California has failed to spend millions it already has on mental health care | Opinion

In 2004, California voters approved Proposition 63, known as the Mental Health Services Act (MHSA). For prevention, care and treatment of the seriously mentally ill (SMI), this act imposes a 1% tax on annual personal income over $1 million, which is then distributed by formula to the counties. The act currently annually generates close to $4 billion per year.

Nevertheless, since 2004, the number of seriously mentally ill homeless people have increased, suicides for youths and adults have increased, SMI-caused calamities have continued, and SMI individuals who should be receiving high quality, secure psychiatric care have instead populated California jails and prisons. Why?

The reason is that hundreds of millions of dollars, more probably billions, that the voters intended in 2004 for construction and staffing of critically needed secure psychiatric hospitals, secure psychiatric components of hospitals, and secure residential treatment centers for the severely mentally ill have instead been spent for less effective and unproductive purposes.

The act requires counties to adopt three-year plans. It states “The three-year program and expenditure plan and annual updates shall include all of the following: (5) A program for technological needs and capital facilities … All plans for proposed facilities with restrictive settings shall demonstrate that the needs of the people to be served cannot be met in a less restrictive or more integrated setting, such as permanent supportive housing.” [W&I Code section 5847 (b)(5)]

The SMI described above manifestly are that demonstration.

Although the code is not clear, it appears that at least 20% of a county’s MHSA annual funds can be used for capital facilities and technology. [W&I Code 5892 (a)(1)-(6) and (b)(1)].

Yet, despite this authorization for secure psychiatric facilities and well-qualified psychiatrists and personnel to staff them, regulators promptly adopted a regulation that since at least 2005 has undermined use of MHSA funds for these purposes. The regulation states: “Programs and/or services provided with MHSA funds shall [b]e designed for voluntary participation.” [9 California Code of Regulations section 3400(b)(2)]

Public data on the website of the Mental Health Services Act Oversight and Accountability Commission document the regulation’s impact: Counties have not been and are not spending their huge allocations of MHSA funds on the necessary secure, high-quality treatment facilities.

For example, the estimated amount of money that Los Angeles County has and will receive for the 2021-2024 fiscal years is shown in its three-year plan on Page 162. It averages around $500 million for each of fiscal years 2021-22, 2022-23, 2023-24, or about $1.5 billion for the three-year period.

Each year the allocation is piled on some $400 million to $500 million of carryover unspent funds. Twenty percent for capital and technology needs of $1.5 billion is $300 million, but Los Angeles allocates only a grand total of roughly $31 million to these needs for those years. Thirty-one million is around 2% of $1.5 billion and even that is not materially used, if at all, for the type of secure treatment facilities needed for the most severely mentally ill.

For another example, pages 178-179 (out of order) of Fresno County’s draft (as of this writing) three-year plan projects receipt of MHSA funds of well over $94 million in each plan year. In two of these years, the amounts under Fresno’s draft plan for capital/technology are around 2% to 5% of the annual $94 million-plus, with just one year in the still inadequate 10%-12% range. None of these expenditures appear to materially address adding or expanding secure mental health facilities. Percentages in Fresno’s preceding five years were similar.

San Diego, Sacramento, San Francisco and Santa Clara counties show similar inadequate treatment of capital/technology.

In recently denying my citizen’s petition to repeal and amend the offending regulation, the California Department of Health Care Services wrote: “The language in section 3400(b)(2) reflects MHSA intent that services and programs be designed with voluntary participation in mind” and does not bar use of the funds for restrictive settings. That is not what the regulation says.

Instead of correcting this errant regulation, Gov. Newsom now proposes a $3 billion to $5 billion bond for residential treatment centers. Properly implemented, the MHSA should already address this without further taxpayer expense for a new bond.

The undermining of the MHSA is a travesty, if not a scandal, of monumental dimensions.