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California setting a new path for mental health services

At the time, I thought it was an odd proposal. California voters in November 2004 were asked to approve a state-wide proposition that would tax individuals making over a million dollars to create a revenue stream to reform and fund mental health services. I cast a "yes" vote knowing how difficult it is for any state legislature to fully fund mental health programs; the proposition was approved by 53.8 percent.

Since the proposition's passage, the Mental Health Services Act has generated up to $2 billion in annual revenues. Those dollars are distributed directly to the state's 58 counties for the development and maintenance of mental health services and programs. A statewide commission oversees the implementation of the Mental Health Systems Act, and I recently spoke with its outgoing chair, Stanford psychiatrist Victor Carrion, MD, and its executive director, Toby Ewing.

When I asked them how vital the funds were to the state and counties, Carrion and Ewing immediately cited the funds as saviors during the nation's economic meltdown that began in late 2007. "During our recession, we would have seen a very big spike of homelessness if it wouldn't have been for this money," Carrion told me during this 1:2:1 podcast. Ewing added, "If it were not for the Mental Health Services Act, when the economy really took a downturn, we would have seen devastating cuts to our mental health system."

Since deinstitutionalization began in the early 1970s, thousands of mentally ill have been forced out of institutions and into the community with bare treatment options or continuity of services. The large institutions clearly failed and became nothing more than warehouses but life on the streets for thousands of mentally ill has been no better. It's no secret that in many cities across the U.S., prisons and jails have been filled to the capacity with mentally ill: Cook County Sheriff Thomas Dart recently wrote in a Wall Street Journal oped that approximately 25-30 percent of the 8,300 prisoners in his jails are mentally ill.

Ewing told me that the dire consequences of life without treatment has led many families to make catastrophic decisions. The state's Little Hoover Commission report in 2000, "Being There, Making a Commitment to Mental Health," concluded "....the best way to get treatment was to get arrested," said Ewing. "We had families that were giving up custody of their children so they could get services through the child welfare system because they could not get services otherwise."

California, with this new influx of revenue, is trying to change the landscape in mental health services and become a national leader. "California needs to set an expectation that every Californian who needs mental health services will receive care in a timely manner, in a way that's integrated with other needs. and is tailored to who they are, where they are with regard to their family, or that aspect in their life. We're not there yet. We have a lot of work to do," said Ewing.

I also asked Carrion what a world-class mental health service system would look like in California. He told me, "Californians really like to emphasize recovery and the hope and potential that every individual that suffers from any mental health condition can actually recover. Offering programs that make that recovery possible in a timely fashion is, I think, one of the things we're after."

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