Funding for Mental Health

While I appreciate the difficulties confronting the Los Angeles County mental health system (“Mental Patients Overload County Emergency System,” March 12), it is unfair to characterize the cause as dependence on sales tax revenues. Yes, sales tax revenues are down and we face some difficult times. But it’s important not to lose sight of the fact that without realignment, what today is a struggle instead could well have been a burial for public mental health services in California.

Times are difficult, both for individuals and for governments. California and the rest of the nation are deep in a recession that has caused a chain reaction affecting resources which depend upon the economy. County mental health programs weren’t previously so directly affected by this chain. But today, under realignment’s funding shift to sales tax revenues, we find ourselves in such a position.

Until passage of the landmark realignment legislation, to say that mental health services were financially vulnerable was an understatement. Prior to realignment, mental health services accounted for about $1 billion of the $4-billion “discretionary” portion of the $48-billion state budget. This resulted in an annual competition against an endless parade of special interests for that small portion (8%) of the budget not already committed through statutory mandates or entitlements.

Two years ago, the state’s budget gap stood at $4 billion. Without the protection of realignment, state funding for local mental health programs was cut by $61 million. Because of the mandated method for determining amounts of county reductions, money later had to be added back to prevent some counties from losing more than 25% of their mental health funding. While Los Angeles County was fortunate not to have fallen into this category, the resulting $21.9-million funding loss was still devastating.

When designing the spending plan for the current 1991-92 fiscal year, the governor and Legislature struggled to cope with a $14-billion shortfall.

But, unlike the previous year, local mental health services were not cut by an amount proportionate to the deficit, or even subject to the across-the-board automatic 4% general fund reduction “triggered” by the shortfall. Instead, through realignment, the program responsibility was transferred to the counties, and funding shifted from General Fund to sales tax revenues. And the result--even in the midst of an economic slump--is a public mental health system that continues to exist, with a potential for future growth.

WILLIAM MAYER MD

Director, California Department of Mental Health, Sacramento