A year and a few weeks from now, California voters may be given the chance to tax the rich in order to solve the state's mental healthcare problems.
The Mental Health Services Act, as proposed for the November 2004 ballot, would adopt somewhat of a Robin Hood approach to ensure public mental health programs have proper funding. The initiative would levy a 1 percent tax on California residents with a net income, after deductions, in excess of $1 million. Only each dollar earned above $1 million would be taxed. For example, a person earning $1.5 million would be taxed 1 percent of $500,000. Roughly 29,000 Californians-with an average income of $5 million among them-would pay the tax.
Rusty Selix, executive director of the California Council of Community Mental Health Agencies and a driving force behind the bill's creation, says he expects the tax will pull in more than $600 million in its first year. The Franchise Tax Board estimates that amount will grow by 7 percent each year. The money will bolster-not replace-federal, state and local funding for mental health programs that are traditionally poorly funded.
The state's mental health budget is roughly $2 billion annually-not nearly enough to provide treatment for the significant portion of California's 2.7 million mentally ill citizens who lack adequate health insurance coverage.
'We still have an estimated 50,000 homeless mentally ill on the streets,' Selix pointed out. 'We have a fail-first system where kids don't get mental healthcare until they end up in the juvenile justice system or special education.'
As proposed, more than half the funds provided by the initiative would go to services for both severely mentally ill children and homeless adults with mental illness. The initiative also seeks to provide funds for new mental healthcare facilities, including transitional housing, as well as dedicate money to education and training programs to ease the shortage of mental health professionals.
A draft of the initiative has made its required stop at the state attorney general's office and is currently waiting for review. After that, the initiative's sponsors will need to collect 450,000 signatures to qualify it for the ballot.
Assemblymember Darrell Steinberg, a Democrat from Sacramento-who four years ago authored a bill that provided $55 million in funding for a comprehensive 'whatever it takes' program to get homeless mentally ill into treatment and recovery programs-played a major role in drafting the initiative. Steinberg told CityBeat that although the state Legislature is becoming more progressive when it comes to mental health funding, there are three decades of neglect-of both the system and the people it's supposed to serve-that lawmakers and advocates are battling.
'A community mental health system was promised by the state 30 years ago,' Steinberg said, 'and it's a promise that's yet been unfulfilled.'
What Steinberg's referring to began back in 1963, when President John F. Kennedy promised federal funding for community-based mental healthcare programs, arguing they were preferable to state-run mental hospitals. In 1967, California Gov. Ronald Reagan, in the midst of a state budget crisis, signed a bill that favored 'deinstitutionalization'-moving large numbers of mentally ill people out of state hospitals and into the community programs Kennedy favored.
In theory, community-based mental health treatment was, at the time, preferable to overcrowded and understaffed state mental hospitals-Ken Kesey's One Flew Over the Cuckoo's Nest is a fairly accurate depiction of the institutions of the time. But what Reagan failed to realize is that community programs, in the late '60s, lacked the infrastructure to take in patients streaming out of state hospitals. The community programs were further crippled by the reality that no one wanted the mentally ill in their community-a problem that still lurks today.
The local programs were hobbled before they really had a chance to get going and quickly became as understaffed and overcrowded as the hospitals had been. And it didn't help matters when, in the first year of his presidency, Reagan suspended federal funding for community-based treatment programs, returning that responsibility to the state and forcing many of the programs to close.
As CityBeat has found, it's not unusual to meet a homeless person who'll point to Reagan administration policy as the reason they're out on the street.
In the ensuing 22 years, state and local mental health departments have struggled to play catch up and keep pace with a growing mentally ill population. Though state funding for mental healthcare grew by 90 percent between 1989 and 1999, the increased funding still didn't cover half the population in need of treatment.
It's easy, perhaps, to attribute the latter problem to misspending, but also a likely culprit is the shift to managed healthcare, which tends to limit access to treatment. The growth of outreach programs and an overall better understanding of what mental illness is have also prompted people to seek treatment. Additionally, we're only just now realizing the link between substance abuse and mental illness, as well as recognizing the signs of early-onset mental illness in children.
Selix says that although the state's mental health programs came out of this year's budget deficit relatively unscathed, they've nevertheless reached a point of stasis. 'We're frozen,' he said. 'We can't expand our care to serve everyone who needs it.'
Going to the state's general fund for more money isn't an option, Steinberg said. 'I think we have to take a shot at the ballot,' he said. 'We have a funding source that I don't think is going to be tapped by anyone else.'
And, Steinberg added, the initiative would ease the problems that come when social services vie for a limited amount of dollars. 'So along as we're not pitting mental health against foster care and health care and education,' he said.
The proposed initiative advocates a treatment model that's proven effective and ultimately cost saving, recognized this year as a model program by the President's Commission on Mental Health. Known as the systems-of-care model, treatment focuses on individual needs rather than a one-size-fits-all approach, which, in the past, tended to be medication-focused, resulting in treatment failure if a person stopped taking their meds. The systems-of-care approach recognizes self-sufficiency as a goal for recovery and, therefore, may include substance abuse treatment, housing and job training as part of an overall treatment plan.
The systems-of-care model has proven by far the most cost effective in treating severely mentally ill, 30,000 of whom are currently housed in state prison or jail at a cost of more than $28,000 a year. Treatment under the systems-of-care model can cost as little as $5,000 and as much as $35,000-on average far less than incarceration. As further comparison, each person confined to a state mental hospital carries an annual bill of $120,000.
A 2001 report by the Little Hoover Commission, an independent state oversight agency, noted that the state spends 'billions of dollars dealing with the consequences of mental illness rather than spending that money wisely on adequate services.'
Selix says that the initiative has the potential to reduce the strain on the state's mental health budget and ultimately offset the costs of mental healthcare. Twenty percent of the annual revenue would go toward prevention and early-intervention programs, particularly in the schools, where a child might not be diagnosed until he becomes unmanageable.
Because of California's shortage of state- and county-funded treatment facilities for severely mentally ill children, parents are often forced to send their child out of state. Selix hopes the initiative will eradicate this problem. 'The idea that a parent might have to lose having a child at home in order to get the [care] they need is a tragedy,' he said.
Shirley Culver, the Mental Health Resource Center program manager for the San Diego Unified School District, says a majority of the district's mental health programs are grant-funded and phase out after two or three years. With limited funding, 'we are not serving the majority of our district,' she said in an e-mail to CityBeat. 'There is a huge mental health need both in the district and in general, both in regular ed[ucation] and special ed.'
Selix says it's not unusual for a child to go six years with an undiagnosed mental illness. 'The sooner in the onset of a mental illness you get people the treatment they need, the sooner they're going to be able to recover.
'The more people we can seek early on,' he said, 'the less expensive it will be to care for them.'