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"content": "\u003cp>When Colleen Henderson’s 3-year-old daughter complained of pain while using the bathroom, doctors brushed it off as a urinary tract infection or constipation, common maladies in the potty-training years.\u003c/p>\n\u003cp>After being told her health insurance wouldn’t cover an ultrasound, Henderson charged the $6,000 procedure to her credit card. Then came the news: There was a grapefruit-sized tumor in her toddler’s bladder.\u003c/p>\n\u003cp>That was in 2009. The next five years, Henderson said, became a protracted battle against her insurer, UnitedHealthcare, over paying for the specialists who finally diagnosed and treated her daughter’s rare condition, \u003ca href=\"https://ajronline.org/doi/10.2214/AJR.07.3663#:~:text=Inflammatory%20Pseudotumor%20of%20the%20Bladder,-Inflammatory%20pseudotumor%20of&text=The%20bladder%20is%20a%20common,have%20been%20reported%20%5B15%5D.\">inflammatory pseudotumor\u003c/a>. She appealed uncovered hospital stays, surgeries, and medication to the insurer and state regulators, to no avail. The family racked up more than $1 million in medical debt, she said, because the insurer told her treatments recommended by doctors were unnecessary. The family declared bankruptcy.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“If I had not fought tooth and nail every step of the way, my daughter would be dead,” said Henderson, of Auburn, California, whose daughter eventually recovered and is now a thriving 20-year-old junior at Oregon State University. “You pay a lot of money to have health insurance, and you hope that your health insurance has your well-being at the forefront, but that’s not happening at all.”\u003c/p>\n\u003cp>While insurance denials are \u003ca href=\"https://www.pbs.org/newshour/health/analysis-health-insurance-claim-denials-are-on-the-rise-to-the-detriment-of-patients\">on the rise\u003c/a>, \u003ca href=\"https://www.commonwealthfund.org/publications/issue-briefs/2024/aug/unforeseen-health-care-bills-coverage-denials-by-insurers\">surveys\u003c/a> show few Americans \u003ca href=\"https://www.kff.org/private-insurance/issue-brief/claims-denials-and-appeals-in-aca-marketplace-plans-in-2023/\">appeal\u003c/a> them. Unlike in Henderson’s case, various analyses have found that many who escalate complaints to \u003ca href=\"https://www.kff.org/medicare/issue-brief/nearly-50-million-prior-authorization-requests-were-sent-to-medicare-advantage-insurers-in-2023/\">government regulators\u003c/a> successfully get \u003ca href=\"https://whyy.org/articles/pennsylvania-health-insurance-denials-data/\">denials overturned\u003c/a>. Consumer advocates and policymakers say that’s a clear sign insurance companies routinely deny care they shouldn’t. Now a proposal in the California Legislature seeks to penalize insurers who repeatedly make the wrong call.\u003c/p>\n\u003cp>While the measure, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202520260SB363\">SB 363\u003c/a>, would cover only about a third of insured Californians whose health plans are regulated by the state, experts say it could be one of the boldest attempts in the nation to rein in health insurer denials — before and after care is given. And California could become one of only a handful of states that require insurers to disclose denial rates and reasoning, statistics the industry often considers proprietary information.\u003c/p>\n\u003cp>The measure also seeks to force insurers to be more judicious with denials and would fine them up to $1 million per case if more than half of appeals filed with regulators are overturned in a year.\u003c/p>\n\u003cp>In 2023, \u003ca href=\"https://www.dmhc.ca.gov/Portals/0/Docs/DO/2023Infographic.pdf\">state data show (PDF)\u003c/a>, about 72% of appeals made to the Department of Managed Health Care, which regulates the vast majority of health plans, resulted in an insurer’s initial denial being reversed.\u003c/p>\n\u003cp>“When you have health insurance, you should have confidence that it’s going to cover your health care needs,” said Sen. Scott Wiener, the San Francisco Democrat who introduced the bill. “They can just delay, deny, obstruct, and, in many cases, avoid having to cover medically necessary care, and it’s unacceptable.”\u003c/p>\n\u003cp>A spokesperson for the California Association of Health Plans declined to comment, saying the group was still reviewing the bill language. Gov. Gavin Newsom’s spokesperson Elana Ross said his office generally does not comment on pending legislation.\u003c/p>\n\u003cp>Concerned about spiraling consumer health costs, \u003ca href=\"https://kffhealthnews.org/news/tag/prior-authorizations/\">state lawmakers across the nation\u003c/a> have increasingly looked for ways to verify that insurers are paying claims fairly.\u003c/p>\n\u003cp>In 2024, 17 states \u003ca href=\"https://app.powerbi.com/view?r=eyJrIjoiNDNlNTJjNzItNjQyNS00NjVmLTk4MjItZDYzZjBlNTQ0ZDA2IiwidCI6IjM4MmZiOGIwLTRkYzMtNDEwNy04MGJkLTM1OTViMjQzMmZhZSIsImMiOjZ9\">enacted\u003c/a> legislation dealing with prior authorization of care by private insurers, according to the National Conference of State Legislatures. Connecticut, which has one of the most robust denial rate disclosure laws, publishes an \u003ca href=\"https://portal.ct.gov/cid/-/media/cid/reports/consumer-report-card/2024-consumerreportcard.pdf?rev=94d0c6b1e170408b974006006dbe6751\">annual report card (PDF)\u003c/a> detailing the number and percentage of claims each insurer has denied, as well as the share that ends up getting reversed. Oregon published similar information \u003ca href=\"https://dfr.oregon.gov/business/reg/health/Documents/mental-health-parity/20240915-mental-health-parity-report.pdf\">until recently\u003c/a>, when state disclosure requirements lapsed.[aside label='Related Coverage' tag='health-insurance']In California, there’s no way to know how often insurers deny care, which health experts say is especially troubling as mental health care is reaching \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/2802915\">crisis levels\u003c/a> among children and young adults. According to Keith Humphreys, a health policy professor at Stanford University, it’s easier to deny mental health care because a diagnosis of, say, depression can be more subjective than that of a broken limb or cancer.\u003c/p>\n\u003cp>“We think it’s unacceptable that the state has absolutely no idea how big of a problem this is,” said Lishaun Francis, senior director of behavioral health for the advocacy group Children Now, a sponsor of the bill.\u003c/p>\n\u003cp>Under Wiener’s proposal, private insurers regulated by the Department of Managed Health Care and the Department of Insurance would be required to submit detailed data about denials and appeals. They would also need to explain those denials and report the outcomes of the appeals.\u003c/p>\n\u003cp>For appeals that make it to the state’s independent medical review process, known as IMR, insurers whose denials are overturned more than half the time would face staggering penalties. The first case that brings a company above the 50% threshold would trigger a fine of $50,000, with a penalty ranging from $100,000 to $400,000 for a second. Each one after that would cost $1 million.\u003c/p>\n\u003cp>If passed, the measure would cover roughly 12.8 million Californians on private insurance. It would not apply to patients on Medi-Cal, the state’s Medicaid program, or Medicare, and it would exclude self-insured plans offered by large employers, which are regulated by the U.S. Department of Labor and cover roughly 5.6 million Californians.\u003c/p>\n\u003cp>The phrase “deny and delay” continues to reverberate across the health care industry after the \u003ca href=\"https://www.nbcnews.com/health/health-news/ceo-shooting-health-insurance-frustration-denied-claims-rcna183805\">killing\u003c/a> of UnitedHealthcare CEO Brian Thompson. A \u003ca href=\"https://apnews.com/article/luigi-mangione-unitedhealthcare-brian-thompson-shooting-b53fde08980d160ee93fd08b1664108d\">survey\u003c/a> by NORC at the University of Chicago released shortly after the brazen attack revealed that 7 in 10 people said they believed denials for health coverage and profits by health insurance companies bore a great deal or a moderate amount of responsibility for Thompson’s death.\u003c/p>\n\u003cp>Following Thompson’s death, UnitedHealthcare said in statements that \u003ca href=\"https://www.uhc.com/news-articles/newsroom/uhg-response\">“highly inaccurate and grossly misleading information”\u003c/a> had been circulated about the way the company treats claims and that insurers, which are highly regulated, “typically have \u003ca href=\"https://www.uhc.com/news-articles/newsroom/false-statements-response\">low- to mid-single digit margins\u003c/a>.”\u003c/p>\n\u003cp>Wiener called Thompson’s killing a “cold-blooded assassination” but said his bill grew out of a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240SB294\">narrower proposal\u003c/a> that failed last year aimed at improving mental health coverage for children and adults under age 26. But he acknowledged the nation’s reaction to the killing underscores the long-simmering anger many Americans feel about health insurers’ practices and the urgent need for reform.\u003c/p>\n\u003cp>Humphreys, the Stanford professor, said the U.S. health system creates strong financial incentives for insurers to deny care. And, he added, state and federal penalties are paltry enough to be written off as a cost of doing business.\u003c/p>\n\u003cp>“The more care they deny, the more money they make,” he said.\u003c/p>\n\u003cp>Increasingly, large employers are starting to include language in contracts with claim administrators that would penalize them for approving too many or too few claims, said Shawn Gremminger, president of the National Alliance of Healthcare Purchaser Coalitions.\u003c/p>\n\u003cp>Gremminger represents mostly large employers who fund their own insurance, are federally regulated, and would be excluded from Wiener’s bill. But even for such so-called self-funded plans, it can be nearly impossible to determine denial rates for the insurance companies hired simply to administer claims, he said.\u003c/p>\n\u003cp>While it could be too late for many families, Sandra Maturino, of Rialto, said she hopes lawmakers tackle insurance denials so other Californians can avoid the saga she endured to get her niece treatment.\u003c/p>\n\u003cp>She adopted the girl, now 13, after her sister died. Her niece had long struggled with self-harm and violent behavior, but when therapists recommended inpatient psychiatric care, her insurer, Anthem Blue Cross, would cover it for only 30 days.\u003c/p>\n\u003cp>For more than a year, Maturino said, her niece cycled in and out of facilities and counseling because her insurance wouldn’t cover a long-term stay. Doctors tested a laundry list of prescription drugs and doses. None of it worked.\u003c/p>\n\u003cp>Anthem declined a request for comment.\u003c/p>\n\u003cp>Eventually, Maturino got her niece into a residential program in Utah, paid for by the adoption agency, where she was diagnosed with bipolar disorder and has been undergoing treatment for a year.\u003c/p>\n\u003cp>Maturino said she didn’t have the energy to appeal to Anthem. “I wasn’t going to wait around for the insurance to kill her, or for her to hurt somebody,” Maturino said.\u003c/p>\n\u003cp>\u003cem>This article was produced by \u003ca href=\"https://kffhealthnews.org/about-us\">KFF Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Colleen Henderson’s 3-year-old daughter complained of pain while using the bathroom, doctors brushed it off as a urinary tract infection or constipation, common maladies in the potty-training years.\u003c/p>\n\u003cp>After being told her health insurance wouldn’t cover an ultrasound, Henderson charged the $6,000 procedure to her credit card. Then came the news: There was a grapefruit-sized tumor in her toddler’s bladder.\u003c/p>\n\u003cp>That was in 2009. The next five years, Henderson said, became a protracted battle against her insurer, UnitedHealthcare, over paying for the specialists who finally diagnosed and treated her daughter’s rare condition, \u003ca href=\"https://ajronline.org/doi/10.2214/AJR.07.3663#:~:text=Inflammatory%20Pseudotumor%20of%20the%20Bladder,-Inflammatory%20pseudotumor%20of&text=The%20bladder%20is%20a%20common,have%20been%20reported%20%5B15%5D.\">inflammatory pseudotumor\u003c/a>. She appealed uncovered hospital stays, surgeries, and medication to the insurer and state regulators, to no avail. The family racked up more than $1 million in medical debt, she said, because the insurer told her treatments recommended by doctors were unnecessary. The family declared bankruptcy.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“If I had not fought tooth and nail every step of the way, my daughter would be dead,” said Henderson, of Auburn, California, whose daughter eventually recovered and is now a thriving 20-year-old junior at Oregon State University. “You pay a lot of money to have health insurance, and you hope that your health insurance has your well-being at the forefront, but that’s not happening at all.”\u003c/p>\n\u003cp>While insurance denials are \u003ca href=\"https://www.pbs.org/newshour/health/analysis-health-insurance-claim-denials-are-on-the-rise-to-the-detriment-of-patients\">on the rise\u003c/a>, \u003ca href=\"https://www.commonwealthfund.org/publications/issue-briefs/2024/aug/unforeseen-health-care-bills-coverage-denials-by-insurers\">surveys\u003c/a> show few Americans \u003ca href=\"https://www.kff.org/private-insurance/issue-brief/claims-denials-and-appeals-in-aca-marketplace-plans-in-2023/\">appeal\u003c/a> them. Unlike in Henderson’s case, various analyses have found that many who escalate complaints to \u003ca href=\"https://www.kff.org/medicare/issue-brief/nearly-50-million-prior-authorization-requests-were-sent-to-medicare-advantage-insurers-in-2023/\">government regulators\u003c/a> successfully get \u003ca href=\"https://whyy.org/articles/pennsylvania-health-insurance-denials-data/\">denials overturned\u003c/a>. Consumer advocates and policymakers say that’s a clear sign insurance companies routinely deny care they shouldn’t. Now a proposal in the California Legislature seeks to penalize insurers who repeatedly make the wrong call.\u003c/p>\n\u003cp>While the measure, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202520260SB363\">SB 363\u003c/a>, would cover only about a third of insured Californians whose health plans are regulated by the state, experts say it could be one of the boldest attempts in the nation to rein in health insurer denials — before and after care is given. And California could become one of only a handful of states that require insurers to disclose denial rates and reasoning, statistics the industry often considers proprietary information.\u003c/p>\n\u003cp>The measure also seeks to force insurers to be more judicious with denials and would fine them up to $1 million per case if more than half of appeals filed with regulators are overturned in a year.\u003c/p>\n\u003cp>In 2023, \u003ca href=\"https://www.dmhc.ca.gov/Portals/0/Docs/DO/2023Infographic.pdf\">state data show (PDF)\u003c/a>, about 72% of appeals made to the Department of Managed Health Care, which regulates the vast majority of health plans, resulted in an insurer’s initial denial being reversed.\u003c/p>\n\u003cp>“When you have health insurance, you should have confidence that it’s going to cover your health care needs,” said Sen. Scott Wiener, the San Francisco Democrat who introduced the bill. “They can just delay, deny, obstruct, and, in many cases, avoid having to cover medically necessary care, and it’s unacceptable.”\u003c/p>\n\u003cp>A spokesperson for the California Association of Health Plans declined to comment, saying the group was still reviewing the bill language. Gov. Gavin Newsom’s spokesperson Elana Ross said his office generally does not comment on pending legislation.\u003c/p>\n\u003cp>Concerned about spiraling consumer health costs, \u003ca href=\"https://kffhealthnews.org/news/tag/prior-authorizations/\">state lawmakers across the nation\u003c/a> have increasingly looked for ways to verify that insurers are paying claims fairly.\u003c/p>\n\u003cp>In 2024, 17 states \u003ca href=\"https://app.powerbi.com/view?r=eyJrIjoiNDNlNTJjNzItNjQyNS00NjVmLTk4MjItZDYzZjBlNTQ0ZDA2IiwidCI6IjM4MmZiOGIwLTRkYzMtNDEwNy04MGJkLTM1OTViMjQzMmZhZSIsImMiOjZ9\">enacted\u003c/a> legislation dealing with prior authorization of care by private insurers, according to the National Conference of State Legislatures. Connecticut, which has one of the most robust denial rate disclosure laws, publishes an \u003ca href=\"https://portal.ct.gov/cid/-/media/cid/reports/consumer-report-card/2024-consumerreportcard.pdf?rev=94d0c6b1e170408b974006006dbe6751\">annual report card (PDF)\u003c/a> detailing the number and percentage of claims each insurer has denied, as well as the share that ends up getting reversed. Oregon published similar information \u003ca href=\"https://dfr.oregon.gov/business/reg/health/Documents/mental-health-parity/20240915-mental-health-parity-report.pdf\">until recently\u003c/a>, when state disclosure requirements lapsed.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>In California, there’s no way to know how often insurers deny care, which health experts say is especially troubling as mental health care is reaching \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/2802915\">crisis levels\u003c/a> among children and young adults. According to Keith Humphreys, a health policy professor at Stanford University, it’s easier to deny mental health care because a diagnosis of, say, depression can be more subjective than that of a broken limb or cancer.\u003c/p>\n\u003cp>“We think it’s unacceptable that the state has absolutely no idea how big of a problem this is,” said Lishaun Francis, senior director of behavioral health for the advocacy group Children Now, a sponsor of the bill.\u003c/p>\n\u003cp>Under Wiener’s proposal, private insurers regulated by the Department of Managed Health Care and the Department of Insurance would be required to submit detailed data about denials and appeals. They would also need to explain those denials and report the outcomes of the appeals.\u003c/p>\n\u003cp>For appeals that make it to the state’s independent medical review process, known as IMR, insurers whose denials are overturned more than half the time would face staggering penalties. The first case that brings a company above the 50% threshold would trigger a fine of $50,000, with a penalty ranging from $100,000 to $400,000 for a second. Each one after that would cost $1 million.\u003c/p>\n\u003cp>If passed, the measure would cover roughly 12.8 million Californians on private insurance. It would not apply to patients on Medi-Cal, the state’s Medicaid program, or Medicare, and it would exclude self-insured plans offered by large employers, which are regulated by the U.S. Department of Labor and cover roughly 5.6 million Californians.\u003c/p>\n\u003cp>The phrase “deny and delay” continues to reverberate across the health care industry after the \u003ca href=\"https://www.nbcnews.com/health/health-news/ceo-shooting-health-insurance-frustration-denied-claims-rcna183805\">killing\u003c/a> of UnitedHealthcare CEO Brian Thompson. A \u003ca href=\"https://apnews.com/article/luigi-mangione-unitedhealthcare-brian-thompson-shooting-b53fde08980d160ee93fd08b1664108d\">survey\u003c/a> by NORC at the University of Chicago released shortly after the brazen attack revealed that 7 in 10 people said they believed denials for health coverage and profits by health insurance companies bore a great deal or a moderate amount of responsibility for Thompson’s death.\u003c/p>\n\u003cp>Following Thompson’s death, UnitedHealthcare said in statements that \u003ca href=\"https://www.uhc.com/news-articles/newsroom/uhg-response\">“highly inaccurate and grossly misleading information”\u003c/a> had been circulated about the way the company treats claims and that insurers, which are highly regulated, “typically have \u003ca href=\"https://www.uhc.com/news-articles/newsroom/false-statements-response\">low- to mid-single digit margins\u003c/a>.”\u003c/p>\n\u003cp>Wiener called Thompson’s killing a “cold-blooded assassination” but said his bill grew out of a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240SB294\">narrower proposal\u003c/a> that failed last year aimed at improving mental health coverage for children and adults under age 26. But he acknowledged the nation’s reaction to the killing underscores the long-simmering anger many Americans feel about health insurers’ practices and the urgent need for reform.\u003c/p>\n\u003cp>Humphreys, the Stanford professor, said the U.S. health system creates strong financial incentives for insurers to deny care. And, he added, state and federal penalties are paltry enough to be written off as a cost of doing business.\u003c/p>\n\u003cp>“The more care they deny, the more money they make,” he said.\u003c/p>\n\u003cp>Increasingly, large employers are starting to include language in contracts with claim administrators that would penalize them for approving too many or too few claims, said Shawn Gremminger, president of the National Alliance of Healthcare Purchaser Coalitions.\u003c/p>\n\u003cp>Gremminger represents mostly large employers who fund their own insurance, are federally regulated, and would be excluded from Wiener’s bill. But even for such so-called self-funded plans, it can be nearly impossible to determine denial rates for the insurance companies hired simply to administer claims, he said.\u003c/p>\n\u003cp>While it could be too late for many families, Sandra Maturino, of Rialto, said she hopes lawmakers tackle insurance denials so other Californians can avoid the saga she endured to get her niece treatment.\u003c/p>\n\u003cp>She adopted the girl, now 13, after her sister died. Her niece had long struggled with self-harm and violent behavior, but when therapists recommended inpatient psychiatric care, her insurer, Anthem Blue Cross, would cover it for only 30 days.\u003c/p>\n\u003cp>For more than a year, Maturino said, her niece cycled in and out of facilities and counseling because her insurance wouldn’t cover a long-term stay. Doctors tested a laundry list of prescription drugs and doses. None of it worked.\u003c/p>\n\u003cp>Anthem declined a request for comment.\u003c/p>\n\u003cp>Eventually, Maturino got her niece into a residential program in Utah, paid for by the adoption agency, where she was diagnosed with bipolar disorder and has been undergoing treatment for a year.\u003c/p>\n\u003cp>Maturino said she didn’t have the energy to appeal to Anthem. “I wasn’t going to wait around for the insurance to kill her, or for her to hurt somebody,” Maturino said.\u003c/p>\n\u003cp>\u003cem>This article was produced by \u003ca href=\"https://kffhealthnews.org/about-us\">KFF Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Alex Crafton stood at the corner of Sixth and Jessie streets in \u003ca href=\"https://www.kqed.org/news/tag/san-francisco\">San Francisco’s\u003c/a> South of Market neighborhood, holding a cup of coffee. A few weeks ago, police arrested the 26-year-old for drug possession outside his former SRO at the same corner, releasing him within 24 hours.\u003c/p>\n\u003cp>He’s currently living with a friend in the Mission, but he came back to the area recently to check out San Francisco’s latest experiment to address the fentanyl crisis, something he knows first-hand through struggling with addiction for several years.\u003c/p>\n\u003cp>“The cops have been cracking down more lately, but it’s a lawless city,” Crafton said after exiting a new triage center \u003ca href=\"https://www.kqed.org/news/tag/daniel-lurie\">Mayor Daniel Lurie\u003c/a> and other city agencies, including the San Francisco Police Department and Public Health Department, opened this month on 469 Stevenson St. in a fenced-off corner of a former Nordstrom parking lot. “I don’t know if I agree with forcing people to go into rehab because that generally doesn’t work.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>On a recent Tuesday, workers at the triage center offered free water, coffee and snacks, and helped visitors sign up for government IDs and other programs like emergency shelter and Journey Home, which offers bus tickets out of the city for people looking to reunite with loved ones.\u003c/p>\n\u003cp>John DaRosa, who lives in his car near Sixth and Jessie, stopped by the triage center to find a place to stay that night and a cup of coffee. While staff connected with him, he left, still unsure about a place to sleep.\u003c/p>\n\u003cp>“They were very welcoming,” he said. “I’d like to get help.”\u003c/p>\n\u003cp>They are some of the people that Lurie is hoping to reach with the space he envisions as a walk-in center where people can get connected with health and social services, as well as a drop-off point where law enforcement can bring people who have been arrested for processing.\u003c/p>\n\u003cp>The triage center opened to the public on Feb. 7, but details about how law enforcement will operate during the 30-day pilot remain scant.\u003c/p>\n\u003cp>In its first week, the site was primarily a few picnic tables and white tents. Spokespersons from both SFPD and the mayor’s office declined to say when police operations would start but noted that site outcomes and local conditions will be evaluated after 30 days.\u003c/p>\n\u003cp>“I can’t sit by, so we are trying this and demand that people move from the street into the triage center, a place where they can get a cup of coffee, they can be seen by somebody,” Lurie said on \u003ca href=\"https://www.kqed.org/forum/2010101908873/san-francisco-mayor-daniel-lurie-takes-your-questions\">KQED’s \u003cem>Forum\u003c/em>\u003c/a>. “We’re going to try something new, and that’s what the triage center is doing.”\u003c/p>\n\u003cfigure id=\"attachment_12026723\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12026723\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-4-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-4-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-4-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-4-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-4-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-4-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-4-KQED-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">A new outdoor triage center in a parking lot on Stevenson Street on Feb. 11, 2025. At the site, individuals who are arrested will get dropped off by police so they can either get treatment, take a bus out of town or go to jail. The center, operating as a 30-day pilot program, also offers resources and food to individuals. \u003ccite>(Gina Castro/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On Feb. 12, Lurie \u003ca href=\"https://www.kqed.org/news/12025495/luries-fentanyl-response-clears-san-francisco-board-of-supervisors\">signed his first major piece of legislation into law\u003c/a>, which aims to expedite hiring and contracting by limiting the Board of Supervisors’ approval for certain programs addressing the fentanyl crisis, an opioid about 50 times stronger than heroin that has been associated with the most overdose deaths in San Francisco in recent years.\u003c/p>\n\u003cp>The same day, Lurie announced a second site will open this spring in the Tenderloin at 822 Geary St. for law enforcement, paramedics and street outreach teams to place people experiencing mental health or substance use crises. The Tenderloin facility is a tenet of Lurie’s plan for his first six months in office, along with opening 1,500 shelter beds, which he’s acknowledged the city lacks enough of to direct people to at the drop-off sites.\u003c/p>\n\u003cp>“The center will be staffed by medical professionals,” he said at a press conference. “It will divert people from the emergency department at places like SF General (Hospital), and it will accept patients dropped off by police, paramedics and street crisis response teams. This will free up essential hospital and first responder resources.”\u003c/p>\n\u003cp>It’s not the first time that the city has tried a pop-up-style center aimed at improving street conditions and connecting people to drug treatment.\u003c/p>\n\u003cp>In 2022, as part of Mayor London Breed’s Tenderloin Emergency Initiative, \u003ca href=\"https://www.kqed.org/news/11915870/inside-san-franciscos-tenderloin-center-that-serves-hundreds-every-day\">the city opened the Tenderloin Center\u003c/a>, a temporary site that operated at United Nations Plaza and offered food, hygiene services and connections to health and social services. Unlike Lurie’s new sites, it allowed supervised drug consumption. Medical professionals there reversed more than 300 overdoses, with no lives lost.\u003c/p>\n\u003cp>However, the Tenderloin Center faced scrutiny from residents and local businesses for its location in the heart of the Civic Center, where it often drew hundreds of people daily.\u003c/p>\n\u003cp>“What was really great about that program (Tenderloin Center) is that with all of the many overdoses they encountered there, not a single life was lost,” said Crafton, who visited the Tenderloin Center during its 10-month run. “That was a good thing.”\u003c/p>\n\u003cfigure id=\"attachment_12026724\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12026724\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-9-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-9-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-9-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-9-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-9-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-9-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-9-KQED-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">John DaRosa and April DaRosa outside of an outdoor triage area on Stevenson Street on Feb. 11, 2025. The two are hoping to get a shelter space. \u003ccite>(Gina Castro/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Law enforcement, along with leaders from the public health and emergency management departments, expressed support for the city’s latest fentanyl response.\u003c/p>\n\u003cp>“This center will be a tremendous help to our officers who are working hard to enforce the law and improve street conditions in San Francisco,” SFPD Chief Bill Scott said in a statement. “I want to thank Mayor Daniel Lurie for moving swiftly to address this crisis and empowering our entire city in the effort.”\u003c/p>\n\u003cp>As of Monday, police have not yet used the triage center for any arrest processing or drop-offs, according to a spokesperson from the mayor’s office. He said police have so far been able to process arrests directly on the street and have not yet utilized the new command center in the SoMa parking lot.\u003c/p>\n\u003cp>The site was closed all Presidents Day weekend due to inadequate staffing, according to the mayor’s spokesperson.\u003c/p>\n\u003cp>But addiction experts like Vitka Eisen, CEO of HealthRIGHT 360, the city’s largest nonprofit drug treatment provider, remain skeptical. While HealthRIGHT has been asked to set aside additional beds for drop-offs at its SoMa RISE sobering center, the broader strategy of the drop-off sites remains unclear.[aside postID=news_12025495 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/250107-LurieInterfaithCeremony-31_qed.jpg']\u003c/p>\n\u003cp>“I don’t think the solution to people’s drug use on the streets — the solution doesn’t come from law enforcement,” said Eisen, as multiple people could be seen bent over using drugs openly in the recently power-washed alleyway near the triage center. “I’m not entirely clear on the intent of what’s been open on Jessie Street.”\u003c/p>\n\u003cp>Neighborhood residents like Byron Carter, who lives about a block from the site at Hotel Henry, are skeptical about the triage center’s long-term goals. He’s noticed cleaner streets during the day since it opened, but said drug dealing, public drug use and other dangerous activity resume after the center closes for the night.\u003c/p>\n\u003cp>Meanwhile, people like Crafton are still trying to navigate the new services. On his way out, he said the triage site could help anyone unaware of available resources. But the help he’s seeking — a place he can afford as he tries to get off fentanyl — wasn’t available.\u003c/p>\n\u003cp>“They have the HOT (Homeless Outreach Team) team there, the people who refer you to different programs like housing or getting public benefits like food stamps. You know, just pointing you in the right direction,” Crafton said. “But I pretty much knew about all those things, and I’m all good. I just wanted a cup of coffee.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Alex Crafton stood at the corner of Sixth and Jessie streets in \u003ca href=\"https://www.kqed.org/news/tag/san-francisco\">San Francisco’s\u003c/a> South of Market neighborhood, holding a cup of coffee. A few weeks ago, police arrested the 26-year-old for drug possession outside his former SRO at the same corner, releasing him within 24 hours.\u003c/p>\n\u003cp>He’s currently living with a friend in the Mission, but he came back to the area recently to check out San Francisco’s latest experiment to address the fentanyl crisis, something he knows first-hand through struggling with addiction for several years.\u003c/p>\n\u003cp>“The cops have been cracking down more lately, but it’s a lawless city,” Crafton said after exiting a new triage center \u003ca href=\"https://www.kqed.org/news/tag/daniel-lurie\">Mayor Daniel Lurie\u003c/a> and other city agencies, including the San Francisco Police Department and Public Health Department, opened this month on 469 Stevenson St. in a fenced-off corner of a former Nordstrom parking lot. “I don’t know if I agree with forcing people to go into rehab because that generally doesn’t work.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>On a recent Tuesday, workers at the triage center offered free water, coffee and snacks, and helped visitors sign up for government IDs and other programs like emergency shelter and Journey Home, which offers bus tickets out of the city for people looking to reunite with loved ones.\u003c/p>\n\u003cp>John DaRosa, who lives in his car near Sixth and Jessie, stopped by the triage center to find a place to stay that night and a cup of coffee. While staff connected with him, he left, still unsure about a place to sleep.\u003c/p>\n\u003cp>“They were very welcoming,” he said. “I’d like to get help.”\u003c/p>\n\u003cp>They are some of the people that Lurie is hoping to reach with the space he envisions as a walk-in center where people can get connected with health and social services, as well as a drop-off point where law enforcement can bring people who have been arrested for processing.\u003c/p>\n\u003cp>The triage center opened to the public on Feb. 7, but details about how law enforcement will operate during the 30-day pilot remain scant.\u003c/p>\n\u003cp>In its first week, the site was primarily a few picnic tables and white tents. Spokespersons from both SFPD and the mayor’s office declined to say when police operations would start but noted that site outcomes and local conditions will be evaluated after 30 days.