Imagine enough resources to provide permanent supportive housing for the thousands of homeless mentally ill and to provide robust mental health services for college students on all our public college campuses without raising a dime of additional state or local dollars.
The vision described is possible with modest adjustments to the Mental Health Services Act, or MHSA, otherwise known as the 2004 ballot initiative, Proposition 63.
The MHSA has helped thousands of Californians living with severe mental illness in its first 10 years. Last March, the Steinberg Institute and the County Behavioral Health Directors Association of California published an evaluation that showed 35,000 Californians with severe mental illness each year receive a whatever-it-takes approach – housing, mental health care, substance abuse treatment, vocational assistance – from MHSA funding. Their lives are demonstrably better as a result.
The act also has produced $400 million of supportive housing, early psychosis identification and treatment for teenagers at risk of serious mental illness and many other innovative approaches.
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Despite numerous advances, issues of the mentally ill homeless, and mental illness in general, are getting worse, not better. As a co-author of the act, I have a responsibility to assess its flaws and recommend improvements. Let’s begin with the fact that the act appropriates few resources for statewide approaches to the system’s most vexing problems.
The public mental health system in California is funded and operated through its 58 counties. While stakeholders recognize that some local priorities differ, parsing $1.8 billion per year 58 ways does not allow for more comprehensive approaches to improving the mental health system.
For example, experts recognize permanent supportive housing as the first requisite to reducing homelessness. While the act has provided the one-time investment for several thousand housing units for people with severe mental illness, there is no ongoing statewide funding commitment to do whatever it takes to make a demonstrable impact on homelessness. And there is no statewide approach to ensure college students get help before they suffer more serious mental illnesses.
We must have a statewide set of priorities that ensure people get help before they suffer the horrific consequences of years of untreated mental illness.
The Mental Health Services Act should aggressively address three statewide priorities.
First, the state should issue a revenue bond to fund tens of thousands of supportive housing units for the mentally ill on our streets.
The Mental Health Services Act’s annual revenue stream allows the state to bond for the capital necessary to build or subsidize housing. A $2 billion bond secured by $130 million per year of MHSA dollars would be the single largest effort in California history to address a social condition that seems unsolvable. It is solvable. No new money. Literally capitalize on an existing state revenue source originally intended to address homelessness.
Second, the state and counties should set aside some of the $400 million per year for prevention and early intervention to focus on our youths.
There are few places of greater need of mental health resources than California’s college campuses. Wait lists and strict limits on visits for students in need are legendary. College is already a difficult time of transition and is often the time students suffer their first breaks. We must build a system of care that helps students avoid the cycle that too often leads to devastating consequences of not receiving help when first experiencing symptoms.
The Mental Health Services Act could offer the UC, CSU and community college systems a significant incentive to improve their campus-based services by matching every new dollar the three systems put up toward increasing therapists, psychologists and other mental health personnel on their campuses. The combination of MHSA, higher-education dollars and health insurance would provide the necessary resources to build quality services where early intervention is crucial.
Third, the Mental Health Services Act and the state should expand its groundbreaking 2013 legislation to provide alternatives to emergency rooms for people suffering a mental health crisis.
The state allocated more than $200 million to provide 2,000 crisis beds and 600 triage workers to alleviate overcrowded ERs. Everyone agrees that the ER is not the place for people in crisis to get better and attain the follow-up care they need, and the 2013 investment is near an end. The state should use its resources, including MHSA, to expand these humane and cost-effective models.
No one act, even one as ambitious as the Mental Health Services Act can solve every societal problem impacted by mental illness. The mental health needs in California outweigh this resource. Therefore, we must use it creatively and purposefully to tackle big problems. There is more at stake here than who decides how to spend MHSA dollars. Demonstrating statewide success might inspire policymakers to make mental health a funding priority to help even more people in need.
Absent bolder action, mental health will continue to be a budget afterthought and a human tragedy.
Darrell Steinberg, former president pro tem of the state Senate, is founder of the Steinberg Institute, which works to advance public policy on mental health issues.