The future of public care for the mentally ill in Los Angeles County depends on whether the county’s heavily Democratic legislative delegation and Republican Gov. George Deukmejian can bridge a huge policy gap that now separates them on the state budget.
Although the television news cameras focus on the weekly County Hall of Administration debates on endangered mental health outpatient clinics, the question of saving them will be decided in the Capitol.
The important players are not the Los Angeles County supervisors, but Deukmejian and three powerful Los Angeles lawmakers, Senate President Pro Tem David Roberti and two Assembly members close to Speaker Willie Brown of San Francisco--Speaker Pro Tem Mike Roos and Democratic Caucus Chairwoman Maxine Waters. That is because state funds largely support the county’s 13 outpatient clinics and finance the care of impoverished mentally ill patients who have been committed to hospitals.
At this early stage in the negotiations over the $46-billion budget for the fiscal year beginning July 1, prospects for a compromise do not appear bright, according to Democratic leaders.
Their appraisal follows two meetings in which Roberti and Brown discussed financing mental health care with Deukmejian.
Roberti said Deukmejian has insisted that the negotiations include possible elimination of cost-of-living increases in welfare programs sponsored by Democrats over the last few years. And Roberti and Brown have said the talks should include the possibility of raising taxes, which Deukmejian opposes.
“The Speaker and I feel we have to put revenue enhancements on the table,” Roberti said in an interview.
But just the fact that the two sides are talking has made Assemblywoman Waters (D-Los Angeles), a tough critic of the governor, optimistic.
“This was the first time the governor ever mentioned being amenable,” said Waters, referring to the governor’s expressed willingness to work out a solution with Democrats. “I think he is going to look for answers too. . . . I am going to keep an open mind and take him at his word.”
Hanging over the talks is the fact, acknowledged by both sides, that the state does not have enough money available to meet its obligations despite California’s prosperity.
“It all reflects the fact that although the state’s economy is booming, its government is poor,” said Assemblyman Bruce Bronzan, (D-Fresno), one of the Legislature’s experts on mental health care.
Some Democratic legislators have said their efforts have been weakened because the county supervisors, and the officials who work for them, have not worked hard enough to exert pressure on the governor. Like the governor, three of the five supervisors are Republicans, and one of them, Deane Dana, is a longtime Deukmejian ally.
“The board majority is not putting the county on the line in the battle,” Assemblyman Burt Margolin (D-Los Angeles) said.
While not wanting to openly criticize county officials, Roberti said, “They don’t grapple with all the options.”
The arithmetic of mental health care survival is complicated.
First, there is this year.
The county supervisors recently voted to close three of the county’s dozen clinics for the mentally ill because of a shortage of county funds to keep them open. These centers, whose threatened closings have attracted widespread publicity, provide treatment to mentally ill who are not hospitalized.
Then there is the coming year.
The negotiations between Deukmejian and the Democratic leaders do not affect the immediate fate of the centers. Centered on the budget for the coming fiscal year, they will have an impact on the centers beginning uly 1.
Deukmejian has cited voter approval of Proposition 98, which required the allocation of large amounts of state funds to education, saying it forces him to cut other programs. In addition, he said, his hands are tied by the so-called Gann Limit, a restriction on state spending.
He has also insisted on setting aside $1 billion as a “prudent reserve” fund. “That means we only have discretion over approximately 8% of the General Fund tax revenues,” he said in January.
Deukmejian has said that if he does not get cost-of-living increases for welfare recipients eliminated next year, he will cut about $200 million in state support for the community mental health clinics. They now get almost $500 million from the state.
That would mean a reduction of about $80 million in aid to Los Angeles County--now about $200 million a year--for what is the state’s biggest system of public mental health care.
That total cut in funding would be made even greater by a recent key decision of county officials.
In the past, Los Angeles County contributed to the clinics more than the minimum required by state law. This year, the county’s contribution could exceed $13 million, according to County Chief Administrative Officer Richard B. Dixon.
But the county cannot afford this any more, Dixon said, meaning there will be more cuts.
Thomas E. Reitz, deputy director of the State Department of Mental Health’s Division of Community Programs, said officials are drawing up contingency plans if the Deukmejian cuts go through.
Available dollars will be used for “the population which needs it most,” Reitz said.
Those committed to hospitals--28% of the state’s mentally ill population--will get first priority in the allocation of funds, he said. Second priority will be given to those using the clinics, 66.5% of the mentally ill, he said.
Assemblyman Terry B. Friedman (D-Los Angeles), chairman of the Assembly Ways and Means Subcommittee on Health and Welfare, said grass-roots groups must be mobilized in a campaign to pressure the Legislature and the governor if the Los Angeles clinics are to be helped.
Friedman said he is trying to recruit wealthy Westside Los Angeles liberals to finance a “sophisticated ad campaign as well as grass-roots involvement.”
The next big event in the fight will be the May estimates of state revenues.
That will provide new information for the negotiators. In the end, the fate of the clinics will be decided in a few days of intense talk at the end of the legislative session in mid-June, when important matters are traditionally settled.