Tag Archives: mental health

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.

A Slight Understatement

Corrections Secretary Jeffrey Beard: “As a society, we just have not done a very good job of dealing with the mentally ill.”

by Brian Leubitz

Dan Morain has a very thought provoking column today taking off from the recent discussion about the prison health care litigation. Long story short, Gov. Brown is working to once again attempt to emerge from the litigation that has upped the prison health budget from $732 million to over $2bln. He makes a fair point:

“That money is coming out of the university, it’s coming out of child care. It’s a situation you wouldn’t dream anyone would want.”(SacBee)

Our spending on prison health care is high, very high, but the problem is that we are spending money in the wrong place. Kind of like our health care system spending big money in ERs, rather than setting up more primary care clinics, we are pushing the mentally ill to the most expensive “treatment” facility available, and one with a poor track record of success. This  spending is really a symptom of the much larger issue of our failing on mental health care in general.

Morain does a good job explaining the process of closing the state hospitals that had been “caring” for the mentally ill. I have no doubt that the decision was completely justified at the time, but the funding necessary to really create a more just and humane system never really appeared. From Reagan on down through the years, the governors and legislators just never felt a high priority on mental health spending. There are many other (completely valid) competing priorities and the mental health lobby is comparatively weak. But on the flip side, there is a large lobbying infrastructure for prison dollars. And nobody wanted to become the politician that was “soft on crime,” so the prisons grew.

In just a few years from the great exodus of the hospitals, homelessness had markedly increased, and we were on our way to a crisis in mental health care. But the bottom line is that the cuts to mental health care, have a remarkably poor return. They boomerang back on us with higher prison and law enforcement cuts rapidly. Back in 2004, Californians voted for Prop 63, which increased taxes for mental health care. However, though the law required that the money not replace what was already being spent. But when the cuts came in earnest over the past 5 years, that part of the law was tossed aside, and mental health lost big. And, predictably, while the numbers are kind of fuzzy on this, the numbers of mentally ill finding themselves in prison increased.

At this point, whether or not we have a receiver for the prison health care system seems mostly beside the point.  It doesn’t address the point upstream where resources could have the most chance of being effective in the reduction of mentally ill inmates. There are plenty of recriminations to go around, but in the end, all of California’s leaders, for decades, have failed our mentally ill population.  

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.


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

California State Plan on Aging

(Thanks for the update. – promoted by Brian Leubitz)

The California State Plan on Aging estimates the population of seniors, over 85 years of age, will increase 172% over the next 20 years.  The most recent draft of the plan finds that “California’s older adult population will increase by 90 percent as members of the Baby Boomer cohort reach 60.” The Plan outlines the major areas of concern for seniors in the next four years.

EDIT By BRIAN: See the flip for more on the Plan on Aging.

The first goal of this plan is to make it easier for older Californians and their caregivers to access local information about services and programs available in their communities. One step to achieving this goal is currently underway. CalCareNetwork is being developed to provide a single searchable web site of information about home, community based and institutional long-term services.

To “enable older Californians, adults with disabilities and their caregivers to be active and supported in their homes and communities” is another stated goal of the state plan. Transportation issues are a major barrier to independence in many communities. Of note in the report is the acknowledgement that transportation planners have not worked with members of human services agencies to integrate the needs of seniors and those with disabilities.  California now has representatives from the Department of Transportation on the California Olmstead Advisory Committee to address transportation concerns from both the individual need and infrastructure perspectives. The Department of Motor Vehicles is developing a Three-Tiered Driver Assessment program. The goal is to keep drivers safely on the road for as long as possible, however this assessment could lead to more adults relying on alternative transportation.

One of the most dramatic changes to the health of seniors has been in the last century is the shift in the causes of death from infectious diseases and acute illnesses to chronic diseases and degenerative illnesses. Californians may live many years with diseases that need to be managed to maintain health. Californians have increased their use of preventive health screenings however significant racial health disparities persist in the treatment of chronic health concerns.  Alzheimer’s disease and other forms of dementia continue to be a substantial concern for individuals and their families. The third goal of the state plan is to promote the health of seniors through increased participation in health  initiatives and expanding  the availability of programs for family caregivers.  Additionally the promotion of early intervention and treatment for mental health issues is a stated goal.

