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A national model for mental health care?

California focus

One of the first bits of advice Vice President Joe Biden received after becoming the point person for shaping new federal gun control and mental health policy, in the wake of December’s mass shootings in Newtown, Conn., was to follow the California example.

  Darrell Steinberg, Democratic leader of the state Senate, told Biden to copy California’s strategy for funding mental health programs. That’s one way, he said, to lessen the chance of deranged individuals blasting children and teachers with assault rifles.

  The California program was created by the 2004 Proposition 63, which imposes a 1 percent supplemental tax for mental health care on incomes over $1 million. So far, this levy has raised more than $8 billion.

  Results of a recent audit on effectiveness of the program aren’t yet in, but there’s no doubt the Proposition 63 money has been helpful in keeping government-funded mental health care alive while other programs, such as in-home care for frail or disabled senior citizens, have been severely cut.

  Patricia Ryan, executive director of the California Mental Health Directors Assn., reported in 2011 numerous successes from Proposition 63, including a full service partnership in Santa Clara County, aiming to help Vietnamese adults with serious mental illnesses such as bipolar disorder and schizophrenia.

  Within a year after that program started in 2006, participants were using emergency psychiatric services 28 percent less than before and were hospitalized 65 percent less, while using long-term care facilities 82 percent less than before.

  Prop. 63-funded programs in Los Angeles County, Ryan reported, served more than 6,200 persons in 2011, producing a 68 percent reduction in homelessness among those clients and a 53 percent increase in days spent living independently, along with a 46 percent reduction of time spent in jails.

  Those programs were designed to fit specific local needs, the result of counties being allowed to choose most uses of Prop. 63 money.

  Ryan also says one provision in Prop. 63 might be most useful in preventing mass slayings: The measure requires that 20 percent of funds it raises go to prevention and early intervention in mental illness or substance abuse. If Colorado or Connecticut had a mandate like that, there’s at least a chance the Aurora and Newtown massacres could have been prevented.

  “If there’s one part of what we do here that should be adopted nationally, that’s it,” Ryan said in an interview.

  And Robert Cabaj, medical director of Community Behavioral Health Services in San Francisco, told the magazine Psychiatric News that “intensive case management in the counties (San Francisco added 400 such slots after Proposition 63 money began flowing) has led to reduced hospitalizations. We have cut our acute inpatient psych beds by more than half, but have had no increase in recidivism or emergency services.” So Prop. 63 has definitely helped prevent some serious problems.

But things are far from perfect when an estimated 750,000 Californians in 2011 failed to get mental health treatment they needed and about half the counties have no inpatient psychiatric services.