\u003c/p>\n\u003cp>“I can’t sit by, so we are trying this and demand that people move from the street into the triage center, a place where they can get a cup of coffee, they can be seen by somebody,” Lurie said on \u003ca href=\"https://www.kqed.org/forum/2010101908873/san-francisco-mayor-daniel-lurie-takes-your-questions\">KQED’s \u003cem>Forum\u003c/em>\u003c/a>. “We’re going to try something new, and that’s what the triage center is doing.”\u003c/p>\n\u003cfigure id=\"attachment_12026723\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12026723\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-4-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-4-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-4-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-4-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-4-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-4-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-4-KQED-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">A new outdoor triage center in a parking lot on Stevenson Street on Feb. 11, 2025. At the site, individuals who are arrested will get dropped off by police so they can either get treatment, take a bus out of town or go to jail. The center, operating as a 30-day pilot program, also offers resources and food to individuals. \u003ccite>(Gina Castro/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On Feb. 12, Lurie \u003ca href=\"https://www.kqed.org/news/12025495/luries-fentanyl-response-clears-san-francisco-board-of-supervisors\">signed his first major piece of legislation into law\u003c/a>, which aims to expedite hiring and contracting by limiting the Board of Supervisors’ approval for certain programs addressing the fentanyl crisis, an opioid about 50 times stronger than heroin that has been associated with the most overdose deaths in San Francisco in recent years.\u003c/p>\n\u003cp>The same day, Lurie announced a second site will open this spring in the Tenderloin at 822 Geary St. for law enforcement, paramedics and street outreach teams to place people experiencing mental health or substance use crises. The Tenderloin facility is a tenet of Lurie’s plan for his first six months in office, along with opening 1,500 shelter beds, which he’s acknowledged the city lacks enough of to direct people to at the drop-off sites.\u003c/p>\n\u003cp>“The center will be staffed by medical professionals,” he said at a press conference. “It will divert people from the emergency department at places like SF General (Hospital), and it will accept patients dropped off by police, paramedics and street crisis response teams. This will free up essential hospital and first responder resources.”\u003c/p>\n\u003cp>It’s not the first time that the city has tried a pop-up-style center aimed at improving street conditions and connecting people to drug treatment.\u003c/p>\n\u003cp>In 2022, as part of Mayor London Breed’s Tenderloin Emergency Initiative, \u003ca href=\"https://www.kqed.org/news/11915870/inside-san-franciscos-tenderloin-center-that-serves-hundreds-every-day\">the city opened the Tenderloin Center\u003c/a>, a temporary site that operated at United Nations Plaza and offered food, hygiene services and connections to health and social services. Unlike Lurie’s new sites, it allowed supervised drug consumption. Medical professionals there reversed more than 300 overdoses, with no lives lost.\u003c/p>\n\u003cp>However, the Tenderloin Center faced scrutiny from residents and local businesses for its location in the heart of the Civic Center, where it often drew hundreds of people daily.\u003c/p>\n\u003cp>“What was really great about that program (Tenderloin Center) is that with all of the many overdoses they encountered there, not a single life was lost,” said Crafton, who visited the Tenderloin Center during its 10-month run. “That was a good thing.”\u003c/p>\n\u003cfigure id=\"attachment_12026724\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12026724\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-9-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-9-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-9-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-9-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-9-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-9-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/20250211_SFPOLICETRIAGE_GC-9-KQED-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">John DaRosa and April DaRosa outside of an outdoor triage area on Stevenson Street on Feb. 11, 2025. The two are hoping to get a shelter space. \u003ccite>(Gina Castro/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Law enforcement, along with leaders from the public health and emergency management departments, expressed support for the city’s latest fentanyl response.\u003c/p>\n\u003cp>“This center will be a tremendous help to our officers who are working hard to enforce the law and improve street conditions in San Francisco,” SFPD Chief Bill Scott said in a statement. “I want to thank Mayor Daniel Lurie for moving swiftly to address this crisis and empowering our entire city in the effort.”\u003c/p>\n\u003cp>As of Monday, police have not yet used the triage center for any arrest processing or drop-offs, according to a spokesperson from the mayor’s office. He said police have so far been able to process arrests directly on the street and have not yet utilized the new command center in the SoMa parking lot.\u003c/p>\n\u003cp>The site was closed all Presidents Day weekend due to inadequate staffing, according to the mayor’s spokesperson.\u003c/p>\n\u003cp>But addiction experts like Vitka Eisen, CEO of HealthRIGHT 360, the city’s largest nonprofit drug treatment provider, remain skeptical. While HealthRIGHT has been asked to set aside additional beds for drop-offs at its SoMa RISE sobering center, the broader strategy of the drop-off sites remains unclear.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I don’t think the solution to people’s drug use on the streets — the solution doesn’t come from law enforcement,” said Eisen, as multiple people could be seen bent over using drugs openly in the recently power-washed alleyway near the triage center. “I’m not entirely clear on the intent of what’s been open on Jessie Street.”\u003c/p>\n\u003cp>Neighborhood residents like Byron Carter, who lives about a block from the site at Hotel Henry, are skeptical about the triage center’s long-term goals. He’s noticed cleaner streets during the day since it opened, but said drug dealing, public drug use and other dangerous activity resume after the center closes for the night.\u003c/p>\n\u003cp>Meanwhile, people like Crafton are still trying to navigate the new services. On his way out, he said the triage site could help anyone unaware of available resources. But the help he’s seeking — a place he can afford as he tries to get off fentanyl — wasn’t available.\u003c/p>\n\u003cp>“They have the HOT (Homeless Outreach Team) team there, the people who refer you to different programs like housing or getting public benefits like food stamps. You know, just pointing you in the right direction,” Crafton said. “But I pretty much knew about all those things, and I’m all good. I just wanted a cup of coffee.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "amid-wildfire-trauma-la-county-dispatches-mental-health-workers-to-evacuees",
"title": "Amid Wildfire Trauma, LA County Dispatches Mental Health Workers to Evacuees",
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"headTitle": "Amid Wildfire Trauma, LA County Dispatches Mental Health Workers to Evacuees | KQED",
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"content": "\u003cp>Pasadena, Los Angeles County — As Fernando Ramirez drove to work the day after the Eaton Fire erupted, smoke darkened the sky, ash and embers rained onto his windshield, and the air smelled of melting rubber and plastic.\u003c/p>\n\u003cp>He pulled to the side of the road and cried at the sight of residents trying to save their homes.\u003c/p>\n\u003cp>“I could see people standing on the roof, watering it, trying to protect it from the fire, and they just looked so hopeless,” said Ramirez, a community outreach worker with the Pasadena Public Health Department.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That evening, the 49-year-old volunteered for a 14-hour shift at the city’s evacuation center, as did colleagues who had also been activated for emergency medical duty. Running on adrenaline and little sleep after finding shelter for homeless people all day, Ramirez spent the night circulating among more than a thousand evacuees, offering wellness checks, companionship, and hope to those who looked distressed.\u003c/p>\n\u003cp>Local health departments, such as Ramirez’s, have become a key part of governments’ response to wildfires, floods, and other extreme weather events, which scientists say are becoming \u003ca href=\"https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter14.pdf#page=20\">more intense and frequent\u003c/a> due to climate change. The emotional toll of fleeing and possibly losing a home can help cause or exacerbate mental health conditions such as anxiety, depression, post-traumatic stress disorder, suicidal ideation, and substance use, according to health and climate experts.\u003c/p>\n\u003cfigure id=\"attachment_12023220\" class=\"wp-caption aligncenter\" style=\"max-width: 2048px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12023220\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-03-3840-copy.jpg\" alt=\"\" width=\"2048\" height=\"1365\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-03-3840-copy.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-03-3840-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-03-3840-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-03-3840-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-03-3840-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-03-3840-copy-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2048px) 100vw, 2048px\">\u003cfigcaption class=\"wp-caption-text\">Fernando Ramirez, an outreach worker with the Pasadena Public Health Department, circulated around the city’s evacuation site on Jan. 8, offering mental health support. He said one of the hardest parts of his shift was helping people look for missing loved ones. \u003ccite>(Molly Castle Work/KFF Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Wildfires have become a recurring experience for many Angelenos, making it difficult for people to feel safe in their home or able to go about daily living, said Lisa Wong, director of the Los Angeles County Department of Mental Health. However, with each extreme weather event, the county has improved its support for evacuees, she said.\u003c/p>\n\u003cp>For instance, Wong said the county deployed a team of mental health workers trained to comfort evacuees without retraumatizing them, including by avoiding asking questions likely to bring up painful memories. The department has also learned to better track people’s health needs and redirect those who may find massive evacuation settings uncomfortable to other shelters or interim housing, Wong said. In those first days, the biggest goal is often to reduce people’s anxiety by providing them with information.\u003c/p>\n\u003cp>“We’ve learned that right when a crisis happens, people don’t necessarily want to talk about mental health,” said Wong, who staffed the evacuation site Jan. 8 with nine colleagues.\u003c/p>\n\u003cp>Instead, she and her team deliver a message of support: “This is really bad right now, but you’re not going to do this alone. We have a whole system set up for recovery, too. Once you get past the initial shock of what happened — initial housing needs, medication needs, all those things — then there’s this whole pathway to recovery that we set up.”\u003c/p>\n\u003cp>The convention center in downtown Pasadena, which normally hosts home shows, comic cons, and trade shows, was transformed into an evacuation site with hundreds of cots. It was one of at least 13 shelters opened to serve \u003ca href=\"https://www.cbsnews.com/news/california-fire-maps-palisades-eaton-hurst-2025/\">more than 200,000 residents\u003c/a> under evacuation orders.\u003c/p>\n\u003cfigure id=\"attachment_12023224\" class=\"wp-caption aligncenter\" style=\"max-width: 2048px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12023224\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-01-3840-copy.jpg\" alt=\"\" width=\"2048\" height=\"1365\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-01-3840-copy.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-01-3840-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-01-3840-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-01-3840-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-01-3840-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-01-3840-copy-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2048px) 100vw, 2048px\">\u003cfigcaption class=\"wp-caption-text\">The Pasadena Convention Center normally hosts home shows, comic cons, and trade shows, but it was transformed into an evacuation site with hundreds of cots — one of at least 13 shelters opened to serve more than 200,000 residents under evacuation orders from the Los Angeles fires. \u003ccite>(Molly Castle Work/KFF Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The January wildfires have burned an estimated 64 square miles — an area larger than the city of Paris — and destroyed at least 12,300 buildings since they started on Jan. 7. AccuWeather estimates the region will likely face more than \u003ca href=\"https://www.accuweather.com/en/weather-news/accuweather-estimates-more-than-250-billion-in-damages-and-economic-loss-from-la-wildfires/1733821\">$250 billion in economic losses\u003c/a> from the blazes, surpassing the estimates from the state’s record-breaking 2020 wildfire season.\u003c/p>\n\u003cp>Lisa Patel, executive director of the \u003ca href=\"https://medsocietiesforclimatehealth.org/\">Medical Society Consortium on Climate and Health\u003c/a>, said she’s most concerned about low-income residents, who are less likely to access mental health support.\u003c/p>\n\u003cp>“There was a mental health crisis even before the pandemic,” said Patel, who is also a clinical associate professor of pediatrics at Stanford School of Medicine, referring to the COVID-19 pandemic. “The pandemic made it worse. Now you lace in all of this climate change and these disasters into a health care system that isn’t set up to care for the people that already have mental health illness.”\u003c/p>\n\u003cp>Early research suggests exposure to large amounts of wildfire smoke can damage the brain and increase the risk of developing anxiety, she added.\u003c/p>\n\u003cp>At the Pasadena Convention Center, Elaine Santiago sat on a cot in a hallway as volunteers pulled wagons loaded with soup, sandwiches, bottled water, and other necessities.\u003c/p>\n\u003cp>Santiago said she drew comfort from being at the Pasadena evacuation center, knowing that she wasn’t alone in the tragedy.\u003c/p>\n\u003cp>“It sort of gives me a sense of peace at times,” Santiago said. “Maybe that’s weird. We’re all experiencing this together.”\u003c/p>\n\u003cp>She had been celebrating her 78th birthday with family when she fled her home in the small city of Sierra Madre, east of Pasadena. As she watched flames whip around her neighborhood, she, along with children and grandkids, scrambled to secure their dogs in crates and grabbed important documents before they left.\u003c/p>\n\u003cp>The widower had leaned on her husband in past emergencies, and now she felt lost.\u003c/p>\n\u003cp>“I did feel helpless,” Santiago said. “I figured I’m the head of the household; I should know what to do. But I didn’t know.”\u003c/p>\n\u003cfigure id=\"attachment_12023226\" class=\"wp-caption aligncenter\" style=\"max-width: 2048px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12023226\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-02-3840-copy.jpg\" alt=\"\" width=\"2048\" height=\"1365\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-02-3840-copy.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-02-3840-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-02-3840-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-02-3840-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-02-3840-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-02-3840-copy-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2048px) 100vw, 2048px\">\u003cfigcaption class=\"wp-caption-text\">Elaine Santiago had been celebrating her 78th birthday with family when she fled her home in the small city of Sierra Madre, east of Pasadena, on the night of Jan. 7. She drew comfort from being at the evacuation site. ‘It sort of gives me a sense of peace at times,” she says. “Maybe that’s weird. We’re all experiencing this together.’ \u003ccite>(Molly Castle Work/KFF Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Donny McCullough, who sat on a neighboring green cot draped in a Red Cross blanket, had fled his Pasadena home with his family early on the morning of Jan. 8. Without power at home, the 68-year-old stayed up listening for updates on a battery-powered radio. His eyes remained red from smoke irritation hours later.[aside label=\"Related Stories\" postID=\"news_12021661,news_12022057,news_12021150\"]“I had my wife and two daughters, and I was trying not to show fear, so I quietly, inside, was like, ‘Oh my God,’” said McCullough, a music producer and writer. “I’m driving away, looking at the house, wondering if it’s going to be the last time I’m going to see it.”\u003c/p>\n\u003cp>He saved his master recording from a seven-year music project, but he left behind his studio with all his other work from a four-decade career in music.\u003c/p>\n\u003cp>Not all evacuees arrived with family. Some came searching for loved ones. That’s one of the hardest parts of his shift, Ramirez said. The community outreach worker helped walk people around the building, cot by cot.\u003c/p>\n\u003cp>A week in, at least two dozen people had been killed in the wildfires.\u003c/p>\n\u003cp>The work takes a toll on disaster relief workers, too. Ramirez said many feared losing their homes in the fires and some already had. He attends therapy weekly, which he said helps him manage his emotions.\u003c/p>\n\u003cp>At the evacuation center, Ramirez described being on autopilot.\u003c/p>\n\u003cp>“Some of us react differently. I tend to go into fight mode,” Ramirez said. “I react. I run towards the fire. I run towards personal service. Then, once that passes, that’s when my trauma catches up with me.”\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Need help?\u003c/em>\u003c/strong> \u003cem>Los Angeles County residents in need of support can call the county’s mental health helpline at 1-800-854-7771. The national Suicide & Crisis Lifeline, 988, is also available for those who’d like to speak with someone confidentially, free of charge.\u003c/em>\u003c/p>\n\u003cp>\u003cem>This article was produced by \u003c/em>\u003ca href=\"https://kffhealthnews.org/about-us\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cem>KFF Health News\u003c/em>\u003c/a>\u003cem>, which publishes \u003c/em>\u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cem>California Healthline\u003c/em>\u003c/a>\u003cem>, an editorially independent service of the \u003c/em>\u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cem>California Health Care Foundation\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Mental health work is crucial as the emotional toll of fleeing or losing a home can cause or exacerbate conditions such as anxiety, depression, suicidal ideation and substance use, according to experts. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Pasadena, Los Angeles County — As Fernando Ramirez drove to work the day after the Eaton Fire erupted, smoke darkened the sky, ash and embers rained onto his windshield, and the air smelled of melting rubber and plastic.\u003c/p>\n\u003cp>He pulled to the side of the road and cried at the sight of residents trying to save their homes.\u003c/p>\n\u003cp>“I could see people standing on the roof, watering it, trying to protect it from the fire, and they just looked so hopeless,” said Ramirez, a community outreach worker with the Pasadena Public Health Department.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That evening, the 49-year-old volunteered for a 14-hour shift at the city’s evacuation center, as did colleagues who had also been activated for emergency medical duty. Running on adrenaline and little sleep after finding shelter for homeless people all day, Ramirez spent the night circulating among more than a thousand evacuees, offering wellness checks, companionship, and hope to those who looked distressed.\u003c/p>\n\u003cp>Local health departments, such as Ramirez’s, have become a key part of governments’ response to wildfires, floods, and other extreme weather events, which scientists say are becoming \u003ca href=\"https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter14.pdf#page=20\">more intense and frequent\u003c/a> due to climate change. The emotional toll of fleeing and possibly losing a home can help cause or exacerbate mental health conditions such as anxiety, depression, post-traumatic stress disorder, suicidal ideation, and substance use, according to health and climate experts.\u003c/p>\n\u003cfigure id=\"attachment_12023220\" class=\"wp-caption aligncenter\" style=\"max-width: 2048px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12023220\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-03-3840-copy.jpg\" alt=\"\" width=\"2048\" height=\"1365\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-03-3840-copy.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-03-3840-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-03-3840-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-03-3840-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-03-3840-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-03-3840-copy-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2048px) 100vw, 2048px\">\u003cfigcaption class=\"wp-caption-text\">Fernando Ramirez, an outreach worker with the Pasadena Public Health Department, circulated around the city’s evacuation site on Jan. 8, offering mental health support. He said one of the hardest parts of his shift was helping people look for missing loved ones. \u003ccite>(Molly Castle Work/KFF Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Wildfires have become a recurring experience for many Angelenos, making it difficult for people to feel safe in their home or able to go about daily living, said Lisa Wong, director of the Los Angeles County Department of Mental Health. However, with each extreme weather event, the county has improved its support for evacuees, she said.\u003c/p>\n\u003cp>For instance, Wong said the county deployed a team of mental health workers trained to comfort evacuees without retraumatizing them, including by avoiding asking questions likely to bring up painful memories. The department has also learned to better track people’s health needs and redirect those who may find massive evacuation settings uncomfortable to other shelters or interim housing, Wong said. In those first days, the biggest goal is often to reduce people’s anxiety by providing them with information.\u003c/p>\n\u003cp>“We’ve learned that right when a crisis happens, people don’t necessarily want to talk about mental health,” said Wong, who staffed the evacuation site Jan. 8 with nine colleagues.\u003c/p>\n\u003cp>Instead, she and her team deliver a message of support: “This is really bad right now, but you’re not going to do this alone. We have a whole system set up for recovery, too. Once you get past the initial shock of what happened — initial housing needs, medication needs, all those things — then there’s this whole pathway to recovery that we set up.”\u003c/p>\n\u003cp>The convention center in downtown Pasadena, which normally hosts home shows, comic cons, and trade shows, was transformed into an evacuation site with hundreds of cots. It was one of at least 13 shelters opened to serve \u003ca href=\"https://www.cbsnews.com/news/california-fire-maps-palisades-eaton-hurst-2025/\">more than 200,000 residents\u003c/a> under evacuation orders.\u003c/p>\n\u003cfigure id=\"attachment_12023224\" class=\"wp-caption aligncenter\" style=\"max-width: 2048px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12023224\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-01-3840-copy.jpg\" alt=\"\" width=\"2048\" height=\"1365\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-01-3840-copy.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-01-3840-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-01-3840-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-01-3840-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-01-3840-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-01-3840-copy-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2048px) 100vw, 2048px\">\u003cfigcaption class=\"wp-caption-text\">The Pasadena Convention Center normally hosts home shows, comic cons, and trade shows, but it was transformed into an evacuation site with hundreds of cots — one of at least 13 shelters opened to serve more than 200,000 residents under evacuation orders from the Los Angeles fires. \u003ccite>(Molly Castle Work/KFF Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The January wildfires have burned an estimated 64 square miles — an area larger than the city of Paris — and destroyed at least 12,300 buildings since they started on Jan. 7. AccuWeather estimates the region will likely face more than \u003ca href=\"https://www.accuweather.com/en/weather-news/accuweather-estimates-more-than-250-billion-in-damages-and-economic-loss-from-la-wildfires/1733821\">$250 billion in economic losses\u003c/a> from the blazes, surpassing the estimates from the state’s record-breaking 2020 wildfire season.\u003c/p>\n\u003cp>Lisa Patel, executive director of the \u003ca href=\"https://medsocietiesforclimatehealth.org/\">Medical Society Consortium on Climate and Health\u003c/a>, said she’s most concerned about low-income residents, who are less likely to access mental health support.\u003c/p>\n\u003cp>“There was a mental health crisis even before the pandemic,” said Patel, who is also a clinical associate professor of pediatrics at Stanford School of Medicine, referring to the COVID-19 pandemic. “The pandemic made it worse. Now you lace in all of this climate change and these disasters into a health care system that isn’t set up to care for the people that already have mental health illness.”\u003c/p>\n\u003cp>Early research suggests exposure to large amounts of wildfire smoke can damage the brain and increase the risk of developing anxiety, she added.\u003c/p>\n\u003cp>At the Pasadena Convention Center, Elaine Santiago sat on a cot in a hallway as volunteers pulled wagons loaded with soup, sandwiches, bottled water, and other necessities.\u003c/p>\n\u003cp>Santiago said she drew comfort from being at the Pasadena evacuation center, knowing that she wasn’t alone in the tragedy.\u003c/p>\n\u003cp>“It sort of gives me a sense of peace at times,” Santiago said. “Maybe that’s weird. We’re all experiencing this together.”\u003c/p>\n\u003cp>She had been celebrating her 78th birthday with family when she fled her home in the small city of Sierra Madre, east of Pasadena. As she watched flames whip around her neighborhood, she, along with children and grandkids, scrambled to secure their dogs in crates and grabbed important documents before they left.\u003c/p>\n\u003cp>The widower had leaned on her husband in past emergencies, and now she felt lost.\u003c/p>\n\u003cp>“I did feel helpless,” Santiago said. “I figured I’m the head of the household; I should know what to do. But I didn’t know.”\u003c/p>\n\u003cfigure id=\"attachment_12023226\" class=\"wp-caption aligncenter\" style=\"max-width: 2048px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12023226\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-02-3840-copy.jpg\" alt=\"\" width=\"2048\" height=\"1365\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-02-3840-copy.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-02-3840-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-02-3840-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-02-3840-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-02-3840-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/California-fires-Pasadena-02-3840-copy-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2048px) 100vw, 2048px\">\u003cfigcaption class=\"wp-caption-text\">Elaine Santiago had been celebrating her 78th birthday with family when she fled her home in the small city of Sierra Madre, east of Pasadena, on the night of Jan. 7. She drew comfort from being at the evacuation site. ‘It sort of gives me a sense of peace at times,” she says. “Maybe that’s weird. We’re all experiencing this together.’ \u003ccite>(Molly Castle Work/KFF Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Donny McCullough, who sat on a neighboring green cot draped in a Red Cross blanket, had fled his Pasadena home with his family early on the morning of Jan. 8. Without power at home, the 68-year-old stayed up listening for updates on a battery-powered radio. His eyes remained red from smoke irritation hours later.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“I had my wife and two daughters, and I was trying not to show fear, so I quietly, inside, was like, ‘Oh my God,’” said McCullough, a music producer and writer. “I’m driving away, looking at the house, wondering if it’s going to be the last time I’m going to see it.”\u003c/p>\n\u003cp>He saved his master recording from a seven-year music project, but he left behind his studio with all his other work from a four-decade career in music.\u003c/p>\n\u003cp>Not all evacuees arrived with family. Some came searching for loved ones. That’s one of the hardest parts of his shift, Ramirez said. The community outreach worker helped walk people around the building, cot by cot.\u003c/p>\n\u003cp>A week in, at least two dozen people had been killed in the wildfires.\u003c/p>\n\u003cp>The work takes a toll on disaster relief workers, too. Ramirez said many feared losing their homes in the fires and some already had. He attends therapy weekly, which he said helps him manage his emotions.\u003c/p>\n\u003cp>At the evacuation center, Ramirez described being on autopilot.\u003c/p>\n\u003cp>“Some of us react differently. I tend to go into fight mode,” Ramirez said. “I react. I run towards the fire. I run towards personal service. Then, once that passes, that’s when my trauma catches up with me.”\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Need help?\u003c/em>\u003c/strong> \u003cem>Los Angeles County residents in need of support can call the county’s mental health helpline at 1-800-854-7771. The national Suicide & Crisis Lifeline, 988, is also available for those who’d like to speak with someone confidentially, free of charge.\u003c/em>\u003c/p>\n\u003cp>\u003cem>This article was produced by \u003c/em>\u003ca href=\"https://kffhealthnews.org/about-us\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cem>KFF Health News\u003c/em>\u003c/a>\u003cem>, which publishes \u003c/em>\u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cem>California Healthline\u003c/em>\u003c/a>\u003cem>, an editorially independent service of the \u003c/em>\u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cem>California Health Care Foundation\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "3-things-that-folks-facing-los-angeles-fires-can-do-from-a-fellow-california-wildfire-survivor",
"title": "3 Things That Folks Facing Los Angeles Fires Can Do, From a Fellow California Wildfire Survivor",
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"headTitle": "3 Things That Folks Facing Los Angeles Fires Can Do, From a Fellow California Wildfire Survivor | KQED",
