Like much of the rest of the nation, California went only halfway toward keeping its promise to improve mental health care. It closed psychiatric hospitals, some of which were really just costly warehouses for the sick rather than modern medical facilities offering effective treatment. But the state didn't follow through on its commitment to provide better alternatives, like community-based clinics that deliver the treatment and services needed to integrate patients into society, working and living independently where possible.
We can see the result of those half-measures every day. About a third of homeless people in Los Angeles and across the country are on the street because of untreated mental illnesses that prevent them from staying housed or holding down a job.
We've begun to make amends, at least of a sort. Fourteen years ago, voters passed Proposition 63, known informally as the millionaires' tax and more properly as the Mental Health Services Act. It raises billions of dollars for services.
More recently, Los Angeles voters adopted tax measures to raise money for supportive housing — units that will give homeless people, including those with serious mental health challenges, the opportunity for dignified and independent living while receiving the medical care and services they need to hold their illnesses at bay and stay off the streets.
These are fine programs, but if they're all we've got they will be futile. The ranks of mentally ill homeless Californians are constantly being replenished. As fast as we can lead the sick and suffering into homes, they are replaced on the street by new generations of people whose mental illnesses were left undiagnosed or untreated at an early stage, when they still could have been held in check. If only California also had funding for that — for prevention, diagnosis, intervention and treatment early enough that patients’ illnesses do not progress to the point where they lose the ability to lead independent lives.
Actually, we do have the funding. The tragedy is that we haven't spent it wisely, or in many cases haven't spent it at all.
Twenty percent of Proposition 63 funding allocated to counties is supposed to be spent on prevention and early intervention programs and treatment. Yet a recent state audit found that counties hadn't spent most of that money, despite statutory deadlines meant to deter hoarding. Hundreds of millions of dollars just sit in county accounts, still waiting to be put to use.
Why? There is too little guidance on how to effectively spend those tax dollars. A state Mental Health Services Oversight and Accountability Commission is supposed to direct counties to best practices, but that loose system has led us to where we are: unmet needs and unspent funds. There is little strategic vision. Programs aren't measured for their effectiveness. Counties aren't held accountable for results.
The law should be tightened to ensure data are gathered, outcomes are measured and the commission offers more exacting spending guidance that prioritizes treatment for young patients.
After all, researchers have found that signs and symptoms of mental illness — hallucinations, delusions and other evidence of psychotic episodes — first present themselves in the patients' early teen years and into their mid-20s. Treatment at or just after the onset of these symptoms can prevent, or at least allow patients to manage, serious mental illness that worsens over time. Failure to respond quickly makes effective treatment later in life much more difficult — and feeds the pipeline that sends sick adults to the street.
A bipartisan proposal from state Sens. Scott Wiener (D-San Francisco) and John Moorlach (R-Costa Mesa) would provide the appropriate spending guidelines and promote some uniformity in treatment around the state while leaving counties the flexibility to spend on different priorities if they can make a persuasive case for them. The measure (Senate Bill 1004) cleared the Legislature and is now on Gov. Jerry Brown's desk.
Brown's Department of Finance opposes it, arguing that the commission can do everything the bill can simply by changing the appropriate regulations. Perhaps it could — but the point is that it hasn't.