AB665 is currently set to be heard before the Senate Judiciary Committee June 13, 2023, beginning at 1:30 pm PST at 1021 O Street, room 2100, therefore we must do the following ASAP:

1. 1. 1. Submit an Opposition Letter through the Portal, here, by 12 p.m. PST Tuesday, June 6.
         1. Organizational letters are powerful.
            1. Identify that you “OPPOSE AB665.”
            2. Provide the name of each organization signing the letter, as well as a named individual responsible for that organization’s position on the bill in the signature section of the letter.
         2. Even if you are part of or representing an organization, write one for yourself, too.
         3. UPDATE: After submit through portal, send directly to committee:
            1. E-mail – sjud.fax@sen.ca.gov
            2. Fax – (916) 403-7394
      2. Call the Senate Rules Committee Chairs and ask AB665 to be referred to the Appropriations Committee. 
         1. Rules Chair: Senator Toni Atikins
            1. Capitol Office: 916-651-4039
            2. San Diego District Office: 619-688-6700
         2. Vice-Chair: Senator Shannon Grove
            1. Capitol Office: 916-651-4021
            2. Bakersfield Office: 661-323-0443
            3. Fresno Office: 559-243-8580
      3. Call and email the Senate Judiciary Members.
         1. Email them your 2-5 questions about AB665 that you are most concerned about.
         2. Ask for a 15-20 minute ZOOM, Monday through Thursday to discuss.
         3. Ask schedule for Friday through Sunday and visit them in their local district offices and/or at local events
         4. Ask them to vote “No” or Abstain unless / until the questions are answered.
         5. Committee Members:
            1. Thomas Umberg (Chair)
            2. Scott Wilk (Vice Chair)
            3. Benjamin Allen
            4. Angelique Ashby
            5. Anna Caballero
            6. Maria Elena Durazo
            7. John Laird
            8. Dave Min
            9. Roger Niello
            10. Henry Stern
            11. Scott Wiener
      4. Start calling and emailing and requesting meetings with your representatives to discuss your questions and ask them to vote “No” or abstain. 
         1. Find your rep here.
      5. BOOK YOUR TICKETS ✈️ FOR JUNE 13 Hearing + Advocacy Day.

L I N K U P.

A R M O R U P.

R I S E U P.

Let’s kill this bill.