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"content": "\u003cp>The devastation brought on by the wildfires blazing through Los Angeles — ash-covered rubble, the air clouded in a smoky haze — is a scene that’s all too familiar to Jeff Okrepkie.\u003c/p>\n\u003cp>When the 2017 Tubbs Fire first spread into his community of Coffey Park in Santa Rosa, “an ember roughly the size of a golf ball hit the ground and rolled in front of my house, setting off other embers,” Okrepkie said. “And that’s when I was like, ‘All right, time to get out.’”\u003c/p>\n\u003cp>The Tubbs Fire is considered one of the most \u003ca href=\"https://34c031f8-c9fd-4018-8c5a-4159cdff6b0d-cdn-endpoint.azureedge.net/-/media/calfire-website/our-impact/fire-statistics/top20_destruction.pdf?rev=8d25d868e50f40aea60833642d65b449&hash=1DBAA251C9CC52EDC5AAEA2358158664\">destructive\u003c/a> wildfires in California history, destroying 5,600 structures, including around 5% of Santa Rosa’s housing stock. (The most destructive fire remains the 2018 Camp Fire that devastated the town of Paradise.)\u003c/p>\n\u003cp>Where the fires in Los Angeles fit in this grim record will likely take a while to work out. Multiple fires have burned over 35,000 acres, as of Friday morning, and have destroyed thousands of structures across several neighborhoods. At least 10 people have died.\u003c/p>\n\u003cfigure id=\"attachment_12021672\" class=\"wp-caption alignright\" style=\"max-width: 528px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-12021672\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/06WUNfLv-e1736558884543.jpg\" alt=\"A middle aged white male with graying hair and goatee beard smiles at the camera standing in a park on a sunny day, crossing his arms, and wearing a light blue and gray suit and an open button shirt with no tie.\" width=\"528\" height=\"688\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/06WUNfLv-e1736558884543.jpg 528w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/06WUNfLv-e1736558884543-160x208.jpg 160w\" sizes=\"auto, (max-width: 528px) 100vw, 528px\">\u003cfigcaption class=\"wp-caption-text\">Jeff Okrepkie. \u003ccite>(Courtesy of Jeff Okrepkie)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For many caught up in this disaster, they’re beginning to process the reality that they’ve lost their entire homes — an experience Okrepkie shares, too.\u003c/p>\n\u003cp>“One of the things that I always hated to hear was, ‘Well, it’s just stuff. And you have your lives, right?’” he said.\u003c/p>\n\u003cp>“Of course, having that is paramount to anything else. But it’s not just the physical object. It’s the memories that come with those — whether it be Christmas ornaments or baby pictures. “It is a long and difficult process and it is extremely emotional.”\u003c/p>\n\u003cp>For other Bay Area residents, like Crystal Johnson, the fires can serve as a reminder of how vulnerable Californians are to the threat of climate disasters. She’s originally from Redondo Beach and has been checking in with family and friends.\u003c/p>\n\u003cp>“Don’t wait. Get your important papers together, medications, you know, important contacts, information, all that kind of stuff. \u003ca href=\"https://www.kqed.org/news/11833686/what-to-pack-in-your-emergency-bag-with-covid-19-in-mind\">Have it ready to go so that if something happens\u003c/a>. Have a plan in place,” Johnson said.\u003c/p>\n\u003cp>In the long term, given the scale of destruction in Los Angeles, the road to recovery could take years. Okrepkie, who started a nonprofit to rebuild his community of Coffey Park in Santa Rosa, offered the following advice:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003ch2>\u003cstrong>‘Do not go through it alone’\u003c/strong>\u003c/h2>\n\u003cp>A wildfire can be a life-threatening event, taking a toll on people’s physical and emotional health.\u003c/p>\n\u003cp>According to a 2023 \u003ca href=\"https://www.mdpi.com/1660-4601/18/4/1487\">study\u003c/a> by researchers at the University of California, San Diego, “climate trauma” led to increased instances of chronic mental health problems, like post-traumatic stress disorder and depression.\u003c/p>\n\u003cp>If you know someone who needs help coping in the aftermath of the Los Angeles fires, here’s a \u003ca href=\"https://www.kqed.org/science/1928658/wildfires-reignite-old-trauma-for-survivors-of-last-octobers-devastation\">list\u003c/a> of what you can do.\u003c/p>\n\u003cp>For Okrepkie, he said one of the most helpful approaches was to seek support among others who’ve gone through a similar experience.\u003c/p>\n\u003cp>“Everyone’s method of going through this and coping with it is going to be different,” he said. “But I will say: Do not go through it alone. Find a group that you can go through this together with.”\u003c/p>\n\u003cp>Okrepkie said he’s seen the difference that a community working together can have, after seeing his nonprofit help to raise $1 million to rebuild Coffey Park. He said he was inspired to do this after seeing misinformation on social media about rebuilding — a dynamic that he sees similarly playing out with the Los Angeles fires currently.\u003c/p>\n\u003ch2>\u003cstrong>‘It takes patience’\u003c/strong>\u003c/h2>\n\u003cp>The long-term financial impacts of major wildfires can take years to resolve.\u003c/p>\n\u003cp>“The responses that are needed — whether it be more firefighting resources to information to funds for those that have lost everything — never ceases,” said Okrepkie. “So it’s not just helping them in the first couple of days after. It’s going to be an ongoing thing for weeks, months and likely years.”[aside label=\"Related Stories\" postID=\"news_12021019,news_12021150,news_12021308\"]Damage from the Tubbs Fires is estimated at over $10 billion, according to one consulting \u003ca href=\"https://vertexeng.com/insights/economic-fallout-of-tubbs-wildfire-santa-rosa/\">group\u003c/a> involved in California wildfire response.\u003c/p>\n\u003cp>Okrepkie, an insurance agent, said the best thing to do is be patient. He moved back into his new rebuilt home in 2020, around three years after Tubbs Fire burned down his home. He said he’s happy his family is cared for and back in their home neighborhood of Coffey Park.\u003c/p>\n\u003cp>“I know that there is a natural urge to get back into your home and want to do it as quickly as possible. But it’s going to take patience because everybody is going to be learning for the first time — or relearning — things,” he said.\u003c/p>\n\u003ch2>\u003cstrong>Where to begin with the insurance claims?\u003c/strong>\u003c/h2>\n\u003cp>Okrepkie himself said he had no fewer than nine insurance adjusters to sort out all his claims.\u003c/p>\n\u003cp>He has the following advice to get started:\u003c/p>\n\u003cul>\n\u003cli>Document everything. “Do not agree to anything over the phone,” he said.\u003c/li>\n\u003cli>Follow up phone conversations over email to confirm the verbal exchange.\u003c/li>\n\u003cli>Accept that the process is complex. Disaster adjusters, typically working out of state, may be reassigned throughout the process — and an adjustor is assigned to a specific line of coverage, from property to additional living expenses. “In case adjuster A leaves and an adjuster B comes in and it’s not documented on their end, you can show them ‘This is what was discussed and this is what was agreed to.’”\u003c/li>\n\u003c/ul>\n\u003cp>An additional complication is that in recent years, \u003ca href=\"https://www.kqed.org/science/1985175/insurance-in-california-is-changing-heres-how-it-may-affect-you\">insurance companies have pulled back from homeowner policies in California\u003c/a>. As for the fires in Los Angeles, there are concerns that the damage could \u003ca href=\"https://www.kqed.org/news/12021019/la-fires-threaten-california-insurance-market-stability-housing-costs\">overextend\u003c/a> the state’s FAIR Plan — the state’s insurer of last resort.\u003c/p>\n\u003cp>You can find more details on navigating insurance claims and wildfires \u003ca href=\"https://laist.com/news/housing-homelessness/cheat-sheet-what-to-do-if-you-need-to-make-a-fire-insurance-claim\">here\u003c/a>.\u003c/p>\n\u003cp>\u003cem>Farida Jhabvala Romero and Brian Watt contributed to this report.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The devastation brought on by the wildfires blazing through Los Angeles — ash-covered rubble, the air clouded in a smoky haze — is a scene that’s all too familiar to Jeff Okrepkie.\u003c/p>\n\u003cp>When the 2017 Tubbs Fire first spread into his community of Coffey Park in Santa Rosa, “an ember roughly the size of a golf ball hit the ground and rolled in front of my house, setting off other embers,” Okrepkie said. “And that’s when I was like, ‘All right, time to get out.’”\u003c/p>\n\u003cp>The Tubbs Fire is considered one of the most \u003ca href=\"https://34c031f8-c9fd-4018-8c5a-4159cdff6b0d-cdn-endpoint.azureedge.net/-/media/calfire-website/our-impact/fire-statistics/top20_destruction.pdf?rev=8d25d868e50f40aea60833642d65b449&hash=1DBAA251C9CC52EDC5AAEA2358158664\">destructive\u003c/a> wildfires in California history, destroying 5,600 structures, including around 5% of Santa Rosa’s housing stock. (The most destructive fire remains the 2018 Camp Fire that devastated the town of Paradise.)\u003c/p>\n\u003cp>Where the fires in Los Angeles fit in this grim record will likely take a while to work out. Multiple fires have burned over 35,000 acres, as of Friday morning, and have destroyed thousands of structures across several neighborhoods. At least 10 people have died.\u003c/p>\n\u003cfigure id=\"attachment_12021672\" class=\"wp-caption alignright\" style=\"max-width: 528px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-12021672\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/06WUNfLv-e1736558884543.jpg\" alt=\"A middle aged white male with graying hair and goatee beard smiles at the camera standing in a park on a sunny day, crossing his arms, and wearing a light blue and gray suit and an open button shirt with no tie.\" width=\"528\" height=\"688\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/06WUNfLv-e1736558884543.jpg 528w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/01/06WUNfLv-e1736558884543-160x208.jpg 160w\" sizes=\"auto, (max-width: 528px) 100vw, 528px\">\u003cfigcaption class=\"wp-caption-text\">Jeff Okrepkie. \u003ccite>(Courtesy of Jeff Okrepkie)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For many caught up in this disaster, they’re beginning to process the reality that they’ve lost their entire homes — an experience Okrepkie shares, too.\u003c/p>\n\u003cp>“One of the things that I always hated to hear was, ‘Well, it’s just stuff. And you have your lives, right?’” he said.\u003c/p>\n\u003cp>“Of course, having that is paramount to anything else. But it’s not just the physical object. It’s the memories that come with those — whether it be Christmas ornaments or baby pictures. “It is a long and difficult process and it is extremely emotional.”\u003c/p>\n\u003cp>For other Bay Area residents, like Crystal Johnson, the fires can serve as a reminder of how vulnerable Californians are to the threat of climate disasters. She’s originally from Redondo Beach and has been checking in with family and friends.\u003c/p>\n\u003cp>“Don’t wait. Get your important papers together, medications, you know, important contacts, information, all that kind of stuff. \u003ca href=\"https://www.kqed.org/news/11833686/what-to-pack-in-your-emergency-bag-with-covid-19-in-mind\">Have it ready to go so that if something happens\u003c/a>. Have a plan in place,” Johnson said.\u003c/p>\n\u003cp>In the long term, given the scale of destruction in Los Angeles, the road to recovery could take years. Okrepkie, who started a nonprofit to rebuild his community of Coffey Park in Santa Rosa, offered the following advice:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch2>\u003cstrong>‘Do not go through it alone’\u003c/strong>\u003c/h2>\n\u003cp>A wildfire can be a life-threatening event, taking a toll on people’s physical and emotional health.\u003c/p>\n\u003cp>According to a 2023 \u003ca href=\"https://www.mdpi.com/1660-4601/18/4/1487\">study\u003c/a> by researchers at the University of California, San Diego, “climate trauma” led to increased instances of chronic mental health problems, like post-traumatic stress disorder and depression.\u003c/p>\n\u003cp>If you know someone who needs help coping in the aftermath of the Los Angeles fires, here’s a \u003ca href=\"https://www.kqed.org/science/1928658/wildfires-reignite-old-trauma-for-survivors-of-last-octobers-devastation\">list\u003c/a> of what you can do.\u003c/p>\n\u003cp>For Okrepkie, he said one of the most helpful approaches was to seek support among others who’ve gone through a similar experience.\u003c/p>\n\u003cp>“Everyone’s method of going through this and coping with it is going to be different,” he said. “But I will say: Do not go through it alone. Find a group that you can go through this together with.”\u003c/p>\n\u003cp>Okrepkie said he’s seen the difference that a community working together can have, after seeing his nonprofit help to raise $1 million to rebuild Coffey Park. He said he was inspired to do this after seeing misinformation on social media about rebuilding — a dynamic that he sees similarly playing out with the Los Angeles fires currently.\u003c/p>\n\u003ch2>\u003cstrong>‘It takes patience’\u003c/strong>\u003c/h2>\n\u003cp>The long-term financial impacts of major wildfires can take years to resolve.\u003c/p>\n\u003cp>“The responses that are needed — whether it be more firefighting resources to information to funds for those that have lost everything — never ceases,” said Okrepkie. “So it’s not just helping them in the first couple of days after. It’s going to be an ongoing thing for weeks, months and likely years.”\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Damage from the Tubbs Fires is estimated at over $10 billion, according to one consulting \u003ca href=\"https://vertexeng.com/insights/economic-fallout-of-tubbs-wildfire-santa-rosa/\">group\u003c/a> involved in California wildfire response.\u003c/p>\n\u003cp>Okrepkie, an insurance agent, said the best thing to do is be patient. He moved back into his new rebuilt home in 2020, around three years after Tubbs Fire burned down his home. He said he’s happy his family is cared for and back in their home neighborhood of Coffey Park.\u003c/p>\n\u003cp>“I know that there is a natural urge to get back into your home and want to do it as quickly as possible. But it’s going to take patience because everybody is going to be learning for the first time — or relearning — things,” he said.\u003c/p>\n\u003ch2>\u003cstrong>Where to begin with the insurance claims?\u003c/strong>\u003c/h2>\n\u003cp>Okrepkie himself said he had no fewer than nine insurance adjusters to sort out all his claims.\u003c/p>\n\u003cp>He has the following advice to get started:\u003c/p>\n\u003cul>\n\u003cli>Document everything. “Do not agree to anything over the phone,” he said.\u003c/li>\n\u003cli>Follow up phone conversations over email to confirm the verbal exchange.\u003c/li>\n\u003cli>Accept that the process is complex. Disaster adjusters, typically working out of state, may be reassigned throughout the process — and an adjustor is assigned to a specific line of coverage, from property to additional living expenses. “In case adjuster A leaves and an adjuster B comes in and it’s not documented on their end, you can show them ‘This is what was discussed and this is what was agreed to.’”\u003c/li>\n\u003c/ul>\n\u003cp>An additional complication is that in recent years, \u003ca href=\"https://www.kqed.org/science/1985175/insurance-in-california-is-changing-heres-how-it-may-affect-you\">insurance companies have pulled back from homeowner policies in California\u003c/a>. As for the fires in Los Angeles, there are concerns that the damage could \u003ca href=\"https://www.kqed.org/news/12021019/la-fires-threaten-california-insurance-market-stability-housing-costs\">overextend\u003c/a> the state’s FAIR Plan — the state’s insurer of last resort.\u003c/p>\n\u003cp>You can find more details on navigating insurance claims and wildfires \u003ca href=\"https://laist.com/news/housing-homelessness/cheat-sheet-what-to-do-if-you-need-to-make-a-fire-insurance-claim\">here\u003c/a>.\u003c/p>\n\u003cp>\u003cem>Farida Jhabvala Romero and Brian Watt contributed to this report.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"slug": "california-bill-would-put-tobacco-like-warnings-social-media-apps",
"title": "California Bill Would Put Tobacco-Like Warnings on Social Media Apps",
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"content": "\u003cp>\u003cem>Updated 3:40 p.m. Monday\u003c/em>\u003c/p>\n\u003cp>Taking a cue from tobacco regulation, \u003ca href=\"https://www.kqed.org/news/tag/california\">California\u003c/a>’s attorney general wants to force social media companies to slap warning labels on their apps that clearly state the risks posed to kids and teens.\u003c/p>\n\u003cp>The proposal follows the advice of the U.S. surgeon general, who called earlier this year \u003ca href=\"https://www.kqed.org/news/11990672/us-surgeon-general-urges-congress-to-require-warning-labels-for-social-media\">for Congress to mandate warning labels\u003c/a> on the federal level — a call that so far, lawmakers have not answered. Attorney General Rob Bonta and Orinda Assemblymember Rebecca Bauer-Kahan announced the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202520260AB56\">new legislation\u003c/a> at a Boys & Girls Club in San Francisco on Monday, alongside a family whose daughter died by suicide four months ago after becoming, as her mother Victoria Hinks said, obsessed with social media.\u003c/p>\n\u003cp>“She was hooked,” a tearful Hinks said of her 16-year-old, Alexandra. Hinks noted that she and her husband implemented all the advice of experts in terms of limiting Alexandra’s screen time, taking her phone away at night and using parental filters and controls.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We tried to pull her out. We took her door off the hinges. We tried to take her phone away at night, but it was like taking a drug away from an addict,” she said. “We set up TikTok’s so-called parental controls to limit Alexandra to one hour per day. It meant nothing.”\u003c/p>\n\u003cp>Bonta said social media companies know their products are addictive and harmful but have refused to make changes.\u003c/p>\n\u003cp>The proposed California label would read: “The Surgeon General has advised that there are ample indicators that social media can have a profound risk of harm to the mental health and well-being of children and adolescents.”\u003c/p>\n\u003cp>[aside postID=news_11999273 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/TikTokGetty-1020x706.jpg']\u003c/p>\n\u003cp>Adolescents who spend more than three hours a day on social media are twice as likely to experience depression and anxiety, Bonta noted. He said if Congress won’t act, California should.\u003c/p>\n\u003cp>“Let’s be clear. This isn’t theoretical. It’s not a study about what might be. This is about real children and teenagers, real families, real impacts on real lives,” he said, noting that many apps have algorithms that “purposely prey on the psychological and developmental vulnerabilities of young people to keep them hooked.”\u003c/p>\n\u003cp>Assemblymember Bauer-Kahan stressed that the government had taken steps for decades to force private industry to make their products safer — such as mandating seatbelts in cars, recalling tainted foods and putting warning labels on tobacco products. A mother of teenagers, Bauer-Kahan said tech companies have a “powerful profit motive” to keep people online.\u003c/p>\n\u003cp>“Our children are aware of the harms, but they feel trapped,” she said. “They feel afraid of being isolated. And they just can’t stop. The companies know this. They know the damage they’re doing. We’ve heard it from the folks inside these companies who have testified on the issue.”\u003c/p>\n\u003cp>Jim Steyer, founder and CEO of Common Sense Media, which is sponsoring the legislation, called this a “tobacco moment for the country,” harkening back to the debates over warning labels and other regulations for cigarette makers who knew their products caused cancer but did not tell the public.\u003c/p>\n\u003cp>It’s not the first foray by California into regulating social media apps. In September, Gov. Gavin Newsom signed \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=202320240SB976\">a bill\u003c/a> aimed at forcing social media companies to change their algorithms to \u003ca href=\"https://www.kqed.org/news/12005967/california-acts-to-protect-children-from-addictive-social-media\">make them less addictive to teens and children\u003c/a>. Bonta supported that law and has also \u003ca href=\"https://oag.ca.gov/news/press-releases/attorney-general-bonta-secures-court-decision-largely-denying-meta%E2%80%99s-attempt\">brought\u003c/a> several \u003ca href=\"https://oag.ca.gov/news/press-releases/attorney-general-bonta-files-lawsuit-against-meta-over-harms-youth-mental-health\">multi-state lawsuits \u003c/a>against social media companies, including Meta and \u003ca href=\"https://oag.ca.gov/news/press-releases/attorney-general-bonta-attorney-general-james-lead-coalition-suing-tiktok\">TikTok\u003c/a>.\u003c/p>\n\u003cp>He said the warning label won’t be a panacea but is part of a multi-pronged effort to address a public health crisis.\u003c/p>\n\u003cp>A spokesperson for Meta declined to comment on the pending legislation. TikTok did not immediately respond to a request for comment.\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Updated 3:40 p.m. Monday\u003c/em>\u003c/p>\n\u003cp>Taking a cue from tobacco regulation, \u003ca href=\"https://www.kqed.org/news/tag/california\">California\u003c/a>’s attorney general wants to force social media companies to slap warning labels on their apps that clearly state the risks posed to kids and teens.\u003c/p>\n\u003cp>The proposal follows the advice of the U.S. surgeon general, who called earlier this year \u003ca href=\"https://www.kqed.org/news/11990672/us-surgeon-general-urges-congress-to-require-warning-labels-for-social-media\">for Congress to mandate warning labels\u003c/a> on the federal level — a call that so far, lawmakers have not answered. Attorney General Rob Bonta and Orinda Assemblymember Rebecca Bauer-Kahan announced the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202520260AB56\">new legislation\u003c/a> at a Boys & Girls Club in San Francisco on Monday, alongside a family whose daughter died by suicide four months ago after becoming, as her mother Victoria Hinks said, obsessed with social media.\u003c/p>\n\u003cp>“She was hooked,” a tearful Hinks said of her 16-year-old, Alexandra. Hinks noted that she and her husband implemented all the advice of experts in terms of limiting Alexandra’s screen time, taking her phone away at night and using parental filters and controls.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We tried to pull her out. We took her door off the hinges. We tried to take her phone away at night, but it was like taking a drug away from an addict,” she said. “We set up TikTok’s so-called parental controls to limit Alexandra to one hour per day. It meant nothing.”\u003c/p>\n\u003cp>Bonta said social media companies know their products are addictive and harmful but have refused to make changes.\u003c/p>\n\u003cp>The proposed California label would read: “The Surgeon General has advised that there are ample indicators that social media can have a profound risk of harm to the mental health and well-being of children and adolescents.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Adolescents who spend more than three hours a day on social media are twice as likely to experience depression and anxiety, Bonta noted. He said if Congress won’t act, California should.\u003c/p>\n\u003cp>“Let’s be clear. This isn’t theoretical. It’s not a study about what might be. This is about real children and teenagers, real families, real impacts on real lives,” he said, noting that many apps have algorithms that “purposely prey on the psychological and developmental vulnerabilities of young people to keep them hooked.”\u003c/p>\n\u003cp>Assemblymember Bauer-Kahan stressed that the government had taken steps for decades to force private industry to make their products safer — such as mandating seatbelts in cars, recalling tainted foods and putting warning labels on tobacco products. A mother of teenagers, Bauer-Kahan said tech companies have a “powerful profit motive” to keep people online.\u003c/p>\n\u003cp>“Our children are aware of the harms, but they feel trapped,” she said. “They feel afraid of being isolated. And they just can’t stop. The companies know this. They know the damage they’re doing. We’ve heard it from the folks inside these companies who have testified on the issue.”\u003c/p>\n\u003cp>Jim Steyer, founder and CEO of Common Sense Media, which is sponsoring the legislation, called this a “tobacco moment for the country,” harkening back to the debates over warning labels and other regulations for cigarette makers who knew their products caused cancer but did not tell the public.\u003c/p>\n\u003cp>It’s not the first foray by California into regulating social media apps. In September, Gov. Gavin Newsom signed \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=202320240SB976\">a bill\u003c/a> aimed at forcing social media companies to change their algorithms to \u003ca href=\"https://www.kqed.org/news/12005967/california-acts-to-protect-children-from-addictive-social-media\">make them less addictive to teens and children\u003c/a>. Bonta supported that law and has also \u003ca href=\"https://oag.ca.gov/news/press-releases/attorney-general-bonta-secures-court-decision-largely-denying-meta%E2%80%99s-attempt\">brought\u003c/a> several \u003ca href=\"https://oag.ca.gov/news/press-releases/attorney-general-bonta-files-lawsuit-against-meta-over-harms-youth-mental-health\">multi-state lawsuits \u003c/a>against social media companies, including Meta and \u003ca href=\"https://oag.ca.gov/news/press-releases/attorney-general-bonta-attorney-general-james-lead-coalition-suing-tiktok\">TikTok\u003c/a>.\u003c/p>\n\u003cp>He said the warning label won’t be a panacea but is part of a multi-pronged effort to address a public health crisis.\u003c/p>\n\u003cp>A spokesperson for Meta declined to comment on the pending legislation. TikTok did not immediately respond to a request for comment.\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"content": "\u003cp>We’re almost there, folks. Two years of nonstop campaigning for the White House will finally come to a close this Tuesday, Nov. 5, on \u003ca href=\"https://www.kqed.org/news/12008419/ballot-drop-off-location-near-me-early-voting-site-election-2024\">Election Day\u003c/a>.\u003c/p>\n\u003cp>In 2023, the Pew Research Center found that \u003ca href=\"https://www.pewresearch.org/politics/2023/09/19/americans-dismal-views-of-the-nations-politics/\">65% of Americans say they always or often feel “exhausted” when thinking about politics\u003c/a>. And that was before all the dramatic twists and turns of 2024 that have given us the present circumstances: Vice President Kamala Harris and former president Donald Trump \u003ca href=\"https://www.nytimes.com/2024/10/25/us/politics/poll-harris-trump-times-siena.html\">deadlocked in the polls of every single swing state\u003c/a>, leaving even the most experienced political analysts with little clue of who will be the next president.\u003c/p>\n\u003cp>But besides election exhaustion, there are other feelings felt across the political spectrum, from anxiety and frustration to straight-up fear. Among many undocumented and mixed-status immigrant families, for example, there’s a lot of nervousness about Trump enacting what he calls “\u003ca href=\"https://www.youtube.com/watch?v=OtpORNvI26w\">the largest deportation program in American history\u003c/a>.” After the former president survived a public assassination attempt in July at a Pennsylvania campaign rally, a large number of his most ardent supporters \u003ca href=\"https://www.pbs.org/newshour/politics/after-the-assassination-attempt-against-trump-anger-and-anxiety-loom-over-the-republican-convention\">fear that Trump could be targeted again\u003c/a>. And as \u003ca href=\"https://www.kqed.org/news/12011576/what-do-young-voters-care-about-most-in-this-presidential-election\">millions of Gen Z Americans prepare to cast their votes for the first time\u003c/a>, many have shared \u003ca href=\"https://www.kqed.org/arts/13967133/charli-xcx-fans-election-2024-harris-trump\">their frustration that neither candidate may do enough to protect the lives of Palestinians in Gaza\u003c/a>.\u003c/p>\n\u003cp>If you’re feeling these big emotions, you’re not alone.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Let’s normalize [feeling] anxious because it is a very high-stakes election,” said Kelli McLean, a California marriage and family therapist who works on issues relating to trauma, anxiety and depression with her clients. “This is anxiety-provoking.”\u003c/p>\n\u003cp>“A lot of times when we’re feeling a certain type of way about something, it comes out in other ways we don’t expect,” said Ioanna Angelakis, a licensed marriage and family therapist based in San Francisco. “So it’s really important to be honest and truthful with yourself and others about what’s going on and to formulate a plan, so you have something to fall back on — should the worst thing happen.”\u003c/p>\n\u003cp>Keep reading for expert advice on the things you can do before, on and after Nov. 5 to help manage anxiety about the 2024 election.\u003c/p>\n\u003ch2>Try to consume less election news\u003c/h2>\n\u003cp>When something is very important to us, it’s normal for us to keep checking on it as much as we can. In a presidential election as unpredictable as this one, we may have the TV on all the time or be constantly checking social media to see if there’s any tiny piece of new information that will give us hope that things will “go our way.”\u003c/p>\n\u003cp>But seeking out this feeling of control — in a situation that frankly cannot be controlled by any one single individual — can lead to us feeling even more helpless, McClean said.\u003c/p>\n\u003cp>“There is a direct correlation between how much anxiety people are feeling to what they’re watching,” she said. “The election is everywhere, and people are inundating themselves with this. It’s information overload.”\u003c/p>\n\u003cp>[aside label=\"2024 Bay Area Voter Guide\" link1='https://www.kqed.org/voterguide/bayarea,Learn about every single race and measure across the nine Bay Area counties' hero=https://cdn.kqed.org/wp-content/uploads/sites/80/2024/02/Aside-Bay-Area-Voter-Guide-2024-Primary-Election-1200x1200-1.png]\u003c/p>\n\u003cp>One recommendation McLean has been sharing with her clients is to stay away from social media as much as they can — or as much as they can bear — for the next few days. “They’re limiting their exposure to these 24-hour news cycles, which can be anxiety-provoking for people,” she said.\u003c/p>\n\u003ch2>Remember, polls aren’t crystal balls\u003c/h2>\n\u003cp>In the \u003ca href=\"https://www.kqed.org/lowdown/3825/what-is-the-electoral-college-and-is-it-time-to-get-rid-of-it\">seven swing states that are key to winning the election\u003c/a>, polls have switched back and forth between a Trump lead and a Harris lead for weeks now. While you may look for any sliver of hope in new polls, keep in mind that most recent polls \u003ca href=\"https://www.cbsnews.com/news/harris-trump-poll-pennsylvania-29-10-2024/\">have only changed by 1 or 2 percentage points\u003c/a>, which is within a poll’s margin of error — the window of uncertainty your poll results may have. For example, in an \u003ca href=\"https://www.cbsnews.com/news/trump-harris-poll-gender-gap/\">Oct. 28 CBS News/YouGov poll of registered voters in Pennsylvania\u003c/a>, Harris and Trump are tied 49%–49%, but the margin of error is 2.6%.\u003c/p>\n\u003cp>Polls are, after all, surveys of smaller groups meant to reflect a larger population. While Harris and Trump are tied among the smaller group surveyed, that doesn’t mean that in all of Pennsylvania, there’s a perfect tie among those who plan to vote for Harris and Trump. The margin of error tells us that the candidates’ numbers could actually be a little higher or a little lower — within that 2.6% range.\u003c/p>\n\u003cp>All of this goes to say that it’s probably a good idea to limit how much we look at polls. Remember: the 2016 and 2020 elections delivered many electoral surprises that polls didn’t predict. Since then, \u003ca href=\"https://www.vox.com/2024-elections/370649/trust-polls-2016-2020-election-2024-pollster-polling-miss\">pollsters have refined their methods\u003c/a> — but even they say that polls are not “perfectly predictive.”\u003c/p>\n\u003cp>That’s why therapists like Angelakis are reminding their clients to accept the uncertainty in this major event and work from there. “The future is unpredictable and unknown — it’s a mystery,” she said. “All we can do is just stay grounded.”\u003c/p>\n\u003ch2>Enjoy the weekend before Election Day as much as you can\u003c/h2>\n\u003cp>Yes, the first Tuesday of November could be historic for the country. But let’s not forget that the first \u003cem>weekend\u003c/em> of November is quite special in its own right.\u003c/p>\n\u003cp>Diwali, the Hindu festival that celebrates light triumphing over darkness, \u003ca href=\"https://www.sfchronicle.com/entertainment/article/diwali-deepavali-hindu-festival-19854481.php\">begins this year in the early hours of Thursday, Oct. 31\u003c/a>, and lasts until the next morning. Halloween is also on Thursday — a perfect excuse for families and friends to get together ahead of the weekend.[aside postID=science_1995033 hero='https://cdn.kqed.org/wp-content/uploads/sites/35/2024/10/Claremont-Canyon-by-Fred-Rowe-East-Bay-Regional-Park-District-1020x574.jpg']\u003c/p>\n\u003cp>On Friday, Nov. 1 and Saturday, Nov. 2, \u003ca href=\"https://www.kqed.org/news/tag/dia-de-los-muertos\">Día de los Muertos\u003c/a> will be celebrated across California, with cities like \u003ca href=\"https://www.dayofthedeadsf.org/\">San Francisco\u003c/a>, \u003ca href=\"https://unitycouncil.org/program/diaoakland/\">Oakland\u003c/a>, \u003ca href=\"https://diasanjose.com/\">San José\u003c/a> and \u003ca href=\"https://boyleheightsbeat.com/your-guide-to-free-dia-de-los-muertos-events-on-the-eastside/\">Los Angeles \u003c/a>hosting community-led celebrations.\u003c/p>\n\u003cp>“Enjoy your weekend,” Angelakis said. “Don’t let these fears take you over because they’re just fears right now … they’re not your reality.”\u003c/p>\n\u003cp>Find \u003ca href=\"https://www.kqed.org/arts/13967439/merlin-the-pig-northern-california-animals-house-pig-mina-alali-davis\">some joyful things going on to distract you\u003c/a>, and most importantly, find ways to laugh with your loved ones, she recommended. Even try to “poke fun at your fears,” Angelakis said, “and you can let out steam that way.”\u003c/p>\n\u003cp>You can also read our guide to \u003ca href=\"https://www.kqed.org/science/1995033/12-bay-area-hikes-for-escaping-the-election-even-for-a-few-hours\">the outdoor spots in the Bay Area that might bring you a little calm and peace\u003c/a> in the run-up to Election Day and beyond.\u003c/p>\n\u003ch2>Parents and caregivers: Keep in mind the needs of your little ones\u003c/h2>\n\u003cp>Even if your family doesn’t talk too much about politics at the dinner table, there’s still a chance that your child may be hearing about the election from their friends or classmates. Whether they share this directly with you or not, they may be absorbing the anxiety of others around them.\u003c/p>\n\u003cp>“Kids are the spokespeople of their parents and their family’s fears,” Angelakis said. “When your child is acting out, or when your child is isolating, these are signs that your child is worried about something.”\u003c/p>\n\u003cp>This is when it’s very important to have \u003ca href=\"https://www.kqed.org/news/11764070/how-to-talk-with-kids-after-a-traumatic-event\">age-appropriate conversations about what’s happening out in the world\u003c/a>, McLean said.\u003c/p>\n\u003cp>[aside postID=news_11764070]“If you’re dealing with a small child, know that a lot of this is too much for them to fully take in, and it can be traumatizing,” she said. “You can explain to them the process without going into scary details: ‘Two people are competing and they have different beliefs. People can get very mad and nervous about it. But you’re still going to be safe in this home with your parents.’”\u003c/p>\n\u003cp>“We don’t want to lie to them or over-promise, but just not expose them to things that are not appropriate on the news or social media,” McLean said.\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/mindshift/59143/war-crisis-tragedy-how-to-talk-with-kids-when-the-news-is-scary\">\u003cem>Read KQED’s bilingual guide on how to talk to kids during difficult or scary major moments.\u003c/em>\u003c/a>\u003c/p>\n\u003ch2>Watch your anxiety levels on Election Day itself …\u003c/h2>\n\u003cp>It’s Nov. 5. You — or those around — have already voted. And results of the presidential election start coming in at 5 p.m. Pacific Time, when the polls close on the East Coast.\u003c/p>\n\u003cp>Every major TV network will have nonstop coverage of the results throughout the night, and it’s very likely that most restaurants, bars and community spaces with a television will be showing this coverage. But remember: you can choose how much of this coverage you consume.\u003c/p>\n\u003cp>If you know that waiting hours into the early morning for the results of each swing state — which just a few thousand votes could decide — will really set your anxiety spiraling, take breaks from watching. What might be even better for you is making a plan with family or friends to do something completely different on Nov. 5.\u003c/p>\n\u003cp>Regardless of how much (or little) news you consume on Tuesday, remember: there will still be results at the end of the vote count — which could take days, like it did in 2020.\u003c/p>\n\u003ch2>… and focus on your breathing\u003c/h2>\n\u003cp>Another strategy that Angelakis recommends is giving yourself time for breathing exercises.