Squeeze on Mental Health

The inadequacy of the Los Angeles County mental-health budget is dramatized this year by the coincidental release of a master plan for mental-health services, developed with broad community participation. The master plan proposes urgent additional services costing $139 million over and above the $300-million gross budget that has been proposed for next year. In other words, the proposed budget covers only about two-thirds of what is needed for an effective system.

Los Angeles Advocates for Mental Health, representing many of the leading mental-health service organizations, has asked the Board of Supervisors to take an immediate step to implement the proposal by increasing the mental-health budget for next year by $14 million, equal to 10% of the increase needed. The state is being asked to provide the rest, on the usual basis in mental-health services of a state share of 90%. That is certainly an appropriate beginning.

Roberto Quiroz, director of the county Department of Mental Health, is already moving ahead on implementing the broad reorganizational proposals of the master plan. That, too, is a welcome development, but it will mean reducing many services in order to fund the new priorities unless there is a substantial increase in state funding and agreement by the county to meet its full share.

Under the plan of action, improved community-based crisis-management programs, integrated with 24-hour mobile psychiatric response services, will be established in each of the county’s eight service areas. There will be a shift of increased funding for programs reaching both chronically and severely mentally ill adult populations, and services targeted for children and adolescents in out-of-home placement or facing out-of-home placement. Of particular usefulness will be a new policy to ensure continuity of care by making sure that each person in the system is assigned to a single mental-health professional who will follow the case through all levels of care and treatment.

Much will be made of the cost of these programs. By comparison with the system of 20 years ago, when there was reliance on in-patient care in state hospitals, it is a bargain. To maintain 15,000 people in a state institution at current prices would cost $1 billion, according to officials. The $439-million program proposed by the master plan would serve an estimated 60,000 chronically mentally ill, including an estimated 12,000 mentally ill homeless.

The supervisors have before them a budget that would actually cut mental-health services by $18 million. And there is fear of further cuts should the state renege on its obligation to assume a greater share of trial-court costs. There are two encouraging developments in Sacramento as the conference committee begins working out differences between the Senate and Assembly budgets. Both budgets respect Gov. George Deukmejian’s commitment of additional state funds to assume the larger state share of trial-court costs--an agreement that would bring $135 million to the county. And both bills include an additional $25 million for mental-health programs statewide.

In the squeeze on budgets, however, short-term savings are often favored over programs with long-term savings. That is particularly the case in public-health and mental-health programs. That temptation needs to be resisted.