Tony Mantor: Why Not Me ? - Dr Aaron Meyer and Ann Marie Counsil: Bridging the Mental Health Gap: Policy, Psychiatry, and the Fight for Early Intervention

Episode Date: June 17, 2026

Send us Fan MailIn this important episode of Why Not Me? Embracing Autism and Mental Health Worldwide, Tony Mantor sits down with Dr. Alan Meyer, psychiatrist and Behavioral Health Officer for the City of San Diego Fire-Rescue Department, and Ann Marie Council, retired Senior Deputy City Attorney and mental health policy advisor, for an in-depth discussion about the challenges facing today's mental health system. Together, they explore why so many individuals with serious mental illness fall through the cracks, the disconnect between policy and real-world implementation, and how communities can better support those in crisis before tragedy strikes.The conversation covers assisted outpatient treatment, California's CARE Act, healthcare burnout, homelessness, autism, schizophrenia, and the urgent need for earlier intervention and stronger collaboration between healthcare providers, lawmakers, first responders, and community organizations.This is the first of a two-part series that shines a light on the people working to create meaningful change in mental healthcare.In this episode you'll learn:Why mental health and physical health must be treated togetherThe barriers preventing people from receiving timely careHow policy often fails frontline healthcare workersThe role of cities, counties, and states in behavioral health servicesWhy assisted outpatient treatment remains difficult to accessHow technology and AI could improve mental health accessThe importance of prevention instead of waiting for crisisWhy community partnerships are essential for lasting solutionsHow burnout is affecting healthcare professionals and first respondersWhat changes could transform the future of mental healthcareOur GuestsDr. Alan MeyerPsychiatrist at the University of California, San DiegoBehavioral Health Officer for the City of San Diego Fire-Rescue DepartmentSpecialist in complex behavioral health and high-utilizer emergency response systemsAnn Marie CouncilRetired Senior Deputy City Attorney for the City of San DiegoFounding Partner and Mental Health Policy Advisor at Quarter Turn StrategiesAdvocate for legislative reform and improved mental health policyKey TakeawayReal change begins when healthcare, government, first responders, and communities stop working in silos and start working together. Early intervention, compassionate care, and practical policy reforms can save lives and restore hope for individuals and families navigating serious mental illness.If this conversation inspires you, follow the show, leave a review, and share this episode with someone who believes mental health deserves greater understanding and action.#MentalHealth #Autism #BehavioralHealth #Psychiatry #HealthcarePolicy #EarlyIntervention #SeriousMentalIllness #WhyNotMePodcast #TonyMantor #MentalHealthAwareness #Homelessness #CommunityCarehttps://tonymantor.comhttps://Facebook.com/tonymantorhttps://instagram.com/tonymantorhttps://twitter.com/tonymantorhttps://youtube.com/tonymantormusicintro/outro music bed written by T. WildWhy Not Me the World music published by Mantor Music (BMI)

What if everything you thought you knew about autism and mental health wasn't the full story? Today's conversation might change the way you see it. This is why not me, embracing autism and mental health worldwide. Real conversations about autism, mental health, and the stories that shape our lives. I'm Tony Mantor. This is where understanding begins. If this kind of conversation matters to you, follow the show, so you don't miss what comes next. Joining us today are two people who share the same mission on mental health, finding better ways to help people who are struggling. Dr. Alan Meyer, a physician

based in San Diego, who works closely with individuals facing complex medical and mental health challenges. Also joining us is Anne-Marie Counsel, a retired senior deputy city attorney for the city of San Diego, and now a founding partner and mental health policy advisor with quarter-turned strategies. Thanks for joining us today. Thanks for inviting me. Anne-Marie will be joining us shortly, So let's start it out with this. When you're looking at behavioral health, you have the clinical perspective and the policy perspective. Where do you see the biggest gaps in the way the community addresses it? That's a good question.

I see both, but I see the policy impacting the clinical. We've seen that in California with our laws related to substance use disorder treatment and people getting excluded because of, with all their presentation, chocked up to substance use disorder. or we have laws that have said that dementia and cognitive disorders, neurodevelopmental disorders, aren't mental disorders. So then you get clinical decisions that point to gaps or exclusions in the law as the reason why this person can't come to a, like a recommended destination, like an inpatient psychiatric unit. Many people hear your name connected to this field, but may not fully understand the work behind it. Can you walk us through what you actually do? Yeah, so I'm a psychiatrist.

psychiatrist at University of California, San Diego. I finished residency in 2018. And since I finished residency, I've worked at inpatient psychiatric units. I've worked on medical surgical floors, particularly for people who are admitted for medical hospitalizations because they don't, and they don't fit into the psychiatric behavioral health world. Currently, I work with the city of San Diego with their fire rescue department, the behavioral health officer for the city. And I work with people who frequently utilize 911, and sometimes up to 100 or 200 times in a year. And a lot of those folks have a combination of substance use disorders, mental health, cognitive disorders, physical issues. And because of their complexity, they fit in nowhere.

