By the early part of this decade, 30 years of underfunding had left California’s mental health system in tatters. Dollars were available to serve only half those in need of services. In this crisis-driven system, individuals too often reached a crisis point before receiving care, resulting in a chronic cycle of homelessness, institutionalization or incarceration.
Voters sought to change this costly system and improve its effectiveness when they passed Prop. 63 in 2004 – providing funding designated to increase delivery of proven services to those with severe mental illness. Recognizing that reducing homelessness and incarceration – and dollars spent on institutionalization—requires taking the long view, MHSA also identified prevention and early intervention as a key priority.
In Los Angeles County alone, results show that since 2006, 528,424 people with mental illness or serious emotional disturbance have been served by MHSA-funded programs and those in crisis are more likely to find the help they need in cost-effective community services rather than costly settings like jails and institutions.
So it is concerning to read the authors of the Capitol Weekly Opinion “In California’s System of Care for the Mentally Ill, Leadership Is Lacking,” advocate for a return to a system which only serves a fraction of the population in need, and only then in the most costly settings.
The authors are flat-out wrong when they say the MHSA hasn’t helped those with severe mental illness. In fact, the largest component of the MHSA is a comprehensive and intensive service program called Full Service Partnerships (FSP). These programs serve mentally ill individuals with recent histories of homelessness, multiple incarcerations and hospitalizations, and children in foster care placements.
In Los Angeles County, FSP programs are currently serving 6,256 individuals of all ages, and the results speak for themselves. Recent data shows severely mentally ill adults enrolled in an FSP program have experienced the following:
• 68% reduction in days spent homeless
• 53% increase in days living independently
• 46% reduction in days incarcerated
• 23% decrease in days psychiatrically hospitalized
What’s more, by serving people with mental illness in community settings, the MHSA saves money. A May 2010 analysis showed enrolling Los Angeles County adults and seniors in FSP programs saved $39 million that would otherwise have been spent on psychiatric hospitalizations and incarcerations.
The MHSA recognizes that there is no one-size-fits-all solution to supporting people with mental illness in their recovery. After a series of comprehensive community meetings and workgroups comprised of stakeholders from all walks of life that informed five plans approved by the state, Los Angeles County has implemented community services and supports to support mentally ill individuals in crisis, and avert, where possible, more expensive and restrictive psychiatric hospitalizations and inappropriate use of emergency departments.
These include clinical services provided in the field, wellness centers to help individuals stay on track with their recovery, and drop-in centers to engage and educate individuals with signs or symptoms of mental illness on the importance of mental health treatment. Because employment is an essential part of recovery for many with mental illness, employment services are an important component of many MHSA-funded programs.
As is so often said about our community’s physical health, prevention is truly the best medicine when it comes to treating mental illness. That’s why Los Angeles and other counties have prioritized services that reach those in need before they reach the crisis point. Suicide hotlines, reducing school violence and reducing the stigma associated with mental illness are all parts of a comprehensive plan to increase the number of clients who seek mental health services for themselves or their family members before they reach the streets or prison.
Just as it wouldn’t make sense to shut down a whole hospital and only leave open the emergency room, a mental health system which serves only those currently in crisis wouldn’t fulfill the mandate the voters gave us to keep Californians from reaching the crisis point.
Unfortunately, the state’s ongoing budgetary crisis has delivered severe setbacks to our efforts to meet the voters’ mandate to significantly expand mental health services. In recent years, the recession has forced hundreds of millions in cuts to state mental health programs over the past three years and left the safety net too damaged to serve all those in need.
Nevertheless, MHSA services have improved the lives of many in our community and are an essential part of counties’ efforts to address the mental health needs of those in our community who need our support.