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Stakeholders Work To Implement Mental Health Services Act

For some people, it means reducing the number of homeless on California streets. For others, it means early intervention for youngsters. For others it means new help for seniors.

The Mental Health Services Act won’t be a panacea for all that troubles the Golden State, but a new infusion of cash and new approaches to old problems should go a long way toward improving what by many accounts is an underfunded, overworked system.

Approved by voters in November 2004 as Proposition 63, the Mental Health Services Act levies a 1% tax on individual incomes exceeding $1 million a year. State officials estimate the new tax could generate as much as $750 million annually.

“It’s not enough to solve every problem the state has in mental health, but it’s going to be a huge advance,” Darrell Steinberg, one of 16 members of the new California Mental Health Services Oversight and Accountability Commission, said.

Steinberg, former Assembly member from Sacramento and co-author of Proposition 63, said California is about to undergo a fundamental shift in how the state deals with mental illness.

“We are about transforming as well as funding this mental health system,” Steinberg said. “This is a unique opportunity to make mental health the priority it ought to be in our health care system.”

Other stakeholders agree.

“We’re getting clear messages from leaders that this is not just about more money to do more of the same,” Carol Wilkins — director of intergovernmental policy for the Corporation for Supportive Housing, a not-for-profit dedicated to developing and advocating housing for the homeless — said.

“From the very onset of this process you’re seeing a genuine sense of optimism and hope which is pretty different from business as usual for people who have been unserved or underserved for so long,” Wilkins said. “The very process of planning is taking place in a way that’s very different: Stakeholders are being sought out and included along with family members and providers and that’s creating an infectious sense of idealism that feeds on itself and generates more enthusiasm and ideas. It’s a catalytic process that can truly create new ways of thinking.”

Counties in the Planning Stages

After Proposition 63 passed, each of California’s 58 counties was directed by the state to draw up proposals for spending the new money, which will begin to flow next year. The state primed the pump with planning money for each county and set a July deadline for counties to submit a first draft proposal.

Most counties, especially urban areas, will zero in on helping homeless people find permanent housing. California’s homeless population, growing and very visible, was the major factor in voters’ decision to approve the new tax, most experts agree.

“The homeless population is a priority, especially the hardcore homeless who don’t lend themselves to necessarily fitting into a process like this,” Monique Zmuda, deputy controller for San Francisco and a member of San Francisco’s task force drawing up the new plan, said.

“We have a very large mental health department in San Francisco, and we offer a lot of different types of services and programs, perhaps more than most counties, so our job of determining the best ways to spend this money involves a number of steps and stages. We’re making progress, but it’s not an overnight thing,” Zmuda adds.

Although most counties appear to be on track, “some counties may be in for a rude shock when they turn their proposals in,” predicts Richard Van Horn, president of the National Mental Health Association of Greater Los Angeles and a 25-year veteran worker in California’s mental health system.

“The state was pretty specific about getting stakeholders to participate in this process and counties are going to be asked to show what they did in terms of outreach. If it wasn’t done well or thoroughly, there could be some ramifications,” Van Horn said.

Los Angeles County, the area with which Van Horn is most familiar, is “going by the book and appears to be in good shape,” Van Horn said. “But others, like San Bernardino for instance, which doesn’t even have a mental health director right now, have some catching up to do,” Van Horn said.

San Joaquin County, according to published reports, also might be lagging.

Funding Priorities Vary

In addition to addressing homeless issues, many counties are working on early childhood intervention programs in schools to help assess and treat mental health problems of kindergartners through sixth graders.

Improved mental health programs for seniors also are in the works in many counties.

A sampling of ideas from up and down the state include a mobile emergency mental health response team in Contra Costa County, a crisis center in Nevada County, streamlining offerings in San Diego County, and improved programs for abused and neglected children in San Benito County.

The Mendocino County Grand Jury, in a report lauding county mental health officials for efforts to include all stakeholders and encouraging new ideas, concluded:

“Innovation for its own sake has limited value, but a study of alternatives to the status quo that is both rigorous and open-minded has great promise. And even if the specific programs initiated as a result of MHSA accomplish relatively little, an honest and truth-seeking debate across all the boundary lines on the map of mental health services may yield great rewards.”

State Commission Considering Best Uses for Funds

While the counties head into the home stretch for their first deadline, state officials are working on ways to leverage the new tax money, which counties must use in specific ways for the first three years.

Each county is supposed to spend 10% of the new tax money on capital improvements and infrastructure for the first three years. After that, the 10% will be added to the majority of the money, which will go to direct services, according to state guidelines.

In addition, for the first three years, 55% of funds should go toward direct services. After three years, the figure rises to 75%.

“I think we ought to be looking at ways to leverage this money,” Steinberg said. “For instance, we could take that 10% for capital and infrastructure for the first three years and pass bonds against it — maybe 20- or 30-year bonds. This initial money could be the floor from which more money grows,” Steinberg said. “I’m trying to see if counties might be interested in ideas like that.”

Overall, the process appears to be proceeding as planned. “I’m very pleased at the progress we’ve seen at both the state and the county level,” Steinberg said. “Counties are hard at work bringing a lot of different people — many of whom have never been involved before — into to the planning process. That, in itself, is a step forward. We’re looking forward to big things.”

Related Topics

Health Care Costs Insight Mental Health Public Health