California mental health care cuts: a cynical attack on the poor
Marc Wells and Rafael Azul
15 September 2007
The recently approved California budget is a blatant bipartisan effort to erode past social gains and greatly diminish the quality of life for millions of Californians. Out of a staggering $700 million cut, the largest portion of the social sacrifice is represented by $527 million slashed from the Health and Human Services Department, the state agency in charge of welfare programs.
The Democrats in Sacramento are fully complicit in this and every other provision contained in the budget recently approved by both parties. They are playing the same role as they have in Washington on the question of the war in Iraq—posing initially as opponents of a reactionary agenda and right-wing policies, ultimately aiding in their implementation.
The cuts suffered by the Health and Human Services Department accommodate Governor Arnold Schwarzenegger’s request to slash $55 million from the state budget currently utilized to finance a program called “Integrated Services for Homeless Adults with Serious Mental Illness.”
The Integrated Services cut is a ruthless attack on the most vulnerable layer of society, the mentally ill and the homeless, as well as thousands of families that are faced daily with the consequences of serious mental illnesses and often consequent drug abuse and street life.
The Integrated Services fund was originally provided through California State Assembly Bills 34 and 2034 in 1999 and 2000, respectively. An initial $10 million was allocated to finance 34 local programs to provide housing and intensive support services to homeless adults with serious mental illness or at risk of incarceration. Such services include outreach, supportive housing and employment, reducing and eliminating substance abuse, and mental and physical healthcare, including medications.
Throughout the 1990s the state of California saw its income increase from higher corporate tax and employee stock option revenues as a result of the stock market bubble that affected the high-tech industry. However, under the terms of Bill 34, no future funding for the Integrated Services program would have been provided unless the project could demonstrate positive client and system outcomes, including cost effectiveness, within its first year.
The programs showed encouraging results in a brief span of time, reducing the number days spent by individuals enrolled in the programs being homeless, incarcerated or in psychiatric hospitals. Hundreds of documented cases prove the urgent need and relative efficacy of the initial measure. As a result, funding was increased in 2000 to $54.9 million to support 34 local programs. In the eight years since it was instituted the programs have been held up as a national model.
However, with a homeless population in California of at least 300,000—of which, according to conservative estimates, 50,000 are mentally ill—less than 5,000 have access to the program, making it grossly inadequate from inception. Now even this very modest concession is being withdrawn.
Mental health advocates, patients and their families have threatened to sue the administration, claiming that the cut would be in violation of Proposition 63, which prohibits the state from slashing mental health funds below its commitment at the time the measure passed. The Schwarzenegger administration has claimed it is not in violation by including an unrelated item in its funding calculation.
Proposition 63 was approved by California voters in November of 2004. It imposed a 1 percent tax on the state’s richest residents (those with taxable income in excess of $1 million). According to the measure, the funds were to be targeted specifically to county mental health services.
State officials claim that the new cuts would not be in violation of Proposition 63 since the overall funds allocated for mental health programs have not been reduced from 2004 levels. The state’s claim is based on a very narrow interpretation of the measure. The figures would be lower were one not to include that the state was required by federal authorities to increase funding for a children’s mental health program in response to a growing caseload.
In other words, the state gives itself the right to ignore demographic and other changes, including increasing living costs. According to the Schwarzenegger administration there is no connection between the rise and intensification of psychiatric and psychological pathologies and the mandate to satisfy these basic social needs. The governor suggested that the program be funded out of Proposition 63 funds.
Ironically, Proposition 63 passed in 2004 riding on the wave of the “success” reported by the Integrated Services for Homeless Adults with Serious Mental Illness, the same program that may now be eliminated. The tax levied amounts to an estimated total of $800 million for 2006-2007. This sum is inadequate to serve hundreds of thousands of individuals with serious mental illness that had no access whatsoever to needed services, according to an estimate by the California Mental Health Planning Council.
In reality, independently of its inadequacy to fulfill its own purported goal, the funds provided by Proposition 63 cannot fill the void caused by the Integrated Services cut. Areas like Tehama County or Marin County stand to lose more than 50 percent of their total state funding. This will cause thousands to lose their homes, their fragile mental balance and to return to a life of destitution, crime and drug abuse. Moreover, people on parole that are excluded from the assistance provided by Proposition 63 are eligible under the Integrated Services program.
Prisons in California have become de facto psychiatric wards. Tens of thousands of individuals are currently incarcerated and not afforded the mental healthcare they need. Conditions of overpopulation and inadequate psychological and psychiatric support only intensify their illnesses, often causing the increase and development of substance abuse and violent behavior.
The Integrated Services cut will directly affect the already small slice of this population that has benefited from the program. In addition, this will effectively counter any effort to decriminalize mental illness.
The National Alliance on Mental Illness (NAMI) issued a comprehensive report in 2006, the first one in 15 years, revealing the staggering conditions and very low quality of mental healthcare that exist in the US in general and in California in particular. Every US state has been scored by the NAMI report on the basis of 39 specific and detailed criteria and on responses from state mental health authorities, resulting in an overall grade and four subcategory grades for each state.
Some of the criteria used were: “Prioritizing services to people with severe and persistent mental illness,” “Demonstrated innovation,” “Supported employment,” “Studies regarding causes of death,” “Supported housing,” “Insurance parity for mental illness” and “Cultural competence assessment and plan.”
The report gives the US an average grade of D. Five states are graded in the B range. Eight states received Fs. None received As. California received an overall C grade, although it scored a D in the “Services” subcategory. The per capita mental health spending is only $109.34 against a per capita income of $38,956 as of 2006 and a total mental health spending of almost $4 billion. However, according to the NAMI report, the state’s Proposition 63 stands as “one of the most dramatic innovations in financing mental health services” and serves as a model for other states.
An ever-increasing level of social polarization, together with increasing poverty, the loss of secure jobs and the uninterrupted attacks on living standards of working families have created a fertile environment for the growth of mental illness, in California and nationwide. Added to this are growing numbers of soldiers returning from Iraq and Afghanistan suffering from war trauma, with at least one in every five affected by a serious psychological disorder such as Post-Traumatic Stress Disorder (PTSD).
The slashing of funds for mental health in California under these conditions assumes a particularly cynical and cruel character, and will inevitably result in a rise in homelessness, drug abuse and crime. These and other cuts in the recently adopted state budget are in line with the host of attacks on the social conditions of working and poor people carried out under the Schwarzenegger administration.