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California mental-health spending often bypasses the mentally ill

As state mental health services have crumbled under budget cuts, tens of millions of dollars raised through a tax designed to help the mentally ill have gone to “wellness” programs like horseback riding for teens and yoga classes for city workers. And that’s by design.
Voters approved Proposition 63, the so-called “millionaire’s tax,” in 2004 to make up for decades of mental health cuts. The ballot summary said it would “expand services and develop innovative programs” for the mentally ill and the text of the measure stipulated 20 percent of the funds would go to programs “effective in preventing mental illnesses from becoming severe” and “reducing the duration of untreated severe mental illnesses.”
In 2007, the Department of Mental Health developed guidelines for counties and dictated that the 20 percent would go to help people who had never been diagnosed with mental illness or even shown any evidence of mental illness. The idea was to promote mental wellness, not just treat mental disorders.
Now, with money to help people diagnosed as mentally ill tighter than ever, some mental health advocates want the state Legislature to redirect that 20 percent into treatment programs.
Peter Mantas, former chairman of the Contra Costa County Mental Health Commission, said state officials violated the intent of the ballot measure.
“In the law, the money was to be focused on people with mental illness, not little boutique programs that made the county personnel feel good,” said Mantas, who resigned in 2010 over what he saw as the squandered promise of Proposition 63. “The Department of Mental Health went astray significantly by doing what they did.”
Proposition 63 has brought in $7.4 billion through a 1 percent tax on income greater than $1 million a year and funded the creation of about 1,500 new programs, many of them general wellness initiatives.
Even with that money, California overall has cut 21 percent, or $764.8 million, from mental health spending since 2009, a higher percentage than all but five states, according to the National Alliance on Mental Illness.
There are no inpatient psychiatric services in 25 of California’s 58 counties, the California Hospital Association reports. Meanwhile, the proportion of prison inmates with mental illnesses has grown from 19 percent in 2007 to 26 percent now. And this year, Gov. Jerry Brown eliminated the Department of Mental Health to help address the state’s huge deficit.
Nearly $1.2 billion in Proposition 63 money has gone to prevention and early intervention programs in the past five years. The state doesn’t track where every dollar ends up, so where it’s all gone is unclear.
However, an Associated Press review of programs in the state’s 58 counties turned up spending on scores of wellness programs, many with seemingly little or no specific connection to mental health.
The state has approved spending on acupuncture, art and drama classes, sweat lodges for American Indians, parenting courses for Spanish-speakers and massage chairs for students in Southern California. More than two dozen counties have spent money on anti-bullying programs and several have used it to fund horseback riding therapy, including a $944,843 program in Kings County.
Fresno County spent $315,000 on gardens for Hmong refugees. In San Francisco, Proposition 63 money pays for city workers with mental illness in their families to attend lunchtime yoga classes.
For three years, the Department of Mental Health paid someone $76,000 a year to work from home and recruit celebrities to promote a Proposition 63 anti-stigma campaign. The position, which also included interacting with local law enforcement, was cut in 2011 after the state auditor’s office determined it had been a waste of public funds.
Ron Henninger, former chairman of the Santa Clara Mental Health Department, said such spending means people with real mental illness have been “left on their own.”
“It’s almost like they were propping up other areas of the county with Prop 63 funds instead of directly taking care of the sick people,” he said.
Rusty Selix, executive director of the California Council of Mental Health Agencies and co-author of Proposition 63, believes counties must be given leeway to develop the most effective programs for their residents.
“We have to learn how to do prevention,” he said. However, Selix acknowledged it can be difficult to see the correlation between mental health prevention and certain wellness programs. “I kind of raise my eyebrows at some of these general wellness campaigns, but I have to admit, they may have payoff.”
Some mental health advocates and public health workers see an opportunity in Brown’s elimination of the Department of Mental Health and shift of some Proposition 63 oversight to the counties to look at how revenue is spent. They want the Legislature to pass a “clarifying amendment” stipulating money raised by the millionaire’s tax go only to help people with mental and emotional problems.
This year’s state budget included several tweaks to Proposition 63 procedures, which are passed with a simple majority. However, so far, critics of wellness programs haven’t found a lawmaker willing to introduce the amendment they seek.
Senate President Pro Tem Darrell Steinberg, who wrote Proposition 63 with Selix, doesn’t think a change is needed.
Steinberg, D-Sacramento, allowed that he might have crafted the measure differently if he had known about the dramatic cuts that lay ahead, but defended the prevention programs, which include anti-stigma campaigns, as the best way to start moving beyond a system where people must succumb to their illness before they can get help.
“Prevention and early intervention is the only way that we are going to change attitudes and make sure people get help before they become a statistic.” he said. “It is vital, especially in communities that have traditionally seen mental health services as a stigma and as something to avoid, to draw people in and to create an atmosphere where getting help is seen as OK.”
In March, the state Oversight and Accountability Commission began its first evaluation of the wellness programs. For years, the only evaluations came from county administrators who, a 2011 UCLA study found, have never reported a negative or neutral finding. Results are expected next May.
Meantime, Selix stands by the decision to fund wellness programs with millionaire’s tax money.
“We knew that most of the people in counties were not in favor of doing prevention, and we feared that they would take that money and divert it to people who were already sick by saying, ‘Well, they could get sicker,'” he said.