So people who cycle through the emergency departments and through the jails, that's the population who I work with. I'm really glad you brought up the part about the city. Since you work closely with local government, and have seen things firsthand at the street level? What have you learned about the role a city can play with mental health services, especially on the things that people might not realize? Yeah, so I think in each state is probably different on how they break down their responsibility for mental health. And I think in cities, often cities get the blame for mental health crises. And in California, it's the counties that get the money from the state for behavioral health infrastructure and planning.

And it's the counties that are authorized by statute to carry the responsibility of public conservator or public guardian. And so cities can help in terms of zoning laws. Cities can help in terms of housing. And that in California, behavioral health is almost 100% managed by counties. The city county, like in California, there's some counties. like San Francisco, where the city and county are together. But in the majority of counties, cities and counties have separate governmental entities. When you were doing this work on the ground,

did you ever feel a disconnect between what you were seeing firsthand and what some of the people in city or county offices might have misunderstood because they were sitting behind that desk? Yeah, I think there needs to be a lot more recognition as to the, I think, the needs of cities. And I think police departments and fire rescue departments understand the gaps in the mental health system intimately because they're experiencing it every day. I think when you're removed from that, when your job is in contracting or your job is in quality assurance or quality improvement, you don't necessarily see the needs of people on the front line. And so the systems that are built,

especially in the public behavioral health setting, don't address the needs of the most severely vulnerable people in our community. And I think that's been a chronic frustration, I think, an age-old frustration in California. When you work with city, county, or state government, there are policies that always sound great when they're on paper, but when they're put into practice on the street, the reality, it can be very different. Have you seen examples where that gap between policy and reality became very clear? Yeah, I think in addition to that, you get policies, or you use, get laws that are passed, then are described and are different than what's described. So I think some of the marketing doesn't always match up with what the law actually says. Yeah. And so a case

and point would be the CARAC in California where the CARE Act was a, dean does a, like a court-mandated treatment. But it doesn't actually mandate treatment. It's court-supervised, but it's not court-mandated. And so I think some of the initial marketing in the CARAC led the public to have a different opinion of what the law was than what the law actually read as. And so you get that too with implementation, how counties would decide to implement the law. Like for instance, in the CARE Act, there's provisions for a court-ordered mental health evaluation if the person's safety is at risk. We did a public record act request on all 58 counties, and no county had processes that were in effect that created or allowed for this court-ordered mental health evaluation to happen. And so you have

laws that are passed that reference these court-ordered mental health evaluations and no county has operationalized it, even though it's been in existence since the 60s. Yeah, I'm really glad you brought that up. Many states approach this very differently. Some call it AOT and others have different acronyms for it. In some states, if a person is not considered a threat to themselves or others, the system can't really step in, even though that person clearly needs help. How does California address that particular challenge? So California's assisted outpatient treatment plan is optional for counties, and only 28 of the 58 counties have implemented assisted outpatient treatment or Laura's law, and access to this program

is limited because while the CAR Act, you have a bunch of different petitioner entities that can go directly to the court and say this individual is someone who needs help. only the county behavioral health program director can make an application for assisted outpatient treatment. And so access is really limited on top of the fact that it's optional and not implemented in more than half of California counties. So how do we move this from being available in only half the counties to something that's available statewide? So everyone who needs help can actually get it. Right. And so I think that's the hope with the CARAC is it's in many ways, take two. on assisted outpatient treatment.

And it comes with more funding for counties to bill the state directly for outreach. Because one of the issues is it costs more and it's more time consuming for people, for counties to care for folks who are more difficult to engage. And so the Care Act provides incentives for counties to engage the people who need help the most. And so I think Care Act is an effort to realize that initial vision of, Laura's Law. So what do you see as the biggest challenge in integrating mental health care with the rest of the health care system? So this way, hopefully, it can be treated more effectively. Yeah, I think the, I mean, that's a multi-layered question. So federally, I think there's problems with how mental health

has been structured because of the sins of the past. You know, we have institutionalization that happened in the 60s earlier than the 60s. And then in the 60s, there was an effort to deinstitutionalize. And with that, there was a federal disincentive to pay for mental health treatment in stand-alone inpatient psychiatric facilities. So there's a ban on Medicaid reimbursement for beds that are more than 16 beds. And so you don't have the federal support. And so, you know, mental health has looked at differently than physical health. And so you've got that layered on top of state issues where the preference is on community-based outpatient treatment, which it should be, and there's individuals that are too severe for that level of care. And so you get a small