The final goal is to protect the rights of older Californians through the Long-Term Care Ombudsman Program and Health Insurance Advocacy and Counseling Program (HICAP).  Updates to these programs and tools to improve communication and recognize fraud are part of the state plan.

The State Plan on Aging is clear in its anticipated funding from the state, noting: “The Department considers increases in State funding unlikely even though the population of older adults and adults with disabilities will continue to increase.” Interestingly over three pages of the State Plan draft is dedicated to the “opportunities for volunteerism and civic engagement.” This is due to the fact that many services are provided within the Aging Network through volunteers. The California Department of Aging (CDA) notes it is difficult to recruit and retain volunteers. The CDA will work to encourage increased volunteerism among older adults for their peers and those with disabilities.

It is difficult to know how anyone program will be affected when the state budget is finalized. The concerns highlighted by this report necessitate planning for the increased needs of a rapidly growing population of seniors. Current fiscal concerns are leading to reduction in services as the leading edge of the baby boomers enters the period of greatest need to age well within their communities.

While the recruitment of volunteers is beneficial for these social programs it will not be a sufficient substitute for the dollars needed for transportation, care, and health concerns of the 14.6 million seniors expected to populate California in the coming decades.  

The Logic of Props 1D and 1E: If It Isn’t Broken – Break It!

In 1998 California voters approved Proposition 10, taxing tobacco sales to pay for educational and health care programs for children under age 5 whose families are otherwise unable to afford those services (the First Five program). And in 2004 voters approved Proposition 63, levying a 1% surcharge on incomes over $1 million to finally reverse decades of deliberate underfunding of mental health services. These programs have been VERY successful and both programs have stable long-term funding.

Only in the twisted logic of the May 19 special election could that be seen as a bad thing.

Propositions 1D and 1E on the May 19 ballot are raids on the Prop 10 and Prop 63 programs, respectively. As the LA Times explained in their article on the propositions today:

The early childhood and mental health programs became prime targets for budget negotiators working to solve the state’s $42-billion deficit. They were sporting a budget surplus of about $2.5 billion each at a time when health and welfare programs funded the old-fashioned way — through the state’s general fund appropriations — were being stripped.

Backers say those surpluses were a fiscal mirage, because the money had been committed to future programs or was being saved for tough times.

Let’s be clear here – because Props 10 and 63 were a successful method of creating important programs and paying for them, they are now seen as viable targets for attack. The LA Times goes further and uses this as an occasion to criticize ballot box budgeting:

But the measures, Propositions 1D and 1E, also represent ballot-box budgeting coming back to haunt the California electorate.

Though they often complain that statehouse lawmakers spend like drunken sailors, the state’s voters have in recent decades repeatedly performed in much the same manner. Time and again they have approved propositions that critics say have combined to straitjacket the state’s budgetary process.

“The voters have been as responsible for this budget mess as anyone else,” said Larry Gerston, a San Jose State political science professor. “Election after election they have authorized money for this or that. And it ties the hands of the Legislature at budget time.”

I don’t buy this. True, I tend to reject the “ballot box budgeting is bad” argument generally speaking, but in particular it’s not appropriate for this situation. Especially when voters are being asked to do more ballot box budgeting. Voters haven’t “tied the legislature’s hands” by things like Prop 10 or Prop 63. What they’ve done is say “we like social programs, we like taxing people to pay for them, and since you have proved unwilling or unable to do it, we’ll do it instead.”

To criticize ballot box budgeting without explaining why it happens – because Prop 13 gutted the state’s ability to pay for core services and created the conservative veto through the 2/3 rule – is to miss the point almost entirely.

And it enables things like Props 1D and 1E, which seem designed to punish voters for having successfully funded important programs.

One-time program raids are not a solution to the budget mess anyway. Nothing the LA Times has included in this article does anything other than convince me a NO vote on Props 1D and 1E is the right move for our state.

Another Poll Shows Trouble In Special Land

The No on 1D/E Campaign, which recently merged, have released an internal poll (PDF) from Tulchin Research.  The data is consistent with a previous PPIC poll. Prop 1D (First 5) is slightly ahead 48-42, and Prop 1E (Mental health) is down 44-46. More spin details from the No campaign:

   *  A solid majority of voters describe the measures as “deceptive” (56%).

