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California has mental health billions. It’s time to improve how they’re spent

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In coming weeks, the Legislature will have the opportunity to pass a measure that would change the lives of thousands of Californians at risk of serious mental illness, increase access to quality mental health treatment, and ultimately turn the tide in our homelessness crisis.

But it means being more strategic and accountable in how we deliver mental health services in California. And that makes it controversial. It’s a gut-check moment. And we’re calling on state leaders to rise to the occasion.

The issue at hand is the state Mental Health Services Act. That’s the millionaire’s tax passed in 2004 that generates $2.2 billion a year for mental health care. Without question, the act has been a game-changer, providing a lifeline for tens of thousands of people whose lives have been derailed by serious mental illness.

But should it – and could it – be making an even bigger difference? We say yes.

In communities across our state, the problems that flow from untreated mental illness continue to mount. It’s a driving factor in virtually every major public policy issue we’re trying to tackle: homelessness, criminal justice, the plight of veterans, family dysfunction.

By statute, 80 percent of MHSA revenue goes to crisis care for people whose mental illness is already progressed and disabling. The other 20 percent goes to Prevention and Early Intervention (PEI) – addressing the illness at the front end, as we do with most other diseases. These PEI funds are crucial. Real change comes when we focus more resources on intervening at Stage 1, before people’s lives spiral out of control.

But there is far more we could be doing to ensure that the money California spends on PEI programs – nearly half a billion dollars a year – has decided impact.

Fourteen years after MHSA’s passage, we lack a statewide strategy for spending these dollars effectively, on services with measurable outcomes. We have no system in place to ensure county providers are using the same standards. We have no system for comparing and sharing outcomes. We have 58 counties doing things 58 ways, and that has led to gross inequities in treatment options. Essentially, a family’s ZIP code defines the services they receive.

Senate Bill 1004 would establish a statewide strategy for PEI spending so that counties target their funds on areas of proven need and employ best practices in treatment. It builds in accountability, ensuring the Mental Health Services Oversight and Accountability Commission provides technical assistance and evaluation.

The time has come to be more deliberate. What are the four or five services we could provide that we know would cause a dramatic decrease in the number of people who end up in our streets or prisons or morgues because of untreated mental illness? How do we scale up what works?

We know how to do this front-end treatment. It’s happening in pockets around the state.

In Sacramento County, UC Davis operates EDAPT. This clinic specializes in early intervention with psychosis-related illness, including schizophrenia and bipolar disorder. Young people recover. They graduate, get jobs, fall in love. They learn to manage their illness and stay on track.

It’s a terrific program, but fewer than half the counties in California offer something similar. Can you imagine being the parent of a child with schizophrenia in a county that does not offer this service?

Los Angeles County is doing tremendous work with young people at risk of mental illness because of sustained exposure to trauma. From 2012 to 2016, the county treated 130,000 at-risk kids. And they were successful in bucking the odds – reaching kids before their illness had progressed. Shouldn’t such programs be standard?

In February, the State Auditor released a report assailing the Department of Health Care Services for failing to recover more than $230 million in MHSA funds that counties did not spend by the deadline set in statute. Most of that money was supposed to fund PEI. It went unspent because counties weren’t sure how to use it.

SB 1004 would create more oversight in how MHSA funds are spent and require counties to focus their PEI funds on four overarching categories:

• Early psychosis and mood disorder detection and intervention.

• Outreach that targets secondary school and transition-age youth, with a priority on college mental health.

• Childhood trauma prevention and early intervention.

• Culturally competent programs that target underserved populations.

The bill has drawn opposition primarily from two camps: those who see it as a threat to county autonomy; and those who object to the priorities that call out youth.

To that first camp: This is about leadership, not micromanaging. It’s about setting basic standards that apply across ZIP codes. It’s about ensuring this precious revenue stream isn’t wasted on well-intended investments with minimal impact.

To the second camp: We make no apologies. Fifty percent of serious mental illness takes root by age 14, and 75 percent by age 25. So, intervening at the earliest age possible to avoid the consequences of years of untreated illness? It’s not only common sense. It is just.

The time has come to puncture the mindset that keeps us locked in a cycle of debilitating and untreated mental illness. Help us bend the treatment curve. Stand in support of SB 1004.

Darrell Steinberg is mayor of Sacramento and author of the MHSA. Scott Wiener represents the 11th Senate District, encompassing San Francisco and northern San Mateo County. Reach them at MayorSteinberg@cityofsacramento.org and senator.wiener@senate.ca. gov.

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