population of people who fall outside the cracks of a public behavioral health system. And it's really what to do with that group and how do you pay for it and how do you build it? So in California, they had Proposition 1, like a $6.4 billion bond for outpatient and inpatient facility. development and the hope is that we can boost up an area of care that's been severely under-invested in for decades. Something that has always amazed me, we often separate mental health from physical health. But the reality is they're deeply connected. If your mental health isn't right, your physical health often suffers as well. Because one affects the other. Too often we measure health by physical signs, heart rate, blood pressure, lab results, that doesn't always reflect what's

happening in someone's mind. How do we help people understand that mental and physical health are inseparable? Right. And I think that gets to a very important point. An issue that I see in the hospital system all the time, just because a person can walk, doesn't mean they can care for themselves. And so what does it mean to care for yourself? And I think there's a huge area that occupational therapy can play in healthcare settings where we're looking at not just physical health, but someone's ability to function. And we're looking at more than just walking and whether or not they can use the bathroom on their own, but whether they can take their own medications. That's an area where we call it instrumental activities of daily living, where you're looking at someone's independence with medications, you're looking at someone's ability to grocery shop,

to, you know, to clean their house, to take care of, you know, what does it really mean to be independent? it. And we don't do that hardly at all. And I think if we took more time to look at whether we're setting a person up to succeed or not by looking at assessing these instrumental activities of daily living, I think we'd have less people who return to the hospital. But you're right, we have to, we not only have to integrate the person's physical health with their mental health, but we need a holistic understanding of who they are. We spend a lot of time talking about treatment, but prevention is just as important. How can our health care system start focusing more on identifying mental health challenges earlier and supporting people

before things reach a crisis stage. Right. And I think getting more at root causes, where instead of looking first for what medication can I prescribe, what assessment do I need to do to find out more about the person? Because if I'm prescribing a medication, I'm presuming that they can take it and that they'll take it reliably. But if they don't have the cognitive functioning to do that, I'm just adding one more, I'm doing what's easiest, and I'm contributing to a mess, you know, to disorganization, which can have consequences. I've spoken with people on the autism spectrum and others living with conditions like schizophrenia, and one thing I keep hearing is that it can take 10 years or more to finally get the right support, treatment, or medication.

that's a huge portion out of someone's life. That's a long time to struggle through all the things that they go through. Some go through homelessness, some go through drug addiction, some go through every imaginable thing that we could think of. So how do we get out of that 10-year journey so people aren't losing so many years just trying to get the help that they definitely, need in order to live their life. Right.

I think we need to look beyond some of the like superficial reasons. I see a lot of times people leave the hospital setting and people say, well, people have the right to make bad decisions. And it doesn't go deeper than that or people get labeled as malingerers and someone who's trying to manipulate the system. But you have to look deeper and say, well, why might the person be making that decision? What's it due to? I think the curiosity can help reduce that 10 years.

gap because there is a significant period before someone's diagnosed with dementia, for instance. We have delays related to getting people involved in the regional center. You talk about autism and if they fell through the cracks before, you know, before they were 18 and then finally get someone who cares and tries to get them involved in the system, but they don't have paperwork. Before they were 18, try convincing the regional center to get them an assessment, especially if the person needs the help but doesn't understand the need for it and doesn't agree. to it. I think it's really challenging, and I think some of the system barriers and rules that are in place can be an impediment. Technology is evolving at an incredible pace. Do you think these new tools,

whether it's AI, better data, or new medical research could help shorten the long journey many people face before the right diagnosis and treatment? Do you see it becoming easier to help the people so they can get back to living a better life? Yeah, I think technology can be a very important tool for access. I think the access points have been really constrained, and the more that we can bring evaluation, bring assessment to people who need it, rather than requiring them to come to a clinic

or requiring them to come to a building, the more that we can bring trained professionals to where that person is at, I think the quicker we can get at treatment, evaluation. We often talk about government and healthcare, systems, what role does community organizations in grassroots efforts play in helping people find mental health support? I think they're the ones who try to help the most. I think traditional health care settings have a tendency to be fairly monolithic. The more that we can partner with

agencies, with housing agencies, with shelters, with day programs, and embed telemedicine, telepsychiatry, and break down some of the barriers that separate health care settings from housing settings, for instance, the better. Perfect timing. Anne-Marie has just joined us. Welcome to the show. Thanks for joining us today. Thanks for inviting me.

I love this topic. I think we can make a difference. Hey, Anna-Marie. Yes, we are trying to make a difference. Before you joined us, we were discussing the growing concerns of health care. With so many professionals feeling overstressed and stretched thin, with so many doctors, nurses, and providers feeling overstressed and emotionally exhausted, do you believe healthcare burnout has reached a level of systemic crisis?

Absolutely. Our first responders, our medical professionals, you know, we're talking about the people who aren't getting care, but how many times is the caregiver the one who actually gets something horrible happening because they're not taking care of themselves? The compassion fatigue? You know, how long can first responders respond to the same person over and over again? And then they pass away. And it's heartbreaking.

