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Are We Spending Mental Health Dollars Wisely?

Audit raises questions about Prop 63 spending

by Brian Leubitz

So-called “ballot box budgeting” comes in waves. California voters tend to draw back from spending money in bad economic times, and will fund more programs in the heydays. 2004’s Prop 63 hit as we were clearly on the upswing after the 2001 recession. The real estate bubble was rapidly building, making everybody feel wealthy. And Prop 63 went for an undeniably good cause, protecting some of the most ignored in California, people with mental health issues.

As both president and governor, Ronald Reagan went about slashing money for social services, especially mental health. The results are written everyday on the streets of Los Angeles, San Francisco, and many other cities across the state and nation. Mental health institutions closed down, and the homeless population went up. California spent about $5 billion before the measure, but could certainly use the additional resources.

But after the measure went into place a number of things happened. As you can tell from the date, we are talking peak of the real estate bubble. Once the bubble burst, mental health spending got slashed from that $5b high. Although Prop 63 wasn’t intended to serve as backfill for cut dollars, it ended up serving those purposes.

Recently, the state auditor released a report on Prop 63 spending, which criticized the state for a lack of spending oversight on those funds. But the news that was getting all the headlines, perhaps because the auditor highlighted them because they sound juicy, were some of the more effective programs. Programs like yoga and gardening were shown to have good outcomes for the mentally ill and to have both therapeutic and preventative value.

On KQED’s Forum today, some of the original authors of that measure debated how the money has been spent. Much of the debate is a little technical, depending on how you define prevention and early treatment, etc. There can be questions of effectiveness, and clearly the state needs to do a better job of consolidating outcome data. But, the question of whether we need to make more substantive changes is still out there.

All that being said, mental health services are still underfunded, as most social services are in this state. But we can always do more to ensure that our dollars work as effectively as possible.

Health Care

Teen Moms and Their Babies Get Boost from Prop. 63

By Dr. Marv Southard

Los Angeles Dept. of Mental Health

Two-year old Brandon wasn’t born when voters passed the Mental Health Services Act (MHSA) in 2004.  But it was young people like Brandon that State Senator Darrell Steinberg had in mind when he spearheaded the groundbreaking initiative known as Proposition 63.  

On Wednesday Senator Steinberg saw firsthand how Prop. 63 has made a difference in the lives of California families when he visited Mamas con Bebes, a highly successful program for at-risk teenage mothers funded by the voter-approved initiative.  

“It makes my heart happy to see Prop. 63 in action,” the Senator said, as he met Brandon and his mom Camille.  

Camille had family and anger issues she was unable to handle. She coped by shoplifting. She was eventually arrested. Her family kicked her out and she became homeless. As part of her rehabilitation, Camille was sent to the Mamas con Bebes program, where she learned the patience needed to effectively handle her issues and love her baby.

The same circumstances – including abuse, neglect, and financial hardship — that lead teen moms to experience time in the juvenile justice system or foster care also put them at risk for mental health issues.  

Mamas con Bebes brings together services like counseling, case management, employment, education, and housing, that help teen moms coming from the juvenile justice system or child welfare services address their own mental health and gain the stability they want for their children.  

Mamas con Bebes is one of many programs funded by the MHSA that are forever changing the way people with mental health needs access services in California, putting a focus on meeting mental health needs early, rather than waiting for early signs to develop into a crisis.  

Currently, 41 mothers and their babies are being served by this intensive early intervention program run by the Los Angeles County Department of Mental Health.

Since the program has been in operation, 95 percent of participating families have found stable housing, 61 percent of the mothers have found stable jobs or are in school, 71 percent have shown improved mother-child attachment, and there’s been a 59 percent decrease in depression and anxiety among mothers.

These statistics show that Prop. 63’s approach is working.  But the real impact goes far beyond numbers – just ask Mom Jasmin, who says the most powerful proof of Prop. 63’s success is chance its given families like hers.  

“You are the reason why we’re all here,” Jasmin said to Senator Steinberg. “You have helped me (and other moms) bond with my child.”

Proposition 63, passed by California voters in 2004, imposed a 1% tax on personal income of more than $1 million to support community mental health programs.

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Dr. Southard is Director of the Los Angeles Department of Mental Health.