Organizing the Mental Health of California

Assembly member Wesley Chesbro (D-Arcata) is nothing if not optimistic.

But at last week’s Assembly hearing on mental health issues, even he was having a little trouble trying to make lemonade of the budget cuts to mental health services.

“We have gotten to the point where we’re cutting things that were originally designed to save costs,” Chesbro said of one particular mental health-related program, the caregiver resource centers.

“At this point,” Chesbro said, “we’re like the farmer eating his seed corn.”

Still, he did manage to look ahead: “California has reduced its investment in mental health issues. … But the economy is recovering, and we can start now in the process of rebuilding,” Chesbro said. “I hope to see the rebuilding of the system.”

The first step in that process, Chesbro said, is to take a hard look at what has happened to mental health services in California, and there were a number of people at the hearing to help with that.

“State support for mental health services has been cut in recent years, in particular Medi-Cal managed care funding has been reduced substantially,” Margaret Jabobson of Disability Rights California said.

“Now that mental health funding has been realigned to the counties, there is very little general fund support for local mental health programs. At the same time, there is less money for county mental health programs overall,” she said. “And while overall funding has been reduced, there is higher demand for services.”

Passage in 2004 of Proposition 63, the Mental Health Services Act, is the lone bright spot in the mental health landscape, Jacobson said. But, she added, a relatively small number of Californians are served by MHSA, “while the rest of the system seems to be crumbling.”

Kathy Gaither, chief deputy director for the California Department of Mental Health, said the first steps in the reorganization of the mental health system are to move Medi-Cal mental health services under the umbrella of the Department of Health Care Services and to give counties more say in running local mental health systems.

“We started an evolution of mental health in California,” Gaither said. “The governor’s goal in proposing realignment is to move provision of services to the level of government where those services are provided. So [treatment] decisions can be made at the county level, rather than having us, at the state level, decide.”

Jacobson said DRC is in favor of realignment, but counties need revenue to properly care for those with mental health problems.

“There are not enough crisis services, emergency response services are being cut, crisis prevention and stabilization services are being cut, 24 hour hotlines are being eliminated,” Jacobson said. “This leads to unnecessary hospitalization, and at the same time there are fewer and fewer hospital beds available. So that results in expensive emergency room stays with inadequate facilities — and with diversions to other institutions, like jails.”

In fact, she said, jails often become the mental health provider of last resort, but they don’t have the money or expertise to do much good for mental health patients.

“All of this results in a revolving door of re-institutionalization and incarceration,” Jacobson said. “Institutional care remains high. Community residential care is rare. There is not enough transitional housing.”

One casualty of the governor’s proposed budget cuts is the $2.9 million set aside for the state’s Caregiver Resource Systems, currently funded by the Department of Mental Health.

“This is our most valuable asset in long-term care,” Kathleen Kelly of CRC said. “It is a silent army of care that provides over 80% of this kind of care in California. Without the 5.8 million informal caregivers in California, the state would just be overwhelmed.”

When Alzheimers or dementia are part of a patient’s condition, that creates a powerful stressor for the family members who care for them, Kelly said.

“Caring for someone with a cognitive impairment, those conditions cause stress in the family. They cause more stress than a physical disability,” she said. “Caregivers have higher rates of suicide, depression, they have higher onset of chronic conditions, substance abuse. This is not just taking someone to a medical appointment, this usually means a loss of income, in part from cutting back on the amount of [paid] work they do.”

Kelly said the CRC program helps people figure out how to make that difficult situation work. “We know the things that can alleviate this,” she said. “I mean, we do know how to address this.” However, her program will not be able to do that, she said, if the governor eliminates it.

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