   * Nearly half of the voters are concerned they will “cut funding for children and the mentally ill” (45%).

   * There are nearly twice as many voters who strongly oppose Props 1D & 1E.

   * The voters most likely to cast a ballot are more likely to vote NO than less likely voters.

   * “Definite” voters reject Proposition 1E (42% Yes – 48% NO).

   * “Definite” voters split their opinion on Proposition 1D (46% Yes – 45% NO).

   * Nearly 1 in 5 voters (18%) believe that Props 1D & 1E hurt programs and services, particularly for children and the mentally ill.

   * 16% of voters describe the initiatives as “deceptive” or “dishonest.”

Either way, being below 50% at this point is just a really bad position. It is possible to make up some grouund with a ton of money, but the yes campaign will be swimming upstream from the general drift towards no.  In a low-turnout special election, that drift is likely to be more visible.

All I’m saying is that if I were on the “Budget Reform Now” campaign, I’d be getting pretty nervous right now.

Arnold: Cruel or Clueless?

The New York Times continues its coverage on shantytowns today, highlighting a Bushville in Fresno that has suddenly popped up.  First of all, given that Los Angeles County has 70,000 homeless people and that number has remained durable for quite some time, I welcome the national media to the issue about the homeless but don’t necessarily think that because this new class puts up tents (they do the same on LA’s Skid Row, BTW) that somehow it’s novel.  The recession clearly has exacerbated this problem and brought it to new areas in the state and the country, but that doesn’t mean homelessness didn’t exist before.

Second, our Governor is either America’s stupidest person or he thinks you are:

Gov. Arnold Schwarzenegger said Wednesday that he has teamed up with Sacramento Mayor Kevin Johnson to help the homeless and has lobbied the president to speed the flow of federal dollars to address the problem […]

U.S. Rep. Doris Matsui, D-Sacramento, in February announced that the city and county of Sacramento each are in line to receive $2.4 million in stimulus money to prevent homelessness.

The money will be managed by the city-county Sacramento Housing and Redevelopment Agency.

In addition, Proposition 63, the ballot measure voters approved in 2004 to provide mental health funding, will provide “a lot of help” for some of those living on the streets, the governor said.

That would be Prop. 63, the fund which the Governor and the legislature are trying to RAID through Prop. 1E, to the tune of $230 million a year diverted to other purposes.  You can debate the pluses and minuses of that, but promising Prop. 63 funds to fight homelessness at the same time as running a campaign to take Prop. 63 funds away is either cruel or clueless.

You decide.

Bush, McCain, Bono Baxely Mack 100 Years War and Occupation: Devastating U.S. Troops’ Mental Health

So-called Pres. George W. Bush initiated a war of aggression and limitless occupation against the sovereign nation of Iraq in order to exact revenge on Sadaam Hussein over Hussein’s assassination attempt on former Pres. George H.W. Bush and to secure Iraqi oil for Bush’s Texas oil cronies.  Sen. John McCain and Rep. Mary Bono Baxely Mack, absentee Congresswoman, have supported every Bush war policy without reservation.  In fact, McCain is prepared for the U.S. to continue the occupation of Iraq ‘for 100 years.’

The U.S. Army recently released a study on the impact of the Bush war of aggression on the mental health of U.S. troops (The Associated Press, by Pauline Jelinek, dated March 7, 2008).  The findings of the report are devastating to the Bush occupation efforts and reveal the harmful impact on a significant percentage of U.S. troops.

More below the flip…

More than 27% of U.S. troops on their third or fourth combat tour suffered anxiety, depression, post-combat stress and other problems.  More than 12% of U.S. troops on their first tour suffered similar mental health problems

Suicide rates “remained elevated” in both Iraq and in Afghanistan.  Four suicides occurred last year in Afghanistan and 34 either confirmed or suspected suicides in Iraq.  If all suicides are confirmed, this would be the highest suicide rate since the Bush war of aggression began

The percentage of soldiers reporting depression in Afghanistan was higher than that in Iraq, and mental health problems in general were higher than they had previously been in Afghanistan.  The adjusted rate in 2007 for depression in Afghanistan was 11.4% compared with 7.6% in Iraq

