Dollars to aid Santa Clara County’s mentally ill are shifting
from old programs to new ones, radically reshaping care.
Gilroy – Dollars to aid Santa Clara County’s mentally ill are shifting from old programs to new ones, radically reshaping care.
While the county’s budget has plummeted, forcing $17 million in mental health cuts, funds skimmed from the state’s millionaires through the Mental Health Services Act are refilling the coffers, to the tune of nearly $30 million. But the money doesn’t fund the same programs: MHSA dollars are earmarked to create or expand new programs, and new programs only.
That leaves county mental health officials juggling new plans with deep cuts – a paradox that puzzles stakeholders such as Kathy Dorsa, a Gilroy woman whose brother suffers from schizophrenia.
“Where is that money? Are we getting it? Where’s it going?” asked Dorsa, who volunteers for the Santa Clara County chapter of the National Alliance on Mental Illness. “With the county cuts, they were talking so much about cutting services. How could they be doing that when we’re supposed to have this new stream of income?”
County cuts originally estimated at $34 million were slimmed to $17 million, thanks in part to new telephone fees. The Mental Health Department lost 41 employees. Meanwhile, funds from the Mental Health Services Act were skyrocketing. The act, passed in 2004 as Proposition 63, imposes a 1 percent tax on personal incomes over $1 million, and was expected to net $800 million annually by 2006, all of it to support mental health care. But California’s rich got richer: By 2006, the tax topped $1.5 billion, and is expected to climb still higher this year.
MHSA has weakened the blow of county cuts, said John Mitchem, president of NAMI’s Santa Clara County chapter, but it’s also shifted money to newer, more innovative programs geared to “consumers” not “patients,” developed with the help of the mentally ill, their families and advocates, who applauded the county’s year-long outreach efforts.
“The whole idea was that [MHSA] would be an increase – not just hold the level,” said John Mitchem, president of NAMI’s Santa Clara County chapter. To snap up MHSA dollars, counties had to agree to keep funding mental health programs at 2003 levels, explained Bruce Copley, deputy director of the Mental Health Department. “Prop. 63 put some money into the movement … It’s often been said that the three biggest mental health institutions in the country are the Cook County Jail, the L.A. County Jail and Rikers. That’s enormous evidence: The system doesn’t work well.”
Equipped with $19 million in ongoing funding and almost $10 million more left over from delayed programs, the county has bankrolled one-stop services for individuals called full-service partnerships, or FSPs, at about $20,000 a pop, said Copley. Full-service partnerships are intended to meet all of a consumer’s needs, by linking different agencies and providing intensive case management. The nonprofit Community Solutions, which handles mostly South County clients, is charged with nearly 28 percent of the budgeted FSPs – 95 clients.
Another new program slotted specifically for South County is Urgent Care, which links police to mental health professionals, allowing them to refer adults who need help. Currently, local police can detain anyone who poses a danger to themselves or others, but have few resources for those who are mentally ill but not dangerous, said Gilroy resident and former Palo Alto police chief Pat Dwyer, the Mental Health Department’s law enforcement liasion. Urgent Care fills that gap. Next year, bolstered by a $750,000 MHSA grant, the San Jose program will expand and add offices in North and South counties, giving police another option.
“The effect will be seen immediately on the street, and in people’s lives,” Dwyer said. Currently, he said, “we’ve got people in this county that are in jail, and are only in jail, because there is nowhere else to put them.”
But MHSA funds haven’t been a cure-all, advocates caution. In Santa Clara County, FSPs have failed to serve target numbers of nonwhite clients but exceeded set targets for white clients, according to July MHSA meeting minutes. The target numbers are set using demographic information from Medi-Cal enrollments, explained Copley, who added that the county is developing a ‘cultural competency plan’ to deliver mental health services to ethnic communities where mental illness carries an even bleaker stigma than among whites.
Researchers studying MHSA’s impact say it’s too soon to gauge the law’s success. While Santa Clara County was awarded funds last June, other counties have only recently submitted their MHSA plans to the state for approval, said Mistique Felton, a research associate with the University of California, Berkeley’s Nicolas C. Petris Center on Health Care Markets and Consumer Welfare.
And while MHSA’s booming tax revenues tickled Erin O’Brien, CEO of Community Solutions, and allowed her nonprofit to expand its mental health staff, she complained that mental health funding still falls far short of county needs. Copley estimated Santa Clara County needs twice its current mental health funding to meet residents’ needs, including undocumented immigrants and specific convicts who are currently barred from Medi-Cal.
“The system as a whole is inadequately funded, and it doesn’t come close to equaling the cuts we’ve have over the last five or six years,” O’Brien said. “We’re grateful for it, but it’s not going to be a solution.”