\u003c/p>\n\u003cp>“Take two breaths in and one breath out,” she said, adding that you can do as many of these exercises until you start feeling a little more grounded.\u003c/p>\n\u003cp>“If you try that breathing, it feels really good,” Angelakis said. “It calms your nervous system down.”\u003c/p>\n\u003cp>She especially recommends doing these breathing exercises if anxious thoughts start coming in throughout Election Night. When you feel these thoughts rising, “visualize the best possible outcome in a day of your life,” she said, “from every last detail that you wake up until the moment you go to bed at night.”\u003c/p>\n\u003cp>Why: By bringing back our focus to our own lives and our own actions, we remind ourselves what is in our own control — and let go of worries about things out of our control.\u003c/p>\n\u003ch2>Don’t forget the power you have in your own community\u003c/h2>\n\u003cp>The results of this general election will not impact everyone equally — and this is true far beyond the presidential race.\u003c/p>\n\u003cp>When talking to folks from communities that are most vulnerable to policy shifts, McLean hears how folks sometimes feel disconnected from the decisions happening in Washington, D.C. “They feel powerless,” she said.\u003c/p>\n\u003cp>But ultimately, “we are not powerless,” McClean said. “Getting involved in grassroots activism, something local in your own community, can help with these feelings of powerlessness.”\u003c/p>\n\u003cp>[aside label='More Election Coverage' tag='election-2024']And remember that even if you can’t vote — whether it’s because of your immigration status, \u003ca href=\"https://www.kqed.org/news/12009162/election-2024-what-are-the-voting-rights-of-current-and-formerly-incarcerated-californians\">criminal record\u003c/a> or age — you still have a lot of power. In the Bay Area, for example, the labor rights organization \u003ca href=\"https://www.tuwu.org/about\">Trabajadores Unidos Workers United\u003c/a> (TUWU) has helped undocumented workers organize themselves for years to demand and gain higher wages, \u003ca href=\"https://www.kqed.org/news/11946661/ive-been-contributing-undocumented-workers-are-key-to-californias-economy-a-new-bill-would-give-them-unemployment-benefits\">labor protections\u003c/a> and \u003ca href=\"https://www.kqed.org/news/12005037/sf-proposes-relief-fund-to-aid-wage-theft-victims-left-unpaid-by-employers\">social services\u003c/a> at the local and state level.\u003c/p>\n\u003cp>“These are multi-year fights. They don’t happen overnight,” said Samuel Romero, organizing director of TUWU. “So many of these things wouldn’t have been able to pass without the support of the community that we organize with, the majority being folks that aren’t even eligible to vote.”\u003c/p>\n\u003cp>And as you work with your community to make change, don’t forget that a big part of that is also what happens in your home. “It is a huge election, and there is a lot at stake,” McClean said. “But it is important for people to ground themselves in their own lives and really take care of themselves first.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>We’re almost there, folks. Two years of nonstop campaigning for the White House will finally come to a close this Tuesday, Nov. 5, on \u003ca href=\"https://www.kqed.org/news/12008419/ballot-drop-off-location-near-me-early-voting-site-election-2024\">Election Day\u003c/a>.\u003c/p>\n\u003cp>In 2023, the Pew Research Center found that \u003ca href=\"https://www.pewresearch.org/politics/2023/09/19/americans-dismal-views-of-the-nations-politics/\">65% of Americans say they always or often feel “exhausted” when thinking about politics\u003c/a>. And that was before all the dramatic twists and turns of 2024 that have given us the present circumstances: Vice President Kamala Harris and former president Donald Trump \u003ca href=\"https://www.nytimes.com/2024/10/25/us/politics/poll-harris-trump-times-siena.html\">deadlocked in the polls of every single swing state\u003c/a>, leaving even the most experienced political analysts with little clue of who will be the next president.\u003c/p>\n\u003cp>But besides election exhaustion, there are other feelings felt across the political spectrum, from anxiety and frustration to straight-up fear. Among many undocumented and mixed-status immigrant families, for example, there’s a lot of nervousness about Trump enacting what he calls “\u003ca href=\"https://www.youtube.com/watch?v=OtpORNvI26w\">the largest deportation program in American history\u003c/a>.” After the former president survived a public assassination attempt in July at a Pennsylvania campaign rally, a large number of his most ardent supporters \u003ca href=\"https://www.pbs.org/newshour/politics/after-the-assassination-attempt-against-trump-anger-and-anxiety-loom-over-the-republican-convention\">fear that Trump could be targeted again\u003c/a>. And as \u003ca href=\"https://www.kqed.org/news/12011576/what-do-young-voters-care-about-most-in-this-presidential-election\">millions of Gen Z Americans prepare to cast their votes for the first time\u003c/a>, many have shared \u003ca href=\"https://www.kqed.org/arts/13967133/charli-xcx-fans-election-2024-harris-trump\">their frustration that neither candidate may do enough to protect the lives of Palestinians in Gaza\u003c/a>.\u003c/p>\n\u003cp>If you’re feeling these big emotions, you’re not alone.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Let’s normalize [feeling] anxious because it is a very high-stakes election,” said Kelli McLean, a California marriage and family therapist who works on issues relating to trauma, anxiety and depression with her clients. “This is anxiety-provoking.”\u003c/p>\n\u003cp>“A lot of times when we’re feeling a certain type of way about something, it comes out in other ways we don’t expect,” said Ioanna Angelakis, a licensed marriage and family therapist based in San Francisco. “So it’s really important to be honest and truthful with yourself and others about what’s going on and to formulate a plan, so you have something to fall back on — should the worst thing happen.”\u003c/p>\n\u003cp>Keep reading for expert advice on the things you can do before, on and after Nov. 5 to help manage anxiety about the 2024 election.\u003c/p>\n\u003ch2>Try to consume less election news\u003c/h2>\n\u003cp>When something is very important to us, it’s normal for us to keep checking on it as much as we can. In a presidential election as unpredictable as this one, we may have the TV on all the time or be constantly checking social media to see if there’s any tiny piece of new information that will give us hope that things will “go our way.”\u003c/p>\n\u003cp>But seeking out this feeling of control — in a situation that frankly cannot be controlled by any one single individual — can lead to us feeling even more helpless, McClean said.\u003c/p>\n\u003cp>“There is a direct correlation between how much anxiety people are feeling to what they’re watching,” she said. “The election is everywhere, and people are inundating themselves with this. It’s information overload.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One recommendation McLean has been sharing with her clients is to stay away from social media as much as they can — or as much as they can bear — for the next few days. “They’re limiting their exposure to these 24-hour news cycles, which can be anxiety-provoking for people,” she said.\u003c/p>\n\u003ch2>Remember, polls aren’t crystal balls\u003c/h2>\n\u003cp>In the \u003ca href=\"https://www.kqed.org/lowdown/3825/what-is-the-electoral-college-and-is-it-time-to-get-rid-of-it\">seven swing states that are key to winning the election\u003c/a>, polls have switched back and forth between a Trump lead and a Harris lead for weeks now. While you may look for any sliver of hope in new polls, keep in mind that most recent polls \u003ca href=\"https://www.cbsnews.com/news/harris-trump-poll-pennsylvania-29-10-2024/\">have only changed by 1 or 2 percentage points\u003c/a>, which is within a poll’s margin of error — the window of uncertainty your poll results may have. For example, in an \u003ca href=\"https://www.cbsnews.com/news/trump-harris-poll-gender-gap/\">Oct. 28 CBS News/YouGov poll of registered voters in Pennsylvania\u003c/a>, Harris and Trump are tied 49%–49%, but the margin of error is 2.6%.\u003c/p>\n\u003cp>Polls are, after all, surveys of smaller groups meant to reflect a larger population. While Harris and Trump are tied among the smaller group surveyed, that doesn’t mean that in all of Pennsylvania, there’s a perfect tie among those who plan to vote for Harris and Trump. The margin of error tells us that the candidates’ numbers could actually be a little higher or a little lower — within that 2.6% range.\u003c/p>\n\u003cp>All of this goes to say that it’s probably a good idea to limit how much we look at polls. Remember: the 2016 and 2020 elections delivered many electoral surprises that polls didn’t predict. Since then, \u003ca href=\"https://www.vox.com/2024-elections/370649/trust-polls-2016-2020-election-2024-pollster-polling-miss\">pollsters have refined their methods\u003c/a> — but even they say that polls are not “perfectly predictive.”\u003c/p>\n\u003cp>That’s why therapists like Angelakis are reminding their clients to accept the uncertainty in this major event and work from there. “The future is unpredictable and unknown — it’s a mystery,” she said. “All we can do is just stay grounded.”\u003c/p>\n\u003ch2>Enjoy the weekend before Election Day as much as you can\u003c/h2>\n\u003cp>Yes, the first Tuesday of November could be historic for the country. But let’s not forget that the first \u003cem>weekend\u003c/em> of November is quite special in its own right.\u003c/p>\n\u003cp>Diwali, the Hindu festival that celebrates light triumphing over darkness, \u003ca href=\"https://www.sfchronicle.com/entertainment/article/diwali-deepavali-hindu-festival-19854481.php\">begins this year in the early hours of Thursday, Oct. 31\u003c/a>, and lasts until the next morning. Halloween is also on Thursday — a perfect excuse for families and friends to get together ahead of the weekend.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>On Friday, Nov. 1 and Saturday, Nov. 2, \u003ca href=\"https://www.kqed.org/news/tag/dia-de-los-muertos\">Día de los Muertos\u003c/a> will be celebrated across California, with cities like \u003ca href=\"https://www.dayofthedeadsf.org/\">San Francisco\u003c/a>, \u003ca href=\"https://unitycouncil.org/program/diaoakland/\">Oakland\u003c/a>, \u003ca href=\"https://diasanjose.com/\">San José\u003c/a> and \u003ca href=\"https://boyleheightsbeat.com/your-guide-to-free-dia-de-los-muertos-events-on-the-eastside/\">Los Angeles \u003c/a>hosting community-led celebrations.\u003c/p>\n\u003cp>“Enjoy your weekend,” Angelakis said. “Don’t let these fears take you over because they’re just fears right now … they’re not your reality.”\u003c/p>\n\u003cp>Find \u003ca href=\"https://www.kqed.org/arts/13967439/merlin-the-pig-northern-california-animals-house-pig-mina-alali-davis\">some joyful things going on to distract you\u003c/a>, and most importantly, find ways to laugh with your loved ones, she recommended. Even try to “poke fun at your fears,” Angelakis said, “and you can let out steam that way.”\u003c/p>\n\u003cp>You can also read our guide to \u003ca href=\"https://www.kqed.org/science/1995033/12-bay-area-hikes-for-escaping-the-election-even-for-a-few-hours\">the outdoor spots in the Bay Area that might bring you a little calm and peace\u003c/a> in the run-up to Election Day and beyond.\u003c/p>\n\u003ch2>Parents and caregivers: Keep in mind the needs of your little ones\u003c/h2>\n\u003cp>Even if your family doesn’t talk too much about politics at the dinner table, there’s still a chance that your child may be hearing about the election from their friends or classmates. Whether they share this directly with you or not, they may be absorbing the anxiety of others around them.\u003c/p>\n\u003cp>“Kids are the spokespeople of their parents and their family’s fears,” Angelakis said. “When your child is acting out, or when your child is isolating, these are signs that your child is worried about something.”\u003c/p>\n\u003cp>This is when it’s very important to have \u003ca href=\"https://www.kqed.org/news/11764070/how-to-talk-with-kids-after-a-traumatic-event\">age-appropriate conversations about what’s happening out in the world\u003c/a>, McLean said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“If you’re dealing with a small child, know that a lot of this is too much for them to fully take in, and it can be traumatizing,” she said. “You can explain to them the process without going into scary details: ‘Two people are competing and they have different beliefs. People can get very mad and nervous about it. But you’re still going to be safe in this home with your parents.’”\u003c/p>\n\u003cp>“We don’t want to lie to them or over-promise, but just not expose them to things that are not appropriate on the news or social media,” McLean said.\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/mindshift/59143/war-crisis-tragedy-how-to-talk-with-kids-when-the-news-is-scary\">\u003cem>Read KQED’s bilingual guide on how to talk to kids during difficult or scary major moments.\u003c/em>\u003c/a>\u003c/p>\n\u003ch2>Watch your anxiety levels on Election Day itself …\u003c/h2>\n\u003cp>It’s Nov. 5. You — or those around — have already voted. And results of the presidential election start coming in at 5 p.m. Pacific Time, when the polls close on the East Coast.\u003c/p>\n\u003cp>Every major TV network will have nonstop coverage of the results throughout the night, and it’s very likely that most restaurants, bars and community spaces with a television will be showing this coverage. But remember: you can choose how much of this coverage you consume.\u003c/p>\n\u003cp>If you know that waiting hours into the early morning for the results of each swing state — which just a few thousand votes could decide — will really set your anxiety spiraling, take breaks from watching. What might be even better for you is making a plan with family or friends to do something completely different on Nov. 5.\u003c/p>\n\u003cp>Regardless of how much (or little) news you consume on Tuesday, remember: there will still be results at the end of the vote count — which could take days, like it did in 2020.\u003c/p>\n\u003ch2>… and focus on your breathing\u003c/h2>\n\u003cp>Another strategy that Angelakis recommends is giving yourself time for breathing exercises.\u003c/p>\n\u003cp>“Take two breaths in and one breath out,” she said, adding that you can do as many of these exercises until you start feeling a little more grounded.\u003c/p>\n\u003cp>“If you try that breathing, it feels really good,” Angelakis said. “It calms your nervous system down.”\u003c/p>\n\u003cp>She especially recommends doing these breathing exercises if anxious thoughts start coming in throughout Election Night. When you feel these thoughts rising, “visualize the best possible outcome in a day of your life,” she said, “from every last detail that you wake up until the moment you go to bed at night.”\u003c/p>\n\u003cp>Why: By bringing back our focus to our own lives and our own actions, we remind ourselves what is in our own control — and let go of worries about things out of our control.\u003c/p>\n\u003ch2>Don’t forget the power you have in your own community\u003c/h2>\n\u003cp>The results of this general election will not impact everyone equally — and this is true far beyond the presidential race.\u003c/p>\n\u003cp>When talking to folks from communities that are most vulnerable to policy shifts, McLean hears how folks sometimes feel disconnected from the decisions happening in Washington, D.C. “They feel powerless,” she said.\u003c/p>\n\u003cp>But ultimately, “we are not powerless,” McClean said. “Getting involved in grassroots activism, something local in your own community, can help with these feelings of powerlessness.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>And remember that even if you can’t vote — whether it’s because of your immigration status, \u003ca href=\"https://www.kqed.org/news/12009162/election-2024-what-are-the-voting-rights-of-current-and-formerly-incarcerated-californians\">criminal record\u003c/a> or age — you still have a lot of power. In the Bay Area, for example, the labor rights organization \u003ca href=\"https://www.tuwu.org/about\">Trabajadores Unidos Workers United\u003c/a> (TUWU) has helped undocumented workers organize themselves for years to demand and gain higher wages, \u003ca href=\"https://www.kqed.org/news/11946661/ive-been-contributing-undocumented-workers-are-key-to-californias-economy-a-new-bill-would-give-them-unemployment-benefits\">labor protections\u003c/a> and \u003ca href=\"https://www.kqed.org/news/12005037/sf-proposes-relief-fund-to-aid-wage-theft-victims-left-unpaid-by-employers\">social services\u003c/a> at the local and state level.\u003c/p>\n\u003cp>“These are multi-year fights. They don’t happen overnight,” said Samuel Romero, organizing director of TUWU. “So many of these things wouldn’t have been able to pass without the support of the community that we organize with, the majority being folks that aren’t even eligible to vote.”\u003c/p>\n\u003cp>And as you work with your community to make change, don’t forget that a big part of that is also what happens in your home. “It is a huge election, and there is a lot at stake,” McClean said. “But it is important for people to ground themselves in their own lives and really take care of themselves first.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>More than 2,400 Kaiser Permanente mental health care workers in Southern California began a strike this morning and established picket lines at locations from Los Angeles to San Diego, marking the second strike among Kaiser therapists in a little more than two years.\u003c/p>\n\u003cp>Mental health workers represented by the National Union of Healthcare Workers prepared for the strike over the weekend after declining Kaiser’s terms on Friday.\u003c/p>\n\u003cp>Kaiser, in a written statement, said it is notifying patients whose appointments could be affected by the strike. “Patients will have the opportunity to be seen by another professional in our extensive network of highly qualified, licensed therapists if their regular provider is engaged in a strike,” the statement read.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/health/2022/08/kaiser-mental-health-worker-strike/\" target=\"_blank\" rel=\"noreferrer noopener\">The previous strike in 2022\u003c/a> among mental health clinicians in Northern California lasted 10 weeks and led to a commitment from \u003ca href=\"https://nuhw.org/northern-california-kaiser-therapists-win-major-gains-as-strike-concludes/\" target=\"_blank\" rel=\"noreferrer noopener\">Kaiser to hire more therapists\u003c/a> and to give employees specific work hours away from face-to-face patient care.\u003c/p>\n\u003cp>Southern California Kaiser workers are now requesting more time between appointments to prepare for patients. They also want a wage increase and a pension benefit that the company provides to its Northern California clinicians.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s pretty simple,” said psychological social worker William Johnson, a union steward who serves on the bargaining committee. “We’re looking for the same three top priorities that Kaiser already said ‘Yes’ to for our Northern California mental healthcare workers.”\u003c/p>\n\u003cp>Johnson said his current workload includes seeing 32 to 35 patients a week in one-hour sessions.\u003c/p>\n\u003cp>Kaiser released a statement in response to the union’s plans to strike, saying, “Unfortunately, this comes as no surprise, as this seems to have been their intention all along.”\u003c/p>\n\u003cp>The company has offered wage increases amounting to 18% over four years and a number of other perks, according to the statement. Kaiser representatives said they have invested more than a billion dollars in expanding mental health capabilities in California and increased the number of licensed mental health clinicians in Southern California by 30% over the past four years.\u003c/p>\n\u003cp>However, union members say \u003ca href=\"https://calmatters.org/health/2024/10/kaiser-permanente-strike-mental-health/\" target=\"_blank\" rel=\"noreferrer noopener\">turnover has been a problem\u003c/a>, with a quarter of therapists hired between January 2021 and August 2024 leaving their jobs. [aside postID=\"news_11964377,news_11964043,news_11923034\" label=\"Related Stories\"]\u003c/p>\n\u003cp>“Kaiser leadership has consistently been dismissive whenever we voice our concerns or experiences,” Johnson said. “They like to tell us things like, ‘We get that it’s not ideal,’ and they also add, ‘But it works for us.’”\u003c/p>\n\u003cp>Jared Garcia, another union steward on the bargaining committee, said he’s hoping the strike lasts less than a month, but he’s prepared to see it go on as long as it takes.\u003c/p>\n\u003cp>“Scabs aren’t going to work,” Garcia said. “Kaiser knows the limitations of finding mental health professionals — let alone to replace 2,400 of our union members at this time.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A year ago, Kaiser entered into a \u003ca href=\"https://calmatters.org/health/2023/10/kaiser-permanente-california-behavioral-health-settlement/\" target=\"_blank\" rel=\"noreferrer noopener\">$200 million settlement agreement \u003c/a>with the state of California, agreeing to pay a $50 million fine and invest another $150 million over five years to address delays in behavioral health appointments.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>More than 2,400 Kaiser Permanente mental health care workers in Southern California began a strike this morning and established picket lines at locations from Los Angeles to San Diego, marking the second strike among Kaiser therapists in a little more than two years.\u003c/p>\n\u003cp>Mental health workers represented by the National Union of Healthcare Workers prepared for the strike over the weekend after declining Kaiser’s terms on Friday.\u003c/p>\n\u003cp>Kaiser, in a written statement, said it is notifying patients whose appointments could be affected by the strike. “Patients will have the opportunity to be seen by another professional in our extensive network of highly qualified, licensed therapists if their regular provider is engaged in a strike,” the statement read.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/health/2022/08/kaiser-mental-health-worker-strike/\" target=\"_blank\" rel=\"noreferrer noopener\">The previous strike in 2022\u003c/a> among mental health clinicians in Northern California lasted 10 weeks and led to a commitment from \u003ca href=\"https://nuhw.org/northern-california-kaiser-therapists-win-major-gains-as-strike-concludes/\" target=\"_blank\" rel=\"noreferrer noopener\">Kaiser to hire more therapists\u003c/a> and to give employees specific work hours away from face-to-face patient care.\u003c/p>\n\u003cp>Southern California Kaiser workers are now requesting more time between appointments to prepare for patients. They also want a wage increase and a pension benefit that the company provides to its Northern California clinicians.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s pretty simple,” said psychological social worker William Johnson, a union steward who serves on the bargaining committee. “We’re looking for the same three top priorities that Kaiser already said ‘Yes’ to for our Northern California mental healthcare workers.”\u003c/p>\n\u003cp>Johnson said his current workload includes seeing 32 to 35 patients a week in one-hour sessions.\u003c/p>\n\u003cp>Kaiser released a statement in response to the union’s plans to strike, saying, “Unfortunately, this comes as no surprise, as this seems to have been their intention all along.”\u003c/p>\n\u003cp>The company has offered wage increases amounting to 18% over four years and a number of other perks, according to the statement. Kaiser representatives said they have invested more than a billion dollars in expanding mental health capabilities in California and increased the number of licensed mental health clinicians in Southern California by 30% over the past four years.\u003c/p>\n\u003cp>However, union members say \u003ca href=\"https://calmatters.org/health/2024/10/kaiser-permanente-strike-mental-health/\" target=\"_blank\" rel=\"noreferrer noopener\">turnover has been a problem\u003c/a>, with a quarter of therapists hired between January 2021 and August 2024 leaving their jobs. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Kaiser leadership has consistently been dismissive whenever we voice our concerns or experiences,” Johnson said. “They like to tell us things like, ‘We get that it’s not ideal,’ and they also add, ‘But it works for us.’”\u003c/p>\n\u003cp>Jared Garcia, another union steward on the bargaining committee, said he’s hoping the strike lasts less than a month, but he’s prepared to see it go on as long as it takes.\u003c/p>\n\u003cp>“Scabs aren’t going to work,” Garcia said. “Kaiser knows the limitations of finding mental health professionals — let alone to replace 2,400 of our union members at this time.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A year ago, Kaiser entered into a \u003ca href=\"https://calmatters.org/health/2023/10/kaiser-permanente-california-behavioral-health-settlement/\" target=\"_blank\" rel=\"noreferrer noopener\">$200 million settlement agreement \u003c/a>with the state of California, agreeing to pay a $50 million fine and invest another $150 million over five years to address delays in behavioral health appointments.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "care-court-was-supposed-to-help-those-hardest-to-treat-heres-how-its-going",
"title": "CARE Court Was Supposed to Help Those Hardest to Treat. Here's How It's Going",
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"headTitle": "CARE Court Was Supposed to Help Those Hardest to Treat. Here’s How It’s Going | KQED",
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"content": "\u003cp>[dropcap]W[/dropcap]hen it rolled out last year in eight counties, CARE Court took aim at one of the state’s most vexing challenges: how to treat people whose illness often makes them believe they are not sick and who, if left untreated, can oscillate between jails, hospitals and homelessness.\u003c/p>\n\u003cp>Using the weight of a judge’s black robe to nudge county health departments’ doctors in white coats to provide an array of services, the program sought to reach the hardest-to-treat cases.\u003c/p>\n\u003cp>Now, a year after the program went live in seven counties — San Francisco, Glenn, Tuolumne, Stanislaus, Orange, Riverside, and San Diego — and ten months after it launched in Los Angeles County, petitions appear to be trickling in slower than expected and treatment plans are taking longer to put in place.\u003c/p>\n\u003cp>And, while Gov. Gavin Newsom, who first \u003ca href=\"https://www.gov.ca.gov/2022/03/03/governor-newsom-launches-new-plan-to-help-californians-struggling-with-mental-health-challenges-homelessness/\">introduced the initiative in March 2022\u003c/a>, initially said it would target those “living on our streets with severe mental health and substance use disorders,” the number of unhoused people going through the program varies widely from county to county.\u003c/p>\n\u003cfigure id=\"attachment_12005914\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12005914\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05.jpg\" alt=\"A white man wearing a suit stands at a podium with a microphone.\" width=\"2000\" height=\"1355\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-800x542.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-1020x691.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-160x108.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-1536x1041.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-1920x1301.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">California State Senator Thomas Umberg speaks before the Senate Judiciary Committee about SB1338, the Community Assistance, Recovery, and Empowerment (CARE) Court Program, on April 26, 2022, in Sacramento. \u003ccite>(Fred Greaves/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>State Sen. Tom Umberg, who co-authored the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB1338\">legislation\u003c/a> that implemented CARE Court, said the gradual rollout hasn’t come as a complete surprise.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We’re changing the culture here,” he said. “So, that takes a little time.”\u003c/p>\n\u003cp>As of mid-September, at least 692 petitions had been filed across seven of the counties in the first cohort, excluding San Francisco, according to data provided by superior court and county health officials. Of those petitions, a little more than a third, or 245, have been dismissed. And nearly one in five, or 121 petitions, have resulted in a CARE Agreement, an official document that details a voluntary treatment regime. There have been six court-ordered, or involuntary, CARE Plans issued.\u003c/p>\n\u003cp>San Francisco has so far received 42 petitions, said Melanie Kushnir, director of the Collaborative Justice Programs at the San Francisco Superior Courts. Of those, she said roughly half are active, meaning the participant is attending hearings and working toward or enrolled in a CARE Agreement. Citing privacy concerns, Kushnir declined to provide data on the exact number of dismissals or CARE Agreements reached but said there had been no CARE Plans issued.\u003c/p>\n\u003cp>The state had initially estimated that between 7,000 and 12,000 people would qualify for CARE Court each year once the program was fully implemented. But even accounting for the small number of counties that launched last year, court and public health officials agree the number of petitions is far fewer than expected — prompting opponents to argue the program is wasting taxpayers’ dollars.\u003c/p>\n\u003cp>According to the California Department of Finance, the state has already allocated $72 million to counties for start-up costs, along with $12 million for ongoing operations in fiscal year 2024–25, which will increase to $47 million in fiscal year 2026–27.\u003c/p>\n\u003cp>“We feel like the program has already failed,” said Samuel Jain, a senior mental health policy attorney at Disability Rights California, which is among the groups that advocated against CARE Court from the start. “The law doesn’t provide any new services and instead directs the limited resources we have to these expensive court processes.”\u003c/p>\n\u003cp>But supporters say it’s too early to pass judgment on a program that has yet to be fully implemented. The remaining 50 counties are due to open their own programs by Dec. 1.\u003c/p>\n\u003cp>“To really make some grand statement about its efficacy in the first 12 months of it rolling out, I think, is a leap for a state with 40 million people,” Dr. Mark Ghaly, the outgoing Secretary of California’s Health and Human Services Agency, told KQED. “But I do think that’s exactly the question that we have to keep in mind.”\u003c/p>\n\u003ch3>The number of petitions varies widely\u003c/h3>\n\u003cp>In Glenn County, with a population of \u003ca href=\"https://data.census.gov/profile/Glenn_County,_California?g=050XX00US06021\">around 29,000\u003c/a>, just one petition has been filed as of Sept. 12, and it was ultimately dismissed, said Chris Ruhl, executive officer of the Glenn County Superior Court. Ruhl expects one or two more may be submitted soon and that more will follow as word of the program spreads.\u003c/p>\n\u003cp>“We generally anticipate there will be an increase in the number of petitions and filings, but we don’t know that for sure,” he said. “We’ll be watching very closely.”\u003c/p>\n\u003cfigure id=\"attachment_12007228\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12007228\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed.jpg\" alt=\"A white man wearing a blue dress suit leans against a wooden divider in a court room.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Judge Michael Begert, presiding over CARE Court, stands in the San Francisco Superior Court in San Francisco on Sept. 17, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the other end of the spectrum is Los Angeles County, which, with a population of around \u003ca href=\"https://data.census.gov/profile/Los_Angeles_County,_California?g=050XX00US06037\">10 million\u003c/a>, has seen the most petitions: 268 as of Sept. 18. There, the number of petitions has been steadily increasing, Los Angeles Superior Court Judge Scott Herin said.\u003c/p>\n\u003cp>“I don’t think it started off like everybody expected, which was an overwhelming flood of cases,” Herin said, adding that the gradual ramp-up was perhaps “more healthy.”\u003c/p>\n\u003cp>That’s allowed some county behavioral health agencies to reappropriate staff assigned to CARE Court to other needs. In Stanislaus County, which has received 47 petitions, 19 of which have been dismissed, Behavioral Health & Recovery Services Director Tony Vartan said some of his CARE Court staff spent the first four to five months doing outreach with police and sheriff departments, hospital workers and others to build awareness.\u003c/p>\n\u003cp>“But as we saw that trend of those petitions, we pulled back some of our staff, and we assigned them to areas that needed more work,” he said. “Our staff emphasize where the cases are, regardless of what program we manage. That way, we make sure that the staff are working and they’ve got cases.”\u003c/p>\n\u003ch3>Cases dismissed\u003c/h3>\n\u003cp>Despite the lower-than-expected number of petitions, county behavioral health and court staff say they weren’t surprised to see that more than a third have been dismissed. Dismissal rates vary across the counties, from just over 90% in Tuolumne County, where 10 of 11 cases were dismissed, to a low of 26% in both Riverside and Los Angeles counties.\u003c/p>\n\u003cp>To be eligible, San Francisco Superior Court Judge Michael Begert said participants need to not only be diagnosed with schizophrenia or another psychotic disorder, but they also must be likely to benefit from services, can’t already be enrolled in services, and must be unlikely to survive without additional support.\u003c/p>\n\u003cp>“And that’s a small eye in a needle to thread,” Begert said.\u003c/p>\n\u003cp>Algenib Collin is trying to thread that needle as she looks for any program that might help for her daughter.\u003c/p>\n\u003cp>Collin applied for CARE Court the day it opened, she said, “I was so desperate.”\u003c/p>\n\u003cp>For roughly 18 months prior, she had seen her daughter, now 27, rapidly deteriorate on San Francisco’s streets. Collin said she would receive a call from the hospital nearly every other week, reporting her daughter had been placed on a 5150, or a temporary mental health hold, only to be rereleased back into homelessness and addiction.\u003c/p>\n\u003cfigure id=\"attachment_11955160\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11955160\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg\" alt=\"A large multi-story building and a driveway alongside it.