83% of U.S. troops in Afghanistan reported exposure to traumatic combat events, a key risk factor for poor mental health among the troops

Spreading U.S. troops out in Afghanistan tended to isolate troops and made it more difficult for them to obtain mental health services in Afghanistan

About 29% of U.S. troops in combat outposts in Iraq reported that it was difficult to obtain mental health services in Iraq.  About 13% of U.S. troops not at outposts reported similar difficulty

U.S. troops receiving “Battlemind” training reported fewer mental health problems than those who did not.  The training teaches U.S. troops and families what to expect before troops depart for the Bush occupation of Iraq and what common problems to look out for when troops readjust to Stateside life following deployment

29% of U.S. troops feared seeking mental health services would harm their careers, down from 34% in 2006.  Fears of seeking mental health services would prevent many from getting help for anxiety, depression, and post-combat stress and would exacerbate the symptoms

89% of U.S. troops reported that their unit’s morale was neither high nor very high, down from 93% in 2006.  79.4% reported neither high nor very high individual morale, down from 81.7% in 2006.

In Iraq, 72% of soldiers reported knowing someone seriously injured or killed

U.S. troops reported an average of only 5.6 hours of sleep nightly in Iraq, significantly less than that needed to maintain optimal level of performance.  This puts U.S. troops at greater risk for harm.  Officers appear to significantly underestimate the impact of sleep deprivation.

Almost 33% of U.S. troops in Afghanistan were highly concerned that they were not getting sufficient sleep, and about 25% reported falling asleep during convoys last year thereby increasing their risk for harm.  16% of U.S. troops reported taking psychiatric medications during 2007 (there was no figure for the percentage of troops who were prescribed psychiatric medications and who were not taking them), and about half of those were sleep medications

Advocates Sue The “Mentally Ill Homeless Terminator”

You may remember that in August, Gov. Schwarzenegger used his line-item veto pen to cancel $55 million in funding for the treatment and care of mentally ill homeless people.

If you don’t remember it, shame on you.  It should be the only thing you think of when you think of this governor.  He should be forever known as the “Mentally Ill Homeless Terminator.”

The claim was that Prop. 63, passed by the voters, adequately funded this need, and so the dedicated funding that passed the legislature as AB 2034 could be eliminated.  That’s not true.  What was actually going on was that the governor was trying to limit political damage by cutting funding for people who don’t vote and therefore aren’t of his concern.

Well, now some advocates of the homeless are suing this governor’s ass.

Advocates for the mentally ill filed a lawsuit Thursday alleging that Gov. Arnold Schwarzenegger subverted the will of voters when he eliminated a $55-million program for the homeless mentally ill — a program he himself had touted as a success.

The suit asks a judge to restore the eliminated funding, order the state to continue paying for the program and declare that the governor acted illegally — an important provision, the advocates said, in establishing precedent for future disputes over mental health system funding.

The suit was filed in Alameda County Superior Court, chosen because the plaintiffs include several mentally ill people in the county who credit the program with improving their lives — helping them kick a drug habit, for instance, or move from the streets into their own apartment.

Allow me to file an amicus brief:

The Mentally Ill Homeless Terminator is a callous, small man.

Proposition 63, a success with failures

We all know mental health care in California has always been a pretty important issue. And in November 2004 California voters passed Proposition 63 in an attempt to take care of some of the mental health care shortages that were occurring throughout the state. The proposition was brought forth by Assemblyman Darrell Steinberg in an attempt to rectify almost 40 years of inadequate mental health care across California.
This editorial from the September 27, 2004 San Francisco Gate gives a pretty good background as to the reasons why Prop 63 was needed.
The California Department of mental Health has a website detailing the planned implementation of the program.

The Los Angeles Times is taking a look at how the program is working. Yesterday’s paper had New funds, enduring ills, and today’s Rural areas reap little from Prop. 63.
And the results seem, currently, to be a mixed blessing.

The L.A. Times says that Prop 63 will generate $1.5 billion this fiscal year.
Prop 63 pays for new, premium programs. It was specifically prohibited from backfilling budget shortfalls in already existing programs.
The programs that it is funding appear to be doing very well. And show progress for the people they are helping.