Overview/Background
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Overview/Background

FROM FAIL-FIRST TO HELP-FIRST - PROPOSITION 63 TRANSFORMS CALIFORNIA'S MENTAL HEALTH SYSTEM

Implementation guide prepared by Rusty Selix, Executive Director, Mental Health Association in California and official co-proponent and co-author of Proposition 63- together with Assemblymember Darrell Steinberg.

PURPOSE AND OVERVIEW

In making the quantum leap from campaigning for passage to implementing this amazing new law, the first and foremost thing that everyone needs to recognize is that it is not increased funding for the old mental health system that we have known for the past decades. Instead, it is a complete transformation to a new system. The old law since realignment in 1991 has had a defined target population of only children with serious emotional disturbances and adults with severe mental illnesses. We are now creating a new approach that brings into action for the first time prevention and early intervention dimension to keep mental illnesses from becoming so severe in the first place.

It also will provide enough funding to eventually enable us to serve everyone who is facing a disabling mental illness.

Now we have a fail first system of waiting for people to hit rock bottom. Hospitalizations, incarcerations, out of home placements, special education and other failures, are the norm before getting the services needed. Usually such tragedies are suffered for several years. Even then we are only able to meet the needs of about half of the population we encounter in this manner.

Now we must move from fail first to help first. Give everyone the right care at the right time in the right place. No child should age out of the child welfare system and be dumped on the streets. No one should be discharged from psychiatric hospitalization without follow up care or discharged from a jail or juvenile justice system without being enrolled in a program appropriate to their level of need. This won't happen overnight, but in a few years it should be an expectation.

A BIG INCREASE IN FUNDING

The Legislative Analyst and the Department of Finance have estimated that the funding increase will average $800 million over the first five years. That is based upon incomes received through tax year 2002. For 2004-05,2005-06 and 2006-07, these estimates reflect the actual dollars that will be received. Each fiscal year thereafter the funding will be adjusted based upon the extent to which the actual income tax receipts are above or below what had been estimated. Accordingly the 2007-08 funds will be revised to reflect what is actually collected for tax year 2005 and future years will be adjusted in the same manner.

Overall the funds were projected to grow at a 7% annual rate which exceeds population and inflation and means that we should eventually have sufficient funds to meet all needs - if we maintain the same level of efficiency and effectiveness. With the prevention and early intervention programs we should be able to improve on cost effectiveness, but this may be offset by program cost increases. As we expand programs the current shortages in facilities and qualified staff will be heightened leading to increased costs in attracting and retaining staff and facilities.

Measured against current total state and federal funding for public mental health services and not counting federal funds that this funding will attract, this represents about a 15% increase in revenues. However, it will not be spread evenly but is concentrated in three areas:

  • Comprehensive Community Mental Health Services to Adults (Including Transition Age Youth 18-25) with severe mental illnesses in accordance with the standards of the Adults System of Care (also known as the AB 34 program) It will probably increase funding for such services by at least 100% - doubling the # that can be served

  • Comprehensive Community Mental Health Services to Children and Adolescents with serious emotional disturbances in accordance with the standards of the Children's System of Care - for those youth who do not qualify for services under one of the existing entitlement programs such as MediCal (mostly funded through EPSDT (Early and Periodic Screening Diagnosis and Treatment) Foster Care (which creates MediCal eligibility) and Special Education (Mental Health Services are funded through the so called AB 3632 program) It will significantly increase the # of such children who are served but only represent about a 10% increase in available funding because the most expensive children have entitlements to care through other funds such as Child Welfare and EPSDT or AB 3632.

  • (Funds will also be available where existing funding/entitlements/private insurance is not sufficient to keep a child at home.)

  • Prevention and Early Intervention Programs to offer help early in the onset of a potentially severe mental illness to prevent mental illnesses from becoming disabling and life threatening (they are currently the leading causes of disability representing 35% of people who get SSI (social security) benefits due to disability. Suicide, which is nearly always due to a mental illness, is the 3rd leading cause of death among teenagers.) This is almost all new money as there are virtually no funds for these purposes.

The 100% increase in funding for extensive community care for adults is several hundred million dollars and will enable us to serve at least 50,000 people currently "in harm's way" (homeless, hospitalized or incarcerated - or at high risk of one of these) due to lack of treatment for a severe mental illness. We estimate that there are currently 50,000 such people homeless on the streets and another 50,000 in other settings. 50,000 seems a reasonable estimate of how many more we need to serve as not all will come in at once and many will be eligible for services through other funding - particularly veterans who have a federal entitlement to funds through Veterans Affairs Healthcare.

END THE DELAYS IN GETTING SERVICES

Programs that see people earlier in the onset of a mental illness can reduce disabilities. The early mental health initiative successfully treats moderate conditions in schools. State Mental Health Director Steve Mayberg has said "we never see those kids again". This shows the cost-effectiveness of prevention and early intervention strategies.

Similarly, many nations led by Australia and Norway have invested in programs known as early psychosis to educate our society to recognize the symptoms of schizophrenia within the first few months of onset. They get people into treatment with the result being that most are living fully productive lives within one year no longer needing extensive mental health treatment, other than maintenance, medications and support.

Teen screen is a program to recognize and prevent suicide that is being implemented in many states. New efforts connect primary care and mental health services to recognize and treat mental illness at primary care settings to reduce the stigma that keeps people from utilizing mental health services.

Proposition 10 (First Five) Commissions have funded a number of programs successful in helping pre school children which could move from pilot projects to system models under Proposition 63.

All of these represent our opportunities to transform the system, but as with so many great ideas, lofty goals are easy to articulate but the devil is in the details.


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