State a leader in mental health prevention, early care

One of the first bits of advice Vice President Joe Biden received after becoming the point person for shaping new federal gun control and mental health proposals in the wake of December’s mass shootings in a Newtown, Conn., elementary school was to follow the California example.

Copy this state’s strategy for funding mental health programs, suggested Darrell Steinberg, Democratic leader of the state Senate. That’s one way, he said, to lessen the chance of deranged individuals blasting dozens of children and teachers with assault rifles or machine pistols.

There was more than a little irony in Steinberg’s suggestion. Only last August, he formally requested a formal audit of billions of dollars in mental health funds raised by the 2004 Proposition 63, which imposes a 1 percent supplemental tax for mental health care on incomes in excess of $1 million.

So far, this levy has taken more than $8 billion from high-income Californians.

But last summer, The Associated Press reported that tens of millions of Proposition 63 dollars have gone to programs aiding state residents not diagnosed as mentally ill, including yoga, art and drama classes, horseback riding and gardening.

The audit results are not yet in, and there are explanations for some of the expenditures the AP noted. Gardening, for example, was to attract Cambodian immigrants who might otherwise avoid mental health services for cultural reasons. Yoga and art therapy can help stave off some forms of mental illness.

There’s no doubt the Proposition 63 money has been helpful in keeping government-funded mental health care alive while other programs like in-home care for frail or disabled senior citizens were severely truncated during half a decade of severe state budget crises.

In 2011, Patricia Ryan, executive director of the California Mental Health Directors Association, reported that “The programs made possible . . . are as varied as California is diverse.”

She cited the highly individualized Vietnamese Full Service Partnership in Santa Clara County, which aims to help Vietnamese adults with serious mental illnesses like bipolar disorder and schizophrenia. Within a year after that program started in 2006, participants were using emergency psychiatric services 28 percent less than before and were hospitalized 65 percent less, while using long-term care facilities 82 percent less than before. So Proposition 63 has saved insurance companies and that county big bucks, although no one has put a precise figure on the savings.

Proposition 63-funded programs in Los Angeles County, Ryan reported, served more than 6,200 people in 2011, producing a 68 percent reduction in homelessness among those clients and a 53 percent increase in days spent living independently, along with a 46 percent reduction of time spent in jails.

Those programs were designed to fit specific local needs, the result of counties being allowed to choose most uses of Proposition 63 money.

Ryan also says one provision in Proposition 63 might be most useful in preventing mass slayings: The measure requires that 20 percent of funds it raises go to prevention and early intervention in mental illness or substance abuse. If Colorado or Connecticut had a mandate like that, there’s at least a chance the Aurora and Newtown massacres could have been prevented.

“If there’s one part of what we do here that should be adopted nationally, that’s it,” Ryan said in an interview.

Tending to back that up, Robert Cabaj, medical director of Community Behavioral Health Services in San Francisco, told the magazine Psychiatric News that “intensive case management in the counties (San Francisco added 400 such slots after Proposition 63 money began flowing) has led to reduced hospitalizations. We have cut our acute inpatient psych beds by more than half, but have had no increase in recidivism or emergency services.”

So Proposition 63 has definitely helped prevent some serious problems.

Things are far from perfect here, though. An estimated 750,000 Californians in 2011 failed to get mental health treatment they needed. About half the counties have no inpatient psychiatric services, suggesting jails are used to hold many people who actually belong in hospitals.

There are also complaints that Proposition 63 allocations favor new programs for new patients over proven programs serving longtime patients.

Then there’s the fact that Proposition 63’s proceeds have allowed legislators to divert some previous mental health money for other uses.

All of this means that while California has seen plenty of positives from Proposition 63, its mental health scene remains far from perfect, even if one part of the program – prevention and early care – probably ought to be copied widely.

Thomas Elias is a California author. Reach him at tdelias@aol.com.