
Joe Simitian grew up with the notion that if “you are not part of the solution, you are part of the problem.”
For the more than 40 years he served in government, he has lived by that tenet, whether it was as councilman in Palo Alto, California State senator or assemblyman, or Santa Clara County supervisor. During his 12 years as a county supervisor, he took that mantra and applied it to the mental health sector where he was chair of the Health and Hospital Committee.
In December 2024, he termed out as county supervisor, leaving a strong legacy in the mental health. For his work in the field of mental health, he will receive NAMI-Santa Clara County’s 2024 Community Merit Award.
During his time in office, he helped the county opt-in to Assisted Outpatient Treatment (AOT). He worked for a decade to bring the county its first inpatient psychiatric facility for children and adolescents, slated to open in 2025. He brought a countywide Behavioral Health Navigator program online to guide residents in need of mental health services. He worked to expand TRUST, a non-law enforcement mental health mobile crisis program into the West Valley, and he has pushed for health care parity.
County Executive James Williams has known Simitian for more than a decade and watched as he navigated the challenging dynamics of a system that serves about two million residents.
“Our community could count on Joe Simitian to always do what he thought was the right thing to do for the people he served,” Williams said. “And that meant doing the right thing even if there were powerful interests on the other side or the work was difficult. He has been a consistent champion for mental health care.”
Simitian said he was schooled by many residents and his former colleague Jim Beall whose mental health advocacy is legendary. They served together on the county board from 1997-2000.
“He started me thinking about [mental health] situations 25 years ago,” Simitian said. “I had that experience, and it stayed with me.”
Simitian was also deeply affected by the number of youth suicides that were occurring in his hometown of Palo Alto. He felt mental health issues needed a champion who could play a constructive role.
Health and Hospital Committee
That opportunity arose when he was re-elected as county supervisor in 2013. Two months into his term, former supervisor George Shirakawa resigned, and then-supervisor Ken Yeager appointed him to fill the vacancy on the Health and Hospital Committee. He served on the committee and later as its chair until he left office more than 10 years later.
“What you quickly realize is the need is great and the impact is wide, and a lot of folks have a story to tell,” he said.
He tackled his county work in the mental health sector by doing his due diligence and that often meant listening to residents and advocates and talking to government officials in counties throughout the state about best practices.
When it came to opting-in for AOT, also known as Laura’s Law, he was familiar with the pros and cons having voted for the initial legislation at the state level. The law is a court-ordered program that requires individuals with a severe mental illness to receive mandatory outpatient treatment. But each county has to vote to opt-in or opt-out of the program. Santa Clara County’s Behavioral Health Department wanted to opt out.
Simitian listened to those who said it was abusive and others who said it would help the homeless on the streets. What helped frame his decision was an individual who told him much of the argument is about imposing treatment. But shouldn’t the question be about a person who needs and deserves help but is incapable of asking for it? “That was a very different way to come at the issue and it affected how I thought of the question,” he said. “It was clear the need was there and if we built the system right, that for a modest number of folks in great need, AOT would be a real plus in their lives.”
County supervisors voted unanimously to opt-in and demand for services has been strong.
Mental Health Parity
Mental health parity is another issue Simitian worked on during his time in office. There are a number of federal and state laws that require commercial insurers and hospitals to treat patients with mental health needs the same as physical needs.
“I kept pushing the issue of mental health parity. But it’s not real yet,” he said. “That’s why we need to keep pushing at all levels and certainly at the county level for legislation and litigation if necessary.”
He noted litigation is rarely an appropriate first response. But there have been laws on the books for decades that purport to provide mental health parity, and it hasn’t come to fruition.
While he battled that front, Simitian also worked on streamlining mental health services by creating a navigation system. The program is available for individuals looking for mental health county services, but Simitian wanted to make sure that those in the private sector could receive guidance. He pointed out that although the county is a safety net for those in the system, it has a responsibility to serve all of its two million residents.
“It’s complicated enough to navigate the system in the best of times, but people looking to navigate the system are not in the best of times,” he said.
Changes Afoot
Simitian agreed that 2024 has been a daunting year for the county. LPS conservatorship legislation expanded the definition of “gravely disabled” for those with a mental illness and includes individuals with substance use disorders. The county also launched CARE Act in December and added a direct line for TRUST.
Simitian is the person who after the case is made and the due diligence is finalized will at some point voice a sense of urgency that goes beyond lip service when it involves mental health needs.
It’s why he pushed hard for the expansion of TRUST into the West Valley. The pilot program’s effectiveness was apparent, he said, and he was eager for the program to grow.
“I don’t mean to be flip or glib, but look, if there is a bank robbery you call a cop. If there is a mental health crisis you call a mental health professional,” he said.
What’s next for Simitian?
One thing is certain, he will be in the audience on the day the new Valley Medical Center psychiatric facility for children and adolescents opens its doors. Until then, he plans to take a brief sabbatical as he contemplates his next move.
At 71, he said there are numerous ways he can still be part of the solution.
“You don’t have to be a political activist, you don’t even have to do it in the political realm,” he said. “Someone can be part of the solution by being a great teacher or great journalist, a teller of truth and shine the light. Political office isn’t for everyone, and its only one way.”