Steps Forward Are a Decent Start for Mental Health Spending, Experts Say

Legislators last week held a hearing on the state of mental health funding in California — and the concerns significantly outweighed the praise.

“The more we do, the more need we see unmet,” Senate President Pro Tempore Darrell Steinberg (D-Sacramento) said during the July 2 meeting of the Senate Select Committee on Mental Health.

“The question we need answered is, ‘How far have we come?'” Steinberg said. “As we sit here today, are we back to the level of funding we had the day the Mental Health Services Act passed, or have we gotten back to the pre-existing core system?”

The state in the 2014 budget revision included roughly $340 million for prison-related mental health programs and in 2013 set up a $206 million fund for mental health stabilization services.

Those recent funding commitments will help, but it’s not the answer to the mental health crisis in California, said Karen Baylor, director of the Mental Health and Substance Use Disorder Services at the Department of Health Care Services.

“Spending on mental health issues is analogous to the rainfall in California,” Baylor said. “We’ve had one rain shower, but that doesn’t fix the drought.”

State officials at the hearing pointed out advancements in crisis residential services, mobile crisis and education-based strategies.

Sen. Jim Beall (D-San Jose), chair of the committee, said the to-do list still is long for mental health services, and a good first step would be to prioritize that list.

“In order to accurately gauge progress,” Beall said, “we have to redefine goals and develop a statewide performance outcome system.”

Two of the chief concerns voiced were mental health care in prisons — where 30% of California’s prisoners have a mental illness — and the emergency departments that are swamped with mentally ill patients.

“We need to get away from a system that is fail-first and instead adopt help-first,” said Rusty Selix, executive director of the Mental Health Association of California. The best models of care are primary care and early intervention, he said.

“Unfortunately, the health care system assumes that a person knows when they are sick, goes to the doctor and gets the help they need,” Selix said. “None of those apply when it comes to mental health.”

Nancy Peña, the mental health director in Santa Clara County, said most people outside of the direct behavioral health care field do not know how to help mentally ill people navigate the system and get the help they need. 

“The two biggest issues are the sheer capacity of people who need help, and the lack of availability of a workforce” to serve them, Peña said. “Since [the passage of the Mental Health Services Act], we’ve had 10 years to learn what person-centered care really needs, which includes assisting those who know nothing about mental health.”

While mentally ill individuals with family support and a community care network are at an advantage to receive proper care, those coming out of prison or who are homeless face innate impediments, Peña said. By developing community-based care and by training law enforcement officers how to respond with knowledge and compassion to those with mental illnesses, fewer individuals would go straight to jail or emergency rooms and instead get on a path to managed care, she said

“All of these programs are interrelated,” said Beall. “If these people don’t have places to go, we go back to where we were a year ago.”

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