Incomplete or missing data about the impacts of California’s decade-old Mental Health Services Act (MHSA) have offered critics of the law an opportunity to sway others by saying that the funding has been poorly targeted. This month marked the release of the first in an expected series of quantitative reports geared to fill the data vacuum and to counteract the arguments of those who doubt whether MHSA spending has significantly improved the lives of state residents with serious mental illness.
This month’s review of the Proposition 63–funded initiative was released by the County Behavioral Health Directors Association of California and the Steinberg Institute for Advancing Behavioral Health Policy & Leadership, a policy group founded last year by strong mental health field supporter and former State Sen. Darrell Steinberg. The county directors group’s participation is noteworthy because the availability of county-level data on the MHSA’s effects has been inconsistent from jurisdiction to jurisdiction up to this point.
“The report reflects a shift in attitude on the part of the counties,” Rusty Selix, executive director of the California Council of Community Mental Health Agencies, told MHW. “The counties will be working together to get the information out there.”
Unveiled March 11 at a press event featuring first-person accounts from individuals helped by the MHSA’s “Whatever It Takes” intensive services approach, the report presents data showing that for the three age groups targeted in the act’s Full Service Partnership (FSP) programs, emergency services and psychiatric hospitalizations have been decreasing considerably. Homelessness and criminal justice involvement also are down in the served population, while more of these clients have been able to live independently.
The MHSA has not focused on establishing entirely new approaches to serve high-need populations such as the homeless, but rather on extending the reach of efforts that already were generating evidence of success in small pilot initiatives prior to Prop. 63.
“The real shift is this is now the main way we’re providing services,” Selix said. “It’s not just a pilot effort off to the side.”
The voter-approved Prop. 63 created a long-term funding stream for these service expansions, in the form of a state tax on incomes above $1 million. This first report on MHSA impacts focuses largely on the populations served with the 40 percent of act dollars that are allocated for the FSP programs, or intensive services targeting high-need populations such as the homeless or those at risk of homelessness.
The report looked at the more than 35,000 Californians who served in FSP programs in fiscal year 2012. The three targeted age groups were transition-age youths in the 16-to-25 range, adults ages 26 to 59 and older adults 60 and over. The report found that when comparing client use of emergency behavioral health services one year prior to FSP enrollment to use during the first year of enrollment, such utilization decreased by an average of 79 percent. Psychiatric hospitalization rates using the same comparison dropped by an average of 42 percent (see tables).
Moreover, homelessness or use of emergency shelters decreased by an average of 47 percent, with the steepest percentage decrease in the oldest population. Arrests dropped by 82 percent, and incarcerations in county jail decreased by 27 percent, the report stated.
A cover note from the organizations that compiled the report based on county-level data states that “the evidence is clear that MHSA is reducing hospitalizations, jail time, out-of-home placement for children, and improving the lives of thousands of people.”
Turning Point Community Programs, serving half a dozen counties in the area in and around Sacramento, carries the perspective of having worked with the highest-need populations both before and after Prop. 63 was adopted. “The situation was bleak prior to passage of the act,” Turning Point CEO Al Rowlett told MHW, as programs depended on a patchwork of government funding that included sales tax and license fee revenue that was highly dependent on the overall state of the economy.
As a result, most of the service focus before the MHSA was on crisis services, with little available for prevention and early intervention initiatives, Rowlett said. With the positive impact that the MHSA has had on an underfunded system, “Our program that works with the chronically homeless has virtually doubled in size,” Turning Point Vice President of Operations John Buck told MHW.
“We are now reaching people who were unreachable prior to the MHSA, because before then we were only reaching people who would come in voluntarily,” Buck said. Now the staff resources are available to be able to engage in much more aggressive outreach, he said.
Rowlett said that one of the individuals who spoke at the event at which this month’s report was released had cycled in and out of homelessness but was able to receive permanent housing as a result of FSP services. Even when he suffered a major setback with physical illness, the support he received allowed him to remain in his housing, from which he now is able to facilitate groups for other residents.
More data to come
The newly released report also documents effects of MHSA funding for urgent-care services designed to connect individuals to support before a crisis event occurs. The report states, for example, that in Los Angeles County in fiscal year 2014, only 6 percent of individuals visiting a mental health urgent-care center subsequently visit a psychiatric emergency department in the next 30 days. Only 11 percent of these individuals are admitted to an inpatient psychiatric facility within that period.
The report’s authors state that this will be the first effort in regular reporting of outcome-based data for the MHSA. Selix added, “It’s not the end — it’s the beginning.”
On the day the report was released, The Sacramento Bee published an editorial that opened with this line that illustrates lingering skepticism about the MHSA’s impact: “More than 10 years after Californians voted for a special income tax on millionaires to pay for expanded mental health services, we still don’t know if the program is working the way its sponsors promised it would.”
The editorial added, in reaction to the new report’s data, “More extensive and independent follow-up is needed to show whether the help these people get is a short-lived salve or is turning their lives around — a crucial question.”
The first in a promised series of reports of county-level data on impacts from California’s Mental Health Services Act shows significant health and criminal justice effects from the most intensive services funded under the act.