California state Sen. Susan Talamantes Eggman, a Stockton Democrat who was instrumental in passing Gov. Gavin Newsom’s signature mental health care laws last 12 months, has been appointed to steer the Senate’s influential health committee, a change that guarantees a more urgent deal with expanding mental health services and moving homeless people into housing and treatment.

Eggman, a licensed social employee, co-authored the novel law that permits families, clinicians, first responders, and others to petition a judge to mandate government-funded treatment and services for people whose lives have been derailed by untreated psychotic disorders and substance use. It was a win for Newsom, who proposed the Community Assistance, Recovery and Empowerment Act, or CARE Court, as a potent recent tool to deal with the tens of 1000’s of individuals in California living homeless or prone to incarceration due to untreated mental illness and addiction. The measure faced staunch opposition from disability and civil liberties groups anxious about stripping people’s right to make decisions for themselves.

“We see real examples of individuals dying each day, they usually’re dying with their rights on,” Eggman said in an interview with KHN before the appointment. “I believe we want to step back slightly bit and have a look at the larger public health issue. It is a danger for everyone to be living around needles or have people burrowing under freeways.”

Senate Pro Tem Toni Atkins announced Eggman’s appointment Thursday evening. Eggman replaces Dr. Richard Pan, who was termed out last 12 months after serving five years as chair. Pan, a pediatrician, had prioritized the state’s response to the covid-19 pandemic and championed laws that tightened the state’s childhood vaccination laws. Those moves made him a hero amongst public health advocates, whilst he faced taunts and physical threats from opponents.

The leadership change is predicted to coincide with a Democratic health agenda focused on two of the state’s thorniest and most intractable issues: homelessness and mental illness. In accordance with federal data, California accounts for 30% of the nation’s homeless population, while making up 12% of the U.S. population. A recent Stanford study estimated that in 2020 about 25% of homeless adults in Los Angeles County had a severe mental illness similar to schizophrenia and 27% had a long-term substance use disorder.

Eggman will work with Assembly member Jim Wood, a Santa Rosa Democrat who’s returning as chair of the Assembly Health Committee. Though the chairs may set different priorities, they should cooperate to get bills to the governor’s desk.

Eggman takes the helm as California grapples with a projected $24 billion budget deficit, which could force reductions in health care spending. The tighter financial outlook is causing politicians to shift from big “moonshot” ideas like universal health care coverage to showing voters progress on the state’s homelessness crisis, said David McCuan, chair of the political science department at Sonoma State University. Seven in 10 likely voters cite homelessness as an enormous problem, in line with a recent statewide survey by the Public Policy Institute of California.

Eggman, 61, served eight years within the state Assembly before her election to the Senate in 2020. In 2015, she authored California’s End of Life Option Act, which allowed terminally unwell patients who meet specified conditions to get aid-in-dying drugs from their doctor. Her past work on mental health included changing eligibility rules for outpatient treatment or conservatorships, and attempting to make it easier for community clinics to bill the federal government for mental health services.

She hasn’t announced her future plans, but she has around $70,000 in a campaign account for lieutenant governor, in addition to $175,000 in a ballot measure committee to “repair California’s mental health system.”

Eggman said the CARE Court initiative seeks to strike a balance between civil rights and public health. She said she believes people must be within the least restrictive environment obligatory for care, but that when someone is a danger to themselves or the community there must be an choice to hold them against their will. A Berkeley Institute of Governmental Studies poll released in October found 76% of registered voters had a positive view of the law.

Sen. Thomas Umberg (D-Santa Ana), who co-authored the bill with Eggman, credited her expertise in behavioral health and dedication to explaining the mechanics of the plan to fellow lawmakers. “I believe she really helped to place a face on it,” Umberg said.

But it is going to be hard to point out quick results. The measure will unroll in phases, with the primary seven counties — Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus, and Tuolumne — set to launch their efforts in October. The remaining 51 counties are set to launch in 2024.

County governments remain concerned about a gradual and sufficient flow of funding to cover the prices of treatment and housing inherent within the plan.

California has allocated $57 million in seed money for counties to establish local CARE Courts, however the state hasn’t specified how much money will flow to counties to maintain them running, said Jacqueline Wong-Hernandez, deputy executive director of legislative affairs on the California State Association of Counties.

Robin Kennedy is a professor emerita of social work at Sacramento State, where Eggman taught social work before being elected to the Assembly. Kennedy described Eggman as someone guided by data, a listener attuned to the needs of caregivers, and a frontrunner willing to do difficult things. The 2 have known one another since Eggman began teaching in 2002.

“Most of us, once we change into faculty members, we just wish to do our research and teach,” Kennedy said. “Susan had only been there for 2 or three years, and she or he was taking up leadership roles.”

She said that Eggman’s vision of mental health as a community issue, somewhat than simply a person concern, is controversial, but that she is willing to tackle hard conversations and take heed to all sides. Plus, Kennedy added, “she’s not only going to do what Newsom tells her to do.”

Eggman and Wood are expected to supply oversight of CalAIM, the Newsom administration’s sweeping overhaul of Medi-Cal, California’s Medicaid program for low-income residents. The trouble is a multibillion-dollar experiment that goals to enhance patient health by funneling money into social programs and keeping patients out of costly institutions similar to emergency departments, jails, nursing homes, and mental health crisis centers. Wood said he believes there are opportunities to enhance the CalAIM initiative and to watch consolidation within the health care industry, which he believes drives up costs.

Eggman said she’s also concerned about workforce shortages within the health care industry, and could be willing to revisit a conversation about the next minimum wage for hospital employees after last 12 months’s negotiations between the industry and labor failed.

But with only two years left before she is termed out, Eggman said, her lens can be tightly framed round her area of experience: improving behavioral health care across California.

“In my previous few years,” she said, “I would like to deal with where my experience is.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.