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Orange County Superior Court will technically house the local CARE Court, though judges say they will more likely hold meetings with patients at a more neutral site, like a conference room at the county health office. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>High on fentanyl and possibly other drugs, Collin said her daughter would bang her head against the sidewalk or speak to herself in a language only she could understand.\u003c/p>\n\u003cp>“My daughter will die if she doesn’t get help,” Collin said. “Believe me.”\u003c/p>\n\u003cp>However, when it came to determining whether she qualified for CARE Court, the petition was rejected. Collin doesn’t know why, and she may never know. Privacy laws prohibit her from accessing her daughter’s medical records, so she isn’t sure whether her daughter has been formally diagnosed with a psychotic disorder.\u003c/p>\n\u003cp>The legislation doesn’t include any provision that gives petitioners the right to appeal a judge’s denial, though Ghaly said she could potentially refile the case.\u003c/p>\n\u003cp>“It’s frustrating,” Collin said. “I don’t want my daughter to die.”\u003c/p>\n\u003cp>Representatives from the San Francisco Public Health Department declined to be interviewed. Begert said he couldn’t comment on individual cases.\u003c/p>\n\u003cp>Ultimately, it’s up to the judge to hold public health departments accountable for providing appropriate care, Ghaly said, sharing an anecdote about how officials in San Diego frame the program: “They share with clients that CARE is an approach for the individual to … really get the black robe effect to hold the county accountable. And that’s exactly the way that we had hoped.”\u003c/p>\n\u003ch3>Breaking the pattern\u003c/h3>\n\u003cp>Collin’s experience, however, highlights a disconnect between the way the program was initially described — to, in Newsom’s words from 2022, “break the pattern that leaves people without hope and cycling repeatedly through homelessness and incarceration” — and what was actually written into legislation.\u003c/p>\n\u003cp>In the first year of the program’s rollout, success rates of getting people who are also experiencing homelessness into the program have varied. In Stanislaus County, for instance, Vartan said roughly 70% of the participants were unhoused before enrolling.\u003c/p>\n\u003cp>The opposite is true in Los Angeles and Riverside counties, where 30% and 20%–25% of enrollees are experiencing homelessness, respectively, health officials said. In Orange County, the figure is closer to 15%, according to Dr. Veronica Kelley, Director of the Orange County Health Care Agency.\u003c/p>\n\u003cfigure id=\"attachment_12007229\" class=\"wp-caption aligncenter\" style=\"max-width: 1024px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12007229\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398.jpg\" alt=\"A man sits next to three women at a table as he points to something.\" width=\"1024\" height=\"694\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398.jpg 1024w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398-800x542.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398-1020x691.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398-160x108.jpg 160w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Veronica Kelley, director of Behavioral Health Services for Orange County, right, listens as Orange County Superior Judge Ebrahim Baytieh speaks during a CARE court information session at Behavioral Health Training Center on Aug. 16, 2023, in Orange. The county’s behavioral health department and a representative from the public defender’s office is meeting with the public to explain what the CARE Act is. \u003ccite>(Gina Ferazzi / Los Angeles Times via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the former two counties, the majority of petitions have come from family members, health officials said. In Orange County, Kelley said the figure is closer to 40%.\u003c/p>\n\u003cp>Rather than view this as a failure to reach people who are living outside, Ghaly said he’s actually pleased to see the higher levels of petitions coming from family members on behalf of people who have housing, emphasizing that the goal was not to solve homelessness but to solve the problem of untreated mental illness “upstream.”\u003c/p>\n\u003cp>“It means that we’re getting to meet them earlier,” he said. “Almost anyone with severe schizophrenia or a psychotic disorder may be at risk of homelessness.”\u003c/p>\n\u003cp>But, Ghaly acknowledged that because eligibility is narrowly tailored, it may also mean, “We might not see the kind of outcomes that we wanted to see.”\u003c/p>\n\u003cp>Under the legislation, people whose primary diagnosis is a psychotic disorder are eligible for CARE Court, but those whose psychosis is primarily the result of using drugs are not. Asked whether the state would consider expanding eligibility to include cases of drug-induced psychosis, Ghaly said the question is a “fraught” one.\u003c/p>\n\u003cp>“If you ask most psychiatrists who take care of patients with these diagnoses and in largely these social circumstances, it’s really hard to tell what came first,” he said. “Was it the substance-use disorder that drove the psychosis? Or, were there underlying psychotic features to some disorder — maybe diagnosed, maybe not — that then drove the substance-use disorder?”\u003c/p>\n\u003cp>He continued, “Where the state lands at the moment is, there may be a very important population of people who have significant substance-use disorders and these other mental health conditions, who could benefit from CARE. And as we engage with our county partners and the practitioners who are in CARE, we’re asking exactly this question.”\u003c/p>\n\u003cp>But, even if someone doesn’t end up in CARE Court, health officials say they’re often referred to other programs within the county. And in Orange County, Kelley said 41 out of 95 petitions were dismissed because the client was already receiving services.\u003c/p>\n\u003cp>“And it would be unethical to remove them from that treatment and stick them over here in court and hope that that works better,” she said.\u003c/p>\n\u003cp>Ultimately, Ghaly said, that is also part of the point.\u003c/p>\n\u003cp>“It really is a group of people who didn’t go all the way down the CARE path, but because the CARE pathway was a potential, they got served and supported,” he said.\u003c/p>\n\u003ch3>Building trust\u003c/h3>\n\u003cp>For those who do qualify for CARE Court, the process to reach a voluntary treatment plan or CARE Agreement can be challenging, judges and health officials said. Just building enough trust to get someone to come into court can itself sometimes take two months, Kelley said.\u003c/p>\n\u003cp>“None of us would be open to a stranger coming up to us and telling us, ‘Come with me to court. I can help you,’” she said. “So, to believe that someone who’s severely impacted by a mental illness would be open to that doesn’t make any sense.” [aside postID=\"news_11955211,news_11952228,news_11924117\" label=\"Related Stories\"]\u003c/p>\n\u003cp>Kaitlyn Willison, an attorney with Legal Assistance to the Elderly in San Francisco who represents CARE Court participants, said the first step might involve combing the streets to search for people, which takes time. Once the person is found, the next hurdle is building trust.\u003c/p>\n\u003cp>“That means I need to see them two, three, four times before they go to court,” Willison said. “And the timelines just aren’t set up in a way that allows us as respondents’ counsel enough time to build that really precious trust that we need to best advocate for our clients.”\u003c/p>\n\u003cp>Umberg said he’s looking into further legislation or possible rule changes within the court system to address the challenges Willison and others have experienced so far.\u003c/p>\n\u003cp>But Jain, with Disability Rights California, is skeptical. One of those challenges is baked into the nature of the program itself, he said: that it has the potential to veer away from voluntary agreements and into coerced care.\u003c/p>\n\u003cp>“The bottom line is that the court is a coercive program,” he said.\u003c/p>\n\u003cfigure id=\"attachment_12007227\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12007227\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed.jpg\" alt=\"A white man wearing a blue dress suit rests his hand on his face with a calendar in the background.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Judge Michael Begert, presiding over CARE Court, sits in the San Francisco Superior Court in San Francisco on Sept. 17, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For Judge Begert in San Francisco, coerced treatment is very much “what we’re trying to avoid.” But, he acknowledged that changing the cultures of both the court system and the mental health care system is no easy task.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Getting people to change their mindset in a culture that’s very well-formed and static is a hard thing to do,” he said. “You bring the healthcare system into the criminal justice system — or the justice system in general — it starts to act like the justice system. So, that’s always a challenge.”\u003c/p>\n\n",
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"excerpt": "The California program is marking one year since it first rolled out in seven counties. It was billed as a way to get people with untreated schizophrenia and associated disorders — particularly those experiencing street homelessness — into services and housing.",
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"title": "CARE Court Was Supposed to Help Those Hardest to Treat. Here's How It's Going | KQED",
"description": "The California program is marking one year since it first rolled out in seven counties. It was billed as a way to get people with untreated schizophrenia and associated disorders — particularly those experiencing street homelessness — into services and housing.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c/p>\u003cp>\u003cspan class=\"utils-parseShortcode-shortcodes-__dropcapShortcode__dropcap\">W\u003c/span>\u003c/p>\u003cp>hen it rolled out last year in eight counties, CARE Court took aim at one of the state’s most vexing challenges: how to treat people whose illness often makes them believe they are not sick and who, if left untreated, can oscillate between jails, hospitals and homelessness.\u003c/p>\n\u003cp>Using the weight of a judge’s black robe to nudge county health departments’ doctors in white coats to provide an array of services, the program sought to reach the hardest-to-treat cases.\u003c/p>\n\u003cp>Now, a year after the program went live in seven counties — San Francisco, Glenn, Tuolumne, Stanislaus, Orange, Riverside, and San Diego — and ten months after it launched in Los Angeles County, petitions appear to be trickling in slower than expected and treatment plans are taking longer to put in place.\u003c/p>\n\u003cp>And, while Gov. Gavin Newsom, who first \u003ca href=\"https://www.gov.ca.gov/2022/03/03/governor-newsom-launches-new-plan-to-help-californians-struggling-with-mental-health-challenges-homelessness/\">introduced the initiative in March 2022\u003c/a>, initially said it would target those “living on our streets with severe mental health and substance use disorders,” the number of unhoused people going through the program varies widely from county to county.\u003c/p>\n\u003cfigure id=\"attachment_12005914\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12005914\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05.jpg\" alt=\"A white man wearing a suit stands at a podium with a microphone.\" width=\"2000\" height=\"1355\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-800x542.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-1020x691.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-160x108.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-1536x1041.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-1920x1301.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">California State Senator Thomas Umberg speaks before the Senate Judiciary Committee about SB1338, the Community Assistance, Recovery, and Empowerment (CARE) Court Program, on April 26, 2022, in Sacramento. \u003ccite>(Fred Greaves/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>State Sen. Tom Umberg, who co-authored the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB1338\">legislation\u003c/a> that implemented CARE Court, said the gradual rollout hasn’t come as a complete surprise.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We’re changing the culture here,” he said. “So, that takes a little time.”\u003c/p>\n\u003cp>As of mid-September, at least 692 petitions had been filed across seven of the counties in the first cohort, excluding San Francisco, according to data provided by superior court and county health officials. Of those petitions, a little more than a third, or 245, have been dismissed. And nearly one in five, or 121 petitions, have resulted in a CARE Agreement, an official document that details a voluntary treatment regime. There have been six court-ordered, or involuntary, CARE Plans issued.\u003c/p>\n\u003cp>San Francisco has so far received 42 petitions, said Melanie Kushnir, director of the Collaborative Justice Programs at the San Francisco Superior Courts. Of those, she said roughly half are active, meaning the participant is attending hearings and working toward or enrolled in a CARE Agreement. Citing privacy concerns, Kushnir declined to provide data on the exact number of dismissals or CARE Agreements reached but said there had been no CARE Plans issued.\u003c/p>\n\u003cp>The state had initially estimated that between 7,000 and 12,000 people would qualify for CARE Court each year once the program was fully implemented. But even accounting for the small number of counties that launched last year, court and public health officials agree the number of petitions is far fewer than expected — prompting opponents to argue the program is wasting taxpayers’ dollars.\u003c/p>\n\u003cp>According to the California Department of Finance, the state has already allocated $72 million to counties for start-up costs, along with $12 million for ongoing operations in fiscal year 2024–25, which will increase to $47 million in fiscal year 2026–27.\u003c/p>\n\u003cp>“We feel like the program has already failed,” said Samuel Jain, a senior mental health policy attorney at Disability Rights California, which is among the groups that advocated against CARE Court from the start. “The law doesn’t provide any new services and instead directs the limited resources we have to these expensive court processes.”\u003c/p>\n\u003cp>But supporters say it’s too early to pass judgment on a program that has yet to be fully implemented. The remaining 50 counties are due to open their own programs by Dec. 1.\u003c/p>\n\u003cp>“To really make some grand statement about its efficacy in the first 12 months of it rolling out, I think, is a leap for a state with 40 million people,” Dr. Mark Ghaly, the outgoing Secretary of California’s Health and Human Services Agency, told KQED. “But I do think that’s exactly the question that we have to keep in mind.”\u003c/p>\n\u003ch3>The number of petitions varies widely\u003c/h3>\n\u003cp>In Glenn County, with a population of \u003ca href=\"https://data.census.gov/profile/Glenn_County,_California?g=050XX00US06021\">around 29,000\u003c/a>, just one petition has been filed as of Sept. 12, and it was ultimately dismissed, said Chris Ruhl, executive officer of the Glenn County Superior Court. Ruhl expects one or two more may be submitted soon and that more will follow as word of the program spreads.\u003c/p>\n\u003cp>“We generally anticipate there will be an increase in the number of petitions and filings, but we don’t know that for sure,” he said. “We’ll be watching very closely.”\u003c/p>\n\u003cfigure id=\"attachment_12007228\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12007228\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed.jpg\" alt=\"A white man wearing a blue dress suit leans against a wooden divider in a court room.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Judge Michael Begert, presiding over CARE Court, stands in the San Francisco Superior Court in San Francisco on Sept. 17, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the other end of the spectrum is Los Angeles County, which, with a population of around \u003ca href=\"https://data.census.gov/profile/Los_Angeles_County,_California?g=050XX00US06037\">10 million\u003c/a>, has seen the most petitions: 268 as of Sept. 18. There, the number of petitions has been steadily increasing, Los Angeles Superior Court Judge Scott Herin said.\u003c/p>\n\u003cp>“I don’t think it started off like everybody expected, which was an overwhelming flood of cases,” Herin said, adding that the gradual ramp-up was perhaps “more healthy.”\u003c/p>\n\u003cp>That’s allowed some county behavioral health agencies to reappropriate staff assigned to CARE Court to other needs. In Stanislaus County, which has received 47 petitions, 19 of which have been dismissed, Behavioral Health & Recovery Services Director Tony Vartan said some of his CARE Court staff spent the first four to five months doing outreach with police and sheriff departments, hospital workers and others to build awareness.\u003c/p>\n\u003cp>“But as we saw that trend of those petitions, we pulled back some of our staff, and we assigned them to areas that needed more work,” he said. “Our staff emphasize where the cases are, regardless of what program we manage. That way, we make sure that the staff are working and they’ve got cases.”\u003c/p>\n\u003ch3>Cases dismissed\u003c/h3>\n\u003cp>Despite the lower-than-expected number of petitions, county behavioral health and court staff say they weren’t surprised to see that more than a third have been dismissed. Dismissal rates vary across the counties, from just over 90% in Tuolumne County, where 10 of 11 cases were dismissed, to a low of 26% in both Riverside and Los Angeles counties.\u003c/p>\n\u003cp>To be eligible, San Francisco Superior Court Judge Michael Begert said participants need to not only be diagnosed with schizophrenia or another psychotic disorder, but they also must be likely to benefit from services, can’t already be enrolled in services, and must be unlikely to survive without additional support.\u003c/p>\n\u003cp>“And that’s a small eye in a needle to thread,” Begert said.\u003c/p>\n\u003cp>Algenib Collin is trying to thread that needle as she looks for any program that might help for her daughter.\u003c/p>\n\u003cp>Collin applied for CARE Court the day it opened, she said, “I was so desperate.”\u003c/p>\n\u003cp>For roughly 18 months prior, she had seen her daughter, now 27, rapidly deteriorate on San Francisco’s streets. Collin said she would receive a call from the hospital nearly every other week, reporting her daughter had been placed on a 5150, or a temporary mental health hold, only to be rereleased back into homelessness and addiction.\u003c/p>\n\u003cfigure id=\"attachment_11955160\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11955160\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg\" alt=\"A large multi-story building and a driveway alongside it.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Orange County Superior Court will technically house the local CARE Court, though judges say they will more likely hold meetings with patients at a more neutral site, like a conference room at the county health office. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>High on fentanyl and possibly other drugs, Collin said her daughter would bang her head against the sidewalk or speak to herself in a language only she could understand.\u003c/p>\n\u003cp>“My daughter will die if she doesn’t get help,” Collin said. “Believe me.”\u003c/p>\n\u003cp>However, when it came to determining whether she qualified for CARE Court, the petition was rejected. Collin doesn’t know why, and she may never know. Privacy laws prohibit her from accessing her daughter’s medical records, so she isn’t sure whether her daughter has been formally diagnosed with a psychotic disorder.\u003c/p>\n\u003cp>The legislation doesn’t include any provision that gives petitioners the right to appeal a judge’s denial, though Ghaly said she could potentially refile the case.\u003c/p>\n\u003cp>“It’s frustrating,” Collin said. “I don’t want my daughter to die.”\u003c/p>\n\u003cp>Representatives from the San Francisco Public Health Department declined to be interviewed. Begert said he couldn’t comment on individual cases.\u003c/p>\n\u003cp>Ultimately, it’s up to the judge to hold public health departments accountable for providing appropriate care, Ghaly said, sharing an anecdote about how officials in San Diego frame the program: “They share with clients that CARE is an approach for the individual to … really get the black robe effect to hold the county accountable. And that’s exactly the way that we had hoped.”\u003c/p>\n\u003ch3>Breaking the pattern\u003c/h3>\n\u003cp>Collin’s experience, however, highlights a disconnect between the way the program was initially described — to, in Newsom’s words from 2022, “break the pattern that leaves people without hope and cycling repeatedly through homelessness and incarceration” — and what was actually written into legislation.\u003c/p>\n\u003cp>In the first year of the program’s rollout, success rates of getting people who are also experiencing homelessness into the program have varied. In Stanislaus County, for instance, Vartan said roughly 70% of the participants were unhoused before enrolling.\u003c/p>\n\u003cp>The opposite is true in Los Angeles and Riverside counties, where 30% and 20%–25% of enrollees are experiencing homelessness, respectively, health officials said. In Orange County, the figure is closer to 15%, according to Dr. Veronica Kelley, Director of the Orange County Health Care Agency.\u003c/p>\n\u003cfigure id=\"attachment_12007229\" class=\"wp-caption aligncenter\" style=\"max-width: 1024px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12007229\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398.jpg\" alt=\"A man sits next to three women at a table as he points to something.\" width=\"1024\" height=\"694\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398.jpg 1024w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398-800x542.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398-1020x691.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398-160x108.jpg 160w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Veronica Kelley, director of Behavioral Health Services for Orange County, right, listens as Orange County Superior Judge Ebrahim Baytieh speaks during a CARE court information session at Behavioral Health Training Center on Aug. 16, 2023, in Orange. The county’s behavioral health department and a representative from the public defender’s office is meeting with the public to explain what the CARE Act is. \u003ccite>(Gina Ferazzi / Los Angeles Times via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the former two counties, the majority of petitions have come from family members, health officials said. In Orange County, Kelley said the figure is closer to 40%.\u003c/p>\n\u003cp>Rather than view this as a failure to reach people who are living outside, Ghaly said he’s actually pleased to see the higher levels of petitions coming from family members on behalf of people who have housing, emphasizing that the goal was not to solve homelessness but to solve the problem of untreated mental illness “upstream.”\u003c/p>\n\u003cp>“It means that we’re getting to meet them earlier,” he said. “Almost anyone with severe schizophrenia or a psychotic disorder may be at risk of homelessness.”\u003c/p>\n\u003cp>But, Ghaly acknowledged that because eligibility is narrowly tailored, it may also mean, “We might not see the kind of outcomes that we wanted to see.”\u003c/p>\n\u003cp>Under the legislation, people whose primary diagnosis is a psychotic disorder are eligible for CARE Court, but those whose psychosis is primarily the result of using drugs are not. Asked whether the state would consider expanding eligibility to include cases of drug-induced psychosis, Ghaly said the question is a “fraught” one.\u003c/p>\n\u003cp>“If you ask most psychiatrists who take care of patients with these diagnoses and in largely these social circumstances, it’s really hard to tell what came first,” he said. “Was it the substance-use disorder that drove the psychosis? Or, were there underlying psychotic features to some disorder — maybe diagnosed, maybe not — that then drove the substance-use disorder?”\u003c/p>\n\u003cp>He continued, “Where the state lands at the moment is, there may be a very important population of people who have significant substance-use disorders and these other mental health conditions, who could benefit from CARE. And as we engage with our county partners and the practitioners who are in CARE, we’re asking exactly this question.”\u003c/p>\n\u003cp>But, even if someone doesn’t end up in CARE Court, health officials say they’re often referred to other programs within the county. And in Orange County, Kelley said 41 out of 95 petitions were dismissed because the client was already receiving services.\u003c/p>\n\u003cp>“And it would be unethical to remove them from that treatment and stick them over here in court and hope that that works better,” she said.\u003c/p>\n\u003cp>Ultimately, Ghaly said, that is also part of the point.\u003c/p>\n\u003cp>“It really is a group of people who didn’t go all the way down the CARE path, but because the CARE pathway was a potential, they got served and supported,” he said.\u003c/p>\n\u003ch3>Building trust\u003c/h3>\n\u003cp>For those who do qualify for CARE Court, the process to reach a voluntary treatment plan or CARE Agreement can be challenging, judges and health officials said. Just building enough trust to get someone to come into court can itself sometimes take two months, Kelley said.\u003c/p>\n\u003cp>“None of us would be open to a stranger coming up to us and telling us, ‘Come with me to court. I can help you,’” she said. “So, to believe that someone who’s severely impacted by a mental illness would be open to that doesn’t make any sense.” \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Kaitlyn Willison, an attorney with Legal Assistance to the Elderly in San Francisco who represents CARE Court participants, said the first step might involve combing the streets to search for people, which takes time. Once the person is found, the next hurdle is building trust.\u003c/p>\n\u003cp>“That means I need to see them two, three, four times before they go to court,” Willison said. “And the timelines just aren’t set up in a way that allows us as respondents’ counsel enough time to build that really precious trust that we need to best advocate for our clients.”\u003c/p>\n\u003cp>Umberg said he’s looking into further legislation or possible rule changes within the court system to address the challenges Willison and others have experienced so far.\u003c/p>\n\u003cp>But Jain, with Disability Rights California, is skeptical. One of those challenges is baked into the nature of the program itself, he said: that it has the potential to veer away from voluntary agreements and into coerced care.\u003c/p>\n\u003cp>“The bottom line is that the court is a coercive program,” he said.\u003c/p>\n\u003cfigure id=\"attachment_12007227\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12007227\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed.jpg\" alt=\"A white man wearing a blue dress suit rests his hand on his face with a calendar in the background.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Judge Michael Begert, presiding over CARE Court, sits in the San Francisco Superior Court in San Francisco on Sept. 17, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For Judge Begert in San Francisco, coerced treatment is very much “what we’re trying to avoid.” But, he acknowledged that changing the cultures of both the court system and the mental health care system is no easy task.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Getting people to change their mindset in a culture that’s very well-formed and static is a hard thing to do,” he said. “You bring the healthcare system into the criminal justice system — or the justice system in general — it starts to act like the justice system. So, that’s always a challenge.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>This week, \u003ca href=\"https://www.npr.org/2024/09/05/nx-s1-5101890/apalachee-high-school-shooting-charges-investigation\">a 14-year-old Georgia high school student was charged as an adult\u003c/a> with four counts of felony murder for allegedly using an assault-style rifle to kill two students and two teachers in the hallway outside his algebra classroom, according to authorities.\u003c/p>\n\u003cp>The shooting at Apalachee High School in Winder, about an hour’s drive from Atlanta, is \u003ca href=\"https://projects.apnews.com/features/2023/mass-killings/index.html\">the latest among dozens of school shootings across the U.S. in recent years\u003c/a>, including especially deadly ones in Newtown, Connecticut; Parkland, Florida; and Uvalde, Texas.\u003c/p>\n\u003cp>The media coverage of these events are once again prompting conversations about how to talk with kids about the news — especially \u003ca href=\"https://www.kqed.org/news/11996268/gun-violence-mental-health-support-compensation-bay-area\">gun violence.\u003c/a> Such acts of violence are disturbing for children to witness, but kid also are exposed to scary-sounding news and alarming imagery when similar traumatic events occur around the country.\u003c/p>\n\u003cp>Schools in the United States have become more prepared for mass shootings in recent years, which has meant learning how to talk with kids about active shooters and “bad guys” on school campuses. While \u003ca href=\"https://www.npr.org/sections/ed/2018/08/27/640323347/the-school-shootings-that-werent\">the incidence of on-campus shootings is extremely low\u003c/a>, they’re something many teachers and parents have prepared for.\u003c/p>\n\u003cp>“The most helpful thing for parents to share with their kids is that these events are rare and that adults are there to protect them,” said Stephen Brock, professor of psychology at CSU Sacramento. “We can’t deny the reality of these things, but kids need to be reassured with these facts.”\u003c/p>\n\u003cp>Some kids find out about the news by seeing it themselves or hearing it discussed at school, at home or in their communities. Young children can especially be harmed by this exposure, so experts recommend restricting their access to traumatic news. Kids old enough to have smartphones will likely get misinformation on the internet and social media, so it’s even more important for parents and caregivers to support their kids.\u003c/p>\n\u003cp>Here are some key steps parents and caregivers can take:\u003c/p>\n\u003ch2>Remind kids that they are safe\u003c/h2>\n\u003cp>Children need to be reassured by their caregivers that they are safe. \u003ca href=\"https://www.apa.org/helpcenter/talking-to-children\">The American Psychological Association says, above all, reassure\u003c/a>:\u003c/p>\n\u003cp>“ … reassure your children that you will do everything you know how to do to keep them safe and to watch out for them. Reassure them that you will be available to answer any questions or talk about this topic again in the future. Reassure them that they are loved.”\u003c/p>\n\u003ch2>Limit young children’s exposure to traumatic news\u003c/h2>\n\u003cp>Young children have less developed skills to separate facts from fears, so psychologists recommend minimizing a child’s exposure to traumatic news.\u003c/p>\n\u003cp>“When kids see the news, even if they are not a resident of [the affected place], they have the mistaken perception that they could be shot at any time,” said Brock. “For little ones, turn [the news] off.”\u003c/p>\n\u003cp>And sometimes, that fear is transferred to children through adult behavior. If adults are behaving in an anxious or fearful manner, kids will pick up on that, especially those in primary grades and younger.\u003c/p>\n\u003cp>“Kids will look to adults to see how scared they should be,” said Brock.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003ch2>Observe your kids for verbal and nonverbal cues\u003c/h2>\n\u003cp>A parent might overhear a child talking about a traumatic news event, or the child might ask about it. If it looks like the child is curious, engage the child in conversation, said Brock, adding, “Let their questions be your guide.”\u003c/p>\n\u003cp>But not all kids can verbalize what they’re feeling, so look for changes in behavior. According to \u003ca href=\"https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-climate-safety-and-crisis/school-violence-resources/talking-to-children-about-violence-tips-for-parents-and-teachers\">the “Talking to Children About Violence: Tips for Parents and Teachers” report\u003c/a> from the National Association of School Psychologists (NASP), caregivers are advised to:\u003c/p>\n\u003cp>“Watch for clues that they may want to talk, such as hovering around while you do the dishes or yard work. Some children prefer writing, playing music, or doing an art project as an outlet. Young children may need concrete activities (such as drawing, looking at picture books, or imaginative play) to help them identify and express their feelings.”\u003c/p>\n\u003cp>But if the child is not aware or expressing any interest in a traumatic event, it’s best to not bring it up.\u003c/p>\n\u003cp>“You don’t want to interject traumatic events into a child,” said Brock, who co-authored the report.\u003c/p>\n\u003ch2>Talk with your kids in a way that’s developmentally appropriate\u003c/h2>\n\u003cp>Parents can talk with kids about anything, but it must be developmentally appropriate. Communicating with a 15-year-old is going to be different from talking with a 4-year-old. The \u003ca href=\"https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-climate-safety-and-crisis/school-violence-resources/talking-to-children-about-violence-tips-for-parents-and-teachers\">NASP\u003c/a> has this advice on how to explain traumas, especially in schools, to different age groups:\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Early elementary school children\u003c/strong> need brief, simple information that should be balanced with reassurances that their schools and homes are safe and that adults are there to protect them. Give simple examples of school safety like reminding children about exterior doors being locked, child monitoring efforts on the playground, and emergency drills practiced during the school day.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Upper elementary and early middle school children\u003c/strong> will be more vocal in asking questions about whether they truly are safe and what is being done at their school. They may need assistance separating reality from fantasy. Discuss efforts of school and community leaders to provide safe schools.