Capitol Weekly Interview:

Randall Hagar and mental health care

by Sigrid Bathen, 

Randall Hagar has been in the forefront of major mental health policy and legislation in California for decades. As the father of a severely mentally ill adult son and longtime legislative advocate for California psychiatrists, he has deep knowledge of both family struggles and the complex intricacies of mental health policy. He represented the California Psychiatric Association for nearly 20 years, and since 2020 represents a successor organization, the Psychiatric Physicians Alliance of California. He also actively advises community groups, families and legislators and has written much of California’s major mental health legislation.

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When did you become interested in mental health advocacy?

I think I caught the buzz from my mother, Phyllis Hagar, who was a first-generation legislative advocate for the Sacramento chapter of the California Mental Health Association. She was a volunteer, a member of the board of directors, and served on the state legislative council. She was active in the Democratic Party. She testified in the Legislature on mental health issues and prison overcrowding, wrote letters to editors, won awards for her advocacy.

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She also suffered from depression and anxiety and was drawn to improving conditions. She became severely depressed, suffered from at least one anxiety disorder, and was twice hospitalized in psychiatric hospitals for several weeks at a time. She and my father, Kenneth, met at Northern Arizona University, and their first teaching jobs were in a one-room school in Rocklin (Placer County). He was a junior high school vice-principal in the San Juan Unified School District in Sacramento County.  She taught second grade in Citrus Heights for 15 years, then quit teaching and devoted her life to serving the mental health association.

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When my son was diagnosed, like many family members facing that news, I didn’t know what to do. He was living with me, and I struggled to figure out how to cope with him. I was desperate, and I enrolled in a family education course through the Sacramento chapter of the California Alliance on Mental Illness (the National Alliance on Mental Illness, or NAMI, is an influential organization representing families, with state and local chapters throughout the U.S.), which I learned about when my son had been hospitalized at Sutter. I became a volunteer for the Sacramento chapter,  and I was trained to teach those courses, then became a trainer for other teachers, eventually a national trainer for the first family educators at affiliates in Nevada and Hawaii. The family-to-family courses taught survival skills for family members, understanding how the brain works, communication, coping and advocacy skills. I eventually became the program director for family education in California.

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Because of my interest in politics, and my earlier work with the Associated Students at UCD, I started working with psychiatrists on legislative issues. I told them they needed to become members of NAMI, to learn what it’s like on the other side of the fence where the family is. My first issue as a California advocate was to advocate for fair housing, learning the intricacies of the 1968 fair housing amendments to the U.S. Civil Rights Act of 1964.

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I became a NAMI-California board member in 1998, and was president of the Sacramento chapter. I couldn’t be both an employee and on the board, so I chose to be actively involved with legislation and chaired the state board’s legislative committee, working with  [then-Assemblywoman] Helen Thomson (D-Davis) on Laura’s Law. (Editor’s Note: Laura’s Law, one of the few legal avenues for family members to get help for mentally ill relatives)

 

How did your experiences with your son inform your work as a legislative advocate?

During my testimony in legislative hearings on Laura’s Law in 2001-02, I said that my son (Chris) had been arrested in three counties, was homeless for 18 months, hospitalized seven or eight times in five different counties. I was educated, well-connected, and there was nothing I could do. He was totally on his own journey, and I was helpless to keep him in the hospital. I testified that one feature of his life that made a huge impression on me is that until age 18, he was under the jurisdiction of the juvenile court, and a probation officer would regularly come out, interview us both, ask how he was doing, if he was keeping appointments, taking his meds. That was a kind of  structure that kept him from getting into worse trouble. I learned that a legal structure could be very helpful in keeping a person stable and avoiding worse outcomes. But when he turned 18, and was no longer under the jurisdiction of the juvenile court, he stopped taking his meds, and entered the cycle of homelessness, hospitalizations, arrests.

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What role did the news media play in passage of the bill?

“… Editorial boards of newspapers throughout California supported Laura’s Law, and the LA Times won a Pulitzer for editorial writing, for a series of editorials urging mental health reform. I remember one of the headlines in that series, based on my interviews and testimony, was “Make Chris Take His Meds.”

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You have represented psychiatrists for more than two decades. What are the major themes of that advocacy?

My agenda has been consistent from my time with NAMI. There are signature themes. The first mental health insurance parity bill (requiring that physical and mental illness be treated equally by insurers and providers) was my bill, Laura’s Law was my bill. I helped write and get them on the governor’s desk. CPA (the California Psychiatric Association) was one of the first groups questioning why we are putting so many mentally ill people in jail.  We supported bills for mental health offender programs, for better outreach to severely mentally ill people who were homeless, bills against suspending or curtailing Medi-Cal benefits for people in jails. We advocated for rational release times, not 2 a.m. with no shoes. We worked with the California Sheriff’s association to get the state to underwrite psychotropic medication costs in jail, where newer, more effective antidepressants and antipsychotics weren’t fully available.

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Jails and prisons are often called “the new asylums.” How have you addressed the criminalizing of mental illness?

By the late 1990s, the mentally ill offender crime reduction statute was passed, which appropriated $55 million annually for treatment programs to prevent re-offending. In 2000-2002, Darrell Steinberg (now Sacramento mayor, former state Senate president) authored a series of three bills which provided assertive outreach and community treatment for homeless individuals with mental illness. Then Helen Thomson offered a package of four mental health bills, one of which was Laura’s Law (Assisted Outpatient Treatment or AOT) in 2002. All relate back to release of people from state hospitals and lack of resources for them in the community. Collectively, these measures signaled a renaissance in public policy to provide adequate support for people with severe mental illness. Steinberg and Thomson were the leaders for a long time, since they first were elected.

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