For Mentally Ill, Ballot Box Budgeting Might Be the Answer

The problem is easily seen and too-often smelled: a lump in a tattered blanket sleeping in a shopkeeper’s doorway. An incoherent panhandler. The stench of body waste.

Shoppers are deterred. Tourists are scared. Cops are distracted from chasing criminals.

Then again, some of the problem isn’t so easily detected: a child acting out. Or is it just acting out? Might there be a budding mental disorder that, left undiagnosed and treated, could lead to schizophrenia, life on the street or suicide?

Nobody has accurate figures. But the best guess is that more than 300,000 California children need some mental health treatment and aren’t getting it.

“Teenagers are often the hardest to diagnose,” says the Mental Health Assn. “It is difficult for parents to distinguish between the normal ‘acting out’ ... and the symptoms of mental illnesses like depression, bipolar mood disorder.... “

Of the estimated 150,000 California homeless, it’s calculated that one-third suffer from a severe mental illness.

Freaks of nature, some might say -- or druggies and boozers; they chose their life. But often the substance abuse has resulted from a mental disease that could have been prevented and still can be controlled.

“Homeless does not have to mean helpless,” says Assemblyman Darrell Steinberg (D-Sacramento).

Steinberg is on a crusade to help these victims of fate, to substantially upgrade and expand California’s sorry system of treatment for the mentally ill.

Who’s the culprit? State government, for starters.

In the late 1960s, when Ronald Reagan was governor, the state began emptying its mental hospitals and shutting down most. It was a tragic, well-intentioned “reform.”

The noble idea was to abandon the old system of excessive, unjust, involuntary commitments that led to patient neglect and abuse, as dramatized in the Jack Nicholson movie “One Flew Over the Cuckoo’s Nest.” Patients would fare better -- and it would cost less -- if they were treated in their communities, close to family. New medications could control behavior.

Treatment money will follow the patients out the door and into the communities, the governor and legislators promised.

Right! That lasted until the first state budget crisis in the early ‘70s. Succeeding budget battles resulted in deeper cuts.

Meanwhile, the state is saving roughly $9 billion a year in mental hospital costs over what it was spending in 1965, adjusted for population growth and inflation, Steinberg says. And because the state failed to invest some of that savings in community-based mental health programs, he adds, “people with severe mental illness are now criminalized in state prison, in county jails and homeless.

“The Los Angeles County Jail houses more mentally ill adults than any facility in the nation.”

Thanks largely to Steinberg, state funding did increase under Gov. Gray Davis. It also helped that first lady Sharon Davis made mental health treatment one of her causes. So far, Gov. Arnold Schwarzenegger has proposed to continue spending $55 million on a Steinberg program that integrates adult services -- treatment, shelter, job training -- into “one-stop” operations.

Schwarzenegger’s budget summary praises the program, saying it “has a proven track record of success in treating ... the mentally ill. Additionally ... this program leads to significant savings at the local level.”

Problem is, it’s only treating roughly 5,000 people because of funding shortages. Meanwhile, there are 10 times that many mentally ill on the street.

So Steinberg and mental health allies have placed an initiative on the November ballot that would greatly expand the program, adding $150 million.

Further, it would boost children’s services by $150 million. There’d be another $120 million for general prevention and $30 million for “innovation.” Plus, $120 million for professional training and capital outlay; after three years, this money would be diverted to patient services.

In all, an estimated $600 million would be raised. How? By taxing the very rich. A 1% surcharge would be levied on taxable personal incomes above $1 million. Thus, if a couple had taxable income of $1.5 million, they’d pay a $5,000 surcharge on $500,000.

Sure, it’s unfair. Everybody should be paying for this. But politically, socking the rich is doable. Besides, this couple also received a $32,500 federal tax cut from President Bush. Moreover, a state tax hike could be deducted on their federal return.

A bigger bugaboo should be ballot box budgeting -- the recent trend where special interests or celebrities carve out a slice of the tax pie, snatching it from the control of elected representatives. It’s the curse of the Capitol. The teachers union did it for school funding. So did Schwarzenegger for after-school programs.

But this latest ballot box budgeting may be justified.

It doesn’t duck the question of who pays -- as the teachers and Schwarzenegger did.

Also, this revenue source -- the super rich -- has been available for legislators to tap, but they have lacked the courage to raise taxes.

Ballot box budgeting is bad. But the state not keeping a promise to the mentally ill for 36 years is worse. That’s the real stench.

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George Skelton writes Mondays and Thursdays. Reach him at george.skelton@latimes.com.