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Upper middle school and high school students\u003c/strong> will have strong and varying opinions about the causes of violence in schools and society. They will share concrete suggestions about how to make school safer and how to prevent tragedies in society. Emphasize the role that students have in maintaining safe schools by following school safety guidelines (e.g., not providing building access to strangers, reporting strangers on campus, reporting threats to the school safety made by students or community members, etc.), communicating any personal safety concerns to school administrators, and accessing support for emotional needs.\u003c/em>\u003c/p>\n\u003cp>Teens need guidance from their parents, too, especially since they’re absorbing the chatter on social media networks and direct messages from friends. Kids with phones will likely see graphic images through friends and news updates, which can create added trauma and anxiety. \u003ca href=\"https://www.commonsensemedia.org/blog/explaining-the-news-to-our-kids\">Common Sense Media advises parents to check in\u003c/a> on their teens:\u003c/p>\n\u003cp>“Since, in many instances, teens will have absorbed the news independently of you, talking with them can offer great insights into their developing politics and their senses of justice and morality. It will also help you get a sense of what they already know or have learned about the situation from their own social networks. It will also give you the opportunity to throw your own insights into the mix (just don’t dismiss theirs, since that will shut down the conversation immediately).”\u003c/p>\n\u003ch2>Maintain a normal routine\u003c/h2>\n\u003cp>Brock said, to the extent that it’s possible, maintain a normal routine. This will be helpful for the kid who’s frightened or anxious about a traumatic event.\u003c/p>\n\u003cp>“The more typical the routine, the more reassuring it can be,” he said.\u003c/p>\n\u003cp>\u003cem>This story contains reporting by the Associated Press, and KQED’s Carly Severn and Spencer Whitney also contributed to this story. A previous version of this story was published on July 15, 2024.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>This week, \u003ca href=\"https://www.npr.org/2024/09/05/nx-s1-5101890/apalachee-high-school-shooting-charges-investigation\">a 14-year-old Georgia high school student was charged as an adult\u003c/a> with four counts of felony murder for allegedly using an assault-style rifle to kill two students and two teachers in the hallway outside his algebra classroom, according to authorities.\u003c/p>\n\u003cp>The shooting at Apalachee High School in Winder, about an hour’s drive from Atlanta, is \u003ca href=\"https://projects.apnews.com/features/2023/mass-killings/index.html\">the latest among dozens of school shootings across the U.S. in recent years\u003c/a>, including especially deadly ones in Newtown, Connecticut; Parkland, Florida; and Uvalde, Texas.\u003c/p>\n\u003cp>The media coverage of these events are once again prompting conversations about how to talk with kids about the news — especially \u003ca href=\"https://www.kqed.org/news/11996268/gun-violence-mental-health-support-compensation-bay-area\">gun violence.\u003c/a> Such acts of violence are disturbing for children to witness, but kid also are exposed to scary-sounding news and alarming imagery when similar traumatic events occur around the country.\u003c/p>\n\u003cp>Schools in the United States have become more prepared for mass shootings in recent years, which has meant learning how to talk with kids about active shooters and “bad guys” on school campuses. While \u003ca href=\"https://www.npr.org/sections/ed/2018/08/27/640323347/the-school-shootings-that-werent\">the incidence of on-campus shootings is extremely low\u003c/a>, they’re something many teachers and parents have prepared for.\u003c/p>\n\u003cp>“The most helpful thing for parents to share with their kids is that these events are rare and that adults are there to protect them,” said Stephen Brock, professor of psychology at CSU Sacramento. “We can’t deny the reality of these things, but kids need to be reassured with these facts.”\u003c/p>\n\u003cp>Some kids find out about the news by seeing it themselves or hearing it discussed at school, at home or in their communities. Young children can especially be harmed by this exposure, so experts recommend restricting their access to traumatic news. Kids old enough to have smartphones will likely get misinformation on the internet and social media, so it’s even more important for parents and caregivers to support their kids.\u003c/p>\n\u003cp>Here are some key steps parents and caregivers can take:\u003c/p>\n\u003ch2>Remind kids that they are safe\u003c/h2>\n\u003cp>Children need to be reassured by their caregivers that they are safe. \u003ca href=\"https://www.apa.org/helpcenter/talking-to-children\">The American Psychological Association says, above all, reassure\u003c/a>:\u003c/p>\n\u003cp>“ … reassure your children that you will do everything you know how to do to keep them safe and to watch out for them. Reassure them that you will be available to answer any questions or talk about this topic again in the future. Reassure them that they are loved.”\u003c/p>\n\u003ch2>Limit young children’s exposure to traumatic news\u003c/h2>\n\u003cp>Young children have less developed skills to separate facts from fears, so psychologists recommend minimizing a child’s exposure to traumatic news.\u003c/p>\n\u003cp>“When kids see the news, even if they are not a resident of [the affected place], they have the mistaken perception that they could be shot at any time,” said Brock. “For little ones, turn [the news] off.”\u003c/p>\n\u003cp>And sometimes, that fear is transferred to children through adult behavior. If adults are behaving in an anxious or fearful manner, kids will pick up on that, especially those in primary grades and younger.\u003c/p>\n\u003cp>“Kids will look to adults to see how scared they should be,” said Brock.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch2>Observe your kids for verbal and nonverbal cues\u003c/h2>\n\u003cp>A parent might overhear a child talking about a traumatic news event, or the child might ask about it. If it looks like the child is curious, engage the child in conversation, said Brock, adding, “Let their questions be your guide.”\u003c/p>\n\u003cp>But not all kids can verbalize what they’re feeling, so look for changes in behavior. According to \u003ca href=\"https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-climate-safety-and-crisis/school-violence-resources/talking-to-children-about-violence-tips-for-parents-and-teachers\">the “Talking to Children About Violence: Tips for Parents and Teachers” report\u003c/a> from the National Association of School Psychologists (NASP), caregivers are advised to:\u003c/p>\n\u003cp>“Watch for clues that they may want to talk, such as hovering around while you do the dishes or yard work. Some children prefer writing, playing music, or doing an art project as an outlet. Young children may need concrete activities (such as drawing, looking at picture books, or imaginative play) to help them identify and express their feelings.”\u003c/p>\n\u003cp>But if the child is not aware or expressing any interest in a traumatic event, it’s best to not bring it up.\u003c/p>\n\u003cp>“You don’t want to interject traumatic events into a child,” said Brock, who co-authored the report.\u003c/p>\n\u003ch2>Talk with your kids in a way that’s developmentally appropriate\u003c/h2>\n\u003cp>Parents can talk with kids about anything, but it must be developmentally appropriate. Communicating with a 15-year-old is going to be different from talking with a 4-year-old. The \u003ca href=\"https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-climate-safety-and-crisis/school-violence-resources/talking-to-children-about-violence-tips-for-parents-and-teachers\">NASP\u003c/a> has this advice on how to explain traumas, especially in schools, to different age groups:\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Early elementary school children\u003c/strong> need brief, simple information that should be balanced with reassurances that their schools and homes are safe and that adults are there to protect them. Give simple examples of school safety like reminding children about exterior doors being locked, child monitoring efforts on the playground, and emergency drills practiced during the school day.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Upper elementary and early middle school children\u003c/strong> will be more vocal in asking questions about whether they truly are safe and what is being done at their school. They may need assistance separating reality from fantasy. Discuss efforts of school and community leaders to provide safe schools.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Upper middle school and high school students\u003c/strong> will have strong and varying opinions about the causes of violence in schools and society. They will share concrete suggestions about how to make school safer and how to prevent tragedies in society. Emphasize the role that students have in maintaining safe schools by following school safety guidelines (e.g., not providing building access to strangers, reporting strangers on campus, reporting threats to the school safety made by students or community members, etc.), communicating any personal safety concerns to school administrators, and accessing support for emotional needs.\u003c/em>\u003c/p>\n\u003cp>Teens need guidance from their parents, too, especially since they’re absorbing the chatter on social media networks and direct messages from friends. Kids with phones will likely see graphic images through friends and news updates, which can create added trauma and anxiety. \u003ca href=\"https://www.commonsensemedia.org/blog/explaining-the-news-to-our-kids\">Common Sense Media advises parents to check in\u003c/a> on their teens:\u003c/p>\n\u003cp>“Since, in many instances, teens will have absorbed the news independently of you, talking with them can offer great insights into their developing politics and their senses of justice and morality. It will also help you get a sense of what they already know or have learned about the situation from their own social networks. It will also give you the opportunity to throw your own insights into the mix (just don’t dismiss theirs, since that will shut down the conversation immediately).”\u003c/p>\n\u003ch2>Maintain a normal routine\u003c/h2>\n\u003cp>Brock said, to the extent that it’s possible, maintain a normal routine. This will be helpful for the kid who’s frightened or anxious about a traumatic event.\u003c/p>\n\u003cp>“The more typical the routine, the more reassuring it can be,” he said.\u003c/p>\n\u003cp>\u003cem>This story contains reporting by the Associated Press, and KQED’s Carly Severn and Spencer Whitney also contributed to this story. A previous version of this story was published on July 15, 2024.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "PTSD Is Common Among Firefighters — but Workers’ Comp for Treatment Is Hard to Get",
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"content": "\u003cp>Todd Nelson could feel it coming on. And he began to run. He was going dark again, retreating to a place where he would curl into a fetal position with his thumb in his mouth, watching from behind closed eyes as his personal reel of horror unspooled. Sights and sounds from three decades of firefighting cued up — shrieks from behind an impenetrable wall of flame, limbs severed in car accidents and the eyes of the terrified and the dead he was meant to save.\u003c/p>\n\u003cp>Nelson was running on the Foresthill Bridge, \u003ca href=\"https://sierranevadageotourism.org/entries/foresthill-bridge/4123fc95-8a25-4827-baba-fca9c8e4485a\">the highest in California\u003c/a>, fleeing cops and firefighters after his wife reported that he was suicidal. He hurdled a concrete barrier and straddled the railing of the bridge in the Sierra Nevada foothills, staring down at a large rock 730 feet below. As the rescuers closed in, Nelson leaned precariously over the chasm. His strategy — making the fatal plunge appear accidental, allowing his family to collect his life insurance.\u003c/p>\n\u003cp>It was not Nelson’s first suicide attempt — the former Cal Fire captain had tried to take his life many times before. But after that 2021 ordeal, which led to an involuntary 72-hour psychiatric hold, something in him shifted. He was ready to admit that he had a problem and seek medical help.\u003c/p>\n\u003cp>The incident began the firefighter’s arduous, years-long journey toward wellness, threaded through a bureaucratic labyrinth strewn with more obstacles than he’d ever encountered on a California wildfire: finding qualified medical help, battling an insurance company to pay for it and navigating the tangled morass of California’s workers’ comp. All without going broke or returning to his dark place.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>No one tracks how many of Cal Fire’s 12,000 firefighters and other employees suffer from mental health problems, but department leaders say post-traumatic stress disorder and suicidal thoughts \u003ca href=\"https://calmatters.org/environment/2022/06/california-firefighter-trauma-ptsd/?series=california-firefighters-trauma-wildfires\">have become a silent epidemic\u003c/a>\u003cstrong> \u003c/strong>at the agency responsible for fighting \u003ca href=\"https://calmatters.org/california-wildfire-map-tracker/\">California’s increasingly erratic and destructive wildfires\u003c/a>. In an \u003ca href=\"https://www.researchgate.net/publication/352466544_Wildland_Firefighter_Psychological_and_Behavioral_Health_Preliminary_Data_from_a_National_Sample_of_Current_and_Former_Wildland_Firefighters_in_the_United_States_Conference_session\">online survey\u003c/a> of wildland firefighters nationwide, about a third reported considering suicide and nearly 40% said they had colleagues who had committed suicide; many also reported depression and anxiety.\u003c/p>\n\u003cp>California’s workers’ comp — which is supposed to help people get medical treatment for workplace illnesses and injuries — can be a nightmare for firefighters and other first responders with PTSD.\u003c/p>\n\u003cp>Claims filed by firefighters and law enforcement officers are more likely to involve PTSD than claims by the average worker in California — and they have been \u003ca href=\"https://calmatters.org/wp-content/uploads/2024/06/RAND-PTSD-REPORT.pdf\">denied more often than claims for other medical conditions (PDF)\u003c/a>, according to the research institute RAND.\u003c/p>\n\u003cp>From 2008 to 2019 in California, workers’ comp officials denied PTSD claims filed by firefighters and other first responders at more than twice the rate of their other work-related conditions, such as back injuries and pneumonia, RAND reported. About a quarter of firefighters’ 1,000 PTSD claims were denied, a higher rate than for PTSD claims from other California workers.\u003c/p>\n\u003cp>“It’s a fail-first system. You have to get a broken leg to show you are in need of support. With mental illness, we are constantly having to prove to everybody why we were ill. You have to get to the point of suicide,” said Jessica Cruz, the California chief executive officer of the \u003ca href=\"https://namica.org/\">National Alliance on Mental Illness\u003c/a>.\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=DLvG2Yy34QM&t=1s\u003c/p>\n\u003cp>Jennifer Alexander, Nelson’s therapist, said patients in acute crisis simply don’t have the mental capacity to ride herd on stubborn workers’ comp claims. Alexander said she was once on hold for more than six hours with Cal Fire’s mental health provider attempting to get one of her bills paid, and she has waited years to get paid for treating firefighters.\u003c/p>\n\u003cp>“People give up. It’s a battle … They are not fully functional,” said Alexander, who for 21 years has specialized in treating first responders with trauma and PTSD and has spent an estimated 25,000 hours treating them. “You are not talking about healthy individuals who can sit on the phone for hours.”\u003c/p>\n\u003cp>Cal Fire firefighters and other workers also have trouble finding qualified therapists, especially outside major cities in rural areas, where many are based. In 2021, less than \u003ca href=\"https://www.commonwealthfund.org/publications/explainer/2023/may/understanding-us-behavioral-health-workforce-shortage\">half of people with a mental illness\u003c/a> in the U.S. were able to access timely care. \u003ca href=\"https://calmatters.org/environment/2024/06/california-workers-comp-firefighters-therapists/\">Therapists are reluctant to take workers’ comp\u003c/a>, or sometimes any type of insurance, because they often have to wait months or years to be reimbursed.\u003c/p>\n\u003cfigure id=\"attachment_11992261\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11992261\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-14-copy-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-14-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-14-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-14-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-14-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-14-copy.jpg 1568w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Therapist Jennifer Alexander listens to Nelson during a treatment session. She called workers’ comp a ‘total system breakdown.’ \u003ccite>(Cristian Gonzalez for CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Michael Dworsky, a senior economist at the research institute RAND and one of the study’s project leaders, called workers’ comp “challenging and bureaucratic.”\u003c/p>\n\u003cp>“Even if the claim is accepted, there can be disputes about the medical necessity of individual bills. Just because your claim is accepted, doesn’t mean you are done fighting with the insurance company,” he said.\u003c/p>\n\u003ch2>A presumption of pain but still a tangled web\u003c/h2>\n\u003cp>Employers in California must provide workers’ comp insurance that will pay for medical costs when a worker is injured on the job. However, in reality, workers’ comp, which serves 16 million Californians, can be ungainly, confusing and, sometimes, no help at all. The system, administered by the state Department of Industrial Relations, is massive: In 2022, almost \u003ca href=\"https://www.dir.ca.gov/CHSWC/Reports/2023/CHSWC_AnnualReport2023.pdf\">750,000 workers’ comp claims (PDF)\u003c/a> were filed statewide.\u003c/p>\n\u003cp>When a firefighter requests coverage for medical treatment, insurance adjusters review the case to determine if it’s medically necessary. If the claim is denied, delayed or modified, a patient may request an independent medical review by so-called “ghost doctors” who review the case.\u003c/p>\n\u003cp>Systemwide in California, patients who appeal their denied workers’ comp claims, don’t fare well: Last year 3,238 appeals for mental health claims were filed, but workers’ comp officials rejected three-quarters of them, about the same as the 10-year average, according to data from the Department of Industrial Relations requested by CalMatters. (Agency officials said they could not provide data on claims from first responders.)\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://datawrapper.dwcdn.net/9hnJM/4/\" width=\"800\" height=\"600\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>For decades, the California Legislature has wrestled with how to fix workers’ comp — in one year alone, lawmakers proposed nearly two dozen bills.\u003c/p>\n\u003cp>In 2020 lawmakers took a major step, adding a \u003ca href=\"https://digitaldemocracy.calmatters.org/hearings/256803?t=1347&f=e8036f39579fee812f324253b5cb224b\">legal \u003c/a>\u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240sb623\">shortcut or “presumption”\u003c/a> to the\u003cstrong> \u003c/strong>state\u003cstrong> \u003c/strong>labor code, stipulating that firefighters and other first responders are considered at high risk for PTSD in the course of doing their job.\u003c/p>\n\u003cp>That means first responders no longer carry the burden of proving their illness is work-related. However, a claims adjuster can still question the diagnosis or assert that the trauma was caused by other factors, such as military service or family events. A law enacted last year \u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240sb623\">extended the presumption to 2029\u003c/a>.\u003c/p>\n\u003cp>In practice, experts say that, despite the law, proving a mental health claim is still almost as difficult to overcome as the psychological injury itself. Break an arm while fighting a wildfire, and, backed up by x-rays, claims are approved. But break your mind after decades of exposure to on-the-job trauma? Prepare for battle.\u003c/p>\n\u003cp>Before enacting the law, state officials asked RAND researchers to report on the scope of the problem. They analyzed nearly 6 million claims filed between 2008 through 2019 and interviewed dozens of experts, including a representative sample of 13 first responders.\u003c/p>\n\u003cp>The researchers found a consistent and troubling trend among the 13: “Nearly all workers said that they had filed a workers’ compensation claim for their mental health conditions — yet almost none received PTSD care paid for by workers’ compensation.”\u003c/p>\n\u003cp>Paying out of pocket “caused severe financial strain in some cases. Some were eventually reimbursed by workers’ compensation, but only after litigation and substantial delay. Some who pursued care through workers’ compensation also noted that claim denials led to delays in the start of mental health treatment,” the RAND researchers wrote.\u003c/p>\n\u003cp>The 13 first responders they surveyed stressed “over and over again about self-pay and barriers,” said \u003ca href=\"https://www.rand.org/about/people/q/quigley_denise_d.html\">Denise D. Quigley, a RAND senior policy researcher\u003c/a> who was a project leader on the study. “It’s not like we heard it once or twice, we heard it over and over again. It’s highly unlikely that we talked to the (only) people in California that had this happen.”\u003c/p>\n\u003cp>Firefighters told of borrowing money from family members and taking out home equity loans to pay for care, Quigley said. The litany of their struggle weighed on her team. “It’s difficult to hear people break down crying while talking to us because of all the things they’ve seen.”\u003c/p>\n\u003cp>According to the RAND research, for the 12-year period from 2008 through 2019, before the new law took effect:\u003c/p>\n\u003cul>\n\u003cli>Firefighters and other first responders were about twice as likely to file PTSD claims as the general workforce — but the numbers are small, under 1% of all workers’ comp claims.\u003c/li>\n\u003c/ul>\n\u003cul>\n\u003cli>Firefighters’ PTSD claims were denied more often than claims of other workers: About 24% were denied, compared to about 19% of PTSD claims for all workers, including those in high-stress occupations. About a quarter of firefighter claims for all mental health conditions were denied.\u003c/li>\n\u003c/ul>\n\u003cul>\n\u003cli>Their PTSD claims were denied at more than twice the rate of their other presumptive medical conditions related to their jobs, such as hernias and back injuries. Even their cancer and heart disease claims were accepted at a higher rate than PTSD.\u003c/li>\n\u003c/ul>\n\u003cul>\n\u003cli>These denial rates were calculated using a sample of only 258 PTSD claims filed by firefighters. But researcher Dworsky said the total number of claims is far higher, about 1,000, with about 230 claims denied, during those 12 years. And countless other firefighters who suffer from PTSD didn’t seek care through workers’ comp.\u003c/li>\n\u003c/ul>\n\u003cp>The RAND report was the most detailed look at the inequities between how physical and mental health are treated among firefighters and how first responders’ claims were handled compared to other workers. However, the researchers struggled with incomplete data and difficulty identifying which claims were from firefighters.\u003c/p>\n\u003cp>Quigley said she is frustrated that no one since has tracked whether the 4-year-old presumption law — known as the Trauma Treatment Act — has helped patients and improved the system.\u003c/p>\n\u003cp>Many therapists say they haven’t seen much, if any, improvement. Nelson’s therapist, Alexander, called workers’ comp a “total system breakdown.”\u003c/p>\n\u003cp>A spokesman for the Department of Industrial Relations refused to grant interview requests from CalMatters or answer questions or provide data about firefighters’ mental health claims.\u003c/p>\n\u003ch2>Navigating the system\u003c/h2>\n\u003cp>During his 28 years with Cal Fire fighting wildfires in combustible regions, such as the Napa Valley and the Sierra Nevada foothills, and responding to other emergencies, Nelson never reported any mental health issues to anyone. Not once. Even as he would regularly pull his truck off the side of the road during wildfires and weep. Even after responding to the scene of traffic accidents, extricating children from crushed cars as their parents fought to get to them. Even after answering a call to a suicide to find a man hanging from the rafters in his barn. Even after the unbidden images began to intrude with greater frequency.\u003c/p>\n\u003cp>Instead, his mantra became “I’m good.”\u003c/p>\n\u003cp>That stoicism, common among first responders, short circuits the insurance system designed to help them — a system that works best with prompt reporting and meticulous documentation.\u003c/p>\n\u003cp>[aside label=\"Related Stories\" postID=\"news_11991959,science_1993253,science_1991079\"]Claims adjusters usually handle clear-cut cases where the date of injury can be pinpointed. More common among PTSD claims, though, is Nelson’s experience with cumulative trauma, with no paper trail of injuries or complaints. He can’t offer a single event as the origin of his trauma and no coherent chronology. Cal Fire folks tend to wait until their dam bursts before asking for the water to be turned off.\u003c/p>\n\u003cp>One Southern California mental health provider told the RAND researchers that firefighters and police officers typically have severe cases of trauma.\u003c/p>\n\u003cp>“On the clinical side, as a mental health provider, it is not realistic to expect a firefighter or a police officer to come in and have had a little trauma or some minor stress condition … Most departments have people with a lot of stress and trauma,” the therapist said. “Just because you had something happen recently, the straw that broke the camel’s back, it is really the cumulative stress that is the issue.”\u003c/p>\n\u003cp>Now retired, Nelson, 54, has been fighting for workers’ compensation for almost three years, since his suicide attempt on the Placer County bridge. He and his wife already have spent more than $10,000 out of pocket for medical care and could face thousands more in legal bills.\u003c/p>\n\u003cp>Nelson’s case is unusually severe and complex, requiring two extended stays in a facility that specifically treats firefighters to diagnose his conditions and finally set him on a treatment path of therapy and multiple medications.\u003c/p>\n\u003cp>Cal Fire Battalion Chief Brad Niven said he has more than a dozen firefighter friends who have had similar experiences.\u003c/p>\n\u003cp>“Talk to anybody that tries to do anything through workers’ comp — it is an absolute nightmare,” he said. “Everybody knows you file your first workers’ comp claim and they will deny it. One guy I worked with went through the works with them. He had to prove beyond a shadow of a doubt that you have problems. You have to relive everything you’ve gone through. It does not make for a friendly system.”\u003c/p>\n\u003cfigure id=\"attachment_11992262\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11992262\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/060822_BRAD_NIVEN_CALFIRE_JH_CM_37-copy-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/060822_BRAD_NIVEN_CALFIRE_JH_CM_37-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/060822_BRAD_NIVEN_CALFIRE_JH_CM_37-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/060822_BRAD_NIVEN_CALFIRE_JH_CM_37-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/060822_BRAD_NIVEN_CALFIRE_JH_CM_37-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/060822_BRAD_NIVEN_CALFIRE_JH_CM_37-copy.jpg 1568w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Cal Fire Battalion Chief Brad Niven, shown at his home in Sonora, said he and more than a dozen firefighter friends have had trouble getting workers’ comp to pay their claims for mental health treatment. \u003ccite>(Julie Hotz for CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Niven considered suicide before Cal Fire’s employee support personnel helped him find a therapist, streamlining what had been a hit-and-miss process.\u003c/p>\n\u003cp>“They blasted away the stumbling blocks,” he said. But the fire agency does not make the decision to approve or deny a claim or handle the bureaucratic thicket that is workers’ comp.\u003c/p>\n\u003cp>Scott O’Mara, a \u003ca href=\"https://law1199.com/\">San Diego-based lawyer\u003c/a> whose firm represents first responders, said adjusters’ training is to look for what they can develop to deny the case. “Their goal is to contain and control cost,” he said. “We do a lot of cases where the compensation is nickels.”\u003c/p>\n\u003cp>Although California law now considers PTSD for first responders a presumption, it is a “disputable presumption.” That means claims administrators can consider other traumatic events in a firefighter’s life that may play a role in a PTSD case.\u003c/p>\n\u003cp>“With cumulative trauma, or stress over the course of their entire employment, we need to request more information from the doctor so that we can see it isn’t because they were in the military or they are going through a divorce, etc.,” one claims adjuster told RAND researchers.\u003c/p>\n\u003cp>The complexity of the system wears down the resistance of injured workers, who need a jungle guide to find their way at a time of profound pain and disorientation.\u003c/p>\n\u003cp>“They can’t navigate this on their own, they really can’t. They’ve got professional litigators opposing them,” said Richard Elder, a \u003ca href=\"https://www.elderandberg.com/attorney/richard-e-elder-jr/\">workers’ comp lawyer\u003c/a> in Concord who regularly represents state firefighters. “The average claims adjuster on the job for more than a month knows more about the system than the average firefighter. They’ve got lawyers on speed dial. The injured worker is adrift. It’s like a do-it-yourself heart transplant.”\u003c/p>\n\u003cp>Elder, who has been in practice for 54 years, used to work as an insurance company claims adjuster. The system, he said, has always been adversarial.\u003c/p>\n\u003cp>“It’s against the law for employers to discriminate against a worker who files a psyche claim. But they do discriminate,” said Elder, who said in the past five decades he has pursued about 500 psychiatric claims.\u003c/p>\n\u003cp>“I just filed a psychiatric claim and the response was ‘give us a list of every medical facility that treated the claimant in the last 10 years,’” he said. “The workers’ comp medical treatments system is a stain upon the soul of the politicians and officials of California.”\u003c/p>\n\u003ch2>Diagnosing PTSD is ‘a complicated process’\u003c/h2>\n\u003cp>One day in March, Nelson sat next to his wife, Leticia, in a quiet room in a Nevada City library near their rental home. He was in the grips of a seizure, brought on by retelling his firefighting nightmares to a CalMatters reporter. His hands were clenched and his torso taut. He stuttered, his eyelids fluttering. The episode lasted a few minutes.\u003c/p>\n\u003cp>During the interview, Nelson was fidgety, his thick fingers constantly worrying about the items he had put on the table in front of him. One was a tiny aluminum cylinder containing medication for his seizures, another was a brass medallion, the iconic firefighter symbols of an ax and firehose nozzle stamped on one side and the serenity prayer on the other.\u003c/p>\n\u003cp>The coin was a kind of talisman given to him after graduating from a \u003ca href=\"https://www.iaffrecoverycenter.com/\">specialized rehab clinic \u003c/a>for firefighters, where he was given his daunting medical diagnosi\u003cem>s: \u003c/em>He suffers from complex PTSD, \u003ca href=\"https://my.clevelandclinic.org/health/diseases/24517-psychogenic-nonepileptic-seizure-pnes\">psychogenic non-epileptic seizures\u003c/a> and dissociative identity disorder.\u003c/p>\n\u003cp>Such anxiety-induced seizures are unusual but not rare, his therapist said, and the totality of Nelson’s mental health issues makes his case unusually severe. Weekly therapy sessions and multiple medications have tempered, but not extinguished, his struggle with crippling anxiety.\u003c/p>\n\u003cp>Nelson wears a medical alert wrist bracelet intended to give first responders a bare-bones outline of his conditions and which medications to avoid when he is experiencing an anxiety-induced seizure. In his back pocket, he carries, always, a medical card with his list of red flags, so extensive that it unspools like an accordion.\u003c/p>\n\u003cp>His seizures may occur several times a day. Some last for hours. Nelson’s usually benign aspect changes: His eyes cross, his hands clench into what he calls “spidey fingers.” He stumbles and stutters through sentences and repeats words, often losing his ability to speak at all. At times he drags his head and face along walls. Leticia Nelson describes the seizures as his body undergoing earthquakes.\u003c/p>\n\u003cfigure id=\"attachment_11992264\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11992264\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-25-copy-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-25-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-25-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-25-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-25-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-25-copy.jpg 1568w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The emergency medical ID card that Nelson carries with him. \u003ccite>(Loren Elliott for CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_11992266\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11992266\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-14-copy-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-14-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-14-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-14-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-14-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-14-copy.jpg 1568w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Nelson alongside his wife, Leticia Nelson, near their Nevada City home. She said it’s been agonizing to see him suffer mental health problems related to his job and have to fight the system to get his treatment paid for. ‘We sacrificed our time with him so that he could help the whole state. And nothing has been there for the family since this happened. Nothing.’ \u003ccite>(Loren Elliott for CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nelson’s unusual body movements during a seizure, his inability to respond to questions and his propensity to run away when confronted puts Nelson in a precarious place in airport lines or with law enforcement, where his non-response has been misconstrued as defiance.\u003c/p>\n\u003cp>Even doctors can misunderstand. Diagnosing and treating PTSD and acute trauma like Nelson’s is notoriously difficult.\u003c/p>\n\u003cp>“Diagnosing PTSD is a complicated process. Diagnostic criteria are complicated,” said Sidra Goldman-Mellor, a \u003ca href=\"https://publichealth.ucmerced.edu/content/sidra-goldman-mellor\">UC Merced psychiatric epidemiologist\u003c/a> who studies depression and suicidal behavior. “Your average primary care clinician is probably not willing to go down that road.”\u003c/p>\n\u003cp>For patients like Nelson, any number of stress-related disorders present themselves and muddy a specific diagnosis that would satisfy a claims adjuster or a workers’ comp review.\u003c/p>\n\u003cp>“That’s the thing with psychiatric disorders, we don’t have a lot of objective measures for a mental health diagnosis. We don’t have blood tests and we don’t have MRIs,” Goldman-Mellor said. “They (mental health issues) are harder to recognize, harder to test for and easier to ignore.”\u003c/p>\n\u003cp>However, firefighters cannot move easily through the workers’ comp or medical insurance system if they don’t have a diagnosis. Constantly proving your pain becomes its own trauma.\u003c/p>\n\u003cp>“He has to prove his world is falling apart,” Leticia Nelson said. “It’s hard to explain to someone that you are broken. They look at you, they think that you look fine. They can’t see in your brain. They can’t see in your mind.”\u003c/p>\n\u003cp>It took four years for Nelson to find the right medical care. One physician’s therapeutic approach was to ask the former firefighter to pray with him.\u003c/p>\n\u003cp>The problem was much more fundamental than finding a compatible therapist: He could not \u003cem>find\u003c/em> one to take his case. Many Cal Fire employees are stationed in rural or remote areas of the state, in communities underserved by health care specialists.\u003c/p>\n\u003cp>Living in rural Nevada County, Nelson faces a barren mental health desert where it’s difficult to find a competent therapist who might have worked with other first responders and understands the specific challenges of the high-stress job.\u003c/p>\n\u003cp>“It’s an absolute specialization. There’s not near enough of us,” said Alexander, Nelson’s therapist. (Nelson granted her permission to speak about his case.) “In the larger Sacramento area, there are less than a dozen competent providers.”\u003c/p>\n\u003cfigure id=\"attachment_11992268\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11992268\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-09-copy-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-09-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-09-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-09-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-09-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-09-copy.jpg 1568w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Nelson recalls memories of his time as a firefighter during a treatment session. \u003ccite>(Cristian Gonzalez for CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Cal Fire is self-insured and offers medical coverage through private companies. The agency does not manage medical claims or workers’ comp but does have programs to assist employees in finding care.\u003c/p>\n\u003cp>Rob Wheatley, staff chief of Cal Fire’s Behavioral Health and Wellness Program, told CalMatters in an email that the agency has expanded support for employees who seek help for mental health issues with peer counseling or referrals for treatment. The agency has a staff of 28 assisting about 12,000 employees.\u003c/p>\n\u003cp>But Wheatley and other Cal Fire officials refused to grant an interview and did not answer CalMatters’ questions about the problems that their employees face with workers’ comp and mental health issues.\u003c/p>\n\u003cp>“Any denial of a mental health claim is concerning,” Wheatley said in the email.\u003c/p>\n\u003ch2> Can the system be repaired?\u003c/h2>\n\u003cp>The Nelsons have seen the insurance and workers’ comp system from the inside, been batted around by it and, they would say, abandoned by it. Still, they have few suggestions for fixing it.\u003c/p>\n\u003cp>They are not alone. Lawyers say that the system is based on how to save money, is too often adversarial and deeply entrenched.\u003c/p>\n\u003cp>Even the employers who participate in the workers’ comp system say it’s not working well. In a recent survey, more than half of the respondents said the system performs poorly, while 42% described the system as challenged but adequate.\u003c/p>\n\u003cp>“Nobody believes it’s ideal,” said Jerry Azevedo, a spokesman for the \u003ca href=\"https://www.workcompaction.org/\">Workers’ Compensation Action Network,\u003c/a> a coalition of California insurers, employers and agents advocating to improve the system. “Every constituency has complaints.”\u003c/p>\n\u003cp>Azevedo said California’s workers’ comp system, which has been in place since 1913, is plagued by \u003ca href=\"https://information.auditor.ca.gov/pdfs/reports/2019-106.pdf\">persistent problems\u003c/a>: high costs to operate, huge claim volume, frequent litigation, slow claim resolution and fraud and abusive practices.\u003c/p>\n\u003cp>“The fundamental challenge we all contend with is complexity. California’s system is arguably the most complex in the nation,” Azevedo said. The good news, he said, is that 86% of workers’ comp claims overall are accepted, according to the California Workers’ Compensation Institute.\u003c/p>\n\u003cp>It’s easy to get the sense of a general throwing up of hands. The state Commission on Health & Safety & Workers’ Comp dedicates a \u003ca href=\"https://www.dir.ca.gov/chswc/WCReformsPage1.htm\">webpage to tracking workers’ comp reforms\u003c/a>, but the last entry was in 2012.\u003c/p>\n\u003cp>Sean Cooper, executive vice president and chief actuary of the \u003ca href=\"https://www.wcirb.com/\">Workers’ Compensation Insurance Rating Bureau of California\u003c/a>, said the system is groaning under its own weight — there are a lot of people filing claims and a lot of lawyers on all sides.\u003c/p>\n\u003cp>Administrative costs are high in California: The cost to deliver $1 of medical benefit from California’s workers’ comp system is 46 cents, compared to two cents for Medicare, 19 cents for private group health insurance and 25 cents for the national state median for workers’ comp according to the group’s 2023 report.\u003c/p>\n\u003cp>One way to fix the inequity is to turn the system on its head, said Cruz of the \u003ca href=\"https://namica.org/\">National Alliance on Mental Illness\u003c/a>.\u003c/p>\n\u003cp>“There is a disparity about how we treat, respond and react to behavioral health versus physical health,” she said. “Maybe we need to start talking about that disparity in workers’ comp. When you have (a claims) approval rating that is flipped on its backside, that’s an obvious parity issue.”\u003c/p>\n\u003cp>Legislators, when they turn their gaze to the massive program, chip away at the edges. The law extending the PTSD presumption will be revisited when the state Commission on Health and Safety and Workers’ Compensation presents its report on claims and denials to the Senate Committee on Labor, Public Employment and Retirement and the Assembly Committee on Insurance, by the end of this year.\u003c/p>\n\u003cp>Cruz said there is more legislative focus on behavioral health than ever, but there are limits, beginning with which groups carry the most influence. Managed health care companies are powerful advocates of the status quo, she said. “We are David and Goliath when we come up against these folks.”\u003c/p>\n\u003cp>“So many great people want to do wonderful things and they have big ideas, but it gets chopped down to a Band-Aid once everyone gets what they want,” she said.\u003c/p>\n\u003ch2>‘A slap in the face to all of us’\u003c/h2>\n\u003cp>Leticia Nelson refers to herself, with only slight exaggeration, as her husband’s “service dog.”\u003c/p>\n\u003cp>She’s the keeper of the couple’s appointment schedule; she’s the chauffeur; and the manager of the financial spreadsheet. And it falls to Leticia to devote untold hours on the phone with insurers and medical providers, bird-dogging bills, late payments and coverage lapses.\u003c/p>\n\u003cp>She has watched her husband humiliated, scared and angry. Their two adult daughters, also have been treated for PTSD, after witnessing their father’s anxiety and mania, and knowing about his suicide attempts.\u003c/p>\n\u003cp>At times, Leticia Nelson said, “I’m mad at God.”\u003c/p>\n\u003cfigure id=\"attachment_11992269\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11992269\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM_21-copy-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM_21-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM_21-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM_21-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM_21-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM_21-copy.jpg 1568w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Retired Cal Fire firefighter Todd Nelson walks with his wife in Nevada City. Nelson suffers from post-traumatic stress disorder resulting from the trauma experienced during his firefighting career. \u003ccite>(Loren Elliott for CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Nelsons, lifelong Californians, want to leave the state and its frightening tableau of wildfires. They sold their house, changed their mind about moving and now are financially shut out of the real estate market, especially because of the high cost of fire insurance in the foothills where they live. They are nomads, shuttling between Airbnbs with two large dogs and three cats in tow and their possessions in storage.\u003c/p>\n\u003cp>Money is tight. Leticia would like to go back to work, but she can’t leave Todd alone.\u003c/p>\n\u003cp>Nelson gave up fighting the state over a disability claim after his attorney told him that an appeal would cost $50,000 — and he would lose because he didn’t claim a disability when he retired.\u003c/p>\n\u003cp>“It’s a slap in the face to all of us because we sacrificed as a family,” Leticia Nelson said of Todd’s long career with Cal Fire. “We sacrificed our time with him so that he could help the whole state. And nothing has been there for the family since this happened. Nothing.\u003c/p>\n\u003cp>“I wish that there’s things in place that would guide us that wouldn’t be so hard. But it just seems like we hit every, every obstacle possible. We’re struggling. We need help. We need to be seen. We need to be treated like humans and not criminals.”\u003c/p>\n\u003cp>For his part, Nelson is coming to terms with the devastation his career wrought. Yet, years after retirement, he still listens to an emergency scanner and shows up at fires in his area, wearing his T-shirt, shorts and Birkenstocks. The pull to serve remains strong.\u003c/p>\n\u003cp>“The crazy thing is I miss my job. I miss it every day. I would do it all over again,” he said wistfully. “I loved the job but I didn’t realize the damage being done.”\u003c/p>\n\u003cp>\u003cem>If you are having suicidal thoughts, you can get help from the National Suicide Prevention Lifeline by calling 988 or visiting \u003c/em>\u003ca href=\"https://suicidepreventionlifeline.org/\">\u003cem>https://suicidepreventionlifeline.org\u003c/em>\u003c/a>\u003c/p>\n\u003cp>\u003cem>This story also was made possible in part by a grant from the \u003ca href=\"https://amarkfoundation.org/\">A-Mark Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Even when suicidal, California firefighters struggle to find medical help and navigate the workers’ comp morass to pay for it. A 2021 analysis showed their claims were more likely to involve PTSD — and were denied more often.",
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"title": "PTSD Is Common Among Firefighters — but Workers’ Comp for Treatment Is Hard to Get | KQED",
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"nprByline": "\u003ca href=\"https://calmatters.org/author/julie-cart/\">Julie Cart\u003c/a>, CalMatters",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Todd Nelson could feel it coming on. And he began to run. He was going dark again, retreating to a place where he would curl into a fetal position with his thumb in his mouth, watching from behind closed eyes as his personal reel of horror unspooled. Sights and sounds from three decades of firefighting cued up — shrieks from behind an impenetrable wall of flame, limbs severed in car accidents and the eyes of the terrified and the dead he was meant to save.\u003c/p>\n\u003cp>Nelson was running on the Foresthill Bridge, \u003ca href=\"https://sierranevadageotourism.org/entries/foresthill-bridge/4123fc95-8a25-4827-baba-fca9c8e4485a\">the highest in California\u003c/a>, fleeing cops and firefighters after his wife reported that he was suicidal. He hurdled a concrete barrier and straddled the railing of the bridge in the Sierra Nevada foothills, staring down at a large rock 730 feet below. As the rescuers closed in, Nelson leaned precariously over the chasm. His strategy — making the fatal plunge appear accidental, allowing his family to collect his life insurance.\u003c/p>\n\u003cp>It was not Nelson’s first suicide attempt — the former Cal Fire captain had tried to take his life many times before. But after that 2021 ordeal, which led to an involuntary 72-hour psychiatric hold, something in him shifted. He was ready to admit that he had a problem and seek medical help.\u003c/p>\n\u003cp>The incident began the firefighter’s arduous, years-long journey toward wellness, threaded through a bureaucratic labyrinth strewn with more obstacles than he’d ever encountered on a California wildfire: finding qualified medical help, battling an insurance company to pay for it and navigating the tangled morass of California’s workers’ comp. All without going broke or returning to his dark place.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>No one tracks how many of Cal Fire’s 12,000 firefighters and other employees suffer from mental health problems, but department leaders say post-traumatic stress disorder and suicidal thoughts \u003ca href=\"https://calmatters.org/environment/2022/06/california-firefighter-trauma-ptsd/?series=california-firefighters-trauma-wildfires\">have become a silent epidemic\u003c/a>\u003cstrong> \u003c/strong>at the agency responsible for fighting \u003ca href=\"https://calmatters.org/california-wildfire-map-tracker/\">California’s increasingly erratic and destructive wildfires\u003c/a>. In an \u003ca href=\"https://www.researchgate.net/publication/352466544_Wildland_Firefighter_Psychological_and_Behavioral_Health_Preliminary_Data_from_a_National_Sample_of_Current_and_Former_Wildland_Firefighters_in_the_United_States_Conference_session\">online survey\u003c/a> of wildland firefighters nationwide, about a third reported considering suicide and nearly 40% said they had colleagues who had committed suicide; many also reported depression and anxiety.\u003c/p>\n\u003cp>California’s workers’ comp — which is supposed to help people get medical treatment for workplace illnesses and injuries — can be a nightmare for firefighters and other first responders with PTSD.\u003c/p>\n\u003cp>Claims filed by firefighters and law enforcement officers are more likely to involve PTSD than claims by the average worker in California — and they have been \u003ca href=\"https://calmatters.org/wp-content/uploads/2024/06/RAND-PTSD-REPORT.pdf\">denied more often than claims for other medical conditions (PDF)\u003c/a>, according to the research institute RAND.\u003c/p>\n\u003cp>From 2008 to 2019 in California, workers’ comp officials denied PTSD claims filed by firefighters and other first responders at more than twice the rate of their other work-related conditions, such as back injuries and pneumonia, RAND reported. About a quarter of firefighters’ 1,000 PTSD claims were denied, a higher rate than for PTSD claims from other California workers.\u003c/p>\n\u003cp>“It’s a fail-first system. You have to get a broken leg to show you are in need of support. With mental illness, we are constantly having to prove to everybody why we were ill. You have to get to the point of suicide,” said Jessica Cruz, the California chief executive officer of the \u003ca href=\"https://namica.org/\">National Alliance on Mental Illness\u003c/a>.\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/DLvG2Yy34QM'\n title='//www.youtube.com/embed/DLvG2Yy34QM'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>Jennifer Alexander, Nelson’s therapist, said patients in acute crisis simply don’t have the mental capacity to ride herd on stubborn workers’ comp claims. Alexander said she was once on hold for more than six hours with Cal Fire’s mental health provider attempting to get one of her bills paid, and she has waited years to get paid for treating firefighters.\u003c/p>\n\u003cp>“People give up. It’s a battle … They are not fully functional,” said Alexander, who for 21 years has specialized in treating first responders with trauma and PTSD and has spent an estimated 25,000 hours treating them. “You are not talking about healthy individuals who can sit on the phone for hours.”\u003c/p>\n\u003cp>Cal Fire firefighters and other workers also have trouble finding qualified therapists, especially outside major cities in rural areas, where many are based. In 2021, less than \u003ca href=\"https://www.commonwealthfund.org/publications/explainer/2023/may/understanding-us-behavioral-health-workforce-shortage\">half of people with a mental illness\u003c/a> in the U.S. were able to access timely care. \u003ca href=\"https://calmatters.org/environment/2024/06/california-workers-comp-firefighters-therapists/\">Therapists are reluctant to take workers’ comp\u003c/a>, or sometimes any type of insurance, because they often have to wait months or years to be reimbursed.\u003c/p>\n\u003cfigure id=\"attachment_11992261\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11992261\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-14-copy-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-14-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-14-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-14-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-14-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-14-copy.jpg 1568w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Therapist Jennifer Alexander listens to Nelson during a treatment session. She called workers’ comp a ‘total system breakdown.’ \u003ccite>(Cristian Gonzalez for CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Michael Dworsky, a senior economist at the research institute RAND and one of the study’s project leaders, called workers’ comp “challenging and bureaucratic.”\u003c/p>\n\u003cp>“Even if the claim is accepted, there can be disputes about the medical necessity of individual bills. Just because your claim is accepted, doesn’t mean you are done fighting with the insurance company,” he said.\u003c/p>\n\u003ch2>A presumption of pain but still a tangled web\u003c/h2>\n\u003cp>Employers in California must provide workers’ comp insurance that will pay for medical costs when a worker is injured on the job. However, in reality, workers’ comp, which serves 16 million Californians, can be ungainly, confusing and, sometimes, no help at all. The system, administered by the state Department of Industrial Relations, is massive: In 2022, almost \u003ca href=\"https://www.dir.ca.gov/CHSWC/Reports/2023/CHSWC_AnnualReport2023.pdf\">750,000 workers’ comp claims (PDF)\u003c/a> were filed statewide.\u003c/p>\n\u003cp>When a firefighter requests coverage for medical treatment, insurance adjusters review the case to determine if it’s medically necessary. If the claim is denied, delayed or modified, a patient may request an independent medical review by so-called “ghost doctors” who review the case.\u003c/p>\n\u003cp>Systemwide in California, patients who appeal their denied workers’ comp claims, don’t fare well: Last year 3,238 appeals for mental health claims were filed, but workers’ comp officials rejected three-quarters of them, about the same as the 10-year average, according to data from the Department of Industrial Relations requested by CalMatters. (Agency officials said they could not provide data on claims from first responders.)\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://datawrapper.dwcdn.net/9hnJM/4/\" width=\"800\" height=\"600\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>For decades, the California Legislature has wrestled with how to fix workers’ comp — in one year alone, lawmakers proposed nearly two dozen bills.\u003c/p>\n\u003cp>In 2020 lawmakers took a major step, adding a \u003ca href=\"https://digitaldemocracy.calmatters.org/hearings/256803?t=1347&f=e8036f39579fee812f324253b5cb224b\">legal \u003c/a>\u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240sb623\">shortcut or “presumption”\u003c/a> to the\u003cstrong> \u003c/strong>state\u003cstrong> \u003c/strong>labor code, stipulating that firefighters and other first responders are considered at high risk for PTSD in the course of doing their job.\u003c/p>\n\u003cp>That means first responders no longer carry the burden of proving their illness is work-related. However, a claims adjuster can still question the diagnosis or assert that the trauma was caused by other factors, such as military service or family events. A law enacted last year \u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240sb623\">extended the presumption to 2029\u003c/a>.\u003c/p>\n\u003cp>In practice, experts say that, despite the law, proving a mental health claim is still almost as difficult to overcome as the psychological injury itself. Break an arm while fighting a wildfire, and, backed up by x-rays, claims are approved. But break your mind after decades of exposure to on-the-job trauma? Prepare for battle.\u003c/p>\n\u003cp>Before enacting the law, state officials asked RAND researchers to report on the scope of the problem. They analyzed nearly 6 million claims filed between 2008 through 2019 and interviewed dozens of experts, including a representative sample of 13 first responders.\u003c/p>\n\u003cp>The researchers found a consistent and troubling trend among the 13: “Nearly all workers said that they had filed a workers’ compensation claim for their mental health conditions — yet almost none received PTSD care paid for by workers’ compensation.”\u003c/p>\n\u003cp>Paying out of pocket “caused severe financial strain in some cases. Some were eventually reimbursed by workers’ compensation, but only after litigation and substantial delay. Some who pursued care through workers’ compensation also noted that claim denials led to delays in the start of mental health treatment,” the RAND researchers wrote.\u003c/p>\n\u003cp>The 13 first responders they surveyed stressed “over and over again about self-pay and barriers,” said \u003ca href=\"https://www.rand.org/about/people/q/quigley_denise_d.html\">Denise D. Quigley, a RAND senior policy researcher\u003c/a> who was a project leader on the study. “It’s not like we heard it once or twice, we heard it over and over again. It’s highly unlikely that we talked to the (only) people in California that had this happen.”\u003c/p>\n\u003cp>Firefighters told of borrowing money from family members and taking out home equity loans to pay for care, Quigley said. The litany of their struggle weighed on her team. “It’s difficult to hear people break down crying while talking to us because of all the things they’ve seen.”\u003c/p>\n\u003cp>According to the RAND research, for the 12-year period from 2008 through 2019, before the new law took effect:\u003c/p>\n\u003cul>\n\u003cli>Firefighters and other first responders were about twice as likely to file PTSD claims as the general workforce — but the numbers are small, under 1% of all workers’ comp claims.\u003c/li>\n\u003c/ul>\n\u003cul>\n\u003cli>Firefighters’ PTSD claims were denied more often than claims of other workers: About 24% were denied, compared to about 19% of PTSD claims for all workers, including those in high-stress occupations. About a quarter of firefighter claims for all mental health conditions were denied.\u003c/li>\n\u003c/ul>\n\u003cul>\n\u003cli>Their PTSD claims were denied at more than twice the rate of their other presumptive medical conditions related to their jobs, such as hernias and back injuries. Even their cancer and heart disease claims were accepted at a higher rate than PTSD.\u003c/li>\n\u003c/ul>\n\u003cul>\n\u003cli>These denial rates were calculated using a sample of only 258 PTSD claims filed by firefighters. But researcher Dworsky said the total number of claims is far higher, about 1,000, with about 230 claims denied, during those 12 years. And countless other firefighters who suffer from PTSD didn’t seek care through workers’ comp.\u003c/li>\n\u003c/ul>\n\u003cp>The RAND report was the most detailed look at the inequities between how physical and mental health are treated among firefighters and how first responders’ claims were handled compared to other workers. However, the researchers struggled with incomplete data and difficulty identifying which claims were from firefighters.\u003c/p>\n\u003cp>Quigley said she is frustrated that no one since has tracked whether the 4-year-old presumption law — known as the Trauma Treatment Act — has helped patients and improved the system.\u003c/p>\n\u003cp>Many therapists say they haven’t seen much, if any, improvement. Nelson’s therapist, Alexander, called workers’ comp a “total system breakdown.”\u003c/p>\n\u003cp>A spokesman for the Department of Industrial Relations refused to grant interview requests from CalMatters or answer questions or provide data about firefighters’ mental health claims.\u003c/p>\n\u003ch2>Navigating the system\u003c/h2>\n\u003cp>During his 28 years with Cal Fire fighting wildfires in combustible regions, such as the Napa Valley and the Sierra Nevada foothills, and responding to other emergencies, Nelson never reported any mental health issues to anyone. Not once. Even as he would regularly pull his truck off the side of the road during wildfires and weep. Even after responding to the scene of traffic accidents, extricating children from crushed cars as their parents fought to get to them. Even after answering a call to a suicide to find a man hanging from the rafters in his barn. Even after the unbidden images began to intrude with greater frequency.\u003c/p>\n\u003cp>Instead, his mantra became “I’m good.”\u003c/p>\n\u003cp>That stoicism, common among first responders, short circuits the insurance system designed to help them — a system that works best with prompt reporting and meticulous documentation.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Claims adjusters usually handle clear-cut cases where the date of injury can be pinpointed. More common among PTSD claims, though, is Nelson’s experience with cumulative trauma, with no paper trail of injuries or complaints. He can’t offer a single event as the origin of his trauma and no coherent chronology. Cal Fire folks tend to wait until their dam bursts before asking for the water to be turned off.\u003c/p>\n\u003cp>One Southern California mental health provider told the RAND researchers that firefighters and police officers typically have severe cases of trauma.\u003c/p>\n\u003cp>“On the clinical side, as a mental health provider, it is not realistic to expect a firefighter or a police officer to come in and have had a little trauma or some minor stress condition … Most departments have people with a lot of stress and trauma,” the therapist said. “Just because you had something happen recently, the straw that broke the camel’s back, it is really the cumulative stress that is the issue.”\u003c/p>\n\u003cp>Now retired, Nelson, 54, has been fighting for workers’ compensation for almost three years, since his suicide attempt on the Placer County bridge. He and his wife already have spent more than $10,000 out of pocket for medical care and could face thousands more in legal bills.\u003c/p>\n\u003cp>Nelson’s case is unusually severe and complex, requiring two extended stays in a facility that specifically treats firefighters to diagnose his conditions and finally set him on a treatment path of therapy and multiple medications.\u003c/p>\n\u003cp>Cal Fire Battalion Chief Brad Niven said he has more than a dozen firefighter friends who have had similar experiences.\u003c/p>\n\u003cp>“Talk to anybody that tries to do anything through workers’ comp — it is an absolute nightmare,” he said. “Everybody knows you file your first workers’ comp claim and they will deny it. One guy I worked with went through the works with them. He had to prove beyond a shadow of a doubt that you have problems. You have to relive everything you’ve gone through. It does not make for a friendly system.”\u003c/p>\n\u003cfigure id=\"attachment_11992262\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11992262\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/060822_BRAD_NIVEN_CALFIRE_JH_CM_37-copy-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/060822_BRAD_NIVEN_CALFIRE_JH_CM_37-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/060822_BRAD_NIVEN_CALFIRE_JH_CM_37-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/060822_BRAD_NIVEN_CALFIRE_JH_CM_37-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/060822_BRAD_NIVEN_CALFIRE_JH_CM_37-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/060822_BRAD_NIVEN_CALFIRE_JH_CM_37-copy.jpg 1568w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Cal Fire Battalion Chief Brad Niven, shown at his home in Sonora, said he and more than a dozen firefighter friends have had trouble getting workers’ comp to pay their claims for mental health treatment. \u003ccite>(Julie Hotz for CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Niven considered suicide before Cal Fire’s employee support personnel helped him find a therapist, streamlining what had been a hit-and-miss process.\u003c/p>\n\u003cp>“They blasted away the stumbling blocks,” he said. But the fire agency does not make the decision to approve or deny a claim or handle the bureaucratic thicket that is workers’ comp.\u003c/p>\n\u003cp>Scott O’Mara, a \u003ca href=\"https://law1199.com/\">San Diego-based lawyer\u003c/a> whose firm represents first responders, said adjusters’ training is to look for what they can develop to deny the case. “Their goal is to contain and control cost,” he said. “We do a lot of cases where the compensation is nickels.”\u003c/p>\n\u003cp>Although California law now considers PTSD for first responders a presumption, it is a “disputable presumption.” That means claims administrators can consider other traumatic events in a firefighter’s life that may play a role in a PTSD case.\u003c/p>\n\u003cp>“With cumulative trauma, or stress over the course of their entire employment, we need to request more information from the doctor so that we can see it isn’t because they were in the military or they are going through a divorce, etc.,” one claims adjuster told RAND researchers.\u003c/p>\n\u003cp>The complexity of the system wears down the resistance of injured workers, who need a jungle guide to find their way at a time of profound pain and disorientation.\u003c/p>\n\u003cp>“They can’t navigate this on their own, they really can’t. They’ve got professional litigators opposing them,” said Richard Elder, a \u003ca href=\"https://www.elderandberg.com/attorney/richard-e-elder-jr/\">workers’ comp lawyer\u003c/a> in Concord who regularly represents state firefighters. “The average claims adjuster on the job for more than a month knows more about the system than the average firefighter. They’ve got lawyers on speed dial. The injured worker is adrift. It’s like a do-it-yourself heart transplant.”\u003c/p>\n\u003cp>Elder, who has been in practice for 54 years, used to work as an insurance company claims adjuster. The system, he said, has always been adversarial.\u003c/p>\n\u003cp>“It’s against the law for employers to discriminate against a worker who files a psyche claim. But they do discriminate,” said Elder, who said in the past five decades he has pursued about 500 psychiatric claims.\u003c/p>\n\u003cp>“I just filed a psychiatric claim and the response was ‘give us a list of every medical facility that treated the claimant in the last 10 years,’” he said. “The workers’ comp medical treatments system is a stain upon the soul of the politicians and officials of California.”\u003c/p>\n\u003ch2>Diagnosing PTSD is ‘a complicated process’\u003c/h2>\n\u003cp>One day in March, Nelson sat next to his wife, Leticia, in a quiet room in a Nevada City library near their rental home. He was in the grips of a seizure, brought on by retelling his firefighting nightmares to a CalMatters reporter. His hands were clenched and his torso taut. He stuttered, his eyelids fluttering. The episode lasted a few minutes.\u003c/p>\n\u003cp>During the interview, Nelson was fidgety, his thick fingers constantly worrying about the items he had put on the table in front of him. One was a tiny aluminum cylinder containing medication for his seizures, another was a brass medallion, the iconic firefighter symbols of an ax and firehose nozzle stamped on one side and the serenity prayer on the other.\u003c/p>\n\u003cp>The coin was a kind of talisman given to him after graduating from a \u003ca href=\"https://www.iaffrecoverycenter.com/\">specialized rehab clinic \u003c/a>for firefighters, where he was given his daunting medical diagnosi\u003cem>s: \u003c/em>He suffers from complex PTSD, \u003ca href=\"https://my.clevelandclinic.org/health/diseases/24517-psychogenic-nonepileptic-seizure-pnes\">psychogenic non-epileptic seizures\u003c/a> and dissociative identity disorder.\u003c/p>\n\u003cp>Such anxiety-induced seizures are unusual but not rare, his therapist said, and the totality of Nelson’s mental health issues makes his case unusually severe. Weekly therapy sessions and multiple medications have tempered, but not extinguished, his struggle with crippling anxiety.\u003c/p>\n\u003cp>Nelson wears a medical alert wrist bracelet intended to give first responders a bare-bones outline of his conditions and which medications to avoid when he is experiencing an anxiety-induced seizure. In his back pocket, he carries, always, a medical card with his list of red flags, so extensive that it unspools like an accordion.\u003c/p>\n\u003cp>His seizures may occur several times a day. Some last for hours. Nelson’s usually benign aspect changes: His eyes cross, his hands clench into what he calls “spidey fingers.” He stumbles and stutters through sentences and repeats words, often losing his ability to speak at all. At times he drags his head and face along walls. Leticia Nelson describes the seizures as his body undergoing earthquakes.