A lot of the first responders I know that did that, they do go to the funerals to show that this was a person that they cared about and tried to help. I'd like to build on Dr. Myers' thoughts. I'd love to hear your thoughts on how you think this approach should be. Sure. One topic I'd like to address is the way we're thinking about crisis response in mental health care. Based on what you have seen, what models or approaches appear to be most effective in helping

people during these critical moments. Are we talking whether or not it's a peace officer who's responding or someone who's trained in psychological treatment? Anyone in the field that is properly trained? Okay. I think that there are wonderful psychologists and there are less wonderful psychologists and there are wonderful peace officers and there are less trained peace officers. So I think it's also about the person and not just the job they're doing.

Obviously, we want to move away from peace officers being the primary 5150 enforcer. However, I want to make sure that people understand the role that peace officers play because a psychologist who's meeting someone who's unstable, schizophrenic, potentially prone to violence. All of them are not prone to violence, but some of them might be, we want to make sure that everyone's protected. And so by training our peace officers specialty units that can go with trained psychologists and clinicians to meet them, that's going to be our surface vet. And if we do it proactively, rather than reactionary, we're going to have a lot better results. Before we move forward, let's take a moment for our listeners. Could you share a little about your background on your role and the work you're involved in? Oh, sure.

So I started working with Aaron about four or five years ago at the city of San Diego, where I was a senior deputy city attorney. I was a prosecutor for almost 20 years. Then I worked on gun violence response or restraining orders, especially for people who had mental illness issues and shouldn't have a fire weapon. And then finally, I got moved to. representing first responders who needed help navigating the mental health system. And so in that way, I was able to help them through probate system, through the LPS secured conservatorship system, and other different avenues of care. Unfortunately, you know, programs change, resources change.

And so my role was cut. And so I was moved to a different department. And so I decided to keep my work with mental health going. I retired. And now I serve as a mental health policy advisor for municipalities, legislators or lawyers. But Dr. Myers still collaborates with me, thank goodness, because we've been a team for a long time now, and I think we complement each other. So I'm pleased to get to still write and work with him. Since you approach this from the legal side, what changes do you believe need to happen? How do we help policymakers and leaders at the state and local level better understand that collaboration is essential? Not only for those with serious mental illness that need the help right now, they need to understand that by everyone working together, it can help prevent these challenges

from becoming even larger in the future. Well, I think it's already a huge issue, but I like what you're saying, and I think programs like yours are so critical. I think that grassroots effort to start from the bottom up to say, hey, we don't like the way it is. When it comes to what I think is going to get people's attention, I think we really, really have to force ourselves to look at the number of people who are incarcerated, who have have severe mental illness and that if we could have gotten them involuntary care, and I am saying

that, involuntary care to care for their unstable schizophrenia or other mental health disorder ahead of time, maybe they wouldn't have committed that felony or they wouldn't have been the victim of that crime. And so I think we think of vulnerable people, they might be the victim, they might be the perpetrator, but all of it is because of a failed system. And so if people can focus, we could take some money, save money on the law enforcement end and reinvest it. And I think we'd be better all around. So hopefully we can get their attention in that way. I'm glad you brought that up. I asked Dr. Meyer earlier about assisted outpatient treatment laws and how they vary across states. We see some states implementing AOT, some doing very little, and others struggling and having

difficulty on how to apply it effectively. How do we help legislators to understand that early intervention is critical, that waiting until someone is a danger to themselves or others may miss the opportunity to help them before a crisis escalates. How do we get them to understand that this is not only helping the person that needs the help now, but is also helping prevent this situation to become a community crisis? Well, I think that that's a great point to bring up, because a lot of people talk about AOT versus Care Court, right? Because in California, we have both. And the problem with both AOT and Care Court is that they have very, very narrow criteria for who is eligible. And so sometimes you have someone that has clear needs, but they're not eligible for either because of that narrow criteria.

Or if they get in, these are both voluntary programs. So don't make any mistake about it. Just because it says assisted outpatient treatment with the court, it is voluntary. And you cannot force someone to get medication through that. The only way in California to force medication is under the Lantern-Petris Short Act in the welfare and institutions code, which is a different section for forced medication and forced treatment. So I think when it comes to AOT, honestly, that should be the model. Voluntary care. That's what we want. But we also have to have compassion for those who are going to wind up in jail or dead if we don't get them help.

That's a huge statement. I have to say this has been a really great session. Thank you so much for being here today, and thank you for agreeing to keep the conversation going. For those of you listening today, we are actually recording more. Part 2 is coming next week. There are many interesting subjects that we will be talking about.

So thank you for joining us. A sincere thank you to our guests for sharing their journey. If today's conversation helped you see the world a little differently, then we're doing exactly what we hope to do. Until next time, keep believing, keep learning, and most importantly, keep asking yourself, why not me?