A look at some Proposition 63 wellness programs in various California counties

* SAN BERNARDINO: Has budgeted $8.1 million over three years for a “holistic campus” of three community centers that provide services like acupuncture, art classes, equine therapy, tai-chi and zumba to the general public. The recently-launched program is expected to reach about 7,000 people a year
* FRESNO: Spends $171,620 a year for a “horticultural therapy” program that serves 110 gardeners annually from marginalized groups, including Hmong immigrants and migrant farmworkers. The program helps residents meet their neighbors and grow produce not available locally, and also holds community events.
* SAN FRANCISCO: Spends $250,000 per year on an African-American Holistic Wellness Program that uses ethnic celebrations, oral histories and arts to build a stronger sense of community among blacks in the low-income Bayview neighborhood. The county also holds a lunchtime yoga class for Department of Public Health “peer staff” workers who have had personal experience with the mental health system, either through their own treatment or through a family member. The classes are an hour long, cost $100 each and attract an average of six attendees.
* KINGS: The state approved $944,843 to start an Equine-Facilitated Psychotherapy program for students who are not reading at grade level or otherwise not doing well in school. The three-year program was expected to serve 24 people a year.
* LOS ANGELES: The Tri-City Mental Health Center, which serves Pomona, Claremont, and La Verne, received approval for $230,000 to develop student well-being programs expected to reach more than 100 people a year. The proposal included a plan for self-help, drop-in centers featuring massage chairs for relieving muscle tension, a meditation room and a biofeedback lab where students use computer software to learn breathing and relaxation techniques.
* SANTA CLARA: The state approved $2.1 million to establish a community center that will be a hub for “traditional” wellness practices including acupuncture and meditation. The center is expected to serve 1,500 people a year and operate for three years.
* NAPA: A monthly sweat lodge session is one element of a program for Native Americans with an approved 10-month budget of $53,692. The program, which was expected to reach 510 people, also includes a monthly potluck, powwows and traditional drumming circles.
* BUTTE: The state approved a three-year $536,540 Therapeutic Wilderness Experience program that takes teenagers with behavioral problems on a 20-day outdoor adventure. The program was expected to help more than 90 families, but has not yet been implemented.
* STANISLAUS: Received a three-year budget of $308,863 for an arts project open to anyone in the county. The arts center provides free classes and youth groups, and doubles as a gallery. The state also approved $75,000 for “Friends are Good Medicine,” an online directory of self-help groups that address topics ranging from bereavement to weight struggles to single parenting.
* RIVERSIDE: Received approval for a 12-week “mood management” course titled Mamas y Bebes that helps young Latina mothers create a healthy physical, social, and psychological environment for themselves and their infants. The course is one of eight parenting programs that together have an annual approved budget of $2,958,317.
* SUTTER: The state approved $93,000 a year to help 40 at-risk youth “thrive not just survive” through gym memberships, dance classes and team sports.
* SAN DIEGO: The state approved $547,805 for the inaugural year of a program where homebound seniors receive daily meals from workers who also screen them for depression or suicidal thoughts.