\u003c/p>\n\u003cfigure id=\"attachment_11992264\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11992264\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-25-copy-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-25-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-25-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-25-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-25-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-25-copy.jpg 1568w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The emergency medical ID card that Nelson carries with him. \u003ccite>(Loren Elliott for CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_11992266\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11992266\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-14-copy-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-14-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-14-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-14-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-14-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM-14-copy.jpg 1568w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Nelson alongside his wife, Leticia Nelson, near their Nevada City home. She said it’s been agonizing to see him suffer mental health problems related to his job and have to fight the system to get his treatment paid for. ‘We sacrificed our time with him so that he could help the whole state. And nothing has been there for the family since this happened. Nothing.’ \u003ccite>(Loren Elliott for CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nelson’s unusual body movements during a seizure, his inability to respond to questions and his propensity to run away when confronted puts Nelson in a precarious place in airport lines or with law enforcement, where his non-response has been misconstrued as defiance.\u003c/p>\n\u003cp>Even doctors can misunderstand. Diagnosing and treating PTSD and acute trauma like Nelson’s is notoriously difficult.\u003c/p>\n\u003cp>“Diagnosing PTSD is a complicated process. Diagnostic criteria are complicated,” said Sidra Goldman-Mellor, a \u003ca href=\"https://publichealth.ucmerced.edu/content/sidra-goldman-mellor\">UC Merced psychiatric epidemiologist\u003c/a> who studies depression and suicidal behavior. “Your average primary care clinician is probably not willing to go down that road.”\u003c/p>\n\u003cp>For patients like Nelson, any number of stress-related disorders present themselves and muddy a specific diagnosis that would satisfy a claims adjuster or a workers’ comp review.\u003c/p>\n\u003cp>“That’s the thing with psychiatric disorders, we don’t have a lot of objective measures for a mental health diagnosis. We don’t have blood tests and we don’t have MRIs,” Goldman-Mellor said. “They (mental health issues) are harder to recognize, harder to test for and easier to ignore.”\u003c/p>\n\u003cp>However, firefighters cannot move easily through the workers’ comp or medical insurance system if they don’t have a diagnosis. Constantly proving your pain becomes its own trauma.\u003c/p>\n\u003cp>“He has to prove his world is falling apart,” Leticia Nelson said. “It’s hard to explain to someone that you are broken. They look at you, they think that you look fine. They can’t see in your brain. They can’t see in your mind.”\u003c/p>\n\u003cp>It took four years for Nelson to find the right medical care. One physician’s therapeutic approach was to ask the former firefighter to pray with him.\u003c/p>\n\u003cp>The problem was much more fundamental than finding a compatible therapist: He could not \u003cem>find\u003c/em> one to take his case. Many Cal Fire employees are stationed in rural or remote areas of the state, in communities underserved by health care specialists.\u003c/p>\n\u003cp>Living in rural Nevada County, Nelson faces a barren mental health desert where it’s difficult to find a competent therapist who might have worked with other first responders and understands the specific challenges of the high-stress job.\u003c/p>\n\u003cp>“It’s an absolute specialization. There’s not near enough of us,” said Alexander, Nelson’s therapist. (Nelson granted her permission to speak about his case.) “In the larger Sacramento area, there are less than a dozen competent providers.”\u003c/p>\n\u003cfigure id=\"attachment_11992268\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11992268\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-09-copy-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-09-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-09-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-09-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-09-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/042424_Therapy_CG-CM-09-copy.jpg 1568w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Nelson recalls memories of his time as a firefighter during a treatment session. \u003ccite>(Cristian Gonzalez for CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Cal Fire is self-insured and offers medical coverage through private companies. The agency does not manage medical claims or workers’ comp but does have programs to assist employees in finding care.\u003c/p>\n\u003cp>Rob Wheatley, staff chief of Cal Fire’s Behavioral Health and Wellness Program, told CalMatters in an email that the agency has expanded support for employees who seek help for mental health issues with peer counseling or referrals for treatment. The agency has a staff of 28 assisting about 12,000 employees.\u003c/p>\n\u003cp>But Wheatley and other Cal Fire officials refused to grant an interview and did not answer CalMatters’ questions about the problems that their employees face with workers’ comp and mental health issues.\u003c/p>\n\u003cp>“Any denial of a mental health claim is concerning,” Wheatley said in the email.\u003c/p>\n\u003ch2> Can the system be repaired?\u003c/h2>\n\u003cp>The Nelsons have seen the insurance and workers’ comp system from the inside, been batted around by it and, they would say, abandoned by it. Still, they have few suggestions for fixing it.\u003c/p>\n\u003cp>They are not alone. Lawyers say that the system is based on how to save money, is too often adversarial and deeply entrenched.\u003c/p>\n\u003cp>Even the employers who participate in the workers’ comp system say it’s not working well. In a recent survey, more than half of the respondents said the system performs poorly, while 42% described the system as challenged but adequate.\u003c/p>\n\u003cp>“Nobody believes it’s ideal,” said Jerry Azevedo, a spokesman for the \u003ca href=\"https://www.workcompaction.org/\">Workers’ Compensation Action Network,\u003c/a> a coalition of California insurers, employers and agents advocating to improve the system. “Every constituency has complaints.”\u003c/p>\n\u003cp>Azevedo said California’s workers’ comp system, which has been in place since 1913, is plagued by \u003ca href=\"https://information.auditor.ca.gov/pdfs/reports/2019-106.pdf\">persistent problems\u003c/a>: high costs to operate, huge claim volume, frequent litigation, slow claim resolution and fraud and abusive practices.\u003c/p>\n\u003cp>“The fundamental challenge we all contend with is complexity. California’s system is arguably the most complex in the nation,” Azevedo said. The good news, he said, is that 86% of workers’ comp claims overall are accepted, according to the California Workers’ Compensation Institute.\u003c/p>\n\u003cp>It’s easy to get the sense of a general throwing up of hands. The state Commission on Health & Safety & Workers’ Comp dedicates a \u003ca href=\"https://www.dir.ca.gov/chswc/WCReformsPage1.htm\">webpage to tracking workers’ comp reforms\u003c/a>, but the last entry was in 2012.\u003c/p>\n\u003cp>Sean Cooper, executive vice president and chief actuary of the \u003ca href=\"https://www.wcirb.com/\">Workers’ Compensation Insurance Rating Bureau of California\u003c/a>, said the system is groaning under its own weight — there are a lot of people filing claims and a lot of lawyers on all sides.\u003c/p>\n\u003cp>Administrative costs are high in California: The cost to deliver $1 of medical benefit from California’s workers’ comp system is 46 cents, compared to two cents for Medicare, 19 cents for private group health insurance and 25 cents for the national state median for workers’ comp according to the group’s 2023 report.\u003c/p>\n\u003cp>One way to fix the inequity is to turn the system on its head, said Cruz of the \u003ca href=\"https://namica.org/\">National Alliance on Mental Illness\u003c/a>.\u003c/p>\n\u003cp>“There is a disparity about how we treat, respond and react to behavioral health versus physical health,” she said. “Maybe we need to start talking about that disparity in workers’ comp. When you have (a claims) approval rating that is flipped on its backside, that’s an obvious parity issue.”\u003c/p>\n\u003cp>Legislators, when they turn their gaze to the massive program, chip away at the edges. The law extending the PTSD presumption will be revisited when the state Commission on Health and Safety and Workers’ Compensation presents its report on claims and denials to the Senate Committee on Labor, Public Employment and Retirement and the Assembly Committee on Insurance, by the end of this year.\u003c/p>\n\u003cp>Cruz said there is more legislative focus on behavioral health than ever, but there are limits, beginning with which groups carry the most influence. Managed health care companies are powerful advocates of the status quo, she said. “We are David and Goliath when we come up against these folks.”\u003c/p>\n\u003cp>“So many great people want to do wonderful things and they have big ideas, but it gets chopped down to a Band-Aid once everyone gets what they want,” she said.\u003c/p>\n\u003ch2>‘A slap in the face to all of us’\u003c/h2>\n\u003cp>Leticia Nelson refers to herself, with only slight exaggeration, as her husband’s “service dog.”\u003c/p>\n\u003cp>She’s the keeper of the couple’s appointment schedule; she’s the chauffeur; and the manager of the financial spreadsheet. And it falls to Leticia to devote untold hours on the phone with insurers and medical providers, bird-dogging bills, late payments and coverage lapses.\u003c/p>\n\u003cp>She has watched her husband humiliated, scared and angry. Their two adult daughters, also have been treated for PTSD, after witnessing their father’s anxiety and mania, and knowing about his suicide attempts.\u003c/p>\n\u003cp>At times, Leticia Nelson said, “I’m mad at God.”\u003c/p>\n\u003cfigure id=\"attachment_11992269\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11992269\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM_21-copy-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM_21-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM_21-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM_21-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM_21-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/031924_Todd-Nelson_LE_CM_21-copy.jpg 1568w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Retired Cal Fire firefighter Todd Nelson walks with his wife in Nevada City. Nelson suffers from post-traumatic stress disorder resulting from the trauma experienced during his firefighting career. \u003ccite>(Loren Elliott for CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Nelsons, lifelong Californians, want to leave the state and its frightening tableau of wildfires. They sold their house, changed their mind about moving and now are financially shut out of the real estate market, especially because of the high cost of fire insurance in the foothills where they live. They are nomads, shuttling between Airbnbs with two large dogs and three cats in tow and their possessions in storage.\u003c/p>\n\u003cp>Money is tight. Leticia would like to go back to work, but she can’t leave Todd alone.\u003c/p>\n\u003cp>Nelson gave up fighting the state over a disability claim after his attorney told him that an appeal would cost $50,000 — and he would lose because he didn’t claim a disability when he retired.\u003c/p>\n\u003cp>“It’s a slap in the face to all of us because we sacrificed as a family,” Leticia Nelson said of Todd’s long career with Cal Fire. “We sacrificed our time with him so that he could help the whole state. And nothing has been there for the family since this happened. Nothing.\u003c/p>\n\u003cp>“I wish that there’s things in place that would guide us that wouldn’t be so hard. But it just seems like we hit every, every obstacle possible. We’re struggling. We need help. We need to be seen. We need to be treated like humans and not criminals.”\u003c/p>\n\u003cp>For his part, Nelson is coming to terms with the devastation his career wrought. Yet, years after retirement, he still listens to an emergency scanner and shows up at fires in his area, wearing his T-shirt, shorts and Birkenstocks. The pull to serve remains strong.\u003c/p>\n\u003cp>“The crazy thing is I miss my job. I miss it every day. I would do it all over again,” he said wistfully. “I loved the job but I didn’t realize the damage being done.”\u003c/p>\n\u003cp>\u003cem>If you are having suicidal thoughts, you can get help from the National Suicide Prevention Lifeline by calling 988 or visiting \u003c/em>\u003ca href=\"https://suicidepreventionlifeline.org/\">\u003cem>https://suicidepreventionlifeline.org\u003c/em>\u003c/a>\u003c/p>\n\u003cp>\u003cem>This story also was made possible in part by a grant from the \u003ca href=\"https://amarkfoundation.org/\">A-Mark Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>California’s latest effort to legalize psychedelic substances for therapeutic purposes has tripped up.\u003c/p>\n\u003cp>A \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240SB803\">bipartisan bill\u003c/a> that would have allowed three counties — San Francisco, San Diego and Santa Cruz — to operate facilities for three years where veterans and former first responders could use psilocybin, or psychedelic mushrooms, under the supervision of a licensed physician died in committee on Tuesday.\u003c/p>\n\u003cp>Sen. John Becker (D-Menlo Park) and Sen. Brian Jones (R-San Diego) recently put Senate Bill 803 forward after a \u003ca href=\"https://www.kqed.org/science/1992363/as-california-seeks-to-legalize-psychedelics-for-therapeutic-use-oregon-provides-key-lessons\">broader bill\u003c/a> aiming to legalize psychedelic substances also \u003ca href=\"https://www.kqed.org/science/1992997/advocates-for-legalized-psychedelics-in-california-plan-a-ballot-measure-push\">died in committee last month\u003c/a>. The authors pulled SB 803, titled the \u003cem>Heal Our Heroes Act\u003c/em>, after it appeared headed for a ‘no’ vote.\u003c/p>\n\u003cp>“While the Heal Our Heroes Act will not advance in the Assembly Health Committee, it has raised awareness of the work-related trauma and troubling mental health issues our veterans and first responders face after honorably serving our state and country,” Becker said in a statement to KQED. “More than 17 veterans die by suicide each week. This is unacceptable. Our heroes deserve the best care possible.”\u003c/p>\n\u003cp>SB 803 was the fourth major effort by state lawmakers in recent years to create legal access to psychedelics for therapeutic use.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The Legislature has again failed veterans, first responders and the 130,000 veteran families that have lost a loved one to suicide,” said Jesse Gould, founder of Heroic Hearts Project, a nonprofit which works to further the acceptance of psychedelic therapies for veterans. “We applaud the legislators that supported SB 803 and its previous iterations, and are undeterred in our fight to find effective solutions to reduce veteran suicide and the veteran mental health crisis.”\u003c/p>\n\u003cp>Assembly Health Committee Chair Mia Bonta vowed to keep the issue top-of-mind.\u003c/p>\n\u003cp>“It may well be that psychedelics have the potential to provide significant mental health benefits for those experiencing Post-Traumatic Stress Disorder. However, it is also crucial to provide a medical and therapeutic pathway with robust and meaningful regulation so California can be a beacon of leadership on this form of care,” Bonta said in a prepared statement. “This issue will undoubtedly remain top of mind for me as I seek to ensure all Californians can access the safest and most effective care possible.”\u003c/p>\n\u003cp>At the local level, cities including Berkeley, Oakland, San Francisco and Santa Cruz have voted to effectively decriminalize psychedelic mushrooms by de-prioritizing law enforcement and penalties for possession and use of the substances.\u003c/p>\n\u003cp>But the push to regulate psychedelics has been an uphill battle in the Golden State, where it is illegal to possess, cultivate and sell psilocybin and psilocin.\u003c/p>\n\u003cp>In 2023, Gov. Gavin Newsom vetoed a broad bill aiming to decriminalize psychedelic substances. In his veto, the governor asked lawmakers to come back with a bill \u003ca href=\"https://www.kqed.org/science/1992363/as-california-seeks-to-legalize-psychedelics-for-therapeutic-use-oregon-provides-key-lessons\">similar to a model already used in Oregon\u003c/a>, the first state in the U.S. to pass a regulatory framework for the use of psychedelic mushrooms.\u003c/p>\n\u003cp>The bill lawmakers came back with, authored by Sen. Scott Wiener (D-San Francisco), would have approved service centers where people could use magic mushrooms, MDMA and mescaline for therapeutic purposes. That bill died in committee in May.\u003c/p>\n\u003cp>Advocates for therapeutic uses of psychedelics said they are seeking to put the issue in voters’ hands in 2026.\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/news/11990945/uc-berkeley-launches-landmark-study-how-exactly-do-magic-mushrooms-alter-the-brain\">A small but growing body of research\u003c/a> shows that using magic mushrooms can help with certain mental health challenges like \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/37844352/\">anxiety and depression\u003c/a>. However, studies have also shown a small portion of people have negative experiences using psychedelics, including anxiety and suicidal thoughts, particularly with recreational use outside of a controlled setting.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story has been updated.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California’s latest effort to legalize psychedelic substances for therapeutic purposes has tripped up.\u003c/p>\n\u003cp>A \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240SB803\">bipartisan bill\u003c/a> that would have allowed three counties — San Francisco, San Diego and Santa Cruz — to operate facilities for three years where veterans and former first responders could use psilocybin, or psychedelic mushrooms, under the supervision of a licensed physician died in committee on Tuesday.\u003c/p>\n\u003cp>Sen. John Becker (D-Menlo Park) and Sen. Brian Jones (R-San Diego) recently put Senate Bill 803 forward after a \u003ca href=\"https://www.kqed.org/science/1992363/as-california-seeks-to-legalize-psychedelics-for-therapeutic-use-oregon-provides-key-lessons\">broader bill\u003c/a> aiming to legalize psychedelic substances also \u003ca href=\"https://www.kqed.org/science/1992997/advocates-for-legalized-psychedelics-in-california-plan-a-ballot-measure-push\">died in committee last month\u003c/a>. The authors pulled SB 803, titled the \u003cem>Heal Our Heroes Act\u003c/em>, after it appeared headed for a ‘no’ vote.\u003c/p>\n\u003cp>“While the Heal Our Heroes Act will not advance in the Assembly Health Committee, it has raised awareness of the work-related trauma and troubling mental health issues our veterans and first responders face after honorably serving our state and country,” Becker said in a statement to KQED. “More than 17 veterans die by suicide each week. This is unacceptable. Our heroes deserve the best care possible.”\u003c/p>\n\u003cp>SB 803 was the fourth major effort by state lawmakers in recent years to create legal access to psychedelics for therapeutic use.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The Legislature has again failed veterans, first responders and the 130,000 veteran families that have lost a loved one to suicide,” said Jesse Gould, founder of Heroic Hearts Project, a nonprofit which works to further the acceptance of psychedelic therapies for veterans. “We applaud the legislators that supported SB 803 and its previous iterations, and are undeterred in our fight to find effective solutions to reduce veteran suicide and the veteran mental health crisis.”\u003c/p>\n\u003cp>Assembly Health Committee Chair Mia Bonta vowed to keep the issue top-of-mind.\u003c/p>\n\u003cp>“It may well be that psychedelics have the potential to provide significant mental health benefits for those experiencing Post-Traumatic Stress Disorder. However, it is also crucial to provide a medical and therapeutic pathway with robust and meaningful regulation so California can be a beacon of leadership on this form of care,” Bonta said in a prepared statement. “This issue will undoubtedly remain top of mind for me as I seek to ensure all Californians can access the safest and most effective care possible.”\u003c/p>\n\u003cp>At the local level, cities including Berkeley, Oakland, San Francisco and Santa Cruz have voted to effectively decriminalize psychedelic mushrooms by de-prioritizing law enforcement and penalties for possession and use of the substances.\u003c/p>\n\u003cp>But the push to regulate psychedelics has been an uphill battle in the Golden State, where it is illegal to possess, cultivate and sell psilocybin and psilocin.\u003c/p>\n\u003cp>In 2023, Gov. Gavin Newsom vetoed a broad bill aiming to decriminalize psychedelic substances. In his veto, the governor asked lawmakers to come back with a bill \u003ca href=\"https://www.kqed.org/science/1992363/as-california-seeks-to-legalize-psychedelics-for-therapeutic-use-oregon-provides-key-lessons\">similar to a model already used in Oregon\u003c/a>, the first state in the U.S. to pass a regulatory framework for the use of psychedelic mushrooms.\u003c/p>\n\u003cp>The bill lawmakers came back with, authored by Sen. Scott Wiener (D-San Francisco), would have approved service centers where people could use magic mushrooms, MDMA and mescaline for therapeutic purposes. That bill died in committee in May.\u003c/p>\n\u003cp>Advocates for therapeutic uses of psychedelics said they are seeking to put the issue in voters’ hands in 2026.\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/news/11990945/uc-berkeley-launches-landmark-study-how-exactly-do-magic-mushrooms-alter-the-brain\">A small but growing body of research\u003c/a> shows that using magic mushrooms can help with certain mental health challenges like \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/37844352/\">anxiety and depression\u003c/a>. However, studies have also shown a small portion of people have negative experiences using psychedelics, including anxiety and suicidal thoughts, particularly with recreational use outside of a controlled setting.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story has been updated.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "uc-berkeley-launches-landmark-study-how-exactly-do-magic-mushrooms-alter-the-brain",
"title": "UC Berkeley Launches Landmark Study: How Exactly Do Magic Mushrooms Alter the Brain?",
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"content": "\u003cp>\u003cem>Updated 3 p.m. Tuesday\u003c/em>\u003c/p>\n\u003cp>Amid mounting efforts to legalize psychedelic drugs, UC Berkeley researchers will use neuroimaging to observe how psilocybin alters the brain — the university’s first human study involving a Schedule 1 substance.\u003c/p>\n\u003cp>While previous research has predominantly focused on the drug’s influence on clinical symptoms or human behavior, this study aims to uncover how the brain constructs reality under the influence of psilocybin, the psychoactive compound in magic mushrooms.\u003c/p>\n\u003cp>Healthy participants will ingest psilocybin and then perform simple perceptual tasks while activity in the part of the brain that processes visual information is recorded using functional magnetic resonance imaging, or fMRI.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We have this incredible opportunity to characterize the psychedelic experience in real-time — while it’s happening — using modern neuroimaging methods,” Michael Silver, the director of the UC Berkeley Center for the Science of Psychedelics and the study’s lead investigator, said in a recent university \u003ca href=\"https://news.berkeley.edu/2024/06/11/psychedelics-change-how-we-see-the-world-a-uc-berkeley-study-aims-to-find-out-why/\">press release\u003c/a>. “Understanding the actions of psychedelics at a neuroscientific level will generate insights into how they’re working as medicines and will hopefully help us develop more effective treatments for mental health disorders.”\u003c/p>\n\u003cp>A growing \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/37844352/\">body of research\u003c/a> suggests psilocybin, when administered in controlled conditions with supportive therapy, is \u003ca href=\"https://www.kqed.org/science/1992997/advocates-for-legalized-psychedelics-in-california-plan-a-ballot-measure-push\">a promising treatment for psychiatric disorders\u003c/a> such as addiction and anxiety. Individuals suffering from long-term, debilitating depression have reported significant relief after a single session of psychedelic-assisted therapy.\u003c/p>\n\u003cp>Still, several recent attempts to reintroduce banned drugs into medical practice have hit roadblocks. Earlier this year, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240SB1012&search_keywords=mushrooms\">SB 1012\u003c/a>, a bill championed by Sen. Scott Wiener (D-San Francisco) to legalize psychedelic-assisted therapy, failed to advance to a full Senate vote. The \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=202320240SB1012\">Senate analysis\u003c/a> indicated “unknown significant ongoing costs, likely ranging in the low millions of dollars,” a daunting prospect given the state’s \u003ca href=\"https://www.kqed.org/news/11986700/california-budget-deficit-forces-lawmakers-to-shelve-bills-on-psychedelic-therapy-reparations\">projected $56 billion budget deficit\u003c/a>.[aside postID=science_1992363 hero='https://cdn.kqed.org/wp-content/uploads/sites/35/2024/04/GettyImages-1449327777-1020x680.jpg']Last year, Gov. Gavin Newsom vetoed a bill to decriminalize the possession and personal use of hallucinogenic drugs, citing the need for more rigorous guidelines to ensure safe use. Similarly, this spring, federal health advisors decisively rejected \u003ca href=\"https://www.kqed.org/forum/2010101893344/the-history-controversy-and-promise-of-mdma\">MDMA-aided therapy\u003c/a> for post-traumatic stress disorder in a 10-1 vote, citing flawed study data, questionable research practices and significant drug risks, including potential heart complications.\u003c/p>\n\u003cp>Despite these setbacks, advocates remain undeterred, pushing for more targeted initiatives. State Senate Minority Leader Brian Jones (R-San Diego) and Sen. Josh Becker (D-Menlo Park) have introduced \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240SB803\">legislation\u003c/a> for a three-year psychedelic therapy pilot program in San Francisco, Santa Cruz, and San Diego counties, focusing on veterans and first responders.\u003c/p>\n\u003cp>“To be clear, I’m not calling for the widespread legalization of psychedelic drugs. Rather, I’m championing a targeted medical treatment aimed specifically at aiding veterans and first responders in their recovery,” Jones said in a \u003ca href=\"https://sr40.senate.ca.gov/content/leader-jones-and-senator-becker-introduce-legislation-authorizing-psychedelic-medical\">statement\u003c/a>.\u003c/p>\n\u003cp>Psilocybin, belonging to the same class of psychedelics as LSD and mescaline, activates serotonin receptors, particularly in the prefrontal cortex. Its effects can include euphoria and hallucinations, spiritual experiences, panic and feelings of detachment.\u003c/p>\n\u003cp>“Psychedelics have always seemed like an interesting, extreme case of how the brain can create really fantastical and amazing visual representations,” said Sean Noah, a UC Berkeley postdoctoral researcher. “I think there’s a lot of unexplored potential in using psychedelics as tools to understand how the brain constructs our visual representation of the world and how the brain is related to consciousness in general.”\u003c/p>\n\u003cp>As researchers in the UC Berkeley study enroll volunteers and begin screening participants, they hope their efforts will solidify the scientific credibility of psilocybin. The recent policy setbacks indicate legislators are not convinced by current evidence, but further clinical trials can help pave the way for more informed policy decisions as advocates continue to push for legalization.\u003c/p>\n\u003cp>“The knowledge we gain from this foundational research will be essential for harnessing the therapeutic potential of psychedelics and improving mental health outcomes for countless individuals in need,” Silver, the study’s lead investigator, said in an email.\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Updated 3 p.m. Tuesday\u003c/em>\u003c/p>\n\u003cp>Amid mounting efforts to legalize psychedelic drugs, UC Berkeley researchers will use neuroimaging to observe how psilocybin alters the brain — the university’s first human study involving a Schedule 1 substance.\u003c/p>\n\u003cp>While previous research has predominantly focused on the drug’s influence on clinical symptoms or human behavior, this study aims to uncover how the brain constructs reality under the influence of psilocybin, the psychoactive compound in magic mushrooms.\u003c/p>\n\u003cp>Healthy participants will ingest psilocybin and then perform simple perceptual tasks while activity in the part of the brain that processes visual information is recorded using functional magnetic resonance imaging, or fMRI.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We have this incredible opportunity to characterize the psychedelic experience in real-time — while it’s happening — using modern neuroimaging methods,” Michael Silver, the director of the UC Berkeley Center for the Science of Psychedelics and the study’s lead investigator, said in a recent university \u003ca href=\"https://news.berkeley.edu/2024/06/11/psychedelics-change-how-we-see-the-world-a-uc-berkeley-study-aims-to-find-out-why/\">press release\u003c/a>. “Understanding the actions of psychedelics at a neuroscientific level will generate insights into how they’re working as medicines and will hopefully help us develop more effective treatments for mental health disorders.”\u003c/p>\n\u003cp>A growing \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/37844352/\">body of research\u003c/a> suggests psilocybin, when administered in controlled conditions with supportive therapy, is \u003ca href=\"https://www.kqed.org/science/1992997/advocates-for-legalized-psychedelics-in-california-plan-a-ballot-measure-push\">a promising treatment for psychiatric disorders\u003c/a> such as addiction and anxiety. Individuals suffering from long-term, debilitating depression have reported significant relief after a single session of psychedelic-assisted therapy.\u003c/p>\n\u003cp>Still, several recent attempts to reintroduce banned drugs into medical practice have hit roadblocks. Earlier this year, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240SB1012&search_keywords=mushrooms\">SB 1012\u003c/a>, a bill championed by Sen. Scott Wiener (D-San Francisco) to legalize psychedelic-assisted therapy, failed to advance to a full Senate vote. The \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=202320240SB1012\">Senate analysis\u003c/a> indicated “unknown significant ongoing costs, likely ranging in the low millions of dollars,” a daunting prospect given the state’s \u003ca href=\"https://www.kqed.org/news/11986700/california-budget-deficit-forces-lawmakers-to-shelve-bills-on-psychedelic-therapy-reparations\">projected $56 billion budget deficit\u003c/a>.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Last year, Gov. Gavin Newsom vetoed a bill to decriminalize the possession and personal use of hallucinogenic drugs, citing the need for more rigorous guidelines to ensure safe use. Similarly, this spring, federal health advisors decisively rejected \u003ca href=\"https://www.kqed.org/forum/2010101893344/the-history-controversy-and-promise-of-mdma\">MDMA-aided therapy\u003c/a> for post-traumatic stress disorder in a 10-1 vote, citing flawed study data, questionable research practices and significant drug risks, including potential heart complications.\u003c/p>\n\u003cp>Despite these setbacks, advocates remain undeterred, pushing for more targeted initiatives. State Senate Minority Leader Brian Jones (R-San Diego) and Sen. Josh Becker (D-Menlo Park) have introduced \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240SB803\">legislation\u003c/a> for a three-year psychedelic therapy pilot program in San Francisco, Santa Cruz, and San Diego counties, focusing on veterans and first responders.\u003c/p>\n\u003cp>“To be clear, I’m not calling for the widespread legalization of psychedelic drugs. Rather, I’m championing a targeted medical treatment aimed specifically at aiding veterans and first responders in their recovery,” Jones said in a \u003ca href=\"https://sr40.senate.ca.gov/content/leader-jones-and-senator-becker-introduce-legislation-authorizing-psychedelic-medical\">statement\u003c/a>.\u003c/p>\n\u003cp>Psilocybin, belonging to the same class of psychedelics as LSD and mescaline, activates serotonin receptors, particularly in the prefrontal cortex. Its effects can include euphoria and hallucinations, spiritual experiences, panic and feelings of detachment.\u003c/p>\n\u003cp>“Psychedelics have always seemed like an interesting, extreme case of how the brain can create really fantastical and amazing visual representations,” said Sean Noah, a UC Berkeley postdoctoral researcher. “I think there’s a lot of unexplored potential in using psychedelics as tools to understand how the brain constructs our visual representation of the world and how the brain is related to consciousness in general.”\u003c/p>\n\u003cp>As researchers in the UC Berkeley study enroll volunteers and begin screening participants, they hope their efforts will solidify the scientific credibility of psilocybin. The recent policy setbacks indicate legislators are not convinced by current evidence, but further clinical trials can help pave the way for more informed policy decisions as advocates continue to push for legalization.\u003c/p>\n\u003cp>“The knowledge we gain from this foundational research will be essential for harnessing the therapeutic potential of psychedelics and improving mental health outcomes for countless individuals in need,” Silver, the study’s lead investigator, said in an email.\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"soldout": {
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