Prop. 187 Fears Tied to Mental Health Woes

Fears arising over Proposition 187 among younger Latinos appear to have caused a 26% decline in their use of outpatient mental health services in San Francisco and contributed to a related increase in their use of emergency health services, a new study shows.

Proposition 187 “caused fear and deterred some people from seeking services they needed,’ said UC San Francisco researcher Joshua J. Fenton, chief author of the study. “It appears that Proposition 187 resulted in some mental health crises because people didn’t get help.”

As a result, Fenton said, many of the patients were later forced to use more expensive emergency and crisis intervention services.

Voters approved Proposition 187 in November 1994. But most of its key provisions, including those barring illegal immigrants from receiving taxpayer-supported health care, have not been implemented because of legal challenges.

Even so, the study, published this month in the national health policy journal Health Affairs, indicates that the measure had a more serious impact than previously believed.

Using a central computerized database maintained by San Francisco County, UC San Francisco and UC Berkeley, researchers tracked 400 Latino men and women between 18 and 45 with histories of mental illness. Over a nearly two-year period they compared the results to a sample of non-Latino whites. The study did not distinguish between legal residents and illegal immigrants.

The researchers found that Latino patients’ use of outpatient mental health services declined below expected levels for five to six months after the vote. Based on the results, the researchers suggest that the overriding reason behind the drop-off in clinic visits, at least among illegal immigrants, was fear that they would be reported to immigration authorities, Fenton said.

Once they stopped going to clinics, the patients being tracked then began using emergency mental health services above expected levels, Fenton said.

This adds more fuel to the ongoing debate in California and elsewhere over proposals to enact tough Proposition 187-style immigration policies.

During the 1994 campaign, advocates argued that Californians could not afford to continue to provide health, education and other services to illegal immigrants. But opponents countered that allowing social problems, particularly those involving health, to fester would only make them more costly to deal with in the long run.

Those studied suffered from a variety of serious disorders such as schizophrenia and manic depression, Fenton said.

“These are people who often have progressive and persistent difficulties with staying in touch with reality,” the researcher said. “Oftentimes, they are people who have been institutionalized in the past. Many now are homeless, living on the street. They are people who in emergency cases can become increasingly psychotic and may become socially disruptive.”

In Los Angeles County, researchers and administrators for health and mental health programs said they were not surprised by the study. They said some of its findings were consistent with the anecdotal reports of experiences in Los Angeles area community health clinics.

In Culver City, there was a marked increase among Latino clients seeking emergency mental health services during the three months after the election, said Fern Seizer of the Didi Hirsch Community Mental Health Center. She said the number of Latinos calling the suicide prevention hotline also increased from 318 in the three months before the election to 390 in the three months after.